Pharmacology Practice HESI Exam

A client asks the nurse if glipizide (Glucotrol) is an oral insulin. Which response should the nurse provide?

"No, it is not an oral insulin and can be used only when some beta cell function is present." An effective oral form of insulin has not yet been developed because when insulin is taken orally, it is destroyed by digestive enzymes. Glipizide (Glucotrol) is an oral hypoglycemic agent that enhances pancreatic production of insulin.

A client receives a new prescription for sustained release levodopa/carbidopa PO BID for the treatment of Parkinson's disease. The client's previous prescription was levodopa PO TID. The client's last dose of levodopa was at 0800 hr. Which set of instructions should the nurse give to the client?

"You can begin taking the levodopa/carbidopa this evening, but do not take any more levodopa." Carbidopa combined with the levodopa significantly reduces the need for levodopa in clients with Parkinson's disease, so the new prescription should not be started until eight hours after the previous dose of levodopa, but can be started the same day.

Which client should the nurse identify as being at highest risk for complications during the use of an opioid analgesic?

A young adult with inflammatory bowel disease. The principal indication for opioid use is acute pain, and a client with inflammatory bowel disease is at risk for toxic megacolon or paralytic ileus related to slowed peristalsis, a side effect of morphine. Adverse effects of morphine do not pose as great a risk for clients with diabetes or a fracture as for the client with bowel disease.

When assessing an adolescent who recently overdosed on acetaminophen (Tylenol), it is most important for the nurse to assess for pain in which area of the body?

Abdomen. Acetaminophen toxicity can result in liver damage; therefore, it is especially important for the nurse to assess for pain in the right upper quadrant of the abdomen, which might indicate liver damage, along with nausea and vomiting.

An adult client has prescriptions for morphine sulfate 2.5 mg IV every 6 hours and ketorolac (Toradol) 30 mg IV every 6 hours. Which action should the nurse implement?

Administer both medications according to the prescription. Morphine and ketorolac (Toradol) can be administered concurrently, and may produce an additive analgesic effect, resulting in the ability to reduce the dose of morphine, as seen in this prescription. Toradol is an antiinflammatory analgesic, and does not have an antagonistic effect with morphine.

A client is taking hydromorphone (Dilaudid) PO every 4 hours at home. Following surgery, Dilaudid IV every 4 hours PRN and butorphanol tartrate (Stadol) IV every 4 hours PRN are prescribed for pain. The client received a dose of the Dilaudid IV four hours ago, and is again requesting pain medication. Which intervention should the nurse implement?

Administer only the Dilaudid every 4 hours PRN for pain. Dilaudid is an opioid agonist. Stadol is an opioid agonist-antagonist. Use of an agonist-antagonist for the client who has been receiving opioid agonists may result in abrupt withdrawal symptoms, and should be avoided.

A client's dose of isosorbide dinitrate (Imdur) is increased from 40 mg to 60 mg PO daily. When the client reports the onset of a headache prior to the next scheduled dose, which action should the nurse implement?

Administer the 60 mg dose of Imdur and a PRN dose of acetaminophen (Tylenol). Imdur is a nitrate which causes vasodilation. This vasodilation can result in headaches, which can generally be controlled with acetaminophen until the client develops a tolerance to this adverse effect.

A client prescribed albuterol tablets reports nausea every evening with the 9:00 p.m. dose. Which action should the nurse perform to alleviate this side effect?

Administer the dose with a snack. Administering oral doses of albuterol with food helps minimize gastrointestinal discomfort such as nausea.

Upon admission to the emergency center, an adult client with acute status asthmaticus is prescribed this series of medications. In which order should the nurse administer the prescribed medications? (Arrange from first to last.)

