Pharm 2019 A

A nurse at an urgent care clinic is collecting a history from a female client who has a urinary tract infection. The nurse anticipates a prescriptions for ciprofloxacin. The nurse should identify that which of the following client statements indicates a contraindication for administering this medication?

"I have tendonitis, so I haven't been able to exercise" The nurse should identify tendonitis as a contraindication for taking ciprofloxacin due to the risk of tendon rupture.

A nurse is caring for a client who received 0.9% NaCl 1 L over 4 hrs. instead of over 8 hrs. as prescribed. Which of the following information should the nurse enter as a complete documentation of the incident?

0.9% NaCl 1 liter infused over 4 hr, vitals stable, provider notified The nurse should document the type and mount of fluid, how long it took to infuse, provider notification, and the clients physical status.

A nurse is preparing to administer a scheduled antibiotic at 0800 to a client and discovers the antibiotic is not present in the client's medication drawer. The nurse should identify that administration of the medication can occur at which of the following time periods without requiring an incident report?

0830 The nurse should identify that an antibiotic can be administered 30 min before or after the scheduled time to maintain therapeutic blood levels without requiring an incident report.

A nurse is preparing to administer dextrose 5% in water (D5W) 400 mL IV to infuse over 1 hr. The drop factor of the manual IV tubing is 15gtt/mL. The nurse should set the manual IV infusion to deliver how many gtt/min?

100 gtt/min-------------- 400ml/60 min *15gtt/1ml = 100gtt/min

A nurse is preparing to administer Ciprofloxacin 15mg/kg PO every 12 hr to a child who weighs 44lbs. how many mg should the nurse administer per dose?

300 mg

A nurse in the emergency department is caring for a client who has myasthenia gravis and is in a cholinergic crisis. Which of the following medications should the nurse plan to administer?

Atropine A cholinergic is caused by an excess amount of cholinesterase inhibitor, such as neostigmine. The nurses should plan to administer atropine, an anticholinergic agent, to reverse cholinergic toxicity.

A nurse is providing teaching to a client who has multiple sclerosis and a new prescription for methlypredinisolone. which of the following instructions should the nurse include?

Blood glucose levels will be monitored during therapy Avoid contact with people who have known infections Grapefruit juice can increase the effects of the medication is correct

a nurse is reviewing the medication list of a client who wants to begin taking oral contraceptives. The nurse should identify that which of the following client medications will interfere with the effectiveness of oral contraceptives?

Carbamazepine carbamazepine causes an accelerated inactivation of oral contraceptives because of its action on hepatic medication-metabolizing enzymes.

A nurse is assessing a client after administering a second dose of cefazolin IV. The nurse notes the client has anxiety, hypotension, and dyspnea. Which of the following medications should the nurse administer first?

Epinephrine According to evidence-based practice, the nurse should administer epinephrine first to induce vasoconstriction and bronchodilation during anaphylaxis.

A nurse is providing teaching to a client who is taking bupropion as an aid to quit smoking. which of the following finding should the nurse identify as an adverse effect of the medication?

Insomia Bupropion, an atypical antidepressant, has stimulant properties, which can result in agitation, tremors, mania, and insomnia.

A nurse in an emergency department is caring for a client who has heroin toxicity. The client is unresponsive with pinpoint pupils and a respiratory rate of 6/min. Which of the following medications should the nurse plan to administer?

Naloxone The nurse should administer naloxone, an opioid antagonist, to a client who has heroin toxicity to reverse the respiratory depressive effects of the heroin. However, the nurse should not administer naloxone too quickly because naloxone can cause hypertension, tachycardia, nausea, vomiting, and might cause the client to enter a state of opioid withdrawal.

A nurse is developing a teaching plan for a client who has a new prescription for simvastatin. Which of the following instructions should the nurse include int he teaching plan? (select all that apply)

Report muscle pain to the provider Avoid taking the medication with grapefruit juice Expect therapy with this medication to be lifelong

A nurse is planning care for a client who is prescribed metoclopramide following bowel surgery. For which of the following adverse effects should the nurse monitor?

