ATI Pharmacology Application Exercises 21-38

A nurse is caring for 4 clients who have peptic ulcer disease. the nurse should identify misoprostol is contraindicated for which of the following clients? A. A client who is pregnant B. A client who has osteoarthritis C. A client who has a kidney stone D. A client who has urinary tract infection

A. A client who is pregnant - Rationale - Misoprostol is pregnancy risk category X - it is teratogenic.

A nurse is admitting a toddler to the hospital after an acetaminophen overdose. Which of the following medications should the nurse anticipate administering to this client? A. Acetylcysteine B. Filgrastim C. Misoprostol D. Naltrexone

A. Acetylcysteine - Rationale : This is the antidote for acetaminophen toxicity.

A nurse is reinforcing teaching where the client who has aneMia and a new prescription for liquid iron supplement. Which of the following Information should the nurse and reinforce in the teaching? (Select all that Apply) A. Add foods that are high in fiber to your diet B. Rinse your mouth after taking the medication C. Expect stools to be green or black D. Take medication with a glass of milk E. Add red meat to your diet

A. Add foods that are high in fiber to your diet - Rationale : Iron supplements can cause constipation. B. Rinse your mouth after taking the medication - Rationale : Iron supplements can stain your teeth. C. Expect stools to be green or black - Rationale : This is a normal reaction that occurs when taking iron supplements. E. Add red meat to your diet - Rationale : Red meats are high in iron.

A nurse is reviewing the medical record of a client who has a new prescription for sargramostim. Which of the following findings should the nurse identify as a contraindication to administering the medication? A. Allergy to yeast B. Hypermagnesemia C. Hypotension D. Allergy to eggs

A. Allergy to years - Rationale :

A nurse is assessing a client who has chronic neutropenia and who has been receiving filgrastim. Which of the following actions should the nurse take to assess for an adverse effect of filgrastim? A. Assess for bone pain. B. Assess for right lower quadrant pain. C. Auscultate for crackles in the bases of the lungs. D. Auscultate the chest to listen for a heart murmur.

A. Bone Pain - Rationale : Bone pain is a dose-related adverse effect of filgrastim. It can be treated with acetaminophen and, if necessary, an opioid analgesic.

A nurse is caring for a client who received IV verapamil to treat supraventricular tachycardia (SVT). The client's pulse rate is now 98/mm and his blood pressure is 74/44 mg Hg. The nurse should anticipate prescription for which of the following IV medications? A. Calcium gluconate B. Sodium bicarbonate C. Potassium chloride D. Magnesium sulfate

A. Calcium gluconate - Rationale : This can reverse the hypotension caused by the Verapamil when given slowly by IV. The calcium counteracts the vasodilation.

A nurse is teaching a client who has a new prescription for digoxin to treat heart failure. Which of the following instructions should the nurse include in the teaching? A. Contact provider if heart rate is less than 60/min. B. Check pulse rate for 30 seconds and multiply result by 2. C. Increase intake of sodium. D. Take with food if nausea occurs.

A. Contact provider if heart rate is less than 60/mins. Rationale : For patients who are on digoxin, a heart rate less than 60 beats a minute requires a hold of the medication. Holding a medication requires contacting the provider.

A nurse is providing teaching to a female client who is taking testosterone to treat advanced breast cancer. The nurse should tell the client that which of the following are adverse effects of this medication? (Select all that apply) A. Deepening Voice B. Weight gain C. Low blood pressure D. Dry mouth E. Facial hair

A. Deepening voice - Rationale : Virilization occurs which causes this. B. Weight gain - Rationale : Edema and weight gain are adverse effects of testosterone. E. Facial hair - Rationale : Virilization occurs which causes this.

A nurse is planning care for a client who has brain cancer and is experiencing headaches. Which of the following adjuvant medications are indicated for this client? A. Dexamethasone B. Methylphenidate C. Hydroxyzine D. Amitriptyline

A. Dexamethasone - Rationale : This is a glucocorticoid which decreases inflammation and swelling.

A nurse is taking a medication history from a client who has angina is to begin taking ranolazine. The nurse should report which of the following medications in the client's history that can interact with ranolazine? (Select all that apply) A. Digoxin B. Simvastatin C. Verapamil D. Amlodipine E. Nitroglycerin transdermal patch

A. Digoxin - Rationale : Increases digoxin levels B. Simvastatin - Rationale : Increases blood levels of simvastatin. C. Verapamil - Rationale : This is a CYP3A4 inhibitor which can increase levels of ranolazine leading to dysrhythmia torsade's de pointe.

