ATI PHARM exam 2

A nurse should identify that timolol is contraindicated for a client who has which of the following disorders? A. Asthma B. Seizure disorder C. Diabetes mellitus D. Rheumatoid arthritis

A. Asthma Rationale: A. Timolol, a beta-adrenergic antagonist, can cause bronchospasm and difficulty breathing. Clients who have asthma or any disorder that compromises respiratory function should not use the drug. B. Timolol, a beta-adrenergic antagonist, is appropriate for clients who have a seizure disorder. However, those who have heart failure or bradycardia should not use the drug. C. Timolol, a beta-adrenergic antagonist, is appropriate for clients who have diabetes mellitus, although caution is essential when patients who have peripheral vascular disease or hyperthyroidism use the drug. D. Timolol, a beta-adrenergic antagonist, is appropriate for clients who have rheumatoid arthritis, although Raynaud's disease is a contraindication for using the drug.

A nurse is providing teaching to a client who is about to begin amitriptyline therapy to treat major depressive disorder. Which of the following instructions should the nurse include? (Select all that apply.) A. Change positions slowly from sitting or lying to standing. B. Do not stop taking the drug abruptly. C. Avoid crushing the tablet. D. Take the drug at bedtime to prevent daytime drowsiness. E. Increase fiber and fluid intake.

A. Change positions slowly from sitting or lying to standing. B. Do not stop taking the drug abruptly. D. Take the drug at bedtime to prevent daytime drowsiness. E. Increase fiber and fluid intake. Rationale: A. Amitriptyline, a tricyclic antidepressant, can cause orthostatic hypotension. Clients should move slowly from sitting or lying to standing. B. Relapse and withdrawal symptoms can occur with abrupt discontinuation of amitriptyline. When discontinuing the drug, it is important to reduce the dosage over a 2-week period to prevent or minimize withdrawal symptoms. C. This medication may be crushed if the client has difficulty swallowing the tablet(s) D. Amitriptyline, a tricyclic antidepressant, can cause drowsiness. Clients should take the drug at bedtime and avoid activities that require alertness until they know how the drug will affect them. E. Amitriptyline, a tricyclic antidepressant, causes anticholinergic effects, such as dry mouth, constipation, and urinary retention. Clients should increase fiber and fluid intake during drug therapy and urinate before taking the drug.

A nurse is assessing a client who has a new diagnosis of osteoarthritis. Which of the following findings should the nurse expect? (Select all that apply.) A. Crepitus with joint movement B. Decreased range of motion of the affected joint C. Low-grade fever D. Spongy tissue over joints E. Joint pain that resolves with rest

A. Crepitus with joint movement B. Decreased range of motion of the affected joint E. Joint pain that resolves with rest

A nurse is reviewing the drug history of a client who is taking lithium carbonate for bipolar disorder. Which of the following findings should indicate to the nurse to monitor for lithium toxicity? A. Furosemide for hypertension B. Acetaminophen for headaches C. Ciprofloxacin for a urinary tract infection D. Montelukast for asthma

A. Furosemide for hypertension Rationale: A. Furosemide, a high-ceiling loop diuretic, increases sodium loss and can cause lithium reabsorption. The nurse should evaluate the client for lithium toxicity. B. Acetaminophen does not increase lithium levels. However, NSAIDs such as ibuprofen can cause lithium reabsorption and toxicity. C. There is no known interaction between lithium and quinolone antibiotics, such as ciprofloxacin. However, the risk of toxicity increases with tetracyclines. D. There is no known interaction between lithium and montelukast. Theophylline preparations, however, can decrease lithium levels.

A nurse is caring for a client who has a prescription for fluoxetine and who reports self-administering St. John's wort daily for the past two weeks.Which of the following findings should the nurse report to the provider as an indication of serotonin syndrome? A. Hallucinations B. Decreased temperature C. Hypersexual behavior D. Constipation

A. Hallucinations Rationale: A. Hallucinations are an expected finding of serotonin syndrome. SSRIs are contraindicated with St. John's wort because the combination can increase the risk of developing serotonin syndrome. B. Fever is an expected finding of serotonin syndrome. The client can also become agitated. C. Fluoxetine can cause sexual dysfunction, not hypersexuality. The client can develop hyperactive deep tendon reflexes. D. Diarrhea is an expected finding of serotonin syndrome. Constipation can be an adverse drug reaction of fluoxetine.

