ATI Pharmacology - Questions Part 2

A nurse is teaching a client who has a prescription for a transdermal estradiol patch. In which of the following locations should the nurse instruct the client to apply the patch?

Abdomen The nurse should instruct the client to apply the transdermal estradioal patch to the skin of the trunk (e.g. the abdominal area) but not the breasts. This allows the estrogen from the patch to be absorbed through the skin directly to the client's blood.

A nurse is preparing to administer a hydromorphone IV infusion to a client for pain. Which of the following actions should the nurse take?

Administer the medication over 4 to 5 minutes The nurse should administer the IV injection of this opioid medication over 4 to 5 minutes to prevent the adverse effects of this medication such as respiratory depression and cardiac arrest.

A nurse is caring for a client who has asthma and a prescription for zileuton. Which of the following laboratory values should the nurse monitor while the client is taking this medication?

Alanine aminotransferase (ALT) The nurse should identify that ALT is a liver function test. Zileuton is a leukotriene modifier that can affect the liver, causing increased ALT levels. The nurse should monitor this laboratory value closely while the client is taking this medication.

A nurse is caring for a client with a pseudomonas infection who has a new prescription for ticarcillin-clavulanate. Which of the following data should the nurse collect before administering this medication?

Baseline BUN and creatinine Ticarcillin-clavulanate is a penicillin antibiotic and is excreted by the kidneys. Therefore, any renal impairment could result in a toxic level of the medication. The nurse should assess baseline BUN and creatinine levels and monitor these values throughout therapy.

A nurse is caring for a client who has a prescription for clopidogrel. The nurse should monitor for which of the following adverse effects?

Bleeding Clopidogrel is an antithrombotic medication that inhibits platelet aggregation. It is used to prevent stenosis of the coronary stents, myocardial infarction, and strokes. The nurse should monitor for coffee-ground emesis, black tarry stools, ecchymosis, or any indication of bleeding.

A nurse is teaching a client who has primary adrenal insufficiency (Addison's disease) and a prescription for hydrocortisone. Which of the following statements should the nurse include in the teaching about this medication?

Carry a supply of pills and a single-use injectable preparation with you at all times. The nurse should tell the client to carry an emergency supply of the medication to take during times of unexpected stress. The client should carry an adequate supply at all times, which should include an injectable preparation plus a supply equal to the regular oral dosage. The single-use injectable preparation should be administered IM if the client has an emergency and needs an extra dose of the glucocorticoid.

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

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

A nurse is completing the admission history for a client who reports drinking 1 pint of whiskey every day for 6 years. The client's las drink was 10 hours ago. Which of the following medications should the nurse plan to administer upon admission?

Chlordiazepoxide The nurse should anticipate the client will experience manifestations of alcohol withdrawal. Benzodiazepines are the most effective medications use to facilitate alcohol withdrawal, and chlordiazepoxide is preferred because it has a longer half-life than other benzodiazepines. Benzodiazepines are safe and can stabilize vital signs, reduce the intensity of symptoms, and decrease the risk of seizures and delirium tremens.

A nurse is administering ciprofloxacin and phenazopyridine to a client who has a severe urinary tract infection (UTI). The client asks why both medications are needed. Which of the following responses should the nurse make?

Ciprofloxacin hydrochloride treats the infection, and phenazopyridine treats pain. Ciprofloxacin hydrochloride is a broad-spectrum quinolone antibiotic, and phenazopyridine is a bladder analgesic/anesthetic that relieves burning and pain in the bladder mucosa caused by bladder spasm and inflammation.

A nurse is reviewing the medical record of a client who is receiving hydrochlorothiazide (HCTZ). The nurse should expect to find an improvement in which of the following conditions as a result of this medication?

Diabetes insipidus A thiazide diuretic such as HCTZ is administered to treat diabetes insipidus. Diabetes insipidus is a condition in which there is an overproduction of urine. Thiazides reduce urine production by 30 to 50%.

A nurse is teaching a client who has a new prescription for warfarin. Which of the following statements should the nurse identify as an indication that the client understands the instructions?

I'll avoid contact sports like football. The most common adverse effect of taking anticoagulants is bleeding. Therefore, the client should avoid any activities that have a high risk of causing injury, such as contact sports.