A nurse is assessing a client who has salicylism. Which of the following findings should the nurse expect? (Select all that apply) A. Dizziness B. Diarrhea C. Jaundice D. Tinnitus E. Headache

A. Dizziness D. Tinnitus E. Headache Rationale : All of these are symptoms of salicylism.

A nurse is providing teaching to a client who has a new prescription for digoxin. The nurse should instruct the client to monitor and report which of the following adverse effects that is a manifestation digoxin toxicity? (Select all that apply) A. Fatigue B. Constipation C. Anorexia D. Rash E. Blurred vision

A. Fatigue C. Anorexia E. Blurred vision Rationale : All of these are manifestations of digoxin toxicity. (Also, note yellowed vision for vision changes)

A nurse is planning to administer ondansetron IV for an older adult client who has a history of diabetes mellitus and cardiac myopathy and is receiving chemotherapy for cancer. For which of the following adverse effects of ondansetron should the nurse monitor? (Select all that apply) A. Headache B. Diarrhea C. Shortened PR interval D. Hyperglycemia E. Prolonged QT interval

A. Headache B. Diarrhea E. Prolonged QT interval Rationale : These are all common adverse effects of Ondansetron.

A nurse is providing teaching to a client who is taking raloxifene to prevent postmenopausal osteoporosis. The nurse should advise the client that which of the following are adverse effects of this medication? (Select all that apply) A. Hot flashes B. Lump in breast C. Swelling or redness in calf D. Shortness of breath E. Difficulty swallowing.

A. Hot flashes - Rationale : Adverse effect C. Swelling or redness in calf - Rationale : can cause thrombolytic events D. Shortness of breath. - Rationale : can cause pulmonary embolism.

A nurse is teaching a client about the a new prescription for celecoxib. Which of the following information should the nurse include in the teaching? A. Increases the risk for a myocardial infarction B. Decreases the risk of stroke C. Inhibits COX‑1 D. Increases platelet aggregation

A. Increases the risk for a myocardial infarction - Rationale : suppresses vasodilation which can cause a heart attack.

A nurse is preparing to administer potassium chloride IV to a client who has hypokalemia. Which of the following actions should the nurse take? (Select all that apply) A. Infuse medication through a large-bore needle. B. Monitor urine output to ensure at least 20ml/hr C. Administer medication via direct IV bolus. D. Implement cardiac monitoring. E. Administer the infusion using an IV pump.

A. Infuse medication through a large-bore needle. - Rationale : Prevents vein irritation, phlebitis, and infiltration. D. Implement cardiac monitoring. - Rationale : to detect cardiac dysrhythmias. E. Administer the infusion using an IV pump. - Rationale : prevent fatal hyperkalemia due to rapid infusion.

A nurse is planning care for a client who is to receive tetracaine prior to a bronchoscopy. Which of the following actions should the nurse include in the plan of care? A. Keep the client NPO until pharyngeal response returns. B. Monitor the insertion site for a hematoma. C. Palpate the bladder to detect urinary retention. D. Maintain the client on bed rest for 12 hr following the procedure.

A. Keep the client NPO until pharyngeal response returns. - Rationale : The patient wont be able to swallow and will choke if they ingest anything.

A nurse is caring for a client who has cancer and is taking morphine and carbamazepine for pain. Which of the following effects should the nurse monitor for when giving the medications together? (Select all that apply) A. Need for reduced dosage of the opioid B. Reduced adverse effects of the opioid C. Increased analgesic effects D. Enhanced CNS stimulation E. Increased opioid tolerance

A. Need for reduced dosage of the opioid - Rationale : Dosage of morphine can be reduced when administered together with carbamazepine. B. Reduced adverse effects of the opioid - Rationale : Adverse effects of morphine are reduced when administered with carbamazepine. C. Increased analgesic effects - Rationale : analgesic effects are increased when administered with carbamazepine.

A nurse is providing information about probiotic supplements to a male client. Which of the following information should the nurse include? (Select all that apply) A. Probiotics are micro-organisms that are normally found in the GI tract B. Probiotics are used to treat Clostridium Difficile. C. Probiotics are used to treat benign prostatic hyperplasia. D. You can experience bloating while taking probiotic supplements. E. If you are prescribed an antibiotic, you should take it at the same time you take your probiotic supplement.

A. Probiotics are micro-organisms that are normally found in the GI tract - Rationale : They are our normal flora. B. Probiotics are used to treat Clostridium Difficile. - Rationale : they replenish our normal flora to calm the C.diff down. E. If you are prescribed an antibiotic, you should take it at the same time you take your probiotic supplement. - Rationale : This helps prevent the depletion the normal flora in our GI tract.

A nurse is teaching a client who has prescription for nitroglycerin transdermal patch for angina pectoris. Which of the following instructions should the nurse include? A. Remove the patch each evening. B. Cut each patch in half if angina attacks are under control. C. Take off the nitroglycerin patch for 30 min if a headache occurs. D. Apply a new patch every 48 hr.

A. Remove the patch each evening. - Rationale : Removing the patch prevents the patient from forming a tolerance to nitroglycerine.

A nurse is teaching a client who has angina how to use nitroglycerin transdermal ointment. The nurse should include which o the following instruction? A. "Remove the prior dose before applying a new dose." B. "Rub the ointment directly into your skin until it is no longer visible.." C. "Cover the applied ointment with a clean gauze pad." D. "Apply the ointment to the same skin area each time."