A nurse is planning care for a client who has a closed head injury from a fall and is receiving mechanical ventilation. Which of the following interventions is the nurse's priority? A. Maintain a PaCO2 of approximately 35 mm Hg B. Provide small doses of fentanyl via IV bolus for pain management C. Measure body temperature every 1 to 2 hr D. Reposition the client every 2 hr

A. Maintain a PaCO2 of approximately 35 mm Hg

A nurse in an emergency department is assessing a client who reports sudden, severe eye pain with blurry vision. The provider determines that the client has primary angle-closure glaucoma. Which of the following medications should the nurse administer? A. Osmotic diuretics via IV bolus B. Mydriatic ophthalmic drops C. Corticosteroid ophthalmic drops D. Epinephrine via IV bolus

A. Osmotic diuretics via IV bolus

A nurse is reviewing the medical history of a client who has a new prescription for a reduced dosage of alprazolam for anxiety. Which of the following findings should indicate to the nurse the reason for the prescription modification? A. Renal function impairment B. Cataracts C. Recent weight loss D. Smoking

A. Renal function impairment Rationale: A. Alprazolam dosage should be decreased for clients who have renal or hepatic impairment. B. Glaucoma is a contraindication for receiving alprazolam, but cataracts do not affect this client's recommended dosage. Clients over 65 years of age might require a decreased dosage. C. Weight gain is an adverse drug reaction of alprazolam. Pediatric clients might require a decreased dosage. D. Smoking can decrease the levels and effects of alprazolam. The client might need an increased dosage if smoking while taking alprazolam.

A nurse is assessing a client who has a head injury following a motor-vehicle crash. The nurse should identify that which of the following findings indicates increasing intracranial pressure? A. Restlessness B. Dizziness C. Hypotension D. Fever

A. Restlessness

A nurse in an emergency department is caring for a client who suddenly lost consciousness and fell in her home. The provider determines that the client had an embolic stroke. Which of the following medications should the nurse administer? A. Tissues plasminogen activator B. Recombinant factor VIII C. Nitroglycerin D. Lidocaine

A. Tissues plasminogen activator

A nurse is caring for a client who has a new prescription for alprazolam. For which of the following adverse effects should the nurse monitor. (Select all that apply.) A. Tolerance B. Anxiety C. Sedation D. Respiratory depression E. Constipation

A. Tolerance B. Anxiety C. Sedation D. Respiratory depression Rationale: A. Tolerance and dependence can develop with benzodiazepines, such as alprazolam. Clients should use these drugs only as needed and for short periods of time. B. Paradoxical reactions, such as anxiety and insomnia, can develop when taking alprazolam, especially in older adults. Clients should report these findings C. CNS depression, manifested as sedation and drowsiness, is an adverse effect of benzodiazepines, such as alprazolam. Clients should take a benzodiazepine 30 min prior to bedtime. D. Benzodiazepines, such as alprazolam, can cause CNS depression when taken with other CNS depressants, especially for older adult clients. It is important to monitor for respiratory depression and recommend the lowest effective dose. Clients should avoid alcohol and other CNS depressants while taking a benzodiazepine. E. Benzodiazepines, such as alprazolam, are unlikely to cause constipation. However, they can cause nausea, vomiting, and diarrhea.

A nurse is caring for a client who is about to begin taking lithium carbonate to treat bipolar disorder. The nurse should instruct the client to monitor for which of the following findings as indications of lithium toxicity? (Select all that apply.) A. Tremors B. Confusion C. Bronchospasm D. Nausea E. Muscle weakness

A. Tremors B. Confusion D. Nausea E. Muscle weakness Rationale: A. A fine hand tremor is an early indication of lithium toxicity. A coarse tremor indicates advanced toxicity that can lead to seizure activity. B. Confusion, slurred speech, and ataxia are indications of lithium toxicity that develop because of the drug's narrow therapeutic range. C. Lithium toxicity is unlikely to cause bronchospasm because it does not usually affect the respiratory system. D. Nausea, vomiting, and diarrhea are early indications of lithium toxicity that develop because of the drug's narrow therapeutic range. Clients should report any of these adverse effects. E. Muscle weakness is an early indication of lithium toxicity that develops because of the drug's narrow therapeutic range. The nurse should monitor lithium levels periodically.

A nurse is caring for a client who has a new prescription for alosetron to treat irritable bowel syndrome. The nurse should instruct the client to report which of the following adverse effects of the drug?

Abdominal pain

A nurse is caring for a client who is taking allopurinol to treat gout and has a new prescription for azathioprine to treat ulcerative colitis. For which of the following reasons should the nurse clarify these prescriptions with the provider?

Allopurinol delays the conversion of azathioprine and can lead to toxicity.

Which of the following drugs has protocols that require clients to meet specific risk-management criteria and sign a treatment agreement before the nurse can administer the drug?

Alosetron

A nurse is caring for a client who has peptic ulcer disease. The nurse should monitor the client's phosphorus levels when administering which of the following drugs?

Aluminum hydroxide

A nurse is caring for a client who has a new prescription for ranitidine to treat GERD. The nurse should instruct the client to wait at least 1 hr between taking ranitidine and which of the following over-the-counter drugs?

Antacids

A nurse should recognize that sulfasalazine is contraindicated for clients who have which of the following conditions?