Albuterol (Proventil) puffs. Salmeterol (Serevent Diskus). Prednisone (Deltasone) orally. Gentamicin (Garamycin) IM. Status asthmaticus is potentially a life-threatening respiratory event, so albuterol, a beta2 adrenergic agonist and short acting bronchodilator, should be administered by inhalation first to provide rapid and deep topical penetration to relieve bronchospasms, dilate the bronchioles, and increase oxygenation. In stepwise management of persistent asthma, a long-action bronchodilator, such as salmeterol (Serevent Diskus), with a 12-hour duration of action should be given next. Prednisone, an oral corticosteroid, provides prolonged anti-inflammatory effects and should be given after the client's respiratory distress begins to resolves. Gentamicin, an antibiotic, is given deep IM, which can be painful, and may require repositioning the client, so should be last in the sequence.

The healthcare provider prescribes naproxen (Naproxen) twice daily for a client with osteoarthritis of the hands. The client tells the nurse that the drug does not seem to be effective after three weeks. Which is the best response for the nurse to provide?

Another type of nonsteroidal antiinflammatory drug may be indicated. Individual responses to nonsteroidal antiinflammatory drugs are vary from person to person, so another nonsteroidal antiinflammatory drug (NSAID) may be indicated for this particular client.

Which action is most important for the nurse to implement prior to the administration of the antiarrhythmic drug adenosine (Adenocard)?

Apply continuous cardiac monitoring. Adenosine (Adenocard) is an antiarrhythmic drug used to restore a normal sinus rhythm in clients with rapid supraventricular tachycardia. The client's heart rate should be monitored continuously for the onset of additional arrhythmias while receiving adenosine.

An adult client is given a prescription for a scopolamine patch (Transderm Scop) to prevent motion sickness while on a cruise. Which information should the nurse provide to the client?

Apply the patch at least 4 hours prior to departure. Scopolamine, an anticholinergic agent, is used to prevent motion sickness and has a peak onset in 6 hours, so the client should be instructed to apply the patch at least 4 hours before departure on the cruise ship. The duration of the transdermal patch is 72 hours. Scolopamine blocks muscarinic receptors in the inner ear and to the vomiting center, so the best application site of the patch is behind the ear. Anticholinergic medications are CNS depressants, so the client should be instructed to avoid alcohol while using the patch.

The healthcare provider prescribes digitalis (Digoxin) for a client diagnosed with heart failure. Which intervention should the nurse implement prior to administering the digoxin?

Assess the serum potassium level. Hypokalemia (decreased serum potassium) will precipitate digitalis toxicity in persons receiving digoxin. The nurse should monitor the client's serum potassium levels. Blood pressure and respiratory rate will not inform the nurse about potential safety issues with digitalis.

A client is prescribed morphine 1 mg IV per hour basal rate with 1 mg IV every 15 minutes per patient-controlled analgesia (PCA) pump for a total of 5 mg IV maximally per hour. Which nursing action has the highest priority before initiating the PCA pump?

Assessment of the rate and depth of the client's respirations. A life-threatening side effect of intravenous administration of morphine sulfate is respiratory depression. Prior to the initiation of the patient-controlled analgesia (PCA) pump, the nurse should assess the client's respirations to obtain a baseline of the client's respiratory rate and depth. Once the PCA pump is initiated, and if the client's respiratory rate falls below 12 breaths per minute, the PCA pump should be stopped and the healthcare provider notified immediately.

Which medications should the nurse caution the client about taking while receiving an opioid analgesic?

Benzodiazepines. Respiratory depression increases with the concurrent use of opioid analgesics and other central nervous system depressant agents, such as alcohol, barbiturates, and benzodiazepines. Antacids and antidiabetic agents do not interact with opiates to produce adverse effects. Antihypertensives may cause morphine-induced hypotension, but should not be withheld without notifying the healthcare provider.

Which antidiarrheal agent should be used with caution in clients taking high dosages of aspirin for arthritis?

Bismuth subsalicylate (Pepto Bismol). Bismuth subsalicylate (Pepto Bismol) contains a subsalicylate that increases the potential for salicylate toxicity when used concurrently with aspirin (acetylsalicylic acid, another salicylate preparation).

A client is receiving clonidine 0.1 mg/24 hr via transdermal patch. Which assessment finding indicates the desired effect of the medication has been achieved?

