Pharm part 3
A nurse is teaching about levodopa with a family member of a client who has Parkinson's disease. Which of the following pieces of information should the nurse include?
"A full therapeutic response may take several months to happen." The nurse should inform the family member that although levodopa is the most effective medication for Parkinson's disease, a full therapeutic response might not occur for several months.
A nurse is caring for a client with chronic obstructive pulmonary disease (COPD) who has been taking tiotropium. Which of the following client statements should indicate to the nurse that the client is experiencing an adverse effect of this medication?
"My mouth feels dry all the time." The nurse should identify that dry mouth is a common adverse effect of this medication's anticholinergic effects. Tiotropium is a long-acting anticholinergic inhaled medication used for maintenance therapy for clients with COPD.
A nurse is teaching a client who is postmenopausal and has a prescription for alendronate. Which of the following statements should the nurse include in the teaching?
"Take this medication on an empty stomach." The nurse should instruct the client to avoid taking alendronate with food or liquids other than water because it can decrease absorption. The client should only take this medication with water 30 minutes before breakfast.
A nurse is teaching about taking donepezil with a client who was recently diagnosed with early Alzheimer's disease. Which of the following instructions should the nurse include in the teaching?
"You should take this medication late in the evening." The nurse should instruct the client to take donepezil late in the evening, just before going to bed.
A nurse is planning care for a client who is postoperative and scheduled to ambulate. At which of the following times should the nurse plan to administer PO morphine to the client for peak analgesic effect during the ambulation?
60 to 90 min prior to ambulation The peak effect of PO morphine takes 60 to 90 minutes to occur. Medicating the client 60 to 90 minutes prior to ambulation will provide the greatest analgesic effect.
A nurse is administering subcutaneous heparin to a client who is at risk for deep vein thrombosis. Which of the following actions should the nurse take?
Administer the medication into the client's abdomen The heparin should be administered into the client's abdomen.
A nurse is caring for a client who has a new prescription for meperidine 500 mg PO q 4 to 6 hr to manage pain. Which of the following actions should the nurse take?
Contact the provider for clarification of the prescription
A nurse is caring for a client who has been taking taken metformin for 6 months. Which of the following findings should the nurse identify as an expected therapeutic effect of the medication?
Decreased blood glucose level A client who has taken metformin for 6 months should experience the expected therapeutic effect of a decrease in blood glucose levels. Metformin is a non-insulin medication for clients who have type 2 diabetes mellitus.
A nurse is caring for a client who is receiving continuous cardiac monitoring. Which of the following medications should the nurse anticipate administering to treat atrial fibrillation?
Diltiazem Diltiazem, a calcium channel blocker, is used to slow the ventricular rate in atrial fibrillation or flutter. Diltiazem is also prescribed to treat hypertension, angina, and other supraventricular tachyarrhythmias.
A nurse is teaching a client who had kidney transplant surgery about immunosuppressive medications. Which of the following adverse effects of these medications should the nurse include in the teaching?
Increased susceptibility to infection Immunosuppressive medications such as cyclosporine increase the risk of infection. As the medication classification indicates, these medications impair immunity and adversely affect the client's ability to resist and fight infection.
A nurse is caring for a client who has asthma and is prescribed a short-acting beta2-agonist. Which of the following should the nurse identify as the expected outcome of this medication?
Reverses bronchospasm The nurse should identify that the expected outcome of a short-acting beta2-agonist is reversal of bronchospasm. Short-acting beta2-agonists bind to beta2-adrenergic receptors in the lungs, resulting in relaxation of bronchial smooth muscles.
A nurse is reviewing laboratory reports for a client who has Clostridium difficile infection and is receiving vancomycin. Which of the following results should the nurse report to the provider before administering the next dose?
Serum creatinine 2.5 mg/dL Vancomycin is nephrotoxic and can result in renal failure, which is indicated by elevated levels of creatinine above the expected reference range of 0.5 to 1.3 mg/dL. The nurse should report this laboratory value to the provider prior to administering any further doses of the medication.
A nurse manager is instructing a newly licensed nurse about routes of medication administration. Which of the following routes involves medication absorption through the mucous membranes under the tongue?
Sublingual
A nurse is caring for a client who is experiencing acute pain and is receiving morphine. Which of the following findings should indicate to the nurse the need to withhold the client's next dose of morphine?
The client's respiratory rate is 10/min. The nurse should identify that morphine can cause respiratory depression. Therefore, if the client's respiratory rate is less than 12/min, the nurse should withhold the next dose of morphine and notify the provider.
