PassPoint Pharmacology Exam Prep
The client has been diagnosed with breast cancer and the oncologist has ordered tamoxifen. Which point(s) are important for the nurse to teach the client? Select all that apply.
Answer: It is important to see the gynecologist regularly. The medication will cause menopause. The client should freeze her eggs. This medication puts the client at risk for cancer in other parts of the body.
Misoprostol
Used to protect stomach's lining when client has peptic ulcer
A client received haloperidol 12 hours previously. The client develops an oculogyric crisis and tongue protrusion. Which is a nursing priority intervention?
Answer: Administer diphenhydramine as ordered The client is experiencing a dystonic reaction to the administration of haloperidol that needs to be reversed by diphenhydramine.
A client has Prinzmetal's angina. Which type of medication should the nurse anticipate to reduce the risk of coronary artery spasms?
Answer: CCB A calcium channel blocker, such as diltiazem, is indicated for the management of Prinzmetal's angina. The class of medication would reduce the incidence of coronary artery spasm. A beta-adrenergic blocker, such as metoprolol, is used to treat angina by decreasing myocardial oxygen needs, and has no effect on coronary artery spasms. An ACE inhibitor, such as enalapril, is used to manage hypertension. An inotropic vasodilator, such as milrinone, is indicated for short-term IV therapy in heart failure.
A client has been prescribed digoxin to increase the heart's ability to contract effectively. The nurse is teaching a client about common side effects of digoxin. Of which side effects should this client be aware? Select all that apply.
Answer: dizziness, anxiety, headache, diarrhea Inotropic agents such as digoxin can trigger common side effects such as dizziness, anxiety, headache, and diarrhea. Changes in mood and alertness that include confusion and depression, rather than hyperactivity, may be observed. Weight loss is not associated with cardiac glycosides. The client should be instructed to notify the health care provider if any of these side effects become severe *Lethargy is also s/s of developing lithium toxicity.
Warfarin
Will prevent a clot from forming
The nurse is preparing to administer morphine 10 mg I.V. to a client who reports pain. When using a computerized automated dispensing (CAD) cabinet, what information will be recorded by the nurse about the administration? Select all that apply.
Answer: client name time of administration name of nurse administering medication number of doses remaining in the CAD cabinet amount, if any, of medication wasted
A nurse is teaching a client with bipolar disorder about the drug carbamazepine. The nurse determines teaching was effective when the client states
Answer: "I need to have my blood counts checked periodically" The most dangerous adverse effect of carbamazepine is bone marrow depression. Other medications may be taken with carbamazepine. Hair loss doesn't occur in clients taking carbamazepine. Clients who take lithium, not carbamazepine, must be closely monitored for nephrogenic diabetes insipidus. The interactions of all drugs must be monitored because some can either increase or decrease the blood level of carbamazepine.
A client is to be discharged with a prescription for lactulose. The nurse teaches the client how to administer this medication. Which statement would indicate that the client has understood the information?
Answer: "I will mix it w/ apple juice" The taste of lactulose is a problem for some clients. Mixing it with fruit juice, water, or milk can make it more palatable. Lactulose should not be given with antacids, which may inhibit its action. Lactulose should not be taken with a laxative because increased stooling is an adverse effect of the drug and would be potentiated by using a laxative. Lactulose comes in the form of syrup for oral or rectal administration.
The client with breast cancer is prescribed tamoxifen 20 mg daily. The client states she does not like taking medicine and asks the nurse if the tamoxifen is really worth taking. What should the nurse tell the client?
Answer: "This drug has been found to decrease metastatic breast cancer" Tamoxifen is an antiestrogen drug that has been found to be effective against metastatic breast cancer and to improve the survival rate. The drug causes hot flashes as an adverse effect.
A client taking newly prescribed metoprolol asks the nurse what medication to take for a headache. What is the nurse's best response?
Answer: Acetaminophen Aspirin and other nonsteroidal antiinflammatory drugs (NSAIDs) counteract the blood pressure reducing effects of beta blockers by reducing the effects of prostaglandins. Acetaminophen is the best medicine for this client to take for a headache.
The nurse is teaching a client who has been prescribed thiothixene. Which adverse reaction is most important for the nurse to discuss with this client?
Answer: Akinesia Thiothixene is a high-potency agent with a high affinity for dopamine-2 receptors. This affinity increases the likelihood of akinesia, a form of extrapyramidal symptoms. Although thiothixene targets other neurotransmitters responsible for hypotension, sedation, and weight gain, its affinity to these receptors is weak, and more likely to occur with lower-potency psychotropics.