Blood pressure from 180/120 mmHg to 140/70 mmHg. Clonidine acts as a centrally-acting analgesic and antihypertensive agent. A reduction of the blood pressure reading of 180/120 mmHg to 140/70 mmHg indicates a reduction in hypertension.

Which change in data indicates to the nurse that the desired effect of the angiotensin II receptor antagonist valsartan has been achieved?

Blood pressure reduced from 160/90 mmHg to 130/80 mmHg. Valsartan is an angiotensin receptor blocker, prescribed for the treatment of hypertension. The desired effect is a decrease in blood pressure.

The nurse administers a dose of metoprolol for a client. Which assessment is most important for the nurse to obtain?

Blood pressure. It is most important to monitor the blood pressure of clients taking this medication because metoprolol is an antianginal, antiarrhythmic, antihypertensive agent.

While taking a medical history, the client states, "I am allergic to penicillin." What related allergy to another type of antiinfective agent should the nurse ask the client about when taking the nursing history?

Cephalosporins. According to research, there appears to be a cross sensitivity between penicillins and first generation cephalosporins; however, research shows there is no evidence of cross sensitivity between PCN and third or fourth generation cephalosporins.

Following the administration of sublingual nitroglycerin to a client experiencing an acute anginal attack, which assessment finding indicates to the nurse that the desired effect has been achieved?

Client states chest pain is relieved. Nitroglycerin reduces myocardial oxygen consumption which decreases ischemia and reduces chest pain.

The nurse is preparing an education session for a client prescribed opioids for intractable cancer pain. The nurse should include strategies to help prevent which common side effect associated with long-term use of opioids?

Constipation. The client should be prepared to implement measures for constipation, which is the most likely persistent side effect related to opioid use. Tolerance to opiate narcotics is common, and the client may experience less sedation and respiratory depression as analgesic use continues. Opioids increase the tone in the urinary bladder sphincter, which causes retention but may subside. The most likely persistent side effect is constipation.

A female client calls the clinic and talks with the nurse to inquire about a possible reaction after taking amoxicillin for 5 days. She reports having vaginal discomfort, itching, and a white discharge. The nurse should discuss which action with the client?

Consult with healthcare provider about another treatment for this effect. A superinfection with normal flora yeast may occur during antibiotic therapy. If suspected, the new onset of findings should be reported to the healthcare provider for another prescribed treatment to treat the superinfection.

The nurse is caring for a client who has taken atenolol for 2 years. The healthcare provider recently changed the medication to enalapril to manage the client's blood pressure. Which instruction should the nurse provide the client regarding the new medication?

D. Rise slowly when getting out of bed or chair. The client's new medication is an angiotensin-converting enzyme (ACE) inhibitor, which has the side effect oforthostatic hypotension. Instructing the client to rise slowly from a sitting or lying down position is important to teach the client to avoid dizziness and potentially falling.

A postoperative client receiving a continuous IV infusion of meperidine 35 mg/hr for the past four days has become increasingly restless and irritable, and begins to hallucinate. Which action should the nurse take first?

Decrease the IV infusion rate of the meperidine. The client is exhibiting symptoms of meperidine toxicity, which is consistent with the large doses of meperidine received over four days. Decreasing the infusion rate of the meperidine as per protocol is the most effective action to immediately decrease the amount of serum meperidine. The next nursing action is for the nurse to notify the healthcare provider.

A client is admitted to the hospital for diagnostic testing for possible myasthenia gravis. The nurse prepares for intravenous administration of edrophonium chloride (Tensilon). What is the expected outcome for this client following administration of this pharmacologic agent?

Decreased muscle weakness. Administration of edrophonium chloride (Tensilon), a cholinergic agent, will temporarily reduce muscle weakness, the most common complaint of newly-diagnosed clients with myasthenia gravis. This medication is used to diagnose myasthenia gravis due to its short duration of action. This drug would temporarily reverse difficulty in swallowing and respiratory effort.

The nurse admits a client with tumor-induced spinal cord compression. Which medication should the nurse anticipate to be prescribed to offer the best palliative treatment for this client?

