pn pharmacology online practice 2020 A

A nurse is reinforcing teaching with a female client who has a new prescription for isotretinoin. which of the following information should the nurse include in the teaching? (Select all that apply)

[-] you will need to have liver enzymes monitored after 1 month [-] you can nosebleed while taking this medication [-you should report any thoughts of harming yourself [-] you will need to have two negative pregnancy test prior to starting this medication "You will need to have your liver enzymes monitored after 1 month" is correct. The client should have their liver enzymes monitored 1 month after therapy and periodically thereafter because isotretinoin is metabolized in the liver. "You can have nosebleeds while taking this medication" is correct. Due to the drying effects of isotretinoin, nosebleeds are very common. "You should report any thoughts of harming yourself" is correct. Isotretinoin can cause depression, which can lead to suicide. The client or the client's family should report these thoughts to the provider. "You will need to have two negative pregnancy tests prior to starting the medication" is correct. Due to the potential for severe birth defects, it is important to confirm the client is not pregnant.

A nurse is collecting data from a client who is receiving digoxin for treatment of heart failure. The nurse should identify which of the following findings as adverse effects of this medication. (Select all that apply.)

[] blurred vision [] Nausea [] Dysrhythmias -Blurred vision is correct. The nurse should identify visual changes such as blurred vision, halos, and a yellow or green tinge to vision as adverse effects of digoxin. -Nausea is correct. The nurse should identify that nausea and vomiting are adverse effects of digoxin. -Dysrhythmia is correct. The nurse should identify that dysrhythmias are an adverse effect of digoxin.

A nurse is preparing to administer a PRN medication to a group of clients. which of the following clients should the nurse administer medication to first?

a client who is attending postoperative physical therapy and requests pain medication

A nurse is reinforcing teaching with a client who has a new prescription for colchicine to manage gouty arthritis, which of the following manifestations should the nurse include as an adverse effect of this medication?

abdominal pain Abdominal pain indicates cellular damage to the gastrointestinal tract. The nurse should notify the provider, and the client should discontinue the medication immediately.

A nurse is reinforcing teaching with a client who has seizures and a new prescription for valproic acid. The nurse should instruct the client to report which of the following adverse effects of valproic acid to the provider immediately?

abdominal pain The greatest risk to the client is hepatotoxicity and pancreatitis, which can cause abdominal pain. Therefore, the client should notify the provider immediately if experiencing a decrease in appetite, nausea, abdominal pain, or yellowing of the skin.

A nurse is preparing to administer diphenhydramine 50 mg P0 at 2200 to a client who has difficulty swallowing pills and capsules. Available is diphenhydramine syrup 12.5 mg/5 mL PO. Which of the following nursing actions requires the completion of an incident report?

administer 25 ml syrup This dose is higher than the client should receive. The correct dosage is 20 mL. Administering an incorrect amount of medication to a client requires completion of an incident report.

A nurse is contributing to the plan of care for a client who has schizophrenia and a new prescription for clozapine. The nurse should include in the plan to monitor the client for which of the following adverse effects of this medication.

agranulocytosis The nurse should monitor the client's WBC count and notify the provider for a value below the expected reference range of 5,000 to 10,000/mm3.

A nurse is reinforcing teaching with a newly licensed nurse about using metoprolol to treat hypertension. Which of the following conditions should the nurse include as a contraindication for this medication?

bradycardia Metoprolol is a beta blocker that slows the conduction through the AV node. Therefore, it is contraindicated for clients who have bradycardia, or a heart rate that is consistently less than 60/min.

A client comes to an urgent care clinic and announces with great enthusiasm, "I am an expert at all things medical as they apply to me. and I require zolpidem." The client's pupils are dilated. along with an elevated heart rate and blood pressure level. The nurse should suspect intoxication with which of the following substances?

cocaine The client who has cocaine toxicity typically has tachycardia, elevated blood pressure, dilated pupils, and displays delusions. This client's behavior and physiological data indicate cocaine intoxication.

A nurse is collecting data from a client who has Parkinson's disease and is taking levodopa/ carbidopa' The nurse should identify which of the following findings as an adverse effect of this medication.

dark urine

A nurse is caring for a client who has hyperthyroidism and has been taking methimazole. Which of the following findings should indicate to the nurse that the medication has had a therapeutic effect?

decreased T4 The nurse should identify that methimazole inhibits the synthesis of thyroid hormone, reducing levels to provide a euthyroid state. Therefore, a decreased level of T4 is an indication of a therapeutic effect.

