RN Pharmacology 2019 A

A nurse is instructing a client on the application of nitroglycerin transdermal patches. Which of the following statements by the client indicates an understanding of the teaching?

"I will take the patch off right after my evening meal." -Clients should remove the patch each evening for a medication free time of 12 to 14 hr before applying a new patch to avoid developing a tolerance to the medication's effects. -Nitroglycerin sublingual tablets are used to treat new onset of angina pain. A client who uses sublingual tablets should place one tablet under their tongue at the onset of angina pain and continue taking a tablet every 5 min for a total of three doses of nitroglycerin. The effects of a nitroglycerin patch will take 30 to 60 min to occur and are not useful to prevent an ongoing angina attack. -Nitroglycerin is an antianginal medication that results in dilation of the coronary vessels. Clients should apply the patch daily to sustain prophylaxis. -Medication remains in the transdermal patch after removing it from the body and must be discarded safely. The nurse should instruct the client to fold the patch ends together with the medication on the inside and place the discarded patch in a closed container so that children and pets cannot gain access to the medication.

A nurse is providing teaching to a client who is to start treatment for asthma with beclomethasone and albuterol inhalers. Which of the following instructions should the nurse include in the teaching?

"Rinse your mouth after inhaling the beclomethasone." The client should rinse their mouth after using beclomethasone, a glucocorticoid inhaler, to prevent oropharyngeal candidiasis and hoarseness. The client should increase the intake of calcium and vitamin D to minimize bone loss while taking beclomethasone, a glucocorticoid inhaler. The client should use the bronchodilator, albuterol, prior to taking beclomethasone, a glucocorticoid inhaler, to enhance its absorption. The client should take albuterol, a short-acting beta2-adrenergic agonist, to avoid an acute asthma attack.

a nurse is providing teaching to a pt who has a gastric ulcer and a new prescription for famotidine. which of the following instructions should the nurse include?

"report yellowing of the skin" -Famotidine can be hepatotoxic and cause jaundice. The nurse should instruct the client to monitor for and report yellowing of the skin or eyes to the provider. -The client who has a gastric ulcer will be prescribed famotidine for a minimum of 6 weeks and typically no longer than a year for treatment. -The client can take famotidine with or without food because food does not affect the medication's effectiveness. -For clients who have a gastric ulcer, famotidine is prescribed to inhibit gastric secretion and must be taken for the full course of therapy to be effective. do not stop taking when stomach feels better.

A nurse is caring for a client who received 0.9% sodium chloride 1L over 4hr instead of over 8hr as prescribed. Which of the following information should the nurse enter as a complete documentation of the incident?

0.9 % sodium chloride 1 L IV infused over 4 hr. Vital signs stable, provider notified (type, amount, time, status) The nurse should document the type and amount of fluid, how long it took to infuse, provider notification, and the client's physical status. -The nurse should only chart factual information in the client's medical record without indicating the error that occurred.

A nurse is preparing to administer dextrose 5% in water (D5W) 400 mL IV to infuse over 1 hr. The drop factor of the manual IV tubing is 15 gtt/mL. The nurse should set the manual IV infusion to deliver how many gtt/min?

100 gtt/min

A nurse is preparing to administer ciprofloxacin 15 mg/kg PO every 12 hr to a child who weighs 44 Ib. How many mg should the nurse administer per dose?

300 mg 44 lb = 20 kg X mg = 15 mg x 20 kg X = 300 mg

A nurse is caring for a client who has acute acetaminophen toxicity. The nurse should anticipate administering which of the following medications?

Acetylcysteine Acetylcysteine is a specific antidote for acetaminophen toxicity. It can prevent severe injury when given orally or by IV infusion within 8 to 10 hr. -Vitamin K is used to treat increased warfarin serum levels, indicated by elevated levels of PT/INR. -Benztropine is an anticholinergic medication used to treat adverse effects of Parkinson's disease by reducing rigidity and tremors. -Physostigmine is an effective antidote for antimuscarinic poisoning from medications such as atropine, scopolamine, some antihistamines, phenothiazines, and tricyclic antidepressants. It has no effect on acetaminophen toxicity.

A nurse is planning care for a client who is receiving mannitol via continuous IV infusion. The nurse should monitor the client for which of the following adverse effects?

Bibasilar crackles (heart failure and pulmonary edema) Mannitol, an osmotic diuretic, can precipitate heart failure and pulmonary edema. Therefore, the nurse should recognize lung crackles as an indicator of a potential complication and stop the infusion. Mannitol has several neurologic adverse effects, including increased intracranial pressure, seizures, confusion, and headaches. However, it does not cause auditory hallucinations. An indication for the use of mannitol is increased intraocular pressure. Mannitol decreases the intraocular pressure by creating an osmotic gradient between the intraocular fluid and the plasma. Mannitol is an osmotic diuretic used to promote diuresis, decrease intracranial pressure, and improve renal function. An expected therapeutic effect of mannitol is weight loss resulting from diuresis.

