CMS Pharm Practice B 🥶
A nurse in a community health clinic is preparing to administer the varicella vaccine to a young adult female client who has not previously had chickenpox or its vaccine. The nurse should withhold the vaccine and collect additional data when the client makes which of the following statements? -"I am allergic to neomycin." -"I am taking antibiotics for my acne." -"My irritable bowel syndrome has been acting up for the last few days." -"I have been taking an oral contraceptive for the last 6 months."
Answer: "I am allergic to neomycin." A hypersensitivity to neomycin is a contraindication for receiving the varicella vaccine.
A nurse is reinforcing teaching w/ a client who has a presciption for scopolamine transfermal patches to prevent motion sickness. Which of the following statements by the client indicates an understanding of the teaching? -"I might have a runny nose during therapy." -"I should replace the patch every day." -"I might experience diarrhea while taking this medication." -"I should place the patch behind my ear."
Answer: "I should place the patch behind my ear." The nurse should reinforce with the client to place the scopolamine patch on a hairless area of skin behind the ear.
A nurse is reinforcing teaching w/ a client who has a new prescription for fluticasone inhaler. Which of the following client statements indicates an understanding of the teaching? -"I will administer two puffs of the medication consecutively." -"I will use this inhaler if I feel an asthma attack coming on." -"I will avoid intake of dairy products in my diet." -"I will rinse my mouth after I use this inhaler."
Answer: "I will rinse my mouth after I use this inhaler." The client should rinse their mouth after using inhaled glucocorticoids to reduce the risk for the development of oral thrush. Therefore, the nurse should identify this statement as indication an understanding of the teaching.
A nurse is collecting data from a client who has angina and a new prescription for sublingual nitroglycerin. Which of the following manifestations should the nurse expect as an adverse effect of this medication? -Shortness of breath -Bradycardia -Headache -Double vision
Answer: Headache The nurse should expect the client to have headaches as a common adverse effect of taking sublingual nitroglyerin because it causes vasodilation.
A nurse is caring for a client who has genital herpes. Which of the following medication should the nurse expect to administer? -Levofloxacin -Acyclovir -Ceftriaxone -Metronidazole
Answer: Acyclovir The client should receive acyclovir, an antiviral medication, to treat genital herpes by reducing manifestations and the rate of viral shedding.
A nurse is performing the third check before administering hydromorphone to a client. After opening the unit-dose packet, the client tells the nurse they do not want to take the medication now. Which of the following actions should the nurse take? -Complete an occurrence report of the incident. -Encourage the client to take the medication. -Leave the medication at the client's bedside in case they change their mind. -Dispose of the medication with a second nurse as a witness.
Answer: Dispose of the medication with a second nurse as a witness. The nurse is legally required to have a witness when disposing of a controlled substance.
A nurse is reinforcing teaching w/ a client who has a new presciption for timolol eye drops to treat glaucoma. Which of the following client statements indicates an understanding of the teaching? -"I will rub my eyes for 10 seconds after putting in the medication." -"I will look up when putting the medication into my eyes." -"I will clean my eyes from the outer edge toward the nose before putting in the medication." -"I will close my eyes tightly after putting in the medication."
After: "I will look up when putting the medication into my eyes." The nurse should reinforce with the client to look up during administration of eye drops to protect the cornea and minimize blinking.
A nurse is reinforcing discharge teaching w/ a client who has a prescription for a metered-dose inhaler (MDI). Which of the following information should the nurse include in the teaching? -"Wait for 15 seconds between each puff of the same medication." -"Hold your breath for 5 seconds after inhaling the medication." -"Take a slow, deep breath lasting 3-5 seconds after released the medication." -"Roll the canister between your hands for 10-15 seconds to mix the medication."
Answer: "Take a slow, deep breath lasting 3-5 seconds after releaseing the medication." The client should take a slow, deep breath lasting 3-5 seconds to allow the medication to be distributed deeply into the lungs.
A nurse is reviewing a client's medical history before administering hydomorphone for postoperative pain. The nurse should notify the provider of which of the following findings before administers this medication? -Benign prostatic hyperplasia -History of hypertension -Rheumatoid arthritis -Allergy to aspirin
Answer: Benign prostatic hyperplasia A client who has BPH is at increased risk for developing acute urinary retention while taking opioids. Therefore, the nurse should notify the provider about this finding before administering hydromorphone.