A. Remove the prior dose before applying a new dose. - Rationale : Prevent toxicity

A nurse is caring for a client who is receiving a local anesthetic of Lidocaine during the repair of a skin laceration. For which of the following manifestations should the nurse monitor as an adverse reaction to the anesthetic? A. Seizures B. Tachycardia C. Hypertension D. Fever

A. Seizures - Rationale : Adverse effect of lidocaine.

A nurse is caring for a client who has a new prescription for calcitonin-salmon for osteoporosis. Which of the following tests should the nurse tell the client to expect before beginning this medication? A. Skin test for allergy to the medication B. ECG to r/o cardiac dysrhythmias. C. Mantoux test to r/o exposure to TB D. Liver function tests to assess for medication toxicity.

A. Skin test for allergy to the medication - Rationale : Severe anaphylaxis can occur with this medication.

A nurse is providing instructions about the use of laxatives to a client who has heart failure. The nurse should tell the client he should avoid which of the following laxatives? A. Sodium Phosphate B. Psyllium C. Bisacodyl D. Polyethylene glycol

A. Sodium Phosphate - Rationale : Absorption of sodium can exacerbate heart failure.

A nurse is transfusing a unit of packed red blood cells (PRBCs) for a client who has anemia due to chemotherapy. The client reports a sudden headache and chills. The client's temperature is 2° F higher than her baseline. In addition to notifying the provider, which of the following actions should the nurse take? (Select all that apply.) A. Stop the transfusion. B. Place the client in an upright position with feet down. C. Remove the blood bag and tubing from the IV catheter. D. Obtain a urine specimen. E. Infuse dextrose 5% in water through the IV.

A. Stop the transfusion - Rationale : client can be having a hemolytic reaction to the blood or a febrile reaction. C. Remove the blood bag and tubing from the IV catheter. - Rationale : The nurse should avoid infusing more PRBCs into the client's vein and should remove the blood bag and tubing from the client's IV catheter. D. Obtain a urine specimen. - Rationale : Obtaining a urine specimen to check for hemolysis is standard procedure when the client has a reaction to a blood transfusion.

A nurse is providing teaching to a client who is starting simvastatin. Which of the following information should the nurse include in the teaching? A. Take this medication in the evening. B. Change position slowly when rising from a chair. C. Maintain a steady intake of green leafy vegetables. D. Consume no more than 1 L/day of fluid.

A. Take this medication in the evening. - Rationale : Night time is when the most cholesterol is synthesized in the body.

A nurse is teaching a client who has osteoporosis and a new prescription for alendronate. Which of the following instructions should the nurse provide? (Select all that apply) A. Take this medication in the morning before eating. B. Chew tablets to increase bioavailability. C. Drink an 8 oz glass of water with each tablet. D. Take medication with an antacid if heartburn occurs. E. Avoid laying down after taking this medication.

A. Take this medication in the morning before eating. - Rationale : Increases absorption. C. Drink an 8 oz glass of water with each tablet. - Rationale - decreases GI upset. E. Avoid laying down after taking this medication. - Rationale - can cause epigastric discomfort.

A nurse is explaining the mechanism of action of combination oral contraceptives to a group of clients. The nurse should tell the clients that which of the following actions occur with the use of combination oral contraceptives? (Select all that apply) A. Thickening the cervical mucus B. Inducing maturation of ovarian follicle C. Increasing development of corpus luteum. D. Altering the endometrial lining E. Inhibiting ovulation

A. Thickening the cervical mucus D. Altering the endometrial lining E. Inhibiting ovulation. Rationale : Oral contraceptives cause all of these.

A nurse is teaching a client about terbutaline. Which of the following statements indicate understanding of the teaching? A. "This medication will stop my contractions." B. "This medication will prevent vaginal bleeding." C. "This medication will promote blood flow to my baby." D. "This medication will increase my prostaglandin production."

A. This medication will stop my contractions. - Rationale : Causes uterine smooth muscle relaxation, is a beta2-adrenergic blocker.

A nurse is preparing to administer an opioid agonist to a client who has acute pain. For which of the following manifestations should the nurse monitor as an adverse effect of this medication? A. Urinary retention B. Tachypnea C. Hypertension D. Irritating cough

A. Urinary retention - Rationale : Morphine suppresses awareness that the bladder is full.

A nurse is caring for a client who has a new prescription for oxytocin to stimulate uterine contractions. Which of the following actions should the nurse take? (Select all that apply) A. Use an infusion pump for medication administrations. B. Obtain vital signs frequently and with every dosage change. C. Stop infusion if uterine contractions occur every 4 mins and last 45 seconds. D. Increase medication infusion rate rapidly. E. Monitor fetal heart rate continuously.

A. Use an infusion pump for medication administrations. - Rationale : Precise dosage is required B. Obtain vital signs frequently and with every dosage change. - Rationale : Obtaining vital signs is required. E. Monitor fetal heart rate continuously. - Rationale : Monitoring fetal heart rate is required to assess for fetal distress.

A nurse is preparing to administer a transfusion of 300 mL of pooled platelets for a client who has severe thrombocytopenia. The nurse should plan to administer the transfusion over which of the following time frames? A. Within 30 min/unit B. Within 60 min/unit C. Within 2 hr/unit D. Within 4 hr/unit

A. Within 30 min/unit - Rationale : Platelets are fragile and should be administered quickly to reduce the risk of clumping. The nurse should administer the platelets within 15 to 30 min/unit.