A nurse is reviewing the medication list of a client who wants to begin taking oral contraceptives. The nurses should identify that which of the following client medications will interfere with the effectiveness of oral contraceptives?

Carbamazepine (cause accelerated inactivation of oral contraceptive by action on hepatic medication metabolizing enzymes) Carbamazepine causes an accelerated inactivation of oral contraceptives because of its action on hepatic medication-metabolizing enzymes.

A nurse is planning care for a client who has hypertension and is to start taking metoprolol. Which of the following intervention should the nurse include in the plan of care?

Determine apical pulse prior to administering. -Life-threatening bradycardia is an adverse effect that might affect this client. Therefore, the nurse should assess the client's apical pulse prior to administering the medication. If the client's pulse rate is less than 60/min, the nurse should withhold the medication and notify the provider. -The nurse should weigh the client daily to monitor for the development of heart failure and weight gain. -The nurse should administer metoprolol following meals or at bedtime if orthostatic hypotension occurs. -The nurse should monitor the client for adverse effects such as hypotension. However, jaundice is not associated with this medication.

A nurse is reviewing the medication administration record of a client who has hypocalcemia and a new prescription for IV calcium gluconate. The nurse should identify that which of the following medications can interact with calcium gluconate?

Digoxin (increased toxicity) -The nurse should identify that calcium gluconate can cause hypercalcemia, which increases the risk of digoxin toxicity. calcium glutinate does not interact with felodipine, guaifenesin, or insulin

A nurse is administering donepezil to a client who has Alzheimer's disease. Which of the following findings should the nurse report to the provider immediately?

Dyspnea -When using the airway, breathing, circulation approach to client care, the nurse should report the adverse effect of dyspnea, caused by bronchoconstriction, to the provider first. Bronchoconstriction, dyspepsia, diarrhea, and dizziness are caused by the increase in acetylcholine levels, which is a primary effect of donepezil. then, after that action, report: diarrhea (fluid imbalance), dizziness (fall risk), dyspepsia (discomfort to esophageal tissues)

A nurse is teaching a client about the use of risedronate for the treatment of osteoporosis. The nurse should identify which of the following statements as an indication that the client understands the teaching?

I should sit up for 30 minutes after taking the risedronate. -Sitting upright for at least 30 min after taking risedronate will reduce the adverse gastrointestinal effects of esophagitis and dyspepsia. Risedronate is contraindicated for a client who cannot sit or stand upright for this length of time. -The absorption of risedronate, a bisphosphonate, will be reduced if it is taken with antacids containing calcium, aluminum, or magnesium. The nurse should instruct the client to take the antacid 2 hr after taking risedronate. -Although the delayed release form of the medication can be taken after eating, the immediate release form of the medication should be taken at least 30 min prior to consuming food or other liquids. Both forms of medication should be taken in the morning. -The nurse should reinforce that risedronate should be taken with a full glass of water, rather than any other liquid.

A nurse is assessing a client who is taking propylthiouracil for the treatment of Graves' disease. Which of the following findings should the nurse identify as an indication that the medication has been effective?

Increase in ability to focus -A client who has Graves' disease can experience psychological manifestations such as difficulty focusing, restlessness, and manic-type behaviors. Propylthiouracil is a thyroid hormone antagonist that decreases the circulating T4 hormone, reducing the manifestations of hyperthyroidism. An increased ability to focus indicates that the medication has been effective. -Graves' disease can result in gastrointestinal manifestations such as increased appetite, weight loss, and increased gastrointestinal motility. Therefore, an increase in appetite indicates the medication has not been effective. -Graves' disease, a form of hyperthyroidism, has neurologic manifestations, including insomnia. Therefore, a decrease in the amount of time sleeping indicates the medication has not been effective. -Propylthiouracil is a thyroid hormone antagonist used in the treatment of hyperthyroidism, or thyroid storms. A decreased WBC count is an adverse effect of propylthiouracil, which can cause myelosuppression. Therefore, a decrease in WBC count indicates the medication has not been effective.

A nurse is preparing to administer PO sodium polystyrene sulfonate to a client who has hyperkalemia. Which of the following actions should the nurse plan to take?

Monitor the client for constipation -The nurse should monitor the client for the adverse effect of constipation and report it to the provider because this can lead to fecal impaction. -Sodium polystyrene sulfonate solution is stable for 24 hr when refrigerated. -Sodium polystyrene sulfonate will not alter the color of the client's stool. -The nurse should hold the client's other oral medications for 6 hr before and after administration of sodium polystyrene sulfonate.

A nurse is reviewing the laboratory results for a client who is receiving heparin via continuous IV infusion for deep - vein thrombosis. The nurse should discontinue the medication infusion for which of the following client findings?