A nurse is caring for a client who has tuberculosis and will begin taking isoniazid. Which of the following actions should the nurse take?

determine the client daily alcohol intake The nurse should instruct the client to reduce or avoid all use of alcohol because isoniazid can cause liver damage; therefore, it is important for the nurse to determine the client's daily alcohol intake.

A nurse is reinforcing teaching with a client who has a new prescription for theophylline. The nurse should instruct the client which of the following is an expected outcome of this medication?

dilates bronchioles Theophylline is a bronchodilator, which affects smooth muscle relaxation and leads to open airways.

A nurse is reinforcing teaching with a client who has a new prescription for etanercept to treat rheumatoid arthritis. which of the following instructions about self-administering this medication should the nurse include?

discard any solution that are cloudy The client should discard any vials or pre-filled syringes that contain solutions that are discolored, cloudy, or have any sediment in them.

A nurse is reinforcing teaching with a client who is using phenylephrine nasal spray three times daily and reports rebound congestion. which of the following instructions should the nurse include to reduce the effects of rebound congestion?

discontinue use in the left nostril, then in the right nostril Discontinuing the medication one nostril at a time can overcome rebound congestion.

A nurse is reviewing medication prescriptions for a group of clients' The nurse should recognize that which of the following prescriptions can result in a medication administration error?

furosemide 10.0 mg po daily The nurse should avoid using a trailing zero following a whole number. This prescription can result in a medication error because the nurse can mistake the dosage as 100 mg instead of 10 mg because the decimal point is not always recognized.

A nurse is reinforcing teaching with the parent of a preschooler who has otitis media. The child has had a low-grade fever and irritability for 2 days. Which of the following instructions should the nurse include in the teaching?

give acetaminophen as needed for discomfort and fever.

A nurse is caring for a client who has chronic kidney disease and has been receiving epoetin for 2 weeks. Which of the following findings should indicate to the nurse that the client's medication is having the desired therapeutic effect?

hemoglobin rises 0.5g/dl Initial therapeutic effects, such as hemoglobin rising 0.5 g/dL, can occur within the first 2 weeks of therapy. The client's hemoglobin should reach target levels of 10 to 11 g/dL in 2 to 3 months.

A nurse is assisting with the care of a client who has a methicillin-resistant Staphylamctus aureus (MRSA) infection and is receiving vancomycin via IV infusion. which of the following changes in the client's condition should the nurse identify as the priority finding to report to the provider?

hypotension When using the urgent vs. nonurgent approach to client care, the nurse determines that the priority finding to report to the provider is hypotension. If the client's vancomycin infusion is too rapid, it can cause red man syndrome, which is a group of adverse effects that includes tachycardia, hypotension, flushing, and urticaria.

A nurse is reinforcing teaching with a client who has HIV and a new prescription for zidovudine. Which of the following client statements should indicate to the nurse an understanding of the teaching?

i will be sure to have my blood tested for anemia Zidovudine can cause severe anemia and neutropenia. The client should have blood tests performed before treatment begins and have continued monitoring during the course of treatment.

A nurse is reinforcing teaching with a client who has a prescription for alendronate. Which of the following client responses indicates to the nurse an understanding of the teaching?

i will take the medication with 8 ounces of water The client should take alendronate on an empty stomach with 240 mL (8 oz) of water to ensure it does not lodge in the esophagus, which can result in esophageal ulcerations.

A nurse is reinforcing teaching with a client who has a new prescription for propranolol. which of the following information should the nurse include in the teaching?

if your pulse rate is less than 50 beats per minute, notify your provider. The nurse should instruct the client to check their pulse before taking the medication and to withhold the medication if their pulse is less than 50/min. The client should also notify their provider. Bradycardia is a common adverse effect of beta blockers.

A nurse is caring for a client who is taking phenylephrine' The nurse should plan to monitor the client for which of the following manifestations as an adverse effect of this medication?

increased HR Due to cardiac effects, phenylephrine can cause tachycardia and other cardiac dysrhythmias.

A nurse is caring for a client who has a history of psychosis and is taking chlorpromazine. Which of the following actions should the nurse take to counteract the adverse effects of this medication?

inform the client to apply sunblock before going outside will counteract the adverse effects of photosensitivity. Chlorpromazine increases skin's sensitivity to ultraviolet light causing temporary pigmentation changes and increases the risk of sunburn.

