Pharm ATI-New copied

57. A patient has received an overdose of intravenous heparin, and is showing signs of excessive bleeding. Which substance is the antidote for heparin overdose? A. vitamin E B. vitamin K C. protamine sulfate D. potassium chloride

ANS: C

59.The nurse assesses the patient's IV site, and it has infiltrated during the infusion of dopamine (Intropin). The nurse will prepare which medication to treat this infiltration? A. Naloxone (Narcan) B. Lidocaine (Xylocaine C. Phentolamine (Regitine) D. Norepinephrine (Levophed)

ANS: C

71. A nurse is teaching a client who takes acetaminophen (Tylenol) daily to manage mild knee pain. The nurse should instruct the client to monitor for which of the following adverse reactions to this medication? A. Tinnitus Rationale: Aspirin can cause ototoxicity. B. Muscle pain Rationale: Atorvastatin can cause muscle pain and rhabdomyolysis. Acetaminophen can reduce muscle pain. C. Hyperglycemia Rationale: Acetaminophen can cause leukopenia and thrombocytopenia. D. Jaundice Rationale: Acetaminophen can cause hepatotoxicity. The client should monitor and report jaundice, abdominal pain, clay colored stools, and fever.

ANS: D

The nurse is preparing to administer a transdermal patch to a patient and finds that the patient already has a medication patch on his right upper chest. What will the nurse do? A. Remove the old medication patch and notify the health care provider B. Apply the new patch without removing the old one C. Remove the old patch and apply the new one in the same spot D. Remove the old patch and apply the new patch to a different clean area

ANS: D

A patient is recovering from an appendectomy. She also has asthma and allergies to shellfish and iodine. To manage her postoperative pain, the physician has prescribed hydromorphone (Dilaudid). Which vital sign is of greatest concern? A. Temperature B. Respirations C. Pulse D. Blood pressure

NAS: B

25. A nurse is caring for a client who is to receive liquid medications via a gastrostomy tube. The client is prescribed phenytoin 250 mg. The amount available is phenytoin oral solution 25 mg/5 mL. How many mL should the nurse administer per dose? (Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.)

50 mL

35.The nurse is monitoring a patient who has severe bone marrow suppression following antineoplastic drug therapy. Which is considered the principal early sign of infection? A. Fever B. Diaphoresis C. Tachycardia D. Elevated white blood cell count

ANS: A

42. A patient has an infestation with flukes. The nurse anticipates the use of which drug to treat this infestation? A. praziquantel (Biltricide) B. pyrantel (Pin-X) C. metronidazole (Flagyl) D. ivermectin (Stromectol)

ANS: A

40.The nurse is reviewing the therapeutic effects of nonsteroidal antiinflammatory drugs (NSAIDs), which include which effect? A. Anxiolytic B. Sedative C. Antipyretic D. Antimicrobial

ANS: C

23.When converting from IV heparin to oral warfarin (Coumadin) therapy, the prescriber monitors which of the following to determine the next appropriate dose of warfarin? A. Platelet count B. aPTT C. Red blood cell count D. PT/INR

ANS: D

98.The nurse has just administered the morning dose of a patient's lispro (Humalog) insulin. Just after the injection, the dietary department calls to inform the patient care unit that breakfast trays will be 45mins late. What will the nurse do next? A. Inform the patient of the delay B. Check the patient's blood glucose levels C. Call dietary department to send a tray immediately D. Give the patient food such as cereal, skim milk and juice

ANS: D

96. A patient is admitted with salicylate toxicity. When assessing the patient, the nurse anticipates which manifestation associated with salicylate toxicity? A. Bradycardia B. Hypoventilation C. Constipation D. Hyperglycemia

ANS: D

82.A nurse is preparing to administer furosemide 40 mg IV. Available is furosemide 10 mg/1 mL. How many mL should the nurse administer per dose?

4 mL

45. A patient is receiving aminoglycoside therapy and will be receiving a beta-lactam antibiotic as well. The patient asks why two antibiotics have been ordered. What is the nurse's best response? A. "The combined effect of both antibiotics is greater than each of them alone." B. "One antibiotic is not strong enough to fight the infection." C. "We have not yet isolated the bacteria, so the two antibiotics are given to cover a wide range of microorganisms." D. "We can give a reduced amount of each one if we give them together."

ANS: A

47.The nurse is providing teaching to a patient taking an oral tetracycline antibiotic. Which statement by the nurse is correct? A. "Avoid direct sunlight and tanning beds while on this medication." B. "Milk and cheese products result in increased levels of tetracycline." C. "Antacids taken with the medication help to reduce gastrointestinal distress." D. "Take the medication until you are feeling better."

ANS: A

49. After receiving a nebulizer treatment with a beta agonist, the patient complains of feeling slightly nervous and wonders if her asthma is getting worse. What is the nurse's best response? A. "This is an expected adverse effect. Let me take your pulse." B. "The next scheduled nebulizer treatment will be skipped." C. "I will notify the physician about this adverse effect." D. "We will hold the treatment for 24 hours."

ANS: A

50.When a male patient is receiving androgen therapy, the nurse will monitor for signs of excessive androgens such as A. fluid retention. B. dehydration. C. restlessness. D. visual changes.