A nurse is planning care for a client with thrombophlebitis who has a prescription to receive heparin via continuous IV infusion. Which of the following actions should the nurse include in the plan of care?

Infuse the heparin using an electronic IV pump The nurse should administer heparin using an electronic IV pump rather than by gravity to prevent an accidental increase or change in the rate of infusion.

A nurse is caring for a client who has a prescription for an oral contraceptive to prevent pregnancy. The nurse should identify that which of the following actions is the purpose of this medication?

Inhibition of ovulation

A nurse is providing discharge teaching to a client who has angina pectoralis and a new prescription for verapamil. The client tells the nurse, "My brother takes verapamil for high blood pressure. Do you think the provider made a mistake?" Which of the following responses should the nurse make?

Verapamil is used to treat both high blood pressure and angina. Verapamil is a calcium channel blocker that is used for both hypertension and anginal pain because of its ability to dilate arteries and decrease afterload.

A nurse is teaching a client who has a prescription for doxycycline for the treatment of a Helicobacter pylori infection. Which of the following instructions should the nurse include in the teaching?

Wear protective clothing while in the sun The nurse should include in the teaching that all tetracycline medications increase the sensitivity of the skin to ultraviolet light and sunlight. Therefore, clients are encouraged to avoid prolonged exposure to the sun and to wear protective clothing while outside and exposed to the sun.

A nurse is providing discharge teaching to a client who had a bleeding duodenal ulcer and has been prescribed omeprazole. Which of the following statements should the nurse include in the teaching?

You should take this medication before breakfast every day. Clients who have active duodenal ulcer or gastric reflux disease should take omeprazole once daily before a meal (usually breakfast) because the medication is less effective when taken with food.

A nurse is caring for a client who is experiencing an acute asthma exacerbation. Which of the following medications should the nurse identify as being contraindicated for this client?

Propranolol The nurse should identify that a client who is experiencing an acute asthma exacerbation requires the use of a beta2-agonist to alleviate bronchospasm and relax the client's airway. Therefore, propranolol is contraindicated for this client. Propranolol is a beta-blocker that is used to treat cardiac conditions, including hypertension. Blocking the beta receptors prevents the action of beta2-agonists such as albuterol.

A nurse is caring for a client who is receiving bleomycin IV to treat lymphoma. Which of the following assessments is the nurse's priority?

Pulmonary function The nurse should apply the safety and risk-reduction priority-setting framework, which assigns priority to the factor or situation posing the greatest safety risk to the client. Bleomycin can cause severe lung injury, including pneumonitis and pulmonary fibrosis, which affects a significant percentage of clients receiving this medication; therefore, pulmonary function is the priority assessment.

A nurse is caring for a client who has asthma and is prescribed a short-acting beta2-agonist. Which of the following should the nurse identify as the expected outcome of this medication?

Reverse bronchospasm The nurse should identify that the expected outcome of a short-acting beta2-agonist is reversal of bronchospasm. Short-acting beta2-agonists bind to beta2-adrenergic receptors in the lung, resulting in relaxation of bronchial smooth muscle.

A nurse is providing discharge teaching to a client who has a bacterial infection about adverse effects of imipenem to report to the provider. Which of the following pieces of information should the nurse include?

Seizures can occur with this medication.

A nurse is assessing a client who is receiving a continuous morphine IV infusion and finds the client's respiratory rate has decreased from 20/min to 12/min. Which of the following actions should the nurse take?

Slow the rate of infusion The nurse should decrease the infusion rate to reduce the amount of morphine the client receives and limit the risk of respiratory depression.

A nurse is providing teaching about food-drug interactions to a client who is prescribed sirolimus following a kidney transplant. Which of the following pieces of information should the nurse include in the teaching?

Avoid eating grapefruit while taking sirolimus The nurse should inform the client that grapefruit and grapefruit juice can inhibit the metabolism of sirolimus. This means that consuming grapefruit and grapefruit juice would cause the levels of the medication to rise in the client's body, which could have adverse effects. Therefore, grapefruits should be avoided.

