IM4 Pharmacology Assessment

The primary healthcare provider prescribed medications to four clients with osteoporosis. Which client is instructed to remain upright for 30 minutes after medication administration? A. Client A - Alendronate B. Client B - Zoledronic acid C. Client C - Calcium supplements D. Client D - Raloxifene

Correct Answer A Alendronate therapy may cause esophageal ulcers. Therefore the nurse instructs client A to remain upright for 30 minutes after medication administration to prevent esophageal ulcers. Standing upright for 30 minutes after medication administration will move the drug fast in the stomach. Client B who is prescribed zoledronic acid is instructed to have a dental examination before drug administration. Client C who is prescribed calcium supplements is advised to take a third of the daily dose at bedtime. Client D who is prescribed raloxifene is advised to have a liver function test done.

A client with type 1 diabetes self-administers NPH insulin every morning at 8 am. The nurse evaluates that the client understands the action of the insulin when the client identifies which time range as the highest risk for hypoglycemia? A. Noon to 8 pm B. 8 pm to noon C. 9 am to 10 am D. 10 am to 11 am

Correct Answer A The time of greatest risk for hypoglycemia occurs when the insulin is at its peak. The action of intermediate-acting insulins peaks in four to 12 hours. Nine to 10 am and 10 am to 11 am are too soon for NPH to produce a hypoglycemic response. NPH insulin will have produced a hypoglycemic response before 8 pm and noon. A hypoglycemic response that occurs in 45 to 60 minutes after administration is associated with rapid-acting insulins.

A nurse is providing instructions for a client who is receiving phenytoin but has limited access to health care. What side effect is the basis for the nurse's emphasis on meticulous oral hygiene? A. Hyperplasia of the gums B. Alkalinity of the oral secretions C. Irritation of the gingiva and destruction of tooth enamel D. Promotion of plaque and bacterial growth at the gum line

Correct Answer A Gingival hyperplasia is an adverse effect of long-term phenytoin therapy; incidence can be decreased by maintaining therapeutic blood levels and meticulous oral hygiene. Alkalinity is not related to phenytoin or to gingival hyperplasia caused by phenytoin. Irritation of the gingiva and destruction of tooth enamel are not direct effects of phenytoin. Plaque and bacterial growth at the gum line are unrelated to phenytoin or to hyperplasia caused by it.

A nurse is caring for a client who is receiving serum albumin. What indicates that the albumin is effective? A. Improved clotting of blood B. Formation of red blood cells C. Activation of white blood cells (WBCs) D. Effective cardiac output

Correct Answer D Serum albumin, a protein, establishes the plasma colloid osmotic (oncotic) pressure because of its high molecular weight and size. Indicators of adequate osmotic pressure include an effective cardiac output. Blood clotting involves blood protein fractions other than albumin; for example, prothrombin and fibrinogen are within the alpha- and beta-globulin fractions. Red blood cell formation (erythropoiesis) occurs in red marrow and can be related to albumin only indirectly; albumin is the blood transport protein for thyroxine, which stimulates metabolism in all cells, including those in red bone marrow. Albumin does not activate WBCs; WBCs are activated by antigens and substances released from damaged or diseased cells.

The nurse is preparing to administer a subcutaneous dose of 15 units of lispro insulin to a client. Choose the proper syringe for this injection.

An insulin syringe, marked in units, is the only appropriate syringe for administering an insulin injection. The 1-mL syringe is a tuberculin syringe. Tuberculin syringes, the 3-mL, and 5-mL syringes, are not appropriate for insulin injections because they are not measured in units.

A client has been taking levothyroxine for hypothyroidism for 3 months. The nurse suspects that a decrease in dosage is needed when the client exhibits which clinical manifestations? Select all that apply. A. Tremors B. Bradycardia C. Somnolence D. Heat intolerance E. Decreased blood pressure

Correct Answer A, D

A client develops a fever after surgery. Ceftriaxone is prescribed. For which potential adverse effect should the nurse monitor the client? A. Dehydration B. Heart failure C. Constipation D. Allergic response

Correct Answer D Rash, urticaria, pruritus, angioedema, and other signs and symptoms of an allergic response may occur a few days after therapy is instituted. Ceftriaxone does not cause dehydration, does not affect the heart, and may cause diarrhea, not constipation.

A client is receiving metoprolol. Which side effect should the nurse teach the client to expect? A. Dizziness with strenuous activity B. Acceleration of the heart rate after eating a heavy meal C. Flushing sensations for a few minutes after taking the drug D. Pounding of the heart for a few minutes after taking the drug

Correct Answer A Because metoprolol competes with catecholamines at beta-adrenergic receptor sites, the expected increase in the heart's rate and contractility in response to exercise does not occur. This, combined with the drug's hypotensive effect, may lead to dizziness. Metoprolol decreases the heart rate. Flushing sensations and pounding of the heart do not represent side effects of metoprolol.

A healthcare provider prescribes an antibiotic intravenous piggyback twice a day for a client with an infection. The healthcare provider prescribes peak and trough levels 48 and 72 hours after initiation of the therapy. The client asks the nurse why there is a need for so many blood tests. What reason does the nurse provide? A. "They determine adequate dosage levels of the drug." B. "They detect if you are having an allergic reaction to the drug." C. "The tests permit blood culture specimens to be obtained when the drug is at its lowest level." D. "These allow comparison of your fever to when the blood level of the antibiotic is at its highest."