A nurse is collecting data from a client who has bacterial pneumonia and is taking ceftriaxone. Which of the following findings indicated a therapeutic effect of the medication? -WBC count 10,500/mm3 -Clear, bilateral breath sounds -Heart rate 110/min -Tolerates small meal servings
Answer: Clear, bilateral breath sounds The nurse should identify that wheexing and cracles are findings of bacterial pneumonia. A decrease in these manifestations indicates a therapeutic effect of the medication.
A nurse erroneously administered zolpidem to the wrong client. Which of the following actions should the nurse take? -Document the completion of the incident report in the medical record of the client who received the zolpidem. -Adminster a dose of naloxone to reverse the effect of the medication. -Keep a copy of the incident report on the unit. -Document the notification of the client's provider.
Answer: Document the notification of the client's provider. In the medical record of the client who received the zolpidem, the nurse should document the objective facts of the error, including follow-up actions and notification of the provider.
A nurse is reinforcing teaching w/ a client who has a new prescription for vitamin B12 intranasal to treat malabsorption syndrome. Which of the following instructions should the nurse include in the teaching? -"Take this medication once per day." -"Drink a hot liquid after administering the medication." -"Massage your nose gently after medication administration." -"Store this medication in the refrigerator."
Answer: "Massage your nose gently after medication administration." The nurse should instruct the client to massage their nose gently to increase absorption of the medication.
A client who has terminal cancer reports pain as 5 on a scale of 0 to 10. The client has a prescription for morphine 15 mg orally every 4 hr. The client's adult children express concern that the client is receiving too much of the medication. Which of the following responses sould the nurse make? -"Clients who receive this medication orally have a lower risk for addiction." -"Additional doses will not be needed because this medication is given on a fixed schedule." -"The dose should remain constant to prevent breakthrough pain." -"We can switch from oral administration to rectal administration."
Answer: "The dose should remain constant to prevent breakthrough pain." Fixed or scheduled dosing around the clock offers the best pain control for clients who have severe and persistent pain.
A nurse on a medical-surgical unit is preparing to administer medications to a client. Which of the following questions should the nurse ask the client to verify the client's identity? -"What is your phone number?" -"What is your room number?" -"What is your provider's name? -"What is your diagnosis?"
Answer: "What is your phone number?" Acceptable client identifiers include the client's name, telephone number, facility identification number, date of birth, and other client-specific identifiers. The nurse must use at least two identifiers to verify the client's identitiy and should compare the information to what is on the client's wristband or in the medical record.
A nurse is reinforcing teaching w/ a client who is to start therapy with a nitroglycerin transdermal patch. Which of the following statements by the client indicates an understanding of the teaching? -"While using the patch, I will be careful when rising from a chair." -"I should leave the patch in place for 24 hours." -"I should apply the patch to the same location with each application." -"I will apply a new patch if I have chest pain."
Answer: "While using the patch, I will careful when rising from a chair." Nitroglycerin can cause orthostatic hypotension, which can result in dizziness. The client should change positions clowly to reduce the risk for injury.
A nurse is reinforcing teaching w/ a client who has type 2 diabetes mellitus about adverse effects of metformin. The nurse should instruct the client to monitor for which of the following findings as manifestations of lactic acidosis? (Select all that apply.)
Answer: -Muscle pain -Hyperventilation -Dizziness
A nurse is caring for a client who is receiving methylprednisolone. Which of the following laboratory values should the nurse plan to montior? (Select all that apply.) -White blood cell count -Serum potassium -Creatine phosphokinase -Blood glucose -Amylase
Answer: -White blood cell count -Serum potassium -Blood glucose
A nurse is preparing to administer phenobarbital 3 mg/kg PO twice a day to a school-age child who weighs 44 lb. Available is penobarbital elixir 20 mg/5 mL. How many mL should the nurse plan to administer per dose? (Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.)
Answer: 15 mL/dose
A nurse is preparing to administer cefazolin 1 g in 100 mL 0.9% sodium chloride to infuse over 30 min. 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. Used a leading zero if it applies. Do not use a trailing zero.)
Answer: 50 gtt/min
A nurse is collecting data from a client who is taking exenatide to treat diabetes mellitus. For which of the following findings should the nurse withhold the exenatide dose and notify the provider immediately? -Loss of appetite -Abdominal pain -Muscle weakness -Heartburn
Answer: Abdominal pain The greatest risk to this client is the development of pancreatitis as an adverse effect of exenatide; therefore, the nurse should withhold the medication and immediately notify the provider of the client's abdominal pain. Manifestations of pancreatitis include severe, persistent abdominal pain with possible emesis.