Sedation Metoclopramide has multiple CNS adverse effects, including dizziness, fatigue, and sedation.

A nurse at a clinic is providing follow-up care to a client who is taking fluoxetine for depression. Which of the following findings should the nurse identify as an adverse effect of the medication?

Sexual Dysfunction Sexual dysfunction, including a decreased libido, impotence, and delayed orgasm, or anorgasmia, is a common adverse effect of fluoxetine and occurs in about 70% of clients who take this SSRI antidepressant.

A nurse is assessing a client who is postoperative following an outpatient endoscopy using midazoam. A nurse should monitor for which of the following findings as an indication that the client is ready for discharge ?

The client's capnography has returned to baseline. the nurse should identify that the client is ready for discharge when the capnography level indicates that gas exchange is adequate.

A nurse on the acute care unit is caring for a client who is receiving gentamicin IV. The nurse should report which of the following findings to the provider as an adverse effect of the medication?

Tinnitus Aminoglycosides, such as gentamicin, are ototoxic, which can manifest as tinnitus and deafness.The nurse should monitor the client for high-pitched ringing in the ears and headaches and should notify the provider if these occur.

A nurse is caring for a client who is in labor. The client is receiving oxytocin by continuous IV infusion with a maintenance IV solution. The external FHR monitor indicates late decelerations. Which of the following actions should the nurse take first?

Turn the client to a side lying position. The greatest risk to the fetus experiencing late decelerations is injury from uteroplacental insufficiency. Therefore, the priority action the nurse should take is to place the client in a lateral position.

A nurse is teaching a client who is to start taking hydrocodone with acetaminophen tablets for pain. Which of the following information should the nurse include in the teaching?

decreased respiration might occur. the nurse should instruct the client that hydrocodone with acetaminophen might cause respiratory depression, which is an adverse effect of the medication. The client should avoid taking over-the-counter medications or newly prescribed medications without consulting their provider to avoid increased respiratory depression.

A nurse is preparing to administer medication to a client who has gout. The nurse discovers that an error was made during the previous shift and the client received atenolol instead of allopurinol. Which of the following actions should the nurse take first?

obtain the clients blood pressure When using the nursing process, the first action the nurse should take to prevent injury to the client is to assess the client for adverse effects of atenolol, such as hypotension.

A nurse is caring for a client who is taking acetazolamide for chronic open-angle glaucoma. For which of the following adverse effects should the nurse instruct the client to monitor and report?

tingling of fingers The nurse should instruct the client to report the adverse effect of paresthesia, tingling sensation in the extremities, when taking acetazolamide.

A nurse is reviewing the ECG of a client who is receiving IV furosemide for HF. The nurse should identify which of the following as an indication of hypokalemia?

Presence of U waves The nurse should identify the presence of U-waves as a manifestation of hypokalemia, an adverse effect of furosemide

A nurse is instructing a client on the application of nitroglycerin transdermal patches. Which of the following statements by the client indicates an understating of the teaching?

"I will take the patch off right after my evening meal" Clients should remove the patch each evening for a medication free time of 12 to 14 hours before applying a new patch to avoid developing a tolerance to the medication's effects.

A nurse is planning care for a client who has hypertension and is to start taking metoprolol. which of the following interventions should the nurse include in the plan of care?

Determine apical pulse prior to administration Life-threatening bradycardia is an adverse effect that might affect this client. therefore, the nurse should assess the client's apical pulse prior to administering the medication. if the client's pulse rate is less than 60/min, the nurse should withhold the medication and notify the provider.

A nurse is administering donepezil to a client who has Alzheimer's disease. Which of the following findings should the nurse report to the provider immediately?

Dyspnea When using the airway, breathing, circulation approach to client care, the nurse should report the adverse effect of dyspnea, caused by bronchoconstriction, to the provider first. Bronchoconstriction, dyspepsia, diarrhea, and dizziness are caused by the increase in acetylcholine levels, which is a primary effect of donepezil.