Correct Answer A Drug dose and frequency are adjusted according to peak and trough levels to enhance efficacy by maintaining therapeutic levels. Peak and trough levels reveal nothing about allergic reactions. Blood cultures are obtained when the client spikes a temperature; they are not related to peak and trough levels of an antibiotic. A sustained decrease in fever is the desired outcome, not reduction just at peak serum levels of the medication.

A client newly diagnosed with type 2 diabetes is receiving glyburide and asks the nurse how this drug works. What mechanism of action does the nurse provide? A. Stimulates the pancreas to produce insulin B. Accelerates the liver's release of stored glycogen C. Increases glucose transport across the cell membrane D. Lowers blood glucose in the absence of pancreatic function

Correct Answer A Glyburide, an antidiabetic sulfonylurea, stimulates insulin production by the beta cells of the pancreas. Accelerating the liver's release of stored glycogen occurs when serum glucose drops below normal levels. Increasing glucose transport across the cell membrane occurs in the presence of insulin and potassium. Antidiabetic medications of the chemical class of biguanide improve sensitivity of peripheral tissue to insulin, which ultimately increases glucose transport into cells. Beta cells must have some function to enable this drug to be effective.

What is the mechanism of action of penicillin? A. Prevents reproduction of the pathogen B. Inhibits cell wall synthesis of the pathogen C. Inhibits nucleic acid synthesis of the pathogen D. Injures the cytoplasmic membrane of the pathogen

Correct Answer B Penicillin is an antimicrobial medication that inhibits cell wall synthesis of the susceptible pathogen. Gentamicin is an antimicrobial medication that prevents the reproduction of the susceptible pathogen. Actinomycin is an antimicrobial medication that inhibits nucleic acid synthesis of the susceptible pathogen. Antifungal agents injure the cytoplasmic membrane of the susceptible pathogen.

What is the priority nursing care for a client who is prescribed hydroxychloroquine (Plaquenil)? A. Teaching the client to report blurred vision B. Teaching the client to report signs of infection C. Teaching the client to report shortness of breath D. Teaching the client to report stomach discomfort

Correct Answer A Plaquenil is a hydroxychloroquine used to treat rheumatoid arthritis. The adverse effect of Plaquenil is retinal damage; therefore, a client on Plaquenil is taught to report blurred vision. A client on steroids is taught to report signs of infection. A client on infliximab is taught to report shortness of breath. Plaquenil causes mild stomach discomfort, which is normal and is not related to priority nursing care.

A client with rheumatoid arthritis has been taking a steroid medication for the past year. For which complication of prolonged use of this medication should the nurse assess the client? A. Decreased white blood cells B. Increased C-reactive protein C. Increased sedimentation rate D. Decreased serum glucose levels

Correct Answer A Prolonged use of steroids may cause leukopenia as a result of bone marrow depression. C-reactive protein and sedimentation rate are elevated in acute inflammatory diseases; steroids help decrease it. Serum glucose levels increase with steroid use.

A nurse is caring for an older adult who is taking acetaminophen for the relief of chronic pain. Which substance is most important for the nurse to determine if the client is taking because it intensifies the most serious adverse effect of acetaminophen? A. Alcohol B. Caffeine C. Saw palmetto D. St. John's wort

Correct Answer A Too much ingestion of alcohol can cause scarring and fibrosis of the liver. Eighty-five percent to 95% of acetaminophen is metabolized by the liver. Acetaminophen and alcohol are both hepatotoxic substances. Metabolites of acetaminophen, along with alcohol, can cause irreversible liver damage. Caffeine stimulates the cardiovascular system, not the liver. In addition, caffeine does not interact with acetaminophen. Saw palmetto is not associated with increased liver damage when taking acetaminophen. It often is taken for benign prostatic hypertrophy because of its antiinflammatory and antiproliferative properties in prostate tissue. St. John's wort is classified as an antidepressant and is not associated with increased liver damage when taking acetaminophen. However, it does decrease the effectiveness of acetaminophen.

Which is a leukotriene modifier used to manage and prevent allergic rhinitis? A. Zileuton B. Ephedrine C. Scopolamine D. Cromolyn sodium

Correct Answer A Zileuton is a leukotriene modifier used to manage and prevent allergic rhinitis. Ephedrine is an ingredient in decongestants used to treat allergic rhinitis. Scopolamine is an anticholinergic used to reduce secretions. Cromolyn sodium is a mast cell stabilizing drug used to prevent mast cell membranes from opening when an allergen binds to IgE.

A client who has been taking spironolactone is admitted to the hospital with hypokalemia. The nurse will assess the client for which clinical findings? Select all that apply. A. Lethargy B. Thready, weak pulse C. Muscle weakness D. Hyperactive deep tendon reflexes E. Numbness and tingling of the hands and feet

Correct Answer A, B, C Altered mental status, including lethargy, occurs with hypokalemia; a thready, weak pulse occurs in hypokalemia because of an impaired conduction system in the cardiac muscle. Muscular weakness may occur with hypokalemia because impulse conduction of skeletal muscles is impaired. An adequate level of potassium is necessary for effective functioning of the sodium-potassium pump. Hyperactive reflexes and numbness and tingling of the hands and feet indicate hyperkalemia, not hypokalemia.

Sildenafil is prescribed for a man with erectile dysfunction. A nurse teaches the client about common side effects of this drug, which include what? Select all that apply. A. Flushing B. Headache C. Dyspepsia D. Constipation E. Hypertension

Correct Answer A, B, C Flushing is a common central nervous system response to sildenafil. Headache is a common central nervous system response to sildenafil. Dyspepsia is a common gastrointestinal response to sildenafil. Diarrhea, not constipation, is a common gastrointestinal response to sildenafil. Hypotension, not hypertension, is a cardiovascular response to sildenafil. It should not be taken with antihypertensives and nitrates because drug interactions can precipitate cardiovascular collapse.

