ATI RN Pharmacology 2019 A
A nurse is preparing to administer dextrose 5% in water (D5W) 400 mL IV to infuse over 1 hr. The drop factor of the manual IV tubing is 15 gtt/mL. The nurse should set the manual IV infusion to deliver how many gtt/min? (Round the answer to the nearest whole number.)
100 gtt/min
A nurse is preparing to administer ciprofloxacin 15 mg/kg PO every 12 hr to a child who weights 44 lb. How many mg should the nurse administer per dose? (Round the answer to the nearest whole number)
300 mg
A nurse at an urgent care clinic is collecting a history from a female client who has a urinary tract infection. The nurse anticipates a prescription for ciprofloxacin. The nurse should identify that which of the following client statements indicates a contraindication for administering this medication? a. "I have tendonitis, so I haven't been able to exercise." b. "I take a stool softener for chronic constipation." c. "I take medicine for my thyroid." d. "I am allergic to sulfa."
a. "I have tendonitis, so I haven't been able to exercise." -the nurse should identify tendonitis as a contraindication for taking ciprofloxacin due to the risk of tendon rupture -diarrhea is an adverse effect of this medication -ciprofloxacin is a quinolone antibiotic
A nurse is preparing to administer heparin subcutaneously to a client. Which of the following actions should the nurse plan to take? a. administer the medication outside the 5 cm (2 in) radius of the umbilicus b. aspirate for blood return before injecting c. rub vigorously after the injection to promote absorption d. place a pressure dressing on the injection site to prevent bleeding
a. administer the medication outside the 5 cm (2 in) radius of the umbilicus -the nurse should administer the heparin by subcutaneous injection to the abdomen in an area that is above the iliac crest and at least 5 cm (2 in) away from the umbilicus -the nurse should not aspirate by pulling back on the plunger of the heparin syringe to check for a blood return, because this will cause the injection site to bruise -the nurse should apply firm pressure to the injection site for 1-2 min after the administration of the heparin to prevent bruising
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) a. blood glucose levels will be monitored during therapy b. avoid contact with people who have known infections c. take the medication 1 hr before breakfast d. decrease dietary intake of foods containing potassium e. grapefruit juice can increase the effects of the medication
a. blood glucose levels will be monitored during therapy, b. avoid contact with people who have known infections, e. grapefruit juice can increase the effects of the medication -the nurse should monitor the client for hyperglycemia while providing methylprednisolone to the client. Glucocorticoids, such as methylprednisolone, increase serum glucose levels and can require management with insulin or antihyperglycemics -the nurse should instruct the client to avoid exposure to infectious agents, such as contact with those who have active infections or illness. Glucocorticoids, such as methylprednisolone, depress the immune system, placing the client at an increased risk for developing an infection -the nurse should instruct the client to take the medication with food or milk to decrease GI upset -the nurse should instruct the patient to increase dietary intake of potassium-rich foods while taking this medication. Glucocorticoids, such as methylprednisolone, deplete potassium in the body, which manifests as hypokalemia -the nurse should instruct the client that grapefruit juice and grapefruit can increase the level of methylprednisolone in the body
A nurse is reviewing the medication list of a client who wants to begin taking oral contraceptives. The nurse should identify that which of the following client medications will interfere with the effectiveness of oral contraceptives? a. carbamazepine b. sumatriptan c. atenolol d. glipizide
a. carbamazepine -carbamazepine causes an accelerated inactivation of oral contraceptives because of its action on hepatic medication-metabolizing enzymes -sumatriptan is a medication to treat migraines -atenolol is a beta blocker -glipizide is an antidiabetic medication
A nurse is caring for a client who has cancer and is taking oral morphine and docusate sodium. The nurse should instruct the client that taking the docusate sodium daily can minimize which of the following adverse effects of morphine? a. constipation b. drowsiness c. facial flushing d. itching
a. constipation -constipation is a common adverse effect of morphine that can be minimized by taking docusate sodium, a stool softener that promotes easier evacuation of stool by increasing water and fat in the intestines
A nurse is preparing to administer medications to a client who tells the nurse, "I don't want to take my fluid pill until I get home today." Which of the following actions should the nurse take? a. document the refusal and inform the client's provider b. file an incident report with the risk manager c. contact the pharmacist to pick up the medication d. give the client the medication to take home and document that it was administered
a. document the refusal and inform the client's provider -the nurse has the responsibility to verify that the client understands the risks of refusing the medication so that an informed decision can be made. The nurse should then document the refusal in the client's medical record and notify the HCP -an incident report is necessary for a medication error -the nurse should follow protocols for discarding the medication. It is not the role of the pharmacist to retrieve medications that a client refuses to take -the nurse should not give the client a scheduled medication to take at home and then document that it was administered, because this violates the ethical principle of accountability
A nurse is providing teaching to a client who is to begin oxybutynin for urinary incontinence. Which of the following adverse effects should the nurse include in the teaching? (Select all that apply.) a. dry mouth b. tinnitus c. blurred vision d. bradycardia e. dry eyes
a. dry mouth, c. blurred vision, e. dry eyes -oxybutynin is an anticholinergic agent that can cause dry mouth, blurred vision due to an increase in intraocular pressure, and dry eyes and mydriasis, or pupil dilation -oxybutynin can cause several sensory adverse effects included increased intraocular pressure. The nurse should instruct the client to report eye pain, seeing colored halos around lights, and decreasing ability to perceive light changes -oxybutynin can cause several cardiovascular adverse effects such as prolongation of the QT interval, palpitations, hypertension, and tachycardia
A nurse is teaching a client who is to begin taking tamoxifen for the treatment of breast cancer. Which of the following adverse effects should the nurse include in the teaching? a. hot flashes b. urinary retention c. constipation d. bradycardia