A nurse in a long-term care facility is administering medications to a group of older adult clients. Which of the following factors of pharmacokinetics should the nurse consider when caring for this age group?
The excretion of medication is reduced.
A nurse is reviewing a new prescription for fexofenadine for a 7-year-old client who has seasonal allergies. Which of the following findings should the nurse clarify with the provider?
The prescription says to take standard tablets. The nurse should identify that this 7-year-old client has been prescribed a standard tablet, which is appropriate for clients 12 years of age and older. Therefore, the nurse should clarify this aspect of the prescription with the provider because a client who is 7 years old should be administered orally disintegrating tablets or a suspension.
A nurse is preparing to administer levothyroxine to a client who has hypothyroidism. The nurse should identify which of the following laboratory results as supporting the administration of this medication?
Thyroid-stimulating hormone (TSH) 8 microunits/mL The expected reference range for TSH is 0.3 to 5 microunits/mL. When a client has primary hypothyroidism, the TSH level becomes elevated in an attempt to normalize the thyroid gland's function. When the client has had a therapeutic response to treatment, the TSH level returns to the expected reference range.
A nurse is preparing to administer an IV injection to a client. For which of the following reasons should the nurse inject the medication slowly?
To reduce toxicity risk Prior to injecting an IV medication, the nurse should plan to infuse the medication slowly over 1 minute to reduce the risk for toxicity to the central nervous system (CNS). Manifestations of CNS toxicity can become evident as soon as 15 seconds after initiating the injection. If the injection is done slowly, only a small amount of the total dose will have been administered when manifestations of toxicity appear. If the nurse is able to discontinue the administration immediately, adverse effects can be much less severe than if the entire dose had been given quickly.
A nurse is assessing a client who takes oral theophylline for chronic bronchitis relief. The nurse should recognize that which of the following findings indicates toxicity to theophylline?
Tremors Theophylline is a xanthine-derivative bronchodilator. An early manifestation of toxicity is CNS stimulation, often seen as tremors. Seizures can occur if blood levels continue to rise.
A nurse in an outpatient facility is assessing a client who is prescribed furosemide 40 mg daily. The client reports taking extra doses to promote weight loss. Which of the following findings should indicate to the nurse that the client is dehydrated?
Urine specific gravity 1.035 Oliguria, an increased urine concentration, and an increased urine specific gravity greater than 1.030 are expected findings in clients who are dehydrated.
A nurse is teaching a client who has a prescription for a combination oral contraceptive (OC) that uses a 28-day cycle. Which of the following instructions should the nurse include in the teaching?
"You can miss up to 7 pills with little risk in getting pregnant as long as you have taken the pills regularly for the previous 3 weeks." The nurse should instruct this client that up to 7 days can be missed with little or no increase in the chance of getting pregnant, provided that the client took the pills continuously for the previous 3 weeks.
A nurse administered an antibiotic 10 min ago to a client who is now reporting wheezing and swelling of the eyelids. Which of the following actions should the nurse perform first?
Administer epinephrine subcutaneously Evidence-based practice indicates the nurse should first administer epinephrine, a catecholamine, which constricts blood vessels, increases cardiac output, and dilates bronchiole passages. Epinephrine is the first-line medication to administer for anaphylaxis and can be administered subcutaneously or via an IV or endotracheal tube. Other early signs of anaphylaxis are often related to the skin, characterized by warmth, redness, itching, hives, and swelling of the head and neck.
A nurse is teaching a client who is using topical lidocaine about preventing systemic toxicity. Which of the following pieces of information should the nurse include about the application of topical lidocaine?
Apply topical lidocaine to affected areas that are intact The nurse should tell the client to apply topical lidocaine to skin that is intact rather than blistered, broken, or irritated to prevent a large amount of medication from being absorbed and to decrease the risk of systemic toxicity.
A nurse is providing teaching to a client who has hypertension and a new prescription for oral clonidine. Which of the following instructions should the nurse include in the teaching?
Avoid driving until the client's reaction to the medication is known. Clonidine can cause drowsiness, weakness, sedation, and other CNS effects. Until the client's response to the medication is known, the nurse should instruct the client to avoid driving or handling other potentially hazardous equipment. Over time, these effects are likely to decrease.
A nurse is caring for a client who takes sulfasalazine twice daily for rheumatoid arthritis. Which of the following values should the nurse review prior to the administration of the medication?
Complete blood count The nurse should identify that sulfasalazine can cause bone marrow suppression, which can lead to agranulocytosis, hemolytic anemia, and macrocytic anemia. As a result, the client's complete blood count should be periodically monitored, and the nurse should review it prior to administering this medication.
