ATI PHARM TEST B

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? (Select all that apply.)

"Blood glucose levels will be monitored during therapy" is correct. The nurse should instruct the client that their blood glucose levels will be monitored during therapy because corticosteroids, such as methylprednisolone, can raise blood glucose levels. "Avoid contact with persons who have known infections" is correct. The nurse should instruct the client to avoid contact with persons who have known infections because corticosteroids, such as methylprednisolone, suppress the immune response and mask manifestations of infection. "Grapefruit juice can increase the blood levels of the medication" is correct. The nurse should instruct the client that grapefruit juice increases the absorption of the medication, which can lead to toxicity and adrenal suppression.

A nurse is teaching a client who is to start taking ranitidine for peptic ulcer disease. Which of the following client statements should the nurse identify as understanding of the teaching?

"I know smoking makes ranitidine less effective." The nurse should instruct the client that smoking decreases the effectiveness of ranitidine by exacerbating the ulcer manifestations.

A nurse is providing teaching to a client who had depression and has a new prescription for fluoxetine. Which of the following statements by the client indicated an understanding of the teaching?

"I should take acetaminophen instead of ibuprofen for my headaches while taking this medication." Fluoxetine suppresses platelet aggregation, which increases the risk of bleeding when used concurrently with NSAIDs and anticoagulants. Therefore, clients who are taking fluoxetine should take acetaminophen for headaches or pain, since acetaminophen does not suppress platelet aggregation.

A nurse is providing discharge instructions to a client who is to self-administer insulin at home. Which of the following client statements should indicate to the nurse that the teaching is effective?

"I will store my unopened bottles of insulin in the refrigerator." The client should store unopened vials of insulin in the refrigerator to maintain medication viability. Once opened, the insulin can remain at room temperature for up to 1 month.

A nurse is teaching about zolpidem to a client who has insomnia. Then urse should identify that which of teh following client statements indicate an understanding of the teaching?

"I will use this medication for a short period of time." Zolpidem is used for short-term treatment of insomnia. Therefore, the provider should reassess the client before refilling the prescription.

A nurse is providing discharge teaching to a client who has a new prescription for furosemide twice daily. The nurse should include which of the following instructions in the teaching?

"Increase intake of potassium-rich foods" is correct. Loop diuretics, such as furosemide, act at the loop of Henle by blocking the resorption of sodium, water, and potassium. An adverse effect of the medication is the development of electrolyte imbalances such as hyponatremia, hypochloremia, and hypokalemia. To prevent hypokalemia, the client should increase intake of potassium-rich foods, such as potatoes, spinach, dried fruit, and nuts. "Monitor for muscle weakness" is correct. Furosemide, a loop diuretic, causes a loss of potassium, which can result in manifestations of hypokalemia such as difficulty concentrating, shallow respirations, hyporeflexia, and muscle weakness. The nurse should instruct the client to monitor for these manifestations and report them to the provider. "Dangle your legs from the side of the bed before standing" is correct. Loop diuretics, such as furosemide, reduce vascular tone and increase fluid excretion. These effects decrease blood return to the heart and can manifest as dizziness and lightheadedness when going from a lying to a standing position. The client should change positions slowly to minimize orthostatic hypotension.

A nurse is preparing to administer 0.9% sodium chloride 1000 mL IV over 8 hr to a client. The drop factor of the manual IV tubing is 15 gtt/min. The nurse should set up the manual IV infusion to deliver how many gtt/min? (Round to the nearest whole number. Use leading zero if it applies. Do not use a trailing zero.)