A 30-year-old multiparous client has been prescribed oral contraceptives as a method of birth control. The nurse instructs the client that decreased effectiveness may occur if the client is prescribed which drug?
Answer: Ampicillin Oral contraceptives may interact with other medications, and the effectiveness may be decreased if the client is prescribed ampicillin, tetracycline, or anticonvulsants, such as phenytoin.
One hour after receiving pyridostigmine bromide for myasthenia gravis, a client reports difficulty swallowing and excessive respiratory secretions. What medication would the nurse anticipate to reverse the effects of pyridostigmine bromide?
Answer: Atropine These symptoms suggest cholinergic crisis or excessive acetylcholinesterase medication, typically appearing 45 to 60 minutes after the last dose of acetylcholinesterase inhibitor. Atropine, an anticholinergic drug, is used to antagonize acetylcholinesterase inhibitors.
The health care provider has prescribed ciprofloxacin for a client who takes warfarin. What should the nurse instruct the client to do? Select all that apply.
Answer: Avoid exposure to sunlight. Report unusual bleeding.
A client comes to the emergency department complaining of sudden onset of diarrhea, anorexia, malaise, cough, headache, and recurrent chills. Based on the client's history and physical findings, the physician suspects legionnaires' disease. While awaiting diagnostic test results, the client is admitted to the facility and started on antibiotic therapy. What's the drug of choice for treating legionnaires' disease?
Answer: Azithromycin Azithromycin is the drug of choice for treating legionnaires' disease. Rifampin is used to treat tuberculosis. Amantadine, an antiviral agent, and amphotericin B, an antifungal agent, are ineffective against legionnaires' disease, which is caused by bacterial infection.
The nurse is caring for a client prescribed a tocolytic agent. The nurse takes immediate action based on what assessment finding?
Answer: Bilateral crackles on auscultation Tocolytics are used to stop labor contractions. The most common adverse effect associated with the use of these drugs is pulmonary edema. Bilateral crackles on lung auscultation is a sign of pulmonary edema, and prompt action would be required.
The nurse should instruct the client to avoid taking which drug while taking metoclopramide hydrochloride?
Answer: CNS Depressants Metoclopramide hydrochloride can cause sedation. Alcohol and other central nervous system depressants add to this sedation. A client who is taking this drug should be cautioned to avoid driving or performing other hazardous activities for a few hours after taking the drug. Clients may take antacids, antihypertensives, and anticoagulants while on metoclopramide.
If a client's central venous catheter accidentally becomes disconnected, what should a nurse do first?
Answer: Clamp the catheter. If a central venous catheter becomes disconnected, the nurse should immediately apply a catheter clamp. If a clamp isn't available, the nurse may place a sterile syringe or catheter plug in the catheter hub. After cleaning the hub with alcohol or povidone-iodine solution, the nurse must replace the I.V. extension set and restart the infusion. Calling the physician, applying a dry sterile dressing to the site, and telling the client to take a deep breath aren't appropriate interventions at this time.
Assessment of a client taking lithium reveals dry mouth, nausea, thirst, and mild hand tremor. Based on an analysis of these findings, which should the nurse do next?
Answer: Continue the lithium, and reassure the client that these temporary side effects will subside The client is exhibiting temporary side effects associated with beginning lithium therapy. Therefore, the nurse should continue the lithium and explain to the client that the temporary side effects of lithium that will subside. Common side effects of lithium are nausea, dry mouth, diarrhea, thirst, mild hand tremor, weight gain, bloating, insomnia, and light-headedness. Immediately notifying the HCP about these common side effects is not necessary.
To treat a urinary tract infection, a client is ordered trimethoprim-sulfamethoxazole. The nurse should teach the client that trimethoprim-sulfamethoxazole is most likely to cause which adverse effect?
Answer: Diarrhea Trimethoprim-sulfamethoxazole is most likely to cause diarrhea. Nausea and vomiting are other common adverse effects. This drug rarely causes anxiety, headache, or dizziness.
A healthcare provider (HCP) has prescribed valproic acid for a client with bipolar disorder who has achieved limited success with lithium carbonate. Which information should the nurse teach the client about taking valproic acid?
Answer: Follow-up blood tests are necessary while on this medication. Valproic acid can cause hepatotoxicity, so regular liver function tests are needed. Other side effects include nausea and drowsiness. Extended-release tablets should not be split or crushed; doing so changes their absorption. Alcohol should never be mixed with this medication. There will be medication in the client's body at all times. Nausea and tachycardia are not common side effects of valproic acid.