A nurse is reinforcing teaching with a client who has bipolar disorder and a new prescription for lithium. which of the following instructions should the nurse include in the teaching?

maintain consistent sodium intake The client should maintain a consistent sodium intake while taking lithium. Decreased serum sodium levels cause lithium excretion to decline, which can lead to toxicity.

A nurse is reinforcing teaching with a client about the adverse effects of simvastatin, For which of the following adverse effects should the nurse instruct the client to notify the provider?

muscle pain The nurse should instruct the client to notify the provider if muscle pain or tenderness develops because this can indicate the client is developing rhabdomyolysis.

A nurse is reviewing the history of a client who is to start taking cefotetan to treat a bacterial infection' which of the following information from the client's medical record should the nurse report to the provider before the client begins receiving this medication?

penicillin allergy Cefotetan is a cephalosporin, an antibiotic structurally similar to penicillins. A client who has a severe allergy to penicillin can develop cross-reactivity and have an allergic reaction to cephalosporins. Therefore, the nurse should report this information to the provider before the client starts taking the medication.

A nurse is reinforcing teaching with a client who is to start therapy using a nitroglycerin transdermal patch. which of the following instructions should the nurse include?

place the path on different site for each application The client should place the patch on a different site for each application to prevent skin irritation.

A nurse is instilling timolol eyedrops for a client who has glaucoma. Which of the following actions should the nurse take after instilling the eyedrops?

press the nasolacrimal duct The nurse should press the client's nasolacrimal duct after instilling the eye drops to prevent the medication from absorbing into systemic circulation.

A nurse is collecting data from a female client who has been taking propylthiouracil (PTU) for 2 months to treat Graves' disease. Which of the following findings should the nurse recognize as an indication that the medication is effective?

pulse 82/min Tachycardia is a manifestation of hyperthyroidism. The nurse should identify that a pulse of 82/min is within the expected reference range of 60 to 100/min, indicating that the medication is effective.

A nurse is monitoring a client who is receiving a transfusion of packed RBCs. The client's temperature increases to 39.1" C (102.4° F). Which of the following actions should the nurse take first?

stop the transfusion The greatest risk to this client is injury from a transfusion reaction that can cause acute intravascular hemolysis or anaphylaxis. Therefore, the first action the nurse should take is to stop the transfusion.

A nurse is reinforcing teaching with a client who has a new prescription for omeprazole oral capsules. Which of the following instructions should the nurse include?

swallow the medication whole The nurse should instruct the client to swallow the capsules or tablets whole and not chew or crush them. Omeprazole, a proton pump inhibitor, blocks the secretion of gastric acid. It is available in delayed-release capsules and over-the-counter in delayed-release tablets, as well as suspensions and powders.

A nurse is caring for a client who has a new prescription for sumatriptan. The nurse notes that the client takes fluoxetine. The nurse should notify the provider that the combination of these medications will place the client at risk for which of the following adverse effects?

tremors can lead to excessive stimulation of serotoin receptors, risk dor serotonin syndrome. SE : tremores, confusion, hallucicatuons

A nurse is planning to administer metoprolol to a client who has heart failure and a heart rate of 48/min. Which of the following actions should the nurse take?

withhold the clients medicaion The nurse should identify that metoprolol, a beta blocker medication, results in a decrease in heart rate and should withhold the medication for a heart rate less than 50/min. The nurse should also notify the client's provider of the client's heart rate.

A nurse is caring for a client who has a prescription for an IM injection of penicillin G benzathine. The client asks why the injection must be given IM instead of through the IV line. Which of the following responses should the nurse make?

"Your medication can't be given IV because it is not watersoluble." The nurse should inform the client this type of penicillin has poor water solubility and is never administered intravenously.

A nurse is collecting data from a client who is postoperative and taking morphine for pain. Which of the following findings is the priority for the nurse to report to the provider?

oxygen saturation 87%

A nurse is planning to reinforce teaching about newborn immunizations with a client who is 24 hr postpartum. Which of the following information should the nurse plan to include?

your baby will receive the first hepatitis B vaccine before discharge. The newborn should receive the first hepatitis B vaccine at birth, with the next dose at age 1 to 2 months.

A nurse is reinforcing teaching with a client who has a new prescription for regular insulin. which of the following statements by the client indicates an understanding of the teaching?

"I should ensure that the Insulin is clear prior to drawing it up." Clients should discard the vial and use a new vial if the insulin appears cloudy.

A nurse is reinforcing teaching with a client who has a new prescription for ethinyl estradiol/norethindrone, an oral contraceptive. which of the following client statements should indicate to the nurse an understanding of the teaching?