31 gtt/min Follow these steps to calculate the infusion rate using the Dimensional Analysis method of calculation: Step 1: What is the unit of measurement the nurse should calculate? (Place the unit of measure being calculated on the left side of the equation.) X gtt/min = Step 2: Determine the ratio that contains the same unit as the unit being calculated. (Place the ratio on the right side of the equation, ensuring that the unit in the numerator matches the unit being calculated.) 15 gttX gtt/min = 1 mL Step 3: Place any remaining ratios that are relevant to the item on the right side of the equation, along with any needed conversion factors, to cancel out unwanted units of measurement. 15 gtt1,000 mL 1 hrX gtt/min = × × 1 mL8 hr 60 min Step 4: Solve for X. X gtt/min = 31.25 gtt/min Step 5: Round if necessary. 31.25 = 31 Step 6: Determine whether the amount to administer makes sense. If the prescription reads 0.9% sodium chloride 1,000 mL IV to infuse over 8 hr with a drop factor of 15 gtt/min, it makes sense to administer 31 gtt/min. The nurse should set the manual IV infusion to deliver 0.9% sodium chloride IV at 31 gtt/min.

A nurse is completing an incident report for a medication error. Which of the following information should the nurse include in the report?

Administered propranolol 80 mg PO at 1800 to the client who did not have a prescription for the medication. The incident report should clearly and thoroughly report the facts of the error.

A nurse is caring for a client who is receiving haloperidol. the nurse should observe for which of the following findings as an adverse effect of the medication?

Akathisia An adverse effect associated with haloperidol is the development of extrapyramidal manifestations such as dystonia, pseudoparkinsonism, and akathisia.

A nurse is reviewing the medical record of a client who has hypertension. The nurse should identify which of the following findings as a contraindication to receiving propranolol?

Asthma Asthma is a contraindication for receiving propranolol. Propranolol is an adrenergic antagonist which blocks the beta2 receptors in the lungs, causing bronchoconstriction and leading to serious airway resistance and possibly respiratory arrest.

A nurse is caring for a client who is recovering from a deep vein thrombosis and is to start taking warfarin. For which of the following findings should the nurse monitor as an adverse effect of warfarin?

Bleeding gums The nurse should monitor the client for bleeding gums, which is an adverse effect of warfarin, an anticoagulant.

A nurse is caring for a client who has a magnesium level of 3.1. The nurse should expect to administer which of the following medications?

Calcium gluconate The nurse should expect to administer IV calcium gluconate to the client and prepare to provide ventilatory support. This client is at risk for respiratory depression and cardiac dysrhythmias because a magnesium level of 3.1 mEq/L is above the expected reference range of 1.3 to 2.1 mEq/L.

A nurse is providing teaching to a client who is to start taking sumatriptan. Which of the following adverse effects should the nurse instrct the client to monitor for and report to the provider?

Chest pressure Sumatriptan is an antimigraine agent which can cause coronary vasospasms, resulting in angina. The client should report chest pressure or heavy arms to the provider.

A nurse is caring for a client who has hypocalcemia and is receiving calcium citrate. The nurse should identify that which of the following findings indicates a therapeutic response to the medication?

Client report of decreased paresthesia Paresthesia is a manifestation of hypocalcemia. A client report of a decrease in paresthesia is an indication of a therapeutic response to calcium citrate. The nurse should also monitor for a decrease in other manifestations of hypocalcemia, including muscle twitching and cardiac dysrhythmias.

A nurse is reviewing laboratory results for a client who is to receive a dose of ceftazidime via intermittent IV bolus. Which of the following laboratory findings is the priority for the nurse to report to the provider before adminstering the medication?

Creatinine 2.6 mg/dL Ceftazidime is excreted primarily by the renal system. A serum creatinine level above 1.3 mg/dL can indicate a kidney disorder requiring a reduction in the dose administered. The nurse should notify the provider, who is likely to prescribe a lowered dose of medication.

A nurse is planning to teach about inhalant medications to a client who has a new diagnosis of exercise-induced asthma. Which of the following medications should the nurse plan to instruct the client to use prior to physical activity?

Cromolyn Cromolyn sodium stabilizes mast cells, which inhibit the release of histamine and other inflammatory mediators. The client should use cromolyn 10 to 15 min before planning to exercise to prevent bronchospasms.

A nurse is administering baclofen for a client who has spinal cord injury. Which of the following findings should the nurse document as a therapeutic outcome?

Decrease in flexor and extensor spasticity A client who has a spinal cord injury and takes baclofen can experience a decrease in the frequency and severity of muscle spasms and in flexor and extensor spasticity.