a. hot flashes -the estrogen receptor blocking action of tamoxifen commonly results in the adverse effect of hot flashes -tamoxifen can cause genitourinary adverse effects such as vaginal discharge and uterine cancer -GI adverse effects of tamoxifen include nausea and vomiting -tamoxifen is an antiestrogen medication that works by blocking estrogen receptors. Cardiovascular adverse effects of the medication include chest pain, flushing, and the development of thrombus
A nurse is caring for a client who is receiving filgrastim. Which of the following findings should the nurse document to indicate the effectiveness of the therapy? a. increased neutrophil count b. increased RBC count c. decreased prothrombin time d. decreased triglycerides
a. increased neutrophil count -filgrastim stimulates the bone marrow to produce neutrophils. For clients receiving chemotherapy, the risk of infection is minimized -filgrastim is used to treat chemotherapy-induced neutropenia
A nurse is preparing to administer medication to a client who has gout. The nurse discovers that an error was made during the previous shift and the client received atenolol instead of allopurinol. Which of the following should the nurse take first? a. obtain the client's blood pressure b. contact the client's provider c. inform the charge nurse d. complete an incident report
a. obtain the client's blood pressure -when using the nursing process, the first action the nurse should take to prevent injury to the client is to assess the client for adverse effects of atenolol, such as hypotension -all of these answers are correct, but checking the client's blood pressure should be the first step
A nurse is planning to teach about the use of a spacer to a child who has a new prescription for a fluticasone inhaler to treat chronic asthma. The nurse should include that the spacer decreases the risk for which of the following adverse effects of the medication? a. oral candidiasis b. headache c. joint pain d. adrenal suppression
a. oral candidiasis -dysphonia and oral candidiasis are adverse effects of inhaled corticosteroids. Using a spacer and rinsing the mouth after inhalation will minimize the amount of medication remaining in the oropharynx, preventing the development of these adverse effects -fluticasone can cause neurologic adverse effects such as dizziness, fatigue, nervousness, and headaches -fluticasone can cause musculoskeletal adverse effects such as bone loss, muscle aches, and joint pain -fluticasone is a glucocorticoid medication that decreases bronchoconstriction. Inhaled glucocorticoids can cause adrenal suppression, although this occurs more often with oral glucocorticoids. The nurse should monitor the client for manifestations of adrenal suppression such as weakness, fatigue, hypotension, and hypoglycemia
A nurse is developing a teaching plan for a client who has a new prescription for simvastatin. Which of the following instructions should the nurse include in the teaching plan? (Select all that apply.) a. report muscle pain to the provider b. avoid taking the medication with grapefruit juice c. take the medication in the early morning d. expect a flushing of the skin as a reaction to the medication e. expect therapy with this medication to be lifelong
a. report muscle pain to the provider, b. avoid taking the medication with grapefruit juice, e. expect therapy with this medication to be lifelong -myopathy is an adverse effect of simvastatin that can lead to rhabdomyolysis -when taken with grapefruit juice, simvastatin increased the risk of muscle injury from elevations in creatine kinase -this medication is most effective when taken in the evening because cholesterol production generally increases overnight -the nurse should identify flushing of the skin as an adverse effect of the medication niacin, which can be used to decrease the client's triglyceride levels -if medication therapy is discontinued, cholesterol levels will return to their pretreatment range within several weeks to months
A nurse is assessing a client who is postoperative following an outpatient endoscopy using midazolam. The nurse should monitor for which of the following findings as an indication that the client is ready for discharge? a. the client's capnography has returned to baseline b. the client can respond to their name when called c. the client is passing flatus d. the client is requesting oral intake
a. the client's capnography has returned to baseline -the nurse should identify that the client is ready for discharge when the capnography level indicates that gas exchange is adequate -the client is considered ready for discharge when the state of arousal is at the preprocedural level -the nurse should monitor for the passing of flatus for a client who received general anesthesia -the nurse should assess for a return of the gag reflex for a client who is postoperative following an endoscopy
A nurse is caring for a client who is taking acetazolamide for chronic open-angle glaucoma. For which of the following adverse effects should the nurse instruct the client to monitor and report? a. tingling of fingers b. constipation c. weight gain d. oliguria
a. tingling of fingers -the nurse should instruct the client to report the adverse effect of paresthesia, a tingling sensation in the extremities, when taking acetazolamide -diarrhea is an adverse effect of acetazolamide due to gastrointestinal disturbances -weight loss is an adverse effect of acetazolamide due to GI disturbances causing reduced appetite -polyuria is an adverse effect of acetazolamide
A nurse is caring for a client who is in labor. The client is receiving oxytocin by continuous IV infusion with a maintenance IV solution. The external FHR monitor indicates late decelerations. Which of the following actions should the nurse take first? a. turn the client to a side-lying position b. disconnect the clients oxytocin from the maintenance IV c. apply oxygen to the client by face mask d. increase the client's maintenance IV infusion rate
a. turn the client to a side-lying position -the greatest risk to the fetus experiencing late decelerations is injury from uteroplacental insufficiency. Therefore, the priority action the nurse should take is to place the client in a lateral position -the nurse should increase the client's maintenance IV infusion rate to maintain adequate blood flow and promote placental perfusion. However, another action is the nurse's priority -all of these answers are correct, however, turning the client to the side is the nurse's priority
A nurse is teaching a client about warfarin. The client asks if they can take aspirin while taking the warfarin. Which of the following responses should the nurse make? a. "It is safe to take an enteric-coated aspirin." b. "Aspirin will increase the risk of bleeding." c. "Acetaminophen mat be substituted for aspirin." d. "The INR lab work must be monitored more frequently if aspirin is taken."