Dexamethasone. Dexamethasone is a palliative treatment modality to manage symptoms related to compression due to tumor growth. Morphine sulphate is an opioid analgesic used in oncology to manage severe or intractable pain. Ibuprofen, a nonsteroidal antiinflammatory drug (NSAID), provides relief for mild to moderate pain, suppression of inflammation, and reduction of fever. Amitriptyline, a tricyclic antidepressant, is often prescribed for pain related to neuropathic origin and provides a reduction in opioid dosage.

A client receiving doxorubicin (Adriamycin) intravenously (IV) complains of pain at the insertion site, and the nurse notes edema at the site. Which intervention is most important for the nurse to implement?

Discontinue the IV fluids. Doxorubicin is an antineoplastic agent that causes inflammation, blistering, and necrosis of tissue upon extravasation. First, all IV fluids should be discontinued at the site to prevent further tissue damage by the vesicant.

An older client with a decreased percentage of lean body mass is admitted to the hospital. Which pharmacokinetic process is affected and should be considered in the client's dosing of medication?

Distribution. A decreased lean body mass in an older adult affects the distribution of drugs, which affects the pharmacokinetics of drug and how the medication is distributed throughout the body.

A client with heart failure is being discharged with a new prescription for the angiotensin-converting enzyme (ACE) inhibitor captopril (Capoten). The nurse's discharge instructions should include reporting which problem to the healthcare provider?

Dizziness. Angiotensin-converting enzyme (ACE) inhibitors are used in heart failure to reduce afterload by reversing vasoconstriction common in heart failure. This vasodilation can cause hypotension and resultant dizziness. Weight loss is desired if fluid overload is present, and may occur as the result of effective combination drug therapy such as diuretics with ACE inhibitors. It does not require reporting to the healthcare provider. Unlike ACE inhibitors, diuretics may result in hypokalemia and excessive diuretic administration may result in fluid volume deficit manifested by symptoms of dehydration.

The nitrate isosorbide dinitrate is prescribed for a client with angina. Which instruction should the nurse include in this client's discharge teaching plan?

Do not get up quickly. Always rise slowly. An expected side effect of nitrates is orthostatic hypotension and the nurse should instruct the client to prevent it by rising slowly.

A client is experiencing anaphylaxis from an insect sting. Which medication should the nurse administer?

Epinephrine. Epinephrine is an adrenergic agent that stimulates beta receptors to increase cardiac automaticity in cardiac arrest and relax bronchospasms in anaphylaxis. Epinephrine is the medication of choice in treating anaphylaxis.

A client is prescribed controlled-release oxycodone. Which dosing schedule is best for the nurse to teach the client?

Every 12 hours. A controlled-release oxycodone provides long-acting analgesia to relieve moderate to severe pain, so a dosing schedule of every 12 hours provides the best around-the-clock pain management. Controlled-release oxycodone is not prescribed for breakthrough pain on a PRN or as needed schedule. Using a schedule of every 4 to 6 hours may jeopardize client safety due to cumulative effects of the medication.

A client with a dysrhythmia is prescribed procainamide (Pronestyl) in 4 divided doses over the next 24 hours. Which dosing schedule is best for the nurse to implement?

Every 6 hours. Pronestyl is a class 1A antidysrhythmic. It should be taken around the clock, so that a stable blood level of the drug can be maintained, thereby decreasing the possibility of hypotension (an adverse effect) occurring because of too much of the drug circulating systemically at any particular time of day. Pronestyl may be given with food if GI distress is a problem.

A client with hyperlipidemia receives a prescription for niacin (Niaspan). Which client teaching is most important for the nurse to provide?

Expected duration of flushing. Flushing of the face and neck, lasting up to an hour, is a frequent reason for discontinuing niacin. Inclusion of this effect in client teaching may promote compliance in taking the medication. While nutrition tips and managing pruritus are worthwhile instructions to help clients minimize or cope with normal side effects associated with niacin (Niaspan), flushing is intense and causes the most concern for the client.