Pharmacokinetic factors determine the concentration of a drug at its site of action. These are different in neonates and infants than they are in small children or adults. Arrange the factors in the order in which they occur. A. Absorption B. Distribution C. Metabolism D. Excretion

Correct Answer A, B, C, D The first step after administering the drug through any route is absorption. For instance, orally administered drugs are generally absorbed in the gastrointestinal tract. After absorption, drugs may be distributed through protein binding, or some may enter the central nervous system through the blood-brain barrier. Most drugs are then metabolized in the liver; this capacity is low in newborns. Drugs do not remain in the body indefinitely; rather they are excreted by the kidneys.

The primary healthcare provider has prescribed rifampin to a client with tuberculosis. Which instructions by the nurse will be beneficial to the client? Select all that apply. A. "You should report any yellow tinge to your skin." B. "Your soft contact lenses will be stained permanently." C. "You should report any reddish orange tinge to your secretions." D. "You need to drink at least 8 ounces of water with the medication." E. "You should report any increased tendency to bruising or bleeding."

Correct Answer A, B, E Rifampin is a first-line drug in the treatment of tuberculosis and clients should report any yellow tinge to the skin because this may be a sign of liver toxicity or failure. Staining of bodily fluids such as tears, urine, and sweat, is commonly associated with rifampin, so warning the client that contact lenses will be stained will be beneficial. The client should be instructed to immediately report any increased tendency to bruising or bleeding because this may indicate liver toxicity or damage. The need to drink at least 8 ounces of water with the medication is beneficial information for a client prescribed pyrazinamide. A reddish orange tinge to secretions is common with rifampin and not harmful, so it need not be reported.

A client complains of fatigue, hair loss, and weight gain. On assessment, the client is found to have anemia. Which therapy does the nurse anticipate in the client's prescription? A. Iodine B. Methimazole C. Levothyroxine D. Propylthiouracil

Correct Answer C Fatigue, hair loss, weight gain, and anemia are the clinical manifestations of hypothyroidism, which occurs due to deficiency of thyroid hormones. Treatment includes restoration of euthyroid state by hormone therapy, such as levothyroxine. Iodine is used to prepare the client for thyroidectomy to treat thyrotoxicosis. Methimazole and propylthiouracil inhibit the synthesis of thyroid hormones and are used to treat hyperthyroidism.

A client with psoriasis is prescribed corticosteroids. What should be taught to the client for a positive outcome? Select all that apply. A. "Apply the drug directly to the skin." B. "Stop the drug when symptoms subside." C. "Apply the drug using warm or moist dressings." D. "Apply the drug for shorter periods to each lesion." E. "Prevent the drug from coming into contact with uninvolved skin."

Correct Answer A, C Corticosteroids should be applied directly to the skin using warm or moist dressings to enhance the action of the drug. The drug should not be discontinued even if the symptoms subside, as abruptly stopping the drug may cause adverse effects. Anthralin should be applied for shorter periods to each lesion while avoiding coming into contact with uninvolved skin to prevent chemical burns.

A client is prescribed albuterol to relieve severe asthma. What adverse effect will the nurse instruct the client to anticipate? Select all that apply. A. Tremors B. Lethargy C. Palpitations D. Visual disturbances E. Decreased pulse rate

Correct Answer A, C Albuterol's sympathomimetic effect causes central nervous stimulation, precipitating tremors, restlessness, and anxiety. Albuterol's sympathomimetic effect causes cardiac stimulation that may result in tachycardia and palpitations. Albuterol may cause restlessness, irritability, and tremors, not lethargy. Albuterol may cause dizziness, not visual disturbances. Albuterol will cause tachycardia, not bradycardia.

A client is scheduled to receive an intravenous (IV) infusion of potassium chloride (KCl) 40 mEq in 100 mL of 5% dextrose and water to be infused over 2 hours. Before administering this IV medication, it is a priority for the nurse to assess which of the following? Select all that apply. A. Urinary output B. Deep tendon reflexes C. Last bowel movement D. Arterial blood gas results E. Last serum potassium level F. Patency of the intravenous access

Correct Answer A, E, F Before administering IV potassium, the urinary output must be normal. If the urine output is low, a potassium infusion may damage renal cells. The last serum potassium level should also be checked to ensure potassium replacement is appropriate. A patent IV access is essential because potassium is very irritating and painful to subcutaneous tissue. The infusion of KCL 40 mEq in 100 mL of 5% dextrose and water has no direct effect on deep tendon reflexes, bowel movement patterns, or arterial blood gases. Therefore these items are not required to be assessed before administration of this medication.

A 60-year-old client with gastric cancer has a shiny tongue, paresthesias of the limbs, and ataxia. The laboratory results show cobalamin levels of 125 pg/mL. Which medication would the nurse consider to be a high priority for the client? A. Oral hydroxyurea B. Vitamin B12 injections C. Oral iron supplements D. Erythropoietin injections

Correct Answer B A shiny tongue, paresthesias of the limbs, ataxia, and cobalamin of 125 pg/mL (normal: 200- 835 pg/mL) are the manifestations of pernicious anemia. The client has pernicious anemia due to a vitamin B12 deficiency and should be given vitamin B12 injections. Vitamin B12 cannot be given orally to a client with pernicious anemia because the client does not produce the intrinsic factors needed to absorb Vitamin B12. Hydroxyurea is administered orally to clients with hemochromatosis. Oral iron supplements are given to clients with iron deficiency anemia. Erythropoietin injections are given to clients who have low red blood cells, hemoglobin, and hematocrit.