ANS: A

66.Which medication is used to treat a patient with severe adverse effects of a narcotic analgesic? A. Naloxone (Narcan) B. Acetylcysteine (Mucomyst) C. Methylprednisolone (Solu-Medrol) D. Flumazenil (Romazicon)

ANS: A

70. A nurse is assessing a client prior to administering atenolol. Which of the following findings should prompt the nurse to withhold the medication? A. Heart rate 46/min Rationale: The nurse should check the client's heart rate prior to administering a beta-blocker. If the client's heart rate is less than 50/min, the nurse should hold the medication and contact the provider. Atenolol is a beta-blocker and is used in the treatment of hypertension and angina, and following a myocardial infarction. This medication works by slowing the heart rate, decreasing the speed of electrical impulses through the atrioventricular node, and decreasing the force of contraction. B. Oxygen saturation 95% Rationale: Atenolol can cause bronchoconstriction in clients who have asthma. This pulse oximetry is within the expected reference range. C. Respiratory rate 18/min Rationale: This respiratory rate is within the expected reference range. Atenolol can cause dyspnea. D. Blood pressure 160/94 mm Hg Rationale: Atenolol is a beta-blocker and is used in the treatment of hypertension. This blood pressure is greater than the expected reference range, indicating hypertension.

ANS: A

72. A nurse is teaching a client who has a new prescription for bumetanide (Bumex). Which of the following instructions should the nurse include in the teaching? A. "Report changes in hearing." Rationale: Bumetanide is a high-ceiling loop diuretic. It promotes diuresis by inhibiting sodium and chloride reabsorption in the thick ascending limb of the loop of Henle. High-ceiling loop diuretics can cause ototoxicity. Concurrent use of aminoglycosides, such as gentamycin, increases the risk of ototoxicity. Inform clients about possible hearing loss, and instruct clients to notify the prescriber if a hearing deficit or tinnitus develops. B. "Avoid foods high in potassium." Rationale: Hypokalemia is an adverse effect of bumetanide due to potassium loss through the distal nephron. The client should consume foods high in potassium content (such as dried fruits, nuts, bananas, and potatoes) to minimize the risk for hypokalemia. The client should be taught to monitor for manifestations of hypokalemia, such as irregular heartbeat, muscle weakness, and leg cramps. C. "Take the prescribed second dose at nighttime." Rationale: Inform the client to expect increased urine volume and frequency of voiding. The client should take diuretics early in the morning when prescribed daily. When prescribed twice per day, the client should take the medication at 0800 and 1400 to avoid frequent diuresis during the night. D. "Limit your fluid intake to no more than 1.5 L a day." Rationale: The client should consume 2-3 L of fluid per day to prevent dehydration due to loss of sodium, chloride, and water.

ANS: A

The nurse on educating the patient on the common side/adverse effects of opioids will educate on which of the following: (Select all that apply) A. decreased respirations B. heartburn C. constipation D. nausea E. insomnia

ANS: A, C, D

80. A nurse is assessing a client who has schizophrenia and has been on long-term treatment with chlorpromazine. He notes the client is experiencing some involuntary movements of the tongue and face. The nurse should suspect the client has developed which of the following adverse effects? A. Tardive dyskinesia Rationale: These findings indicate tardive dyskinesia, which can develop in clients during long-term therapy with chlorpromazine. For many clients, the manifestations are irreversible. B. Parkinsonism Rationale: Parkinsonism can occur in clients taking chlorpromazine; however, it is characterized by drooling, shuffling gait and bradykinesia. C. Dystonia Rationale: Dystonia is an acute adverse effect involving severe spasm of the muscles of the tongue, face, neck or back that generally develops within the first few days of therapy. D. Akathisia Rationale: Akathisia can occur in clients taking chlorpromazine; however, it is characterized by pacing and squirming, which is brought on by an uncontrollable need to stay in motion.

ANS: A

83. A nurse is caring for a client who has just begun therapy with alprazolam (Xanax) to treat anxiety. The nurse should monitor the client for which of the following adverse effects of this medication? A. Insomnia Rationale: The nurse should monitor the client for paradoxical effects such as insomnia and excitation. If these occur, the medication should be withdrawn. B. Bradycardia Rationale: Alprazolam is more likely to cause tachycardia than bradycardia. C. Hearing loss Rationale: Alprazolam can cause the adverse effect of tinnitus but does not cause hearing loss. D. Hypertension Rationale: The nurse should monitor the client for the adverse effects of hypotension and orthostatic hypotension rather than hypertension.

ANS: A

84. A nurse is reviewing the laboratory results of a client who has liver failure with ascites and is receiving spironolactone. Which of the following findings should the nurse expect? A. Decreased sodium level Rationale: The nurse should expect a decreased sodium level. Spironolactone is a potassium-sparing diuretic that inhibits the action of aldosterone, resulting in an increased excretion of sodium. B. Decreased phosphate level Rationale: The nurse should not expect a decreased phosphate level. Spironolactone inhibits the action of aldosterone, resulting in the retention of phosphate. C. Decreased potassium level Rationale: The nurse should not expect a decreased potassium level. Spironolactone is a potassium-sparing diuretic that inhibits the action of aldosterone, resulting in the retention of potassium. D. Decreased chloride level Rationale: The nurse should not expect a decreased chloride level. Spironolactone is a potassium-sparing diuretic that inhibits the action of aldosterone, resulting in the retention of chloride.

ANS: A

91. A nurse is caring for a client who is taking lisinopril. Which of the following outcomes indicates a therapeutic effect of the medication? A. Decreased blood pressure Rationale: Lisinopril, an ACE inhibitor, may be used alone or in combination with other antihypertensives in the management of hypertension and congestive heart failure. A therapeutic effect of the medication is a decrease in blood pressure. B. Increase of HDL cholesterol Rationale: This is not an intended effect of lisinopril. C. Prevention of bipolar manic episodes Rationale: This is not an intended effect of lisinopril. D. Improved sexual function Rationale: This is not an intended effect of lisinopril. Lisinopril may in fact cause sexual dysfunction and impotence.