A nurse is providing discharge teaching to a client who is postoperative and has a new prescription for oral opioid analgesic. Which of the following pieces of information should the nurse include as a rationale for increasing the client's daily intake of fiber?

Dietary fiber helps prevent constipation. The nurse should inform the client that constipation is an adverse effect of opioids. Increasing dietary fiber consumption can help manage opioid-induced constipation. The nurse should instruct the client to increase physical activity and fluid intake. A stool softener and laxative might also be needed to prevent the complications associated with opioid-induced constipation.

A nurse is caring for an older adult client who has a prescription for zolpidem at bedtime to promote sleep. The nurse should plan to monitor the client for which of the following adverse effects?

Dizziness Zolpidem can cause dizziness and daytime drowsiness. It can cause confusion in the older adult client.

A nurse is providing discharge teaching to a client who has a new prescription for metoprolol. Which of the following instructions should the nurse include? (Select all that apply)

Don't stop taking this medication abruptly. Count your radial pulse daily. Change positions slowly. Clients who stop taking metoprolol abruptly increase their risk of angina, hypertension, and MI. They should reduce the dosage gradually over 1 to 2 weeks. Clients should count the radial pulse daily and report a heart rate slower than 60/min. Metoprolol can cause orthostatic hypotension; to prevent injury, the client should move slowly from lying down or sitting to standing.

A nurse is teaching a newly licensed nurse about caring for a client who is receiving patient-controlled analgesia (PCA). Which of the following actions by the newly licensed nurse indicates an understanding of the teaching?

Having a second nurse check the PCA setting The nurse should have a second nurse check the PCA settings to ensure the correct amount of medication is being administered to the client.

A nurse is caring for a client who has schizophrenia and a prescription for chlorpromazine. For which of the following adverse effects should the nurse monitor?

Orthostatic hypotension Orthostatic hypotension is an adverse effect of chlorpromazine. Other adverse effects include palpitations, tachycardia, constipation, sedation, and photosensitivity

A nurse is caring for a client who was brought to the emergency department by friends after a reported heroin overdose. Which of the following findings should the nurse expect to assess?

Pinpoint pupils Pinpoint pupils are an expected finding in opioid toxicity. Increased pupil size is seen in opioid withdrawal.

A nurse is preparing to administer medications to a client who is NPO and is receiving enteral feedings through an NG tube. Which of the following prescriptions should the nurse clarify with the provider?

Aspirin EC 325 mg per NG tube daily The nurse should clarify the prescription for aspirin EC 325 mg per NG tube daily, as enteric-coated tablets should not be crushed.

A nurse is preparing to administer an epinephrine IV bolus to a client. Which of the following should the nurse verify before initiating the IV medication?

Concentration of the formulation The nurse should verify the concentration of the formulation of the medication prior to admin. Epinephrine can be injected through several routes, and a solution prepared for use by a certain route can differ in concentration from others. Solutions intended for subcutaneous admin are generally concentrated, whereas solutions intended for intravenous use are dilute. If a solution prepared for subcutaneous admin is given intravenously, the result could be fatal because IV admin of concentrated epinephrine can overstimulate the heart and blood vessels, causing severe hypertension, cerebral hemorrhage, stroke, and death.

A nurse is reviewing the laboratory data for a client who has Alzheimer's disease and a new prescription from memantine. The nurse should identify that which of the following findings increases the client's risk for reduced clearance of the medication?

Creatinine clearance 35 mL/min Creatinine clearance is an estimate of the glomerular filtration rate (GFR) and the kidney's ability to filter waste. A creatinine clearance of 35 mL/min is below the expected reference range of 87 to 139 mL/min and indicates a moderate renal impairment. Memantine is excreted by the kidneys, and decreased clearance occurs with moderate renal impairment.

A nurse is reviewing the medical history of a client who has spasticity due to multiple sclerosis and a new prescription for tizanidine. Which of the following co-morbidities increases the client's risk of adverse effects while taking this medication?

Hepatitis Tizanidine can cause liver damage. This medication should be used with extreme caution in a client who has a preexisting impairment of hepatic function.

A nurse is monitoring a client who received diphenoxylate-atropine. Which of the following statements by the client should indicate to the nurse that the medication has been effective?