Aspirin sensitivity

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

Avoid activities that require alertness.

A nurse is providing teaching to a client who has a new prescription for fluoxetine. Which of the following instructions should the nurse include? A. "Weigh yourself twice a month." B. "If you have persistent headaches, let the provider know." C. "Reduce your daily sodium intake." D. "If your symptoms don't improve in 10 days, you will need a higher dosage."

B. "If you have persistent headaches, let the provider know." Rationale: A. The nurse should instruct the client to measure their weight weekly and report a consistent decline to the provider. Fluoxetine can cause abdominal pain, abnormal taste, dry mouth, nausea, and anorexia, which can affect appetite. B. The client should report persistent headache, anxiety, or insomnia to the provider as an adverse drug reaction. C. Fluoxetine can cause hyponatremia. The nurse should instruct the client to maintain consistent sodium intake and to monitor for indications of a low blood sodium level. D. The nurse should inform the client that the medication can take up to 4 weeks to become effective, and the client should communicate a lack of effectiveness after that time.

A nurse is teaching a client who has osteoporosis and a new prescription for alendronate. Which of the following information should the nurse include in the teaching? A. "Take the medication with 240 mL of milk." B. "Remain upright for 30 min after taking this medication." C. "Expect the medication to cause insomnia." D. "Take vitamin C to promote medication absorption."

B. "Remain upright for 30 min after taking this medication."

A nurse in an emergency department is assessing a client who has myasthenia gravis. The client reports recent increasing muscle weakness and the nurse suspects the client is having a myasthenic crisis. Which of the following actions is the nurse's priority? A. Administer artificial tears B. Assist with a Tensilon test C. Administer immunosuppressants D. Assist with plasmapheresis

B. Assist with a Tensilon test

A nurse is caring for a client who has schizoaffective disorder and who has been prescribed chlorpromazine IV. Which of the following client findings should the nurse monitor after administering the medication? A. BUN level B. Blood pressure C. Urine specific gravity D. Pedal pulse strength

B. Blood pressure Rationale: A. Chlorpromazine is unlikely to cause kidney impairment; however, an adverse effect is urinary retention. Therefore, the nurse should monitor the client's urine output. B. Clients who receive chlorpromazine are at risk for hypotension during and immediately after IV administration. The client should remain supine for 30 min while the nurse monitors their blood pressure. The nurse should instruct the client to change positions slowly as a safety precaution to prevent client injury. This medication can also cause orthostatic hypotension. C. Chlorpromazine is unlikely to alter urine specific gravity; however, it can cause urinary retention. It is important to monitor the client's urine output. D. Chlorpromazine is unlikely to alter the client's peripheral circulation; however, it can cause tachycardia. Therefore, the nurse should monitor the client's heart rate.

A nurse is caring for a client who has a full arm cast and reports a pain severity of 8 on a scale from 0 to 10 that pain medication does not relieve. Which of the following actions should the nurse plan to take first? A. Administer additional pain medication B. Check the circulation of the affected extremity C. Document the findings D. Reposition the affected extremity

B. Check the circulation of the affected extremity

A nurse is caring for a client who is in balanced suspension skeletal traction and reports intermittent muscle spasms. Which of the following actions should the nurse take first? A. Reposition the client B. Check the position of the weights and ropes C. Administer a muscle relaxant D. Provide distraction

B. Check the position of the weights and ropes

A nurse is providing teaching for a client who has a prescription for phenelzine. The nurse should instruct the client to avoid tyramine-enriched foods because of an increased risk for which of the following adverse effects? A. Respiratory depression B. Hypertensive crisis C. Neuroleptic malignant syndrome D. Serotonin syndrome

B. Hypertensive crisis Rationale: A. Phenelzine, a monoamine oxidase inhibitor (MAOI), is not likely to cause respiratory depression; however, it can cause fatigue and weakness. B. Tyramine-enriched foods, such as aged cheese and processed meat, can trigger severe hypertension in clients who are taking phenelzine. Manifestations include hypertension, headache, and nausea. C. Neuroleptic malignant syndrome is a serious adverse effect of some antipsychotic drugs, such as haloperidol, but not of monoamine oxidase inhibitors (MAOIs), such as phenelzine. Manifestations include high fever, rigidity, vital-sign instability, and loss of consciousness. D. Signs of serotonin syndrome can begin 2 to 72 hr after initiating therapy with a selective serotonin reuptake inhibitor (SSRI). Manifestations include mental confusion, difficulty concentrating, and agitation.

