ATI Pharm Practice A & B

A nurse is caring for a client who has a new prescription for eplerenone to treat hypertension. The nurse should monitor for which of the following adverse effects of this medication? A. Hematuria B. Hypernatremia C. Hyperkalemia D. Constipation

Hyperkalemia *The nurse should identify that eplerenone can place the client at risk for increased potassium levels because eplerenone can cause potassium retention.

A nurse is reinforcing teaching with a client who has a new prescription for ethinyl estradiol/norethindrone, an oral contraceptive. Which of the following client statements should indicate to the nurse an understanding of the teaching? A. "I should expect my menstrual flow to increase." B. "I should monitor my blood pressure for hypotension while on this medicaiton." C. "I will take the medication at the same time each day." D. "This type of medication is the most effective because it only contains estrogen."

"I will take the medication at the same time each day." *The client should take this medication at the same time each day to maintain a consistent level to reduce fertility and the chance of pregnancy.

A nurse is caring for child who is receiving 0.9% sodium chloride 1000mL to infuse over 8hr. The drop factor on the manual IV tubing is 15 gtt/mL. Nurse should ensure that the manual infusion is set to deliver how many gtt/min?

31

A nurse is reinforcing teachig with a client who has a new prescription for colchicine to manage gouty arthritis. Which of the following manifestations should the nurse include as an adverse effect of this medication? A. Abdominal pain B. Wheezing C. Excessive urination D. Tinnitus

Abdominal pain *Abdominal pain indicates cellular damage to the gastrointestinal tract. The nurse should notify the provider, and the client should discontinue the medication immediately.

A nurse is caring for a client who has genital herpes. Which of the following medications should the nurse expect to administer? A. Levofloxacin B. Acyclovir C. Ceftriaxone D. Metronidazole

Acyclovir *The client should receive acyclovir, an antiviral medication, to treat genital herpes by reducing manifestations and the rate of viral shedding.

A nurse is contributing to the plan of care for a client who has schizophrenia and a new prescription for clozapine. The nurse should incude in the plan to monitor the client for which of the following adverse effects of this medication? A. Hypoglycemia B. Iron-deficiency anemia C. Serotonin syndrome D. Agranulocytosis

Agranulocytosis *The nurse should monitor the client's WBC count and notify the provider for a value below the expected reference range of 5,000 to 10,000/mm3.

A nurse is reinforcing teaching with a client who experiences migraine headaches and has a new prescription for sumatriptan. The nurse should instruct the client to report which of the following manifesations to the provider as an adverse effect of this medicaton? A. Insomnia B. Photophobia C. Chest tightness D. Respiratory depresson

Chest tightness *The nurse should instruct the client to report chest pain or tightness to the provider because this can be a manifestation of a vasospastic response.

A nurse is collecting data from a client who has bacterial pneumonia and is taking ceftriaxone. Which of the following findings indicates a therapeutic effect of the medicaiton? A. WBC count 10,500/mm3 B. Clear, bilateral breath sounds C. Heart 100/min D. Tolerates small meal servings

Clear, bilateral breath sounds *The nurse should identify that wheezing and crackles are findings of bacterial pneumonia. A decrease in these manifestations indicates a therapeutic effect of the medication.

A nurse is caring for a client who has multiple sclerosis and a new prescription for baclofen. Which of the following findings indicates to the nurse that the medication is having a therapeutic effect? A. Decreased muscle spasticity B. Increased urinary output C. Increased mental alertness D. Decreased heart rate

Decreased muscle spasticity *The nurse should identify that baclofen is an antispasmodic that decreases muscle spasticity in a client who has multiple sclerosis.

A nurse is collecting data from a client who is taking oral amoxicillin to treat a repiratory infection. The nurse should monitor the client for which of the following manifestations as an adverse effect of the medication? A. Hearing loss B. Diarrhea C. Bruising D. Tendonitis

Diarrhea *The nurse should monitor the client for diarrhea, which is an adverse effect of antibiotics, such as amoxicillin.

A nurse is reinforcing teaching with a client who is receiving enalapril 20 mg PO daily. The nurse should instruct the client to monitor for which of the following adverse effects of this medication? A. Hypokalemia B. Blurred vision C. Tremors D. Dry cough

Dry cough *Dry cough MY ANSWER The nurse should identify that a persistent dry or nonproductive cough is an adverse effect of enalapril. The underlying cause of the dry cough is the accumulation of bradykinin from the medication. The client should notify the provider of this adverse effect.

A nurse is reinforcing teaching with a client who is using phenylnephrine nasal spray three times daily and reports rebound congestion. Which of the following instructions should the nurse include to reduce the effects of rebound congestion? A. "Decrease the frequency to twice daily." B. "Continue use for one more week." C. "Discontinue use in the left nostril, then in the right nostril." D. "Add oxymetazoline nasal spray to relieve symptoms."

"Discontinue use in the left nostril, then in the right nostril." *Discontinuing the medication one nostril at a time can overcome rebound congestion.

A nurse is reinforcing teaching with the parent of a preschooler who has otitis media. The child has had a low-grade fever and irritability for 2 days. Which of the following instructions should the nurse include in the teaching? A. "Administer amoxicillin twice a day for 3 days." B. "Apply cold packs every 4 hours for relief of pain." C. "Give acetaminophen as needed for discomfort and fever." D. "Return to the office in 72 hours for a follow-up appointment."

"Give acetaminophen as needed for discomfort and fever." *The nurse should instruct the parent to administer analgesics, such as acetaminophen or ibuprofen, to decrease discomfort and fever related to otitis media.

A nurse in a community health clinic is preparing to administer the varicella vaccine to a young adult female client who has not previously had chickenpox or its vaccine. The nurse should withhold the vaccine and collect additional data when the client makes which of the following statements? A. "I am allergic to neomycin." B. "I am taking antibiotics for my acne." C. "My irritable bowel syndrome has been acting up the last few days." D. "I have been taking an oral contraceptive for the last 6 months."

"I am allergic to neomycin." *"I am allergic to neomycin."