A client prescribed atenolol has a blood pressure of 120/68 mmHg, displaying a sinus bradycardia with a rate of 58 beats/minute, and a P-R interval of 0.24. Which action should the nurse take?

Give the medication as prescribed and continue to monitor the client. Since the client's blood pressure is within normal limits, and the pulse is above 50 beats/min with a first degree block, the medication can be administered. Atenolol is a beta-blocker that slows the heart rate and lowers the blood pressure; this drug is generally held if the heart rate is less than 50 beats/min or the client exhibits dizziness related to hypotension.

The healthcare provider prescribes a beta-1 agonist medication to be administered. The nurse should anticipate the medication to be prescribed for a client diagnosed with which condition?

Heart failure. Beta-1 agonists improve cardiac output by increasing the heart rate and blood pressure. They are indicated in heart failure, shock, atrioventricular block dysrhythmias, and cardiac arrest.

A client is prescribed 1 mcg/kg/min of dobutamine hydrochloride via IV infusion. Which client's condition would benefit the most from an administration of dobutamine hydrochloride?

Heart failure. Dobutamine is a beta-1 adrenergic agonist that is indicated for short term use in cardiac decompensation or heart failure related to reduced cardiac contractility due to organic heart disease or cardiac surgical procedures.

A peak and trough level is prescribed for a client receiving antibiotic therapy. When should the nurse should obtain the trough level?

Immediately before the next antibiotic dose is given. Trough levels are drawn when the blood level is at its lowest, which is typically just before the next dose is given.

Which instruction) should the nurse give to a female client who just received a prescription for oral metronidazole (Flagyl) for treatment of trichomonas vaginalis? (Select all that apply.)

Increase fluid intake, especially cranberry juice. Avoid drinking alcohol while taking this medication. Use condoms until treatment is completed. Ensure that all sexual partners are treated at the same time. Increased fluid intake and cranberry juice are recommended for prevention and treatment of urinary tract infections, which frequently accompany vaginal infections. It is not necessary to taper use of this drug or to check the blood pressure daily, as this condition is not related to hypertension. Flagyl can cause a disulfiram-like reaction if taken in conjunction with ingestion of alcohol, so the client should be instructed to avoid alcohol. All sexual partners should be treated at the same time and condoms should be used until after treatment is completed to avoid reinfection.

Which nursing intervention is most important when caring for a client receiving the antimetabolite cytosine arabinoside (Arc-C) for chemotherapy?

Inspect the client's oral mucosa for ulcerations. Cytosine arabinoside (Arc-C) affects the rapidly growing cells of the body, therefore stomatitis and mucosal ulcerations are key signs of antimetabolite toxicity.

A client is prescribed aluminum hydroxide for peptic ulcer disease. Which statement by the client demonstrates an understanding of the action of the medication?

It helps maintain a gastric pH of 3.5 or above. The objective of antacids is to neutralize gastric acids and keep a gastric pH of 3.5 or above, which is necessary for pepsinogen inactivity.

A client being treated for hyperthyroidism with propylthiouracil (PTU) asks the nurse how the medication works. Which is the best response to give the client?

It inhibits the synthesis of T3 and T4 by the thyroid gland. Propylthiouracil (PTU) is an adjunct therapy used to control hyperthyroidism by inhibiting the production of thyroid hormones. It is often prescribed in preparation for thyroidectomy or radioactive iodine therapy.

A client with Parkinson's disease is taking carbidopa-levodopa (Sinemet). Which observation by the nurse would indicate that the desired outcome of the medication is being achieved?

Lessening of tremors. Sinemet increases the amount of levodopa to the CNS (dopamine to the brain). Increased amounts of dopamine improve the symptoms of Parkinson's, such as involuntary movements, resting tremors, shuffling gait, etc. Decreased drooling would be a desired effect, not increased salivation.

A client who was prescribed atorvastatin (Lipitor) one month ago calls the triage nurse at the clinic complaining of muscle pain and weakness in his legs. Which statement reflects the correct drug-specific teaching the nurse should provide to this client?

