Pharm exam 2 4a4b5a5b
The nurse is caring for a client who has just been started on meclizine 25 mg PO b.i.d. What assessment question should the nurse prioritize when following up the administration of the drug?
"How would you rate your nausea right now?"
A student asks the pharmacology instructor how succinylcholine differs from acetylcholine (ACh). What should the instructor respond?
"Succinylcholine is not broken down instantly."
The nurse receives a prescription for morphine sulfate 8 mg IV every hour as needed for pain. For which client would the nurse need to question this order?
A 78-year-old with osteoarthritis
The nurse is caring for four clients. Which client would have the highest risk for hepatotoxicity from dantrolene?
A 60-year-old woman who is on hormone replacement therapy
The nurse is caring for several clients who are being treated with adrenergic antagonists. Which client is most likely to benefit from the administration of tamsulosin?
A 76-year-old male client with urinary hesitation and nocturia
A female client has been taking dantrolene for several years and has now requested a prescription for oral contraceptives from her primary care provider. What is the nurse's best action?
Ensure all members of the care team are aware of the risk for hepatotoxicity
A client is brought to the emergency department after losing consciousness at home. The client's low blood pressure and health history suggest a cholinergic reaction. What is the nurse's best action?
Ensure that there is ready access to atropine on the unit
The nurse is caring for a client experiencing parasympathetic nervous system blockade cause. What assessment finding supports this diagnosis? Select all that apply.
Increase in heart rate Decrease in gastrointestinal (GI) activity Decrease in urinary bladder tone
The nurse administered a hospital client's scheduled dose of clonidine PO 30 minutes ago. How should the nurse best assess for therapeutic effect?
Assess the client's blood pressure
A new resident has just been admitted to the long-term care facility. When reviewing the client's medication record, the nurse observes that the client is currently taking donepezil. What should the nurse include in the resident's plan of care?
Assess the client's orientation each shift
The nurse is admitting an adult client to the preoperative unit in preparation for an elective inguinal hernia repair procedure to be performed under general anesthesia. What is the nurse's initial priority nursing assessment related to anesthesia?
Assess the client's weight
The nurse is caring for a client who is taking an adrenergic blocking agent. What assessment would be among the nurse's priorities?
Assessing heart rate
A nurse has administered a prescribed dose of an anticholinergic agent to a client. What assessment finding most clearly indicates a therapeutic response?
Increased heart rate
The nurse is assessing a client who has been diagnosed with myasthenia gravis. The nurse should anticipate the administration of what drugs?
Indirect-acting cholinergic agonists
A client's postsurgical pain is severe and persistent, and the client states that recent doses of morphine IV have "helped only a little bit." The client has a PRN dose of morphine available and wants to receive the medication, but the client's respiratory rate is 14 breaths/minute. What is the nurse's best action?
Administer the morphine as prescribed and monitor the client's respiratory status closely
The nurse is caring for an intraoperative client whose temperature has increased suddenly to 103.2°F (39.6°C). What intervention should the nurse anticipate?
Administration of dantrolene
A client has a progressive neuromuscular disorder that causes muscle weakness. A deficiency of what neurotransmitter would be most likely to cause this client's symptoms?
Acetylcholine
A 72-year-old client presents at the emergency department with respiratory depression and excessive sedation. The care team confirms that the client has overdosed on diazepam. What is the nurse's best action?
Administer flumazenil as prescribed
What client would be most likely to benefit from the administration of a beta2-specific adrenergic agonist?
A client who is having an exacerbation of chronic bronchitis
What client receiving an adrenergic agonist should the nurse assess first?
A client who is receiving an isoproterenol infusion
What client is exhibiting an expected assessment finding after the administration of a sympathomimetic drug?
A client whose respiratory rate has changed from 9 to 18 breaths/minute
The nurse is teaching a client taking a monoamine oxidase inhibitor (MAOI) about dietary changes required to minimize adverse effects of the drug. The nurse determines that the client understands a low-tyramine diet when what meal is chosen?