A nurse is reinforcing teaching with a client who has a new prescription for regular insulin. Which of the following statements by the client indicates an understanding of the teaching? A. "I should eat right before I give myself an insulin injection." B. "I should shake the vial gently prior to drawing up the insulin." C. "I should ensure that the insulin is clear prior to drawing it up." D. "I should inject the insulin deep into a muscle."

"I should ensure that the insulin is clear prior to drawing it up." *Regular insulin is clear in appearance. Clients should discard the vial and use a new vial if the insulin appears cloudy.

A nurse is reinforcing teaching with a client who has a prescription for scopolamine transdermal patches to prevent motion sickness. Which of the following statements by the client indicates an understanding of the teaching? A. "I might have a runny nose during therapy." B. "I should replace the patch every day. C. "I might experience diarrhea while taking this medication." D. "I should place the patch behind my ear."

"I should place the patch behind my ear." *The nurse should reinforce with the client to place the scopolamine patch on a hairless area of skin behind the ear.

A nurse is reinforcing teaching with a client who has HIV and a new prescription for zidovudine. Which of the following client statements should indicate to the nurse an understanding of the teaching? A. "I can have unprotected sext after 6 months of taking this medication." B. "I can expect to have constipation while taking this medication." C. "I will be sure to have my blood tested for anemia." D. "My fingers might feel numb after I start therapy."

"I will be sure to have my blood tested for anemia." *Zidovudine can cause severe anemia and neutropenia. The client should have blood tests performed before treatment begins and have continued monitoring during the course of treatment.

A nurse is reinforcing teaching with a client who has a new prescription for timolol eye drops to treat glaucoma. Which of the following client statements indicates an understanding of the teaching? A. "I will rub my eyes for 10 seconds after putting in the medication." B. "I will look up when putting the medication into my eyes." C. "I will clean my eyes from the outer edge toward the nose before putting in the medication." D. "I will close my eyes tightly after putting in the medication."

"I will look up when putting the medication into my eyes." *The nurse should reinforce with the client to look up during administration of eye drops to protect the cornea and minimize blinking.

A nurse is reinforcing teaching with a client who has a new prescription for a fluticasone inhaler. Which of the following client statements indicates an understanding of the teaching? A. "I will administer two puffs of the medication consecutively." B. "I will use this inhaler if I feel an asthma coming on." C. "I will avoid intake of dairy products in my diet." D. "I will rinse my mouth after I use this inhaler."

"I will rinse my mouth after I use this inhaler." *The client should rinse their mouth after using inhaled glucocorticoids to reduce the risk for the development of oral thrush. Therefore, the nurse should identify this statement as indicating an understanding of the teaching.

A nurse is reinforcing teaching with a client who has a prescription for alendronate. Which of the following client responses indicates to the nurse an understanding of the teaching? A. "I will take the medication with my breakfast." B. "I will take the medication with 1 tablespoon of an antacid." C. "I will lie down for 30 minutes after taking the medication." D. "I will take the medication with 8 ounces of water."

"I will take the medication with 8 ounces of water." *The client should take alendronate on an empty stomach with 240 mL (8 oz) of water to ensure it does not lodge in the esophagus, which can result in esophageal ulcerations.

A nurse is reinforcing teaching with a client who has a new prescription for propranolol. Which of the following information should the nurse include in the teaching? A. "If you miss a dose, double the next scheduled dose." B. "Discontinue this medication if lightheadedness occurs." C. "If your pulse rate is less than 50 beats per minute, notify your provider." D. "This medication can cause heat intolerance."

"If your pulse rate is less than 50 beats per minute, notify your provider." *The nurse should instruct the client to check their pulse before taking the medication and to withhold the medication if their pulse is less than 50/min. The client should also notify their provider. Bradycardia is a common adverse effect of beta blockers.

A nurse is reinforcing teaching with a client who has new prescription for vitamin B12 intranasal to treat malabsorption syndrome. Which of the following instructions should the nurse include in the teaching? A. "Take this medication once per day." B. "Drink a hot liquid after administering the medication." C. "Massage your nose gently after medication administration." D. "Store this medication in the refrigerator."

"Massage your nose gently after medication administration." *The nurse should instruct the client to massage their nose gently to increase absorption of the medication.

A nurse is reinforcing discharge teaching with a client who has a prescription for a metered-dose inhaler (MDI). Which of the following information should the nurse include in the teaching? A. "Wait for 15 seconds between each puff of the same medication." B. "Hold your breath for 5 seconds after inhaling the medication." C. "Take a slow, deep breath lasting 3 to 5 seconds after releasing the medication." D. "Roll the canister between your hands for 10 to 15 seconds to mix the medication."

"Take a slow, deep breath lasting 3 to 5 seconds after releasing the medication." *The client should take a slow, deep breath lasting 3 to 5 seconds to allow the medication to be distributed deeply into the lungs.

An older adult client who has terminal cancer reports pain at a level of 5 using a 0 to 10 pain scale. The client has a prescription for morphine 15 mg orally every 4 hr. The client's children express concern that the client is revive too much of the medication. Which of the following responses should the nurse make? A. "Clients who receive this medication orally have a lower risk of addiction." B. "Additional doses will not be needed because this medication is given on a fixed schedule." C. "The dose should remain constant to prevent breakthrough pain." D. "We can switch from oral administration to rectal administration."

"The dose should remain constant to prevent breakthrough pain." *Fixed or scheduled dosing around the clock offers the best pain control for clients who have severe and persistent pain.

A nurse on a medical-surgical unit is preparing to administer medications to a client. Which of the following questions should the nurse ask the clietn to verify the client's identity? A. "What is your phone number?" B. "What is your room number?" C. "What is your provider's name?" D. "What is your diagnosis?"

"What is your phone number?" *Acceptable client identifiers include the client's name, telephone number, facility identification number, date of birth, and other client-specific identifiers. The nurse must use at least two identifiers to verify the client's identity and should compare the information to what is on the client's wristband or in the medical record.