A client who had a tonic-clonic seizure of unknown etiology is to begin taking phenytoin. What instructions will the nurse give to the client? A. Take the medication on an empty stomach. B. Brush the teeth and gums three times daily. C. Stop taking the drug if abdominal pain occurs. D. Note any change in pulse and respiratory rates.

Correct Answer B Adequate dental hygiene is essential to control or prevent the common side effect of hypertrophy of the gums. The medication should be taken with food or milk to decrease gastrointestinal side effects. The healthcare provider should be consulted before the drug is discontinued or the dosage is adjusted; usually in this situation, a gradual dosage reduction is prescribed. Changes in pulse and respiratory rates are unrelated to phenytoin therapy.

A nurse administers beclomethasone by inhalation to a client with asthma, and the client asks why this medication is necessary. What should the nurse explain is the purpose of this pharmacologic therapy? A. Promotes comfort B. Decreases inflammation C. Stimulates smooth muscle relaxation D. Reduces bacteria in the respiratory tract

Correct Answer B Beclomethasone reduces the inflammatory response in bronchial walls by suppression of polymorphonuclear leukocytes and fibroblasts and the reversal of capillary permeability. Beclomethasone does not directly promote comfort. Beclomethasone does not stimulate smooth muscle relaxation. Beclomethasone is not an antibiotic.

A healthcare provider prescribes bed rest, loperamide, and esomeprazole for a client who just had major surgery. After several days of this regimen, the client complains of diarrhea. Which treatment strategy does the nurse conclude is the most likely cause of the diarrhea? A. Loperamide B. Esomeprazole C. Bed rest D. Diet alteration

Correct Answer B Esomeprazole, a proton pump inhibitor, may cause diarrhea related to a higher risk for Clostridium difficile intestinal infection. Loperamide, an antidiarrheal, may cause constipation, not diarrhea. Immobility causes constipation, not diarrhea. Although diet can affect elimination, no data are presented to support this conclusion.

A client with hypertensive heart disease, who had an acute episode of heart failure, is to be discharged on a regimen of metoprolol and digoxin. What outcome does the nurse anticipate when metoprolol is administered with digoxin? A. Headaches B. Bradycardia C. Hypertension D. Junctional tachycardia

Correct Answer B Metoprolol and digoxin both exert a negative chronotropic effect, resulting in a decreased heart rate. Metoprolol reduces, not produces, headaches. These drugs may cause hypotension, not hypertension. These drugs may depress nodal conduction; therefore, junctional tachycardia would be less likely to occur.

The nurse finds the respiratory rate is 8 breaths per minute in a client who is on intravenous morphine sulfate. What should the nurse do immediately in this situation? A. Measure other vital signs. B. Stop administering the medication. C. Elevate the head of the client's bed. D. Report to the primary healthcare provider.

Correct Answer B Morphine sulfate is an opioid analgesic and can depress the central nervous system, which results in respiratory depression. A respiratory rate of 8 breaths per minute indicates respiratory depression, and the nurse should stop the medication immediately. The nurse can measure the other vital signs after discontinuing the medication administration. Elevating the head of the client's bed ensures proper breathing. Therefore the nurse should elevate the client's bed after discontinuing the medication. The nurse should report to the primary healthcare provider for an appropriate antidote after stopping the medication administration.

Which information should be included in the teaching plan for the elderly client with peptic ulcer disease who is taking an antacid and sucralfate? A. Antacids should be taken 30 minutes before a meal. B. Sucralfate should be taken on an empty stomach one hour before meals. C. Sucralfate is prescribed for the long-term maintenance of peptic ulcer disease. D. Sodium bicarbonate is an inexpensive over-the-counter antacid with few adverse effects.

Correct Answer B Sucralfate works best in a low pH environment; therefore it should be given on an empty stomach either one hour before or two hours after meals. Sucralfate also should be administered no sooner than 30 minutes before or after an antacid. The acid-neutralizing effects of antacids last approximately 30 minutes when taken on an empty stomach and 3 to 4 hours when taken after meals. When sucralfate and an antacid are both prescribed, they are each most effective when the sucralfate is scheduled an hour before meals and the antacid is scheduled after meals. Sucralfate is prescribed for the short-term treatment of peptic ulcers. Its use is limited to 4 to 8 weeks. The client should follow the recommendations of the primary health care provider with regard to antacid selection. Sodium bicarbonate can produce acid-base imbalances which could be harmful, especially in elderly clients.

A client develops a maculopapular rash on the upper extremities and audible wheezing during the administration of intravenous vancomycin. To ensure the client's safety, which action would the nurse carry out first? A. Notify healthcare provider B. Stop infusion C. Decrease flow rate D. Reassess in 15 minutes

Correct Answer B The first action the nurse should take is to stop the infusion immediately. The client may be experiencing an allergic reaction. The nurse should stop the medication infusion and then notify the healthcare provider. Decreasing the flow rate is not an appropriate action. Infusions must be stopped if allergic reaction is suspected. This could be an emergent situation, so reassessing in 15 minutes is not the most appropriate action.