ANS: A

92. A nurse caring for a client who has hypertension and asks the nurse about a prescription for propranolol. The nurse should inform the client that this medication is contraindicated in clients who have a history of which of the following conditions? A. Asthma Rationale: Propranolol, a beta-blocker, is contraindicated in clients who have asthma because it can cause bronchospasms. Propranolol blocks the sympathetic stimulation, which prevents smooth muscle relaxation. B. Glaucoma Rationale: Beta-blockers are contraindicated in clients who have cardiogenic shock, but are not contraindicated in a client who has glaucoma. C. Depression Rationale: Beta-blockers are contraindicated in clients who have AV heart block, but are not contraindicated in clients who have depression. D. Migraines Rationale: Beta-blockers are used for prophylactic treatment of migraine headaches.

ANS: A

95.When handling and administering vesicant drugs, the nurse will: A. double flush the patient's bodily secretions in the commode. B. use sterile towels to clean up after chemotherapy spills. C. mix chemotherapeutic drugs in the patient's room. D. teach the patient how to administer parenteral chemotherapeutic drugs.

ANS: A

99.Which information will the nurse include when teaching a patient about thyroid replacement therapy? A. "Take this medication on an empty stomach" B. "You will experience beneficial effects of the drug after one week of treatment" C. "Stop taking the drug if you experience insomnia." D. "Take the medication before bed"

ANS: A

A nurse is teaching a client about a new medication, verapamil (Calan), for hypertension. What information should be include in teaching? A. Increase the amount of dietary fiber in the diet B. Drink grapefruit juice daily to increase vitamin C intake C. Decrease the amount of calcium in diet D. Withhold food for 1 hour after the medication is taken

ANS: A

During an intravenous (IV) infusion of amphotericin B, a patient develops tingling and numbness in his toes and fingers. What will the nurse do first? A. Discontinue the infusion immediately. B. Reduce the infusion rate gradually until the adverse effects subside. C. Administer the medication by rapid IV infusion to reduce these effects. D. Nothing; these are expected side effects of this medication.

ANS: A

The nurse should teach the patient taking an oral corticosteroid to take the medication at what time? A. 8:00 am B. 8:00 pm C. 12 noon D. 5:00 pm

ANS: A

Which drug will the nurse anticipate administering to a patient experiencing a benzodiazepine overdose? A. Flumazenil B. Narcan C. Methadone D. Antabuse

ANS: A

88. A nurse on a medical unit is planning care for an older adult client who takes several medications. Which of the following prescribed medications places the client at risk for orthostatic hypotension? (Select all that apply.) A. Furosemide (Lasix) B. Losartan (Cozaar) C. Metoprolol (lopressor) D. Clopidogrel (Plavix) E. Atorvastatin (Lipitor)

ANS: A, B, C

A nursing is planning care for a client who is receiving furosemide (lasix) IV for peripheral edema. Which of the following interventions should the nurse include in the plan of care? (Select all that apply) A. Assess for tinnitus B. Monitor serum potassium C. Elevate head of bed before ambulation D. Report urine output of 50mL/hr E. Recommend eating a banana daily

ANS: A, B, C, E

100.A patient with a history of chronic obstructive pulmonary disease and type 2 diabetes has been treated for pneumonia for the past week. The patient has been receiving intravenous corticosteroids as well as antibiotics as part of his therapy. At this time, the pneumonia has resolved, but when monitoring the blood glucose levels, the nurse notices that the level is still elevated. What is the best explanation for this elevation? A. The antibiotics may cause an increase in glucose levels. B. The corticosteroids may cause an increase in glucose levels. C. His type 2 diabetes has converted to type 1. D. The hypoxia caused by the chronic obstructive pulmonary disease causes an increased need for insulin.

ANS: B

22. A patient wants to take garlic to improve his cholesterol levels. Which condition would be a contraindication? A. Hptertension B. Scheduled surgery C. Sinus infection D. Bowel obstruction

ANS: B

28. A nurse is providing discharge teaching for a client who has a new prescription for warfarin. Which of the following instructions should the nurse include in the teaching? A. Mild nosebleeds are common during initial treatment. Rationale: Warfarin, an anticoagulant, increases the client's risk for bleeding. The nurse should instruct the client to stop the medication and notify the provider for manifestations of bleeding. B. Use an electric razor while on this medication. Rationale: Warfarin, an anticoagulant, increases the client's risk for bleeding. The nurse should teach the client safety measures, such as using an electric razor, to decrease the risk for injury and bleeding. C. If a dose of the medication is missed, double the dose at the next scheduled time. Rationale: Warfarin, an anticoagulant, should be taken at the same time each day and the client should not adjust the dose. Doubling a dose increases the client's risk for bleeding. D. Increase fiber intake to reduce the adverse effect of constipation. Rationale: Warfarin can cause diarrhea.

ANS: B

30. A nurse is teaching a client who has a new prescription for transdermal nitroglycerin to treat angina pectoris. Which of the following instructions should the nurse include in the teaching? A. Apply a new transdermal patch once a week. Rationale: The client should apply a new patch each day, not once a week. B. Apply the transdermal patch in the morning. Rationale: The client should apply the patch every morning and leave it in place for a 12 to 14 hr, then remove it in the evening. C. Apply the transdermal patch in the same location as the previous patch. Rationale: The client should rotate the sites used for patch placement to avoid areas of local skin irritation. D. Apply a new transdermal patch when chest pain is experienced. Rationale: The transdermal route of nitroglycerin has a delayed onset of action, making it suitable for prophylaxis use but not for immediate relief of chest pain.

ANS: B

31. A nurse in the emergency department is caring for a client who took 3 nitroglycerin tablets sublingually for chest pain. The client reports relief from the chest pain but now he is experiencing a headache. Which of the following statements should the nurse make? A. "A headache is an indication of an allergy to the medication." B. "A headache is an expected adverse effect of the medication." C. "A headache indicates tolerance to the medication." D. "A headaches likely due to the anxiety about the chest pain."

