ATI Pharmacology Practice Set #8

A nurse is preparing to administer furosemide 40 mg via IV bolus to a client. The amount available is furosemide 10 mg/1 mL. How many mL should the nurse administer per dose?

4 mL Rationale: 1. 10 mg/1 mL = 40 mg/x mL 2. 10x = 40 3. x = 4 mL

A nurse is preparing to administer digoxin 0.25 mg PO daily. The amount available is digoxin 0.125 mg tablets. How many tablets should the nurse administer?

2 tablets Rationale: 1. 0.125 mg/1 tablet = 0.25 mg/x tablet 2. 0.125x = 0.25 3. x = 2 tablets

A nurse is assessing a client after administering a dose of losartan. The client has a hoarse voice, and swollen lips and tongue. In which order should the nurse take the following actions? 1. Call the emergency response team. 2. Assess the client's airway. 3. Initiate IV access. 4. Administer IV epinephrine. 5. Apply high-flow oxygen. 6. Administer IV antihistamines.

2. Assess the client's airway. 1. Call the emergency response team. 5. Apply high-flow oxygen. 3. Initiate IV access. 4. Administer IV epinephrine. 6. Administer IV antihistamines. Rationale: The nurse should first assess the client's airway and oxygen saturation to determine the need for respiratory support. Intubation or tracheostomy is considered if adequate oxygenation is not maintained. The second step the nurse should take is to call the rapid response team to provide emergency treatment in case of cardiac or respiratory arrest. Next, the nurse should apply high-flow oxygen to increase oxygenation and then initiate an IV site, if one is not present, and administer isotonic IV fluids to prevent hypotension and provide access for IV medications. The nurse should then administer IV epinephrine to constrict blood vessels, dilate bronchioles, and increase cardiac function. And finally, the nurse should administer IV antihistamines and corticosteroids to block the effects of histamine and decrease edema.

A nurse is teaching a client who is taking atorvastatin daily. Which of the following statements by the client indicates an understanding of the teaching? A. "I will avoid drinking grapefruit juice." B. "I should take this medication without food." C. "I should expect my stools to turn clay-colored." D. "It is not necessary to have routine blood tests done."

A. "I will avoid drinking grapefruit juice." Rationale: A. Grapefruits and grapefruit juice can reduce metabolism of atorvastatin, which increases the risk for toxicity. B. The client can take atorvastatin with or without food. C. Clay-colored stools are a manifestation of hepatotoxicity, an adverse effect to atorvastatin. D. Clients who are taking atorvastatin should have their liver enzymes assessed before treatment and 1 to 2 months initially, then in 6 to 12 weeks, and periodically during therapy. They should also have their cholesterol levels monitored to evaluate the effects of treatment.

A nurse is teaching a client who has a new prescription for bumetanide. Which of the following instructions should the nurse include in the teaching? A. "Report changes in hearing." B. Avoid foods high in potassium." C. "Take the prescribed second dose at nighttime." D. "Limit your fluid intake to no more than 1.5 L per day."

A. "Report changes in hearing." Rationale: A. Bumetanide is a high-ceiling loop diuretic. It promotes diuresis by inhibiting sodium and chloride reabsorption in the thick ascending limb of the loop of Henle. High-ceiling loop diuretics can cause ototoxicity. Concurrent use of aminoglycosides, such as gentamicin, increases the risk of ototoxicity. Inform clients about possible hearing loss, and instruct clients to notify the prescriber if a hearing deficit or tinnitus develops. B. Hypokalemia is an adverse effect of bumetanide due to potassium loss through the distal nephron. The client should consume foods high in potassium content (such as dried fruits, nuts, bananas, and potatoes) to minimize the risk for hypokalemia. The client should be taught to monitor for manifestations of hypokalemia, such as irregular heartbeat, muscle weakness, and leg cramps. C. Inform the client to expect increased urine volume and frequency of voiding. The client should take diuretics early in the morning when prescribed daily. When prescribed twice per day, the client should take the medication at 0800 and 1400 to avoid frequent diuresis during the night. D. The client should consume 2-3 L of fluid per day to prevent dehydration due to loss of sodium, chloride, and water.

A nurse on a telemetry unit is caring for a client who has unstable angina and is reporting chest pain with a severity of 6 on a 0 to 10 scale. The nurse administers 1 sublingual nitroglycerin tablet. After 5 minutes, the client states that his chest pain is now a severity of 2. Which of the following actions should the nurse take? A. Administer another nitroglycerin tablet. B. Initiate a peripheral IV. C. Call the rapid response team. D. Obtain an ECG.

A. Administer another nitroglycerin tablet. Rationale: A. Administration guidelines for sublingual nitroglycerin indicate that it is appropriate to administer another tablet 5 min after the first one if the client is still reporting pain. B. As the first dose of nitroglycerin decreased the client's pain, there is no indication that an IV is necessary. C. As the first dose of nitroglycerin decreased the client's pain, there is no indication that calling the Rapid Response Team is necessary. D. There is no indication at this point for an ECG. The client's pain did decrease with nitroglycerin administration, which would not happen if the client were having a myocardial infarction.

A nurse is caring for four clients for whom she has to administer oral medications in the morning. The nurse should administer which of the following medications before breakfast? A. Alendronate B. Digoxin C. Mycostatin mouthwash D. Divalproex

A. Alendronate Rationale: A. The client must take alendronate first thing in the morning on an empty stomach and wait at least 30 minutes before eating, drinking, or taking other medications. B. Digoxin treats hearts failure and dysrhythmias. While it is important that the client get the morning dose in a timely manner, the nurse does not have to administer it before a meal. C. Any mouthwash or rinse is most effective after a meal. D. Divalproex, an anticonvulsant, helps control seizures and treats the manic phase of bipolar disorder. The client should take the dose on time, but not necessarily before a meal.

A nurse is assessing an older adult client who is receiving digoxin. The nurse should recognize that which of the following findings is a manifestation of digoxin toxicity? A. Anorexia B. Ataxia C. Photosensitivity D. Jaundice

A. Anorexia Rationale: A. Anorexia, vomiting, confusion, headache, and vision changes are manifestations of digoxin toxicity. B. Ataxia (lack of muscle coordination) is a manifestation of benzodiazepine toxicity. C. Digoxin toxicity causes halos around lights. Photosensitivity is a manifestation of NSAID toxicity. D. Jaundice is a manifestation of sulfonylurea toxicity.