The nurse reviews the client's laboratory report to determine the client's blood level of valproic acid, which is 35 mcg/mL (243 µmol/L). Based on this report, what should the nurse do first?
Answer: Give next dose as prescribed The nurse should give the next dose as prescribed because the blood level is 35 mcg/mL, which is lower than the normal range of 50 to 100 mcg/mL. Withholding the next dose, notifying the HCP, and taking the client's vital signs are not indicated in this situation.
A client is experiencing status asthmaticus. For which would the nurse anticipate an immediate order?
Answer: Inhaled Beta2 Adrengergic Agonist Inhaled beta-adrenergic agonists agents are the first line of therapy in status asthmaticus, as they help promote bronchodilation, which improves oxygenation. I.V. beta-adrenergic agents can be used, but must be carefully monitored because of their systemic effects. They are typically used when the inhaled beta-adrenergic agents do not work. Inhaled and oral corticosteroids are slow-acting, and their use won't reduce hypoxia in the acute phase.
A laboring client in the latent stage of labor begins reporting pain in the epigastric area, blurred vision, and a headache. Which medication would the nurse anticipate for these symptoms?
Answer: Magnesium Sulfate Magnesium sulfate is the drug of choice to treat hypertension of pregnancy because it reduces edema by causing a shift from the extracellular spaces into the intestines. It also depresses the central nervous system, which decreases the incidence of seizures. Terbutaline is a smooth muscle relaxant used to relax the uterus. Oxytocin is the synthetic form of the pituitary hormone used to stimulate uterine contractions. Calcium gluconate is the antagonist for magnesium toxicity.
When preparing the teaching plan for a client about lithium therapy, the nurse should provide which instruction to the client concerning sodium?
Answer: Maintain adequate sodium intake The nurse would teach the client taking lithium and his family about the importance of maintaining adequate sodium intake to prevent lithium toxicity. Because lithium is a salt, reduced sodium intake could result in lithium retention with subsequent toxicity. Increasing sodium in the diet is not recommended and may be harmful. Increased sodium levels result in lower lithium levels. Therefore, the drug may not reach therapeutic effectiveness.
A nursing coordinator calls the intensive care unit (ICU) to inform the department that a client with a suspected pheochromocytoma will be admitted from the emergency department. The ICU nurse should prepare to administer which drug to the client?
Answer: Nitroprusside Excess catecholamine release occurs with pheochromocytoma and causes hypertension. The nurse should prepare to administer nitroprusside to control the hypertension until the client undergoes adrenalectomy to remove the tumor. Dopamine is used to treat hypotension, which is not associated with pheochromocytoma. Pheochromocytoma does not affect blood glucose levels, so insulin is not indicated in this client unless there is an underlying diagnosis of diabetes mellitus. Lidocaine is sometimes used to treat ventricular arrhythmias, which are not associated with pheochromocytoma.
A client with heart failure is allergic to sulfa-based medications. Which diuretic would the nurse anticipate ordered as an alternate?
Answer: Potassium-Sparing Diuretics The only diuretics that are not sulfonamide derivatives are the potassium-sparing diuretics (triamterene, spironolactone, and amiloride) and ethacrynic acid. Thiazide and thiazide-like diuretics, loop, and carbonic anhydrase inhibitor diuretics should be used in caution with clients with a sulfa allergy.
A physician orders a tricyclic antidepressant for a client who has suffered an acute myocardial infarction (MI) within the previous 6 months. Which action should the nurse take?
Answer: Question MD about order Cardiovascular toxicity is a problem with tricyclic antidepressants, and the nurse should question the use of these drugs in a client with cardiac disease. Administering the medication would be an act of negligence. A nurse can't discontinue a medication without a physician's order. It's the nurse's responsibility, not the client's, to discuss questions of care with the physician.
A client is receiving TPN administered through a central line. What should the nurse do to prevent complications associated with this infusion?
Answer: Secure all connections of system Complications associated with administration of TPN through a central line include infection and air embolism. To prevent these complications, strict aseptic technique is used for all dressing changes, the insertion site is covered with an air-occlusive dressing, and all connections of the system must be secure. Ambulation and activities of daily living are encouraged and not limited during the administration of TPN.