Make an appointment to see the healthcare provider, because muscle pain may be an indication of a serious side effect. Myopathy, suggested by the leg pain and weakness, is a serious and potentially life-threatening complication of Lipitor, and should be evaluated immediately by the healthcare provider.

A client with acute myocardial infarction is admitted to the coronary care unit. Which medication should the nurse administer to lessen the workload of the heart by decreasing the cardiac preload and afterload?

Nitroglycerin. Nitroglycerin is a nitrate that causes peripheral vasodilation and decreases contractility, thereby decreasing both preload and afterload.

The nurse is assessing the effectiveness of high dose aspirin therapy for an 88-year-old client with arthritis. The client reports hearing non-stop ringing in the ears. Which action should the nurse implement?

Notify the healthcare provider of the finding immediately. Tinnitus (ringing in the ears) is an early sign of salicylate toxicity. The healthcare provider should be notified immediately, and the medication discontinued.

A client has a continuous IV infusion of dopamine (Intropin) and an IV of normal saline at 50 mL/hour. The nurse notes that the client's urinary output has been 20 mL/hour for the last 2 hours. Which intervention should the nurse initiate?

Notify the healthcare provider of the urinary output. The main effect of dopamine is adrenergic stimulation used to increase cardiac output, which should also result in increased urinary output. A urinary output of less than 20 mL/hour is oliguria and should be reported to the healthcare provider, so the dose of dopamine can be adjusted. Depending on the current rate of administration, the dose may need to be increased or decreased.

A client with osteoarthritis receives a new prescription for celecoxib (Celebrex) orally for symptom management. The nurse notes the client is allergic to sulfa. Which action is most important for the nurse to implement prior to administering the first dose?

Notify the healthcare provider. Celebrex contains a sulfur molecule, which can lead to an allergic reaction in individuals who are sensitive to sulfonamides, so the healthcare provider should be notified of the client's allergies.

A client being discharged home is prescribed an antibiotic with a dosage three times higher than it was administered when the client was in the hospital. Which route of administration should the nurse anticipate will be prescribed for the greatest first-pass effect?

Oral. The first-pass effect is a pharmacokinetic phenomenon that is related to the drug's metabolism in the liver. After oral medications are absorbed from the gastrointestinal tract, the drug is carried directly to the liver via the hepatic portal circulation, where hepatic inactivation occurs and reduces the bioavailability (strength/concentration) of the drug.

The nurse is reviewing admission prescriptions for a client with myxedema. The nurse should clarify with the healthcare provider which prescription for the client?

Pentobarbital sodium for sleep. Clients with myxedema are dangerously hypersensitive to narcotics, barbiturates and anesthetics and should not be prescribed these medications if possible.

A client is admitted to the hospital for a new onset of supraventricular tachycardia (SVT) and is prescribed digoxin. For which laboratory finding should the nurse notify the healthcare provider immediately?

Potassium level of 3.1 mEq/L. Hypokalemia affects myocardial contractility and places this client at greatest risk for dysrhythmias that may be unresponsive to drug therapy. Although an imbalance of serum sodium, calcium, and magnesium can effect cardiac rhythm, the greatest risk for a client receiving digoxin is low potassium.

The nurse is planning discharge instructions for a client prescribed cyclosporine following a liver transplant. Which adverse reactions should the nurse instruct the client to report to the healthcare provider?

Presence of hand tremors. Neurological complications, such as hand tremors, occur in about 50% of clients taking cyclosporine and should be reported. Although this drug can be nephrotoxic, changes in urine color typically does not occur. Nausea is a common side effects, but is not usually severe.

A client being discharged is prescribed warfarin for the treatment following a pulmonary embolism. Which diagnostic test should the nurse instruct the client to receive once a month?

Prothrombin Time (PT). When used for a client with pulmonary embolus, the therapeutic goal for warfarin therapy is a PT 1 to 2 times greater than the control, or an INR of 2 to 3. A client prescribed warfarin should have the PT or INR levels checked at a minimum once a month.