A nurse is administering cefotetan via intermittent IV bolus to a client who suddenly develops dyspnea and widespread hives. Which of the following actions should the nurse take first?

Discontinue the medication IV infusion. The greatest risk to the client is respiratory arrest from anaphylaxis. Therefore, the first action the nurse should take is to discontinue the medication IV infusion to prevent the client from receiving more medication. However, the nurse should not remove the IV catheter. Instead, the nurse should change the tubing and administer 0.9% sodium chloride by continuous IV infusion.

A nurse is caring for a client who has developed hypomagnesemia due to long-term therapy with lansoprazole. The nurse should monitor the client for which of the following manifestations?

Disorientation The nurse should monitor the client for disorientation and confusion as manifestations of hypomagnesemia. The nurse should also assess the client for a positive Chvostek's and Trousseau's signs.

A nurse is caring for a client who has pneumonia. The client tells the nurse she is pregnant and that she has not told her provider yet. The nurse should identify that pregnancy is a contraindication to receiving which of the following medications?

Doxycycline Doxycycline is a tetracycline antibiotic. The nurse should identify that doxycycline can cause teratogenic effects such as staining of the infant's teeth when exposed to this medication. Therefore, this medication is contraindicated for the client.

A nurse is teaching a clinet who is takng allopurinol for the treatment of gout. Which of the following info should the nurse include in the teaching?

Drink 2 L of water daily. The nurse should instruct the client to drink at least 2 L of water each day to prevent renal stone formation and kidney injury, because allopurinol is eliminated through the kidneys.

A nurse is providing teaching to a client who has a prescription for trimethoprim/sulfamethoxazole. Which of the following instructions should the nurse include in the teaching?

Drink 8 to 10 glasses of water daily. The nurse should instruct the client to increase water intake to 1,920 to 2,400 mL (65 to 81 oz) a day to decrease the chance of kidney damage from crystallization.

A nurse contacts a client's provider on the telephone to obtain a prescription for pain medication. Which of the following actions should the nurse take?

Have the provider spell out the unfamiliar medication names. The nurse should ask the provider to spell out the name of the medication if the stated name is one the nurse is not familiar with.

A nurse is caring for a client who has sickle cell anemia and is taking hydroxyurea. Which of the following findings should the nurse report to the provider? (Select all that apply.)

Hemoglobin 7.0 g/dL is correct. A hemoglobin level of 7.0 g/dL indicates hydroxyurea toxicity. This hemoglobin level is below the expected reference range of 14 to 19 g/dL for a male client and 12 to 16 g/dL for a female client. Therefore, the nurse should report this finding to the provider. Platelets 75,000/mm3 is correct. A platelet level of 75,000/mm3 indicates hydroxyurea toxicity. This platelet level is below the expected reference range of 150,00 to 400,000/mm3. Therefore, the nurse should report this finding to the provider. Potassium 5.2 mEq/L is correct. A potassium level of 5.2 mEq/L indicates tumor lysis syndrome. This potassium level is above the expected reference range of 3.5 to 5 mEq/L. Therefore, the nurse should report this finding to the provider.

A nurse is assessing a client who is receiving epoetin alfa to treat anemia. Which of the following findings should the nurse monitor?

Increased blood pressure The therapeutic effect of epoetin alfa is an increase in hematocrit levels, which can result in an increase in a client's blood pressure. If the client's hematocrit level rises too rapidly, hypertension and seizures can result. The nurse should monitor the client's blood pressure and ensure hypertension is controlled prior to administering the medication.

A nurse is teaching a client who is to begin taking tamoxifen for the treatment of breast cancer. Which of the following finding is the priority for the nurse report to the provider?

Leg tenderness The greatest risk to this client is the development of a thromboembolism, which is an adverse effect of tamoxifen. The nurse should also monitor the client for other manifestations of a thromboembolism, including leg tenderness, redness, swelling, and shortness of breath.

A nurse is caring for a client who is receiving treatment for opioid use disorder. Which of the following medications should the nurse expect to administer?

Methadone The nurse should expect to administer methadone for treatment of opioid use disorder. Methadone can be administered for withdrawal and to assist with maintenance and suppressive therapy.