A nurse is providing teaching to a client who has stable angina and a new prescription for transdermal nitroglycerin. Which of the following instructions should the nurse include? (Select all that apply.) A. Apply the patch to a hairless area and rotate sites. B. Apply a new patch each morning. C. Remove the patch for 10 to 12 hours daily. D. Apply the patch to dry skin and cover the area with plastic wrap. E. Apply a new patch at the onset of anginal pain.

A. Apply the patch to a hairless area and rotate sites. B. Apply a new patch each morning. C. Remove the patch for 10 to 12 hours daily. Rationale: A. Hair can interfere with the adhesion of the patch. Rotating sites helps prevent skin irritation. B. Therapeutic preventive effects of transdermal nitroglycerin patches begin 30 to 60 min after application and last up to 14 hr. C. Removing the patches for 10 to 12 hr each day helps prevent tolerance to the medication. D. These instructions apply to topical nitroglycerin ointment, not to nitroglycerin patches. E. Nitroglycerin patches prevent angina attacks. They do not treat acute angina attacks.

A nurse is teaching a client who has hypertension and a new prescription for atenolol. Which of the following findings should the nurse include as adverse effects of this medication? A. Bradycardia B. Tremor C. Cough D. Constipation

A. Bradycardia Rationale: A. Atenolol is a beta-blocker, which slows the heart rate. The nurse should instruct the client to monitor his pulse rate and report bradycardia. B. Lethargy and drowsiness are adverse effects of atenolol. C. Bronchospasms and wheezing are adverse effects of atenolol. Coughing is an adverse effect of ACE inhibitors. D. Nausea, vomiting, and diarrhea are adverse effects of atenolol.

A client who is receiving magnesium sulfate has a urine output of 20 mL/hour. Which of the following medications should the nurse expect to administer? A. Calcium gluconate B. Flumazenil C. Naloxone D. Protamine

A. Calcium gluconate Rationale: A. Magnesium sulfate is used to manage clients who have preeclampsia and require close monitoring for signs of excessive administration. Central nervous system and respiratory depression, depression of deep tendon reflexes, hypotension, diaphoresis, and decreased or loss of urinary output are signs of excessive magnesium administration. Calcium gluconate is administered intravenously over several minutes as the antidote for magnesium sulfate toxicity. B. Flumazenil is administered as a reversal agent for the sedative effects of benzodiazepines. C. Naloxone is administered to reverse the effects of opioid medications, including respiratory depression, sedation and hypotension. D. Protamine is administered for a heparin overdose.

A nurse is caring for a client who has congestive heart failure and is taking digoxin daily. The client refused breakfast and is complaining of nausea and weakness. Which of the following actions should the nurse take first? A. Check the client's vital signs. B. Request a dietician consult. C. Suggest that the client rests before eating the meal. D. Request an order for an antiemetic.

A. Check the client's vital signs. Rationale: A. It is possible that the client's nausea is secondary to digoxin toxicity. By obtaining vital signs, the nurse can assess for bradycardia, which is a symptom of digoxin toxicity. The nurse should withhold the medication and call the provider if the client's heart rate is less than 60 bpm. B. While the dietitian might be able to assist the client with making appropriate food choices, this is not the first action the nurse should take. C. While this intervention might be appropriate, this is not the first action the nurse should take. D. While this intervention might relieve the client's nausea, this is not the first action the nurse should take.

A nurse is preparing a client for surgery. Prior to administering the prescribed hydroxyzine, the nurse should explain to the client that the medication is for which of the following indications? (Select all that apply.) A. Controlling emesis B. Diminishing anxiety C. Reducing the amount of narcotics needed for pain relief. D. Preventing thrombus formation E. Drying secretions

A. Controlling emesis B. Diminishing anxiety C. Reducing the amount of narcotics needed for pain relief. E. Drying secretions Rationale: A. Hydroxyzine is an effective antiemetic that may be used to control nausea and vomiting in preoperative and postoperative clients. B. Hydroxyzine is an effective anti-anxiety agent that may be used to diminish anxiety in surgical clients, as well as in clients who have moderate anxiety. C. Hydroxyzine potentiates the actions of narcotic pain medications; therefore, narcotic requirements may be significantly reduced. D. Hydroxyzine, an antihistamine, has no role in the prevention of thrombi. E. Hydroxyzine, an antihistamine, commonly causes drying of the oral mucous membranes.

A nurse is teaching a client who has a new prescription for captopril. Which of the following instructions should the nurse include in the teaching? A. Monitor for a cough. B. Hold medication for heart rate less than 60/minute. C. Take this medication with food. D. Avoid grapefruit juice.

A. Monitor for a cough. Rationale: A. Captopril is an ACE inhibitor used to treat hypertension. The client should monitor and report a cough and dyspnea. B. Captopril can cause tachycardia. C. The client should take captopril on an empty stomach to increase absorption. D. Grapefruit juice can reduce the metabolism of atorvastatin.

A nurse is caring for a client who is taking lisinopril. Which of the following outcomes indicates a therapeutic effect of the medication? A. Decreased blood pressure. B. Increased HDL cholesterol. C. Prevention of bipolar manic episodes. D. Improved sexual dysfunction

A. Decreased blood pressure. Rationale: A. Lisinopril, an ACE inhibitor, may be used alone or in combination with other antihypertensives in the management of hypertension and congestive heart failure. A therapeutic effect of the medication is a decrease in blood pressure. B. This is not an intended effect of lisinopril. C. This is not an intended effect of lisinopril. D. This is not an intended effect of lisinopril. Lisinopril may in fact cause sexual dysfunction and impotence.

A nurse is providing teaching to a client who has hypertension and a new prescription for captopril. Which of the following instructions should the nurse provide? A. Do not use salt substitutes while taking this medication. B. Take the medication with food. C. Count your pulse rate before taking the medication. D. Expect to gain weight while taking this medication

A. Do not use salt substitutes while taking this medication. Rationale: A. Captopril, an ACE inhibitor, can cause hyperkalemia due to potassium retention by the kidney. The client should avoid salt substitutes, as most of them are high in potassium. B. The client should take captopril on an empty stomach, 1 hr before or 2 hr after a meal, in order to not reduce the medication's absorption. C. It is not necessary to count a pulse before taking captopril. D. Weight gain is not an adverse effect of captopril.