Platelets 96,000/mm^3 -A platelet count of 96,000/mm3 is below the expected range of 150,000 to 400,000/mm3. A platelet count less than 100,000/mm3 while receiving heparin can indicate heparin-induced thrombocytopenia, a potentially fatal condition that requires stopping the infusion. -An Hgb of 15 g/dL is within the expected reference range of 14 to 18 g/dL for a male and 12 to 16 g/dL for a female and is not an indication to stop the heparin infusion. -This is a therapeutic aPTT level for a client receiving heparin and is not an indication to stop the heparin infusion. -Although heparin can cause an increase in potassium levels, the client's potassium level is within the expected reference range of 3.5 to 5 mEq/L.

A nurse is reviewing the laboratory results of a client who is taking digoxin for heart failure. Which of the following result should the nurse report to the provider?

Potassium level 2.8 A potassium level of 2.8 mEq/L is below the expected reference range of 3.5 to 5 mEq/L. The nurse should notify the provider if a client has hypokalemia prior to administration of digoxin due to the increased risk of developing digoxin toxicity and cardiac dysrhythmias. normal range: calcium = 9.0 to 10.5 magnesium = 1.3 to 2.1 digoxin = 0.8 to 2 potassium = 3.5 to 5 *report values out of reference range to provider

A nurse is reveiwing the ECG of a client who is receiving IV furosemide for heart failure. The nurse should identify which of the following findings as an indication of hypokalemia?

Presence of U waves -The nurse should identify the presence of U-waves as a manifestation of hypokalemia, an adverse effect of furosemide. -The nurse should identify tall, tented T-waves as a manifestation of hyperkalemia. Flattened or inverted T-waves are a manifestation of hypokalemia. -The nurse should identify a widened QRS complex as a manifestation of hyperkalemia. -The nurse should identify ST elevation is an indication of ischemia. ST depression is a manifestation of hypokalemia.

A nurse is caring for a client who is experiencing acute alcohol withdrawal. For which of the following client outcomes should the nurse administer chlordiazepoxide?

Prevent delirium tremens -The client should take chlordiazepoxide to prevent delirium tremens during acute alcohol withdrawal. -The client should take propranolol to decrease cravings during alcohol withdrawal. -The client should take acamprosate to help maintain abstinence from alcohol by decreasing anxiety and other uncomfortable manifestations. -The client should take clonidine or a beta-adrenergic blocker, such as atenolol, to minimize autonomic components, such as diaphoresis, during alcohol withdrawal.

A nurse is providing discharge teaching about handling medication to a client who is to continue taking oral transmucosal fentanyl raspberry - flavored lozenges on a stick. Which of the following information should the nurse include in the teaching?

Store unused medication sticks in a storage container. -The nurse should instruct the client to store unused, used, or partially used medication sticks in the safe storage container that comes in the kit when the medication is initially prescribed. -The nurse should instruct the client to expect the medication's analgesia effects to begin within 10 to 15 min. -The nurse should instruct the client to periodically move the medication stick to a different location in the mouth for best absorption. -The nurse should instruct the client to place the fentanyl stick between their cheek and lower gum and actively suck it for increased absorption of the medication.

A nurse is providing teaching to a client who has a prescription for ergotamine sublingual to treat migraine headaches. Which of the following information should the nurse include in the instructions?

Take one tablet at onset of migraine -The client should take one tablet immediately after the onset of aura or headache. -Ergotamine, an alpha-adrenergic blocking medication, is not used prophylactically because this can result in ergotamine dependence. -The client can take up to a maximum of three tablets in a 24-hr period. Excessive dosing can lead to ergotism, which can cause peripheral gangrene due to vasoconstriction and ischemia. -The client can take one sublingual tablet every 30 min for a maximum of three tablets in a 24-hr period to manage a migraine.

A nurse is assessing a client who is postoperative following an outpatient endoscopy procedure using midazolam. The nurse should monitor for which of the following findings as an indication that the client is ready for discharge?

The client's capnography has returned to baseline -The nurse should identify that the client is ready for discharge when the capnography level indicates that gas exchange is adequate. -The client is considered ready for discharge when the state of arousal is at the preprocedure level. -The nurse should monitor for the passing of flatus for a client who received general anesthesia. -A request for oral intake does not indicate the client is ready for discharge. The nurse should assess for a return of the gag reflex for a client who is postoperative following an endoscopy.

A nurse is caring for a client who is in labor. The client is receiving oxytocin by continuous IV infusion with a maintenance IV solution. The external FHR monitor indicates late decelerations. Which of the following actions should the nurse take first?

Turn the client to a side lying position -The greatest risk to the fetus experiencing late decelerations is injury from uteroplacental insufficiency. Therefore, the priority action the nurse should take is to place the client in a lateral position. -The nurse should discontinue the oxytocin to reduce uterine contractions. However, another action is the nurse's priority. -The nurse should apply oxygen by face mask to provide supplemental oxygen to the fetus. However, another action is the nurse's priority. -The nurse should increase the client's maintenance IV infusion rate to maintain adequate blood flow and promote placental perfusion. However, another action is the nurse's priority.