A nurse administered digoxin immune Fab to a client who received the incorrect dose of digoxin over a period of 3 days. The nurse should identify that which of the following findings indicates the antidote was effective?

Normal sinus rhythm Dysrhythmias are a life-threatening adverse effect of digoxin toxicity. The return of the heart to normal sinus rhythm indicates a therapeutic response to the antidote. Digoxin immune Fab is administered to a client who is experiencing severe digoxin toxicity. It binds with digoxin and works to reduce the client's blood digoxin level.

A nurse is caring for a client who reports lethrargy and myalgia after taking clozapine for 6 months. Which of the following actions should then nurse plan to take?

Obtain WBC with absolute neutrophil count. The client who takes clozapine can develop lethargy and myalgia caused by the adverse effect of agranulocytosis. Therefore, monitoring the WBC with absolute neutrophil count weekly for the first 6 months of treatment is recommended. After 6 months, monitoring can occur every 2 weeks up to 1 year.

A nurse is providing teaching to a client who has a new prescription for ferrous sulfate. The nurse should instruct the client to take the medication with which of the following to promote absorption?

Orange juice The absorption of ferrous sulfate is enhanced by a vitamin C source, such as orange juice.

A nurse is caring for a client who has diabetes mellitus and is taking glyburide. The client reports feeling confused and anxious. Which of the following actions should the nurse take first?

Perform a capillary blood glucose test. The greatest risk to this client is injury from hypoglycemia. Therefore, the nurse should perform a capillary blood glucose test to determine the client's blood glucose status. Manifestations of hypoglycemia include weakness, anxiety, confusion, sweating, and seizures.

A circulating nurse is planning care for a client who is scheduled for surgery and has a latex allergy. Which of the following actions should the nurse include in the plan of care?

Place monitoring cords and tubes in a stockinet. The nurse should place monitoring devices in a stockinet to prevent direct contact with the client's skin.

A nurse is caring for a client who is receivng end-of-life care and has a prescription for fentanyl patches. Which of the folowing info regarding the adverse effects of fentanyl should the nurse plan to give to client and family?

Take a stool softener on a daily basis. Constipation is an adverse effect of opioid use. Stool softeners can decrease the severity of this adverse effect.

A nurse administers ceftazidime to a client who has a severe penicillin allergy. The nurse should identify which of the following client findings as an indication that she should complete an incident report?

The client reports shortness of breath. A severe penicillin allergy is a contraindication for taking ceftazidime, a cephalosporin antibiotic, due to the potential for cross-sensitivity. Shortness of breath can indicate the client is developing anaphylaxis.

A nurse in a clinic is caring for a clietn who is taking aspirin for the treatment of arthritis. The nurse should identify which of the following findings as an indication that the client is beginning to exhibit salicylism?

Tinnitus Tinnitus is a manifestation of aspirin toxicity, also called salicylism. Other manifestations include sweating, headache, and dizziness.

A nurse is reviewing the medical record of a client who has schizophrenia and a prescription for clozapine. Which of the following laboratory tests should the nurse review before adminstering the medication?

Total cholesterol The nurse should review the client's total cholesterol before administering clozapine, because this medication can cause hyperlipidemia

A nurse is teaching a client who is starting to take amitriptyline. Which of the following finds should the nurse include in the teachings as an adverse effect of the medication?

Urinary retention The nurse should instruct the client that amitriptyline causes the anticholinergic effect of urinary retention.

A nurse is preparing to administer a new prescription of amoxicillin/clavulanic to a client. The client tells the nurse that he is allergic to penicillin. Which of the following actions should the nurse take first?

Withhold the medication. When using the urgent vs nonurgent approach to client care, the nurse should determine that the priority action is to withhold the medication to prevent injury to the client.

A nurse is providing teaching to a client who is to start therapy with digoxin. For which of the following adverse effects should the nurse instruct the client to monitor and report to the provider?

