Pharmacology ATI

A client taking lithium should be cautioned about drug interactions with which below medication? Select one: a. Fluoxetine b. Nifedipine c. Warfarin d. St. John's Wart

A Lithium and fluoxetine drug-drug interaction can lead to serotonin syndrome which may include symptoms such as confusion, hallucination, seizure and increase in heart rate and blood pressure. In severe cases, death can be the outcome. The other medications do not have documented instances of drug/drug interactions with lithium. The correct answer is: Fluoxetine

A nurse is administering 15,000 units of subcutaneous heparin. The amount available is heparin injection 30,000 units/mL. How many milliliters should the nurse administer per dose? (Round the answer to the nearest tenth. Use a leading zero if it applies. Do not use a trailing zero). Select one: a. 1.0 mL b. 0.4 mL c. 0.5 mL d. 2.0 mL

Answer: 0.5 mL C Rationale: 30,000 units x 15,000 units __________ __________ 1 mL X mL = 0.5 mL The correct answer is: 0.5 mL

Before administering blood products, which action should be taken? Select one: a. Prime IV tubing with 0.45% sodium chloride. b. Assess the client's temperature. c. Document client response. d. Administer epinephrine.

B When administering blood products, assess the client's vital signs, obtain consent for the procedure and ensure compatibility. Prime the IV tubing with 0.9% sodium chloride. The nurse would not document client response or administer epinephrine prior to starting the transfusion. The correct answer is: Assess the client's temperature.

A client prescribed the tricyclic antidepressant, amitriptyline has been on the medication for three weeks. The client vocalizes increased mood, but complains of anticholinergic effects. What is an example of an anticholingeric adverse effect? Select one: a. Anxiety b. Orthostatic hypotension c. Urinary retention d. Sedation

C Anticholinergic effects include dry mouth, blurred vision, photophobia, urinary retention, constipation and tachycardia. Orthostatic hypotension, sedation and anxiety are not associated with anticholingeric effects. The correct answer is: Urinary retention

Methotrexate blood levels are monitored to determine therapeutic dosing. The nurse knows that high-dose levels of methotrexate therapy can lead to __________ damage. Select one: a. connective tissue b. retinal c. neurologic d. liver

D Acetaminophen, methotrexate, tetracyclines, and tamoxifen increase levels of mipomersen and can increase risk for liver damage. The correct answer is: liver

A 55-year-old client has levothyroxine ordered. Which of the below past medical history concerns may contraindicate with her medication management of hypothyroidism? Select one: a. Peripheral Vascular Disease b. Asthma c. Scleroderma d. Osteoporosis

D Caution should be used to prevent overtreatment with levothyroxine and monitor drug levels. Chronic overtreatment can cause atrial fibrillation and an increased risk of fractures from bone loss, especially in older adults. The correct answer is: Osteoporosis There is an increased risk for fractures, especially in older adults.

A client with peptic ulcer disease takes cimetidine. Which of the below outcomes can occur if H2-receptor antagonists, such as cimetidine are taken long term? Select one: a. Hyperkalemia b. Paralytic Ileus c. Fluid Retention d. Pneumonia

D H2-receptor antagonists decrease gastric acidity, which promotes bacterial colonization of the stomach and the respiratory tract, which can lead to the outcome of pneumonia. Paralytic Ileus, fluid retention, and hyperkalemia are not expected outcomes with long term use of H2-receptor antagonists. The correct answer is: Pneumonia

Disulfiram is taken by a client daily for abstinence maintenance. What is an adverse effect of this therapy? Select one: a. Suicidal ideations b. Diarrhea c. Wernicke's aphasia d. Hepatoxicity

D Hepatoxicity is an adverse effect of disulfiram. Wernicke's aphasia, suicidal ideations and diarrhea are not associated with this therapy. The correct answer is: Hepatoxicity

Which of the following agents is used for motion sickness? Select one: a. Misoprostol b. Oprelvekin c. Raberprazole d. Scopolamine

