ATI Learning System RN 2.0 | Pharmacology Final Practice

A nurse is preparing to administer dextrose 5% in 0.45% sodium chloride 400 mL IV to an older adult client over 8 hr. 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.)

ANS: 50 mL/hr

A nurse is administering insulin glulisine 10 units subcutaneously at 0730 to an adolescent client who has type 1 diabetes mellitus. The nurse should anticipate the onset of action of the insulin at which of the following times? A. 0800 B. 0745 C. 0900 D. 1030

ANS: B 0745 Insulin glulisine has a very short onset of action of 15 min. The nurse should expect the onset of action around 0745 and ensure the client eats breakfast immediately following administration of the insulin.

A nurse is collecting data from a client who takes oral theophylline for relief of chronic bronchitis. The nurse should recognize that which of the following findings indicates toxicity to theophylline? A. Constipation B. Tremors C. Fatigue D. Bradycardia

ANS: B Tremors Theophylline is a xanthine derivative bronchodilator. An early manifestation of toxicity is CNS stimulation, often seen as tremors. Seizures can occur if blood levels continue to rise.

A nurse is caring for a client who has heart failure and is taking oral furosemide 40 mg daily. For which of the following adverse effects should the client be taught to monitor and notify the provider if it occurs? A. Nasal congestion B. Tremors C. Tinnitus D. Frontal headache

ANS: C Tinnitus Loop diuretics, such as furosemide, can cause ototoxicity. The client should be taught to notify the provider if tinnitus, a full feeling in the ears, or hearing loss occurs.

A nurse is collecting data from a client who has hypothyroidism and takes levothyroxine. Which of the following findings should alert the nurse that the client is experiencing acute levothyroxine overdose? A. Bradycardia B. Cold intolerance C. Tremor D. Hypothermia

ANS: C Tremor Tremor and anxiety are expected findings in acute levothyroxine overdose. These findings are similar to those seen in hyperthyroidism.

A nurse is reinforcing teaching with a client who has hypertension and a new prescription for oral clonidine. Which of the following instructions should the nurse include in the teaching? A. Discontinue the medication if a rash develops. B. Expect increased salivation during the first few weeks of therapy. C. Minimize fiber intake to prevent diarrhea. D. Avoid driving until the client's reaction to the medication is known.

ANS: D Avoid driving until the client's reaction to the medication is known. Clonidine can cause drowsiness, weakness, sedation, and other CNS effects. Until the client's response to the medication is known, the nurse should instruct the client to avoid driving or handling other potentially hazardous equipment. Over time, these effects are likely to decrease.

A nurse is preparing to administer codeine 30 mg PO every 4 hr PRN to a client for pain. The amount available is codeine oral solution 15 mg/5ml. How many mL should the nurse plan to administer per dose? (Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.)

ANS: 10 mL

A nurse is reinforcing teaching with a client who has postmenopausal osteoporosis and a new prescription for intranasal calcitonin-salmon. Which of the following statements by the client indicates an understanding of the teaching? A. "I will administer a spray into each nostril daily." B. "I should expect nasal bleeding for the first week." C. "I will need to depress the side arms to initially activate the pump." D. "I should expect to take this medication for a short-term course of treatment."

ANS: C "I will need to depress the side arms to initially activate the pump." The nurse should instruct the client to activate the pump on the initial use by holding the bottle upright and depressing the two white side arms toward the bottle six times.

A nurse is reinforcing discharge teaching with a client who has venous thrombosis and a prescription for warfarin. Which of the following instructions should the nurse include in the teaching? A. Take ibuprofen as needed for headache or other minor pains. B. Carry a medic alert ID card. C. Report to the laboratory weekly to have blood drawn for aPTT. D. Increase intake of dark green vegetables.

ANS: B Carry a medic alert ID card. A client who is taking warfarin is at increased risk for bleeding. In the case of an emergency, it is important that any medical personnel are aware of the client's medication history.

A nurse is administering oral hydroxyzine to a client. Which of the following adverse effects should the nurse instruct the client to expect? A. Diarrhea B. Anxiety C. Nausea and Vomiting D. Dry mouth

ANS: D Dry mouth Hydroxyzine has anticholinergic properties. Dry mouth is a common adverse effect of this medication. The nurse should encourage the client to take sips of water or suck hard candies to minimize this effect.

A nurse is preparing to administer ampicillin 500 mg in 50 ml of dextrose 5% in water (D5W) to infuse over 15 min. 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 to answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.)