I have not had a bowel movement today. The nurse should identify that diphenoxylate-atropine is an opioid used to treat diarrhea. The therapeutic response of this medication is a decrease in the frequency of watery stools due to reduced motility of the intestinal lining.

A nurse is preparing a continuous IV infusion of erythromycin lactobionate for a client who has a Bordetella pertussis infection. Which of the following actions should the nurse take to minimize the risk of thrombophlebitis?

Infuse the medication slowly. The nurse should infuse erythromycin slowly to minimize the risk of thrombophlebitis, which is an inflammatory process resulting from the formation of a blood clot in a vein. These blood clots usually form in the legs.

A nurse is reviewing laboratory values for a client who reports fatigue and cold intolerance. The client has an increased thyroid-stimulating hormone (TSH) level and a decreased total T3 and T4 level. The nurse should anticipate a prescription for which of the following medications?

Levothyroxine Levothyroxine replaces thyroid hormone for a client who has hypothyroidism. Lab values for hypothyroidism include an increased TSH level and decreased total T3 and T4 levels. Clinical manifestations of hypothyroidism include fatigue, cold intolerance, and a decreased body temp and pulse.

A nurse is caring for a client with chronic obstructive pulmonary disease (COPD) who has been taking tiotropium. Which of the following client statements should indicate to the nurse that the client is experiencing an adverse effect of this medication?

My mouth feels dry all the time. The nurse should identify that dry mouth is a common adverse effect of this medication's anticholinergic effects. Tiotropium is a long-acting anticholinergic inhaled medication used for maintenance therapy for clients with COPD.

A nurse is teaching a client who is postmenopausal and has a prescription for alendronate. Which of the following statements should the nurse include in the teaching?

Take this medication on an empty stomach The nurse should instruct the client to avoid taking alendronate with food or liquids other than water because it can decrease absorption. The client should only take this medication with water 30 minutes before breakfast.

A nurse is caring for a client who is developing acute pulmonary edema and has a new prescription for furosemide 40 mg IV bolus. The nurse should plan to administer the medication using which of the following methods?

Undiluted administered over 2 min The nurse should plan to administer low-dose furosemide therapy (e.g. 40 mg undiluted via IV bolus) at a rate of 20 mg/min or a dose of 40 mg over 2 min

A nurse is caring for a client who has severe asthma and allergic rhinitis. The client is taking theophylline. Which of the following medications should the nurse identify as being incompatible with theophylline?

Zafirlukast The nurse should identify that zafirlukast is a leukotriene receptor antagonist prescribed for asthma maintenance. Concurrent use of zafirlukast along with theophylline suppresses the metabolism of theophylline, which can lead to toxicity. There, another medication should be used.

A nurse on a medical unit is preparing to administer alendronate 40 mg PO for an older client who has Paget's disease of the bone. Which of the following actions should be the nurse's priority?

Ambulate the client to a chair prior to administering the medication. The nurse should ambulate the client to a chair to ensure that the client is sitting upright before administering alendronate to prevent esophagitis from occurring. The client must also be able to sit or stand upright for 30 minutes after taking the medication.

A nurse is teaching a client who has diabetes mellitus about a new prescription for pioglitazone. Which of the following statements should the nurse include in the teaching?

This medication can be taken when using insulin. The client can take pioglitazone when using insulin because pioglitazone increases the cellular response to insulin, and insulin is needed in order for the medication to be effective.

A nurse is caring for a client who is receiving lidocaine for localized pain. The nurse should recognize that which of the following actions will help prevent systemic toxicity of this medication?

Applying the medication to intact skin Lidocaine applied to broken or irritated skin can increase the risk of systemic absorption.

A nurse is caring for a client who has a prescription for a QT interval medication. Which of the following conditions should the nurse identify as an adverse effect of this medication?

Bradycardia The nurse should identify that an adverse effect of a QT interval medication is bradycardia. This medication should be used with caution for clients who have hypotension or heart failure, older adult clients, or clients who have low potassium or magnesium levels.

A nurse is caring for a client who is receiving continuous cardiac monitoring. Which of the following medications should the nurse anticipate administering to treat atrial fibrillation?