b. "Aspirin will increase the risk of bleeding." -aspirin inhibits platelet aggregation and can potentiate the action of the anticoagulant warfarin. Therefore, the client should avoid taking aspirin because it increases the risk for bleeding -salicylates inhibit platelet aggregation and increase the potential for hemorrhage. Therefore, the client should avoid taking enteric-coated aspirin -acetaminophen, an analgesic, can potentiate the action of the anticoagulant warfarin when administered in high doses and is not a safe substitute for aspirin -the client should continue to follow the provider's prescription for monitoring the PT and INR levels to adjust warfarin dosages. However, the nurse should discourage the client from using aspirin products because these medications increase the antiplatelet action of the warfarin and can result in bleeding
A nurse is reviewing the laboratory results for a client who is receiving heparin via continuous IV infusion for deep-vein thrombosis. The nurse should discontinue the medication infusion for which of the following client findings? a. potassium 5.0 mEq/L b. aPTT 2 times the control c. hemoglobin 15 g/dL d. platelets 96,000 mm3
d. platelets 96,000 mm3 -a platelet count of 96,000 mm3 is below the expected range of 150,000-400,000 mm3. A platelet countless than 100,000 mm3 while receiving heparin can indicate heparin-induced thrombocytopenia, a potentially fatal condition that requires stopping the infusion -an Hgb of 15 g/dL is within the expected range or 14-18 g/dL for a male and 12-16 g/dL for a female and is not an indication to stop the heparin infusion
A nurse is instructing a client on the application of nitroglycerin transdermal patches. Which of the following statements by the client indicates an understanding of the teaching? a. "I should apply a patch every 5 mins if I develop chest pain." b. "I will take the patch off right after my evening meal." c. "I will leave the patch off at least 1 day each week." d. "I should discard the used patch by flushing it down the toilet."
b. "I will take the patch off right after my evening meal." -clients should remove the patch each evening for a medication free time of 12-14 hr before applying a new patch to avoid developing a tolerance to the medication's effects -nitroglycerin sublingual tablets are used to treat new onset of angina pain. A client who uses sublingual tablets should place one tablet under their tongue at the onset of angina pain and continue taking a table every 5 min for a total of three doses of nitroglycerin. The effects of a nitroglycerin patch will take 30-60 min to occur and are not useful to prevent an ongoing angina attack -nitroglycerin is an antianginal medication that results in dilation of the coronary vessels. Clients should apply the patch daily to sustain prophylaxis -medication remains in the transdermal patch after removing it from the body and must be discarded safely. The nurse should instruct the client to fold the patch ends together with the medication on the inside and place the discarded patch in a closed container so that children and pets cannot gain access to the medication
A nurse is providing teaching to a client who has a prescription for ergotamine sublingual to treat migraine headaches. Which of the following information should the nurse include in the instructions? a. "Take one tablet three times a day before meals." b. "Take one tablet at onset of migraine." c. "Take up to eight tablets as needed within a 24-hour period." d. "Take one tablet every 15 minutes until migraine subsides."
b. "Take one tablet at onset of migraine." -the client should take one tablet immediately after the onset of aura or headache -ergotamine, an alpha-adrenergic blocking medication, is not used prophylactically because this can result is ergotamine dependence -the client can take up to a maximum of three tablets in a 24-hr period. Excessive dosing can lead to ergotism, which can cause peripheral gangrene due to vasoconstriction and ischemia -the client can take one sublingual tablet every 30 min for a maximum of 3 tablets in a 24-hour period to manage migraine
A nurse is caring for a client who received 0.9% sodium chloride 1 L over 4 hr instead over 8 hr as prescribed. Which of the following information should the nurse enter as a complete documentation of the incident? a. IV fluid infused over 4 hr instead of the prescribed 8 hr. Client tolerated fluids well, provider notified b. 0.9% sodium chloride 1 L IV infused over 4 hr. Vital signs stable, provider notified c. 1 L of 0.9% sodium chloride completed at 0900. Client denies shortness of breath d. IV fluid initiated at 0500. Lungs clear to auscultation
b. 0.9% sodium chloride 1 L IV infused over 4 hr. Vital signs stable, provider notified -the nurse should document the type and amount of fluid, how long it took to infuse, provider notification, and the client's physical status -the nurse should only chart factual information in the client's medical record without indicating the error that occurred
A nurse is caring for the parent of a newborn. The parent asks the nurse when their newborn should receive the first diphtheria, tetanus, and pertussis vaccine (DTaP). The nurse should instruct the parent that their newborn should receive the immunization at which of the following ages? a. at birth b. 2 months c. 6 months d. 15 months
b. 2 months -the CDC recommends that newborns receive the first dose of the five-dose series of the DTaP immunization at 2 months of age -according to the current recommended immunization schedule, only the hepatitis B vaccine is given at birth -the CDC recommends that newborns receive the third dose of the five-dose series of the DTaP immunization at 6 months of age -the CDC recommends that newborns receive the fourth dose of the five-dose series of the DTaP immunization between 15-18 months of age