A nurse is providing instruction to a client who has a new prescription for calcitonin-salmon for postmenopausal osteoporosis. Which of the following instructions should the nurse include in the teaching? A. Swallow tablets on an empty stomach with plenty of water. B. Watch for skin rash and redness when applying calcitonin-salmon topically. C. Mix the liquid medication with juice and take it after meals. D. Alternate nostrils each time calcitonin-salmon is inhaled.

Alternate nostrils each time calcitonin-salmon is inhaled. Rationale : calcitonin-salmon is a nasal spray.

A nurse is evaluating a group of clients at a health fair to identify the need for folic acid therapy. Which of the following clients require folic acid therapy? (Select all that apply) A. 12-year-old child who has iron deficiency anemia. B. 24-year-old female who has no health problems C. 44 year old male with hypertension. D. 55-year-old female who has alcohol use disorder. E. 35 year-old male who has type 2 diabetes mellitus.

B. 24-year-old female who has no health problems. - Rationale : Prevents neural tube defects in the fetus for people who are of childbearing age. D. 55-year-old female who has alcohol use disorder. - Rationale : Excess alcohol intake can cause decreased folic acid dietary intake.

A nurse is preparing to administer pamidronate to a client who has bone pain related to cancer. Which of the following precautions should the nurse take when administering pamidronate? A. Inspect the skin for redness and irritation when changing the intradermal patch. B. Assess the IV site for thrombophlebitis frequently during administration. C. Instruct the client to sit upright or stand for 30 min following oral administration. D. Watch for manifestations of anaphylaxis for 20 min after IM administration.

B. Assess the IV site for thrombophlebitis frequently during administration. - Rationale : This medication is administered via IV and can cause irritation to veins.

A nurse is teaching a client who has angina pectoris and is learning how to treat acute anginal attacks. The clients asks. "What is my next step if I take one tablet, wait 5 minutes, but still have anginal pain? Which of the following responses should the nurse make? A."Take two more sublingual tablets at the same time. B. "Call the emergency response team. C. "Take a sustained-release nitroglycerin capsule." D. "Wait another 5 minutes then take a second sublingual tablet.

B. Call the emergency response team - Rationale : a patient should take a sublingual tablet every 5 minutes for 15 minutes. The patient should not take more than 3 tablets. If the chest pain has not subsided after 3 tablets, emergency response should be called.

A nurse is monitoring a client who takes aspirin 81 mg PO daily. The nurse should identify which of the following manifestations as adverse effects of daily aspirin therapy? (Select all that apply) A. Hypertension B. Coffee-ground emesis C. Tinnitus D. Paresthesia of the extremities E. Nausea

B. Coffee-ground emesis C. Tinnitus E. Nausea Rationale for all - All of these are adverse effects of aspirin therapy.

A nurse is reviewing the medication administration record for a client who is receiving transdermal fentanyl for severe pain. The nurse should identify that which of the following medications can cause an adverse effect when administered concurrently with fentanyl? A. Ampicillin B. Diazepam C. Furosemide D. Prednisone

B. Diazepam - Rationale : This combination increases risk of serious CNS depression.

A nurse is caring for a client who is receiving IV potassium. The nurse should monitor the client for which of the following manifestation as an indication of hyperkalemia? A. Tachycardia B. Dyspnea C. Lethargy D. Increased thirst

B. Dyspnea - Rationale : This is a symptom of Hyperkalemia.

A nurse is caring for a client who has a new prescription for niacin to reduce cholesterol. The nurse should monitor for which of the following findings as an adverse effect of niacin? (Select all that apply) A. Muscle aches B. Hyperglycemia C. Hearing loss D. Flushing of the skin E. Jaundice

B. Hyperglycemia D. Flushing of the skin E. Jaundice

A nurse is monitoring a clientwho is receiving epoetin alfa for adverse effects. The nurse should identify which of the following findings as an adverse effect of this medication? (Select all that apply) A. Leukocytosis B. Hypertension C. Edema D. Blurred vision E. Headache

B. Hypertension E. Headache Rationale : These are adverse effects of epoetin alfa. The others are not.

A nurse is providing teaching to a client who is experiencing migraine headaches. Which of the following instructions should the nurse provide? (Select all that apply) A. Take ergotamine as a prophylaxis to prevent a migraine headache. B. Identify and avoid trigger factors. C. Lie down in a dark quiet room at the onset of a migraine. D. Avoid foods that contain tyramine. E. Avoid exercise that can increase heart rate.

B. Identify and avoid trigger factors. C. Lie down in a dark quiet room at the onset of a migraine. D. Avoid foods that contain tyramine. Rationale : Using nonpharmaceutical methods is primary intervention. Tyramine is known to cause migraines.

A nurse is administering a dopamine infusion at a low dose to a client who has severe heart failure. Which of the following findings is an expected effect of this medication? A. Lowered heart rate. B. Increased urinary output. C. Decreased conduction through the AV node. D. Vasoconstriction of renal blood vessels.

B. Increased urinary output - Rationale : Dopamine increases renal perfusion due to the dopamine receptors in the kidneys.