A nurse is caring for a client who has cancer and is taking oral morphine and docusate sodium. The nurse should instruct the client that taking the docusate sodium daily can minimize which of the following adverse effects of morphine?

constipation -Constipation is a common adverse effect of morphine that can be minimized by taking docusate sodium, a stool softener that promotes easier evacuation of stool by increasing water and fat in the intestine. -Drowsiness is not an adverse effect of morphine that can be minimized by taking docusate sodium. -Facial flushing is not an adverse effect of morphine that can be minimized by taking docusate sodium. -Itching is not an adverse effect of morphine that can be minimized by taking docusate sodium.

A nurses is assessing a client's vital signs prior to the administration of PO digoxin. The client's BP is 144/86 mm Hg, heart rate is 55/min, and respiratory rate is 20/min. The nurse should withhold the medication and contact the provider for which of the following findings?

heart rate Digoxin slows the conduction rate through the SA and AV nodes, thereby decreasing the heart rate. The nurse should withhold the medication and notify the provider for a heart rate of 55/min because this is an early indication of digoxin toxicity.

A nurse is providing teaching to a client who is taking bupropion as an aid to quit smoking. Which of the following findings should the nurse identify as an adverse effect of the medication?

insomnia -Bupropion, an atypical antidepressant, has stimulant properties, which can result in agitation, tremors, mania, and insomnia. -Bupropion can cause sensory adverse effects such as changes in vision and hearing. However, it does not cause alopecia. -Bupropion can cause neurologic adverse effects such as bradykinesia. However, it does not cause joint pain. -Bupropion, an atypical antidepressant, does not cause coughing.

A nurse is preparing to administer medication to a client who has gout. The nurse discovers that an error was made during the previous shift and the client received atenolol instead of allopurinol. Which of the following actions should the nurse take first?

obtain the pt's blood pressure -When using the nursing process, the first action the nurse should take to prevent injury to the client is to assess the client for adverse effects of atenolol, such as hypotension. -The nurse should contact the provider, who can provide direction to the nurse to prevent injury to the client. However, there is another action the nurse should take first. -The nurse should alert the charge nurse about the medication error. However, there is another action the nurse should take first. -The nurse should complete an incident report, which is used as part of a facility's quality assurance program. However, there is another action the nurse should take first.

A nurse is caring for a client who is taking acetazolamide fr chronic open angle glaucoma. For which of the following adverse effects should the nurse instruct the client to monitor and report?

tingling of fingers -The nurse should instruct the client to report the adverse effect of paresthesia, a tingling sensation in the extremities, when taking acetazolamide. -Diarrhea is an adverse effect of acetazolamide due to gastrointestinal disturbances. -Weight loss is an adverse effect of acetazolamide due to gastrointestinal disturbances causing reduced appetite. -Polyuria, rather than oliguria, is an adverse effect of acetazolamide.

A nurse is providing teaching to a client who has peptic ulcer disease and is to start a new prescription for sucralfate. Which of the following actions of sucralfate should the nurse include in the teaching?

-Forms a protective barrier over ulcers -Secretions by the parietal and chief cells, hydrochloric acid and pepsin, can further irritate the ulcerated areas. Sucralfate, a mucosal protectant, forms a gel-like substance that coats the ulcer, creating a barrier to hydrochloric acid and pepsin. -A common cause of peptic ulcers is a bacterial infection with Helicobacter pylori. Treatment of the ulcer includes a combination of antibiotics, such as metronidazole, tetracycline, clarithromycin, or amoxicillin, to eradicate the H. pylori infection. -Acid production in the stomach causes further irritation and pain to a client who has a peptic ulcer. Antacids, such as aluminum hydroxide, neutralize acids in the stomach and prevent pepsin formation, a digestive enzyme that can further damage the eroded epithelium. -Peptic ulcer disease manifests as an erosion of the gastric or duodenal mucosa. The acid production in the stomach causes further irritation and pain. H2 receptor antagonists, such as famotidine, decrease stomach acid secretion.

A nurse is preparing to administer a scheduled antibiotic at 0800 to a client and discovers the antibiotic is not present in the client's medication drawer. The nurse should identify that administration of the medication can occur at which of the following time periods without requiring an incident report?

0830 The nurse should identify that an antibiotic can be administered 30 min before or after the scheduled time to maintain therapeutic blood levels without requiring an incident report. *administering an antibiotic 1hr, 2hr after the scheduled time is too late and requires filling an incident report

A nurse is providing teaching to a client who has multiple sclerosis and a new prescription for methylprednisolone. Which of the following instructions should the nurse include?

1. Blood glucose levels will be monitored during therapy (medication increase serum glucose level & require management) 2. Avoid contact with people who has known infection (medication decreased immunity putting patient at increased risk for infection) 3. Grapefruit juice can increase the effects of the medication (grapefruit juice can increase the level of methylprednisolone in the body)

A nurse is developing a teaching plan for a client who has a new prescription for simvastatin. Which of the following instructions should the nurse include in the teaching plan?