When reviewing the indications for various antidepressants, a nurse should identify that bupropion hydrochloride is an appropriate choice for clients who have which of the following? (Select all that apply.) A. Motion sickness B. Seasonal affective disorder C. Insomnia D. Nicotine addiction E. Depression

B. Seasonal affective disorder D. Nicotine addiction E. Depression Rationale: A. Bupropion, an atypical antidepressant, can cause nausea, vomiting, and constipation. It does not prevent or treat motion sickness. B. Bupropion, an atypical antidepressant, helps prevent and treat seasonal affective disorder, a type of depression associated with the reduction of natural light during winter months. C. Bupropion, an atypical antidepressant, can cause insomnia and agitation. It does not prevent or treat insomnia. D. Bupropion, an atypical antidepressant, is an appropriate adjunct for clients who are trying to quit smoking. E. Bupropion, an atypical antidepressant, can help treat depression.

A nurse is caring for a client who has a spastic bladder following a spinal cord injury. Which of the following actions should the nurse take to help stimulate micturition? A. Encourage the client to use the Valsalva maneuver. B. Stroke the client's inner thigh. C. Perform the Credé manuever. D. Administer a diuretic.

B. Stroke the client's inner thigh.

A nurse is assessing a client who has rheumatoid arthritis. Which of the following assessment findings should the nurse expect? A. Unitlateral joint involvement B. Ulnar deviation C. Fractures of the spine D. Decreased sedimentation rate

B. Ulnar deviation

A nurse is providing teaching to a client who has a prescription for chlorpromazine. Which of the following instructions should the nurse include? A. Stop taking the drug immediately with the first sign of a sore throat. B. Wear sunscreen when exposed to sunlight. C. Take the drug with food to reduce gastrointestinal distress. D. Take the drug in the morning to prevent nocturia.

B. Wear sunscreen when exposed to sunlight. Rationale: A. Clients who take chlorpromazine, a conventional antipsychotic, should taper the drug slowly to prevent withdrawal symptoms. The drug is appropriate for clients who have a sore throat, but those who have respiratory impairment because of infection require cautious use. B. Chlorpromazine, a conventional antipsychotic, can cause photosensitivity, or increased susceptibility to sunburn, when exposed to sunlight. Clients should limit their exposure to sunlight and wear sunscreen and protective clothing while outdoors. C. Chlorpromazine, a conventional antipsychotic, treats nausea and vomiting. It is not necessary to take it with food. D. Chlorpromazine, a conventional antipsychotic, can cause sedation and urinary hesitancy, not urinary frequency. Clients should take it in the evening.

A nurse is teaching a client who has Parkinson's disease about taking carbidopa-levodopa. Which of the following statements should the nurse identify as an indication that the client understands the teaching? A. "I should expect a slight increase in my blood pressure while taking this medication." B. "I should take my medication with a high-protein food." C. "I should expect my urine to be a darker color." D. "I should expect it to take up to a week for this medication to work."

C. "I should expect my urine to be a darker color."

A nurse is caring a client who is 72 hr postoperative following an above-the-knee amputation and reports phantom limb pain. Which of the following actions should the nurse take? A. Remind the client that the surgery removed the limb B. Change the dressing on the client's residual limb C. Administer a dose of gabapentin to the client D. Elevate the client's residual limb above heart level

C. Administer a dose of gabapentin to the client

A nurse is providing teaching to a client who has a prescription for buspirone. Which of the following instructions should the nurse include? A. Take the drug with grapefruit juice to increase absorption. B. Use the drug as needed for anxiety. C. Allow 2 to 4 weeks for full therapeutic effects. D. Take the drug on an empty stomach.

C. Allow 2 to 4 weeks for full therapeutic effects. Rationale: A. Clients who take buspirone should not drink grapefruit juice, because it increases buspirone drug levels. B. To avoid a recurrence or exacerbation of symptoms, clients should take buspirone on a regular basis and not PRN. C. It can take up to 4 weeks for a client to feel the drug's full therapeutic effects. D. Buspirone can cause nausea, so taking it with food can help minimize this effect.

A nurse is providing teaching to a client who has a prescription for lithium carbonate about reducing the risk for lithium toxicity. Which of the following instructions should the nurse include? A. Consume a low-sodium diet. B. Reduce fluid intake. C. Avoid taking NSAIDs. D. Take the drug with food.

C. Avoid taking NSAIDs. Rationale: A. Reduced serum sodium decreases lithium excretion, which can lead to toxicity. B. Dehydration increases the risk for lithium toxicity. C. NSAIDs increase renal reabsorption of lithium and sodium. Clients who take lithium should not take NSAIDs. D. Taking lithium with food can reduce gastric irritation, but it does not reduce the risk for lithium toxicity.