A nurse is caring for a client who is taking digoxin for heart failure and develops indications of severe digoxin toxicity. Which of the following medications should the nurse prepare to administer? A. Fab antibody fragments B. Flumazenil C. Acetylcysteine D. Naloxone

A. Fab antibody fragments Rationale: A. Fab antibody fragments, also called digoxin immune Fab, bind to digoxin and block its action. The nurse should prepare to administer this antidote IV to clients who have severe digoxin toxicity. B. Flumazenil, a benzodiazepine antagonist, reverses the effects of benzodiazepines. C. Acetylcysteine, a mucolytic, reduces the risk of hepatotoxicity after acetaminophen overdose. D. Naloxone reverses the effects of opioid analgesics.

A nurse is preparing to administer potassium chloride (KCl) to a client who is receiving diuretic therapy. The nurse reviews the client's serum potassium level results and discovers the client's potassium level is 3.2 mEq/L. Which of the following actions should the nurse take? A. Give the ordered KCl as prescribed. B. Omit the KCl dose and document that it was not given. C. Hold the prescribed dose and notify the provider of the serum potassium level. D. Call the lab to verify the client's results.

A. Give the ordered KCl as prescribed. Rationale: A. The client's serum potassium level is below the recommended reference range. The nurse should administer the KCL as prescribed. B. The nurse should not omit the ordered medication. C. The client's serum potassium level is below the recommended reference range. The nurse should not hold the medication. There is no indication that the provider should be notified, as a prescription for the low level of potassium has been given. D. The nurse has already received the lab values from the lab, so notifying the laboratory is not indicated.

A nurse is assessing a client prior to administering atenolol. Which of the following findings should prompt the nurse to withhold the medication? A. Heart rate 46/minute B. Oxygen saturation 95% C. Respiratory rate 18/minute D. Blood pressure 160/94 mmHg

A. Heart rate 46/minute Rationale: A. The nurse should check the client's heart rate prior to administering a beta-blocker. If the client's heart rate is less than 50/min, the nurse should hold the medication and contact the provider. Atenolol is a beta-blocker and is used in the treatment of hypertension and angina, and following a myocardial infarction. This medication works by slowing the heart rate, decreasing the speed of electrical impulses through the atrioventricular node, and decreasing the force of contraction. B. Atenolol can cause bronchoconstriction in clients who have asthma. This pulse oximetry is within the expected reference range. C. This respiratory rate is within the expected reference range. Atenolol can cause dyspnea. D. Atenolol is a beta-blocker and is used in the treatment of hypertension. This blood pressure is greater than the expected reference range, indicating hypertension.

A nurse is teaching about necessary baseline examinations with a female client who is to start taking atorvastatin. Which of the following baseline examinations should the nurse include in the teaching? A. Liver function tests B. Hearing test C. Papanicolaou test D. Dental examination

A. Liver function tests Rationale: A. The nurse should inform the client that statins such as atorvastatin can cause liver damage and should not be taken by clients who have a history of liver disease. The client should undergo baseline liver function testing before beginning therapy, and every 6 to 12 months thereafter. B. Atorvastatin does not affect the hearing. Therefore, the nurse should not recommend a baseline examination of the client's hearing before starting this medication. C. Papanicolaou test is not a necessary baseline examination for this medication. Atorvastatin is not known to affect the female reproductive system. However, it can cause impotence in male clients. D. A dental examination is not a necessary baseline examination for this medication. Atorvastatin is not known to affect the teeth and gums.

A nurse in a coronary care unit is admitting a client who has had CPR following a cardiac arrest. The client is receiving lidocaine IV at 2 mg/minute. When the client asks the nurse why he is receiving that medication, the nurse should explain that it has which of the following actions? A. Prevents dysrhythmias B. Slows intestinal motility C. Dissolves blood clots D. Relieves pain

A. Prevents dysrhythmias Rationale: A. Lidocaine is an antidysrhythmic medication that delays the conduction in the heart and reduces the automaticity of heart tissue. B. Lidocaine does not have anticholinergic properties, as do some other antidysrhythmics such as procainamide and quinidine. Also, clients who have cardiac problems should prevent constipation. An anticholinergic medication would increase the risk for constipation. C. A fibrinolytic medication, such as alteplase, dissolves blood clots via the conversion of plasminogen to plasmin. D. Topical lidocaine is a local anesthetic that produces numbness or loss of feeling before surgery or another painful procedure, but this is not the reason for administering it to this client.

A nurse is monitoring a client who received epinephrine for angioedema after a first dose of losartan. Which of the following data indicates a therapeutic response to epinephrine? A. Respirations are unlabored. B. Client reports a decreased groin pain of 3 on a 1 to 10 scale. C. The client's blood pressure when arising from resting position is at premedication levels. D. The client tolerates a second dose of medication with no greater than 1+ peripheral edema.

A. Respirations are unlabored. Rationale: A. Losartan is an angiotensin receptor blocker (ARB). Both ARBs and angiotensin converting enzyme (ACE) inhibitors have the adverse effect of angioedema. The primary symptom of angioedema is swelling of the tongue, glottis, and pharynx. This results in limitation or blockage of the airway. Angioedema causes the capillaries to become more permeable, resulting in fluid shifting into the subcutaneous tissues. Although the mouth and throat are most often affected, any area may be involved in the process. Untreated, angioedema can result in death. Improvement of respiratory effort following the administration of epinephrine is the most important therapeutic indicator. B. Although edema can occur in any area, the groin is not affected specifically by the disorder. Angioplasty and angiograms most often utilize the femoral vessels, but the prefix "angio" is a general term for blood vessel rather than a reference to the femoral area. C. Hypotension is a common side effect of angiotensin II receptor blockers (ARBs) such as losartan. For this side effect, the nurse should monitor blood pressure when the client changes position. However, angioedema is an adverse reaction that can result in swelling of the lips, tongue, and glottis. The client experiences extreme respiratory distress. D. Peripheral edema is not usually associated with angioedema. The edema that is significant in this client occurs in the lips, mouth, and throat, causing airway obstruction. Once the client has this response, the client must know to never take any medication in the angiotensin II receptor blocker classification.