A nurse is caring for a client who is having an acute asthma attack. Which of the following medications should the nurse administer first? -Beclometasone -Albuterol -Cromolyn -Prednisone
Answer: Albuterol According to evidence-based practice, the nurse should administer a short-acting beta2 agonist with a rapid onset when a client is experiencing an acute asthma attack. Therefore, the nurse should administer the albuterol prior to the other medications for prompt relief of airway constriction.
A nurse is collecting data prior to administering digoxing to a client. For which of the following findings should the nurse withhold this medication and notify the provider? -Digoxin level 0.9 ng/mL -Blood pressure 142/80 mm Hg -Potassium 4.4 mEq/L -Apical pulse 52/min
Answer: Apical pulse 52/min The nurse should check the client's apical pulse prior to administering digoxing because it can cause bradycardia. If the client's heart rate is below 60/min, the nurse should withhold the dose and notify the provider.
A nurse is monitoring a client who is 2 hr postoperative and has a prescription for opioid analgesics. Which of the following actions provides the nurse with the priority data to determine the client's need for analgesia? -Observe the client for signs of restlessness -Monitor the client for facial grimacing -Watch the client for indication of decreased mobility -Ask the client to rate their pain level
Answer: Ask the client to rate their pain level According to evidence-based practice, the nurse should first ask the client to rate their pain level to provide a verbal report of pain, which if the priority indicator of the need for pain medication.
A nurse is reviewing the medical record of a client who has a new prescription for dimenhydrinate to treat motion sickness. Which of the following conditions in the client's medical record should the nurse report to the provider? -Major depressive disorder -Diabetes mellitus -Benign prostatic hyperplasia -Meniere's disease
Answer: Benign prostatic hyperplasia Clients who have benign prostatic hyperplasia might have urinary hesitancy and retention and, therefore, should not take dimenhydrinate due to the anticholinergic adverse effects of the medication.
A nurse is reinforcing teaching w/ a client who experiences migraine headaches and has a new prescription for sumatriptan. The nurse should instruct the client to report which of the following manifestations to the provider as an adverse effect of this medication? -Insomnia -Photophobia -Chest tightness -Respiratory depression
Answer: Chest tightness The nurse should instruct the client to report chest pain or tightness to the provider because this can be a manifestation of vasopastic response.
A nurse is collecting data from a client who is taking oral amoxicillin to treat a respiratory infection. The nurse should monitor the client for which of the following manifestations as an adverse effect of the medication? -Hearing loss -Diarrhea -Bruising -Tendonitis
Answer: Diarrhea The nurse should monitor the client for diarrhea, which is an adverse effect of antibiotics, such as amoxicillin.
A nurse is collecting data from a client who has multiple sclerosis and a new prescription for baclofen. Which of the following findings should the nurse identify as an adverse effect of this medication? -Diarrhea -Weight loss -Drowsiness -Hypertension
Answer: Drowsiness The nurse should identify drowsiness as an adverse effect of baclofen. Other adverse effects include dizziness, weakness, and fatigue.
A nurse is reinforcing teaching w/ a client who is receiving enalapril 20 mg PO daily. The nurse should instruct the client to monitor for which of the following adverse effects of this medication? -Hypokalemia -Blurred vision -Tremors -Dry cough
Answer: Dry cough The nurse should identify that a persistent dry or nonproductive cough is an adverse effect of enalapril. The underlying cause of the dry cough is the accumulation of bradykinin from the medication. The client should notify the provider of this adverse effect.
A nurse is caring for a client who has a new prescription for risperidone to manage schizophrenia. Which of the following laboratory tests should the nurse plan to obtain prior to administering the first dose? -Fasting blood glucose level -Albumin level -CD4 T-cell count -Blood creatinine level
Answer: Fasting blood glucose The development of hyperglycemia can be an adverse effect of risperidone. The nurse should obtain a fasting blood glucose level prior to administration of the first dose and periodically during treatment.
A nurse is reviewing the medication administration record of a client who has a history of Stevens-Johnson syndrome when taking sulfamethoxazole-trimethoprim. Which of the following medications should the nurse identify as contraindicated for this client? -Prednisone -Furosemide -Lansoprazole -Digoxin
Answer: Furosemide A client who has a history of Stevens-Johnson syndrome when taking sulfonamides is at risk for an allergic reaction to furosemide because the two medications are chemically related. The client should also avoid tiazide diuretics and sulfonylurea-type oral hypoglycemic agents.
