Pharmacology Exam 3 Review
A client is taking large doses of acetylsalicylic acid for rheumatoid arthritis. Which assessment findings indicate that the client is experiencing ototoxicity as a result of the medication?
Tinnitus, hearing loss, dizziness, and ataxia
A client about to receive a morning dose of digoxin has an apical pulse of 50 beats/min. What will the nurse do next?
Withhold the dose, and notify the prescriber. Digoxin doses are held and the prescriber notified if the apical pulse is 60 beats/min or lower or is higher than 100 beats/min.
Given the nurse's knowledge of the side effects of alpha blockers, which instruction should the nurse provide to the client with a new order for an alpha blocker to treat hypertension?
change positions slowly Orthostatic hypertension can with anti-hypertensive medications
A client is receiving both captopril and spironolactone for treatment of hypertension. The nurse should carefully monitor which laboratory test?
serum potassium Spironolactone, which is a potassium-sparing diuretic that is an aldosterone antagonist, and enalapril, which is an angiotensin-converting-enzyme (ACE) inhibitor, both contribute to elevated potassium levels in the body. The nurse will need to monitor the client's blood work carefully and report any elevated potassium level.
A client is being treated for a blood pressure of 200/130. Which medication does the nurse anticipate to administer?
sodium nitroprusside Given in emergency situations to treat hypertension
The nurse is teaching a client how to self-administer triptan injections for migraine headaches. Which statement by the client indicates that he needs further teaching?
"I will take this medication regularly to prevent a migraine headache from occurring."
The nurse is teaching a client with hypertension about the prescribed antihypertensive medications: hydrochlorothiazide (HCTZ) and enalapril. What is important to include in this teaching?
"Stand up slowly to decrease problems with dizziness." A common side effect of a combination of antihypertensive (enalapril) and diuretic (HCTZ) medications is postural hypotension. I
A 65 year-old-client has been taking clonidine for 8 months. For the past 3 months, the client's blood pressure has been in the range of 104-118/72-78. During this clinic visit, the client states, "I'd like to stop taking this medication because my blood pressure is fine now." What is the nurse's best response?
"This drug should not be stopped suddenly; let's talk to your provider."
The nurse is assessing a client for contraindications to drug therapy with acetaminophen. Which client should not receive acetaminophen?
A client with a history of liver disease Liver disease is a contraindication to the use of acetaminophen.
A client is admitted to the hospital for a diagnostic workup for hypertension. What assessment data gathered by the nurse would confirm this diagnosis?
A sustained increase in systolic pressure above 140 mm Hg and diastolic above 90 mm Hg The diagnosis of hypertension is based on the sustained increases in systolic (greater than 140 mm Hg) and diastolic (greater than 90 mm Hg) pressures.
A client is in the intensive care unit and receiving an infusion of milrinone for severe heart failure. The prescriber has written an order for an intravenous dose of furosemide. How will the nurse give this drug?
Administer the furosemide in a separate intravenous line. Furosemide must not be injected into an intravenous line with milrinone because it will precipitate immediately. The infusion must not be stopped because of the client's condition. A separate line will be needed.
The client with coronary artery disease (CAD) is prescribed cholestryramine. Which intervention should the nurse implement when administering the medication?
Administer the medication with fruit juice The medication should be administered with water, fruit juice, soup or pulpy fruit (applesauce, pineapple) to reduce the risk of esophageal irritation.
A 78-year-old client is in the recovery room after having a lengthy surgery on his hip. As the client is gradually awakening, the client requests pain medication. Within 10 minutes after receiving a dose of morphine sulfate, the client is very lethargic and respirations are shallow, with a rate of 7 breaths/minute. The nurse prepares for which priority action at this time?
Administration of naloxone Naloxone, an opioid-reversal agent, is used to reverse the effects of acute opioid overdose and is the drug of choice for reversal of opioid-induced respiratory depression.
A client 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?
Amiodarone Amiodarone is the drug of choice for ventricular dysrhythmias according to the Advanced Cardiac Life Support guidelines.
Which drug classes are considered first-line treatment for heart failure? (Select all that apply.
Angiotensin-converting enzyme (ACE) inhibitors Beta blockers Angiotensin II receptor blockers
The nurse is completing morning care with a client diagnosed with angina when the client complains of chest pain. The client has a saline lock in the right forearm (no fluids are infusing). Which intervention should the nurse at the beside implement first?
Assess the client's vital signs. The nurse would have oxygen at the bedside, and applying it would be the first intervention the nurse could implement at the bedside.
While assessing a patient who is taking a beta blocker for angina, the nurse knows to monitor for which adverse effect?
Bradycardia Adverse effects of beta blockers include bradycardia, hypotension, dizziness, lethargy, impotence, and several other effects, but not dry cough or nervousness.
A client has been prescribed codeine. The nurse has given the client instructions for its use. The nurse concludes that the client understands the instructions if the client verbalizes to self-assess for which side effect?