A nurse is caring for a client who has viral meningitis. Which of the following actions should the nurse take? A. Assess the client's neurologic status every 8 hr B. Initiate droplet precautions C. Check capillary refill at least every 4 hr D. Place the client in a well-lit environment

C. Check capillary refill at least every 4 hr

A nurse is caring for a client who has retinal detachment. Which of the following client reports about the affected eye should the nurse expect? A. Photophobia B. Complete blindness C. Flashes of bright light D. Pain

C. Flashes of bright light

A nurse is providing teaching to a client about the adverse effects of drug therapy. The nurse should include that orthostatic hypotension is a common adverse reaction of which of the following drugs? A. Venlafaxine B. Bupropion C. Imipramine D. Valproic acid

C. Imipramine Rationale: A. Venlafaxine, a serotonin/norepinephrine reuptake inhibitor, is more likely to cause hypertension than orthostatic hypotension. B. Adverse effects of bupropion, an atypical antidepressant, include nausea, vomiting, headache, and insomnia. This drug is unlikely to cause orthostatic hypotension. C. Imipramine, a tricyclic antidepressant, can result in orthostatic (postural) hypotension. Clients who take this drug should change positions slowly from sitting or lying to standing. D. Valproic acid, a conventional antipsychotic, typically causes extrapyramidal effects, including akathisia, Parkinsonism, acute dystonia, and tardive dyskinesia. This drug is unlikely to cause orthostatic hypotension.

A nurse is assessing a client who had a right hemispheric stroke. Which of the following neurologic deficits should the nurse expect? A. Aphasia B. Right-sided neglect C. Impulsive behavior D. Inability to read

C. Impulsive behavior

A nurse is caring for a client who has multiple sclerosis. Which of the following findings should the nurse expect? A. Hypoactive deep-tendon reflexes B. Ascending paralysis C. Intention tumors D. Increased lacrimation

C. Intention tumors

A nurse is caring for a client who has advancing amyotrophic lateral sclerosis. Which of the following interventions is the nurse's priority? A. Provide for frequent rest periods throughout the day B. Medicate for pain on a regular schedule C. Monitor pulse oximetry findings D. Administer baclofen for spasticity

C. Monitor pulse oximetry findings

A nurse is caring for a client who is taking venlafaxine to treat major depressive disorder. The nurse should identify that which of the following drugs can cause serotonin syndrome when taken concurrently with venlafaxine? A. Alprazolam B. Phenytoin C. Phenelzine D. Pilocarpine

C. Phenelzine Rationale: A. Venlafaxine, a serotonin norepinephrine reuptake inhibitor, is unlikely to interact with alprazolam, a benzodiazepine. Cimetidine is a drug that interacts with alprazolam to increase alprazolam levels. B. Venlafaxine, a serotonin norepinephrine reuptake inhibitor, is unlikely to interact with phenytoin, an anticonvulsant. Amiodarone is a drug that interacts with phenytoin to increase phenytoin levels. C. Clients should not take venlafaxine, a serotonin norepinephrine reuptake inhibitor, within 14 days of taking phenelzine, other MAOIs, or serotonergic drugs. Serotonin syndrome is a life-threatening complication characterized by anxiety, confusion, hallucinations, and fever. D. Venlafaxine, a serotonin norepinephrine reuptake inhibitor, is unlikely to interact with pilocarpine, a direct-acting cholinergic. Ipratropium is an anticholinergic drug that interacts with pilocarpine to reduce ipratropium levels.

A nurse is caring for a client who is taking lithium carbonate to treat bipolar disorder. Which of the following diagnostic tests should the nurse recommend that the client undergo periodically? A. Chest x-ray B. Tonometry C. Thyroid function tests D. Endoscopic retrograde cholangiopancreatography (ERCP)

C. Thyroid function tests Rationale: A. Chest x-rays help identify problems with the heart and lungs. Lithium can cause dysrhythmias, but it is unlikely to cause a dysfunction of the heart or lungs that will be detectable on chest x-rays. B. Tonometry is a method of testing for glaucoma. Lithium carbonate is unlikely to cause glaucoma. C. ​Hypothyroidism is an adverse effect of lithium carbonate. Clients should report neck enlargement, weight gain, lethargy, and constipation. They should also have their thyroid function checked before they begin taking lithium and annually thereafter. D. An ERCP helps identify disorders of the liver, gallbladder, bile ducts, and pancreas. Lithium carbonate is unlikely to cause abnormalities of these structures.

A nurse is providing teaching to a client who has a new prescription for diazepam to treat anxiety disorders. Which of the following client statements indicates an understanding of the teaching? A. "It is not a big deal if I forget my pills for a couple of days." B. "I should limit alcohol intake to one drink daily while taking this medication." C. "I will avoid salt because this medication can increase my blood pressure." D. "If I become pregnant, it is important to let my health care provider know."

D. "If I become pregnant, it is important to let my health care provider know." Rationale: A. The nurse should instruct the client that abruptly stopping this medication can cause seizures, insomnia, nervousness, or irritability. B. Taking alcohol with diazepam can cause CNS depression. The nurse should instruct the client to avoid alcohol intake. C. Diazepam can cause hypotension when administered IV. The nurse should instruct the client to use caution when changing positions. D. Diazepam can increase the risk of congenital malformations and is contraindicated for clients who are pregnant.