A nurse receives a verbal order from the provider to administer morphine five milligrams every 4 hours subcutaneously for severe pain as needed. The nurse should identify which of the following entries as the correct format for the medication administration record (MAR)? a. MSO4 5 mg subcut every 4 hr PRN severe pain b. Morphine 5 mg subcut every 4 hr PRN severe pain c. MSO4 5 mg SQ every 4 hr PRN severe pain d. Morphine 5.0 mg subcutaneously every 4 hr PRN severe pain
b. Morphine 5 mg subcut every 4 hr PRN severe pain -the medication name is spelled out and there are not any abbreviations from The Joint Commission's "Do Not Use" list included in the transcript -the use of the abbreviation MSO4 is prohibited by The Joint Commission. The medication name morphine must be spelled out to reduce the risk for error -SQ is prohibited by The Joint Commission; this route should be written as subcut, subq, or subcutaneously -the trailing zero on 5.0 can be mistaken for 50 if the decimal point is missed
A nurse is caring for a client who has acute acetaminophen toxicity. The nurse should anticipate administering which of the following medications? a. vitamin K b. acetylcysteine c. benztropine d. physostigmine
b. acetylcysteine -acetylcysteine is a specific antidote for acetaminophen toxicity. It can prevent severe injury when given orally or by IV infusion within 8-10 hours -vitamin K is used to treat increased warfarin serum levels, indicated by elevated levels of PT/INR -benztropine is an anticholinergic medication used to treat adverse effects of Parkinson's disease by reducing rigidity and tremors -physostigmine is an effective antidote for antimuscarinic poisoning from medications such as atropine, scopolamine, some antihistamines, phenothiazines, and tricyclic antidepressants
A nurse is caring for a client who is receiving heparin therapy via continuous IV infusion to treat pulmonary embolism. Which of the following findings should the nurse identify as an adverse effect of the medication and report to the provider? a. vomiting b. blood in the urine c. positive Chvostek's sign d. ringing in the ears
b. blood in the urine -the nurse should report blood in the urine to the provider because this can be a manifestation of heparin toxicity. Other manifestations can include bruising, hematomas, hypotension, and tachycardia. -a Chvostek's sign is seen in clients who have hypocalcemia or hypomagnesemia -aminoglycosides, such as vancomycin, are medications that cause ringing in the ears
A nurse is planning care for a client who has hypertension and is to start taking metoprolol. Which of the following interventions should the nurse include in the plan of care? a. weigh the client weekly b. determine apical pulse prior to administering c. administer the medication 30 mins prior to breakfast d. monitor the client for jaundice
b. determine apical pulse prior to administering -life-threatening bradycardia is an adverse effect that might affect this client. Therefore, the nurse should assess the client's apical pulse prior to administering the medication. If the client's pulse rate is less than 60/min, the nurse should withhold the medication and notify the provider -the nurse should weight the client daily to monitor for the development of heart failure and weight gain -the nurse should administer metoprolol following meals or at bedtime if orthostatic hypotension occurs -the nurse should monitor for adverse effects such as hypotension
A nurse is collecting a medication history from a client who has a new prescription for lithium. The nurse should identify that the client should discontinue which of the following over-the-counter medications? a. aspirin b. ibuprofen c. ranitidine d. bisacodyl
b. ibuprofen -most NSAIDs can significantly increase lithium levels. Therefore, the client should not take ibuprofen and lithium concurrently -although most NSAIDs interact with lithium to increase lithium levels, aspirin does not interact with lithium
A nurse in an emergency department is caring for a client who has heroin toxicity. The client is unresponsive with pinpoint pupils and a respiratory rate of 6/min. Which of the following medications should the nurse plan to administer? a. methadone b. naloxone c. diazepam d. bupropion
b. naloxone -the nurse should administer naloxone, an opioid antagonist, to a client who has heroin toxicity to reverse the respiratory depressive effects of the heroin. However, the nurse should not administer the naloxone too quickly because naloxone can cause hypertension, tachycardia, nausea, vomiting, and might cause the client to enter a state of opioid withdrawal -the nurse should administer methadone, an opioid agonist, to a client who has heroin toxicity to decrease manifestations of opioid withdrawal and suppress the euphoria the client feels when using heroin -the nurse should administer diazepam, a benzodiazepine, to a client who has alcohol toxicity to decrease the manifestations of alcohol withdrawal and prevent withdrawal seizures -the nurse should administer bupropion, an atypical antidepressant, to a client who is trying to quit nicotine to decrease the manifestations of nicotine withdrawal and ease the client's cravings for nicotine
A nurse is caring for a 20 year old female client who has a prescription for isotretinoin for severe nodulocystic acne vulgaris. Before the client can obtain a refill, the nurse should advise the client that which of the following tests is required? a. serum calcium b. pregnancy test c. 24-hr urine collection for protein d. aspartate aminotransferase level