D Scopolamine is an anticholingeric that interferes with the transmission of nerve impulses traveling from the vestibular apparatus of the inner ear to the vomiting center of the brain. Misoprostol prevents gastic ulcers from forming by promoting submucosal blood flow. Raberprazole is a proton pump inhibitor that reduces gastric acid secretion to prevent erosion and ulcers of the gut. Oprelvekin is a thrombopoietic growth factor agent to increase platelet production. The correct answer is: Scopolamine

The nurse knows that a client with renal insufficiency should be reevaluated for best diabetic management, when it is noted the client is on metformin. What is the reason metformin is contraindicated for clients who have renal insufficiency? Select one: a. The medication increases potassium excretion. b. The medication increases glucose productions. c. The medication decrease renal perfusion. d. The medication increases the risk of lactic acidosis.

D The medication increases lactic acidosis. The medication does not decrease renal perfusion, increase potassium excretion or increase glucose production. The correct answer is: The medication increases the risk of lactic acidosis.

A 45-year-old client is taking methylprednisolone. What pharmacological action should the nurse expect with this therapy? Select one: a. Fortification of bones. b. Suppression of beta2 receptors. c. Suppression of airway mucus production. d. Suppression of candidiasis.

Reference: RM Pharm RN 6.0 Chp 17 The correct answer is: C Suppression of airway mucus production. Corticosteroids, such as methylprednisolone (Solu-Medrol) will suppress airway mucus production.

A 52-year-old client with a history of angina has been prescribed transdermal nitroglycerin. Which of the following adverse effects is not seen with this therapy? Select one: a. Orthostatic hypotension b. Headache c. Tolerance d. Productive cough

Reference: RM Pharm RN 6.0 Chp 22 The correct answer is: D Productive cough Nitroglycerin therapy does not directly have an effect lung function. Physiologically, vasodilation should effect capillary perfusion and decrease lung secretions.

A nurse is reviewing the medication class, benzodiazepines. The nurse would use caution when administering benzodiazepines to which of the below clients? Select one: a. A client with insomnia. b. A client with hypertension. c. A client with renal failure. d. A client with glaucoma.

Reference: RM Pharm RN 6.0 Chp 7 The correct answer is: D A client with glaucoma. Benzodiazepines can increase intraocular pressure due to the pupil-dilating effects of the medication.

A client diagnosed with Parkinson's disease is prescribed levodopa. The nurse should instruct the client not to take over the counter pyridoxine supplements while taking this medication. Select one: True False

TRUE. Pyridoxine (vitamin B6) decreases the effects of levodopa. Clients should not take over the counter supplements without consulting their provider. The correct answer is 'True'.

A nurse have provided education to a client regarding prescribed levothyroxene sodium. What of the following client statements demonstrates understanding of medication administration? Select one: a. "I should take the medication in the morning to prevent insomnia." b. "I should take my medication as needed to alleviate symptoms." c. "I should take the medication in divided doses to ensure therapeutic drug levels." d. "I should take the medication on a full stomach."

The correct answer is: A "I should take the medication in the morning to prevent insomnia." Synthroid should be taken once in the morning to prevent insomnia.

A nurse is caring for a client prescribed montelukast. Which of the following should the nurse include in teaching related to this medication? Select one: a. Advise client to take the medication once daily at bedtime. b. If the client forgets to take the medication for a few days he can double up on doses to catch up. c. This medication is for acute management of asthma. d. Avoid dairy products while taking this medication.

The correct answer is: A Advise client to take the medication once daily at bedtime. There is no indication for a client to avoid dairy products while taking leukotriene modifiers.

A nurse is to instill ear drops to a 2 year-old child. To straighten the ear canal, the nurse should pull the auricle of the ear: Select one: a. Down and backward b. Down and outward c. Upward and outward d. Upward and backward

The correct answer is: A Down and backward In infants and young children, the nurse should gently pull the auricle of the ear down and back.