1. Report muscle pain to the provider. 2. Avoid taking the medication with grapefruit juice. 3. Expect therapy with this medication to be lifelong. -Myopathy is an adverse effect of simvastatin that can lead to rhabdomyolysis. The nurse should instruct the client to report this to the provider. -When taken with grapefruit juice, simvastatin increases the risk of muscle injury from elevations in creatine kinase. -This medication is most effective when taken in the evening because cholesterol production generally increases overnight. -The nurse should identify flushing of the skin as an adverse effect of the medication niacin, which can be used to decrease the client's triglyceride levels. -If medication therapy is discontinued, cholesterol levels will return to their pretreatment range within several weeks to months.

A nurse is caring for the parent of a newborn. The parent asks the nurse when their newborn should receive the first diphtheria, tetanus, and pertussis vaccine (DTaP). The nurse should instruct the parent that their newborn should receive the immunization at which of the following ages?

2 months (1st dose) The CDC recommends that newborns receive the first dose of the five-dose series of the DTaP immunization at 2 months of age. According to the current recommended immunization schedule, only the hepatitis B vaccine is given at birth. The CDC recommends that newborns receive the third dose of the five-dose series of the DTaP immunization at 6 months of age. The CDC recommends that newborns receive the fourth dose of the five-dose series of the DTaP immunization between 15 to 18 months of age.

A nurse is teaching a group of unit nurses about medication reconciliation. Which of the following information should the nurse include in the teaching?

A transition in care requires the nurse to conduct medication reconciliation -The nurse should conduct medication reconciliation anytime the client is undergoing a change in care such as admission, transfer from one unit to another, or discharge. A complete listing of all prescribed and over-the-counter medications should be reviewed. -The name of the current medication and new medication, over-the-counter medications, vitamins, herbal supplements, and nutritional supplements are included at the medication reconciliation. The indication, route, dosage size, and dosing interval are also required. -Medication reconciliation at discharge includes medications ordered at the time of discharge, over-the-counter medications, vitamins, herbal supplements, nutritional supplements, and other medications the client is taking. -The nurse or a member of the health care team, such as the pharmacist, is required to complete medication reconciliation.

A nurse is preparing to administer heparin subcutaneously to a client. Which of the following actions should the nurse plan to take?

Administer the medication outside the 5 cm (2 in) radius of the umbilicus. -The nurse should administer the heparin by subcutaneous injection to the abdomen in an area that is above the iliac crest and at least 5 cm (2 in) away from the umbilicus. -The nurse should not aspirate by pulling back on the plunger of the heparin syringe to check for a blood return, because this will cause the injection site to bruise. -The nurse should apply firm pressure to the injection site for 1 to 2 min after the administration of the heparin to prevent bruising. -The nurse does not need to apply a dressing over the injection site if pressure is held for at least 1 min to prevent bleeding.

A nurse is teaching a client about warfarin. The client asks if they can take aspirin while taking the warfarin. Which of the following responses should the nurse make?

Aspirin will increase the risk of bleeding -Aspirin inhibits platelet aggregation and can potentiate the action of the anticoagulant warfarin. Therefore, the client should avoid taking aspirin because it increases the risk for bleeding. -Although it is common for clients to consider an occasional aspirin harmless, salicylates inhibit platelet aggregation and increase the potential for hemorrhage. Therefore, the client should avoid taking enteric-coated aspirin. -Acetaminophen, an analgesic, can potentiate the action of the anticoagulant warfarin when administered in high doses and is not a safe substitute for aspirin. -The client should continue to follow the provider's prescription for monitoring the PT and INR levels to adjust warfarin dosages. However, the nurse should discourage the client from using aspirin products because these medications increase the antiplatelet action of the warfarin and can result in bleeding.

A nurse administers a dose of metformin for a client instead of the prescribed dose of metoclopramide. Which of the following actions should the nurse take first?

Check the client's blood glucose -The first action the nurse should take using the nursing process is to assess the client. The client is at risk for hypoglycemia. The nurse should monitor the client's blood glucose and provide the client with a snack to reduce the risk for hypoglycemia. Actions after would be: -report the incident to the charge nurse -notify the provider -fill out an incident report

A nurse is teaching a client who is to start taking hydrocodone with acetaminophen tablets for pain. Which of the following information should the nurse include in the teaching?

Decreased respiration might occur -The nurse should instruct the client that hydrocodone with acetaminophen might cause respiratory depression, which is an adverse effect of the medication. The client should avoid taking over-the-counter medications or newly prescribed medications without consulting their provider to avoid increased respiratory depression. -The client should avoid crushing, chewing, or breaking the extended release or immediate release hydrocodone tablets to prevent an immediate increase in CNS effects. Hydrocodone with acetaminophen tablets can be crushed if needed. -The nurse should instruct the client that they should experience the effects of hydrocodone with acetaminophen within 20 min of administration and that pain relief should last for 4 to 6 hr. -The client should take hydrocodone and acetaminophen with food or milk to decrease gastric irritation.