A nurse is reinforcing teaching with a client who is to start therapy with a nitroglycerin transdermal patch. Which of the following statements by the client indicates an understanding of the teaching? A. "While using the patch, I will be careful when rising from a chair." B. "I should leave the patch in place for 24 hours." C. "I should apply the patch to the same location with each application." D. "I will apply a new patch if I have chest pain."

"While using the patch, I will be careful when rising from a chair." *Nitroglycerin can cause orthostatic hypotension, which can result in dizziness. The client should change positions slowly to reduce the risk for injury.

A nurse is planning to reinforce teaching about newborn immunizations with a client who is 24 hr postpartum. Whcih of the following information should the nurse plan to include? A. "Your baby will receive the first hepatitis B vaccine before discharge." B. "Your baby will receive the rotavirus vaccine if your blood titer is low." C. "Your baby will receive their dirst influenza vaccine at the 4-week checkup." D. "Your baby will receive the varicella vaccine if you have a history of chickenpox."

"Your baby will receive the first hepatitis B vaccine before discharge." *The newborn should receive the first hepatitis B vaccine at birth, with the next dose at age 1 to 2 months.

A nurse is caing for a client who has a prescription for an IM injetion of penicillin G benzathine. The client asks why the injection must be given IM instead of through the IV line. Which of the following responses should the nurse make? A. "The medication is more rapidly absorbed when given IM." B. "Your medication can't be given IV because it is not water-soluble." C. "You will experience less discomfort with an IM injection." D. "An IM injection allows more prescise control of the medication level in your blood."

"Your medication can't be given IV because it is not water-soluble." *The nurse should inform the client this type of penicillin has poor water solubility and is never administered intravenously.

A nurse is reinforcing teaching with a female client who has a new prescription for isotretinoin. Which of the following information should the nurse include in the teaching? (select all that apply) A. "You will need to have your liver enzymes monitored after 1 month." B. "You can have nosebleeds while taking this medication." C. "You should report any thoughts of harming yourself." D. "You will need to have two negative pregancy tests prior to starting the medication." E. "You will need to take a vitamin A supplement twice daily."

1. "You will need to have your liver enzymes monitored after 1 month." 2. "You can have nosebleeds while taking this medication." 3. "You should report any thoughts of harming yourself." 4. "You will need to have two negative pregancy tests prior to starting the medication." *The client should have their liver enzymes monitored 1 month after therapy and periodically thereafter because isotretinoin is metabolized in the liver. Due to the drying effects of isotretinoin, nosebleeds are very common. Isotretinoin can cause depression, which can lead to suicide. The client or the client's family should report these thoughts to the provider. Due to the potential for severe birth defects, it is important to confirm the client is not pregnant. Vitamin A enhances the risk of isotretinoin toxicity. The client should avoid taking vitamin A supplements because isotretinoin is a derivative of vitamin A.

A nurse is collecting data from a client who is receiving digoxin for treatment of heart failure. The nurse should identify which of the following findings as adverse effects of this medication? (Select all that apply) A. Blurred vision B. Nausea C. Hyperactivity D. Increased appetite E. Dysrhythmia

1. Blurred vision 2. Nausea 3. Dysrhythmia *The nurse should identify visual changes such as blurred vision, halos, and a yellow or green tinge to vision as adverse effects of digoxin. The nurse should identify that nausea and vomiting are adverse effects of digoxin. The nurse should identify that fatigue and weakness are adverse effects of digoxin. The nurse should identify that anorexia is an adverse effect of digoxin. The nurse should identify that dysrhythmias are an adverse effect of digoxin.

A nurse is reinforcing teaching with a client who has type 2 diabetes mellitus about adverse effects of metform. The nurse should instruct the clent to monitor for which of the following findings as manifestations of lactic acidosis? (Select all that apply) A. Muscle pain B. Hyperventilaiton C. Weight gain D. Constipation E. Dizziness

1. Muscle pain 2. Hyperventilation 3. Dizziness *Clients taking metformin should monitor for manifestations of lactic acidosis such as muscle pain, hyperventilation, and dizziness. Lactic acidosis is a severe adverse effect of metformin that the nurse should report to the provider immediately. Clients taking metformin should monitor for manifestations of lactic acidosis such as muscle pain, hyperventilation, and dizziness. Lactic acidosis is a severe adverse effect of metformin that the nurse should report to the provider immediately. Weight gain is not a manifestation of lactic acidosis. Metformin can cause weight loss rather than weight gain. Diarrhea is a manifestation of lactic acidosis rather than constipation. Clients taking metformin should monitor for manifestations of lactic acidosis such as muscle pain, hyperventilation, and dizziness. Lactic acidosis is a severe adverse effect of metformin that the nurse should report to the provider immediately.

A nurse is caring for a client who is receiving methylprednisolone. Which of the following laboratory values should the nurse plan to monitor? (Select all that apply) A. White blood cell count B. Serum potassium C. Creatinine phosphokinase D. Blood glucose E. Amylase

1. White blood cell count 2. Serum potassium 3. Blood glucose *Methylprednisolone can increase the client's risk for infection and cause leukocytosis. Methylprednisolone can cause hypokalemia, as well as fluid and sodium retention. Methylprednisolone does not damage the muscles and, therefore, does not cause release of creatine phosphokinase. Methylprednisolone can cause increased blood glucose levels. Methylprednisolone does not affect pancreatic function.

A nurse is preparing to administer phenobarbital 3 mg/kg PO twice a day to a school age child who weighs 44IB. Available is phenobarbital elicit 20 mg/5 ml. How many ml should the nurse plan to administer per dose? Round to the nearest whole number

15

at 0800 hr nurse initiates a 1000mL IV infusion on a client, which is running at 125 mL/hr. It is now 1300hr. How much fluid is left in the IV bag? Round to the nearest whole number

375

A nurse is preparing to administer cefazolib 1 g in 100 ml 0.9% sodium chloride to infuse over 30min. The drop factor of the manual IV tubing is 15gtt/ml. The nurse should set the manual IV infusion to deliver how many gtt/min?