At 0900, the nurse started an infusion of one liter of D5NS infusing at a keep-vein-open rate. At 0945, the client reports a pounding headache, is dyspneic, is experiencing chills, and has a heart rate of 116 bpm. The nurse notes that the IV bag has 400 mL remaining. The nurse should take which action first?
Answer: Slow IV Infusion. The nurse notes that 600 mL of D5NS has infused over 45 minutes. The client is showing signs of circulatory overload, and the first action the nurse should take is to slow the IV infusion as the source of the problem. The nurse can then elevate the head of the bed to improve the client's ability to breathe and notify the HCP<glicon> of the change in condition. The nurse should not remove the IV catheter unless there is infiltration as the open line may be needed for administration of medications.
A client has been receiving oxytocin to augment her labor. The nurse notes that contractions are lasting 100 seconds. Which immediate action should the nurse take?
Answer: Stop oxytocin infusion Oxytocin should be withheld immediately, as it stimulates contractions. A contraction that continues for more than 90 seconds signals tetany and could lead to decreased placental perfusion and possibly uterine rupture. The nurse should monitor the fetal heart tones, stop the oxytocin, and notify the provider. The client should be turned on her left side to increase blood flow to the fetus, which can be decreased with tetany. This decreased blood flow can potentially compromise the fetus.
To prevent development of peripheral neuropathies associated with isoniazid administration, what should the nurse teach the client to do?
Answer: Supplement diet w/ Pyridoxine (Vitamin B6) Isoniazid competes for the available vitamin B6 in the body and leaves the client at risk for developing neuropathies related to vitamin deficiency. Supplemental vitamin B6 is routinely prescribed to address this issue. Avoiding sun exposure is a preventive measure to lower the risk of skin cancer. Following a low-cholesterol diet lowers the individual's risk of developing atherosclerotic plaque. Rest is important in maintaining homeostasis but has no real impact on neuropathies.
A client calls the clinic and tells the nurse that she forgot to take her oral contraceptive this morning. What should the nurse tell the client to do?
Answer: Take med immediately The nurse should instruct the client to take the medication immediately or as soon as she remembers that she missed the medication. There is only a slight risk that the client will become pregnant when only one pill has been missed, so there is no need to use another form of contraception. However, if the client wishes to increase the chances of not getting pregnant, a condom can be used by the male partner. The client should not omit the missed pill and then restart the medication in the morning because there is a possibility that ovulation can occur, after which intercourse could result in pregnancy. Taking two pills is not necessary and also will result in putting the client off her schedule.
Which instruction should a nurse give to a client with diabetes mellitus when teaching about "sick day rules"?
Answer: Test BG every 4 hours The nurse should instruct a client with diabetes mellitus to check their blood glucose levels every 3 to 4 hours and take insulin or an oral antidiabetic agent as usual, even when the client is sick. If the client's blood glucose level rises above 300 mg/dl, the client should call their physician immediately. If the client is unable to follow the regular meal plan because of nausea, the client should substitute soft foods, such as gelatin, soup, and custard.
A client with chronic obstructive pulmonary disease has a new prescription for theophylline. Which information obtained from the client would prompt the nurse to consult with the healthcare provider?
Answer: The client takes cimetidine 150 mg daily. Cimetidine interferes with the metabolism of theophylline and may cause theophylline toxicity. Theophylline should be taken as prescribed even if the client is not experiencing any symptoms of shortness of breath. An elevated heart rate is an expected side effect of theophylline and moderate exercise in a client with COPD. Thick mucus production is also an expected symptom of COPD.
The nurse is aware that antihypertensives should be used cautiously in clients already taking
Answer: Thioridzaine Thioridazine affects the neurotransmitter norepinephrine, which causes hypotension and other cardiovascular effects. Administering an antihypertensive to a client who already has hypotension could have serious adverse effects
As an initial step in treating a client with angina, the health care provider (HCP) prescribes nitroglycerin tablets, 0.3 mg given sublingually. This drug's principal effects are produced by:
Answer: Vasodilation of peripheral vasculature Nitroglycerin produces peripheral vasodilation, which reduces myocardial oxygen consumption and demand. Vasodilation in coronary arteries and collateral vessels may also increase blood flow to the ischemic areas of the heart. Nitroglycerin decreases myocardial oxygen demand. Nitroglycerin does not have an effect on pericardial spasticity or conductivity in the myocardium.
A client has developed a hospital-acquired pneumonia. When preparing to administer cephalexin 500 mg, the nurse notices that the pharmacy sent cefazolin. What should the nurse do? Select all that apply.