ANS: B

32. A patient has an order for the monoclonal antibody adalimumab (Humira). The nurse notes that the patient does not have a history of cancer. What is another possible reason for administering this drug A. Severe anemia B. Rheumatoid arthritis C. Thrombocytopenia D. Osteoporosis

ANS: B

39. An elderly patient tells the nurse that he uses aspirin for "anything that hurts." The nurse will assess for which most common signs of chronic salicylate intoxication in adults? A. Photosensitivity and nervousness B. Tinnitus and hearing loss C. Acute gastrointestinal bleeding and anorexia D. Hyperventilation and central nervous system (CNS) effects

ANS: B

46.The nurse is administering a vancomycin (Vancocin) infusion. Which measure is appropriate for the nurse to implement in order to reduce complications that may occur with this drug's administration? A. Monitoring blood pressure for hypertension during the infusion B. Discontinuing the drug immediately if red man syndrome occurs C. Restricting fluids during vancomycin therapy D. Infusing the drug over at least 1 hour

ANS: B

51.The nurse is administering oxytocin (Pitocin). Which situation is an indication for the use of oxytocin? A. Decreased fetal heart rate and movements B. Stimulation of contractions in prolonged labor C. Cervical ripening near term in pregnant patients D. To reverse premature onset of labor

ANS: B

54. After starting treatment for type 2 diabetes mellitus 6 months earlier, a patient is in the office for a follow-up examination. The nurse will monitor which laboratory test to evaluate the patient's adherence to the antidiabetic therapy over the past few months? A. Hemoglobin levels B. Hemoglobin A1C level C. Fingerstick fasting blood glucose level D. Serum insulin levels

ANS: B

56.When reviewing the laboratory values of a patient who is taking antithyroid drugs, the nurse will monitor for which adverse effect? A. Decreased glucose levels B. Decreased white blood cell count C. Increased red blood cell count D. Increased platelet count

ANS: B

60. A patient who is prescribed tamsulosin (Flomax) does not have a history of hypertension. The nurse knows this medication is also used for what condition? A. Migraine headache B. Benign prostatic hyperplasia (BPH) C. Glaucoma D. Erectile dysfunction

ANS: B

62.Cholinergic (parasympathomimetic) drugs have which therapeutic effect? A. Pupil dilation B. Increased gastrointestinal (GI) motility C. Urinary retention D. Blood vessel vasoconstriction

ANS: B

65. A patient is prescribed an opioid analgesic for chronic pain. Which information should the nurse discuss with the patient to minimize the GI adverse effects? A. Avoid eating foods high in lactobacilli. B. Increase fluid intake and fiber in the diet C. Take the medication on an empty stomach. D. Take diphenoxylate-atropine (Lomotil) for diarrhea with each dose.

ANS: B

38.The nurse is teaching a patient who is taking colchicine for the treatment of gout. Which instruction will the nurse include during the teaching session? A. "Fluids should be restricted while on colchicine therapy." B. "Take colchicine with meals." C. "The drug will be discontinued when symptoms are reduced." D. "Call your doctor if you have increased pain or blood in the urine."

ANS: D

67. A nurse is teaching a client who has a new prescription for simvastatin. Which of the following instructions should the nurse include? A. "You should expect brown-colored urine." Rationale: Brown-colored urine is a manifestation of liver dysfunction, an adverse effect of simvastatin. The client should report this to the provider. B. "You should avoid grapefruit juice." Rationale: Grapefruit inhibits the drug-metabolizing enzyme CYP3A4 which slows the metabolism of simvastatin. This can cause an increase in serum simvastatin. Potential adverse effects include elevated liver enzymes, and rhabdomyolysis. C. "You should monitor for ringing in the ears." Rationale: Simvastatin can cause rhabdomyolysis and myopathy. D. "You should take the medication in the morning." Rationale: The nurse should instruct the client to take the medication in the evening to increase efficacy.

ANS: B

69. A nurse is assessing a client who is taking lisinopril to treat hypertension. Which of the following findings is a priority to report? A. Dry cough Rationale: Dry cough is non-urgent because it is a mild adverse effect of lisinopril; therefore, there is another finding that is the priority. B. Swelling of the tongue Rationale: When using the urgent vs non-urgent approach to client care, the nurse determines that the priority finding is swelling of the tongue, which is a manifestation of angioedema. The nurse should withhold the medication and notify the provider immediately if the client reports swelling of the tongue or throat. Other manifestations include giant wheals and edema of the tongue, glottis, and pharynx. Severe reactions are treated with subcutaneous epinephrine. If angioedema develops, ACE inhibitors are discontinued. C. Nausea Rationale: Nausea is non-urgent because it is a mild adverse effect of lisinopril; therefore, there is another finding that is the priority. D. Nasal congestion Rationale: Nasal congestion is non-urgent because it is a mild adverse effect of lisinopril; therefore, there is another finding that is the priority.

ANS: B

94. A 40-year-old female patient is seen in the clinic. She has been newly diagnosed with RA. Which medication does the nurse anticipate being ordered for the patient? A. adalimumab B. methotrexate C. infliximab D. etanercept

ANS: B

97.The nurse enters the patient's room to complete the discharge process and finds the patient to be lying in bed unresponsive and breathing. The patient has a blood glucose of 48mg/dL. What is the most appropriate response by the nurse? A. Place a packet of sugar in the patient's mouth B. Roll the patient to the side and administer glucagon C. Start cardiopulmonary resuscitation (CPR) D. Have the patient drink orange juice

ANS: B

A patient is complaining of severe pain and has orders for morphine sulfate. The nurse knows that the route that would give the slowest pain relief is which route? A. IV B. PO C. Subcutaneous D. IM

ANS: B

A patient is taking guaifenesin (Humibid) as part of treatment for a sinus infection. Which instruction will the nurse include during patient teaching? A. Report clear-colored sputum to the prescriber. B. Force fluids to help loosen and liquefy secretions. C. Avoid driving a car or operating heavy machinery because of the sedating effects. D. Report symptoms that last longer than 2 days.