A nurse is assessing a client who has hypercholesterolemia and is receiving simvastatin. Which of the following findings should the nurse recognize as a potential adverse effect? A. Urinary retention B. Muscle weakness C. Orthostatic hypotension D. Blurred vision

B. Muscle weakness Rationale: A. Urinary retention is not an adverse effect of simvastatin. B. Myopathy is an adverse effect of this medication. Signs of myopathy include muscle aches, tenderness, and muscle weakness. C. Orthostatic hypotension is not an adverse effect of simvastatin. D. Blurred vision is not an adverse effect of simvastatin.

A nurse is providing teaching to a client who has a new prescription for transdermal nitroglycerin paste. Which of the following statements by the client indicates the need for further teaching? A. "I should measure the dosage on the supplied paper." B. "I should leave the patch in place until it is time for the next dose." C. "I should get up slowly when I stand." D. "I might have a headache when I first start taking this medication."

B. "I should leave the patch in place until it is time for the next dose." Rationale: A. Transdermal nitroglycerin is measured by placing the nitroglycerin paste onto an applicator patch. B. Clients should have a period of 10 to 12 hr without the patch on to reduce the risk for nitrate tolerance. C. Nitroglycerin patches can cause orthostatic hypotension. Instruct clients to rise slowly, and rest their feet on the floor for a few minutes before standing. D. Headaches caused by the vasodilation of cranial blood vessels can occur when using a topical nitroglycerin. The headaches should diminish as the client adjusts to the vasodilation effects of nitroglycerin.

A nurse is teaching a client who has a new prescription for hydrochlorothiazide for management of hypertension. Which of the following instructions should the nurse include? A. "Take this medication before bedtime." B. "Monitor for leg cramps." C. "Avoid grapefruit juice." D. "Reduce intake of potassium-rich foods."

B. "Monitor for leg cramps." Rationale: A. The client should take this medication in the morning to reduce the risk for nocturia. B. Hydrochlorothiazide can cause hypokalemia. The client should monitor for manifestations of hypokalemia, such as fatigue, tachycardia, leg cramps, and muscle weakness. C. Clients who take statins, such as atorvastatin, should avoid grapefruit juice because it can reduce the metabolism of the medication and cause toxicity. D. Hydrochlorothiazide can cause hypokalemia. The client should increase intake of potassium-rich foods, such as spinach and bananas.

A nurse is providing teaching for a client who has hypertension and a prescription change from metoprolol to metoprolol/hydrochlorothiazide. Which of the following statements by the client indicates an understanding of the teaching? A. "Now I will not have to diet to lose weight." B. "With the new medication, I should experience fewer side effects." C. "I will not have to do anything different because it is the same medication." D. "The extra letters after the name of the medication means it is a stronger dose."

B. "With the new medication, I should experience fewer side effects." Rationale: A. Hydrochlorothiazide (HCTZ) is a diuretic, and the loss of fluid will result in weight loss. The client should be instructed to weigh daily and watch for weight loss, but it is a change in fluid rather than loss of fat that is the cause of the weight loss. Continuing the recommended diet for control of blood pressure can be an additional part of the client's care plan. This client needs further reinforcement of teaching to understand the action of the thiazide diuretic. B. The client has stated an understanding of the purpose of the addition of the hydrochlorothiazide (HCTZ) to the metoprolol dosage. When used in combination with thiazide diuretics, a lower dose of the beta-blocker can be used. The benefit is there are fewer side effects when beta-blockers (and other antihypertensives) are used in lower dosages. C. The client does not indicate an understanding that this medication includes a diuretic that requires an increase in potassium in the diet. This statement indicates a need for further teaching on the addition of the diuretic in the combination drug. D. This statement by the client indicates a need for further reinforcement of teaching. The nurse should clarify that the additional letters indicate a new medication has been combined with the old medication rather than a stronger dose being given.

A nurse is teaching a client who has a new prescription for simvastatin. Which of the following instructions should the nurse include? A. "You should expect brown-colored urine." B. "You should avoid grapefruit juice." C. "You should monitor for ringing in the ears." D. "You should take the medication in the morning."

B. "You should avoid grapefruit juice." Rationale: A. Brown-colored urine is a manifestation of liver dysfunction, an adverse effect of simvastatin. The client should report this to the provider. B. Grapefruit inhibits the drug-metabolizing enzyme CYP3A4 which slows the metabolism of simvastatin. This can cause an increase in serum simvastatin. Potential adverse effects include elevated liver enzymes, and rhabdomyolysis. C. Simvastatin can cause rhabdomyolysis and myopathy. D. The nurse should instruct the client to take the medication in the evening to increase efficacy.

A nurse is reviewing the medical record of a client who has hypertension and a new prescription for metoprolol. Which of the following findings should the nurse investigate further? A. Diet-controlled type 2 diabetes B. A history of left-sided heart failure. C. A concurrent prescription for tadalafil. D. Recently treated bilateral pneumonia

B. A history of left-sided heart failure. Rationale: A. Metoprolol does not suppress beta₂ mediated glycogenolysis, so it can be used more safely than other beta blockers in clients who have diabetes mellitus, especially for a client who is diet-controlled and not taking diabetic medications. The nurse should instruct the client that manifestations of hypoglycemia can be masked with this medication. B. The nurse should further investigate the client's history of heart failure. Although metoprolol can be used to treat heart failure, it can also cause heart failure, so this medication should be used with great caution with a client who has a history of heart failure. The nurse should teach the client to watch for signs of increasing left-sided heart failure, such as shortness of breath and weight gain indicating fluid retention, and report these findings to the provider. C. Beta blockers are not contraindicated for concurrent use of an erectile dysfunction medication; however, erectile dysfunction medication used concurrently with nitrates can cause a catastrophic drop in blood pressure that does not respond to treatment. D. Pneumonia, and its course of treatment, is not a contraindication for the use of beta blockers. Beta blockers are generally not used with clients who have bronchospastic diseases.

A nurse is caring for four clients. After administering morning medications, she realizes that the nifedipine prescribed for one client was inadvertently administered to another client. Which of the following actions should the nurse take first? A. Notify the client's provider. B. Check the client's vital signs. C. Fill out an occurrence form. D. Administer the medication to the correct client.

B. Check the client's vital signs. Rationale: A. The nurse should notify the client's provider to inform her of the event; however, there is another action the nurse should take first. B. The first action the nurse should take using the nursing process is to assess the client. The nurse should know that the action of nifedipine is to lower blood pressure. Immediately upon realizing the error, the nurse should check the client's vital signs (especially the client's blood pressure) to ensure that the client is not hypotensive as a result. Only after ensuring that the client is safe and has stable vital signs should the nurse take other actions. C. The nurse should fill out an occurrence form to report the event to hospital personnel; however, there is another action the nurse should take first. D. The nurse should administer the medication to the correct client to fulfill the provider's prescription; however, there is another action the nurse should take first.