Diltiazem Diltiazem, a calcium channel blocker, is used to slow the ventricular rate in atrial fibrillation or flutter. Diltiazem is also prescribed to treat hypertension, angina, and other supraventricular tachyarrhythmias.

A nurse is admitting a client who has atrial fibrillation with a heart rate of 155/min. The nurse should anticipate a prescription from the provider for which of the following medications?

Diltiazem The nurse should anticipate the provider to prescribe diltiazem for a client who is experiencing atrial fibrillation. Diltiazem is an anti-arrhythmic agent that reduces the ventricular rate in A-fib.

A nurse is caring for a client who takes scheduled morphine for cancer pain. The client reports experiencing breakthrough pain. The nurse should anticipate a prescription from the provider for which of the following medications to treat breakthrough pain?

Fentanyl The nurse should expect a prescription for fentanyl transmucosal (nasal spray) to treat breakthrough pain. Fentanyl is an opioid agonist with a rapid onset and a duration of 2 to 4 hours. Fentanyl should not interfere with the client's long-term opioid medication but should relieve breakthrough pain.

A nurse is performing a preoperative assessment of a client who is about to undergo an aneurysm clipping. The nurse should identify a risk for increased bleeding when the client reports taking which of the following dietary supplements?

Garlic Many dietary supplements can affect clotting or interact with other medications that affect clotting, thereby increasing the client's risk of bleeding. Examples include garlic, ginger, and ginkgo blob. The nurse should notify the provider immediately about this potential risk.

A nurse is teaching a client who has a new diagnosis of angina and has a prescription for isosorbide mononitrate 10 mg PO twice daily. Which of the following client statements indicates an understanding of the teaching?

I should change positions slowly when getting out of bed. The nurse should identify that isosorbide mononitrate is an anti-anginal medication that produces vasodilation. Therefore, this medication can cause orthostatic hypotension. Clients should change position slowly upon rising to minimize the effects of orthostatic hypotension.

A nurse is teaching a client who has systemic lupus erythematosus about a new prescription for oral glucocorticoid therapy. Which of the following client statements indicates an understanding of the teaching?

I should take a calcium supplement while on this medication. An adverse effect of systemic glucocorticoid therapy is osteoporosis. Increasing calcium-rich foods in the diet and adding calcium and vitamin D supplements should be encouraged to prevent osteoporosis and decrease risk of fractures.

A nurse is teaching a client who has a new prescription for sucralfate for a duodenal ulcer. Which of the following client statements indicates an understanding of the teaching?

I should wait at least 30 minutes before taking this medication after I take an antacid The nurse should recognize that antacids can raise the gastric pH above 4, which can interfere with sucralfate. To minimize these interactions, sucralfate should be taken at least 30 minutes apart from antacids.

A nurse is providing discharge teaching to a client who has heart failure and a prescription for digoxin 0.125 mg PO daily and furosemide 20 mg PO daily. Which of the following statements by the client indicates an understanding of the teaching?

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

A nurse is reviewing the medical record for a client who has a migraine and a prescription for sumatriptan. Which of the following factors in the client's medical history should the nurse identify as a contraindication to receiving sumatriptan?

Ischemic heart disease The nurse should identify that ischemic heart disease is a contraindication to receiving sumatriptan. Sumatriptan is a serotonin receptor agonist that can cause vasoconstriction and coronary vasospasm. This medication is also contraindicated in clients who have MI or coronary artery disease, uncontrolled hypertension, or other types of heart disease.

A nurse is providing teaching to a client who has ulcerative colitis and a new prescription for sulfasalazine. The nurse should instruct the client to monitor for which of the following adverse effects of this medication?

Jaundice Sulfasalazine can cause yellow discoloration of the skin and yellow/orange discoloration of the urine. The nurse should instruct the client to notify the provider if these occur.

A nurse is reviewing the medication administration record of a client who has impaired swallowing. The nurse should crush the medication when administering which of the following prescriptions?

Levothyroxine 75 mcg PO q AM before breakfast Levothyroxine can be crushed because it is not extended-release, sublingual, or enteric-coated. If crushed, the medication should be mixed with 5 to 10 mL of water.