A client with arthritis is taking large doses of aspirin. What symptom does the nurse include when teaching the client about the clinical manifestations of aspirin toxicity? A. Feelings of drowsiness B. Disturbances in hearing C. Intermittent constipation D. Metallic taste in the mouth

Correct Answer B Ringing in the ears occurs because of its effect on the eighth cranial nerve and is a classic symptom of aspirin toxicity. Feelings of drowsiness are not side effects of aspirin; aspirin promotes comfort, which may permit rest. Aspirin may cause diarrhea, nausea, and vomiting, not intermittent constipation. A metallic taste in the mouth is not a side effect of salicylates such as aspirin.

What are the desired outcomes that the nurse expects when administering ibuprofen? Select all that apply. A. Diuresis B. Pain relief C. Antipyresis D. Bronchodilation E. Anticoagulation F. Reduced inflammation

Correct Answer B, C, F Prostaglandins accumulate at the site of an injury, causing pain; non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen inhibit COX-1 and COX-2 (both are isoforms of the enzyme cyclooxygenase), which inhibit the production of prostaglandins, thereby contributing to analgesia. NSAIDs inhibit COX-2, which is associated with fever, thereby causing antipyresis. NSAIDs inhibit COX-2, which is associated with inflammation, thereby reducing inflammation. NSAIDs do not cause diuresis; reversible renal ischemia and renal insufficiency in clients with heart failure, cirrhosis, or hypovolemia can be potential adverse effects of NSAIDs. NSAIDs do not cause bronchodilation. Anticoagulation is an adverse effect, not a desired outcome; NSAIDs can impair platelet function by inhibiting thromboxane, an aggregating agent, resulting in bleeding.

A client is receiving furosemide to help treat heart failure. Which laboratory result will cause the nurse to notify the primary healthcare provider? A. Hematocrit 46% B. Hemoglobin 14.1 g/dL (141 mmol/L) C. Potassium 3.0 mEq/L (3.0 mmol/L) D. White blood cell 9200/mm3 (9.2 × 109/L)

Correct Answer C A potassium level of 3.0 mEq/L (3.0 mmol/L) is indicative of hypokalemia. Normal values for an adult are 3.5 to 5.0 mEq/L (3.5 to 5.0 mmol/L). Potassium, calcium, and magnesium control the rate and force of heart contractions. Diuretics often are used to reduce fluid volume, so the heart does not work as hard. Furosemide is a potassium-losing diuretic. Hypokalemia can result in death from dysrhythmia; therefore this must be addressed. The hematocrit level of 46% is within the normal range. A hemoglobin of 14.1 (141 mmol/L) is within normal values. White blood cell level of 9200 cells/mm3is within the normal range of 4000 to 11,000 cells/mm3 (4 to 11 × 109/L).

A client with gastric ulcer disease asks the nurse why the health care provider has prescribed metronidazole. What purpose does the nurse provide? A. To augment the immune response B. To potentiate the effect of antacids C. To treat Helicobacter pylori infection D. To reduce hydrochloric acid secretion

Correct Answer C Approximately two thirds of clients with peptic ulcer disease are found to have Helicobacter pylori infecting the mucosa and interfering with its protective function. Antibiotics do not augment the immune response, potentiate the effect of antacids, or reduce hydrochloric acid secretion.

A nurse is preparing medications. Which client's health problem motivates the nurse to question a prescription for a beta blocker? A. Coronary artery disease B. Essential hypertension C. Acute heart failure D. Sinus tachycardia

Correct Answer C Beta blockers reduce cardiac output and must be started slowly, so they are contraindicated for clients with acute heart failure. Beta blockers are used to treat coronary artery disease because they decrease myocardial oxygen demand by reducing peripheral resistance and cardiac contractility. Beta blockers are used to treat essential hypertension because they cause vasodilation and decrease cardiac contractility. Beta blockers lower heart rate.

When obtaining a health history, the nurse is informed that a client has been taking digoxin. What therapeutic effect of digoxin does the nurse expect? A. Decreased cardiac output B. Decreased stroke volume of the heart C. Increased contractile force of the myocardium D. Increased electrical conduction through the atrioventricular (AV) node

Correct Answer C Digoxin produces a positive inotropic effect that increases the strength of myocardial contractions and thus cardiac output. The positive inotropic effect of digoxin increases, not decreases, cardiac output. Digoxin increases the strength of myocardial contractions (positive inotropic effect) and slows the heart rate (negative chronotropic effect); these effects increase the stroke volume of the heart. Digoxin decreases the refractory period of the AV node and decreases conduction through the sinoatrial (SA) and AV nodes.

A client is diagnosed with Parkinson disease and receives a prescription for levodopa therapy. What does the nurse identify as the drug's mechanism of action? A. Blocks the effects of acetylcholine B. Increases the production of dopamine C. Restores the dopamine levels in the brain D. Promotes the production of acetylcholine

Correct Answer C Levodopa is a precursor of dopamine, a catecholamine neurotransmitter; it increases dopamine levels in the brain that are depleted in Parkinson disease. Blocking the effects of acetylcholine is accomplished by anticholinergic drugs. Increasing the production of dopamine is ineffective because it is believed that the cells that produce dopamine have degenerated in Parkinson disease. Levodopa does not affect acetylcholine production.