A hamburger, French fries, and a strawberry milkshake
The nurse in the postanesthesia care unit (PACU) cares for many clients who receive succinylcholine during surgery. The nurse should expect which client to spend more time in the postanesthesia care unit due to prolonged paralysis and delayed return of spontaneous ventilation?
A middle-aged client who is an Alaskan Eskimo
A hospital client's pain is rated at 9/10, and the nurse is preparing to administer 4 mg hydromorphone PO as prescribed. Before administering the medication, the nurse should:
assess the client's baseline respiratory rate.
A 73-year-old male with Parkinson's disease, emphysema, and benign prostatic hyperplasia has present to the clinic for routine care. Following detailed assessment, the provider has prescribed an anticholinergic drug for the client. What is the nurse's priority teaching point to the client in regard to his new medication?
"Make sure to seek care promptly if you're not able to urinate."
A client received atropine and meperidine preoperatively. After surgery, the client reports mouth dryness. What is the nurse's best response?
"Your medications decreased saliva production but it is temporary and will improve."
A client, newly diagnosed with Parkinson's disease, has been prescribed an anticholinergic drug. What assessment should the nurse perform when monitoring for adverse effects of anticholinergic agents used for the treatment of Parkinson's disease?
Assessment of the client's bowel pattern
The nurse is caring for a client who is unconscious and requires an anticholinergic drug to treat bradycardia. What drug can the nurse administer IV for this purpose?
Atropine
A client with depression has been prescribed a monoamine oxidase inhibitor (MAOI). What education should the nurse provide to this client? Select all that apply.
Avoid foods containing tyramines. Do not take over-the-counter (OTC) drugs without talking to physician. Monitor blood pressure closely.
A female client has been experiencing increased muscle spasticity since being diagnosed with multiple sclerosis. What drug is most likely to meet this client's needs?
Baclofen
A surgical client develops nonobstructive postoperative urinary retention. What drug would the nurse expect to be ordered for this client?
Bethanechol
The 10-year-old child is brought to the clinic and is prescribed ipratropium. Prior to administering the medication, what assessment should the nurse prioritize?
Breath sounds
The nurse is preparing a client for surgery who will receive a neuromuscular junction blocker during the procedure. It is important for the nurse to review the client's medication history for concurrent use of what class of medications?
Calcium-channel blockers
A client has been taking levodopa (L-dopa) for the treatment of Parkinson's disease. What additional medication may decrease the amount of levodopa needed to reach a therapeutic level in the brain, thereby reducing adverse effects of levodopa?
Carbidopa
An 80-year-old client has been brought to the emergency department in shock. The client is receiving dopamine. The nurse should prioritize the assessment for what potentially serious adverse effect?
Cardiac arrhythmia
A client with muscle spasticity has begun taking baclofen. What recent assessment findings should the nurse attribute to possible adverse effects? Select all that apply.
Client reports frequent urges to void Blood pressure 103/59 mm Hg Client reports light-headedness transitioning from lying to sitting
The nurse is serving a breakfast tray to the client receiving an alpha- and beta-adrenergic agonist medication. The nurse notifies dietary of the error with the client's diet when finding what on the tray?
Coffee
The critical care nurse is providing care for a client whose heart rate has dropped to 29 beats/minute. The care provider has prescribed atropine 0.5 mg IV. What is the nurse's best action?
Confirm the client's identity, administer the drug, and monitor closely
A 54-year-old client with chronic obstructive pulmonary disease is admitted for emergency surgery. What anesthetic agent would be dangerous to use on this client?
Desflurane
A 10-year-old child with spina bifida is receiving bethanechol for treatment of neurogenic bladder. What assessment finding should suggest that the client is experiencing adverse effects?
Diarrhea
The client has been mechanically ventilated for the past week and is receiving a neuromuscular junction (NMJ) blocker, an analgesic, and a sedative. The goal is to extubate the client. The nurse should anticipate what action by the care team?
Discontinuing the NMJ blocker first
The client with a complex health history has been taking medication affecting both alpha- and beta-receptor sites in the past. What medications would the nurse include in this category? Select all that apply.
Dobutamine Dopamine Epinephrine
The nurse evaluates the client's latest serum phenytoin level, which is revealed to be 16 mcg/mL. What is the nurse's best action?