The nurse is making early morning rounds on a group of clients when a client begins exhibiting symptoms of an acute asthma attack. The nurse administers a PRN prescription for a Beta 2 receptor agonist agent. Which client response should the nurse expect?

Rapid resolution of wheezing. Correct Improved pulse oximetry values. Correct Beta 2 receptor agonist agents should provide immediate return of airflow and resolve wheezing and improve oxygenation.

A client is prescribed ampicillin sodium (Omnipen) for a sinus infection. The nurse should instruct the client to notify the healthcare provider immediately if which symptom occurs?

Rash. Rash is the most common adverse effect of all penicillins, indicating an allergy to the medication that could result in anaphylactic shock, a medical emergency.

A client with heart failure is prescribed spironolactone (Aldactone). Which information is most important for the nurse to provide to the client about diet modifications?

Refrain for eating foods high in potassium. Spironolactone (Aldactone), an aldosterone antagonist, is a potassium-sparing diuretic, so a diet high in potassium should be avoided, along with table salt substitutes, which generally contain potassium chloride that can lead to hyperkalemia.

The healthcare provider prescribes naloxone (Narcan) for a client in the emergency room. Which assessment data would indicate that the naloxone has been effective?

Respiratory rate is 16 breaths/minute. Naloxone (Narcan) is a narcotic antagonist that reverses the respiratory depression effects of opiate overdose, so assessment of a normal respiratory rate would indicate that the respiratory depression has been reversed.

Which nursing diagnosis is important to include in the plan of care for a client receiving the angiotensin-2 receptor antagonist irbesartan (Avapro)?

Risk for injury. Avapro is an antihypertensive agent, which acts by blocking vasoconstrictor effects at various receptor sites. This can cause hypotension and dizziness, placing the client at high risk for injury.

A client is receiving methylprednisolone 40 mg IV daily. The nurse should monitor which laboratory value closely?

Serum glucose. Methylprednisolone is a corticosteroid with glucocorticoid and mineralocorticoid actions. These effects can lead to hyperglycemia, which is reflected as an increase in the serum glucose value. The client taking methylprednisolone is also at risk for hypocalcemia and hypokalemia. These medications also alter the some of the body's immune responses by suppressing the migration of white blood cells decreasing inflammation response.

A 43-year-old female client is prescribed thyroid replacement hormone following a thyroidectomy. Which adverse effects should the nurse instruct the client to report immediately to the healthcare provider?

Tachycardia and chest pain. Thyroid replacement hormone increases the metabolic rate of all tissues. Common signs and symptoms of toxicity include tachycardia and chest pain and should be reported to the healthcare provider immediately.

A client is being treated for osteoporosis with alendronate (Fosamax), and the nurse has completed discharge teaching regarding medication administration. Which morning schedule would indicate to the nurse that the client teaching has been effective?

Take medication, go for a 30 minute morning walk, then eat breakfast. Alendronate (Fosamax) is best absorbed when taken thirty minutes before eating in the morning. The client should also be advised to remain in an upright position for at least thirty minutes after taking the medication to reduce the risk of esophageal reflux and irritation.

A client with giardiasis is taking metronidazole (Flagyl) 2 grams PO. Which information should the nurse include in the client's instruction?

Take the medication with food. Correct Flagyl, an amoebicide and antibacterial agent, may cause gastric distress, so the client should be instructed to take the medication on a full stomach. Urine may be red-brown or dark from taking Flagyl, but this side effect is an expectant finding and not necessary to report tot he healthcare provider.

After abdominal surgery, a client is prescribed low molecular weight heparin (LMWH). During administration of the medication, the client asks the nurse the reason for the medication. Which is the best response for the nurse to provide the client?

This medication is given to prevent blood clot formation. Unfractionated heparin or low molecular weight heparin (LMWH) is an anticoagulant that inhibits thrombin-mediated conversion of fibrinogen to fibrin and is given prophylactically to prevent postoperative venous thrombosis in order to prevent pulmonary embolism or deep vein thrombosis following knee and abdominal surgeries.