A nurse is teaching a client and his family about the diagnosis and treatment of Alzheimer's disease. Which of the following statements should the nurse identify as an indication that the family understands the teaching? A. "There is a test for Alzheimer's disease that can establish a reliable diagnosis." B. "The goal of medication therapy is to revers the degenerative changes that can occur in brain tissue." C. "Early manifestations of Alzheimer's disease include mild tremors and rigidity." D. "The medications that treat Alzheimer's disease can help delay cognitive changes."

D. "The medications that treat Alzheimer's disease can help delay cognitive changes."

A nurse is caring for a client who recently began taking chlorpromazine to treat schizophrenia and was admitted to the emergency room with spasms of their face and back. Which of the following adverse reactions should the nurse expect? A. Cholinergic crisis B. Serotonin syndrome C. Stevens-Johnson syndrome D. V

D. Acute dystonia Rationale: A. Manifestations of a cholinergic crisis include nausea, vomiting, diaphoresis, and bradycardia. Chlorpromazine is unlikely to cause a cholinergic crisis. B. Indications of serotonin syndrome include agitation, confusion, and anxiety. Chlorpromazine is unlikely to cause serotonin syndrome. C. Indications of Stevens-Johnson syndrome include fever, rash, and blisters. Chlorpromazine is unlikely to cause Stevens-Johnson syndrome. D. Acute dystonia can develop during the first few days of treatment with chlorpromazine. Manifestations include muscle spasms of the back, neck, face, and tongue. Treatment includes immediate administration of an anticholinergic drug, such as diphenhydramine.

A nurse is providing teaching for a client who has a new prescription for betaxolol eye drops. Which of the following adverse effects should the nurse include in the teaching? A. Constricted pupils B. Discoloration of the iris C. Hypertension D. Bradycardia

D. Bradycardia Rationale: A. Pilocarpine, a direct-acting cholinergic drug, causes miosis, or constricted pupils, and blurred vision. Betaxolol is unlikely to constrict the pupils. B. Latanoprost can cause a brownish discoloration of the iris. Betaxolol is unlikely to cause this effect. C. Betaxolol can cause hypotension. Oral betaxolol treats hypertension. D. Betaxolol and timolol can cause bradycardia because of the blockade of cardiac beta1 receptors. Clients should check their pulse rate regularly and report any sustained decreases.

A nurse is caring for a client who has a basilar skull fracture following a fall from a ladder. Which of the following assessment findings should the nurse report to the provider? A. Glasgow Coma Scale score of 15 B. Intracranial pressure reading of 15 mm Hg C. Ecchymosis at base of the skull D. Clear drainage from nose

D. Clear drainage from nose

A nurse is performing a pain assessment for a client who is postoperative. Which of the following findings should the nurse use to determine the severity of the client's pain? A. Client's vital sign changes B. Client's report of the type of pain C. Client's nonverbal communication D. Client's report of pain on a pain scale

D. Client's report of pain on a pain scale

A nurse is assessing a client who is quadriplegic following a cervical fracture at vertebral level C5. The client reports a throbbing headache and nausea. The nurse notes facial flushing and a blood pressure of 220/110 mm Hg. Which of the following actions should the nurse take first? A. Administer hydralazine via IV bolus B. Loosen the client's clothing C. Empty the client's bladder D. Elevate the head of the client's bed

D. Elevate the head of the client's bed R: the client is experiencing autonomic dysreflexia and is at greatest risk for possible rupture of a cerebral vessel or increased ICP.

A nurse is caring for a client who has a history of status epilepticus and requires seizure precautions. Which of the following actions should the nurse take? A. Assess hourly for a spike in blood pressure B. Keep the client on bed rest C. Keep a padded tongue blade at the bedside D. Establish IV access

D. Establish IV access

A nurse is teaching an assistive personnel (AP) about care of a client following a total hip arthroplasty. Which of the following instructions should the nurse include? A. Avoid applying anti-embolism stockings to the affected leg B. Have the client lean forward when moving from a sitting to a standing position C. Discourage the client from sitting in a wheelchair with the back reclined D. Place an abductor pillow between the client's legs when turning the client

D. Place an abductor pillow between the client's legs when turning the client

A nurse is caring for a client who is recovering from a stroke and has right-sided homonymous hemianopsia. To help the client adapt to the hemianopsia, the nurse should take which of the following actions? A. Check the client's cheek on his affected side after he eats to be sure no food remains there. B. Encourage the client to sit upright with his head tilted slightly forward during meals. C. Provide the client with eating utensils that have large handles. D. Remind the client to look consciously at both sides of his meal tray.