A nurse is planning to administer subcutaneous enoxaparin 40 mg using a prefilled syringe of enoxaparin 40 mg/0.4 mL to an adult client following hip arthroplasty. Which of the following actions should the nurse plan to take? A. Expel the air bubble from the prefilled syringe before injecting. B. Insert the needle completely into the client's tissue. C. Administer the injection in the client's thigh. D. Aspirate carefully after inserting the needle into the client's skin.

B. Insert the needle completely into the client's tissue. - Rationale : The nurse should inject the needle on the prefilled syringe completely when administering enoxaparin in order to administer the medication by deep subcutaneous injection.

A nurse is caring for a client who has angina and asks about obtaining a prescription for sildenafil to treat erectile dysfunction. Which of the following medications is contraindicated with sildenafil? A. Aspirin B. Isosorbide C. Clopidogrel D. Atorvastatin

B. Isosorbide - Rationale : This is a medication to treat angina by reducing blood pressure. Taking this with Sildenafil can cause dangerous hypotension. (Clopidogrel (Plavix) is an antiplatelet, which is technically a blood thinner. But there are no interactions between it and sildenafil (Viagra).)

A nurse is caring for a client who has diabetes and is experiencing nausea due to gastroparesis. The nurse should anticipate a prescription for which of the following medications? A. Lubiprostone B. Metoclopramide C. Bisacodyl D. Loperamide

B. Metoclopramide - Rationale : It's the only antinausea medication on the list - The others are laxatives and antidiarrheals.

A nurse is planning care for a client who has cancer and is taking a glucocorticoid as an adjuvant medication for pain control. Which of the following interventions should the nurse include in the plan of care? (Select all that apply) A. Monitor for urinary retention B. Monitor blood glucose C. Monitor blood potassium level D. Monitor for gastric bleeding E. Monitor for respiratory depression

B. Monitor blood glucose - Rationale : Glucocorticoids cause hyperglycemia. C. Monitor blood potassium level - Rationale : Glucocorticoids can cause hypokalemia. D. Monitor for gastric bleeding - Rationale : Glucocorticoids irritate gastric mucosa.

A nurse is preparing to transfusea unit of packed red blood cells (PRBCs) for a client who has severe anemia. Which of the following interventions will prevent an acute hemolytic reaction? A. Ensure that the client has a patent IV line before obtaining blood product from the refrigerator. B. Obtain help from another nurse to confirm the correct client and blood product. C. Take a complete set of vital signs before beginning transfusion and periodically during the transfusion. D. Stay with the client for the first 15 to 30 min of the transfusion.

B. Obtain help from another nurse to confirm the correct client and blood product. - Rationale : Identifying and matching the correct blood product with the correct client will prevent an acute hemolytic reaction from occurring because this reaction is caused by ABO or Rh incompatibility.

A nurse is planning to administer IV alteplase to a client who is demonstrating manifestations of a massive pulmonary embolism. Which of the following interventions should the nurse plan to take? A. Administer IM enoxaparin along with the alteplase dose. B. Obtain the client's weight. C. Administer aminocaproic acid IV prior to alteplase infusion. D. Prepare to administer alteplase within 8 hr of manifestation onset.

B. Obtain the client's weight. - Rationale : an accurate weight is required to give the correct dose.

A nurse is teaching a client who will begin taking aluminum hydroxide. Which of the following information should the nurse include in the teaching? A. "If constipation develops, switch to a calcium-based antacid." B. "Take this medication 2 hours before or after other medications." C. "This medication increases the risk for pneumonia." D. "Have your magnesium level monitored while taking this medication."

B. Take this medication 2 hours before or after other medications. - Rationale : Cimetidine alters absorption of many medication.

A nurse is caring for a client who has a new prescription for adalimumab for rheumatoid arthritis. Based on the route of administration for adalimumab, which of the following should the nurse plan to monitor? A. The vein for thrombophlebitis during IV administration B. The subcutaneous site for redness following the injection. C. The oral mucosa for ulceration after oral administration. D. The skin for irritation following removal of transdermal patch.

B. The subcutaneous site for redness following the injection. Rationale : This is normal procedure for subq administrations.

A nurse is teaching a client who has a new prescription for omeprazole. Which of the following info should the nurse include in the teaching? A. Take this medication at bedtime. B. This medication decreases the production of gastric acid. C. Take this medication 2 hr after eating. D. This medication can cause hyperkalemia.

B. This medication decreases the production of gastric acid. - Rationale : Omeprazole reduces gastric acid secretion by inhibiting the enzyme that produces gastric acid.

A nurse is caring for a client who has a new prescription for alirocumab to reduce cholesterol. The nurse should monitor for which of the following findings as an adverse effect of alirocumab? (Select all that apply) A. Muscle Aches B. Vasculitis C. Hearing loss D. Urticaria E. Jaundice

B. Vasculitis - Rationale : an allergic reaction to Alirocumab. D. Urticaria - Rationale : an allergic reaction to Alirocumab. E. Jaundice - Rationale : All statins have a risk of causing liver disorders.