ANS: 33 gtt/min

A nurse is caring for a client who has a positive tuberculin skin test and a new prescription for isoniazid. For which of the following laboratory values should the nurse monitor? A. Thyroid Stimulating Hormone level (TSH) B. Aspartate aminotransferase (AST) C. Potassium D. Sodium

ANS: B Aspartate aminotransferase (AST) Isoniazid can be toxic to the liver. Therefore, it is important to monitor liver enzymes, such as AST, during therapy with isoniazid. In addition, the nurse should instruct the client to notify the provider about jaundice, nausea, dark-colored urine or other findings indicating hepatitis.

A nurse is caring for a client who has alcohol use disorder and is admitted with lower extremity fractures following a motor-vehicle crash. A few hours after admission, the client develops restlessness and tremors. Which of the following medications should the nurse anticipate administering to the client first? A. Acamprosate B. Naltrexone C. Chlordiazepoxide D. Disulfiram

ANS: C Chlordiazepoxide Chlordiazepoxide, a long-acting oral benzodiazepine, is a first-line medication to use for a client who is experiencing manifestations of acute alcohol withdrawal. For clients who are nauseated or vomiting, another benzodiazepine, such as lorazepam, can be administered via IV. The nurse should apply the acute versus chronic priority-setting framework when caring for this client. Using this framework, acute needs (manifestations of acute alcohol withdrawal) are typically the priority need because they pose more of a threat to the client. Because chronic needs usually develop over a period of time, the client has more of an opportunity to adapt to the alteration in health.

A nurse is reinforcing teaching with a client who is to start taking hydrochlorothiazide for hypertension. The nurse instructs the client to eat foods rich in potassium. Which of the following statements by the client indicates an understanding of the teaching? A. "This medication will not work unless I have enough potassium." B. "This medication can cause a loss of potassium." C. "Potassium will lower my blood pressure." D. "Potassium will increase the therapeutic effect of my blood pressure medication."

ANS: B "This medication can cause a loss of potassium." Hydrochlorothiazide can result in hypokalemia caused by excessive potassium excretion by the kidneys. The client should supplement his diet with potassium-rich foods to avoid the occurrence of hypokalemia. Foods that are high in potassium include bananas, raisins, baked potatoes, pumpkins, and milk.

A nurse is preparing to administer ampicillin 50 mg/kg/day PO divided into 4 equal doses for a toddler who weight 33 lb. Available is ampicillin 125 mg/5mL oral solution. How many mL should the nurse administer per dose? (Round the answer to the nearest tenth. Use a leading zero if it applied. Do not use a trailing zero.)

ANS: 7.5 mL

A nurse is reinforcing discharge teaching with a 6-year-old client who has asthma and several prescription medications using a metered dose inhaler (MDI). Which of the following instructions should the nurse include in the teaching? A. Add a spacer to each MDI. B. Instruct the child to inhale more rapidly than usual when using an MDI. C. Request that the provider change the child's medications from inhaled to oral formulations. D. Administer oxygen by facemask along with the MDI.

ANS: A Add a spacer to each MDI. MDIs are difficult to use correctly and, even when properly used, only a portion of the medication is delivered to the lungs. A spacer applied to an MDI can make up for lack of hand-lung coordination by increasing the amount of medication delivered to the lungs.

A nurse is planning to administer epoetin alfa to a client who has chronic kidney failure. Which of the following data should the nurse plan to review prior to the administration of this medication? A. Blood pressure B. Temperature C. Blood glucose levels D. Total protein level

ANS: A Blood pressure Epoetin alfa often causes hypertension, which can lead to stroke or other cardiovascular complications. The nurse should monitor the client's blood pressure and notify the provider about increases. The client who receives epoetin alfa frequently requires concurrent use of antihypertensive medication.

A nurse is reinforcing discharge teaching with a client who has major depressive disorder and a new prescription for phenelzine. Which of the following foods should the nurse include in the plan as safe for the client to consume while taking phenelzine? A. Broiled beef steak B. Macaroni and cheese C. Pepperoni pizza D. Smoked salmon

ANS: A Broiled beef steak Phenelzine, an MAOI, is an antidepressant. This medication interacts with a variety of foods to produce a hypertensive crisis. Beef steak and other meats that are fresh do not interact with phenelzine and are safe to consume. Most cheeses, except for cottage cheese and cream cheese, interact with MAOIs, such as phenelzine, and can cause hypertensive crisis. Pepperoni, salami, and other dried or cured meats interact with MAOIs, such as phenelzine, and can cause hypertensive crisis. Fish that has been cured or dried interacts with MAOIs, such as phenelzine, and can cause hypertensive crisis.