A nurse is providing care to a client with staphylococcus epidermidis, who is prescribed vancomycin. Identify the adverse effect associate with this antibiotic therapy? Select one: a. Infusion reaction b. Constipation c. Immunosuppression d. Hepatotoxicity

The correct answer is: A Infusion reaction Red Man Syndrome or an infusion reaction that results in rashes, flushing, tachycardia and hypotension can occur as an adverse reaction. For this reason, vancomycin should be administered over a 60 minute period.

A nurse is caring for a client receiving a dopamine infusion via a peripheral IV. Which of the following actions should the nurse take if the IV site appears infiltrated? Select one: a. Stop the infusion. b. Apply a warm compress to the site. c. Slow the infusion and continue to monitor the site. d. Apply a cold compress to the site.

The correct answer is: A Stop the infusion. If infiltration is suspected, the infusion should be stopped. Necrosis can occur from extravasation of high doses of dopamine. Extravasation can be treated with local injection of an alpha-adrenergic blocking agent, such as phentolamine.

A nurse is caring for a client prescribed digoxin. Which the following should alert the nurse to possible digitalis toxicity? Select one: a. anorexia and weakness b. tachycardia and increased urination c. hyperactivity and hunger d. polyphagia and polydipsia

The correct answer is: A anorexia and weakness Anorexia, fatigue and weakness are signs of potential digitalis toxicity. GI effects of digitalis toxicity include anorexia, nausea, vomiting and abdominal pain. CNS effects include fatigue, weakness, vision changes (diplopia, blurred vision, yellow-green or white halos around objects). Bradycardia is also commonly noted in digitalis toxicity.

A client is prescribed propranolol. Which of the following client history findings would require the nurse to clarify this medication prescription? Select one: a. Hypertension b. Asthma c. Tachydysrhythmias d. Urolithiasis

The correct answer is: B Asthma Clients with asthma should avoid Beta2 Blockade agents such as propranolol. Bronchoconstriction can occur. Clients with asthma should be administered a beta1selective agent.

A client has been prescribed metoclopramide. Which of the following should the nurse include in client education regarding this medication? Select one: a. This medication can cause insomnia. b. Notify your provider if you experience restlessness or spasms of the face or neck. c. Decrease your fluid intake while taking this medication. d. This medication can cause urinary frequency.

The correct answer is: B Notify your provider if you experience restlessness or spasms of the face or neck. An adverse effect of Reglan is extrapyramidal symptoms. The client should stop the medication and notify the provider if these occur.

A nurse has just administered a wrong medication to a client. Which of the following actions should the nurse take next? Select one: a. Inform the client that the wrong medication was given. b. Report error to the provider. c. No action is needed. d. Complete an institutional incident report.

The correct answer is: B Report error to the provider. The nurse should acknowledge the error and report it to the provider for further orders. The nurse should also monitor the client for adverse effects.

A nurse is caring for a client prescribed ferrous sulfate for the treatment of anemia. Which of the following instructions should be included in client teaching about this medication? Select one: a. Take prescribed antacids at the same time as this medication. b. Take the medication on an empty stomach to maximize absorption. c. Decrease dietary fiber intake while taking this medication. d. Notify your provider if your stool becomes dark green.

The correct answer is: B Take the medication on an empty stomach to maximize absorption. The nurse should instruct the clients to take iron on an empty stomach, such as 1 hr before meals to maximize absorption. Stomach acid increases absorption. If GI adverse effects occur, the client can take with food to increase adherence to therapy even though absorption is also decreased.

A client has been prescribed vasopressin for the treatment of diabetes insipidus. What is the expected pharmacological action of this medication? Select one: a. To slow the absorption of glucose in the intestine. b. To increase reabsorption of water in the renal tubules. c. To increase blood pressure. d. To stimulate the pancreas to secrete insulin.

The correct answer is: B To increase reabsorption of water in the renal tubules. The expected pharmacological action is to promote reabsorption of water within the kidney.

Which of the following are contraindications to aspirin therapy? Select all that apply. Select one or more: a. Deep vein thrombus b. Thrombocytopenia c. Adolescents with chickenpox d. Third trimester pregnancy e. Coronary artery disease

The correct answer is: B, C, D Third trimester pregnancy, Thrombocytopenia, Adolescents with chickenpox Aspirin is contraindicated in clients with bleeding disorders and thrombocytopenia. Aspirin should not be given to children or adolescents with fever or recent chickenpox due to the risk of Reye syndrome. Aspirin is pregnancy risk category D in the third trimester.