In evaluating the effects of lactulose (Cephulac), which outcome would indicate that the drug is performing as intended?

Two or three soft stools per day. The medication lactulose can be administered for either chronic constipation or for portal-systemic encephalopathy in clients with hepatic disease. Two to three stools a day indicate that lactulose is performing as intended for chronic constipation. This would also indicate it should be effective for the clients with encephalopathy because the lactulose's action prevents absorption of ammonia in the colon as it increases water absorption and softens the stool. The efficacy of the use for ammonia absorption would have to be verified by a serum ammonia level and observation of clearing of the client's mental status.

A Category X drug is prescribed for a young adult female client. Which instruction is most important for the nurse to teach this client?

Use a reliable form of birth control. Drugs classified in the Category X place a client who is in the first trimester of pregnancy at risk for teratogenesis, so women in the childbearing years should be counseled to use a reliable form of birth control during drug therapy. If the client is planning to become pregnant, she should be encouraged to discuss plans for pregnancy with the healthcare provider, so a safer alternative prescription can be provided if pregnancy occurs.

A female client with rheumatoid arthritis takes ibuprofen (Motrin) 600 mg PO 4 times a day. To prevent gastrointestinal bleeding, misoprostol (Cytotec) 100 mcg PO is prescribed. Which information is most important for the nurse to include in client teaching?

Use contraception during intercourse. Cytotec, a synthetic form of a prostaglandin, is classified as pregnancy Category X and can act as an abortifacient, so the client should be instructed to use contraception during intercourse to prevent loss of an early pregnancy. A common side effect of Cytotec is diarrhea, so constipation prevention strategies are usually not needed. Cytotec and Motrin should be taken together to provide protective properties against gastrointestinal bleeding.

The nurse is transcribing a new prescription for spironolactone (Aldactone) for a client who receives an angiotensin-converting enzyme (ACE) inhibitor. Which action should the nurse implement?

Verify both prescriptions with the healthcare provider. The concomitant use of an angiotensin-converting enzyme (ACE) inhibitor and a potassium-sparing diuretic such as spironolactone, should be given with caution because the two drugs may interact to cause an elevation in serum potassium levels. Although the client is currently receiving an ACE inhibitor, verifying both prescriptions alerts the healthcare provider about the client's medication regimen and provides the safest action before administering the medication.

A client with coronary artery disease who is taking digoxin (Lanoxin) receives a new prescription for atorvastatin (Lipitor). Two weeks after initiation of the Lipitor prescription, the nurse assesses the client. Which finding requires the most immediate intervention?

Vomiting. Vomiting, anorexia, and abdominal pain are early indications of digitalis toxicity. Since Lipitor increases the risk for digitalis toxicity, this finding requires the most immediate intervention by the nurse.

The nurse is providing care for a client prescribed propranolol. Which symptoms should the nurse report to the healthcare provider immediately?

Wheezing, hypotension, and AV block. Wheezing, hypotension, and AV block represents the most serious adverse effects of beta-blocking agents. AV block is generally associated with bradycardia and results in potentially life-threatening decreases in cardiac output. Additionally, wheezing secondary to bronchospasm and hypotension represent life-threatening respiratory and cardiac disorders.

The nurse is preparing the 0900 dose of losartan (Cozaar), an angiotensin II receptor blocker (ARB), for a client with hypertension and heart failure. The nurse reviews the client's laboratory results and notes that the client's serum potassium level is 5.9 mEq/L. Which action should the nurse take first?

Withhold the scheduled dose. The nurse should first withhold the scheduled dose of Cozaar because the client is hyperkalemic (normal range 3.5 to 5 mEq/l). Although hypokalemia is usually associated with diuretic therapy in heart failure, hyperkalemia is associated with several heart failure medications, including ARBs. Because hyperkalemia may lead to cardiac dysrhythmias, the nurse should check the apical pulse for rate and rhythm, and blood pressure. Awarded 1.0 points out of 1.0 possible