A nurse is assessing a client who has taken procainamide to treat dysrhythmias for the last 12 months. The nurse should assess the client for which of the following adverse effects of this medication? (Select all that apply) A. Hypertension B. Widened QRS complex C. Narrowed QT interval D. Easy bruising E. Swollen joints

B. Widened QRS complex - Rationale : Symptom of cardiotoxicity. D. Easy bruising - Rationale : Procainamide can cause thrombocytopenia, which can lead to bruising. E. Swollen joints - Rationale : Systemic Lupus Erythematous-like syndrome can be an adverse effect of Procainamide.

A nurse is reviewing a new prescription for terbutaline with a client who has a history of preterm labor. Which of the following client statements indicates understanding of the teaching? A. "I can increase my activity now that I've started on this medication." B. "I will increase my daily fluid intake to 3 quarts." C. "I will report increasing intensity of contractions to my doctor." D. "I am glad this will prevent preterm labor."

C. "I will report increasing intensity of contractions to my doctor."

A nurse is evaluating teaching for a client who has rheumatoid arthritis and a new prescription for methotrexate. Which of the following statements by the client indicates understanding of the teaching? A. "I will be sure that I return to the clinic at least once a year to have my blood drawn while taking methotrexate." B. "I can receive live-virus vaccines while taking this medication." C. "I'll let the doctor know if I develop sores in my mouth while taking this medication." D. "I should stop taking oral contraceptives while I'm taking methotrexate."

C. "I'll let the doctor know if I develop sores in my mouth while taking this medication." - Rationale : first symptoms of methotrexate toxicity.

A nurse is caring for a client who has end-stage cancer and is receiving morphine. The client's family member asks why the provider prescribed methylnaltrexone. Which of the following responses should the nurse make? A. " The medication will increase respirations." B. " The medication will prevent dependence on the morphine." C. " The medication will relieve constipation." D. "The medication works with the morphine to increase pain relief."

C. "The medication will relieve constipation." - Rationale : This is an opioid antagonist that relieves severe constipation in opioid-dependent patients that isn't relieved by other laxatives.

A nurse is caring for a client who has preeclampsia and is receiving magnesium sulfate IV continuous infusion. Which of the following findings should the nurse report to the provider? A. 2+ deep tendon reflexes B. 2+ pedal edema C. 24mL/hr urinary output D. Respirations 12/min

C. 24mL/hr urinary output - Rationale : Urine output less than 25-30ml/hr indicates hypermagnesemia.

A nurse is completing a nursi ng history for a client who takes simvastatin. The nurse should identify which of the following disorders as a contraindication to adding ezetimibe to the client's medications? A. History of severe constipation B. History of hypertension C. Active hepatitis C D. Type 2 diabetes mellitus

C. Active hepatitis C - Rationale : Ezetimibe is contraindicated in patients that have any kind of liver disorder, in this case especially because the patient is on Simvastatin.

A nurse is teaching a client who takes phenytoin and has a new prescription for sucralfate tablets. Which of the following instructions should the nurse include? A. Take an antacid with sucralfate B. Take sucralfate with a glass of milk C. Allow a 2 hr interval between these medications D. Chew the sucralfate thoroughly before swallowing

C. Allow a 2 hr interval between these medications. - Rationale : Sucralfate interferes with absorption of phenytoin. Allow a 2 hr interval between the sucralfate and phenytoin.

A nurse is preparing to administer propranolol to a client who has a dysrhythmia. Which of the following actions should the nurse plan to take? A. Hold propranolol for an apical pulse greater than 100/min. B. Administer propranolol to increase the client's blood pressure. C. Assist the client when sitting up or standing after taking this medication. D. Check for hypokalemia frequently due to the risk for propranolol toxicity

C. Assist the client when sitting up or standing after taking this medication. - Rationale : Propranolol can cause orthostatic hypotension and dizziness.

A nurse is assessing a client who is receiving magnesium sulfate and notes the client has decreased deep tendon reflexes. The nurse should expect to administer which of the following medications? A. Potassium Chloride B. Folic Acid C. Calcium Gluconate D. Cyanocobalamin

C. Calcium Gluconate - Rationale : counteracts hypermagnesemia

A nurse is teaching a client about cimetidine. which of the following are adverse effects of cimetidine? (Select all that apply) A. Increased libido B. Insomnia C. Enlargement of breast tissue D. Confusion E. Decreased sperm count

C. Enlargement of breast tissue. D. Confusion. E. Decreased sperm count. Rationale : All of these are side effects of cimetidine. The others are not.

A nurse is caring for a hospitalized client who has an activated partial thromboplastin time (aPTT) greater than 1.5 times the expected reference range. Which of the following blood products should the nurse prepare to transfuse? A. Whole blood B. Platelets C. Fresh frozen plasma D. Packed red blood cells

C. Fresh frozen plasma - Rationale : Fresh frozen plasma is indicated for a client who has an elevated aPTT because it replaces coagulation factors and can help prevent bleeding.