A nurse is teaching a client about the use of risedronate for the treatment of osteoporosis. The nurse should identify which of the following statements as an indication that the client understands the teaching?

I should sit up for 30 minutes after taking the risedronate Sitting upright for at least 30 min after taking risedronate will reduce the adverse gastrointestinal effects of esophagitis and dyspepsia. risedronate is contraindicated for a client who cannot sit or stand upright for this length of time.

A nurse is assessing a client who has myasthenia graves and is taking neostigmine. Which of the following findings should indicate to the nurse the client is experiencing an adverse effect?

Miosis Miosis, which is pupillary constriction, is a common adverse effect of neostigmine due to the excessive muscarinic stimulation that causes difficulty with visual accommodation.

A nurse is preparing to administer PO sodium polystyrene sulfonate to a client client who has hyperkalemia. Which of the following action should the nurse plan to take?

Monitor for constipation The nurse should monitor the client for the adverse effect of constipation and report it to the provider because this can lead to fecal impaction.

A nurse is planning to teach about the use of a spacer to a child who has a new prescription for a fluticasone inhaler to treat chronic asthma. the nurse should include that the spacer deceases the risk for which of the following adverse effect of the medication?

Oral candidiasis Dysphonia and oral candidiasis are adverse effects of inhaled corticosteroids. using a spacer and rinsing the mouth after inhalation will minimize the amount of medication remaining in the oropharynx, preventing the development of these adverse effects.

A nurse is reviewing laboratory results for a client who is receiving heparin via continuous IV infusion for deep-vein thrombosis. The nurse should discontinue the medication infusion for which of the following client findings?

Platelets 96000/mm3 a platelet count of 96,000/mm3 is below the expected range of 150,000 to 400,000/mm3. a platelet count less than 100,000/mm3 while receiving heparin can indicate heparin-induced thrombocytopenia, a potentially fatal condition that requires stopping the infusion.

A nurse is providing teaching to a client who has a gastric ulcer and a new prescription for ranitidine. which of the following instructions should the nurse include?

Report yellowing of the skin Famotidine can be hepatotoxic and cause jaundice. the nurse should instruct the client to monitor for and report yellowing of the skin or eyes to the provider.

A nurse is providing discharge teaching about handling medication to a client who is to continue taking oral transmucosal fentanyl raspberry flavored lozenges on a stick. Which of the following information should the nurse include in the teaching?

Store unused medication sticks in a storage container the nurse should instruct the client to store unused, used, or partially used medication sticks in the safe storage container that comes in the kit when the medication is initially prescribed.

A nurse is assessing a client 1 hours after administering morphine for pain. The nurse should identify which of the following findings as best indication that them morphine has been effective?

The client rates pain as 3 on a scale of 0/10 the client's description of the pain is the most accurate assessment of pain.

A nurse is teaching a client about warfarin. The client asks if she can take aspirin while taking the warfarin. Which of the following responses should the nurse make?

"Aspirin will increase risk of bleeding" aspirin inhibits platelet aggregation and can potentiate the action of the anticoagulant warfarin. Therefore, the client should avoid taking aspirin because it increases the risk for bleeding

A nurse is caring for a client who has cancer and is taking morphine and docusate sodium. The nurse should instruct the client that taking the dosusate sodium daily can minimize which of the following adverse effects of morphine?

Constipation constipation is a common adverse effect of morphine that can be minimized by taking docusate sodium, a stool softener that promotes easier evacuation of stool by increasing water and fat in the intestine.

A nurse is caring for a client who is experiencing acute alcohol withdrawal. For which of the following client outcomes should the nurse administer chlordiazepoxide?

Prevent Delirium Tremens The client should take chlordiazepoxide to prevent delirium tremens during acute alcohol withdrawal.

A nurse is providing teaching to a client who is to start treatment for asthma with beclomethasone and albuterol inhalers. Which of the following instructions should the nurse include in the teaching?

"Rinse your mouth after inhaling the beclomethasone" The client should rinse their mouth after using beclomethasone, a glucocorticoid inhaler, to prevent oropharyngeal candidiasis and hoarseness.