A nurse is caring for a client with Alzheimer's disease who has a new prescription for memantine. Which of the following laboratory results should the nurse identify as increasing the client's risk for decreased clearance of the medication?
Creatinine clearance 35 mL/min Creatinine clearance is an estimate of the glomerular filtration rate and the kidney's ability to filter waste. A creatinine clearance of 35 mL/min indicates moderate renal impairment. The kidneys excrete memantine, and decreased clearance occurs with moderate renal impairment.
A nurse is monitoring a client who is receiving lactulose for cirrhosis. Which of the following laboratory values related to this medication should indicate to the nurse that the treatment is effective?
Decreased serum ammonia The nurse should identify that lactulose is a laxative that can be used for chronic liver disorders such as cirrhosis. Lactulose improves the client's condition by decreasing ammonia levels through enhancing intestinal secretion of ammonia so that it can be eliminated from the body.
A nurse is monitoring a client who has asthma, takes albuterol, and recently started taking propranolol to treat a cardiovascular disorder. The client reports that the albuterol has been less effective. Which of the following factors should the nurse identify as a possible explanation for this change?
Detrimental inhibitory interaction A detrimental inhibitory interaction can occur with the concurrent use of propranolol and albuterol. When a client takes propranolol and albuterol together, propranolol can interfere with albuterol's therapeutic effects.
A nurse is monitoring a client who has diabetes insipidus and was administered desmopressin. Which of the following findings should indicate to the nurse the client is experiencing an adverse effect of this medication?
Headache Headaches are an indicator of the adverse effect of water intoxication, which can occur as a result of taking desmopressin. This medication causes fluid retention and places the client at risk of water intoxication.
A nurse is reviewing the medical history of a client who has spasticity due to multiple sclerosis and a new prescription for tizanidine. Which of the following comorbidities increases the client's risk of adverse effects while taking this medication?
Hepatitis Tizanidine can cause liver damage. This medication should be used with extreme caution in a client who has a preexisting impairment of hepatic function.
A nurse is caring for a client who has a prescription for an oral contraceptive to prevent pregnancy. The nurse should identify that which of the following actions is the purpose of this medication?
Inhibition of ovulation The nurse should identify that this medication inhibits ovulation to prevent pregnancy.
A nurse is caring for a client who is in preterm labor and has a new prescription for nifedipine. The client states she is concerned because her father takes nifedipine for his angina pectoris. The nurse should explain that nifedipine works for clients who are pregnant through which of the following mechanisms?
It inhibits uterine contractions by blocking the entry of calcium into uterine cells. Nifedipine, a calcium channel blocker, causes uterine relaxation by blocking the flow of calcium to the myometrial cells of the uterus.
A nurse is providing teaching to a client who has type 2 diabetes mellitus and a new prescription for metformin. Which of the following adverse effects of metformin should the nurse instruct the client to watch for and report to the provider?
Myalgia Myalgia, malaise, somnolence, and hyperventilation are manifestations of lactic acidosis, which rarely occur while taking metformin due to the blockage of lactic acid oxidation. The nurse should instruct the client to report these findings promptly to the provider.
A nurse is admitting a client who has unstable angina. Which of the following medications should the nurse anticipate administering to the client?
Nitroglycerin The nurse should anticipate administering nitroglycerin to a client who has unstable angina. This medication acts by relaxing or preventing spasms in the coronary arteries along with dilating the arteries, which increases oxygenation and blood flow.
The nurse is assessing a client who has been taking linezolid to treat a Staphylococcus aureus infection. Which of the following findings should the nurse report to the provider?
Paresthesias Although these reactions are rare, some clients who take linezolid develop irreversible peripheral neuropathy and reversible optic neuropathy. The nurse should report this finding to the provider because it might warrant switching the client to another antibiotic.
A nurse is reviewing the medical record of a client who is scheduled for induction of labor and has a prescription for misoprostol. Which of the following conditions should the nurse identify as a contraindication to administering this medication?
Past cesarean delivery Misoprostol is used for cervical ripening and induction of labor. It causes a higher incidence of uterine tachysystole. Therefore, it is contraindicated in clients who have a history of major uterine surgery or cesarean delivery with past pregnancies because of the risk of uterine rupture.
A nurse is teaching a newly licensed nurse about contraindications to ceftriaxone. A severe allergy to which of the following medications is a contraindication to ceftriaxone?
Piperacillin Clients who have a severe allergy to piperacillin, which is a penicillin, can have a cross-sensitivity reaction to ceftriaxone, a third-generation cephalosporin. Ceftriaxone is contraindicated for a client who has an allergy to cephalosporins or a severe allergy to penicillin.