Which pharmacokinetic condition of a drug may result in a high intensity and long duration of response? A. When both absorption and elimination are rapid B. When both absorption and elimination are delayed C. When absorption is rapid but elimination is delayed D. When absorption is delayed but elimination is rapid

Correct Answer C Pharmacokinetic factors determine the concentration of a drug at its sites of action. When the drug's absorption is rapid and elimination is delayed, the concentration of the drug at the site of action is high. This action increases the intensity and duration of the drug response. When both the absorption and elimination rates are rapid, the concentration of drug at the site of action is lesser. This in turn decreases the duration of the drug response. In contrast, when both the absorption and elimination of the drug are delayed, the intensity of the drug's effect is also decreased. When absorption is delayed but elimination is rapid, the duration and intensity of the drug are decreased because the concentration of the drug at the site of action is low.

A 63-year-old woman with the diagnosis of estrogen receptor-positive cancer of the breast undergoes lumpectomy and radiation therapy, and tamoxifen is prescribed. The client asks the nurse how long she will have to take the medication. How will the nurse respond? Incorrect1 A. "You'll have to take it for the rest of your life." B. "You'll need to take it for 10 days, like an antibiotic." C. "You'll need to take it for 5 years, after which it will be discontinued." D. "You'll need to take it for several months, until the bone pain subsides."

Correct Answer C Tamoxifen is an estrogen antagonist antineoplastic medication that has been found to be effective in 50% to 60% of women with estrogen receptor-positive cancer of the breast. After 5 years of administration there is an increased risk of complications, and the drug is discontinued. Tamoxifen usually is prescribed for 5 years after initiation of therapy, not for the rest of the client's life; this duration will not produce positive effects for the client. Tamoxifen usually is prescribed for 5 years after initiation of therapy, not just for 10 days. Tamoxifen may cause the adverse effect of bone pain, which indicates the drug's effectiveness. Medication is given to manage the pain and the drug is continued.

A client has primary open-angle glaucoma. The nurse expects that the client will receive a prescription for which eyedrops? A. Tetracaine B. Cyclopentolate C. Timolol maleate D. Atropine sulfate

Correct Answer C Timolol maleate is a beta-adrenergic antagonist that decreases aqueous humor production and increases outflow, thereby reducing intraocular pressure. Tetracaine is a topical anesthetic; it will not reduce the increased intraocular pressure associated with glaucoma. Cyclopentolate is contraindicated because it dilates the pupil and paralyzes ciliary muscles. Atropine sulfate, a mydriatic, is contraindicated because it dilates the pupil, obstructing drainage, which increases intraocular pressure.

After 3 months of supplemental oral iron therapy, there is no significant increase in an adolescent's hemoglobin level. Iron dextran is prescribed. What is the best way for the nurse to administer this medication? A. With a transdermal needle B. By massaging the injection site C. With the use of the Z-track method D. By administering a local anesthetic first

Correct Answer C The Z-track injection method prevents seepage of iron dextran through the needle track, thereby limiting irritation of subcutaneous tissue and staining of the skin. The length of a transdermal needle is too short to reach a muscle; a 1.5-inch (3.8 centimeters) needle is required. Massage will force iron dextran into the subcutaneous tissue, causing irritation and staining. Although an injection may be uncomfortable, a local anesthetic is unnecessary.

A client with hypertension is to take an angiotensin II receptor blocker (ARB). What should the nurse teach about this medication? Select all that apply. A. Monitor the blood pressure daily. B. Stop treatment if a cough develops. C. Stop the medication if swelling of the mouth, lips, or face develops. D. Have blood drawn for potassium levels 2 weeks after starting the medication. E. Do not take nonsteroidal antiinflammatory drugs (NSAIDs) concurrently with this medication.

Correct Answer C, D The medication should be stopped if angioedema occurs, and the healthcare provider should be notified. Electrolyte levels of potassium, sodium, and chloride should be obtained 2 weeks after the start of therapy and then periodically thereafter. Daily monitoring is not indicated. The blood pressure should be monitored at routine office visits. There is no need to avoid the use of NSAIDs while taking an ARB. A dry cough may occur during treatment with ARBs; however, it is not necessary to discontinue the medication because the cough usually resolves.

Valsartan, an angiotensin II receptor antagonist, is prescribed for a client. For which possible side effects should the nurse monitor the client? Select all that apply. A. Constipation B. Hypokalemia C. Irregular pulse rate D. Change in visual acuity E. Orthostatic hypotension

Correct Answer C, E Dysrhythmias, including second-degree heart block, are cardiovascular side effects of valsartan. It also may precipitate angina pectoris, myocardial infarction, and brain attack (cerebrovascular accident, CVA). Angiotensin II receptor antagonists, such as valsartan, block vasoconstrictor and aldosterone-producing effects of angiotensin II at receptor sites, including vascular smooth muscle, thus reducing the blood pressure; dizziness, orthostatic hypotension, and excessive hypotension may occur. Diarrhea, not constipation, may occur with valsartan. Hyperkalemia, not hypokalemia, may occur with valsartan. Valsartan does not cause altered visual acuity.

A client being treated for hypertension reports having a persistent hacking cough. What class of antihypertensive should the nurse identify as a possible cause of this response when reviewing a list of this client's medications? A. Thiazide diuretics B. Calcium channel blockers C. Angiotensin receptor blockers D. Angiotensin-converting enzyme (ACE) inhibitors

Correct Answer D ACE increases the sensitivity of the cough reflex, leading to the common adverse effect sometimes referred to as an ACE cough. A cough is not a side effect of thiazide diuretics, calcium channel blockers, or angiotensin receptor blockers.