A nurse is providing discharge teaching for a client who has pulmonary edema and is about to start taking furosemide. Which of the following instructions should the nurse include? A. Take aspirin if headaches develop. B. Eat foods that contain plenty of potassium. C. Expect some swelling in the hands and feet. D. Take the medication at bedtime.

B. Eat foods that contain plenty of potassium. Rationale: A. Furosemide can increase the effects of aspirin and anticoagulants. B. Furosemide, a high-ceiling (loop) diuretic, can cause potassium loss. The client should add potassium-rich foods to his diet, such as nuts, dried fruits, bananas, and citrus fruits. C. Furosemide should reduce swelling in the hands and feet. D. The client should take furosemide early in the day so that the diuretic action will not disturb his sleep.

A nurse is preparing to administer verapamil by IV bolus to a client who is having cardiac dysrhythmias. For which of the following adverse effects should the nurse monitor when giving this medication? A. Hyperthermia B. Hypotension C. Ototoxicity D. Muscle pain

B. Hypotension Rationale: A. Temperature is not affected by verapamil. B. Verapamil, a calcium channel blocker, can be used to control supraventricular tachyarrhythmias. It also decreases blood pressure and acts as a coronary vasodilator and antianginal agent. A major adverse effect of verapamil is hypotension; therefore, blood pressure and pulse must be monitored before and during parenteral administration. C. Verapamil is not toxic to the ear. D. Verapamil does not cause muscle pain.

A nurse is caring for a client who is experiencing severe nausea and vomiting after a course of chemotherapy. The nurse should monitor the client for which of the following clinical manifestations? A. Metabolic acidosis B. Metabolic alkalosis C. Respiratory acidosis D. Respiratory alkalosis

B. Metabolic alkalosis Rationale: A. Hypermetabolism, such as with fever or exercise, can cause metabolic acidosis. B. Metabolic alkalosis can occur in clients who have excessive vomiting because of the loss of hydrochloric acid. C. Respiratory depression can cause respiratory acidosis. D. Hyperventilation can cause respiratory alkalosis.

A nurse is assessing a client who is taking lisinopril to treat hypertension. Which of the following findings is priority to report? A. Dry cough B. Swelling of the tongue C. Nausea D. Nasal congestion

B. Swelling of the tongue Rationale: A. Dry cough is non-urgent because it is a mild adverse effect of lisinopril; therefore, there is another finding that is the priority. B. When using the urgent vs non-urgent approach to client care, the nurse determines that the priority finding is swelling of the tongue, which is a manifestation of angioedema. The nurse should withhold the medication and notify the provider immediately if the client reports swelling of the tongue or throat. Other manifestations include giant wheals and edema of the tongue, glottis, and pharynx. Severe reactions are treated with subcutaneous epinephrine. If angioedema develops, ACE inhibitors are discontinued. C. Nausea is non-urgent because it is a mild adverse effect of lisinopril; therefore, there is another finding that is the priority. D. Nasal congestion is non-urgent because it is a mild adverse effect of lisinopril; therefore, there is another finding that is the priority.

A nurse is reviewing the health history of a client who has angina pectoris and a prescription for propranolol hydrochloride PO 40 mg twice daily. Which of the following findings in the health history should the nurse report to the provider? A. The client has a history of hypothyroidism. B. The client has a history of bronchial asthma. C. The client has a history of hypertension. D. The client has a history of migraine headaches.

B. The client has a history of bronchial asthma. Rationale: A. Beta-adrenergic blockers may mask the symptoms of hyperthyroidism; therefore, they must be used with caution in clients taking propranolol hydrochloride. Hypothyroidism is not a contraindication for its use. B. Beta-adrenergic blockers can cause bronchospasm in clients who have bronchial asthma; therefore, this is a contraindication to its use and should be reported to the provider. C. Beta-adrenergic blockers, such as propranolol hydrochloride, may be used in combination with other medications for the treatment of hypertension; therefore, this is not a contraindication to the use of this medication. D. Beta-adrenergic blockers, such as propranolol hydrochloride, may be prescribed for the prevention of migraine headaches; therefore, this is not a contraindication to the use of the medication.

A nurse is reviewing the medication record for a client who has chronic kidney disease. Which of the following medications should the nurse identify as having the potential to cause nephrotoxicity? A. Omeprazole B. Vancomycin C. Ondansetron D. Diphenhydramine

B. Vancomycin Rationale: A. Omeprazole, a proton pump inhibitor, does not cause nephrotoxicity. B. The nurse should identify that vancomycin, an antibiotic, to be associated with nephrotoxic adverse effects. C. Ondansetron, an antiemetic, does not cause nephrotoxicity. D. Diphenhydramine, an antihistamine, does not cause nephrotoxicity.

A nurse is providing teaching to a client who has breast cancer about the adverse effects of chemotherapy. Which of the following client statements indicates an understanding of the teaching? A. "I will take the antiemetic as soon as the chemotherapy infusion is complete." B. "I will run my toothbrush in the dishwasher every month." C. "I'll call my doctor if I notice any unusual menstrual bleeding." D. "I will avoid crowds to keep from infecting others."

C. "I'll call my doctor if I notice any unusual menstrual bleeding." Rationale: A. Antiemetics to treat nausea and vomiting associated with chemotherapy should be taken before, not after, the treatment. B. Clients should be taught to run their toothbrush through the dishwasher every week to help prevent infection. C. Clients should be taught bleeding precautions and to report bruising or excessive bleeding. D. Clients who are neutropenic from chemotherapy are not infectious to others. Infected people are, however, hazardous to the client.

A nurse is providing discharge teaching to a client who has a new prescription for verapamil for angina. Which of the following instructions should the nurse include? A. "Limit your fluid intake to meal times." B. "Do not take this medication on an empty stomach." C. "Increase your daily intake of dietary fiber." D. "You can expect swelling of the ankles while taking this medication."