50

A nurse is preparing to administer a PRN medication to a group of clients. Which of the following clients should the nurse administer medication to first? A. A client who has GERD and requets an antacid B. A client who reports constipation for 3 days and requests a stool softener C. A client who has mild generalized anxiety disorder and requests an antianxiety medication D. A client who is atending postoperative physical therapy and requests pain medication

A client who is atending postoperative physical therapy and requests pain medication *When using the urgent vs. nonurgent approach to client care, the nurse should determine that the client who is postoperative and going to physical therapy should receive medication first. Administering medication to the client can reduce the client's pain during and after therapy.

A nurse is reinforcing teaching with a client who has seizures and a new prescription for valproic acid. The nurse should instruct the client to report which of the following adverse effects of valproic acid to the provider immediately? A. Abdominal pain B. Hair loss C. Weight gain D. Ataxia

Abdomina pain *The greatest risk to the client is hepatotoxicity and pancreatitis, which can cause abdominal pain. Therefore, the client should notify the provider immediately if experiencing a decrease in appetite, nausea, abdominal pain, or yellowing of the skin.

A nurse is collecting data from a client who is taking exenatide to treat diabetes mellitus. For which of the following findings should the nurse withhold the exenatide dose and notify the provider immediately? A. Loss of appetite B. Abdomina pain C. Muscle weakness D. Heartburt

Abdominal pain *A nurse is monitoring a client who has been receiving long-term hydrochorothiazide therapy for recurring episodes of heart failure.

A nurse is preparing to administer diphenhydramine 50 mg PO at 2200 to a client who has difficulty swallowing pills and capsules. Available is diphenhydramine syrup 12.5 mg/5 mL PO. Which of the following nursing actions requres the completion of an incident report? A. Giving the medication at 2140 B. Administering the medication with grapefruit juice C. Give the medication when the client's apical pulse is 58/min D. Administering 25 mL of the syrup

Administering 25 mL of the syrup *This dose is higher than the client should receive. The correct dosage is 20 mL. Administering an incorrect amount of medication to a client requires completion of an incident report.

A nurse is caring for a client who is having an acute asthma attack. Which of the following medications should the nurse administer first? A. Beclomethasone B. Albuterol C. Cromolyn D. Prednisone

Albuterol *According to evidence-based practice, the nurse should administer a short-acting beta2 agonist with a rapid onset when a client is experiencing an acute asthma attack. Therefore, the nurse should administer the albuterol prior to the other medications for prompt relief of airway constriction.

A nurse is collecting data prior to administering digoxin to a client. For which of the following findings should the nurse withhold this medication and notify the provider? A. Digoxin level 0.9 ng/mL B. Blood pressure 142/80 mmHg C. Potassium 4.4 mEq/L D. Apical pulse 52/min

Apical pulse 52/min *The nurse should check the client's apical pulse prior to administering digoxin because it can cause bradycardia. If the client's heart rate is below 60/min, the nurse should withhold the dose and notify the provider.

A nurse is monitoring a client who is 2 hr postoperative and has a prescription for opioid analgesics. Which of the following actions provides the nurse with the priority data to determine the client's need for analgesia? A. Observe the client for signs of restlessness B. Monitor the client for facial grimacing C. Watch the client for indications of decreased motility D. Ask the client to rate their pain

Ask the client to rate their pain *According to evidence-based practice, the nurse should first ask the client to rate their pain level to provide a verbal report of pain, which is the priority indicator of the need for pain medication.

A nurse is reviewing a client's medical history before administering hydromorphone for posteroperative pain. The nurse should notify the provider of which of the following findings before administering this medication? A. Benign prostatic hyperplasia B. History of hypertension C. Rheumatoid arthritis D. Allergy to aspirin

Benign prostatic hyperplasia *A client who has benign prostatic hyperplasia is at increased risk for developing acute urinary retention while taking opioids. Therefore, the nurse should notify the provider about this finding before administering hydromorphone.

A nurse is reviewing a medical record of a client who has a new prescription for dimenhydrinate to treat motion sickness. Which of the following conditions in the client's medical record should the nurse report to the provider? A. Major depressive disorder B. Diabetes mellitus C. Benign prostatic hyperplasia D. Ménière's disease

Benign prostatic hyperplasia *Clients who have benign prostatic hyperplasia might have urinary hesitancy and retention and, therefore, should not take dimenhydrinate due to the anticholinergic adverse effects of the medication.

A nurse is reinforcing teaching with a newly licensed nurse about using metoprolol to treat hypertension. Which of the following conditions should the nurse include as a contraindication for this medication? A. Peripheral vascular disease B. Diabetes mellitus C. Bradycardia D. Chronic kidney disease

Bradycardia *Metoprolol is a beta blocker that slows the conduction through the AV node. Therefore, it is contraindicated for clients who have bradycardia, or a heart rate that is consistently less than 60/min.

A client comes to an urgent care clinic and announces with great enthusiasm, "I am an expert at all things medical as they apply to me, and I require zolpidem." The client's pupils are dilated, along wth an elevated heart rate and blood pressure level. The nurse should suspect intoxication with which of the following substances? A. Alcohol B. Cocaine C. Barbiturates D. Heroin

Cocaine *The client who has cocaine toxicity typically has tachycardia, elevated blood pressure, dilated pupils, and displays delusions. This client's behavior and physiological data indicate cocaine intoxication.

A nurse is collecting data from a client who has Parkinson's disease and is taking levodopa/carbidopa. The nurse should identify which of the following findings as an adverse effect of this medication? A. Dark urine B. Hypertension C. Increased salivation D. Bradycardia

Dark urine *The nurse should identify that levodopa/carbidopa can cause a darkening of the client's urine, sweat, and saliva.

A nurse is caring for a client who has hyperthyroidism and has been taking methimazole. Which of the following findings should indicate to the nurse that the medication has had a therapeutic effect? A. Decreased blood glucose level B. Increased Hgb C. Increased platelets D. Decreased T4

Decreased T4 *The nurse should identify that methimazole inhibits the synthesis of thyroid hormone, reducing levels to provide a euthyroid state. Therefore, a decreased level of T4 is an indication of a therapeutic effect.

