Dynamic Quizzes for Pharm

A nurse is providing teaching to a client who has a new prescription for doxycycline. The nurse should instruct the client to monitor for which of the following adverse effects. a. Photosensitivity b. Constipation c. Ototoxicity d. Blurred Vision

Ans: A. An adverse effect of doxycycline, a tetracycline antibiotic, is photosensitivity. This makes skin react abnormally to light. Especially UV radiation or sunlight. Prevention involves avoiding direct exposure to sunlight and UV light, wearing a protective clothing outdoors, and using sunscreen. Doxycycline is more likely to cause diarrhea than constipation. Ototoxicity is an adverse effect of aminoglycosides. Doxycycline is a tetracycline antibiotic. Doxycycline is more likely to interfere with color vision than visual acuity.

A nurse is providing teaching to a female client who has a new prescription for pravastatin to treat hyperlipidemia. Which f the following pieces of information should the nurse include in the teaching? a. Pravastatin can be taken with grapefruit juice. b. Pravastatin can be continued during pregnancy. c. Pravastatin should be taken with morning meal. d. Laboratory testing to monitor to the clients WBC count is required.

Ans: A. Pravastatin, unlike other statins such as lovastatin, simvastatin and atorvastatin. Pravastatin does not affect WBC count.

A nurse is teaching a client who is about to start taking propylthiouracil to treat hyperthyroidism. Which of the following statements should the nurse identify as an indication that the teaching has been effective? a. "I will need laboratory tests to check my liver function." b. "I should take this medication once daily." c. "If I get a rash, I am probably having an allergic reaction." d. "If I have difficulty sleeping, its probably because of this medication."

Ans: A. Propylthiouracil is a hepatotoxic and can cause severe liver injury. The nurse should instruct the client to report dark urine and yellowing of the eyes, which can indicate injury to the liver. During initial treatment patient will have to take propylthiouracil multiple times each day. A rash is the most common adverse reaction to propylthiouracil. Propylthiouracil will cause drowsiness.

A nurse is preparing to administer levothyroxine to a client who has hypothyroidism. The nurse should identify which of the following laboratory results as supporting the administration of this medication. a. Thyroid-stimulationg hormone (TSH) 8 microunits/mL b. Free triiodothyronine (T3) 300pg/dL c. Free thyroxine (T4) 7mcg/dL d. Thryoxine-binding globulin 2.3 mg/dL

Ans: A. The expected reference range for TSH is 0.3 to 5 microunits/ml. When a client has primary hypothyroidism, the TSH level becomes elevated in an attempt to normalize the thyroid gland's function. When the client has had a therapeutic response to treatment the TSH level returns to the expected reference range. T3 is a hormone the thyroid gland produces, used to diagnose hyperthyroidism. T4 is hormone produced in thyroid, it helps evaluate thyroid function, with primary hypothyroidism, the level of T4 decreases. Thyroxine-binding globulin is a thyroid hormone protein carrier that helps evaluate clients who have T3 and T4 outside of the expected range.

A nurse is preparing to administer hydromorphone IV infusion to a client for pain. Which of the following actions should the nurse take? a. Administer the medication over 4-5 min b. Place the client in high-Fowlers' position. c. Assess the client's pain level after administering the medication. d. Review the client's last set of vitals.

Ans: A. The nurse should administer the IV injection of this opioid medication over 4-5 minutes to prevent the adverse effects of the medication such as respiratory depression and cardiac arrest. Nurse should assess the client's pain level before administering the pain medication and then 30 min. to 1 hr after administering the medication. The nurse should obtain current set of vitals before administering. If they have a RR below 12/min, the BP is low, or the pulse differs greatly from the clients baseline then don't administer

A nurse is caring for a client who received naloxone for a suspected opioid overdose. Which of the following findings would the nurse identify as an adverse effect of this medication? a. Report of pain b. Respiratory rate 8/min c. Report numbness d. Report abdominal cramping and diarrhea

Ans: A. The nurse should identify that naloxone is used to reveres the effects of an opioid overdose administered for pain, sedation euphoria, and respiratory depression. Excess doses of naloxone can cause the return of pain but can improve the client's respiratory rate. Hypo/hypertension can happen, but numbness is not an adverse effect. Naloxone can cause nausea but not abdominal cramping and diarrhea.

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? a. Infuse the medication slowly b. Administer half of the dosage c. Initiate intermittent dosing. d. Initiate intermittent dosing

Ans: A. 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. Not in nurse's scope of practice to alter medication dosage. Infusing erythromycin in a dilute solution is an effective way to minimize the risk of thrombophlebitis. A continuous infusion of erythromycin is preferable to intermittent dosing, this will not minimize the risk of thrombophlebitis.