C. "Increase your daily intake of dietary fiber." Rationale: A. The nurse should instruct the client to increase fluid intake rather than limit intake to meal times due to the potential adverse effect of constipation. B. The nurse should instruct the client that verapamil can be taken without food. C. The nurse should instruct the client to increase his daily intake of dietary fiber to reduce the risk of constipation associated with verapamil. D. The nurse should instruct the client to report any swelling of the ankles or feet to the provider immediately, as these are manifestations of an adverse effect.

A nurse is teaching a client who has angina pectoris about starting therapy with sublingual nitroglycerin tablets. The nurse should include which of the following instructions regarding how to take the medication? A. "Take this medication after each meal and at bedtime." B. "Take one tablet every 15 minutes during an acute attack." C. "Take one tablet at the first indication of chest pain." D. "Take this medication with 8 oz. of water."

C. "Take one tablet at the first indication of chest pain." Rationale: A. The client should take nitroglycerin tablets on a PRN basis, not routinely at specific times. B. If one tablet does not relieve the client's pain, he should access emergency services and then take two more at 5-min intervals if he still has pain. C. The client should take nitroglycerin as soon as he feels pain, pressure, or tightness in his chest and not wait until his chest pain is severe. D. Nitroglycerin tablets are sublingual. The client should place them under the tongue, not swallow them with water.

A nurse in a provider's clinic is assessing a client who takes sublingual nitroglycerin for stable angina. The client reports getting a headache each time he takes the medication. Which of the following statements should the nurse make? A. "Take only one dose of nitroglycerin to reduce the risk of getting a headache." B. "There's nothing that can be done to relieve the headaches that nitroglycerin causes." C. "Try taking a mild analgesic to relieve the headache." D. "We will ask the provider to prescribe a different medication for you."

C. "Try taking a mild analgesic to relieve the headache." Rationale: A. Sublingual nitroglycerin may be taken up to three times, five minutes apart. Reducing the number of doses may not relieve the angina pain. B. The headaches associated with nitroglycerin use diminish over time. Until then, headaches can be relieved by mild analgesics. C. Headache is a common side effect of nitroglycerin. The nurse should suggest conservative measures, such as taking aspirin, acetaminophen, or some other mild analgesic, to manage the headache. Generally, headaches that are a side effect of nitroglycerin are transient. D. Nitroglycerin is the drug of choice for acute angina attacks. The headaches associated with its use diminish over time. Until then, headaches can be relieved by mild analgesics.

A nurse is providing dietary teaching for a client who has a new prescription for a monoamine oxidase inhibitor (MAOI). When the client develops a sample lunch menu, which of the following items requires intervention by the nurse? A. Glass of whole milk B. Celery sticks C. Bologna sandwich D. Sliced apples

C. Bologna sandwich Rationale: A. Clients who are receiving an MAOI should avoid foods containing a high tyramine content. Milk is safe for a client taking an MAOI. B. Clients who are receiving an MAOI should avoid foods containing a high tyramine content. Celery is safe for a client taking an MAOI. C. Clients who are receiving an MAOI should avoid foods containing a high tyramine content. Bologna has a high tyramine content and should be avoided. D. Clients who are receiving an MAOI should avoid foods containing a high tyramine content. Apples are safe for a client taking an MAOI.

A nurse is caring for a client who has heart failure and a new prescription for furosemide. For which of the following adverse effects should the nurse monitor? A. Hypervolemia B. Hypertension C. Hypokalemia D. Hypoglycemia

C. Hypokalemia Rationale: A. Hypovolemia, not hypervolemia, is an adverse effect of furosemide. B. Hypotension, not hypertension, is an adverse effect of furosemide. C. Hypokalemia is an adverse effect of furosemide. D. Hyperglycemia, not hypoglycemia, is an adverse effect of furosemide.

A nurse is providing teaching to a client who has a new diagnosis of Parkinson's disease. On which of the following medications should the nurse prepare to instruct the client? A. Piperacillin/tazobactam B. Levothyroxine C. Levodopa/carbidopa D. Carbamazepine

C. Levodopa/carbidopa Rationale: A. Piperacillin/tazobactam is a broad spectrum anti-infective used in the treatment of moderate to severe infections. It is not used in the treatment of Parkinson's disease. B. Levothyroxine is a thyroid hormone used in the treatment of hypothyroidism. It is not used in the treatment of Parkinson's disease C. Levodopa/carbidopa is the cornerstone of Parkinson's treatment. The nurse should prepare to instruct the client on the use of this medication. D. Carbamazepine is an anticonvulsant used in the treatment of seizures, trigeminal neuralgia, bipolar disorder, and diabetic neuropathy. It is not used in the treatment of Parkinson's disease.

A nurse is caring for a client who has atrial fibrillation and receives digoxin daily. Before administering this medication, which of the following actions should the nurse take? A. Offer the client a light snack. B. Measure the client's blood pressure. C. Measure the client's apical pulse. D. Weigh the client.

C. Measure the client's apical pulse. Rationale: A. The client can take the medication with or without food, although giving it immediately after food can delay absorption slightly. B. It is not necessary to measure blood pressure immediately before dosing, but the nurse should monitor the client's blood pressure routinely. C. Digoxin decreases the heart rate, so the nurse should count the apical pulse for at least 1 min before administering. The nurse should hold the medication and notify the provider if the client's heart rate is below 60/min or if a change in heart rhythm is detected. D. It is not necessary to weigh the client immediately before dosing, but the nurse should monitor the client's weight routinely.

A nurse is caring for a client who has a new prescription for propranolol. The nurse should monitor the client for which of the following adverse reactions to this medication? A. Ototoxicity B. Tachycardia C. Postural hypotension D. Hypokalemia

C. Postural hypotension Rationale: A. Propranolol can cause bronchoconstrictions in clients who have asthma. B. Bradycardia is an adverse reaction of beta-blockers. The nurse should withhold the medication if the client's heart rate is less than 50/min. C. Propranolol can cause postural hypotension. The client should change positions slowly and the nurse should monitor the client's blood pressure from a lying to sitting to standing position. D. Propranolol can mask tachycardia, an early manifestation of hypoglycemia in clients who have diabetes mellitus.