A nurse is teaching a client about the use of dinoprostone vaginal insert pouch to stimulate labor. Which of the following statements should the nurse include in the teaching?

Lie on your back for at least 2 hours without getting up. The client should remain supine for at least 2 hours after the dinoprostone vaginal pouch is inserted to allow a slow release of the medication from the pouch to stimulate labor.

A nurse is teaching a client who has a prescription for chenodiol for the treatment of gallstones. Which of the following client statements indicates an understanding of the teaching?

Liver function tests are required while taking this medication. The nurse should identify that chenodiol is hepatotoxic and can injure the liver. Periodic liver function tests are required during treatment. This medication is contraindicated in clients who have a pre-existing liver condition.

A nurse is assessing a client who is taking varenicline for smoking cessation. Which of the following findings in the nurse's priority?

Mood changes The nurse should apply the safety and risk-reduction priority-setting framework, which assigns priority to the factor or situation posing the greatest safety risk to the client. When there are several risks to client safety, the one posing the greatest threat is the highest priority. The nurse should use Maslow's hierarchy of needs, the ABC priority-setting framework, and/or nursing knowledge to identify which risk poses the greatest threat to the client. The greatest risk to the client is the development of neuropsychiatric effects that can progress to depression and suicide. Therefore, the highest priority is a change in the client's mood.

A nurse is caring for a client who has been in the PACU for more than 1 hour, has a respiratory rate of 9/min, and is difficult to arouse. The nurse should expect a prescription for which of the following medications?

Naloxone The nurse should expect a prescription for naloxone. This medication displaces opiate medications from receptor sites, reversing the respiratory depression, sedation, and analgesia that opiates cause.

A nurse is admitting a client who has unstable angina. Which of the following medications should the nurse anticipate administering to the client?

Nitroglycerin The nurse should anticipate giving nitroglycerin to a client who has unstable angina. This medication acts by relaxing or preventing spasms in the coronary arteries along with dilating the arteries, which increases oxygenation and blood flow.

A hospice nurse is caring for a client who has cancer and is taking naproxen 250 mg 3 times daily PO and gabapentin 1,800 mg 3 times daily PO to manage pain. The client tells the nurse, "I'm having pain that keeps me from doing what I'd like most of the time." Which of the following additions should the nurse anticipate to the client's medication regimen?

Oral oxycodone The client's current pain regimen consists of a non-opioid analgesic (naproxen) and an adjuvant medication for neuropathic pain (gabapentin). According to the WHO analgesic ladder for cancer pain management, the next addition to the pain regimen is an opioid for moderate pain. Oxycodone is an oral opioid that relieves moderate to moderately severe pain; therefore, it is an appropriate choice to add to the client's pain regimen.

A nurse is teaching a client who has chronic stable angina pectoris and a prescription for sublingual nitroglycerin tablets. What sequence of instructions should the nurse tell the client to use if he experiences chest pain?

Stop activity Place tablet under the tongue Wait 5 min Call 911 if the pain is not relieved

A nurse is providing teaching for a client who has received a liver transplant and has a prescription to transition from cyclosporine to tacrolimus. Which of the following instructions should the nurse include in the teaching?

Stop taking the cyclosporine for 24 hr and then begin taking the tacrolimus. The nurse should instruct the client that these medications should not be taken concurrently due to the increased risk of developing nephrotoxicity. The client should stop cyclosporine for 24 hours prior to beginning the tacrolimus prescription.

A nurse is caring for a client who is experiencing acute pain and is receiving morphine. Which of the following findings should indicate to the nurse the need to withhold the client's next dose of morphine?

The client's respiratory rate is 10/min The nurse should identify that morphine can cause respiratory depression. Therefore, if the client's respiratory rate is less than 12/min, the nurse should withhold the next dose of morphine and notify the provider.

A nurse is teaching the guardian of an infant about the diphtheria, tetanus, and pertussis (DTaP) vaccine. Which of the following pieces of information should the nurse include in the teaching?

The first immunization for DTaP in the series is given at 2 months. The nurse should tell the guardian that the first immunization is given at 2 months, with the rest of the vaccinations occurring at 4 months, 6 months, 15 to 18 months, and 4 to 6 years of age.