A nurse is preparing to administer an intramuscular injection to an adult client. At what angle should the nurse administer the medication using the ventrogluteal site? Select one: a. a 75 degree angle b. a 45 degree angle c. A 90 degree angle d. a 60 degree angle

The correct answer is: C A 90 degree angle IM injections should be administered at a 90 degree angle.

A nurse is preparing to administer enoxaparin to a client. Which of the following actions should the nurse take when administering this medication? Select one: a. Aspirate prior to administration b. Carefully rub the injection site after administration c. Do not expel the air bubble from the prefilled syringe d. Administer the medication via shallow subcutaneous injection in the deltoid muscle

The correct answer is: C Do not expel the air bubble from the prefilled syringe The nurse should not expel the air bubble from the prefilled syringe. The air bubble should follow the medication to ensure the client receives the full dose of medication in the syringe.

A nurse is caring for a client receiving patient-controlled analgesia (PCA). Which of the following interventions should the nurse take while caring for this client? Select one: a. Encourage the client's family to administer PCA while client is sleeping. b. Advise the client to use the pump sparingly to prevent addiction. c. Encourage the client to use the PCA before dressing changes. d. Increase client's 4-hr limit as needed.

The correct answer is: C Encourage the client to use the PCA before dressing changes. The nurse should encourage the client to use the PCA prophylactically prior to activities that are likely to augment pain levels.

A nurse is caring for a client prescribed the HMG CoA reductase inhibitor, atorvastatin. Which of the following should be monitored while this medication is prescribed? Select one: a. Renal function tests b. Visual acuity screenings c. Liver function tests d. Hearing screenings

The correct answer is: C Liver function tests Statins (HMG CoA reductase inhibitors) like atorvastatin (Lipitor) can cause hepatotoxicity. Prior to initiating therapy the client's baseline liver function should be determined then liver function tests should be checked after 12 weeks of therapy and then every 6 months. The nurse should advise the client to observe for symptoms of liver dysfunction (anorexia, vomiting, nausea, jaundice) and to notify the provider if these occur.

A client has been prescribed lisinopril. Which of the following medication interactions should the nurse instruct this client about? Select one: a. Magnesium supplements b. Ciprofloxacin c. Potassium supplements d. Escitalopram

The correct answer is: C Potassium supplements Potassium supplements and potassium-sparing diuretics increase the risk of hyperkalemia in clients taking ACE inhibitors such as lisinopril. Clients should only take potassium supplements if prescribed by the provider. Clients should also avoid salt substitutes that contain potassium.

A client with osteoporosis is prescribed alendronate. What client education should the nurse provide to ensure optimal absorption of the medication? Select one: a. Advise the client to take the medication with grapefruit juice. b. Advise the client to take the medication with a glass of milk. c. Advise the client to take the medication with no more than 4 oz of water. d. Advise the client to take the medication on an empty stomach with at least 8 oz of water.

The correct answer is: D Advise the client to take the medication on an empty stomach with at least 8 oz of water. This is a correct statement. Alendronate absorption decreases when taken with calcium supplements, antacids, citric juices and caffeine.

A nurse is caring for a client newly prescribed doxazosin mesylate. Which of the following instructions should the nurse include in client education regarding taking the first dose of this medication? Select one: a. Do not eat green leafy vegetables. b. There is no need to avoid normal activities. c. Avoid dairy products while taking this medication. d. Change positions slowly and lie down if dizziness occurs.

The correct answer is: D Change positions slowly and lie down if dizziness occurs. First-dose orthostatic hypotension can occur with Cardura. The nurse should instruct clients to change positions slowly and to lie down if feeling dizzy, lightheaded or faint.