A nurse is caring for a client who has heart failure and a new prescription for furosemide. Which of the following laboratory values should the nurse review before administering furosemide? A. Bicarbonate B. Carbon dioxide C. Potassium D. Phosphate

C. Potassium Rationale: A. The nurse should check the client's electrolytes and other laboratory results before initiating diuretic therapy; however, furosemide does not generally affect bicarbonate levels. B. The nurse should check the client's electrolytes and other laboratory results before initiating diuretic therapy; however, furosemide does not generally affect carbon dioxide levels. C. Furosemide is a loop diuretic and therefore promotes excretion of potassium. The nurse should monitor the client's serum potassium level before administering it to prevent hypokalemia. D. The nurse should check the client's electrolytes and other laboratory results before initiating diuretic therapy; however, furosemide does not generally affect phosphate levels.

A nurse is providing teaching for a client who is on diuretic therapy and has a new prescription for potassium chloride (KCl) 20 mEq extended release PO daily. Which of the following instructions should the nurse provide about the new prescription? A. Take the extended release tablets on an empty stomach. B. Add an antacid if the medication causes indigestion. C. Take the extended release tablets whole. D. Expect urinary output to decrease while on this medication.

C. Take the extended release tablets whole. Rationale: A. The nurse should instruct the client that the medication should be taken with or after meals. B. The nurse should advise the client to avoid OTC medications, including antacids, without the approval of the provider. Calcium containing antacids can increase the effect of the potassium supplement. C. The nurse should teach the client that extended release tablets should be taken whole and should not be broken, crushed, or chewed. D. The nurse should instruct the client to notify the provider immediately for any decrease in urinary output.

A nurse is providing teaching to a client who has hypertension and a new prescription for hydrochlorothiazide. Which of the following instructions should the nurse include? A. Weigh weekly to monitor therapeutic effect. B. Take medication on an empty stomach. C. Take the medication early in the day. D. Muscle pain is an expected adverse effect.

C. Take the medication early in the day. Rationale: A. The nurse should instruct the client to weigh daily to determine fluid loss. B. Hydrochlorothiazide can be taken with food or milk. C. The nurse should instruct the client to take hydrochlorothiazide early in the day to avoid nocturia. D. The nurse should instruct the client that muscle pain may be an indication of hypokalemia and should be reported to the provider.

A nurse is caring for a client who has heart failure and a prescription for digoxin. Which of the following statements by the client indicates an adverse effect of the medication? A. "I can walk a mile a day." B. "I've had a backache for several days." C. "I am urinating more frequently." D. "I feel nauseated and have no appetite."

D. "I feel nauseated and have no appetite." Rationale: A. Improving the client's cardiac output, which in turn will improve the client's exercise tolerance, is a therapeutic response to digoxin. B. Backaches are not an adverse effect of digoxin. C. Improving the client's cardiac output, which in turn will increase blood flow to the kidneys and urination, is a therapeutic response to digoxin. D. Anorexia, nausea, vomiting, and abdominal discomfort are early signs of digoxin toxicity.

A nurse is providing teaching to a client who has a new prescription for lisinopril. Which of the following statements by the client indicates an understanding of the teaching? A. "I should increase my intake of potassium-rich foods." B. "I should expect to have facial swelling when taking this medication." C. "I should take this medication with food." D. "I should report a cough to the provider."

D. "I should report a cough to the provider." Rationale: A. ACE inhibitors can cause an increase in serum potassium. Clients should avoid foods high in potassium. B. Clients can develop angioedema when on ACE inhibitors. The client should immediately call 911 if shortness of breath, swelling of the tongue or lips, or facial edema develops. C. Food does not alter absorption of lisinopril. Lisinopril can be administered with or without food. D. The client should report a cough to the provider. The provider should discontinue the medication for a persistent, irritating cough.

A nurse is providing teaching to a client who has angina pectoris and a new prescription for nitroglycerin sublingual tablets. Which of the following statements by the client indicates an understanding of the teaching? A. "I'll dial 911 if I still have pain after taking 3 nitroglycerin tablets 5 minutes apart." B. "I'll dial 911 if I still have pain after taking 4 nitroglycerin tablets over a 20-minute period." C. "I'll dial 911 when I have pain and then take the nitroglycerin tablets." D. "I'll dial 911 if 1 nitroglycerin tablet does not relieve my pain, and then take up to 2 more tablets 5 minutes apart while waiting."

D. "I'll dial 911 if 1 nitroglycerin tablet does not relieve my pain, and then take up to 2 more tablets 5 minutes apart while waiting." Rationale: A. The client should access emergency services sooner than this. B. The client should access emergency services sooner than this. C. The client should take the first nitroglycerin tablet at the onset of pain and see if it relieves symptoms. D. If 1 nitroglycerin tablet does not relieve the client's pain, he should access emergency services and then take 2 more tablets at 5-min intervals if he still has pain.

A nurse is teaching a client who has angina about nitroglycerin sublingual tablets. Which of the following statements should the nurse include in the teaching? A."Place one tablet under your tongue every 5 minutes for 30 minutes to relieve chest pain." B. "Nitroglycerin decreases chest pain by dissolving blood clots that are occluding the arteries." C. "You can store the bottle of tablets in your bathroom medicine cabinet." D. "Nitroglycerin dilates cardiac blood vessels to deliver more oxygen to the heart."

D. "Nitroglycerin dilates cardiac blood vessels to deliver more oxygen to the heart." Rationale: A. The client should place one tablet under the tongue every 5 min for 15 min, for 3 total doses, to relieve chest pain. B. Nitroglycerin relaxes the blood vessels, which increases blood and oxygen supply to the heart. Nitroglycerin does not dissolve blood clots. C. Nitroglycerin loses its effectiveness after 6 months or after exposure to light or moisture. The client should not store the tablets in the bathroom. D. Nitroglycerin is a nitrate medication that increases collateral blood flow, redistributes blood flow toward the subendocardium, and dilates the coronary arteries.

A nurse is caring for a client with HIV-1 infection and is prescribed zidovudine as part of antiretroviral therapy. The nurse should monitor the client for which of the following adverse effects of this medication? A. Cardiac dysrhythmia B. Metabolic alkalosis C. Renal failure D. Aplastic anemia

D. Aplastic anemia Rationale: A. Zidovudine has no documented adverse effects on the heart. B. Lactic acidosis, not metabolic alkalosis, is an adverse effect of zidovudine. C. Zidovudine is not known as a nephrotoxic agent. D. Severe myelosuppression that results in anemia (decreased red blood cells), agranulocytosis (decreased white blood cells), and thrombocytopenia (decreased platelets) is a life-threatening adverse reaction to zidovudine therapy. Consequently, zidovudine must be used cautiously in clients already experiencing myelosuppression, and the client must be monitored with a CBC performed every few weeks for early detection of marrow failure, which may lead to aplastic anemia.