ANS: B

A patient is taking ibuprofen 800 mg three times a day by mouth as treatment for OA. While taking a health history, the nurse finds out that the patient has a few beers on weekends. What concern would there be with the interaction of the alcohol and ibuprofen? A. Increased bleeding tendencies B. Increased chance for GI bleeding C. Increased nephrotoxic effects D. Reduced antiinflammatory effects of the NSAID

ANS: B

A patient is taking nystatin (Mycostatin) oral lozenges to treat an oral candidiasis infection resulting from inhaled corticosteroid therapy for asthma. Which instruction by the nurse is appropriate? A. "Chew the lozenges until they are completely dissolved." B. "Let the lozenge dissolve slowly and completely in your mouth without chewing it." C. "Rinse your mouth with water before taking the inhaler." D. "Rinse your mouth with mouthwash after taking the inhaler."

ANS: B

A patient on a dobutamine drip starts complaining that her IV line "hurts really bad" The nurse on assessing the site notices that it is red, swollen and cool to touch. What will the nurse do first? A. Slow the infusion rate B. Stop the infusion C. Inject the area with phentolamine D. Notify the health care provider

ANS: B

A patient with active HIV has been taking zidovudine (Retrovir). Which is potential adverse effect may limit the length of time this medication can be taken? A. Lactic Acidosis B. Bone marrow suppression C. Hepatomegaly D. Fatigue

ANS: B

The patient is diagnosed with Parkinson's disease and has been started on a dopaminergic replacement drug therapy with carbidopa-levodopa, it is important for the nurse to A. assess the patient for dizziness and syncope when the patient is walking B. administer the medication first thing in the morning C. administer the medication on an empty stomach D. remove protein from the patient's diet

ANS: B

A nurse is planning to administer a first dose of captopril to a client who has hypertension. Which of the following medications can intensify first dose hypotension? (Select all that apply) A. Simvastain (Zocor) B. Hydrochlorothiazide (HCTZ) C. Dilantin (Phenytoin) D. Clonidine (Catapres) E. Nitroglycerin (Nitrostat)

ANS: B, D, E

26. A nurse is educating a group of clients about the contraindications of warfarin therapy. Which of the following statements should the nurse include in the teaching? A. "Clients who have glaucoma should not take warfarin." Rationale: Liver disease is a contraindication for warfarin therapy. B. "Clients who have rheumatoid arthritis should not take warfarin." Rationale: Thrombocytopenia is a contraindication for warfarin therapy. C. "Clients who are pregnant should not take warfarin." Rationale: Warfarin therapy is contraindicated in the pregnant client because it crosses the placenta and places the fetus at risk for bleeding. D. "Clients who have hyperthyroidism should not take warfarin." Rationale: Peptic ulcer disease is a contraindication for warfarin therapy

ANS: C

48.The nurse is providing instructions about the Advair inhaler (fluticasone propionate and salmeterol). Which statement about this inhaler is accurate? A. It is indicated for the treatment of acute bronchospasms. B. It needs to be used with a spacer for best results. C. Patients need to avoid drinking water for 1 hour after taking this drug. D. It is used for prevention of bronchospasms.

ANS: D

27. A nurse is reviewing the medication list for a client who has a new prescription for warfarin. The nurse should recognize that which of the following medications is incompatible with warfarin? A. Furosemide Rationale: Furosemide can cause potassium loss and increase the risk for digoxin toxicity when used concurrently with digoxin. B. Alprazolam Rationale: Alprazolam, used with sedative hypnotic medications, can increase the risk for CNS depression. C. Vitamin K Rationale: These two medications are not compatible. Vitamin K antagonizes the action of warfarin and is the antidote for warfarin toxicity. D. Vitamin A Rationale: Oral contraceptives can increase vitamin A levels.

ANS: C

33. A patient who has received chemotherapy has a critically low platelet count. The nurse expects which drug or drug class to be used to stimulate platelet cell production? A. filgrastim (Neupogen) B. Interferons C. oprelvekin (Neumega) D. epoetin alfa (Epogen)

ANS: C

34. A patient asks about his cancer treatment with monoclonal antibodies. The nurse tells him that which is the major advantage of treating certain cancers with monoclonal antibodies? A. They will help the patient improve more quickly than will other antineoplastic drugs. B. They are more effective against metastatic tumors. C. Monoclonal antibodies target certain tumor cells and bypass normal cells. D. There are fewer incidences of opportunistic infections with monoclonal antibodies.

ANS: C

41. A patient is receiving hydroxychloroquine therapy but tells the nurse that she has never traveled out of her city. The nurse knows that a possible reason for this drug therapy is which condition? A. Lyme disease B. Toxoplasmosis C. Systemic lupus erythematosus D. Intestinal tapeworms

ANS: C

43.When monitoring patients on antitubercular drug therapy, the nurse knows that which drug may cause a decrease in visual acuity? A. rifampin (Rifadin) B. isoniazid (INH) C. ethambutol (Myambutol) D. streptomycin

ANS: C

44. A young adult calls the clinic to ask for a prescription for "that new flu drug." He says he has had the flu for almost 4 days and just heard about a drug that can reduce the symptoms. What is the nurse's best response to his request? A. "Now that you've had the flu, you will need a booster vaccination, not the antiviral drug." B. "We will need to do a blood test to verify that you actually have the flu." C. "Drug therapy should be started within 2 days of symptom onset, not 4 days." D. "We'll get you a prescription. As long as you start treatment within the next 24 hours, the drug should be effective."