A nurse is caring for a client who has tuberculosis and will begin taking isoniazid. Which of the following actions should the nurse take? A. Determine the client's daily alcohol intake B. Tell the client to expect red-orange colored urine C. Reinforce teaching about a low-calorie diet D. Instruct the client to have a yearly tuberculin skin test

Determine the client's daily alcohol intake *The nurse should instruct the client to reduce or avoid all use of alcohol because isoniazid can cause liver damage; therefore, it is important for the nurse to determine the client's daily alcohol intake.

A nurse is reinforcing teaching with a client who has a prescription for theophylline. The nurse should instruct the client that which of the following is an expected outcome of this medication? A. Dilates bronchioles B. Reduces inflammation C. Loosens secretions D. Blocks leukotrienes

Dilates bronchioles *Theophylline is a bronchodilator, which affects smooth muscle relaxation and leads to opened airways.

A nurse is reinforcing teaching with a client following placement of a cast for a fractured ankle. The client is to take oxycodone for pain management. The nurse should instruct the client that which of the following over-the-counter medications is a contraindication while taking oxycodone? A. Docusate sodium B. Famotidine C. Diphehydramine D. Ibuprofen

Diphenhydramine *Both diphenhydramine, an antihistamine, and oxycodone, an opioid analgesic, can cause CNS depression. Therefore, when a client uses the two medications together, the client is at increased risk for sedation, respiratory depression, and injury.

A nurse is reinforcing teaching with a client who has a new prescription for etanercept to treat rheumatoid arthritis. Which of the following instructions about self-administering this medication should the nurse include? A. Discard any solutions that are cloudy B. Attach a 21-gauge needle to the syringe for injection C. Self-administer the medication on alternate days D. Shake the reconstituted solution well before self-administration

Discard any solutions that are cloudy *The client should discard any vials or pre-filled syringes that contain solutions that are discolored, cloudy, or have any sediment in them.

A nurse is performing the third check before administering hydromorphone to a client. After opening the unit-dose packet, the clients tells the nurse they do not want to take the medication now. Which of the following actions should the nurse take? A. Complete an occurrence report of the incident B. Encourage the client to take the medication C. Leave the medication at the client's bedside in case they chage their mind D. Dispose of the medication with a second nurse as a witness

Dispose of the medication with a second nurse as a witness *The nurse is legally required to have a witness when disposing of a controlled substance.

A nurse erroneously administered zolpidem to the wrong client. Which of the following actions should the nurse take? A. Document the completion of an incident report in the medical record of the client who received the zolpidem B. Administer a dose of naloxone to reverse the effects of the medication C. Keep a copy of the incident report on the unit D. Document the notification of the client's provider

Document the notification of the client's provider *In the medical record of the client who received the zolpidem, the nurse should document the objective facts of the error, including follow-up actions and notification of the provider.

A nurse is collecting data from a client who has multiple sclerosis and a new prescription for baclofen. Which of the following findings should the nurse identify as an adverse effect of this medication? A. Diarrhea B. Weight loss C. Drowsiness D. Hypertention

Drowsiness *The nurse should identify drowsiness as an adverse effect of baclofen. Other adverse effects include dizziness, weakness, and fatigue.

A nurse is caring for a client who has a new prescription for risperidone to manage schizophrenia. Which of the following laboratory tests should the nurse plan to obtain prior to administering the first dose? A. Fasting blood glucose level B. Albumin level C. CD4 T-cell count D. Blood creatinine level

Fasting blood glucose level *The development of hyperglycemia can be an adverse effect of risperidone. The nurse should obtain a fasting blood glucose level prior to administration of the first dose and periodically during treatment.

A nurse is reviewing the medication administration record of a client who has a history of Stevens-Johnson syndrome when taking sulfamethoxazole-trimethoprim. Which of the following medications should the nurse identify as contraindication for this client? A. Prednisone B. Furosemide C. Lansoprazole D. Digoxin

Furosemide *A client who has a history of Stevens-Johnson syndrome when taking sulfonamides is at risk for an allergic reaction to furosemide because the two medications are chemically related. The client should also avoid thiazide diuretics and sulfonylurea-type oral hypoglycemic agents.

A nurse is reviewing the medication administration record for a client who has a new prescription for tobramycin to treat a pulmonary infection. Which of the following medications should the nurse identify as increasing the risk for ototoxicity while taking tobramycin? A. Furosemide B. Propranolol C. Gabapentin D. Guaifenesin

Furosemide *Tobramycin is an aminoglycoside antibiotic that can cause ototoxicity. Furosemide is a diuretic that also can cause ototoxicity. The client's risk for hearing loss is increased if receiving both of these medications at the same time.

A nurse is reviewing medication prescriptions for a group of clients. The nurse should recognize that which of the following prescriptions can result in a medication administration error? A. Penicillin G benzathine 1.2 units IM daily B. Furosemide 10.0 mg PO daily C. Albuterol 2.5 mg inhalations every 6 hr as needed for shortness of breath D. Insulin glargine 15 units subcutaneous daily at bedtime

Furosemide 10.0 mg PO daily *The nurse should avoid using a trailing zero following a whole number. This prescription can result in a medication error because the nurse can mistake the dosage as 100 mg instead of 10 mg because the decimal point is not always recognized.

A nurse is collecting data from the parent of a toddler who is about to receive the varicella immunization. The nurse should identify that an anaphylactic reaction to which of the following substances is a contraindication for receiving this immunizaion? A. Gelatin B. Penicillin C. Sulfa D. Eggs

Gelatin *The nurse should identify that a hypersensitivity reaction to either gelatin or neomycin is a contraindication for receiving the varicella vaccine because it contains both of these substances

A nurse is monitoring a client who has type 2 diabetes mellitus and is receiving repaglinide. Which of the following laboratory tests should the nurse plan to review to obtain information about the long-term therapeutic effect of this medication? A. Fasting blood glucose level B. 1-hr oral glucose tolerance level C. Urinary ketones D. Glycosylated HbA1c

Glycosylated HbA1c *The client's HbA1c value measures the average of blood glucose levels over the past 2 to 3 months. Therefore, the nurse should review this laboratory test to obtain information about the long-term therapeutic effect of repaglinide.