A nurse is providing discharge instructions to a client who has heart failure and a new prescription for captopril. Which of the following client statements indicates an understanding of the teaching?

I should tell my provider if I develop a sore throat The client should report a sore throat to the provider because this can indicate neutropenia, a serious adverse effect of captopril. Neutropenia can be reversed if it is identified early and the medication is promptly discontinued.

A nurse is teaching a client about cyclobenzaprine. Which of the following client statements should indicate to the nurse that the teaching is effective?

I will taper off the medication before discontinuing The client should taper off cyclobenzaprine before discontinuing it to prevent abstinence syndrome or rebound insomnia.

A nurse is collecting a medication history from a client who has a new prescription for lithium. The nurse should identify that the client should discontinue which of the following over-the-counter medications?

Ibuprofen Most NSAIDs can significantly increase lithium levels. therefore, the client should not take ibuprofen and lithium concurrently.

A nurse is providing teaching to a client who has a prescription for ergotamine sublingual to treat migraine headaches. Which of the following information should the nurse include in her instructions?

Take one tablet at onset of migraine take one tablet immediately after the onset of aura or headache.

A nurse is caring for the mother of a newborn. The mother asks the nurse when her newborn should receive his first diphtheria, tetanus, and pertussis vaccine (DTaP). The nurse should instruct the mother that her newborn should receive the immunization at which of the following ages?

2 months The CDC recommends that newborns receive the first dose of the five-dose series of the DTAP immunization at 2 months of age.

A nurse is caring for a client who has acute acetaminophen toxicity. The nurse should anticipate administering which of the following medication?

Acetylcysteine Acetylcysteine is a specific antidote for acetaminophen toxicity. it can prevent severe injury when given orally or by IV infusion within 8 to 10 hr.

A nurse is preparing to administer heparin subcutaneously to a client. Which of the following actions should the nurse plan to take?

Administer the medication outside the 5cm (2in) radius of the umbilicus The nurse should admi. the heparin by subQ injection to the abdomen in an area that is above the iliac crest and at least 5 cm (2 in) away fro the umbilicus.

A nurse is caring for a client who is receiving filgrastim. Which of the following finds should the nurse document to indicate the effectiveness of the therapy?

Increased neutrophil count Filgrastim stimulates the bone marrow to produce neutrophils. For clients receiving chemotherapy, the risk of infection is minimized.

A nurse is teaching a group of unit nurses about medication reconciliation. Which of the following information should the nurse include in the teaching? increased platelet

A transition in care requires the nurse to conduct medication reconciliation. The nurse should conduct medication reconciliation anytime the client is undergoing a change in care such as admission, transfer from one unit to another, or discharge. A complete listing of all prescribed and over-the-counter medications should be reviewed.

A nurse is planning care for a clienct who is receiving mannitol via continuous IV infusion. The nurse should monitor the client for which of the following adverse effects?

Bibasilar crackles mannitol, an osmotic diuretic, can precipitate heart failure and pulmonary edema. therefore, the nurse should recognize lung crackles as an indicator of a potential complication and stop the infusion.

A nurse is caring for a client who is receiving heparin therapy via continuous IV infusion to treat a pulmonary embolism. Which of the following findings should the nurse identify as an adverse effect of the medication and report to the provider?

Blood in urine The nurses should report blood in the urine to the provider because this can be a manifestation of heparin toxicity. Other manifestations can include bruising, hematomas, hypotension, and tachycardia.

A nurse adminsters a dose of metformin to a client instead of the prescribed dose of metaclopramide. Which of the actions should the nurse take first?

Check the clients blood glucose The first action the nurse should take using the nursing process is to assess the client. the client is at risk for hypoglycemia. the nurse should monitor the client's blood glucose and provide the client with a snack to reduce the risk for hypoglycemia.

A nurse is reviewing the medication administration record of a client who has hypecalcemia and a new prescription for IV calcium gluconate. the nurse should identify that which of the following medication can interact with calcium gluconate

Dioxin The nurse should identify that calcium gluconate can cause hypercalcemia, which increases the risk of digoxin toxicty.