ANS: C

53. A patient is receiving oxytocin (Pitocin) to induce labor. During administration of this medication, the nurse will also implement which action? A. Giving magnesium sulfate along with the oxytocin B. Administering the medication in an intravenous bolus C. Administering the medication with an IV infusion pump D. Monitoring fetal heart rate and maternal vital signs every 6 hours

ANS: C

68. A nurse is assessing a client who has hypercholesterolemia and is receiving simvastatin. Which of the following findings should the nurse recognize as a potential adverse effect? A. Blurred vision Rationale: Blurred vision is not an adverse effect of simvastatin. B. Orthostatic hypotension Rationale: Orthostatic hypotension is not an adverse effect of simvastatin. C. Muscle aches Rationale: Myopathy is an adverse effect of this medication. Signs of myopathy include muscle aches, tenderness, and muscle weakness. D. Urinary retention Rationale: Urinary retention is not an adverse effect of simvastatin.

ANS: C

73. A nurse is providing teaching to a client who has a new diagnosis of Parkinson's disease. On which of the following medications should the nurse prepare to instruct the client? A. Piperacillin/tazobactam Rationale: Piperacillin/tazobactam is a broad spectrum anti-infective used in the treatment of moderate to severe infections. It is not used in the treatment of Parkinson's disease. B. Levothyroxine Rationale: Levothyroxine is a thyroid hormone used in the treatment of hypothyroidism. It is not used in the treatment of Parkinson's disease C. Levodopa/carbidopa Rationale: Levodopa/carbidopa is the cornerstone of Parkinson's treatment. The nurse should prepare to instruct the client on the use of this medication. D. Carbamazepine Rationale: Carbamazepine is an anticonvulsant used in the treatment of seizures, trigeminal neuralgia, bipolar disorder, and diabetic neuropathy. It is not used in the treatment of Parkinson's disease.

ANS: C

78. A nurse is providing discharge teaching to a client who has a new prescription for lithium. Which of the following information should the nurse include in the teaching? A. Follow a low-sodium diet. Rationale: Clients who are taking lithium should avoid a low-sodium diet due to the risk of hyponatremia. B. Limit daily fluid intake. Rationale: Clients who are taking lithium should drink plenty of fluids. C. Obtain a daily weight. Rationale: Clients who are taking lithium should monitor their daily weight due to the risk of fluid imbalance. D. Avoid foods that have a high tyramine content. Rationale: Clients who are taking a monoamine oxidase inhibitor (MAOI), rather than lithium, should avoid foods that have a high tyramine content.

ANS: C

79. A nurse is providing dietary teaching for a client who has a new prescription for a monoamine oxidase inhibitor (MAOI). When the client develops a sample lunch menu, which of the following items requires intervention by the nurse? A. Glass of whole milk Rationale: Clients who are receiving an MAOI should avoid foods containing a high tyramine content. Milk is safe for a client taking an MAOI. B. Celery sticks Rationale: Clients who are receiving an MAOI should avoid foods containing a high tyramine content. Celery is safe for a client taking an MAOI. C. Bologna sandwich Rationale: Clients who are receiving an MAOI should avoid foods containing a high tyramine content. Bologna has a high tyramine content and should be avoided. D. Sliced apples Rationale: Clients who are receiving an MAOI should avoid foods containing a high tyramine content. Apples are safe for a client taking an MAOI.

ANS: C

81. A nurse is caring for a client who is exhibiting signs of alcohol withdrawal. Which of the following medications should the nurse plan to administer? A. Methadone Rationale: Methadone is prescribed for detoxification of opiates rather than for the treatment of alcohol withdrawal. B. Disulfiram (Antabuse) Rationale: Disulfiram is prescribed to deter alcohol consumption rather than for the treatment of alcohol withdrawal. C. Diazepam (Valium) Rationale: Diazepam is prescribed to treat the symptoms and prevent complications of alcohol withdrawal. D. Buprenorphine (Buprenex) Rationale: Buprenorphine is prescribed to block heroin cravings for detoxification of opiates rather than for the treatment of alcohol withdrawal.

ANS: C

85. A nurse is teaching a client who has a new prescription for alprazolam (Xanax) to treat insomnia. Which of the following instructions should the nurse included? A. "Take this medication every night before sleep." Rationale: The client should take this medication intermittently (3 or 4 nights per week) to prevent physical dependence. B. "Take this mediation with a high fat meal." Rationale: Fatty foods reduce the absorption of this medication. C. "Avoid activities that require alertness such as driving." Rationale: The client should avoid activities that require alertness. Diazepam is a benzodiazepine that causes sedation and dizziness. D. "Monitor for urinary retention." Rationale: Morphine can cause urinary retention.

ANS: C

89. A nurse is teaching a client who has bipolar disorder and a prescription for lithium to recognize the manifestations of toxicity. Which of the following statements by the client indicates an understanding of the teaching? A. "I will report any loss of appetite." Rationale: Anorexia is a common side effect, especially in the period after lithium has first been prescribed and the body is adjusting to the medication. It is not a sign of toxicity. B. "Increased flatulence is an indication of toxicity." Rationale: Increased flatulence is a common adverse effect, especially in the period after lithium is first prescribed and the body is adjusting to the medication. It is not a sign of toxicity. C. "Vomiting is an indication of toxicity." Rationale: Since vomiting and diarrhea are early signs of lithium toxicity, the client should omit the next dose of lithium and call the provider. D. "I will call my provider if I experience any headaches." Rationale: Headaches are a common adverse effect, especially in the period after lithium has first been prescribed and the body is adjusting to the medication. It is not a sign of toxicity.