A nurse is collecting data from a client who has angina and a new prescription for sublingual nitroglycerin. Which of the following manifestations should the nurse expect as an adverse effect of this medication? A. Shortness of breath B. Bradycardia C. Headache D. Double vision

Headache *The nurse should expect the client to have headaches as a common adverse effect of taking sublingual nitroglycerin because it causes vasodilation.

A nurse is caring for a client who has chronic kidney disease and has been receiving epoetin for 2 weeks. Which of the following findings should indicate to the nurse that the client's medication is having the desired therapeutic effect? A. Albumin is within the expected reference range B. Urine output increases to 60/hr C. Hemoglobin rises 0.5 g/dL D. Blood urea nitrogen level is within the expected reference range

Hemoglobin rises 0.5 g/dL *Initial therapeutic effects, such as hemoglobin rising 0.5 g/dL, can occur within the first 2 weeks of therapy. The client's hemoglobin should reach target levels of 10 to 11 g/dL in 2 to 3 months.

A nurse is collecting data from a client who is taking celecoxib for treatment of joint pain. The nurse should identify that which of the following findings is a contraindication to receiving celecoxib? A. Hypoglycemia B. Allergy to penicillin C. History of myocardial infarction D. Peptic ulcer disease

History of myocardial infarction *Celecoxib increases the risk of myocardial infarction caused by increased vasoconstriction and unimpeded platelet aggregation. It is contraindicated for a client who has a history of myocardial infarction or heart disease.

Which of the following findings should the nurse identify as an adverse effect of this medication? A. Hypokalemia B. Hypermagnesemia C. Hypertremia D. Hypocalcemia

Hypokalemia *Hydrochlorothiazide is a thiazide diuretic that can cause hypokalemia due to excessive potassium excretion in the urine.

A nurse is assisting with collecting data for a client who is in preterm labor and is receiving magnesium sulfate via continuous IV infusion. Which of the following findings should the nurse identify as an indication of magnesium toxicity? A. Urinary output 60 mL/hr B. Hyporeflexia C. Respirations 16/min D. Tachycardia

Hyporeflexia *Magnesium sulfate depresses neuromuscular activity, causing muscle weakness and paralysis. Therefore, the nurse should identify hyporeflexia as an indication of magnesium toxicity and report it to the charge nurse.

A nurse is evaluating a client who is receiving amphotericin B via intermittent IV bolus. Which of the following findings indicates an adverse reaction to this medication? A. Serum potassium 5.6 B. Hematocrit 55% C. Polyuria D. Hypotension

Hypotension *The nurse should identify that amphotericin B is considered a high-alert medication due to potentially serious adverse effects, such as hypotension. Therefore, the nurse should report this or other adverse effects of amphotericin, such as nephrotoxicity, hypokalemia, and cardiac dysrhythmias.

A nurse is assisting with the care of a client who has a methicillin-resistant Staphylococcus aureus (MRSA) infection and is receiving vancomycin via IV infusion. Which of the following changes in the client's condition should the nurse identify as the priority finding to report to the provider? A. Nausea B. Back pain C. Hypotension D. Chills

Hypotension *When using the urgent vs. nonurgent approach to client care, the nurse determines that the priority finding to report to the provider is hypotension. If the client's vancomycin infusion is too rapid, it can cause red man syndrome, which is a group of adverse effects that includes tachycardia, hypotension, flushing, and urticaria.

A nurse is caring for a client who has a 10-year history of alcohol use disorder and is experiencing acute alcohol withdrawal. The nurse should identify which of the following interventions as the priority? A. Suggest the client attend a support group B. Administer naltrexone C. Implement seizure precautions D. Assist the client to identify triggers of alcohol use

Implement seizure precautions *The greatest risk to the client is injury from seizures and falls. Grand mal seizures can occur during severe alcohol withdrawal. Therefore, the nurse's priority is to implement seizure precautions to reduce the risk of injury if the client experiences a seizure.

A nurse is caring for a client who has schizophrenia and is to start therapy with risperidone. For which of the following manifestations should the nurse monitor to determine whether the treatment is effective? A. Improved social interactions B. Decreased obsessive-compulsive thoughts C. Decreased hand tremors D. Improved urinary control

Improved social interactions *Clients who have schizophrenia typically have difficulty interacting with others and maintaining relationships. Manifestations can include dull affect and speech deficiency. Risperidone is an atypical antipsychotic that can minimize these manifestations, improving social interactions with others.

A nurse is reinforcing teaching with a client who has rheumatoid arthritis and a new prescription for methotrexate. Which of the following information should the nurse include in the teaching? A. Avoid grapefruit juice B. Increase salt intake C. Avoid aged cheese D. Increase fluid intake

Increase fluid intake *Clients who are taking methotrexate should increase fluid intake to reduce the risk for renal damage and to increase medication excretion.

A nurse is caring for a client who has kidney failure and has been taking epoetin. Which of the following is a therapeutic effect of this medication? A. Decreased BUN B. Increased Hgb C. Decreased leukocyte production D. Increased production

Increased Hgb *Epoetin is used to elevate the erythrocyte count for clients who have kidney failure. An increased Hgb is the desired therapeutic effect of this medication.

A nurse is caring for a client who is taking phenylephrine. The nurse should plan to monitor the client for which of the following manifestations as an adverse effect of this medication? A. Increased drowsiness B. Increased heart rate C. Decreased blood pressure D. Decreased WBC count

Increased heart rate *Due to cardiac effects, phenylephrine can cause tachycardia and other cardiac dysrhythmias.

A nurse is collecting data from a client who is taking ferrous sulfate orally. Which of the following findings reported by the client should indicate to the nurse that the medication is having a therapeutic effect? A. Passing of a soft, formed stol daily B. Decreased number of viral illnesses C. Improved ability to fall asleep D. Increased tolerance to exercise

Increased tolerance to exercise *The client who takes ferrous sulfate, which is used to treat iron-deficiency anemia, can have fatigue and shortness of breath due to a low hemoglobin level. An increased tolerance to exercise is an indication the ferrous sulfate is having a therapeutic effect. Increased tolerance to exercise occurs when the hemoglobin level increases, allowing more oxygen to be carried to the vital organs and tissues.