A nurse is preparing to administer medications to a client who tells the nurse, "I don't want to take my fluid pill until I get home today." Which of the following actions should the nurse take?

Document the refusal and inform the client's provider (verify understanding of refusing medication) -The nurse has the responsibility to verify that the client understands the risks of refusing the medication so that an informed decision can be made. The nurse should then document the refusal in the client's medical record and notify the health care provider. -The nurse does not need to complete an incident report if a client refuses to take a medication. An incident report is necessary for a medication error. -The nurse should follow facility protocols for discarding the medication. It is not the role of the pharmacist to retrieve medications that a client refuses to take. -The nurse should not give the client a scheduled medication to take at home and then document that it was administered, because this violates the ethical principle of accountability.

A nurse is assessing a client after administering a second dose of cefazolin IV. The nurse notes the client has anxiety, hypotension, and dyspnea. Which of the following medications should the nurse administer first?

Epinephrine -According to evidence-based practice, the nurse should administer epinephrine first to induce vasoconstriction and bronchodilation during anaphylaxis. -The nurse should plan to administer prednisone, a glucocorticoid, for the urticaria following anaphylaxis and to prevent a delayed anaphylactic reaction from occurring. However, evidence-based practice indicates that administering another medication is the priority. -The nurse should administer albuterol, a bronchodilator, for a client who has dyspnea from bronchospasms during anaphylaxis. However, evidence-based practice indicates that administering another medication is the priority. -The nurse should administer diphenhydramine, an antihistamine, as a second-line medication to decrease angioedema and urticaria following anaphylaxis. However, evidence-based practice indicates that administering another medication is the priority.

A nurse is an emergency department is caring for a client whose family reports the client has taken large amounts of diazepam. Which of the following medications should the nurse anticipate administering?

Flumazenil -The nurse should anticipate administering flumazenil, an antidote used to reverse benzodiazepines such as diazepam. -Ondansetron is an antiemetic that is used to treat nausea and vomiting. -Magnesium sulfate is an electrolyte replacement that is used to treat clients who are at risk for seizure activity. -Protamine sulfate is an antidote for heparin and is used to reverse an elevated aPTT caused by taking heparin.

A nurse is providing discharge instructions to a client who has heart failure and a new prescription for captopril. Which of the following client statements indicates an understanding of the teaching?

I should tell my provider if I develop a sore throat (neutropenia) -The client should report a sore throat to the provider because this can indicate neutropenia, a serious adverse effect of captopril. Neutropenia can be reversed if it is identified early and the medication is promptly discontinued. -The client should take captopril on an empty stomach because food reduces absorption of the medication. The nurse should instruct the client to take the medication 1 hr before or 2 hr after a meal. -Naproxen and other NSAIDs can interact with captopril, which can decrease the effect of the antihypertensive and increase the risk of kidney dysfunction. -Captopril affects the urinary system by causing dysuria, urinary frequency, and changes in the normal amount of urine. However, captopril does not affect the color of the urine.

A nurse is teaching a client about cyclobenzaprine. Which of the following client statements should indicate to the nurse that the teaching is effective?

I will taper off the medication before discontinuing it -The client should taper off cyclobenzaprine before discontinuing it to prevent abstinence syndrome or rebound insomnia. -The client should use gum or sip on water to prevent dry mouth, which is an adverse effect of cyclobenzaprine. -The client should take cyclobenzaprine for treatment of muscle spasms. This medication does not affect skin rashes. -The client should report any urinary retention because of the anticholinergic effects caused when taking cyclobenzaprine.

A nurse is caring for a client who is receiving filgrastim. Which of the following findings should the nurse document to indicate the effectiveness of the therapy?

Increased neutrophil count -Filgrastim stimulates the bone marrow to produce neutrophils. For clients receiving chemotherapy, the risk of infection is minimized. -Filgrastim stimulates the bone marrow to produce neutrophils and has no effect on a client's RBC count. -Prothrombin time measures the effectiveness of warfarin therapy. Filgrastim therapy does not cause a decrease in prothrombin time. -Triglycerides are a form of lipids found in the blood stream. Increased levels are associated with an increased risk for heart disease. Decreased levels can occur in clients who have malnutrition or malabsorption disorders. Filgrastim is used to treat chemotherapy-induced neutropenia and has no effect on a client's triglyceride levels.

A nurse is assessing a client who has myasthenia gravis and is taking neostigmine. Which of the following findings should indicate to the nurse that the client is experiencing an adverse effect?