b. pregnancy test -the nurse should instruct the client that isotretinoin has teratogenic effects; therefore, pregnancy must be ruled out before the client can obtain a refill. The client must provide two negative pregnancy tests for the initial prescription and one negative test before monthly refills -the client should have a laboratory test for aspartate aminotransferase levels prior to starting isotretinoin, 1 month after starting the medication, and periodically thereafter. However, a laboratory test for aspartate aminotransferase is not required to renew a prescription for isotretinoin
A nurse is reviewing the ECG of a client who is receiving IV furosemide for heart failure. The nurse should identify which of the following findings as an indication of hypokalemia? a. tall, tented T-waves b. presence of U-waves c. widened QRS complex d. ST elevation
b. presence of U-waves -the nurse should identify the presence of U-waves as a manifestation of hypokalemia, an adverse effect of furosemide -the nurse should identify tall, tented T-waves as a manifestation of hyperkalemia. Flattened or inverted T-waves are a manifestation of hypokalemia -the nurse should identify a widened QRS complex as a manifestation of hyperkalemia -the nurse should identify ST elevation as an indication of ischemia. ST depression is a manifestation of hypokalemia
A nurse is planning care for a client who is prescribed metoclopramide following bowel surgery. For which of the following adverse effects should the nurse monitor? a. muscle weakness b. sedation c. tinnitus d. peripheral edema
b. sedation -metoclopramide has multiple CNS adverse effects, including dizziness, fatigue, and sedation -metoclopramide is a central dopamine receptor antagonist that increased GI motility and prevents nausea. Tardive dyskinesia is an adverse effect of metoclopramide
A nurse at a clinic is providing follow-up care to a client who is taking fluoxetine for depression. Which of the following findings should the nurse identify as an adverse effect of the medication? a. tingling toes b. sexual dysfunction c. absence of dreams d. pica
b. sexual dysfunction -sexual dysfunction, including a decreased libido, impotence, and delayed orgasm, or anorgasmia, is a common adverse effect of fluoxetine and occurs in about 70% of clients who take this SSRI antidepressant -fluoxetine is an SSRI that can cause muscle twitching -fluoxetine can cause CNS adverse effect including abnormal dreaming, sedation, delusions, hallucinations, and psychosis -fluoxetine can cause neurologic adverse effects such as agitation, euphoria, and sedation
A nurse on the acute care unit is caring for a client who is receiving gentamicin IV. The nurse should report which of the following findings to the provider as an adverse effect of the medication? a. constipation b. tinnitus c. hypoglycemia d. joint pain
b. tinnitus -aminoglycosides, such as gentamicin, are ototoxic, which can manifest as tinnitus and deafness. The nurse should monitor for high-pitched ringing in the ears and headaches and should notify the provider if these occur -gentamicin, an aminoglycoside used to treat serious infections, can cause several GI adverse effects, such as inflammation of the liver and spleen, but does not cause constipation -aminoglycosides, such as gentamicin, can result in neuromuscular adverse effects such as twitching or flaccid paralysis.
A nurse is providing discharge instructions to a client who has heart failure and a new prescription for captopril. Which of the following client statements indicates an understanding of the teaching? a. "I should take the medication with food." b. "I should take naproxen if I develop joint pain." c. "I should tell my provider if I develop a sore throat." d. "I should expect the medication to cause my urine to look orange."
c. "I should tell my provider if I develop a sore throat." -the client should report a sore throat to the provider because this can indicate neutropenia, a serious adverse effect of captopril. Neutropenia can be reversed if it is identified early and the medication is promptly discontinued -the client should take captopril on an empty stomach because food reduces absorption of the medication. The nurse should instruct the client to take the medication 1 hr before or 2 hr after a meal -naproxen and other NSAIDs can interact with captopril, which can decrease the effect of the antihypertensive and increase the risk of kidney dysfunction -captopril affects the urinary system by causing dysuria, urinary frequency, and changes in the normal amount of urine. Captopril does not affect the color of the urine
A nurse is teaching a client about cyclobenzaprine. Which of the following client statements should indicate to the nurse that the teaching is effective? a. "I will have increased saliva production." b. "I will continue taking the medication until the rash disappears." c. "I will taper off the medication before discontinuing it." d. "I will report any urinary incontinence."
c. "I will taper off the medication before discontinuing it." -the client should taper off cyclobenzaprine before discontinuing it to prevent abstinence syndrome or rebound insomnia -the client should use gum or sip on water to prevent dry mouth, which is an adverse effect of cyclobenzaprine -the client should take cyclobenzaprine for treatment of muscle spasms -the client should report any urinary retention because of the anticholinergic effects caused when taking cyclobenzaprine
A nurse is providing teaching to a client who has a gastric ulcer and a new prescription for ranitidine. Which of the following instructions should the nurse include? a. "Take the medication on an empty stomach for full effectiveness." b. "You may discontinue this medication when stomach discomfort subsides." c. "Report yellowing of the skin." d. "Store the medication in the refrigerator."