A nurse is reinforcing teaching with a client who recently began taking furosemide. Which of the following instructions should the nurse include in the teaching? A. Increasing dietary potassium while taking the medicaion B. Lie down for 30 min after taking the medication C. Take the medication 30 min before going to bed D. Avoid taking the medication with dairy products

Increasing dietary potassium while taking the medicaion *The nurse should reinforce with the client to increase dietary intake of potassium because furosemide causes potassium to be excreted in the urine. Increasing dietary potassium will help prevent hypokalemia.

A nurse is caring for a client who has a history of psychosis and is taking chlorpromazine. Whch of the following actions should the nurse take to counteract the adverse effects of this medication? A. Suggest that the client apply antiperspirant deoderant more frequently B. Inform the client to apply sunblock before going outside C. Give the client a list of over-the-counter antidiarrheal medications D. Recommend that the client take the medication on an empty stomach

Inform the client to apply sunblock before going outside *The nurse should inform the client to apply sunblock, which will counteract the adverse effects of photosensitivity. Chlorpromazine increases skin's sensitivity to ultraviolet light causing temporary pigmentation changes and increases the risk of sunburn.

A nurse is reinforcing teaching with a client who has bipolar disorder and a new prescription for lithium. Which of the following instructions should the nurse include in the teaching? A. Take the medication on an empty stomach B. Monitor for signs of hyperthyroidism C. Watch for signs of urinary retention D. Maintain a consistent sodium intake

Maintain a consistent sodium intake *The client should maintain a consistent sodium intake while taking lithium. Decreased serum sodium levels cause lithium excretion to decline, which can lead to toxicity.

A nurse in a provider's office is reiewing the immunization records of a 12-month-old infant who is immunocomprised. Which of the following vaccines should the nurse identify as contraindicated for this client? A. Hepatitis A (HepA) B. Measles, mumps, and rubella (MMR) C. Pneumococcal conjugate (PCV13) D. Haemophilus B conjugate (HiB)

Measles, mumps, and rubella (MMR) *Although most infants should receive the MMR vaccine between the ages of 12 months and 15 months, the nurse should identify that the MMR vaccine is composed of live viruses and is contraindicated for an infant who is immunocompromised.

A nurse is reinforcing teaching with a client about the adverse effects of simvastatin. For which of the following adverse effects should the nurse instruct the client to notify the provider? A. Muscle pain B. Fine hand tremors C. Urinary retention D. Double vision

Muscle pain The nurse should instruct the client to notify the provider if muscle pain or tenderness develops because this can indicate the client is developing rhabdomyolysis.

A nurse is collecting data from a client who is taking tobramycin. Which of the following findings should the nurse report to the provider immediately? A. Report of nausea B. Fever C. Oliguria D. Report of headache

Oliguria *Oliguria indicates the client is at greatest risk for nephrotoxicity. Therefore, the nurse should report this finding to the provider immediately.

A nurse is collecing data from a client who is postoperative and taking morphine for pain. Which of the following findings is the priority for the nurse to report to the provider? A. Constipation B. Oxygen saturation 87% C. Vomiting D. Urinary output 25 mL over 1 hr

Oxygen saturation 87% *When using the airway, breathing, and circulation approach to client care, the nurse determines that the priority finding is an oxygen saturation of 87%, which is a manifestation of respiratory depression and should be reported to the provider.

A nurse is reviewing the history of a client who is to start taking cefotetan to treat a bacterial infection. Which of the foloowing information from the client's medical record should the nurse report to the provider before the client begins receiving this medication? A. Hearing impairment B. Milk-protein allergy C. Tendon pain D. Penicillin allergy

Penicillin allergy *Cefotetan is a cephalosporin, an antibiotic structurally similar to penicillins. A client who has a severe allergy to penicillin can develop cross-reactivity and have an allergic reaction to cephalosporins. Therefore, the nurse should report this information to the provider before the client starts taking the medication.

A nurse is reinforcing teaching with a client who is newly diagnosed with hypertension and is taking metoprolol. The nurse should instruct the client to report which of the following manifestations to the provider as an adverse effect of this medication? A. Tachycardia B. Tinnitus C. Peripheral edema D. Urinary retention

Peripheral edema *The nurse should instruct the client to monitor for and report the development of peripheral edema because this can be an indication of heart failure, which is an adverse effect of metoprolol.

A nurse is reinforcing teaching with a client who is to start therapy using a nitroglycerin transdermal patch. Which of the following instructions should the nurse include? A. Cover the patch with a dry dressing B. Apply another patch if experiencing chest pain C. Leave each patch in place for 24 hr D. Place the patch on a different site for each application

Place the patch on a different site for each application *The client should place the patch on a different site for each application to prevent skin irritation.

A nurse is instilling timolol eyedrops for a client who has glaucoma. Which of the following actions should the nurse take after instilling the eyedrops? A. Press the nasolacrimal duct B. Apply pressure to the upper eyelid C. Ask the client to blink their eyes several times D. Tell the client to keep their eyes open for at least 15 seconds

Press the nasolacrimal duct *The nurse should press the client's nasolacrimal duct after instilling the eye drops to prevent the medication from absorbing into systemic circulation.

A nurse is collecting data from a female client who has been taking propylthiouracil (PTU) for 2 months to treat Graves' disease. Which of the following findings should the nurse recognize as an indication that the medication is effective? A. Weight loss B. Pulse 82/min C. Respiratory rate 22/min D. Decreased menstrual flow

Pulse 82/min *Tachycardia is a manifestation of hyperthyroidism. The nurse should identify that a pulse of 82/min is within the expected reference range of 60 to 100/min, indicating that the medication is effective.

A nurse is caring for a client who is taking disulfiram and consumed alcohol 12 hr ago. Which of the following adverse reactions is the priority finding to report to the provider? A. Hyperemesis B. Severe headache C. Palpitations D. Respiratory depression

Respiratory depression *When using the urgent vs. nonurgent approach to client care, the nurse should determine that the priority finding is respiratory depression, which can indicate the client is experiencing acetaldehyde syndrome, a life-threatening event.