A nurse is reviewing the laboratory results for a client who has a prescription for filgrastim. An increase in which of the following values indicates a therapeutic effect of this medication a. Erythrocyte count b. Neutrophil count c. Lymphocyte count d. Thrombocyte count

Ans: B. Filgrastim increases neutrophil production. It is given to treat neutropenia and reduce the risk of infection in clients who are receiving chemotherapy for cancer or who have undergone bone marrow transplant. Filgrastim does not increase erythrocyte production and can cause anemia. Filgrastim does not increase lymphocytes or thrombocytes.

A nurse is reviewing the medical record of a client who has postmenopausal osteoporosis and a prescription for raloxifene. Which of the following findings in the client's medical record should the nurse identify as a contraindication to receiving this medication? a. Breast Cancer b. History of DVT c. Allergy to calcitonin d. Current diagnosis of cholecystitis.

Ans: B. The nurse should identify that a history of DVT is contraindication for receiving raloxifene because this medication can cause DVT in client who have a prior history. Therefore, the nurse should notify the provider of this finding and request an alternative medication prescription for the client. Raloxifene can be used to prevent and treat breast cancer so its not a contraindication. Raloxifene is prescribed as an alternative to calcitonin. Cholecystitis is not a contraindication to receiving raloxifene.

A nurse is teaching a client who has a new prescription for alosetron. Which of the following client statements indicates an understanding of the teaching? a. Nausea is common adverse effect of this medication b. I should contact my provider immediately if I experience constipation. c. If I do not respond to treatment at the lowest dosage, my provider may continue to increase the dosage at weekly intervals. d. Abdominal pain with diarrhea can indicate a serious complication.

Ans: B. The nurse should identify that constipation is an adverse effect of this medication and requires the provider to be notified. The provider may adjust the dose or withhold the medication and then instruct the client to resume taking it once the constipation has resolved. Nausea is not an adverse effect of this medication. Abdominal pain and diarrhea are primary manifestations of IBS-D, a decrease is considered therapeutic effect.

A nurse is reviewing the medical record of a client who has a prescription for a combination oral contraceptive. The nurse should identify findings that which of the following findings is a contraindication to receiving this medication? a. High cholesterol levels b. Liver disease c. Family history of ovarian cancer d. Client report of hypermenorrhea

Ans: B. The nurse should identify that liver disease or abnormal liver function is a contraindication to receiving a combination oral contraceptive. Therefore, the nurse should notify the client's provider. Other contraindications include thrombophlebitis or breast cancer. Cholesterol is not a contraindication. Combination oral contraceptives protect against ovarian cancer. Hypermenorrhea (excessive bleeding) is corrected with contraceptive.

A nurse is providing teaching for a client who has received 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? a. "Take both medications together for 72 hour and then stop taking cyclosporine." b. "Stop taking the cyclosporine for 24 hr and then begin taking tacrolimus." c. "Alternate taking the medications for 48 hr and then take only the tacrolimus." d. "If adverse reactions to the tacrolimus occur, stop taking it and restart the cyclosporine."

Ans: B. 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. Both of these medications should not be taken concurrently due to the increased risk of nephrotoxicity neither should they alternate between medications.

A nurse is providing teaching to a client who has a new prescription for fentanyl transdermal patch. Which of the following statements by the client indicates an understanding of the teaching? a. "The patch will not cause constipation like other pain medications do." b. "I will have to stop drinking grapefruit juice while using the patch." c. "I will place a heating pad over the patch to boost its effectiveness." d. "The patch will give me relief from my pain faster than pill can."

Ans: B. The nurse should instruct the client to avoid drinking grapefruit juice while using fentanyl transdermal patch. Grapefruit juice can increase the absorption of the medication, raising the amount of fentanyl in the client's blood. This can place the client at risk for CNS and respiratory depression. Using an opioid transdermal form does not prevent constipation from occurring. Client should avoid heat pad because it increases the absorption putting them at risk for overdose. It takes up to 24 hrs for a fentanyl patch to gain max effect.

A nurse is assessing a client who takes oral theophylline for chronic bronchitis relief. The nurse should recognize that which of the following findings indicates toxicity to theophylline? a. Constipation b. Tremors c. Fatigue d. Bradycardia

Ans: B. Theophylline is a xanthine-derivative bronchodilator. An early manifestation of toxicity is CNS stimulation, often seen as tremors. Seizures can occur if blood levels continue to rise. Diarrhea rather than constipation is a manifestation of theophylline toxicity. Theophylline is a CNS stimulant and it causes restlessness and irritability not fatigue. It also causes tachycardia not bradycardia.