Document the fact that the client's phenytoin level is therapeutic.
The nurse is preparing to administer morphine IV to a client with multiple trauma. Before administering the morphine, what common adverse effect should the nurse inform the client about?
Drowsiness
The postanesthesia care unit (PACU) nurse is caring for a client who had succinylcholine as an adjunct to anesthesia. What action best addresses the potential adverse effects of this medication?
Ensuring dantrolene is readily available
A client has been treating his seasonal rhinitis with an adrenergic agonist that he has been purchasing at his local pharmacy. Which medication may the client be using?
Ephedrine
What drug should the nurse consider contraindicated for the client taking a monoamine oxidase inhibitor (MAOI)?
Escitalopram
The nurse is assisting the nurse practitioner who is preparing to intubate the client. The nurse practitioner has prescribed atracurium and midazolam, a short-acting benzodiazepine used to sedate the client. In what order will the client be given these medications?
Give midazolam and then give atracurium few moments later.
The nurse is caring for a client newly diagnosed with schizophrenia and whose medical history requires a typical antipsychotic. When explaining possible anticholinergic effects to the client, the nurse should address what potential problems related to these effects? Select all that apply.
Gum ulceration Urinary retention Blurred vision Constipation
The nurse is caring for a 64-year-old male client with diabetes who is being treated with a nonselective beta-blocker. What health education should the nurse prioritize with this client?
Identifying the signs and symptoms of hypo- or hyperglycemic reactions
The home care nurse is providing teaching for a 59-year-old client taking a nonselective beta-blocker. The nurse teaches the client the importance of notifying the prescribing physician when what occurs related to this medication?
If the client's pulse is ≤60 beats/minute on consecutive days
An 11-year-old client has been hospitalized on the adolescent psychiatry unit with severe depression. For the past several weeks, the client has been prescribed a selective serotonin reuptake inhibitor (SSRI). What is the priority nursing action?
Implement suicide precautions.
A nurse is writing a plan of care for a client who has been prescribed bethanechol. What outcome should the nurse include in the care plan?
Improved bladder function
The nurse is caring for a client with a dysrhythmia who will undergo cardioversion this morning. The client will receive propofol as anesthetic during the procedure. What are the benefits of using propofol for this procedure? Select all that apply.
It allows for quick recovery from anesthesia. It has a very rapid clearance. It produces less of a hangover effect.
The postsurgical client appears to be awake but is in fact unconscious and has no response to painful stimuli. What nonbarbiturate anesthetic may the client have received?
Ketamine
The nurse is providing care for a client recovering from spinal anesthesia. How should the nurse best reduce the client's risk for headache during recovery?
Maintain the client in the supine position
A client is positioned on the operating room table in preparation for knee surgery. After the anesthesiologist begin anesthesia, what is the next phase of anesthesia?
Maintenance
The nurse is providing care for a 72-year-old female client whose diagnosis of bipolar disorder is treated with lithium. What nursing responsibility should be prioritized?
Monitor the client's fluid balance and sodium intake
The nurse is writing a plan of care for a client receiving an alpha-specific adrenergic agonist. What is the priority component of client's plan of care?
Monitoring blood pressure and heart rate frequently
The nurse administers a dose of carbachol to an ophthalmologic client. When assessing this client for drug effects, the nurse would expect to see effects arising from stimulation of what receptors?
Muscarinic
The nurse is caring for a client who has indirect-acting cholinergic agonists prescribed to treat myasthenia gravis. When administering this classification of drug, the nurse should assess the client for what sign of a potential toxic effect?
Muscle weakness
The nurse is caring for a client with an infusing IV who is allowed noting by mouth due to a paralytic ileus. What centrally acting medication could the nurse administer to this client?
Orphenadrine
Before administering a client's prescribed nonselective adrenergic blocker, what should the nurse assess?
Pulse and blood pressure
A client diagnosed with myasthenia gravis is having trouble swallowing. What anticholinesterase inhibitor would be the drug of choice for this client?