c. "Report yellowing of the skin." -ranitidine can be hepatotoxic and cause jaundice. The nurse should instruct the client to monitor for and report yellowing of the skin or eyes to the provider -the client can take ranitidine with or without food because food does not affect the medication's effectiveness -for clients who have a gastric ulcer, ranitidine is prescribed to inhibit gastric secretion and must be taken for the full course of therapy to be effective -the client should store ranitidine at room temperature
A nurse is preparing to administer a scheduled antibiotic at 0800 to a client and discovers the antibiotic is not present in the client's medication drawer. The nurse should identify that administration of the medication can occur at which of the following time periods without requiring an incident report? a. 1000 b. 0900 c. 0830 d. 1200
c. 0830 -the nurse should identify that an antibiotic can be administered 30 min before or after the scheduled time to maintain therapeutic blood levels without requiring an incident report
A nurse is teaching a group of unit nurses about medication reconciliation. Which of the following information should the nurse include in the teaching? a. the client's provider is required to complete medication reconciliation b. medication reconciliation at discharge is limited to the medication ordered at the time of discharge c. a transition in care requires the nurse to conduct medication reconciliation d. medical reconciliation is limited to the name of the medications that the client is currently taking
c. a transition in care requires the nurse to conduct a medication reconciliation -the nurse should conduct medication reconciliation anytime the client is undergoing a change in care such as admission, transfer from one unit to another, or discharge. A complete listing of all prescribed and over-the-counter medications should be reviewed. -the nurse or member of the health care team, such as the pharmacist, is required to complete medication reconciliation -medication reconciliation at discharge includes medications ordered at the time of discharge, over-the-counter medications, vitamins, herbal supplements, nutritional supplements, and other medications the client is taking. The indication, route, dosage size, and dosing interval are also required
A nurse in an emergency department is caring for a client who has myasthenia gravis and is in cholinergic crisis. Which of the following medications should the nurse plan to administer? a. potassium iodide b. glucagon c. atropine d. protamine
c. atropine -a cholinergic crisis is caused by an excess amount of cholinesterase inhibitor, such as neostigmine. The nurse should plan to administer atropine, an anticholinergic agent, to reverse cholinergic toxicity -potassium iodide is a thyroid hormone antagonist used in the treatment of radioactive iodine exposure -glucagon is an antihypoglycemic medication used in the treatment of low blood glucose levels -protamine is a heparin antagonist that is administered to reverse heparin toxicity evidenced by an aPTT greater than 70 seconds
A nurse administers a dose of metformin to a client instead of the prescribed dose of metoclopramide. Which of the following actions should the nurse take first? a. report the incident to the charge nurse b. notify the provider c. check the client's blood glucose d. fill our an incident report
c. check the client's blood glucose -the first action the nurse should take using the nursing process is to assess the client. The client is at risk for hypoglycemia. The nurse should monitor the client's blood glucose and provide the client with a snack to reduce the risk of hypoglycemia -the rest of these answers are also correct, but there is another action the nurse should take first
A nurse is reviewing the medication administration record of a client who has hypocalcemia and a new prescription for IV calcium gluconate. The nurse should identify that which of the following medications can interact with calcium gluconate? a. felodipine b. guaifenesin c. digoxin d. regular insulin
c. digoxin -the nurse should identify that calcium gluconate can cause hypercalcemia, which increases the risk of digoxin toxicity
A nurse is assessing a client after administering a second dose of cefazolin IV. The nurse notes the client has anxiety, hypotension, and dyspnea. Which of the following medications should the nurse administer first? a. diphenhydramine b. albuterol inhaler c. epinephrine d. prednisone
c. epinephrine -according to evidence-based practice, the nurse should administer epinephrine first to induce vasoconstriction and bronchodilation during anaphylaxis -the nurse should administer diphenhydramine, an antihistamine, as a second-line medication to decrease angioedema and urticaria following anaphylaxis -the nurse should administer albuterol, a bronchodilator, for a client who has dyspnea from bronchospasms during anaphylaxis -the nurse should plan to administer prednisone, a glucocorticoid, for the urticaria following anaphylaxis and to prevent a delayed anaphylactic reaction from occurring
A nurse in an emergency department is caring for a client whose family reports the client has taken large amounts of diazepam. Which of the following medications should the nurse anticipate administering? a. ondansetron b. magnesium sulfate c. flumazenil d. protamine sulfate
c. flumazenil -the nurse should anticipate administering flumazenil, an antidote used to reverse benzodiazepines such as diazepam -ondansetron is an antiemetic that is used to treat nausea and vomiting -magnesium sulfate is an electrolyte replacement that is used to treat clients who are at risk for seizure activity -protamine sulfate is an antidote for heparin and is used to reverse and elevated aPTT caused by taking heparin
A nurse is providing teaching to a client who has peptic ulcer disease and is to start a new prescription for sucralfate. Which of the following actions of sucralfate should the nurse include in the teaching? a. decreases stomach acid secretion b. neutralizes acids in the stomach c. forms a protective barrier over ulcers d. treats ulcers by eradicating H. pylori
c. forms a protective barrier over ulcers -secretions by the parietal and chief cells, hydrochloric acid and pepsin, can further irritate the ulcerated areas. Sucralfate, a mucosal protectant, forms a gel-like substance that coats the ulcer, creating a barrier to hydrochloric acid and pepsin -peptic ulcer disease manifests as an erosion of the gastric or duodenal mucosa. The acid production in the stomach causes further irritation and pain. H2 receptor antagonists, such as famotidine, decrease stomach acid secretion -acid production in the stomach causes further irritation and pain to a client who has a peptic ulcer. Antacids, such as aluminum hydroxide, neutralize acids in the stomach and prevent pepsin formation, a digestive enzyme the can further damage the eroded epithelium -a common cause of peptic ulcers is a bacterial infection with Helicobacter pylori. Treatment of the ulcer includes a combination of antibiotics, such as metronidazole, tetracycline, clarithromycin, or amoxicillin, to eradicate the H. pylori infection
A nurse is assessing a client's vital signs prior to the administration of PO digoxin. The client's BP is 144/86 mm Hg, heart rate is 55/min, and respiratory rate is 20/min. The nurse should withhold the medication and contact the provider for which of the following findings? a. diastolic BP b. systolic BP c. heart rate d. respiratory rate
c. heart rate -digoxin slows the conduction rate through the SA and AV nodes, thereby decreasing the heart rate. The nurse should withhold the medication and notify the provider for a heart rate of 55/min because this is an early indication of digoxin toxicity -digoxin increased cardiac output and reduces the heart rate, a diastolic BP of 86, systolic BP of 140, and respiratory rate of 20/min is not cause for holding the medication and contacting the provider -
A nurse is teaching a client about the use of risedronate for the treatment of osteoporosis. The nurse should identify which of the following statements as an indication that the client understands the teaching? a. "I will drink a glass of milk when I take the risedronate." b. "I will take the risedronate 15 minutes after my evening meal." c. "I should take an antacid with the risedronate to avoid nausea." d. "I should sit up for 30 minutes after taking the risedronate."