Constipation The client is taught about side and adverse effects that could occur with the use of codeine sulfate. The most common side effects include drowsiness, confusion, hypotension, nausea and vomiting, and constipation. Adverse effects include bradycardia, respiratory depression, and urinary retention.
A client has been started on therapy of a continuous infusion of lidocaine after receiving a loading dose of the drug. The nurse will monitor the client for which adverse effect?
Convulsions Convulsions are possible if lidocaine reaches toxic levels.
A client is taking procainamide for a cardiac dysrhythmia. The nurse will monitor the patient for which possible adverse effect?
Diarrhea Diarrhea is a potential adverse effect of procainamide therapy.
A client is concerned about the adverse effects of the fibric acid derivative she is taking to lower her cholesterol level. Which is an adverse effect of this class of medication?
Diarrhea Fibric acid derivatives may cause nausea, vomiting, diarrhea, drowsiness, and dizziness. Other effects are listed in Table 27-8. The other options are not adverse effects of fibric acid derivatives.
The nurse will monitor for myopathy when a client is taking which class of dislipidemic/antilipemic drugs?
HMG-CoA reductase inhibitors Myopathy (muscle pain) is a clinically important adverse effect that may occur with HMG-CoA reductase inhibitors. It may progress to a serious condition known as rhabdomyolysis. Patients receiving statin therapy need to be advised to report any unexplained muscular pain or discomfort to their health care providers immediately.
A client has been prescribed lisinopril for treatment of hypertension. Several days later, the client calls the nurse complaining of a nagging, dry cough and some swelling around the lips and tongue. What would be the best response by the nurse?
Have the client see the health care provider immediately.
The nurse is preparing discharge teaching for a client with hypertension who is being treated with furosemide. The nurse would caution the client about which over-the-counter medication?
Ibuprofen
A client has been diagnosed with angina and will be given a prescription for sublingual nitroglycerin tablets. When teaching the client how to use sublingual nitroglycerin, the nurse will include which instruction?
If the chest pain is not relieved after one tablet, call 911 immediately. According to current guidelines, if the chest pain or discomfort is not relieved in 5 minutes, after 1 dose, the patient (or family member) must call 911 immediately.
A nurse is caring for a client with intracranial edema. After the administration of mannitol, what outcome should the nurse expect to occur?
Increased tubular excretion of water Mannitol is an osmotic diuretic that creates an osmotic force in the nephron and inhibits reabsorption of water.
An older adult client has been taking chlorothiazide for several months for treatment of blood pressure. What nursing assessment findings would correlate with the client having hypokalemia?
Increased weakness and fatigue Clients taking thiazide and thiazide-like diuretics most often develop problems with hypokalemia, which is characterized by hypotension, tachydysrhythmias, muscle weakness, abdominal pain, diminished bowel sounds, and paralytic ileus.
A client has a digoxin level of 1.1 ng/mL. Which interpretation by the nurse is correct?
It is within the therapeutic range. The normal therapeutic drug level of digoxin is between 0.5 and 2 ng/mL.
Colchicine is prescribed for a client with a diagnosis of gout. The nurse reviews the client's record, knowing that this medication would be used with caution in which disorder?
Kidney disease Colchicine is used with caution in older clients, debilitated clients, and clients with cardiac, kidney, or gastrointestinal disease.
While a client is receiving dyslipidemic/antilipemic therapy, the nurse knows to monitor the patient closely for the development of which problem?
Liver dysfunction Antilipemic drugs may adversely affect liver function; therefore, liver function studies need to be closely monitored.
A client reports frequent use of acetaminophen for relief of headaches and other discomforts. The nurse would evaluate which diagnostic data to determine whether the client is at risk for toxicity?
Liver function studies In adults, overdose of acetaminophen causes liver damage. In addition, clients with liver disorders are at a higher risk of experiencing hepatotoxicity with chronic acetaminophen use.
In assessing a client before administration of a cardiac glycoside, the nurse knows that which lab result can increase the toxicity of the drug?
Potassium level 2.8 mEq/L Hypokalemia increases the chance of digitalis toxicity.
The nurse is preparing to administer spironolactone to a client. After assessing the client, what data indicate the need to withhold the medication and notify the health care provider?
Potassium level: 5.8 mEq/L Spironolactone is a potassium-sparing diuretic. The client's potassium level is high; therefore, the medication should be held and the doctor should be notified
The nurse is reviewing the classes of antidysrhythmic drugs. Amiodarone is classified on the Vaughan Williams classification as a class III drug, which means it works by which mechanism of action?
Prolonging action potential duration Vaughan Williams class III drugs (amiodarone, dronedarone, sotalol, ibutilide, and dofetilide) increase the action potential duration by prolonging repolarization in phase 3.
A client with elevated lipid levels has a new prescription for nicotinic acid. The nurse informs the patient that which adverse effects may occur with this medication?
Pruritus, cutaneous flushing Possible adverse effects of nicotinic acid include pruritus, cutaneous flushing, and gastrointestinal distress.