A nurse is assessing a client during transfusion of a unit of whole blood. The client develops a cough, shortness of breath, elevated blood pressure, and distended neck veins. The nurse should anticipate a prescription for which of the following medications? A. Epinephrine B. Lorazepam C. Furosemide D. Diphenhydramine

C. Furosemide - Rationale : Lasix is sometimes prescribed for people experiencing symptoms of circulatory overload.

A nurse is providing teaching to a client who will start alfuzosin for treatment of benign prostate hyperplasia. The nurse should instruct the client that which of the following is an adverse effect of this medication? A. Bradycardia B. Edema C. Hypotension D. Tremor

C. Hypotension - Rationale : Alfuzosin relaxes muscle tone in veins which leads to hypotension.

A nurse is collecting data from a client who is taking gemfibrozil Which of the following assessment findings should the nurse identify as an adverse reaction to the medication? A. Mental status changes B. Tremor. C. Jaundice D. Pneumonia

C. Jaundice - Rationale : Gemfibrozil can cause liver impairment.

A nurse is providing teaching to a client who has gout and a new prescription for allopurinol. For which of the following adverse effects should the client be taught to monitor? (Select all that apply) A. Stomatitis B. Insomnia C. Nausea D. Rash E. Increased gout pain

C. Nausea - Rationale : adverse effect of allopurinol. D. Rash - Rationale : allergic reaction to allopurinol. E. Increased gout pain - Rationale : adverse effect of allopurinol.

A nurse is caring for a client whohas atrial fibrillation and a new prescription for dabigatran to prevent development of thrombosis. Which of the following medications is prescribed concurrently to treat an adverse effect of dabigatran? A. Vitamin K B. Protamine C. Omeprazole D. Probenecid

C. Omeprazole - Rationale : Omeprazole or another proton pump inhibitor is prescribed for a client who is taking dabigatran and has abdominal pain and other GI findings that can occur as adverse effects of dabigatran. The nurse should advise the client who has GI effects to take dabigatran with food.

A nurse is providing teaching to a client who has migraine headaches and a new prescription for ergotamine. For which of the following manifestations indicating a possible adverse reaction should the nurse instruct the client to stop taking the medication and notify the provider? (Select all that apply) A. Nausea B. Visual disturbances C. Positive home pregnancy test D. Numbness and tingling in fingers E. Muscle pain

C. Positive home pregnancy test - Rationale : Ergotamine is pregnancy category X. D. Numbness and tingling in fingers - Rationale : Symptom of ergotamine toxicity. E. Muscle pain - Rationale : Symptom of Ergotamine toxicity.

A nurse in a provider's office is monitoring serum electrolytes for four older adult clients who take digoxin. Which of the following electrolyte values increases a client's risk for digoxin toxicity? A. Calcium 9.2 mg/dL B. Calcium 10.3 mg/dL C. Potassium 3.4 mEq/L D. Potassium 4.8 mEq/L

C. Potassium 3.4 mEq/L - Rationale : Low potassium levels put patients at risk for Digoxin Toxicity.

A nurse is assessing a client who is taking amiodarone to treat atrial fibrillation. Which of the following findings is a manifestation of amiodarone toxicity? A. Light yellow urine B. Report of tinnitus C. Productive cough D. Blue-gray skin discoloration

C. Productive cough - Rationale : This can indicate pulmonary toxicity or heart failure.

A nurse is caring for a hospitalized client who is receiving IV heparin for a deep-vein thrombosis. The client begins vomiting blood. After the heparin has been stopped, which of the following medications should the nurse prepare to administer? A. Vitamin K B. Atropine C. Protamine D. Calcium gluconate

C. Protamine - Rationale : Protamine is the antidote to heparin toxicity.

A nurse is reviewing the health care record of a client who is asking about conjugated equine estrogens. The nurse should inform the client this medication is contraindicated in which of the following conditions? A. Atrophic vaginitis B. Dysfunctional uterine bleeding C. Osteoporosis D. Thrombophlebitis

C. Thrombophlebitis - Rationale : Estrogen increases the risk of thrombolytic events.

A nurse is caring for an older adult client who has a new prescription for digoxin and takes multiple other medications. The nurse should recognize that concurrent use of which of the following medications places the client at risk for digoxin toxicity? A. Phenytoin B. Verapamil C. Warfarin D. Aluminum hydroxide

C. Verapamil - Rationale : Verapamil is a calcium-channel blocker which can increase Digoxin levels. Digoxin should be decreased and levels should be monitored closely.

A nurse is taking a history for a client who reports that he is taking aspirin about four times daily for a sprained wrist. Which of the following prescribed medications taken by the client is contraindicated with aspirin? A. Digoxin B. Metformin C. Warfarin D. Nitroglycerin

C. Warfarin - Rationale : Under normal circumstances, Aspirin is contraindicated for patients that take Warfarin because it increases the risk of bleeding. It can be prescribed together, but only under intense supervision.

A nurse is planning to administer morphine IV to a client who is postoperative. Which of the following actions should the nurse take? A. Monitor for seizures and confusion with repeated doses. B. Protect the clients skin from the severe diarrhea that occurs with morphine. C. Withhold this medication if respiratory rate is less than 12/min. D. Give morphine intermittent via IV bolus over 30 seconds or less.

C. Withhold this medication if respiratory rate is less than 12/min. - Rationale : Morphine causes respiratory depression.