Yellow-tinged vision The nurse should instruct the client to monitor for and report yellow-tinged vision, which is a sign of digoxin toxicity. Other manifestations of digoxin toxicity include nausea, vomiting, loss of appetite, and fatigue. As the digoxin levels increase, the client can experience cardiac dysrhythmias.

A nurse is p reparing to teach a client who is to start a new prescription for extended release verpamil. Which of the following instructions should the nurse plan to include?

​Change positions slowly. The nurse should instruct the client to change positions gradually to prevent orthostatic hypotension and syncope.

A nurse is caring for a client who is refusing to take their scheduled morning furosemide. Which of the following statements should the nurse make?

"By not taking your furosemide, you might retain fluid and develop swelling." The nurse should respect the client's right to refuse the medication and inform the client of the risks of not taking the medication, notify the provider, and document the refusal. Furosemide is a loop diuretic given to reduce edema.

A nurse is planning discharge teaching for a client who has a prescription for furosemide. The nurse should plan to include which of the following statements in the teaching?

"Drink a glass of milk with each dose of medication." The client should take furosemide with food or milk to reduce gastric irritation.

A nurse is teaching a client who is starting to take diltiazem. Which of the following statements should the nurse identify as an indication that the client understands the teaching?

"I will check my heart rate before I take the medication." Diltiazem, a calcium channel blocker, has cardio-suppressant effects at the SA and AV nodes, which can lead to bradycardia. The client should check their heart rate before taking the medication and notify the provider if it falls below the expected reference range.

A nurse is providing teaching to a client about the use of ethinyl estradiol/norelgestromin. The nurse should identify that which of the following statements by the client indicates an understanding of the teaching?

"I will fold the sticky sides of the old patch together before disposing it." The client should fold the sticky sides of the old patch together and then place it in a childproof container to ensure safe disposal of the patch.

A nurse is teaching about self-administration of transdermal medication with a male client who has a new prescription for nitroglycerin. The nurse should identify that which of the following statements by the client indicates an understanding of the teaching?

"I will remove the patch after 14 hours." The client should remove the patch after 12 to 14 hr to prevent tolerance of the medication.

A nurse is teaching about a new prescription for ciprofoxacin who has a UTI. The nurse should identify which of the following statements as an indication that the client understands the teaching?

"I will report any signs of tendon pain or swelling." Ciprofloxacin, a fluoroquinolone, is associated with a risk of tendon rupture. This risk is increased in older adult clients, so the client should notify the provider at the onset of tendon pain or swelling.

A nurse is preparing to administer 0.9% sodium chloride 1500 mL to infuse over 8 hr to a client who is postoperative. The nurse should set the IV pump to deliver how many mL/hr? (Round to the nearest whole number. Use leading zero if it applies. Do not use a trailing zero.)

188 mL/hr Follow these steps to calculate the infusion rate using the Dimensional Analysis method of calculation: Step 1: What is the unit of measurement the nurse should calculate? (Place the unit of measure being calculated on the left side of the equation.) X mL/hr = Step 2: Determine the ratio that contains the same unit as the unit being calculated. (Place the ratio on the right side of the equation, ensuring that the unit in the numerator matches the unit being calculated.) 1,500 mLX mL/hr = 8 hr Step 3: Place any remaining ratios that are relevant to the item on the right side of the equation, along with any needed conversion factors, to cancel out unwanted units of measurement. 1,500 mLX mL/hr = 8 hr Step 4: Solve for X. X mL/hr = 187.5 mL/hr Step 5: Round if necessary. 187.5 mL/hr = 188 mL/hr Step 6: Determine whether the amount to administer makes sense. If the prescription reads 1,500 mL 0.9% sodium chloride IV to infuse over 8 hr, it makes sense to administer 188 mL/hr. The nurse should set the IV pump to deliver 0.9% sodium chloride IV at 188 mL/hr.

A nurse is precepting a newly licensed nurse who is caring for four clients. The nurse should complete an incident report for which of the following actions by the newly licensed nurse?

Administers isosorbide mononitrate to a client who has BP 82/60 mm Hg Isosorbide mononitrate is a nitrate used for clients with angina. Taking isosorbide mononitrate leads to vasodilation, which can result in hypotension. The nurse should withhold the medication and notify the provider if the client's systolic blood pressure is below the expected reference range of 120/80.