The nurse is caring for a client who has been taking hydrocodone for the last 3 months. For which side and adverse effects of this medication would the nurse assess the client?
Psychological and physical dependence Hydrocodone is an opioid analgesic that also has antitussive properties. Side and adverse effects of this medication include physical and psychological dependence, bradycardia and hypotension, respiratory depression, nausea, vomiting, constipation, sedation, and confusion.
When the nurse is administering topical nitroglycerin ointment, which technique is correct?
Remove the old ointment before new ointment is applied. he ointment should be applied to clean, dry, hairless skin of the upper arms or body, not below the elbows or below the knees.
What would be important to teach a client who is being prescribed furosemide for control of hypertension?Select all that apply.
Report changes in hearing Be sure to rise slowly from chairs Nausea can be a side effect
A client with cancer is receiving a continuous intravenous infusion of morphine sulfate. The nurse monitoring the client for adverse effects would become most concerned about which vital sign?
Respirations of 10 breaths/minute Before an opioid is administered, respiratory rate, blood pressure, and pulse rate need to be assessed. Morphine sulfate needs to be withheld and the primary health care provider notified if the respiratory rate is at or below 12 breaths per minute, if the blood pressure is significantly below the pretreatment value, or if the pulse rate is significantly above or below pretreatment value.
The nurse is caring for a client who underwent an open reduction internal fixation to the right hip. When administering opioid analgesics for pain, the nurse would instruct the client that which are side and adverse effects of opioid analgesics? Select all that apply.
Sedation Respiratory Depression Constipation
A client will be discharged on quinidine sulfate extended-release tablets for the treatment of ventricular ectopy. The nurse will include which information in the teaching plan?
Signs of cinchonism, such as tinnitus, loss of hearing, or slight blurring of vision, may occur. Quinidine may cause the symptoms of cinchonism, including tinnitus, loss of hearing, slight blurring of vision, and gastrointestinal upset.
Propofol is being administered to induce sedation in a client who is intubated and is being mechanically ventilated. The nurse would monitor for which adverse effect during infusion of the medication?
Signs of respiratory depression Propofol is an anesthetic agent that is used to provide continuous sedation in a client receiving mechanical ventilation. Adverse effects include respiratory depression and cardiovascular depression. Itching, skin redness, and elevated triglyceride levels are possible side effects, not adverse effects.
A client is seen in the hospital emergency department after injury to the right ankle. The client tells the nurse that the ankle was twisted while playing volleyball. The primary health care provider (PHCP) has prescribed a topical analgesic cream for the injury. The nurse providing instruction about the medication would provide the client with which information?
That the medication contains a combination of medications, one of which is an analgesic Topical analgesics are used for the temporary relief of muscular aches, rheumatism, arthritis, sprains, and neuralgia.
The nurse is administering propranolol to a client who is being treated for hypertension. What is the desired response to this medication?
The cardiac rate is decreased with a resulting decrease in the cardiac output. The primary action of the beta blocker propranolol is to slow the cardiac rate. The medication is effective in the treatment of hypertension or dysrhythmias that result in tachycardia.
The nurse is the health care provider's (HCP's) office is completing an assessment on a client who has been prescribed digoxin for congestive heart failure (CHF). Which data indicates the medication has been effective?
The client has clear breath sounds bilaterally. Clear lung sounds bilaterally indicate the treatment is effective. The nurse assess for the cues of the disease for which the medication is being administered. If the symptoms are resolving, then the medication is effective.
The nurse is administering 1300 medications to the following clients. Which client should the nurse question administering the medication?
The client receiving carvedilol with a dorsalis pedis pulse of 45 beats per minute The pulse should be greater than 60 beats per minute before a BB is administered because this medication can cause bradycardia.
Which assessment data should the nurse obtain prior to administering a calcium channel blocker?
The client's blood pressure The nurse should not administer this medication if the client's BP is less than 90/60 because it will further decrease the blood pressure, resulting in the brain not being perfused with oxygen.
Which data indicates to the nurse that gemfibrozil is effective?
The client's high-density lipoprotein (HDL) is 70 mg/dL To demonstrate effectiveness of treatment, the HDL being MORE than 45 mg/dL in males and 55 mg/dL in females) shows that the medication is working. The LDL needs to below 130 mg/dL. Total cholesterol needs to be below 200. The mg/dL And the normal range for triglycerides is 35-135 mg/dL in females and 45-160 mg/dL in males
The client with chronic low back pain has been taking baclofen. Which instruction should the nurse review with the client?
The medication must be tapered off when discontinued.
The primary health care provider has prescribed a lidocaine 5% patch for a client with a diagnosis of neck pain due to osteoarthritis. What would the nurse tell the client regarding this medication?
The medication patch will act as a local anesthetic. A lidocaine patch provides a local anesthetic effect to the site of application. The medication does not act in a systemic manner. It is not prescribed to cause the skin to peel, so if this reaction occurs, the primary health care provider would be notified.