A nurse is reviewing the medication administration record for a client who has a new prescription for tobramycin to treat a pulmonary infection. Which of the following medications should the nurse identify as increasing the risk for ototoxicity while taking tobramycin? -Furosemide -Propranolol -Gabapentin -Guaifenesin
Answer: Furosemide Tobramycin is an aminoglycoside antibiotic that can cause ototoxicitiy. Fursemide is a diuretic that also can cause ototoxicity. The client's risk for hearing loss is increased if receiving both of these medications at the same time.
A nurse is monitoring a client who has been receiving long-term hydrochlorothiazide therapy for recurring episodes of heart failure. Which of the following findings should the nurse identify as an adverse effect of this medication? -Hypokalemia -Hypermagnesemia -Hypernatremia -Hypocalcemia
Answer: Hypokalemia Hydrochlorothiazide is a thiazide diuretic that can cause hypokalemia due to excessive potassium excretion in the urine.
A nurse is assisting with collecting data for a client who is in preterm labor and is receiving magnesium sulfate via continuous IV infusion. Which of the following findings should the nurse identify as an indication of magnesium toxicity? -Urinary output 60 mL/hr -Hyporeflexia -Respirations 16/min -Tachycardia
Answer: Hyporeflexia Magnesium sulfate depresses neuromuscular activity, causing muscle weakness and paralysis. Therefore, the nurse should identify hyporeflexia as an indication of magnesium toxicity and report it to the charge nurse.
A nurse is evaluating a client who is receiving amphotericin B via intermittent IV bolus. Which of the following findings indicates an adverse reaction to this medication? -Serum potassium 5.6 mEq/L -Hematocrit 55% -Polyuria -Hypotension
Answer: Hypotension The nurse should identify that amphotericin B is considered a high-alert medication due to potentially serious adverse effects, such as hypotension. Therefore, the nurse should report this or other adverse effects of amphotericin, such as nephrotoxicity, hypokalemia, and cardiac dysrhythmias.
A nurse is caring for a client who has a 10-year history of alcohol use disorder and is experiencing acute alcohol withdrawal. The nurse should identify which of the following interventions as the priority? -Suggest the client attend a support group. -Administer naltrexone. -Implement seizure precautions. -Assist the client to identify triggers of alcohol use.
Answer: Implement seizure precautions. The greatest risk to the client is injury from seizures and falls. Grand mal seizures can occur during severe alcohol withdrawal. Therefore, the nurse's priority is to implement seizure precautions to reduce the risk of injury if the client experiences a seizure.
A nurse is reinforcing teaching w/ a client who recently began taking furosemide. Which of the following instructions should the nurse include in the teaching? -Increase dietary potassium while taking the medication. -Lie down for 30 min after taking the medication. -Take the medication 30 min before going to bed. -Avoid taking the medication with dairy products.
Answer: Increase dietary potassium while taking the medication. The nurse should reinforce with the client to increase dietary intake of potassium because furosemide causes potassium to be excreted in the urine. Increasing the dietary potassium will help prevent hypokalemia.
A nurse is reinforcing teaching w/ a client who has rheumatoid arthritis and a new prescription for methotrexate. Which of the following information should the nurse include in the teaching? -Avoid grapefruit juice -Increase salt intake -Avoid aged cheese -Increase fluid intake
Answer: Increase fluid intake Clients who are taking methotrexate should increase fluid intake to reduce the risk for renal damage and to increase medication excretion.
A nurse is caring for a client who has kidney failure an has been taking epoetin. Which of the following is a therapeutic effect of this medication? -Decreased BUN -Increased Hgb -Decreased leukocyte -Increased platelet production
Answer: Increased Hgb Epoetin is used to elevate the erythrocyte count for clients who have kidney failure. An increased Hgb is the desired therapeutic effect of this medication.
A nurse in a provider's office is reviewing the immunization records of a 12-month-old infant who is immunocompromised. Which of the following vaccines should the nurse identify as contraindication for this client? -Hepatitis A (Hep A) -Measles, mumps, and rubella (MMR) -Pneumococcal conjugate (PCV13) -Haemophilus B conjugate (Hib)
Answer: Measles, mumps, and rubella (MMR) Although mose infants should receive the MMR vaccine between the ages of 12 months and 15 months, the nurse shold identidy that the MMR vaccine is composed of live viruses and is contraindicated for an infant who is immunocompromised.