d. "I should sit up for 30 mins after taking the risedronate." -sitting upright for at least 30 min after taking risedronate will reduce the adverse GI effects of esophagitis and dyspepsia. Risedronate is contraindicated for a client who cannot sit or stand upright for this length of time -the nurse should reinforce that risedronate should be taken with a full glass of water, rather than any other liquid -although the delayed release form of the medication can be taken after eating, the immediate release form of the medication should be taken at least 30 min prior to consuming food or other liquids. Both forms of medication should be taken in the morning -the absorption of risedronate, a bisphosphonate, will be reduced if it is taken with antacids containing calcium, aluminum, or magnesium. The nurse should instruct the client to take the antacid 2 hr after taking risedronate
A nurse is providing teaching to a client who is to start treatment for asthma with beclomethasone and albuterol inhalers. Which of the following instructions should the nurse include in the teaching? a. "Take beclomethasone to avoid an acute attack." b. "Use beclomethasone 5 mins before using albuterol." c. "Limit your calcium and vitamin D intake when taking beclomethasone." d. "Rinse your mouth after inhaling the beclomethasone."
d. "Rinse your mouth after inhaling the beclomethasone." -the client should rise their mouth after using beclomethasone, a glucocorticoid inhaler, to prevent oropharyngeal candidiasis and hoarseness -the client should take albuterol, a short-acting beta 2- adrenergic agonist, to avoid an acute asthma attack -the client should use the bronchodilator, albuterol, prior to taking beclomethasone, a glucocorticoid inhaler, to enhance its absorption -the client should increase the intake of calcium and vitamin D to minimize bone loss while taking beclomethasone, a glucocorticoid inhaler
A nurse is planning care for a client who is receiving mannitol via continuous IV infusion. The nurse should monitor the client for which of the following adverse effects? a. weight loss b. increased intraocular pressure c. auditory hallucinations d. bibasilar crackles
d. bibasilar crackles -mannitol, an osmotic diuretic, can precipitate heart failure and pulmonary edema. Therefore, the nurse should recognize lung crackles as an indicator of a potential complication and stop the infusion -mannitol is an osmotic diuretic used to promote diuresis, decrease intracranial pressure, and improve renal function. An expected therapeutic effect of mannitol is weight loss resulting from diuresis -an indication for the use of mannitol is increased intracranial pressure. Mannitol decreased the intraocular pressure by creating an osmotic gradient between the intraocular fluid and the plasma -mannitol has several neurologic adverse effects, including increased intracranial pressure, seizures, confusion, and headaches.
A nurse is teaching a client who is to start taking hydrocodone with acetaminophen tablets for pain. Which of the following information should the nurse include in the teaching? a. the medication should be taken 1 hr prior to eating b. it takes 48 hr for therapeutic effects to occur c. tablets should not be crushed or chewed d. decreased respirations might occur
d. decreased respirations might occur -the nurse should instruct the client that hydrocodone with acetaminophen might cause respiratory depression, which is an adverse effect of the medication. The client should avoid taking over-the-counter medications or newly prescribed medications without consulting their provider to avoid increased respiratory depression -the client should take hydrocodone and acetaminophen with food or milk to decrease gastric irritation -the nurse should instruct the client that they should experience the effects of hydrocodone with acetaminophen within 20 min of administration and that pain relief should last 4-6 hr -can be crushed if needed
A nurse is administering donepezil to a client who has Alzheimer's disease. Which of the following findings should the nurse report to the provider immediately? a. dyspepsia b. diarrhea c. dizziness d. dyspnea
d. dyspnea -when using the airway, breathing, circulation approach to client care, the nurse should report the adverse effect of dyspnea, caused by bronchoconstriction, to the provider first. Bronchospasm, dyspepsia, diarrhea, and dizziness are caused by the increase in acetylcholine levels, which is a primary effect of donepezil -all of these answers should be reported to the provider, but dyspnea should be reported first
A nurse is assessing a client who is taking propylthiouracil for the treatment of Graves' disease. Which of the following findings should the nurse identify as an indication that the medication has been effective? a. decrease in WBC count b. decrease in amount of time sleeping c. increase in appetite d. increase in ability to focus
d. increase in ability to focus -a client who has Graves' disease can experience psychological manifestations such as difficulty focusing, restlessness, and manic-type behaviors. Propylthiouracil is a thyroid hormone antagonist that decreases the circulating T4 hormone, reducing the manifestations of hyperthyroidism. An increased ability to focus indicates that the medication has been effective -propylthiouracil is a thyroid hormone antagonist used in the treatment of hyperthyroidism, or thyroid storms. A decreased WBC count is an adverse effect of propylthiouracil, which can cause myelosuppression. -Graves' disease, a form of hyperthyroidism, has neurologic manifestations, including insomnia -Graves' disease can result in GI manifestations such as increased appetite, weight loss, and increased GI motility
A nurse is providing teaching to a client who is taking bupropion as an aid to quit smoking. Which of the following findings should the nurse identify as an adverse effect of the medication? a. cough b. joint pain c. alopecia d. insomnia