D. Remind the client to look consciously at both sides of his meal tray.

A nurse is caring for a client who was admitted to the emergency department with a head injury. The nurse notes that the client has an existing prescription for bupropion hydrochloride to treat depression. For which of the following adverse effects is the client at increased risk? A. Ischemic stroke B. Drowsiness C. Respiratory depression D. Seizure activity

D. Seizure activity Rationale: A. Bupropion, an atypical antidepressant, is unlikely to cause an ischemic stroke. However, it can cause headache and agitation. B. Bupropion, an atypical antidepressant, is more likely to cause insomnia than drowsiness. C. Bupropion, an atypical antidepressant, is unlikely to cause respiratory depression because it does not affect the respiratory system. However, it can cause nausea and vomiting. D. Bupropion, an atypical antidepressant, can cause seizure activity when clients take high doses or have a seizure disorder, a CNS tumor, or a history of head trauma.

A nurse is planning to teach a client who has epilepsy and is to start therapy with phenytoin. Which of the following instructions should the nurse include in the client's medication teaching plan? A. Rinse with antiseptic mouthwash in place of using dental floss B. Use and over-the-counter antihistamine if a rash develops C. Slowly taper the medication after 6 consecutive months without seizure activity D. Take medications at a consistent time each day to maintain therapeutic blood levels

D. Take medications at a consistent time each day to maintain therapeutic blood levels

A nurse is caring for a client who has been taking alprazolam for an extended period of time to treat anxiety. The nurse should identify that abruptly stopping alprazolam therapy can result in which of the following adverse effects? A. Anterograde amnesia B. Respiratory depression C. Paradoxical reaction D. Withdrawal symptoms

D. Withdrawal symptoms Rationale: A. Alprazolam, a benzodiazepine, can impair the memory of events that occur after taking the drug. Stopping drug therapy does not cause this effect. B. Alprazolam, a benzodiazepine, can cause respiratory depression and drowsiness. Stopping drug therapy does not cause this effect. C. A paradoxical reaction to alprazolam, a benzodiazepine, includes excitement and agitation. This does not occur with sudden cessation of drug therapy. D. Physical dependence can develop with extended use of alprazolam, a benzodiazepine. To prevent withdrawal symptoms, clients should taper the dose slowly over several weeks.

A nurse is assessing a client who was administered ondansetron IV 1 hr ago. Which of the following findings should the nurse recognize as an adverse effect of this drug?

Dizziness

A nurse is teaching a client who has a new prescription for methotrexate. The nurse should instruct the client to monitor for manifestations of which of the following conditions?

Gout

Carbidopa/Levodopa for Parkinson's disease. Which of the following client statements indicates an understanding of the teaching?

I should expect that this medication can cause me to be drowsy. R. avoid heavy machinery and driving

A nurse is teaching. client who has MS and has a new prescription for glatiramer acetate. Which of the following statements indicates that the client understands the teaching?

I will avoid going to the store when it is crowded R: Immunomodulators or stops the body from damaging its own cells. Risk for developing cancer and infection.

A nurse should recognize that diphenoxylate/atropine should be used with caution for a client who has which of the following conditions?

Inflammatory bowel disease

A nurse is reviewing the medical record of a client who has a new prescription for ranitidine. The nurse should recognize that which of the following drugs interacts with ranitidine?

Ketoconazole

A nurse is caring for an older adult client who has renal impairment and a new prescription for cimetidine. The nurse should instruct the client to report which of the following manifestations?

Lethargy

A nurse is caring for a client who is taking lubiprostone. The nurse should tell the client that lubiprostone can cause which of the following adverse drug reactions?

Nausea

A nurse is caring for a client who has a prescription for alosetron. The nurse should recognize that alosetron therapy is effective when the client reports which of the following?

One formed stool per day.

A nurse is teaching a client who recently had a myocardial infarction and has a new prescription for docusate sodium. The nurse should inform the client that docusate sodium has which of the following therapeutic effects?

Prevents straining

A nurse is caring for a client who is taking phenytoin for a seizure disorder and has a new prescription for sucralfate to treat a duodenal ulcer. The nurse should instruct the client to take the drugs at least 2 hr apart for which of the following reasons?

Sucralfate interferes with the absorption of phenytoin.

A nurse is providing teaching to a client who has a new prescription for omeprazole to treat a duodenal ulcer. Which of the following instructions should the nurse include?

Swallow the capsules whole.

A nurse is caring for a male client who asks the nurse about taking alosetron for irritable bowel syndrome with diarrhea (IBS-D) lasting 3 months. Which of the following information should the nurse provide the client about alosetron?

The drug is prescribed to female clients who have IBS-D lasting more than 6 months.

A nurse is planning teaching for a client who has been prescribed loperamide to treat diarrhea. Which of the following statements should the nurse plan to include?

"Avoid driving or activities requiring alertness."

A nurse is teaching a client who has a new prescription for sulfasalazine. Which of the following statements should the nurse make?