A nurse is assessing a client who has received atropine eye drops during an eye examination. Which of the following findings should the nurse expect as an adverse effect of the medication?

Blurred vision Blurred vision is an expected finding following the administration of atropine eye drops. This is due to the cycloplegic effects of the medication, which cause near objects to appear blurry to the client.

A nurse is caring for a client who is taking atorvastatin for hyperlipidemia. Which of the following lab values should the nurse monitor?

Creatinine kinase The client who is taking atorvastatin can develop an adverse effect called rhabdomyolysis, which causes muscle weakness or pain and can progress to myositis. Creatinine kinase levels rise in response to enzymes released with muscle injury.

A nurse is teaching a client who has a new prescription for docusate sodium about the medication's mechanism's of action (MOA). Which of the following information should the nurse include in the teaching?

Docusate sodium reduces the surface tension of the stools to change their consistency. Docusate sodium is a surfactant that softens stool by reducing surface tension, allowing water to penetrate more easily into the stool.

A nurse is assessing a client who is taking amitriptyline for depression. Which of the following findings should the nurse identify as an adverse effect of the medication?

Dry mouth The nurse should expect the client to have a dry mouth due to the blocking of acetylcholine receptors that cause anticholinergic responses.

A nurse is administering diazepam to a client who is having a colonoscopy. Which of the following actions should the nurse take?

Ensure flumazenil is available to administer for toxicity management. The nurse should monitor the client for manifestations of diazepam toxicity, such as respiratory depression and hypotension. The nurse should be prepared to administer flumazenil to reverse the effects of diazepam.

A nurse is caring for a client who has heart failure and a prescription for enalapril. The nurse should monitor the client for which of the following findings as an adverse effect of the medication?

Hyperkalemia Enalapril improves cardiac functioning in clients who have heart failure and can cause hyperkalemia due to potassium retention by the kidneys.

A nurse in a provider's office is assessing a client who has been taking aspirin daily for the past year. For which of the following findings should the nurse notify the provider immediately?

Hyperventilation When using the urgent vs. nonurgent approach to client care, the nurse should determine that the priority finding is hyperventilation. This finding indicates the client might have acute salicylate poisoning, which causes respiratory alkalosis in the early stages.

A nurse is caring for a client who has heart failure and is receiving an IV infusion of dopamine. Which of the following findings indicates that the medication is effective?

Increased cardiac output Dopamine is an adrenergic that causes a receptor specificity effect, which increases cardiac output and improves perfusion.

A nurse is preparing to administer hydrochlorothiazide (HCTZ) to a client. Which of the following actions should the nurse take prior to administering the medication?

Obtain the client's blood pressure. HCTZ is a thiazide diuretic administered to promote urine output and reduce blood pressure and edema. The nurse should obtain the client's blood pressure prior to administration of the medication.

A nurse is monitoring for adverse effects of hydrochlorothiazide after administering the medication to an older adult client who has heart failure. Which of the following findings should the nurse identify as an adverse effect of the medication?

Orthostatic hypotension The nurse should identify that hydrochlorothiazide is an antihypertensive thiazide diuretic medication, which can cause orthostatic hypotension and light headedness. Therefore, the nurse should instruct the client to rise slowly when moving from a recumbent to a standing position.

A nurse is preparing to mix and administer dantrolene via IV bolus to a client who has developed malignant hyperthermia during surgery. Which of the following actions should the nurse take?

Reconstitute the initial dose with 60 mL of sterile water without a bacteriostatic agent. The nurse should dilute the medication with 60 mL of sterile water without a bacteriostatic agent and inject rapidly.

A nurse is reviewing the laboratory results of a client who is taking carbamazepine for a seizure disorder. Which of the following findings should the nurse report to the provider?

WBC 3,500/mm3 A WBC count of 3,500/mm3 is below the expected reference range of 5,000 to 10,000/mm3. Leukopenia is an adverse effect of carbamazepine. The nurse should report this finding to the provider and monitor the client for manifestations of infection.