Miosis -Miosis, which is pupillary constriction, is a common adverse effect of neostigmine due to the excessive muscarinic stimulation that causes difficulty with visual accommodation. -Neostigmine can cause increased salivation, rather than dry mouth, due to the excessive muscarinic stimulation. -Neostigmine can cause urinary urgency, rather than decreased urinary output, due to the excessive muscarinic stimulation. -Neostigmine can cause bradycardia, rather than tachycardia, due to the excessive muscarinic stimulation.

A nurse receives a verbal order from the provider to administer morphine 5 mg every 4 hours subcutaneously for severe pain as needed. The nurse should identify which of the following entries as the correct format for the medication administration record (MAR)?

Morphine 5 mg subcut every 4 hr PRN severe pain The nurse should identify this entry as the correct format for the MAR. The medication name is spelled out and there are not any abbreviations from The Joint Commission's "Do Not Use" list included in the transcription. -The use of the abbreviations MSO4 and SQ are prohibited by The Joint Commission. The abbreviation SQ can be mistaken for SL and, therefore, this route should be written as subcut, SUBQ, or subcutaneously. -The trailing zero on 5.0 can be mistaken for 50 if the decimal point is missed. Therefore, the dosage should be written as 5 mg without a trailing zero.

A nurse is an emergency department is caring for a client who has heroin toxicity. The client is unresponsive with pinpoint pupils and a respiratory rate of 6/min. Which of the following medications should the nurse plan to administer?

Naloxone -The nurse should administer naloxone, an opioid antagonist, to a client who has heroin toxicity to reverse the respiratory depressive effects of the heroin. However, the nurse should not administer naloxone too quickly because naloxone can cause hypertension, tachycardia, nausea, vomiting, and might cause the client to enter a state of opioid withdrawal. -The nurse should administer methadone, an opioid agonist, to a client who has heroin toxicity to decrease manifestations of opioid withdrawal and suppress the euphoria the client feels when using heroin. However, the client should not receive methadone in an emergency. -The nurse should administer diazepam, a benzodiazepine, to a client who has alcohol toxicity to decrease the manifestations of alcohol withdrawal and prevent withdrawal seizures. -The nurse should administer bupropion, an atypical antidepressant, to a client who is trying to quit nicotine to decrease the manifestations of nicotine withdrawal and ease the client's cravings for nicotine.

A nurse is caring for a 20 year old female client who has a prescription for isotretinoin for severe nodulocystic acne vulgaris. Before the client can obtain a refill, the nurse should advise the client that which of the following tests is required?

Pregnancy test (must provide two negative pregnancy tests) The nurse should instruct the client that isotretinoin has teratogenic effects; therefore, pregnancy must be ruled out before the client can obtain a refill. The client must provide two negative pregnancy tests for the initial prescription and one negative test before monthly refills. -The client should have a laboratory test for aspartate aminotransferase levels prior to starting isotretinoin, 1 month after starting the medication, and periodically thereafter. However, a laboratory test for aspartate aminotransferase is not required to renew a prescription for isotretinoin.

A nurse at a clinic is providing follow - up care to a client who is taking fluoxetine for depression. Which of the following findings should the nurse identify as an adverse effect of the medication?

Sexual dysfunction Sexual dysfunction, including a decreased libido, impotence, and delayed orgasm, or anorgasmia, is a common adverse effect of fluoxetine and occurs in about 70% of clients who take this SSRI antidepressant. Fluoxetine can cause CNS adverse effects including abnormal dreaming, sedation, delusions, hallucinations, and psychosis. However, an absence of dreams is not associated with fluoxetine. Fluoxetine can cause neurologic adverse effects such as agitation, euphoria, and sedation. However, an eating disorder such as pica is not associated with fluoxetine. Fluoxetine is an SSRI that can cause muscle twitching. However, distorted sensations in the extremities are not adverse effects of fluoxetine.

A nurse is assessing a client who has schizophrenia and is taking haloperidol. The nurse should report which of the following findings to the provider as a manifestation of neuroleptic malignant syndrome (NMS)?

Temperature of 39.7° C (103.5° F) The nurse should report fever to the provider as an indication of NMS, an acute life-threatening emergency. Other manifestations can include respiratory distress, diaphoresis, and either hyper- or hypotension. The nurse should report incontinence as a manifestation of NMS. The nurse should report tachycardia as a manifestation of NMS. The nurse should report severe muscle rigidity as a manifestation of NMS.

A nurse is assessing a client 1 hr after administering morphine for pain. The nurse should identify which of the following findings as the best indication that the morphine has been effective?

The client rates pain as 3 on a scale from 0 to 10 -The client's description of the pain is the most accurate assessment of pain. -The client might rest with their eyes closed as a method to try to manage pain. However, this does not indicate that the pain is controlled. -Clients often do not request medicine even when they are experiencing pain. -Vital signs can be within normal limits for clients who have pain.

A nurse is an emergency department is caring for a client who has myasthenia gravis and is in a cholinergic crisis. Which of the following medications should the nurse plan to administer?

atropine -A cholinergic crisis is caused by an excess amount of cholinesterase inhibitor, such as neostigmine. The nurse should plan to administer atropine, an anticholinergic agent, to reverse cholinergic toxicity.