"Use sunscreen and protective clothing while taking sulfasalazine to prevent sunburn."

A nurse is caring for a client who is receiving chemotherapy and has a new prescription for ondansetron. Which if the following actions should the nurse plan to take? (Select all)

1. Infuse the drug 30 min prior to chemotherapy. 2. Infuse the drug slowly over 15 min. 3. Repeat the dose 4 hf after chemotherapy.

A nurse is administering sulfasalazine to a client. Which of the following data should the nurse collect to help identify an adverse drug reaction? (Select all)

1. Skin integrity 2. Temperature 3. CBC

A nurse is providing teaching to a client who has a new prescription for dimenhydrinate to prevent motion sickness. Which of the following instructions should the nurse include? (Select all)

1. Take the drug 30 to 60 min before activities that trigger nausea. 2. Avoid activities that require alertness. 3. Increase fluid and fiber intake.

A nurse is providing teaching to a client who is about to start taking psyllium to treat constipation. Which of the following instructions should the nurse include? (Select all)

1. Take the drug with at least 8 oz (237 mL) of fluid. 2. Increase fluid and fiber intake.

A nurse should recognize that misoprostol is contraindicated for a client who has which of the following conditions?

A positive pregnancy test

A nurse is reviewing postoperative instructions with a client following cataract surgery. Which of the following statements should the nurse identify as an indication that the client understands the instructions? A. "I should call my doctor if my vision gets worse." B. "I will take aspirin for eye discomfort." C. "I can blow my nose to clear out any drainage." D. "I can lift objects up to 20 pounds."

A. "I should call my doctor if my vision gets worse."

A nurse is developing a teaching plan for a client who has Ménière's disease. Which of the following instructions should the nurse include? A. "Move your head slowly to decrease vertigo." B. "Apply warm packs to the affected ear during acute attacks." C. "Increase your intake of foods and fluids high in salt." D. "Take corticosteroids during acute attacks."

A. "Move your head slowly to decrease vertigo."

A nurse is providing teaching to a client who has a prescription for buspirone to treat anxiety. Which of the following instructions should the nurse include? A. "Take a missed dose as soon as you remember." B. "Take the drug as needed at the first sign of anxious feelings." C. "Take the drug in the morning with a glass of grapefruit juice." D. "Drink a cup of chamomile tea at night with the drug."

A. "Take a missed dose as soon as you remember." Rationale: A. Buspirone should be taken on a regular scheduled basis to be therapeutic. If a client misses a dose, then they should take one as soon as they remember, as long as it is not close to time for the next scheduled dose. B. Buspirone should be taken on a regular basis, not as needed. The onset of action is 1 to 2 weeks, so it is important to maintain consistent blood levels. C. Grapefruit juice can increase serum levels and the effects of buspirone. The client should avoid drinking grapefruit juice while taking this drug. D. Chamomile can increase CNS depression and should be avoided while taking this drug.

A nurse is assessing a client who has been taking alprazolam for several days. Which of the following findings should the nurse identify as an adverse drug reaction caused by alprazolam? A. Anxiety B. Ringing in the ears C. Increased appetite D. Muscle spasms

A. Anxiety Rationale: A. The client can experience a paradoxical effect when taking benzodiazepines or buspirone, indicated by increased anxiety rather than relief of anxiety. The nurse should report this to the provider, who might consider a different medication. B. The nurse should recognize that blurred vision is a possible adverse drug reaction of alprazolam. C. The nurse should recognize that nausea and vomiting are possible adverse drug reactions of alprazolam. D. Muscle spasms are not an expected adverse drug reaction for alprazolam. Diazepam, another benzodiazepine, can be prescribed to treat muscle spasms.

A nurse is providing teaching to a client about instilling pilocarpine for managing open-angle glaucoma. Which of the following instructions should the nurse include in the teaching? (Select all that apply.) A. Apply gentle pressure to the nasolacrimal duct for 1 min after instilling the drops. B. Do not touch the tip of the dropper. C. Wash hands after instilling the drops. D. Rub eyes gently after instilling the drops. E. Remove contact lenses prior to instilling the drops.

A. Apply gentle pressure to the nasolacrimal duct for 1 min after instilling the drops. B. Do not touch the tip of the dropper. E. Remove contact lenses prior to instilling the drops. Rationale: A. Applying gentle pressure to the nasolacrimal duct for 1 to 2 min after instillation helps keep the drug from entering the systemic circulation. B. The tip of the dropper should remain sterile. It is important that clients avoid touching the dropper's tip or touching it to the eye area. C. Clients should wash their hands before instilling eye drops. It is not necessary after instillation unless they have spilled any of the drops on their hands. D. Clients should avoid rubbing or touching their eyes because doing so can cause eye damage. E. Clients should remove contact lenses before instilling eye drops because they can cause further irritation if left in place.