A client with type 2 diabetes develops gout, and allopurinol is prescribed. The client is also taking metformin and an over-the-counter nonsteroidal antiinflammatory drug (NSAID). When teaching about the administration of allopurinol, what should the nurse instruct the client to do? A. Decrease the daily dose of NSAIDs. B. Limit fluid intake to one quart a day. C. Take the medication on an empty stomach. D. Monitor blood glucose levels more frequently.

Correct Answer D Allopurinol can potentiate the effect of oral hypoglycemics, causing hypoglycemia; the blood glucose level should be monitored more frequently. NSAIDs can be taken concurrently with allopurinol. A daily fluid intake of 2500 to 3000 mL will limit the risk of developing renal calculi. Allopurinol should be taken with milk or food to decrease gastrointestinal irritation.

A nurse is counseling a client with tuberculosis regarding isoniazid (INH) therapy. Which statement made by the client indicates the nurse needs to follow up? A. "I should take a multivitamin supplement daily." B. "I should take the medication 1 hour before eating." C. "I should immediately report to the primary healthcare provide if my skin and eyes appear yellow." D. "I should apply sunscreen and wear sun-protective clothing while going outside."

Correct Answer D Applying sunscreen needs to be followed up since this is a misconception and needs to be corrected. INH is a first-line medication used in the treatment of tuberculosis. This medication is not a photosensitive medication. All the rest are correct statements and require no follow up. Clients taking INH may have low levels of vitamin B complex; therefore, the client should take a daily supplement to prevent peripheral neuropathy. The client should take the medication 1 hour before meals because the presence of food may prevent the absorption of the medication from the gastrointestinal tract. Yellow discoloration of the skin and eyes should be immediately reported because it may indicate medication-induced liver toxicity or failure.

A nurse administers carbidopa-levodopa to a client with Parkinson disease. Which therapeutic effect does the nurse expect the medication to produce? A. Increase in acetylcholine production B. Regeneration of injured thalamic cells C. Improvement in myelination of neurons D. Replacement of a neurotransmitter in the brain

Correct Answer D Carbidopa-levodopa is used because levodopa is the precursor of dopamine. It is converted to dopamine in the brain cells, where it is stored until needed by axon terminals; it functions as a neurotransmitter. Regeneration of injured thalamic cells is not an action of this drug; neurons do not regenerate. Increase in acetylcholine production and improvement in myelination of neurons are not actions of this drug.

A client with type 2 diabetes is taking one oral hypoglycemic tablet daily. The client asks whether an extra tablet should be taken before exercise. What is the best response by the nurse? A. "You will need to decrease your exercise." B. "An extra tablet will help your body use glucose correctly." C. "When taking medicine, your diet will not be affected by exercise." D. "No, but you should observe for signs of hypoglycemia while exercising."

Correct Answer D Exercise improves glucose metabolism; with exercise there is a risk of developing hypoglycemia, not hyperglycemia. Exercise should not be decreased because it improves glucose metabolism. An extra tablet probably will result in hypoglycemia because exercise alone improves glucose metabolism. Control of glucose metabolism is achieved through a balance of diet, exercise, and pharmacologic therapy.

A client with a history of pulmonary emboli is taking warfarin daily. The nurse teaches the client about foods that are appropriate to consume when taking this medication. The nurse evaluates that the client needs further teaching when the client makes which statement? A. "Eggs provide a good source of iron, which is needed to prevent anemia." B. "Yellow vegetables are high in vitamin A and should be included in the diet." C. "Fish and shrimp are iodine-rich food sources that can prevent hypothyroidism." D. "Dark green leafy vegetables are high in vitamin K so I should eat them more often."

Correct Answer D Foods high in vitamin K should be limited to the usual amounts eaten by the client when establishing the prothrombin time/international normalized ratio (PT/INR) because vitamin K is part of the body's blood-clotting mechanism and will counter the effects of warfarin if eaten in excess. Foods containing protein, iron, vitamin A, and iodine are permitted because they are unrelated to blood clotting.

A client is undergoing highly active antiretroviral therapy (HAART). From what viral disease could the client possibly be suffering? A. Hepatitis B. Herpes simplex virus (HSV) C. Human papillomavirus (HPV) D. Human immunodeficiency virus

Correct Answer D Highly active antiretroviral therapy (HAART) is a combination of antiretroviral drugs used to treat human immunodeficiency virus (HIV). Because hepatitis, herpes simplex virus (HSV), and human papillomavirus (HPV) are not retroviral, HAART is ineffective for these disorders.

A client is prescribed metformin extended release to control type 2 diabetes mellitus. Which statement made by this client indicates the need for further education? A. "I will take the drug with food." B. "I must swallow my medication whole and not crush or chew it." C. "I will notify my doctor if I develop muscular or abdominal discomfort." D. "I will stop taking metformin for 24 hours before and after having a test involving dye."

Correct Answer D Metformin must be withheld for 48 hours before the use of iodinated contrast materials to prevent lactic acidosis. Metformin is restarted when kidney function has returned to normal. Metformin is taken with food to avoid adverse gastrointestinal effects. If crushed or chewed, metformin XL will be released too rapidly and may lead to hypoglycemia. Muscular and abdominal discomfort is a potential sign of lactic acidosis and must be reported to the health care provider.