A nurse is preparing to administer digoxin to a client who heart failure. Which of the following actions is appropriate? A. Withholding the medication if the heart rate is above 100/minute. B. Instructing the client to eat foods that are low in potassium. C. Measuring apical pulse rate for 30 seconds before administration. D. Evaluating the client for nausea, vomiting, and anorexia.

D. Evaluating the client for nausea, vomiting, and anorexia. Rationale: A. The nurse should withhold the medication if the client's heart rate is below 60/min. B. The client should eat foods high in potassium to prevent hypokalemia, which increases the risk of digoxin toxicity. C. The nurse should measure the apical pulse rate for 1 min. D. Loss of appetite, nausea, vomiting, and blurred or yellow vision may be signs of digoxin toxicity.

A nurse is providing teaching to a client who has hypertension and a new prescription for verapamil. Which of the following beverages should the nurse tell the client to avoid while taking this medication? A. Milk B. Orange juice C. Coffee D. Grapefruit juice

D. Grapefruit juice Rationale: A. Milk has no known effect on the metabolism of verapamil; therefore, this is a safe beverage for the client to drink while on this medication. B. Orange juice has no known effect on the metabolism of verapamil; therefore, this is a safe beverage for the client to drink while on this medication. C. Although coffee consumption should be limited while taking verapamil, it does not have to be avoided. D. Grapefruit juice increases blood levels of verapamil, a calcium channel blocker, by inhibiting its metabolism. The excess amount of medication can intensify the medication's hypotensive effects, putting the client at risk for syncope and dizziness.

A nurse is assessing a client who has heart failure and is prescribed furosemide. Which of the following findings is an adverse effect of this medication? A. Weight gain B. Increased blood pressure C. Hypoglycemia D. Leg cramps

D. Leg cramps Rationale: A. Weight gain is not an adverse effect of furosemide. Weight loss can occur with fluid loss; a therapeutic effect of furosemide. B. Hypotension is an adverse effect of furosemide. C. Hyperglycemia is an adverse effect of furosemide. D. Leg cramps are a manifestation of hypokalemia, an adverse effect of furosemide. The nurse should assess the client for hypokalemia and monitor the client's potassium level.

A nurse is caring for a client who has a traumatic head injury and is exhibiting signs of increasing intracranial pressure. Which of the following medications should the nurse plan to administer? A. Albumin 25% B. Dextran 70 C. Hydroxyethyl glucose D. Mannitol 25%

D. Mannitol 25% Rationale: A. Albumin 25% is not administered to relieve increased intracranial pressure. B. Dextran 70 is not administered to relieve increased intracranial pressure. C. Hydroxyethyl glucose is not administered to relieve increased intracranial pressure. D. The nurse should plan to administer mannitol 25%, an osmotic diuretic that lowers intracranial pressure by promoting diuresis.

A nurse is teaching a client who has a new prescription for aspirin to prevent cardiovascular disease. Which of the following instructions should the nurse include in the teaching? A. Take the tablets on an empty stomach. B. Expect stools to turn black. C. Anticipate the tablets to smell like vinegar. D. Monitor for tinnitus.

D. Monitor for tinnitus. Rationale: A. The client should take aspirin with a full glass of water or with food to reduce gastric distress. B. The client should monitor for black, tarry stools and other manifestations of bleeding, such as bruising. C. Discard aspirin tablets that smell like vinegar because these tablets are decomposing and are ineffective. D. Tinnitus is a manifestation of salicylism, or aspirin toxicity. Other manifestations include sweating, headache, and dizziness.

A nurse is providing instruction to a new nurse about caring for clients who are receiving diuretic therapy to treat heart failure. The nurse should explain that which of the following medications puts clients at risk for both hyperkalemia and hyponatremia? A. Furosemide B. Hydrochlorothiazide C. Metolazone D. Spironolactone

D. Spironolactone Rationale: A. Furosemide is a high-ceiling (loop) diuretic that increases the risk of hyponatremia and hypokalemia, not hyperkalemia. B. Hydrochlorothiazide is a thiazide diuretic that increases the risk of hypokalemia, not hyperkalemia. C. Metolazone is a thiazide diuretic that increases the risk of hyponatremia and hypokalemia, not hyperkalemia. D. Spironolactone is a potassium-sparing diuretic. It blocks the effects of aldosterone in the renal tubules, causing a loss of sodium and water and the retention of potassium. The possible adverse reactions include hyperkalemia and hyponatremia.

A nurse is providing teaching to a client who has stable angina and a new prescription for nitroglycerin oral, sustained-release capsules. Which of the following instructions should the nurse include? A. Take 1 capsule at the onset of anginal pain. B. Stop taking the medication if the side effects are troublesome. C. Take the medication with meals. D. Swallow the capsules whole.

D. Swallow the capsules whole. Rationale: A. Sustained-release capsules are not used for acute attacks of angina. B. Abruptly discontinuing the use of long-acting nitroglycerin capsules can cause vasospasm. C. The client should take the medication on an empty stomach 1 hr before or 2 hr after a meal with 8 oz of water. D. The client should swallow the capsules whole and not chew or crush them or place them under the tongue.

A hospice nurse is caring for a client who has terminal cancer and takes PO morphine for pain relief. The client reports that he had to increase the dose of morphine this week to obtain pain relief. Which of the following scenarios should the nurse document as the explanation for this situation? A. The client has not been taking the medication properly. B. The client is experiencing episodes of confusion. C. The client has become addicted to the medication. D. The client developed a tolerance to the medication.

D. The client developed a tolerance to the medication. Rationale: A. The nurse should not document the client has not been taking the medication properly without further investigation. The client is able to tell the nurse that he had to increase the dose, which does not indicate taking the medication improperly. B. The nurse should not document the client is experiencing confusion. The client is clearly able to tell the nurse that that he had to increase the dose to achieve pain relief. This does not indicate the client is confused. C. Addiction is the compulsive need for and use of a habit-forming substance, such as a narcotic. However, this client is not describing addiction, and addiction is not a concern when treating a terminal client who has cancer pain. D. The nurse should document that the client has developed a tolerance to the medication. Morphine is a narcotic analgesic used for the treatment of severe pain. Tolerance is an adverse effect of narcotic analgesics in which a larger dose is needed to produce the same response.