A nurse is teaching a client who is experiencing age-related vaginal atrophy and has a prescription for estradiol cream. Which of the following statements should the nurse include in the teaching?

This medication has fewer systemic effects than oral estrogen. The nurse should instruct the client that intravaginal estradiol cream has fewer systemic side effects because it is applied topically.

A nurse is planning discharge teaching for a client who has major depressive disorder and a new prescription for phenelzine. Which of the following foods should the nurse include in the plan as safe for the client to consume while taking phenelzine?

Broiled beef steak Phenelzine, an MAOI, is an antidepressant. This medication interacts with a variety of foods to produce a hypertensive crisis. Beef steak and other meats that are fresh do not interact with phenelzine and are safe to consume.

A nurse is caring for an older adult client who has a new prescription for amitriptyline to treat depression. Which of the following diagnostic tests should the nurse plan to perform prior to starting the client on this medication?

Electrocardiogram Amitriptyline can cause tachycardia and ECG changes. An older adult client is at risk for cardiovascular effects while using amitriptyline; therefore, an ECG should be performed prior to the start of therapy to obtain a baseline of the client's cardiovascular status.

A nurse is caring for a client who has osteoporosis and has been taking vitamin D supplement. The nurse notes that the client reports also taking a multivitamin daily. Which of the following findings should indicate to the nurse that the client might be experiencing vitamin D toxicity?

Hypercalcemia The nurse should identify that vitamin D increases plasma calcium levels by increasing reabsorption from bone, decreasing excretion by the kidneys and increasing absorption from the intestines. Clients who take a vitamin D supplement along with a multivitamin daily might be taking too much calcium.

A nurse is educating a client with urethritis who has a new prescription for oral erythromycin. Which of the following statements should the nurse include in the teaching?

Report persistent diarrhea to the provider. Although gastrointestinal disturbances are the most common adverse effects of erythromycin, clients should report persistent or severe gastrointestinal reactions to the provider. Erythromycin can cause superinfection of the bowel because it destroys some sensitive flora in the GI system.

A nurse is teaching a client who has asthma and a prescription for a fluticasone dry powder inhaler (DPI). Which of the following instructions should the nurse include in the teaching?

Rinse your mouth after administering this medication The nurse should include in the teaching that this medication is an oral corticosteroid. Oral corticosteroids increase the risk of the development of oral candidiasis, also known as thrush. In order to prevent this effect, the nurse should advise the client to rinse the mouth after admin of this medication.

A nurse is caring for a client who has cystic fibrosis (CF) and has a prescription for high-dose ibuprofen daily. The nurse should identify that which of the following is an expected outcome for the client receiving this medication?

Slowed progression of pulmonary damage The nurse should identify that clients who have CF are prescribed high-dose ibuprofen, an NSAID, to slow the progression of pulmonary damage by suppressing the inflammatory response that causes pulmonary damage. CF is a genetic disorder that primarily affect the lungs, pancreas, and sweat glands.

A nurse is caring for a school-aged child who has cystic fibrosis (CF) and has been using a corticosteroid inhaler for long-term treatment. Which of the following findings should the nurse identify as an adverse effect of long-term use of this medication?

Small stature for age The nurse should identify that an adverse effect of the long-term use of inhaled glucocorticoids can be a slowing in the rate of growth in children.

A nurse is teaching a client who has a new prescription for phenytoin. The nurse should inform the client that which of the following adverse effects can occur with the abrupt withdrawal of phenytoin?

Status epilepticus

A nurse is preparing to administer 100 units of insulin glargine and 4 units of NPH insulin subcutaneously to a client. Which of the following actions should the nurse plan to take?

Use separate syringes for administering insulin glargine and NPH insulin. The nurse should not mix insulin glargine with any other insulin. The nurse should administer the NPH insulin and insulin glargine separately.

A nurse is teaching about taking donepezil with a client who was recently diagnosed with early Alzheimer's disease. Which of the following instructions should the nurse include in the teaching?

You should take this medication late in the evening. The nurse should instruct the client to take donepezil late in the evening, just before bed.