A nurse is collecting data from a client who is taking tobramycin. Which of the following findings should the nurse report to the provider immediately? -Report of nausea -Fever -Oliguria -Report of headache
Answer: Oliguria Oliguria indicates the client is at greatest risk for nephrotoxicity. Therefore, the nurse should report this finding to the provider immediately.
A nurse is reinforcing teaching w/ a client who is newly diagnosed with hypertension and is taking metoprolol. The nurse should instruct the client to report which of the following manifestations to the provider as an adverse effect of this medication? -Tachycardia -Tinnitus -Peripheral edema -Urinary retention
Answer: Peripheral edema The nurse should instruct the client to monitor for an report the development of peripheral edema because this can be an indication of heart failure, which is an adverse effect of metoprolol.
A nurse is caring for a client who is taking disulfiram and consumed alcohol 12 hr ago. Which of the following adverse reactions is the priority finding to report to the provider? -Hyperemesis -Severe headache -Palpitations -Respiratory depression
Answer: Respiratory depression When using the urgent vs. nonurgent approach to client care, the nurse should determine that the priority finding is respiratory depression, which can indicate the client is experiencing acetaldehyde syndrome, a life-threatening event.
A nurse is collecting data from a client who received morphine IV for pain relief. Which of the following findings is the nurse's priority to report to the provider? -Emesis -Sedation -Respiratory rate 11/min -Blood pressure 90/54 mm Hg
Answer: Respiratory rate 11/min When using the airway, breathing, and circulation approach to client care, the priorty finding is respiratory rate of 11/min, which indicates respiratory depression.
A nurse is collecting data from a client who is taking lithium to treat bipolar disorder. Which of the following findings should the nurse report to the provider? -Bloating -WBC count 8,500/mm3 -Slurred speech -Sodium 140 mEq/L
Answer: Slurred speech The nurse should recognize that slurred speech is a manifestion of lithium toxicity and should be reported to the provider.
A nurse is collecting data from a client who has hyperthyroidism and a new prescription for propylthiouracil. The nurse should monitor the client for which of the following manifestations as an adverse effect of this medication? -Sore throat -Metallic taste -Mania -Urinary retention
Answer: Sore throat The nure should monitor for sore throat and fever because these are early indications of agranulocytosis, which is an adverse effect of propylthiouracil.
A nurse is collecting data from a client who has been taking levodopa/carbidopa. Which of the following findings should indicate to the nurse that this medication is effective? -The client is able to wash their face. -The client experiences fewer seizures. -The client reports decreased heartburn. -The client is able to sleep through the night.
Answer: The client is able to wash their face. Levodopa works by activiating dopamine receptors, restoring never transmission for clients who have Parkinson's disease. Carbidopa enhances these effects by inhibiting the breakdown of levodopa in the intestine and periphery. These therapeutic effects assist the client with moving freely and resuming ADLs.
A nurse is reinforcing teaching w/ a client who has type 1 diabetes mellitus and is learning to self-administer NPH insulin. Which of the following client actions indicates an understanding of the teaching? -The client shakes the vial prior to drawing up the dose. -The client uses the tip of the plunger to measure the correct dose. -The client injects air into the vial after inverting it. -The client wipes the cap with alcohol prior to filling the syringe.
Answer: The client wipes the cap with alcohol prior to filling the syringe. The client should wipe the cap with alcohol prior to filling the syringe to reduce the risk for contamination.
A nurse is collecting data from a client who has been taking digoxin for 1 month. The nurse should identify which of the following findings as a manifestation of digoxin toxicity? -Pule rate 100/min -Blood pressure 140/90 mm Hg -Wheezing -Vomiting
Answer: Vomiting The nurse should identify vomiting as an early manifestation of digoxin toxicity.
A nurse is reinforcing dietary teaching w/ a client who has a new presciption for phenelzine. Which of the following foods should the nurse include in the teaching as an appropriate food choice? -Yogurt -Avovado -Smoked salmon -Pepperoni
Answer: Yogurt Clients taking phenelzine should avoid consuming tyramine, which can cause high blood pressure. Yogurt contains little or no tyramine. Therefore, the nurse should instruct the client that yogurt is an appropriate food choice.