"I will take the medication at the same time each day." The client should take this medication at the same time each day to maintain a consistent level to reduce fertility and the chance of pregnancy.

A nurse is caring for a client who is receiving 0.9% sodium :chloride,000 mL to infuse over 8 hr. The drop factor on the manual IV tubing is 15 gtt/mL. The nurse should ensure that the manual IV infusion is set to deliver how many gtt/min? (Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.)

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At 0800 a nurse assists with initiating a 1,000 mL IV infusion for a client, which is running at 125 mL/hr. How much fluid is left in the IV bag at 1300? (Round the answer to the nearest whole number. Use a leading zero if it applies' Do not use a trailing zero.)

375 Step 1: What is the unit of measurement the nurse should calculate? mL Step 2: What is the total volume to be infused? Total volume = 1,000 mL Step 3: What is the rate of infusion? Rate = 125 mL/hr Step 4: What is the total infusion time so far? Time = 5 hr Step 5: Should the nurse convert the units of measurement? No Step 6: Set up an equation and solve for X. Rate (mL/hr) x Time (hr) = Volume infused (X mL) 125 mL/hr x 5 hr = X mL Volume infused = 625 mL Total volume (mL) - Volume infused (mL) = Volume remaining (mL) 1,000 mL - 625 mL = 375 mL Volume remaining = 375 mL

A nurse is caring for a client who has multiple sclerosis and a new prescription for baclofen. Which of the following findings indicates to the nurse that the medication is having a therapeutic effect?

Decreased muscle spasticity The nurse should identify that baclofen is an antispasmodic that decreases muscle spasticity in a client who has multiple sclerosis.

A nurse is reinforcing teaching with a client following the placement of a cast for a fractured ankle. The client is to take oxycodone for pain management. The nurse should instruct the client which of the following over-the-counter medications is contraindicated while taking oxycodone.

Diphenhydramine Both diphenhydramine, an antihistamine, and oxycodone, an opioid analgesic, can cause CNS depression. Therefore, when a client uses the two medications together, the client is at increased risk for sedation, respiratory depression, and injury.

A nurse is collecting data from the parent of a toddler who is about to receive the varicella immunization. The nurse should identify that an anaphylactic reaction to which of the following substances is a contraindication for receiving this immunization.

Gelatin

A nurse is monitoring a client who has type 2 diabetes mellitus and is receiving repaglinide. Which of the following laboratory tests should the nurse plan to review to obtain information about the long- term therapeutic effect of this medication?

Glycosylated HBA1C The client's HbA1c value measures the average of blood glucose levels over the past 2 to 3 months. Therefore, the nurse should review this laboratory test to obtain information about the long-term therapeutic effect of repaglinide.

A nurse is collecting data from a client who is asking about taking celecoxib for treatment of joint pain. The nurse should identify that which of the following findings is a contraindication to receiving celecoxib?

History of myocardial infraction

A nurse is caring for a client who has a new prescription for eplerenone to treat hypertension. The nurse should monitor for which of the following adverse effects of this medication?

Hyperkalemia The nurse should identify that eplerenone can place the client at risk for increased potassium levels because eplerenone can cause potassium retention.

A nurse is collecting data from a client who is taking ferrous sulfate orally. Which of the following findings reported by the client should indicate to the nurse that the medication is having a therapeutic effect?

Increased tolerance to exercise The client who takes ferrous sulfate, which is used to treat iron-deficiency anemia, can have fatigue and shortness of breath due to a low hemoglobin level. An increased tolerance to exercise is an indication the ferrous sulfate is having a therapeutic effect. Increased tolerance to exercise occurs when the hemoglobin level increases, allowing more oxygen to be carried to the vital organs and tissues.

A nurse is reinforcing teaching with a client who has hypertension and a new prescription for spironolactone. Which of the following instructions should the nurse include in the teaching?

Restrict foods high in potassium. The nurse should instruct the client that spironolactone is a potassium-sparing diuretic, which can cause hyperkalemia. Therefore, the client should restrict foods that are high in potassium and salt substitutes that contain potassium.

A nurse is reinforcing teaching about comfort measures with the parent of a 10-year-old child who has a viral infection. The nurse should plan to tell the parent that aspirin is contraindicated because of the risk for which of the following conditions?

Reye syndrome Aspirin is contraindicated for children and adolescents who have a viral illness because it increases the risk for the development of Reye syndrome.