ANS: C

93. A patient is in the intensive care unit because of an acute myocardial infarction. He is experiencing severe ventricular dysrhythmias. The nurse will prepare to give which drug of choice for this dysrhythmia? A. Diltiazem (Cardizem) B. Verapamil (Calan) C. Amiodarone (Cordarone) D. Adenosine (Adenocard)

ANS: C

A patient is suffering from tendonitis of the knee. The nurse is reviewing the patient's medication administration record and recognizes that which adjuvant medication is most appropriate for this type of pain? A. Antidepressant B. Anticonvulsant C. Corticosteroid D. Local anesthesia

ANS: C

A patient who is receiving high-dose chemotherapy with methotrexate is also receiving leucovorin. The purpose of the leucovorin is to: A. produce an additive effect with the methotrexate by increasing its potency against the cancer cells. B. reduce the incidence of cardiomyopathy caused by the methotrexate. C. reduce the Bone Marrow Suppression caused by the methotrexate. D. add its antiinflammatory effects to the treatment regimen.

ANS: C

The nurse answers a patient's call light and finds the patient sitting up in bed and requesting pain medication. What will the nurse do first? A. Check the orders and give the patient the requested pain medication B. Provide comfort measures to the patient C. Assess the patient's pain and pain level D. Evaluate the effectiveness of previous pain medications

ANS: C

When planning care for an assigned patient, the nurse identifies the outcome of "Patient will be able to safely self-administer enoxaparin (Lovenox) subcutaneously upon discharge." Which method is best for the nurse to use in evaluating the patient's achievement of this outcome? A. Demonstrate the correct administration procedure to the patient. B. Give the patient detailed written instructions illustrating the procedure. C. Observe the patient's return demonstration of the administration procedure. D. Ask the patient to verbalize the correct administration procedure step by step.

ANS: C

Which statement is important for the nurse to include when teaching a patient about disulfiram (Antabuse) therapy? A. This medication will cure your alcoholism if you take as directed B. This medication will cause your blood pressure to get very high if you drink alcohol after taking it C. "You cannot drink alcohol for at least 3-4 days after taking this medication" D. "If you miss a dose of Antabuse, double up the next time it is due"

ANS: C

24. A patient with extremely high blood pressure is in the emergency department. The physician will order therapy with nitroglycerin to manage the patient's blood pressure. Which form of nitroglycerin is most appropriate? A. Sublingual spray B. Transdermal patch C. Oral capsule D. IV infusion

ANS: D

29. A nurse is teaching a client who has angina about nitroglycerin sublingual tablets. Which of the following statements should the nurse include in the teaching? A. "Place one tablet under your tongue every 5 minutes for 30 minutes to relieve chest pain." Rationale: The client should place one tablet under the tongue every 5 min for 15 min, for 3 total doses, to relieve chest pain. B. "Nitroglycerin decreases chest pain by dissolving blood clots that are occluding the arteries." Rationale: Nitroglycerin relaxes the blood vessels, which increases blood and oxygen supply to the heart. Nitroglycerin does not dissolve blood clots. C. "You can store the bottle of tablets in your bathroom medicine cabinet." Rationale: Nitroglycerin loses its effectiveness after 6 months or after exposure to light or moisture. The client should not store the tablets in the bathroom. D. "Nitroglycerin dilates cardiac blood vessels to deliver more oxygen to the heart." Rationale: Nitroglycerin is a nitrate medication that increases collateral blood flow, redistributes blood flow toward the subendocardium, and dilates the coronary arteries.

ANS: D

36. A patient has used enteric aspirin for several years as treatment for osteoarthritis. However, the symptoms are now worse and she is given a prescription for a nonsteroidal antiinflammatory drug (NSAID) and misoprostol (Cytotec). The patient asks the nurse, "Why am I now taking two pills for arthritis?" What is the nurse's best response? A. "Cytotec will also reduce the symptoms of your arthritis." B. "Cytotec helps the action of the NSAID so that it will work better." C. "Cytotec reduces the mucous secretions in the stomach, which reduces gastric irritation." D. "Cytotec may help to prevent gastric ulcers that may occur in patients taking NSAIDs."

ANS: D

37. A mother brings her toddler into the emergency department and tells the nurse that she thinks the toddler has eaten an entire bottle of chewable aspirin tablets. The nurse will assess for which most common signs of salicylate intoxication in children? A. Photosensitivity and nervousness B. Tinnitus and hearing loss C. Acute gastrointestinal bleeding D. Hyperventilation and drowsiness

ANS: D

52. A woman visits a health center requesting oral contraceptives. Which laboratory test is most important for the nurse to assess before the patient begins oral contraceptive therapy? A. Complete blood count B. Serum potassium level C. Vaginal cultures D. Pregnancy test

ANS: D

55.A patient has been taking levothyroxine (Synthroid) for more than 1 decade for primary hypothyroidism. Today she calls because she has a cousin who can get her the same medication in a generic form from a pharmaceutical supply company. Which is the nurse's best advice? A. "This would be a great way to save money." B. "There's no difference in brands of this medication." C. "This should never be done; once you start with a certain brand, you must stay with it." D. "It's better not to switch brands unless we check with your doctor."

ANS: D

58. A patient has been prescribed warfarin (Coumadin) in addition to a heparin infusion. The patient asks the nurse why he has to be on two medications. The nurse's response is based on which rationale? A. The oral and injection forms work synergistically. B. The combination of heparin and an oral anticoagulant results in fewer adverse effects than heparin used alone. C. Oral anticoagulants are used to reach an adequate level of anticoagulation when heparin alone is unable to do so. D. Heparin is used to start anticoagulation so as to allow time for the blood levels of warfarin to reach adequate levels.