A nurse is teaching a female client who has a new prescription for misoprostol to treat peptic ulcer disease. Which of the following client statements should indicate to the nurse that the teaching was effective? a. " I should avoid taking NSAIDS while using this medication." b. "Misoprostol is used to treat stress-induced gastric ulcers." c. "I should avoid becoming pregnant while taking this medication." d. "This medication is also used to treat dysmenorrhea."

Ans: C The nurse should identify that misoprostol is contraindicated during pregnancy and is classified as pregnancy risk category X by the FDA. It has potential to stimulate uterine contractions and use of misoprostol during pregnancy has been known to cause partial or complete expulsion of the developing fetus. Misoprostol is an analog of prostaglandin E. NSAID and aspirin can cause gastric ulcers by inhibiting prostaglandin synthesis. This makes misoprostol and ideal antiulcer medication for clients who frequently take NSAIDs. Misoprostol is approved to prevent gastric ulcers but not to treat them. Dysmenorrhea is the adverse effect of this medication.

A nurse is administering oral hydroxyzine to a client. Which of the following adverse effects should the nurse instruct the client to expect? a. Diarrhea b. Anxiety c. Nausea and vomiting. d. Dry mouth

Ans: D. Hydroxyzine has anticholinergic properties. Dry mouth is common adverse effect of this medication. The nurse should instruct the client to take sips of water or suck hard candies to minimize this effect. Diarrhea is not an expected adverse effect of hydroxyzine. Hydroxyzine is an H1 receptor antagonist and is sometime used to treat anxiety. Hydroxyzine has antiemetic properties thereby reducing the occurrent of nausea and vomiting. Hydroxyzine is an antihistamine that is used to treat anxiety, nausea, allergies, skin, rash hives and itching.

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. a. Dextromethorphan b. Montelukast c. Ciprofloxacin d. Propranolol

Ans: D. The nurse should identify that a client who is experiencing an acute asthma exacerbation requires the use of 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 prevent the action of beta2-agonists such as albuterol. Dextromethorphan is an over the counter cough suppressant not contraindication with clients with asthma. Montelukast is a leukotriene receptor blocker that is used as a prophylaxis for the maintenance of asthma. Ciprofloxacin is an antibiotic used to treat bacterial infections. This is not contraindicated with asthma patients.

A nurse in an acute care facility is preparing a reconciled list of medications for a client who is being discharged home. Which of te following actions should the nurse take? a. Give the client a handwritten medication list to the next care provider following discharge. b. Include a list of medications the client received during care at the facility. c. Inform the client that he can get a complete list of his medications from the provider who will be caring for him after discharge. d. Provide the client and the next care provider with a list of medications the client will take after discharge.

Ans: D. The nurse should provide a reconciled medication list that includes any medications the provider prescribes at the time of discharge for the client to take after discharge. The list should also include any other medications the client will be taking, including over the counter medications and supplements. If the client was taking other prescription medications before admission to the acute-care facility and did not receive them during treatment in the facility, the provider should confirm whether the client should resume taking them after discharge.

A nurse is assessing a client who has been taking simvastatin to treat hyperlipidemia. Which of the following statements by the client indicate and adverse effect of the medication that should be reported to the provider immediately. a. "I have had occasional constipation." b. "I have had some gas." c. "My head has been hurting for some days" d. "My legs feel weak and achy"

Ans: D. When using the urgent vs nonurgent approach to the client care, the nurse should determine that the priority finding is muscle pain and weakness. A serious adverse effect of this medication is muscle injury, which can progress to severe myositis. The client should report any unusual onset of muscle pain or tenderness's to the provider immediately. Constipation is an expected finding. Flatulence (gas) and headaches a an expected finding.

A nurse is caring for a client who is experiencing acute alcohol withdrawal. The nurse should expect to administer which of the following medications? a. Disulfiram b. Chlordiazepoxide c. Methadone d. Varenicline

a. Varenicline Ans: B. The nurse should expect to administer chlordiazepoxide to a client who is experiencing manifestations of acute alcohol withdrawal. Chlordiazepoxide is a benzodiazepine; this class of medications is often. Used to facilitate withdrawal. Chlordiazepoxide assists with decreasing withdrawal manifestations, stabilizing vital signs, and preventing seizures and delirium tremens. Disulfiram is used to maintain abstinence from alcohol but does not help a client who is experiencing acute alcohol withdrawal. Methadone is used for withdrawal of opioids. Varenicline is used to assist with smoking cessation, it promotes dopamine release, diminish nicotine cravings and intensity of nicotine withdrawal.