A nurse is caring for a client who is receiving heparin therapy via continuous IV infusion to treat a pulmonary embolism. Which of the following findings should the nurse identify as an adverse effect of the medication and report to the provider?

blood in urine -The nurse should report blood in the urine to the provider because this can be a manifestation of heparin toxicity. Other manifestations can include bruising, hematomas, hypotension, and tachycardia. -Vomiting is not an expected adverse effect of heparin therapy. The nurse should assess the client for other causes for vomiting. -A Chvostek's sign is seen in clients who have hypocalcemia or hypomagnesemia. -Ringing in the ears is not an expected adverse effect of heparin therapy. Aminoglycosides, such as vancomycin, are medications that cause ringing in the ears.

A nurse is providing teaching to a client who is begin taking oxybutynin for urinary incontinence. Which of the following adverse effects should the nurse include in the teaching?

dry mouth blurred vision dry eyes -Dry mouth is correct. Oxybutynin is an anticholinergic agent that can cause dry mouth. -Tinnitus is incorrect. Oxybutynin can cause several sensory adverse effects including increased intraocular pressure. The nurse should instruct the client to report eye pain, seeing colored halos around lights, and a decreased ability to perceive light changes. However, tinnitus is not an adverse effect associated with oxybutynin administration. -Blurred vision is correct. Oxybutynin is an anticholinergic agent that can cause blurred vision due to an increase in intraocular pressure. -Bradycardia is incorrect. Oxybutynin can cause several cardiovascular adverse effects such as a prolongation of the QT interval, palpitations, hypertension, and tachycardia. -Dry eyes is correct. Oxybutynin is an anticholinergic agent that can cause dry eyes and mydriasis, or pupil dilation.

A nurse is teaching a client who is to begin taking tamoxifen for the treatment of breast cancer. Which of the following adverse effects should the nurse include in the teaching?

hot flashes -The estrogen receptor blocking action of tamoxifen commonly results in the adverse effect of hot flashes. -Tamoxifen can cause genitourinary adverse effects such as vaginal discharge and uterine cancer. However, urinary retention is not an expected adverse effect of tamoxifen. -Gastrointestinal adverse effects of tamoxifen include nausea and vomiting. However, constipation is not an expected adverse effect of tamoxifen. -Tamoxifen is an antiestrogen medication that works by blocking estrogen receptors. Cardiovascular adverse effects of the medication include chest pain, flushing, and the development of thrombus. However, bradycardia is not an expected adverse effect of tamoxifen.

A nurse is collecting a medication history from a client who has a new prescription for lithium. The nurse should identify that the client should discontinue which of the following over the counter medications?

ibuprofen -Most NSAIDs can significantly increase lithium levels. Therefore, the client should not take ibuprofen and lithium concurrently. Does not interact with: aspirin famotidine bisacodyl

A nurse is planning to teach about the use of a spacer to a child who has a new prescription for a fluticasone inhaler to treat chronic asthma. The nurse should include that the spacer decreases the risk for which of the following adverse effects of the medication?

oral candidiasis Dysphonia and oral candidiasis are adverse effects of inhaled corticosteroids. Using a spacer and rinsing the mouth after inhalation will minimize the amount of medication remaining in the oropharynx, preventing the development of these adverse effects. -the use of a spacer will not decrease systemic adverse effects of fluticasone, such as headaches.

A nurse is planning care for a client who is prescribed metoclopramide following bowel surgery. For which of the following adverse effects should the nurse monitor?

sedation -Metoclopramide has multiple CNS adverse effects, including dizziness, fatigue, and sedation. -Metoclopramide is a central dopamine receptor antagonist that increases gastrointestinal motility and prevents nausea. Tardive dyskinesia is an adverse effect of metoclopramide. However, metoclopramide does not cause muscle weakness. -Metoclopramide does not cause ringing in the ears. -Metoclopramide does not cause peripheral edema.

A nurse on the acute care unit is caring for a client who is receiving gentamicin IV. The nurse should report which of the following findings to the provider as an adverse effect of the medication?

tinnitus -Aminoglycosides, such as gentamicin, are ototoxic, which can manifest as tinnitus and deafness. The nurse should monitor the client for high-pitched ringing in the ears and headaches and should notify the provider if these occur. -Gentamicin, an aminoglycoside used to treat serious infections, can cause several gastrointestinal adverse effects, such as inflammation of the liver and spleen. However, it does not cause constipation. -Gentamicin, an aminoglycoside used to treat serious infections, can cause alternations in the functions of the liver and spleen. However, pancreatic function, mainly insulin production, is not affected by this medication. -Aminoglycosides, such as gentamicin, can result in neuromuscular adverse effects such as twitching or flaccid paralysis. However, joint pain is not an adverse effect of gentamicin.