A nurse is collecint data from a client who received morphine IV for pain relief. Which of the following findings is the nurse's priority to report to the provider? A. Emesis B. Sedation C. Respiratory rate 11/min D. Blood pressure 90/54 mmHg

Respiratory rate 11/min *When using the airway, breathing, and circulation approach to client care, the priority finding is a respiratory rate of 11/min, which indicates respiratory depression.

A nurse is reinforcing teaching with a client who has hypertension and a new prescription for spirolactone. Which of the following instructions should the nurse in the teaching? A. Increase foods high in zinc B. Restrict foods high in potassium C. Restrict foods high in vitamin K D. Increase foods high in magnesium

Restrict foods high in potassium *The nurse should instruct the client that spironolactone is a potassium-sparing diuretic, which can cause hyperkalemia. Therefore, the client should restrict foods that are high in potassium and salt substitutes that contain potassium.

A nurse is reinforcing teaching about comfort measures with the parent of a 10-year-old child who has a viral infection. The nurse should plan to tell the parent that aspirin is conctraindicated because of the risk for which of the following conditions? A. Juvenile idiopathic arthritis B. Reye syndrome C. Glomerulonephritis D. Iron-deficiency anemia

Reye's syndrome *Aspirin is contraindicated for children and adolescents who have a viral illness because it increases the risk for the development of Reye syndrome.

A nurse is collecting data from a client who is taking lithium to treat bipolar disorder. Which of the following findings should the nurse report to the provider? A. Bloating B. WBC count 8,500/mm3 C. Slurred speech D. Sodium 140 mEq/L

Slurred speech *The nurse should recognize that slurred speech is a manifestation of lithium toxicity and should be reported to the provider.

A nurse is collecting data from a client who has hyperthyroidism and a new prescription for propylthiouracil. The nurse should monitor the client for which of the following manifestations as an adverse effect of this medication? A. Sore throat B. Metallic taste C. Mania D. Urinary retention

Sore throat *The nurse should monitor for sore throat and fever because these are early indications of agranulocytosis, which is an adverse effect of propylthiouracil.

A nurse is monitoring a client who is receiving a transfusion of packed RBCs. The client's temperature increases to 39.1° (102.4°F). Which of the following actions should the nurse take first? A. Obtain a urine spcimen B. Administer diphenhydramine C. Stop the transfusion D. Notify the charge nurse

Stop the transfusion *The greatest risk to this client is injury from a transfusion reaction that can cause acute intravascular hemolysis or anaphylaxis. Therefore, the first action the nurse should take is to stop the transfusion.

A nurse is reinforcing teaching with a client who has a new prescription for omeprazole oral capsules. Which of the following instructions should the nurse include? A. Take the medication at bedtime B. Swallow the medication whole C. Take the medication with food D. Avoid antactids when taking this medication

Swallow the medication whole *The nurse should instruct the client to swallow the capsules or tablets whole and not chew or crush them. Omeprazole, a proton pump inhibitor, blocks the secretion of gastric acid. It is available in delayed-release capsules and over the counter in delayed-release tablets, as well as suspensions and powders.

A nurse is collecting data from a client who has been taking levodopa/carbidopa. Which of the following findings should indicate to the nurse that the medication is effective? A. The client is able to wash their face B. The client experiences fewer seizures C. The client reports decreased hearburn D. The client is able to sleep through the night

The client is able to wash their face *Levodopa works by activating dopamine receptors, restoring nerve transmission for clients who have Parkinson's disease. Carbidopa enhances these effects by inhibiting the breakdown of levodopa in the intestine and periphery. These therapeutic effects assist the client with moving freely and resuming ADLs.

A nurse is reinforcing teaching with a client who has tye 1 diabetes mellitus and is learning to self-administer NPH insulin. Which of the following client actions indicates an understanding of the teaching? A. The client shakes the insulin via prior to drawing up the dose B. The client uses the tip of the plunger to measure the correct dose C. The client injects air into the vial after inverting it D. The client wipes the cap with alcohol prior to filling the syringe

The client wipes the cap with alcohol prior to filling the syringe *The client should wipe the cap with alcohol prior to filling the syringe to reduce the risk for contamination.

A nurse is caring for a client who has a new prescription for sumatriptan. The nurse notes that the client takes fluoxetine. The nurse should notify the provider that the combination of these medications will place the client at risk for which of the following adverse effects? A. Tremors B. Renal calculi C. Dysphagia D. Hearing loss

Tremors *Concurrent use of sumatriptan and fluoxetine can lead to excessive stimulation of serotonin receptors, placing the client at risk for serotonin syndrome. The client can experience tremors, confusion, and hallucinations.

A nurse is collecting data from a client who has been taking digoxin for 1 month. The nurse should identify which of the following findings as a manifestation of digoxin toxicity? A. Pulse rate 100/min B. Blood pressure 140/90 mmHg C. Wheezing D. Vomiting

Vomiting *The nurse should identify vomiting as an early manifestation of digoxin toxicity.

A nurse is planning to administer metoprolol to a client who has heart failure and a heart rate of 48/min. Which of the following actions should the nurse take? A. Encourage the client to ambulate B. Request a different beta blocker medication to administer C. Administer one-half of the client's prescribed dose D. Withhold the client's medication

Withhold the client's medication *The nurse should identify that metoprolol, a beta blocker medication, results in a decrease in heart rate and should withhold the medication for a heart rate less than 50/min. The nurse should also notify the client's provider of the client's heart rate.

A nurse is reinforcing dietary teaching with a client who has a new prescription for phenelzine. Which of the following foods should the nurse include in the teaching as an appropriate foods choice? A. Yogurt B. Avocado C. Smoked salmon D. Pepperoni

Yogurt *Clients taking phenelzine should avoid consuming tyramine, which can cause high blood pressure. Yogurt contains little or no tyramine. Therefore, the nurse should instruct the client that yogurt is an appropriate food choice.