A nurse is caring for a client who is at 6 weeks of gestation and has just received a diagnosis of hyperthyroidism. The nurse should anticipate a prescription from the provider for which of the following medications?
Propylthiouracil This medication is used to treat hyperthyroidism during the first trimester of pregnancy because it does not cross the placental barrier well, posing little risk to the fetus. However, methimazole is the preferred medication in the second and third trimesters of pregnancy.
A nurse is caring for a client who is receiving bleomycin IV to treat lymphoma. Which of the following assessments is the nurse's priority?
Pulmonary function Bleomycin can cause severe lung injury, including pneumonitis and pulmonary fibrosis, which affects a significant percentage of clients receiving this medication; therefore, pulmonary function is the priority assessment.
A nurse is caring for a client who has cancer involving the lumbar vertebrae and has been prescribed gabapentin. Which of the following therapeutic effects should the nurse identify for the client when taking this medication?
Reduced cramping, aching, and burning neuropathic pain The nurse should identify that gabapentin is administered to treat neuropathic pain that is sharp and darting. The medication can also decrease cramping, aching, and burning pain and suppress spontaneous neuronal firing that causes pain.
A nurse is assessing a client who is receiving clozapine to treat schizophrenia. The nurse should identify an increase in which of the following parameters as an early indication of an adverse effect of this medication?
Temperature Antipsychotic medications such as clozapine can cause agranulocytosis, which is the depletion of WBCs. This increases the client's risk of infection. A fever is an early indication to check the client's WBC count to detect agranulocytosis.
A nurse is assessing a client who has heart failure and is receiving digoxin. Which of the following findings should indicate to the nurse the client is experiencing digoxin toxicity?
Visual disturbances The nurse should recognize that nausea, vomiting, abdominal discomfort, fatigue, and visual disturbances are common manifestations that can indicate that the client is experiencing digoxin toxicity.
A nurse is teaching a client who has a new prescription for enteric-coated aspirin as stroke prophylaxis. The client asks the nurse why the provider prescribed an enteric-coated medication. Which of the following responses should the nurse give?
"Enteric-coated medications cause less gastric irritation." Enteric-coated medications do not dissolve until they reach the small intestine, which reduces the risk of gastric irritation
A nurse in a provider's office is assessing a client who has been taking feverfew. Which of the following statements by the client indicates a therapeutic effect of the supplement?
"I am having fewer migraine headaches since I started taking feverfew." Feverfew is an herb that is used for the prophylaxis of migraine headaches. It can reduce the frequency of migraines and decrease the severity of accompanying manifestations such as nausea and photophobia.
A nurse is providing teaching about sodium phosphate to a client who has a new prescription for sodium phosphate. The client is scheduled for a colonoscopy and is currently taking furosemide for hypertension. Which of the following client statements should indicate to the nurse that the teaching has been effective?
"I can experience an imbalance in my electrolytes from this medication." Sodium phosphate can cause excess fluid loss as a result of cleansing the bowel of stool. Therefore, the client is at risk for electrolyte imbalance and should be monitored closely.
A nurse is caring for a client who has tuberculosis and is taking rifampin. Which of the following client statements should indicate to the nurse that the client is experiencing an adverse effect of the medication?
"I have noticed my urine is orange in color." The nurse should identify that an adverse effect of rifampin can be red-orange colored urine, saliva, sweat, and tears as the medication is excreted from the body. The nurse should also inform the client that permanent staining of contact lenses can occur. However, this adverse effect is harmless. The client should inform the provider if urine becomes dark in color since this can be an indication of hepatotoxicity.
A nurse is teaching a client who has a new diagnosis of angina and has a prescription for isosorbide mononitrate 10 mg PO twice daily. Which of the following client statements indicates an understanding of the teaching?
"I should change positions slowly when getting out of bed." The nurse should identify that isosorbide mononitrate is an antianginal medication that produces vasodilation. Therefore, this medication can cause orthostatic hypotension. Clients should change positions slowly upon rising to minimize the effects of orthostatic hypotension.
A nurse is teaching about the adverse effects of baclofen with a client who has multiple sclerosis with spasms. Which of the following statements should the nurse identify as an indication that the client understands the teaching?
"I should not stop taking this medication suddenly." The nurse should inform the client about the adverse effects associated with abrupt withdrawal of baclofen such as visual hallucinations, paranoid ideations, and seizures.
A nurse is teaching to a client who has systemic lupus erythematosus about a new prescription for oral glucocorticoid therapy. Which of the following client statements indicates an understanding of the teaching?