A nurse is reviewing the medical record of a client who is experiencing an acute migraine attack and has a new prescription for sumatriptan. Which of the following findings indicates a contraindication to the administration of the medication? A. History of uncontrolled hypertension B. Currently taking metformin for type 2 diabetes mellitus C. Currently taking an oral contraceptive D. History of recurrent urinary tract infections

ANS: A History of uncontrolled hypertension Sumatriptan can cause coronary vasospasm; therefore, it is contraindicated for a client who has a history of a myocardial infarction, heart disease, or uncontrolled hypertension.

A nurse in an outpatient facility is collecting data from a client who has a prescription for furosemide 40 mg daily. The client reports that she has been taking extra doses to promote weight loss. Which of the following findings should indicate to the nurse that the client is dehydrated? A. Urine specific gravity 1.035 B. Distended neck veins C. BUN 18 mg/dL D. Bounding radial pulses

ANS: A Urine specific gravity 1.035 Oliguria, increased urine concentration, and an increase in urine specific gravity greater than 1.030 are expected findings in clients who are dehydrated.

A nurse is reinforcing discharge teaching about lithium toxicity with a client who has a new prescription for lithium. Which of the following statements by the client indicates and understanding of the teaching? A. "I should take naproxen if I have a headache because aspirin can cause lithium toxicity." B. "I can develop lithium toxicity if I eat foods with lots of sodium." C. "I can develop lithium toxicity if I experience vomiting or diarrhea." D. "I might need to take a daily diuretic along with my lithium to prevent lithium toxicity."

ANS: C "I can develop lithium toxicity if I experience vomiting or diarrhea." Vomiting or diarrhea can cause electrolyte imbalances. If serum sodium decreases, lithium is retained by the kidneys and the risk for lithium toxicity increases.

A nurse is caring for a client and realizes after administering the 0900 medications that she administered digoxin 0.25 mg PO to the client instead of the prescribed digoxin 0.125 mg PO. Which of the following actions should the nurse take first? A. Notify the provider. B. Contact the nursing supervisor. C.Check the client's apical pulse. D. Complete an incident report.

ANS: C Check the client's apical pulse. Caring for this client requires application of the nursing process priority-setting framework. The nurse can use the nursing process to plan client care and prioritize nursing actions. Each step of the nursing process builds on the previous step, beginning with data collection. Before the nurse can formulate a plan of action, implement a nursing intervention, or notify a provider about a change in the client's status, she must first collect adequate data from the client. Collecting additional data will provide the nurse with knowledge to make an appropriate decision. Therefore, the first action the nurse should take is to assess the client.

A nurse is reinforcing discharge teaching with a client who has heart failure and a prescription for digoxin 0.125 mg PO daily and furosemide 20 mg PO daily. Which of the following statements by the client indicates an understanding of the teaching? A. "I know that blurred vision is something I will expect to happen while taking digoxin." B. "I will measure my urine output each day and document it in my diary." C. "I will skip a dose of my digoxin if my resting heart rate is below 72 beats per minute." D. "I will eat fruits and vegetables that have high potassium content every day."

ANS: D "I will eat fruits and vegetables that have high potassium content every day." Hypokalemia is an adverse effect of diuretic therapy. Because the client is taking digoxin, it is important to maintain the potassium level between 3.5 to 5.0 mg/dL to avoid digoxin toxicity.

A nurse is reinforcing teaching with the parents of a school-age child who has asthma about medications for bronchospasm. Which of the following inhaled medications should the nurse instruct the parents to use to relieve and acute asthma attack? A. Salmeterol B. Cromolyn C. Fluticasone D. Albuterol

ANS: D Albuterol Albuterol is a short-acting beta2-adrenergic agonist that is used to provide immediate relief for an acute asthma attack. One or two puffs every 4 to 6 hr PRN is the usual prescribed dose for a school-age child. If higher or more frequent doses are needed, the provider should evaluate the client for worsening asthma.

A nurse is preparing to administer a transfermal contraceptive patch to a female client. Which of the following actions should the nurse plan to take? A. Remove the patch from the pouch 30 min prior to placing it on the client. B. Place a new patch on the client at the same time each day C. Use a thin layer of barrier cream on the skin prior to applying the patch. D. Apply the patch to an area of skin on the lower abdomen.

ANS: D Apply the patch to an area of skin on the lower abdomen. The nurse should apply the patch to a clean, dry area of the lower abdomen, buttocks, upper outer arm, or the front or back of the upper torso. The nurse should avoid breast tissue or skin that is red, cut, or irritated.