Answer: Verify the medication order as written by the by the health care provider. (HCP). Contact the pharmacy and speak to a pharmacist. Request that cephalexin be sent promptly. Return the cefazolin to the pharmacy.
A physician prescribes several drugs for a client admitted to the emergency department with Laennec's cirrhosis. Which drug order should the nurse question?
Answer: Warfarin Laennec's cirrhosis is caused by excessive alcohol use. Folacin or folic acid and vitamin K are all appropriate for this client due to vitamin deficiencies caused by cirrhosis. The client is at risk for bleeding related to the inability of the liver to alteration in clotting factors; therefore, warfarin is contraindicated. Ketorolac is a nonopioid analgesic and is appropriate for pain control in this client.
The nurse is caring for a client postoperatively after having a low anterior resection of the colon 6 hours prior. The client rates incisional pain 6/10. The prescribed orders include morphine 1 to 2 mg IV every hour as needed for pain. The client is alert with vital signs within normal limits. How will the nurse best manage the client's pain?
Answer: administer morphine 1 mg IV and reassess pain level in 20 minutes Morphine is an opioid analgesic. Prevention of respiratory depression and increased sedation begins with the administration of the lowest effective dose. To best manage the client's pain with dose range orders, the nurse would begin with the lowest prescribed dose and titrate as needed to achieve effective analgesia while minimizing side effects. After administering the lowest prescribed dose, the nurse would assess the client's pain level and response to the therapy in 20 minutes (morphine peaks in 20 minutes). Based on the client's response, the nurse would then administer additional morphine as necessary.
The nurse is teaching the parents of a child with growth hormone deficiency how to administer growth hormone to their child. At what time should the nurse suggest administration of this medication?
Answer: at bedtime Optimal therapeutic effect is typically achieved when the prescribed growth hormone is administered at bedtime. Pituitary release of growth hormone occurs during the first 45 to 90 minutes after the onset of sleep, so normal physiological release is mimicked with bedtime dosing.
An auto mechanic accidentally has battery acid splashed in their eyes. The coworkers irrigate the eyes with water for 20 minutes, then take the mechanic to the emergency department of a nearby hospital, where the mechanic receives emergency care for corneal injury. The physician orders dexamethasone, two drops of 0.1% solution to be instilled initially into the conjunctival sacs of both eyes every hour; and polymyxin B sulfate, 0.5% ointment to be placed in the conjunctival sacs of both eyes every 3 hours. The nurse knows that dexamethasone exerts its therapeutic effect by
Answer: decreasing leukocyte infiltration at site of ocular inflammation Dexamethasone exerts its therapeutic effect by decreasing leukocyte infiltration at the site of ocular inflammation. This action reduces the exudative reaction of diseased tissue, lessening edema, redness, and scarring. Dexamethasone and other anti-inflammatory agents don't inhibit the action of carbonic anhydrase or produce any type of miotic reaction.
A client has been placed on long-term sulfasalazine therapy for treatment of ulcerative colitis. The nurse should encourage the client to eat which foods to help avoid the nutrient deficiencies that may develop as a result of this medication?
Answer: green, leafy veggies In long-term sulfasalazine therapy, the client may develop folic acid deficiency. The client can take folic acid supplements, but the nurse should also encourage the client to increase the intake of folic acid in his diet. Green, leafy vegetables are a good source of folic acid. Citrus fruits, eggs, and milk products are not good sources of folic acid.
Ibuprofen
Can further impair renal or liver function in elderly NSAIDs can also cause nephrosis, cirrhosis, and HF in elderly, as well
A client has been prescribed sertraline. Which adverse effects are most important for the nurse to communicate to this client? Select all that apply.
Common adverse effects of sertraline include agitation, sleep disturbance, and dry mouth. Agranulocytosis, intermittent tachycardia, and seizures are adverse effects of clozapine.
Gentamicin
Ototoxicity is a serious side effect of gentamicin. Tinnitus and dizziness are common; irreversible deafness can develop if the onset of ototoxicity is not detected early. Gentamicin is also known to be nephrotoxic and hepatotoxic.
The nurse is teaching a client with iron-deficiency anemia about ferrous gluconate therapy. Which statement, if made by the client, would indicate a correct understanding of the teaching?
Preferably, ferrous gluconate should be taken on an empty stomach with orange juice. Ferrous gluconate shouldn't be taken with antacids, milk, or whole-grain cereals because these foods reduce iron absorption