"I should take a calcium supplement while on this medication." An adverse effect of systemic glucocorticoid therapy is osteoporosis. Increasing calcium-rich foods in the diet and adding calcium and vitamin D supplements should be encouraged to prevent osteoporosis and decrease the risk of fractures.
A nurse is teaching a client who has a new prescription for amitriptyline to treat depression. Which of the following client statements indicates an understanding of the teaching?
"I should take this medication before bedtime." The nurse should instruct the client that an adverse effect of amitriptyline is sedation. The nurse should instruct the client to take the medication at bedtime to minimize sedation during waking hours while promoting sleep.
A nurse is teaching a client who has a prescription for chenodiol for the treatment of gallstones. Which of the following client statements indicates an understanding of the teaching?
"Liver function tests are required while taking this medication." The nurse should identify that chenodiol is hepatotoxic and can injure the liver. Periodic liver function tests are required during treatment. This medication is contraindicated in clients who have a preexisting liver condition.
A nurse is teaching a client who has been taking an NSAID to treat rheumatoid arthritis. During the client's first month checkup, the provider prescribed methotrexate to be added to the medication regimen. Which of the following statements should the nurse include in the teaching about the purpose of this change in the client's medication?
"This medication was added to delay the disease progression." The nurse should inform the client that the provider prescribed methotrexate to be added to the medication regimen along with an NSAID to delay the progression of the disease and to delay joint damage or deformity that can result from the disease.
A nurse is administering an enteric-coated tablet to a client and explaining the pharmaceutical preparation. Which of the following statements should the nurse make?
"You are less likely to have an upset stomach with this pill because of the coating on the tablet." Enteric-coated preparations have an outside coating of a substance that dissolves in the intestines instead of in the stomach. This protects the medication from acids and enzymes in the stomach and protects the stomach from ingredients in the medication that can cause gastric upset.
A nurse working in the emergency department is admitting a client who has a gastric ulcer and gastrointestinal (GI) bleeding. Which of the following factors in the client's medical history should the nurse report to the provider?
Arthritis treated with ibuprofen every 8 hours as needed The nurse should identify that ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID). NSAIDs can cause gastrointestinal bleeding and are contraindicated for clients who have ulcer disease. NSAIDs inhibit prostaglandin secretion, which decreases blood flow in the GI tract and decreases bicarbonate and mucus secretion. This environment promotes the secretion of gastric acid and needs to be reported to the provider.
A nurse is caring for a client who has a positive tuberculin skin test and is beginning a prescription for isoniazid. Which of the following laboratory values should be monitored while the client is taking isoniazid?
Aspartate aminotransferase (AST) Isoniazid can be toxic to the liver. Therefore, it is important to monitor liver enzymes such as AST during therapy with isoniazid. In addition, the nurse should instruct the client to notify the provider of jaundice, nausea, dark-colored urine, or other findings indicating hepatitis.
A nurse is planning to administer diphenhydramine 50 mg via IV bolus to a client who is having an allergic reaction. The client has an IV infusion containing a medication that is incompatible with diphenhydramine in solution. Which of the following actions should the nurse take?
Aspirate to check for IV patency before administering the diphenhydramine It is important to confirm IV patency prior to administering an IV bolus. Some medications cause severe tissue damage when inadvertently administered into tissue rather than into a vein.
A nurse is preparing to administer timolol eye drops to a client who has primary open-angle glaucoma (POAG). Prior to administering the medication, the nurse should recognize that which of the following conditions in the client's medical history is a contraindication to receiving this medication?
Asthma The nurse should identify that asthma is a contraindication to receiving timolol. Timolol is a beta-blocker that can cause blocking of the beta2-receptors, causing bronchospasm. A client who has a history of asthma is a candidate for an alternate medication to treat this condition such as betaxolol.
A nurse is monitoring the laboratory values of a male client who has leukemia and is receiving weekly chemotherapy with methotrexate via IV infusion. Which of the following laboratory values should the nurse report to the provider?
Platelets 78,000/mm^3 The nurse should monitor the platelet count of a client who is taking methotrexate because the medication can cause thrombocytopenia. This client's platelet count is very low and puts the client at risk of severe bleeding. The nurse should report this finding promptly to the provider.
A nurse is providing teaching to a client who has chronic kidney failure with an AV fistula for hemodialysis and a new prescription for epoetin alfa. Which of the following therapeutic effects of epoetin alfa should the nurse include in the teaching?
Promotes RBC production Epoetin alfa stimulates erythropoiesis in the bone marrow to increase RBC production and reduce anemia. Anemia is common in clients who have chronic kidney failure since erythropoietin is produced by the kidney.