A nurse is caring for a young adult client whose serum calcium us 8.8 mg/dL. Which of the following medications should the nurse anticipate administering to the client? A. Calcitonin-salmon B. Calcium carbonate C. Zoledronic Acid D. Obandronate

Calcium Carbonate - Rationale : Patients calcium is low.

A nurse is reviewing the health history of a client who has migraine headaches and is to begin prophylaxis therapy with propranolol. Which of the following findings in the client history should the nurse report to the provider? A. The client had a prior myocardial infarction. B. The client takes warfarin for atrial fibrillation. C. The client takes an SSRI for depression. D. An ECG indicates a first-degree heart block.

D. An ECG indicates a first-degree heart block. - Rationale : Propranolol is contraindicated in patients with first-degree heart block. Notify the provider.

A nurse is preparing to administer butorphanol to a client who has a history of substance use disorder. The nurse should identify which of the following information as true regarding butorphanol? A. Butorphanol has a greater risk for abuse than morphine. B. Butorphanol causes a higher incidence of respiratory depression than morphine. C. Butophanol cannot be reversed with an opioid antagonist. D. Butorphanol can cause abstinence syndrome in opioid- dependent clients.

D. Butorphanol can cause abstinence syndrome in opioid- dependent clients. Rationale : symptoms of abstinence syndrome are abdominal pain, anxiety, and fever.

A nurse is preparing to administer filgrastim for the first time to a client who has just undergone a bone marrow transplant. Which of the following interventions is appropriate? A. Administer IM in a large muscle mass to prevent injury. B. Ensure that the medication is refrigerated until just prior to administration. C. Shake vial gently to mix well before withdrawing dose. D. Discard vial after removing one dose of the medication.

D. Discard vial after removing one dose of the medication. Rationale : Only one dose of filgrastim should be withdrawn from the vial and the vial should then be discarded.

A nurse is caring for a client who is prescribed isosorbide mononitrate for chronic stable angina and develops reflex tachycardia. Which of the following medications should the nurse expect to administer? A. Furosemide B. Captopril C. Ranolazine D. Metoprolol

D. Metoprolol - Rationale : This is a beta adrenergic blocker often given to patients to treat hypertension and angina pectoris to decrease heart rate.

A nurse is preparing to administer belimumab for a client who has systemic lupus erythematosus. Which of the following actions should the nurse plan to take? A. Warm the medication to room temperature over 1 hour prior to administering. B. Administer medication by IV bolus C. Dilute the medication in 5% dextrose and water solution. D. Monitor the client for hypersensitivity reactions.

D. Monitor the client for hypersensitivity reactions. - Rationale : belimumab can cause severe anaphylaxis.

A nurse is administering amitriptyline to a client who is experiencing cancer pain. For which of the following adverse effects should the nurse monitor? A. Decreased appetite B. Explosive Diarrhea C. Decreased pulse rate D. Orthostatic hypotension

D. Orthostatic hypotension - Rationale : A common side effect of amitriptyline is hypotension.

A nurse is assessing a client who is taking digoxin to treat heart failure. Which of the following findings is a manifestation of digoxin toxicity? A. Bruising B. Report of metallic taste C. Muscle pain D. Report of anorexia

D. Report of anorexia - Rationale : Anorexia is a manifestation of Digoxin toxicity.

A nurse in an emergency department is performing an admission assessment for a client who has severe aspirin toxicity. Which of the following findings should the nurse expect? A. Body temperature 35° C (95° F) B. Lung crackles C. Cool, dry skin D. Respiratory depression

D. Respiratory depression - Rationale : This is a symptom of aspirin toxicity because of respiratory acidosis.

A nurse is teaching a client who is taking digoxin and has a new prescription for colesevelam. Which of following instructions should nurse include in the teaching? A. "Take digoxin with your morning dose of colesevelam" B. "Your sodium and potassium levels will be monitored periodically while taking colesevelam." C. "Watch for bleeding or bruising while taking colesevelam." D. "Take colesevelam with food and at least one glass of water."

D. Take colesevelam with food and at least one glass of water. - Rationale : To avoid GI upset

A nurse is caring for a client who received prochlorperazine 4 hours ago. The client reports spasms of his face. The nurse should anticipate a prescription for which of the following medications? A. Fomepizole B. Naloxone C. Phytonadione D. Diphenhydramine

Diphenhydramine - Rationale : Benadryl suppresses extrapyramidal effects of the dystonia that can be a side effect of prochlorperazine.

A nurse is caring for a client who has a new diagnosis of fibromyalgia. Which of the following medications should the nurse anticipate being prescribed for this client? A. Colchicine B. Hydroxychloroquine C. Auranofin D. Duloxetine

Duloxetine - Rationale : This is an SNRI for fibromyalgia.

A nurse is caring for a client who is in labor and is receiving oxytocin. The nurse should monitor the client for which of the following complications of oxytocin? (Select all that apply) A. Uterine rupture B. Uterine tachysystole C. Placental abruption D. Hyponatremia E. Placenta Previa

Uterine rupture - Rationale : Adverse effect Uterine tachysystole - Rationale : increases frequency of uterine contractions. Placental abruption - Rationale : Adverse effect Hyponatremia - Rationale : Water intoxication