Pyridostigmine
A client has received an excessive dose of atracurium, a neuromuscular junction blocker. Which indirect-acting anticholinesterase medication will most likely be administered as an antidote?
Pyridostigmine
The Air Force nurse is treating a client who was exposed to a nerve gas. What drug should the nurse prepared to administer?
Pyridostigmine
A surgical client was administered a neuromuscular junction (NMJ) blocker in addition to balanced anesthesia. During the procedure, the anesthesiologist administers a cholinesterase inhibitor. The nurse should assess for what expected effect?
Return of voluntary movement
A client is having outpatient surgery that should last only 45 minutes. The client is planning to go home as soon as possible after the surgery is complete. What nondepolarizing neuromuscular junction blocker will most likely be used as an adjunct therapy to general anesthesia for this client?
Rocuronium
A client is preoperative, and there is a need to decrease the client's sympathetic stimulation to ensure that the client does not remember the procedure. The nurse should anticipate the use of what type of agent?
Sedative-hypnotic
A client has been prescribed tamsulosin 0.5 mg PO daily. What assessment finding most clearly indicates that the medication is having the desired effect?
The client denies urinary hesitation or frequency
The registered nurse anesthetist has administered a small dose of nondepolarizing neuromuscular junction (NMJ) blocker before administering succinylcholine. What outcome most clearly indicates therapeutic effect of this action?
The client does not experience discomfort of depolarization of muscles
The nurse is assessing a client who was given succinylcholine earlier in the day during a surgical procedure. What assessment finding would suggest to the nurse that the client experienced histamine release as a result of succinylcholine administration?
The client has an audible wheeze on inspiration
The 38-year-old client with a recent history of varied neuromuscular symptoms has just been administered edrophonium. Half an hour later, the client demonstrates significantly increased muscle strength. How should the nurse best interpret this finding?
The client likely has myasthenia gravis
The nurse, working in the preoperative area, is caring for a 65-year-old client who is scheduled to receive succinylcholine as part of general anesthesia. When collecting the nursing history, what finding should require the nurse to notify the anesthesiologist?
The client takes timolol eye drops to treat narrow-angle glaucoma
A client is scheduled for surgery, and it is planned that the client will receive pancuronium as an adjunct to general anesthesia. What should the nurse teach the client about this medication?
The client will be unable to move approximately 5 minutes after receiving the drug
The nurse is caring for a client with bipolar disorder whose medication regimen includes lithium and who will soon be discharged. What health education should the nurse prioritize?
The need to have follow-up blood samples drawn on schedule
The nurse is administering an ophthalmic adrenergic agonist. What action would reflect the need for further education about how to administer a medication ophthalmically?
The nurse gently rests the tip of the dropper against the lower eyelid
The perioperative nurse is caring for a surgical client whose anesthesiologist has just administered atropine. When assessing the client, what finding should the nurse interpret as achieving the desired effect?
There is no evidence of excessive oral or bronchial secretions
The client will be receiving succinylcholine prior to surgery. During preoperative teaching, the nurse should caution the client about what potential adverse effect that may be experienced after surgery?
Throat and back pain
The nurse is educating a client who has just been prescribed bethanechol. The nurse has taught the client to take the medication on an empty stomach. What is the rationale for the nurse's instruction?
To decrease nausea and vomiting
The pediatric nurse is preparing to administer an anticholinergic drug to a client. When assessing for adverse and therapeutic effects, what assessment should the nurse prioritize?
Urine output
The nurse administers bethanechol 25 mg PO to a client as prescribed. What assessment should the nurse prioritize when assessing for therapeutic effects.
Urine output and voiding pattern
A client has been administered a scheduled dose of atropine to treat bradycardia. The nurse understands that the therapeutic effects of the drug are due to:
antagonism of the muscarinic effectors in the parasympathetic nervous system.
The nurse is assessing a client who has been prescribed a cholinergic agonist. The nurse should recognize that the therapeutic effects of this medication are due to:
increased activity of acetylcholine receptor sites throughout the body.
The nurse is preparing to administer a sympathomimetic drug to a client. The nurse is aware that this drug will achieve a therapeutic effect by:
stimulating alpha- and beta-receptors.