A nurse is preparing to administer medication to a client who tells the nurse, " I don't want to take my fluid pill until I get home today." Which of the following action should the nurse take?

Document the refusal and inform the client's provider. The nurse has the responsibility to verify that the client understands the risk of refusing the medication so that an informed decision can be made. the nurse should then document the refusal in the client's medical record and notify the health care provider.

A nurse is providing teaching to a client who is to begin taking oxybutynin for urinary incontinence. The nurse should instruct the client to report which of the following findings as an adverse effect of the medication?

Dry mouth Blurred vision Dry eyes

A nurse in an emergency department is caring for a client whose family reports the client has taken large amounts of diazepam. Which of the following medications should the nurse anticipate administering?

Flumazenil the nurse should anticipate administering flumazenil, an antidote used to reverse benzodiazepines such as diazepam.

A nurse is providing teaching to a client who has peptic ulcer disease and is starting a new prescription for sucralfate. Which of the following actions of sulcralfate should the nurse inclide in the teaching

Forms a protective barrier over ulcers Sucralfate a mucosal protectant forms a gel like substance coating the ulcer creating a barrier to hydrochloric acid

A nurse is assessing a client's vital signs prior to the administration of PO digoxin. The clients BP is 144/86, heart Rate is 55 and RR is 20/min. The nurse should withhold the medication and contact the provider for which of the following findings

Heart Rate Digoxin slows the conduction rate through the SA and AV nodes, thereby decreasing the heart rate. the nurse should withhold the medication and notify the provider for a heart rate of 55/min because this is an early indication of dig toxicity.

A nurse is teaching a client who is to begin taking tamoxifen for the treatment of breast cancer. Which of the following adverse effects should the nurse include in the teaching?

Hot flashes The estrogen receptor blocking action of tamoxifen commonly results in the adverse effect of hot flashes.

A nurse is assessing a client who is taking propylthiouracil for the treatment of Graves disease. Which of the following findings should the nurse identify as as an indication of the medication has been effective?

Increase in ability to focus A client who has Graves' disease can experience psychological manifestations such as difficulty focusing, restlessness, and manic-type behaviors. Propylthiouracil is a thyroid hormone antagonist that decreases the circulating T4 hormone, reducing the manifestations of hyperthroidism. an increased ability to focus indicates that the medication has been. effective.

A nurse receives a verbal order from the provider to administer morphine five milligrams every 4 hours subcutaneously for severe pain as needed. The nurse should identify which of the following entries as the correct format for the medication administration record (MAR)?

Morphine 5mg subcut every 4 hr PRN sever pain The nurse should identify this entry as the correct format for the MAR. The medication name is spelled out and there are not any abbreviations from The Joint Commission's "Do Not Use" list included in the transcription.

A nurse is reviewing the lab results of a client who is taking digoxin for heart failure. Which of the following results should the nurse report to the provider?

Potassium level 2.8 meq/L A K level of 2.8 is below the expected reference range of 3.5 - 5. the nurse should notify the provider if a client has hypokalemia prior to administration of digoxin due to the increased risk of developing digoxin toxicity and cardiac dysrhythmias.

A nurse is caring for a 20 year old female client who has a prescription for isotretinoin for severe nodulocystic acne vulgarism. Before the client can obtain a refill, the nurse should advise the client that which of the following tests is required?

Pregnancy Test The nurse should instruct the client that isotretinoin has teratogenic effects; therefore, pregnancy must be ruled out before the client can obtain a refill. the client must provide two negative pregnancy tests for the initial prescription and one negative test before monthly refills.

A nurse is assessing a client who has schizophrenia and is taking haloperidol. The nurse should report which of the following to the provider as a manifestation of neuroleptic malignant syndrome (NMS)?

Temperature of 39.7 (103.5) the nurse should report fever to the provider as an indication of NMS, an acute life-threatening emergency. Other manifestations can include respiratory distress, diaphoresis, and either hyper- or hypotension.