ANS: D

61.The nurse understands a patient who is treated for hypertension may be switched to an angiotensin receptor blocker (ARB) because of which angiotensin-converting enzyme (ACE) inhibitor adverse effect? A. Fatigue B. Hypokalemia C. Orthostatic hypotension D. Dry, nonproductive cough

ANS: D

63.The health care provider prescribes donepezil (Aricept) for a patient. The patient states to the nurse, "I have no idea why I take this medication." The nurse knows the administration of donepezil (Aricept) is MOST commonly associated with what condition? A. Bladder spasms B. Urinary retention C. Parkinson's disease D. Alzheimer's disease

ANS: D

64.The nurse instructs a patient receiving phenytoin (Dilantin) to visit the dentist regularly and perform frequent oral hygiene. What common adverse effect is the nurse educating the patient about for this medication? A. Oral candidiasis B. Increased incidence of dental caries C. Increased risk of tooth abscess D. Gingival hyperplasia

ANS: D

74. A nurse is teaching an adolescent about medication therapy with oral acetylcysteine (Mucomyst). Which of the following information should the nurse include in the teaching? A. "You should avoid eating eggs." Rationale: There are no dietary restrictions when taking acetylcysteine. B. "Your mouth will become dry." Rationale: Increased oral secretions occur when taking this medication. C. "It is necessary to monitor your serum electrolyte levels." Rationale: ABG levels and pulmonary function might be monitored when taking this medication. D. "This medication has a very unusual odor." Rationale: This medication has an odor similar to rotten eggs due to the presence of disulfide linkages.

ANS: D

75. A nurse is providing instruction to a new nurse about caring for clients who are receiving diuretic therapy to treat heart failure. The nurse should explain that which of the following medications puts clients at risk for both hyperkalemia and hyponatremia? A. Furosemide Rationale: Furosemide is a high-ceiling (loop) diuretic that increases the risk of hyponatremia and hypokalemia, not hyperkalemia. B. Hydrochlorothiazide Rationale: Hydrochlorothiazide is a thiazide diuretic that increases the risk of hypokalemia, not hyperkalemia. C. Metolazone Rationale: Metolazone is a thiazide diuretic that increases the risk of hyponatremia and hypokalemia, not hyperkalemia. D. Spironolactone Rationale: Spironolactone is a potassium-sparing diuretic. It blocks the effects of aldosterone in the renal tubules, causing a loss of sodium and water and the retention of potassium. The possible adverse reactions include hyperkalemia and hyponatremia.

ANS: D

76. A nurse is providing teaching to a client who has hypertension and a new prescription for verapamil. Which of the following beverages should the nurse tell the client to avoid while taking this medication? A. Milk Rationale: Milk has no known effect on the metabolism of verapamil; therefore, this is a safe beverage for the client to drink while on this medication. B. Orange juice Rationale: Orange juice has no known effect on the metabolism of verapamil; therefore, this is a safe beverage for the client to drink while on this medication. C. Coffee Rationale: Although coffee consumption should be limited while taking verapamil, it does not have to be avoided. D. Grapefruit juice Rationale: Grapefruit juice increases blood levels of verapamil, a calcium channel blocker, by inhibiting its metabolism. The excess amount of medication can intensify the medication's hypotensive effects, putting the client at risk for syncope and dizziness.

ANS: D

77. A nurse is teaching a client who has a new prescription for cyclobenzaprine (Flexeril). Which of the following information should the nurse include in the teaching? A. Discontinue medication if nausea occurs. Rationale: The client should take the medication with food if nausea occurs. The client should not discontinue the medication abruptly. B. Expect urine to turn orange. Rationale: Cyclobenzaprine does not cause urine to turn orange. Rifampin can cause body fluids to turn a red-orange color. C. Monitor for increased muscle spasms. Rationale: Cyclobenzaprine should reduce muscle spasms. D. Avoid driving until effects are known. Rationale: Cyclobenzaprine can cause drowsiness and dizziness. Instruct the client to avoid driving if these effects occur.

ANS: D

86. A nurse is teaching a client who has a new prescription for fluoxetine (Prozac) to treat depression. Which of the following statements by the client indicates an understanding of the teaching? A. "I should expect to feel better after 24 hours of starting this medication." Rationale: The therapeutic effects of this medication can take 1 to 4 weeks to occur. B. "I should not take this medicine with grapefruit juice." Rationale: Grapefruit juice can interfere with the metabolism of lovastatin, but it does not affect fluoxetine. C. "I'll take this medicine with food." Rationale: The client can take fluoxetine with or without food. D. "I'll take this medicine first thing in the morning." Rationale: The client should take fluoxetine in the morning to reduce the risk for insomnia.

ANS: D

87. A nurse is assessing a client prior to the administration of morphine. The nurse should recognize that which of the following assessments is the priority? A. Pupil reaction Rationale: The nurse should assess the client's pupils because morphine can cause miosis; however, another assessment is the priority. B. Urine output Rationale: The nurse should assess the client's urine output because morphine can cause urinary retention; however, another assessment is the priority. C. Bowel sounds Rationale: The nurse should assess the client's bowel sounds because morphine can cause constipation; however, another assessment is the priority. D. Respiratory rate Rationale: When using the airway, breathing, circulation approach to client care, the nurse should determine the priority assessment is respiratory rate. Morphine can cause respiratory depression. The nurse should withhold the medication and notify the prescriber if the client has a respiratory rate less than 12/min.

ANS: D

90. A nurse is performing discharge teaching for a client who has seizures and a new prescription for phenytoin. Which of the following statements by the client indicates a need for further teaching? A. "I will notify my doctor before taking any other medications." Rationale: Many medication interactions can occur with phenytoin; therefore, the client's provider should be notified that the client is taking phenytoin. B. "I have made an appointment to see my dentist next week." Rationale: The client understands that phenytoin causes an overgrowth of the gums that makes dental monitoring important. C. "I know that I cannot switch brands of this medication." Rationale: The client understands that bioavailability varies with different brands, so no substitutions should be made. D. "I'll be glad when I can stop taking this medicine." Rationale: Phenytoin is an anticonvulsant used to treat various types of seizures. Clients on anticonvulsant medications commonly require them for lifetime administration, and phenytoin should not be stopped without the advice of the client's provider.

ANS: D