Which drug prescribed to a client with a urinary tract infection (UTI) turns urine reddish-orange in color? A. Amoxicillin B. Ciprofloxacin C. Nitrofurantoin D. Phenazopyridine

Correct Answer D Phenazopyridine is a topical anesthetic that is used to treat pain or burning sensation associated with urination. It also imparts a characteristic orange or red color to urine. Amoxicillin is a penicillin form that could cause pseudomembranous colitis as a complication; it is not associated with reddish-orange colored urine. Ciprofloxacin is a quinolone antibiotic used for treating UTIs and can cause serious cardiac dysrhythmias and sunburns. It is not, however, responsible for reddish-orange colored urine. Nitrofurantoin is an antimicrobial medication prescribed for UTIs. This drug may affect the kidneys but is not associated with reddish-orange colored urine.

A nurse considers that the safe administration of high-dose methotrexate therapy should include which intervention? A. Maintaining an acidic urine B. Restricting intravenous fluids C. Providing a diet high in folic acid D. Monitoring plasma levels of the medication

Correct Answer D Plasma levels indicate whether therapeutic or toxic levels are present. Methotrexate (Rheumatrex) crystallizes in the kidneys if urine becomes acidic. The regimen should include hydration with a minimum of intravenous fluids of 125 mL/hr 6 to 12 hours before and during therapy. The effectiveness of methotrexate, a folic acid antagonist, is minimized by a diet high in folic acid.

A healthcare provider prescribes simvastatin 20 mg daily for elevated cholesterol and triglyceride levels for a female client. Which is most important for the nurse to teach when the client initially takes the medication? A. Take the medication with breakfast. B. Have liver function tests every 6 months. C. Wear sunscreen to prevent photosensitivity reactions. D. Inform the healthcare provider if the client wishes to become pregnant.

Correct Answer D Simvastatin is contraindicated in pregnancy because it is capable of causing fetal damage (teratogenic). It is a pregnancy category X teratogen. Simvastatin should be taken in the evening because most cholesterol is synthesized between midnight and 3:00 AM. Liver function tests should be done at 6 to 12 weeks initially and only then every 6 months. Although wearing sunscreen should be taught, sensitivity reactions are a rare occurrence and this is not as important.

After taking spironolactone, the client inquires about foods and fluids that contain potassium. Which juice should the nurse recommend? A. Prune juice B. Orange juice C. Tomato juice D. Cranberry juice

Correct Answer D Spironolactone is a potassium-sparing diuretic, and foods high in potassium should be avoided. Cranberry juice should be recommended because it contains the least amount of potassium. Prune, orange, and tomato juice are all high in potassium.

The healthcare provider prescribes enoxaparin to be administered subcutaneously daily to a client who had a total knee replacement. To ensure client safety, which measure would the nurse take when administering this medication? A. Remove air pocket from prepackaged syringe before administration. B. Rub the injection site after administration for 30 seconds. C. Administer medication over 2 minutes. D. Administer in the abdomen area only.

Correct Answer D The preferred site for enoxaparin administration is the abdomen. According to package directions, the air pocket in the prepackaged syringe should not be removed. Rubbing the injection site also is contraindicated. Subcutaneous injections should not be given over 2 minutes.

A client with hyperthyroidism is treated initially with propylthiouracil (PTU). What should the nurse include when teaching the client about this medication? A. This medication will have to be taken for the remainder of the client's life. B. Milk should be taken with the medication so that gastric irritation does not occur. C. The medication should be taken between meals so that it is more readily absorbed. D. Symptoms may not subside until the client has taken the medication for several weeks.

Correct Answer D This drug does not interfere with thyroxine already stored in the gland; symptoms remain until the hormone is depleted. Duration of therapy varies depending on the severity of the disease and the client's response to therapy. Milk does not need to be taken because this drug is not irritating to mucosal tissue, and no special precautions are necessary. Absorption is not affected by the presence of food in the stomach.

The nurse is caring for a client who is receiving azathioprine, cyclosporine, and prednisone before receiving a kidney transplant. What does the nurse identify as the purpose of these drugs? A. Stimulate leukocytosis B. Provide passive immunity C. Prevent iatrogenic infection D. Reduce antibody production

Correct Answer: D These drugs suppress the immune system, decreasing the body's production of antibodies in response to the new organ, which acts as an antigen. These drugs decrease the risk of rejection. These drugs inhibit leukocytosis. These drugs do not provide immunity; they interfere with natural immune responses. Because these drugs suppress the immune system, they increase the risk of infection.

A health care provider prescribes 36 units of NPH insulin and 12 units of regular insulin. The nurse plans to administer these drugs in one syringe. Identify the steps in this procedure by listing the numbers by each picture next to the step below in priority order. (Start with the number of the picture that represents the first step and end with the number by the picture that represents the last step.) A. Inject air equal to NPH dose into NPH vial. B. Inject air equal to regular dose into regular vial. C. Invert regular insulin bottle and withdraw regular insulin dose. D. Invert NPH vial and withdraw NPH dose

Correct Order A,B,C,D Air should be injected into the NPH insulin vial first, which allows withdrawal of the NPH insulin at a later step in the procedure without having to instill air into the vial from a syringe that contains regular insulin. Instilling air into the regular insulin vial increases the pressure in the vial, facilitating removal of the required dose. Removing the desired dose of insulin while the needle is still in the vial reduces the risk of contamination by repeated punctures and maintains the sharpness of the needle. Having the syringe contain regular insulin first prevents the need to withdraw the regular insulin into a syringe that contains NPH insulin and inadvertently contaminating the regular insulin vial with the longer-acting NPH insulin; contaminating regular insulin with NPH insulin will reduce the speed at which the regular insulin functions, which in turn will delay treatment of a hyperglycemic event. Finally, the required dose of NPH insulin can be removed from the NPH insulin vial.