A nurse is preparing to administer a measles, mumps, and rubella vaccine (MMR) to an adult client. Which of the following is a contraindication to this vaccine? Select one: a. Client history of genital herpes b. Client allergy to strawberries c. The possibility of overseas travel in the next month d. The possibility of pregnancy within 4 weeks

The correct answer is: D The possibility of pregnancy within 4 weeks Pregnancy or the possibility of pregnancy with 4 weeks is a contraindication to the MMR vaccine.

A client has been prescribed isosorbide mononitrate. Which of the following should the nurse include in this client's education related to this medication? Select one: a. Take an additional tablet if you experience chest pain. b. You can crush this medication if needed. c. Take the medication in the evening after dinner. d. This medication is prescribed for long-term prophylaxis against anginal attacks.

The correct answer is: D This medication is prescribed for long-term prophylaxis against anginal attacks. Isosorbide mononitrate (Imdur) is used for long-term prophylaxis against anginal attacks.

A nurse is caring for a client prescribed hydromorphone for severe pain. The client's respiratory rate has decreased from 16 breaths per minute to 6. Which if the following medications should the nurse prepare to administer? Select one: a. Activated charcoal b. Flumazenil c. Naloxone d. Aluminum hydroxide

The correct answer is: Naloxone C This client is experiencing respiratory depression likely related to over administration of hydromorphone (Dilaudid). Naloxone (Narcan) and nalmefene (Revex) are opioid antagonists used to reverse an overdose of opioids.

Match the following classifications of diuretics to their mechanism of action. Potassium-sparing diuretics Loop diuretics Osmotic diuretics Thiazide diuretics

The correct answer is: Potassium-sparing diuretics - Block the action of aldosterone (sodium and water retention) which result in potassium retention and the secretion of sodium and water., Loop diuretics - Work on the ascending limb of the loop of Henle to block reabsorption of sodium and chloride and to prevent reabsorption of water., Osmotic diuretics - Reduce intracranial pressure and intraocular pressure by raising serum osmolality and drawing fluid back into the vascular and extravascular space., Thiazide diuretics - Work in the early distal convoluted tubule to block the reabsorption of sodium and chloride and prevent the reabsorption of water that this site.

Match the hematopoietic medication to the correct expected pharmacological action. Thrombopoietic growth factor that increase the production of platelets. Granulocyte macrophage colony stimulator that acts on the bone marrow to increase production of white blood cells (neutrophils, monocytes, macrophages, eosinophils). Leukopoietic growth factor that stimulates the bone marrow to increase production of neutrophils. Erythropoietic growth factor that acts on the bone marrow to increase production of red blood cells.

The correct answer is: Thrombopoietic growth factor that increase the production of platelets. - oprelvekin, Granulocyte macrophage colony stimulator that acts on the bone marrow to increase production of white blood cells (neutrophils, monocytes, macrophages, eosinophils). - sargramostim, Leukopoietic growth factor that stimulates the bone marrow to increase production of neutrophils. - filgrastim, Erythropoietic growth factor that acts on the bone marrow to increase production of red blood cells. - epoetin alfa

Match the medication to the lab value that should be monitored during therapy with that medication. Match the antidote to the correct medication. Vitamin K Heparin Warfarin Protamine sulfate

The correct answer is: Vitamin K - Warfarin (Coumadin), Heparin - activated partial thromboplastin time (aPTT), Warfarin - prothrombin time (PT) and International Normalized Ratio (INR), Protamine sulfate - Heparin

Match the following medications with the correct classification. amiodarone glipizide ondansetron atenolol captopril clonidine ciprofloxacin prednisone terazosin

amitriptyline (Elavil) The correct answer is: amiodarone - Antidysrhythmic agent, glipizide - Oral hypoglycemic, Sulfonylurea, ondansetron - Antiemetic, Serotonin antagonist, atenolol - Beta Adrenergic Blocker, captopril - Angiotensin converting enzyme (ACE) inhibitor, clonidine - Centrally acting alpha-2 agonist, ciprofloxacin - Fluroquinolone, prednisone - Glucocorticoid, terazosin - Alpha-Adrenergic blocker