d. insomnia -bupropion, an atypical antidepressant, has stimulant properties, which can result in agitation, tremors, mania, and insomnia -bupropion can cause neurologic adverse effects such as bradykinesia -bupropion can cause adverse effects such as changes in vision and hearing
A nurse is assessing a client who has myasthenia gravis and is taking neostigmine. Which of the following findings should indicate to the nurse that the client is experiencing an adverse effect? a. tachycardia b. oliguria c. xerostomia d. miosis
d. miosis -miosis, which is pupillary constriction, is a common adverse effect of neostigmine due to the excessive muscarinic stimulation that causes difficulty with visual accommodation -neostigmine can cause bradycardia, urinary urgency, and increased salivation due to the excessive muscarinic stimulation
A nurse is preparing to administer PO sodium polystyrene sulfonate to a client who has hyperkalemia. Which of the following actions should the nurse plan to take? a. hold the client's other oral medication for 8 hr post administration b. inform the client that his medication can turn stool a light tan color c. keep the client's solution in the refrigerator for up to 72 hours d. monitor the client for constipation
d. monitor the client for constipation -the nurse should monitor the client for the adverse effect of constipation and report it to the provider because this can lead to fecal impaction -the nurse should hold the client's other medications for 6 hr before and after administration of sodium polystyrene sulfonate -sodium polystyrene sulfonate will not alter the color of the client's stool and is stable for 24 hr when refrigerated
A nurse is reviewing the laboratory results of a client who is taking digoxin for heart failure. Which of the following results should the nurse report to the provider? a. calcium level 9.2 mg/dL b. magnesium level 1.6 mEq/L c. digoxin level 1.1 ng/mL d. potassium level 2.8 mEq/L
d. potassium level 2.8 mEq/L -a potassium level of 2.8 is below the expected reference range of 3.5-5 mEq/L. The nurse should notify the provider if a client has hypokalemia prior to administration of digoxin due to the increased risk of developing digoxin toxicity and cardiac dysrhythmias -a calcium level of 9.2 is within the expected reference range of 9.0-10.5 mg/dL -a magnesium level of 1.6 is within the expected reference range of 1.3-2.1 mEq/L -a digoxin level of 1.1 is within the expected reference range of 0.8-2 ng/mL
A nurse is caring for a client who is experiencing acute alcohol withdrawal. For which of the following client outcomes should the nurse administer chlordiazepoxide? a. minimize diaphoresis b. maintain abstinence c. lessen craving d. prevent delirium tremens
d. prevent delirium tremens -the client should take chlordiazepoxide to prevent delirium tremens during acute alcohol withdrawal -the client should take clonidine or a beta-adrenergic blocker, such as atenolol, to minimize autonomic components, such as diaphoresis, during alcohol withdrawal -the client should take acamprosate to help maintain abstinence from alcohol by decreasing anxiety and other uncomfortable manifestations -the client should take propranolol to decrease cravings during alcohol withdrawal
A nurse is providing discharge teaching about handling medication to a client who is to continue taking oral transmucosal fentanyl raspberry-flavored lozenges on a stick. Which of the following information should the nurse include in the teaching? a. chew of the medication stick to release the medication b. leave the medication stick in one location of the mouth until melted c. allow the medication 1 hr for analgesia effects to begin d. store unused medication sticks in a storage container
d. store unused medication sticks in a storage container -the nurse should instruct the client to store unused, used or partially used medication sticks in the safe storage container that comes in the kit when the medication is initially prescribed -the nurse should instruct the client to place the fentanyl stick between their cheek and lower gum and actively suck it for increased absorption of the medication -the nurse should instruct the client to periodically move the medication stick to a different location in the mouth for best absorption -the nurse should instruct the client to expect the medication's analgesia effects to begin within 10-15 mins
A nurse is assessing a client who has schizophrenia and is taking haloperidol. The nurse should report which of the following findings to the provider as a manifestation of neuroleptic malignant syndrome (NMS)? a. temperature of 39.7 C (103.5 F) b. urinary retention c. heart rate 56/min d. muscle flaccidity
d. temperature of 39.7 C (103.5 F) -the nurse should report fever to the provider as an indication of NMS, an acute life-threatening emergency. Other manifestations can include respiratory distress, diaphoresis, and either hyper- or hypotension -incontinence, tachycardia, and severe muscle rigidity are also manifestations of NMS
A nurse is assessing a client 1 hr after administering morphine for pain. The nurse should identify which of the following findings as the best indication that the morphine has been effective? a. the client's vital signs are within normal limits b. the client has not requested additional medication c. the client is resting comfortably with eyes closed d. the client rates pain as 3 on a scale from 0 to 10
d. the client rates pain as a 3 on a scale from 0 to 10 -the client's description of the pain is the most accurate assessment of pain -vital signs can be within normal limits for clients who have pain -clients often do not request medicine even when they are experiencing pain -the client might rest with their eyes closed as a method to try to manage pain. However, this does not indicate that the pain is controlled.
