Pharm Quiz 4

A nurse is providing teaching to a client who has asthma and a new prescription for inhaled beclomethasone. Which of the following instructions should the nurse provide? Check the pulse after medication administration. Take the medication with meals. Rinse the mouth after administration. Limit caffeine intake.

Rinse the mouth after administration. Use of glucocorticoids by metered dose inhaler can allow a fungal overgrowth in the mouth. Rinsing the mouth after administration can lessen the likelihood of this complication.

A nurse is caring for a client who has thrombophlebitis and is receiving heparin by continuous IV infusion. The client asks the nurse how long it will take for the heparin to dissolve the clot. Which of the following responses should the nurse give? "It usually takes heparin at least 2 to 3 days to reach a therapeutic blood level." "A pharmacist is the person to answer that question." "Heparin does not dissolve clots. It stops new clots from forming." "The oral medication you will take after this IV will dissolve the clot."

"Heparin does not dissolve clots. It stops new clots from forming." This statement accurately answers the client's question.

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

"Increase your daily intake of dietary fiber." The nurse should instruct the client to increase his daily intake of dietary fiber to reduce the risk of constipation associated with verapamil.

A nurse is teaching the parents of a child who is to start using a metered-dose inhaler (MDI) to treat asthma. Which of the following information should the nurse include in the teaching? "The spacer increases the amount of medication delivered to the oropharynx." "The spacer increases the amount of medication delivered to the lungs." "Inhale rapidly using the spacer with the MDI." "Cover exhalation slots of the spacer with lips when inhaling."

"The spacer increases the amount of medication delivered to the lungs." The client uses a spacer to increase the amount of medication that reaches the lungs.

A nurse caring for a client who has hypertension and asks the nurse about a prescription for propranolol. The nurse should inform the client that this medication is contraindicated in clients who have a history of which of the following conditions? Asthma Glaucoma Depression Migraines

Asthma Propranolol, a beta-blocker, is contraindicated in clients who have asthma because it can cause bronchospasms. Propranolol blocks the sympathetic stimulation, which prevents smooth muscle relaxation.

A nurse is providing teaching to a client who has emphysema and a new prescription for theophylline. Which of the following instructions should the nurse provide? Consume a high-protein diet. Administer the medication with food. Avoid caffeine while taking this medication. Increase fluids to 1L/per day.

Avoid caffeine while taking this medication. The nurse should instruct the client that caffeine should be avoided while taking theophylline, as it can increase central nervous system stimulation

A nurse is caring for a client who develops a ventricular fibrillation rhythm. The client is unresponsive, pulseless, and apneic. Which of the following actions is the nurse's priority? Defibrillation Airway management Epinephrine administration Amiodarone administration

Defibrillation The greatest risk to the client is death from a lack of cardiac output. Ventricular defibrillation is a lethal rhythm in which the ventricles are in a quivering pattern and there is no atrial activity. Defibrillation is essential to resolve ventricular defibrillation promptly and convert the rhythm to restore cardiac output. The nurse should follow defibrillation with cardiopulmonary resuscitation and repeated defibrillation, if necessary, to convert the ventricular defibrillation into a sustainable rhythm

A nurse is teaching a client who is to start taking warfarin about herbal supplements. The nurse should inform the client that which of the following herbal supplements can interact adversely with warfarin? Valerian Black cohosh Echinacea St. John's wort

St. John's wort The nurse should instruct the client that St. John's wort can decrease anticoagulation when taking warfarin.

A nurse is preparing to administer enoxaparin to a client. Which of the following actions should the nurse plan to take? Insert the needle at a 45º angle. Aspirate for a blood return before depressing the plunger. The nurse should not expel the air bubble in the prefilled syringe. Administer the medication 2.54 cm (1 in) from the umbilicus

The nurse should not expel the air bubble in the prefilled syringe. The nurse should not expel the air bubble that is in the prefilled syringe prior to administering the medication.

A nurse is teaching a client who takes warfarin daily. Which of the following statements by the client indicates a need for further teaching? "I have started taking ginger root to treat my joint stiffness." "I take this medication at the same time each day." "I eat a green salad every night with dinner." "I had my INR checked three weeks ago."

"I have started taking ginger root to treat my joint stiffness." Ginger root can interfere with the blood clotting effect of warfarin and place the client at risk for bleeding. This statement indicates the client needs further teaching.

A nurse is providing discharge teaching to a client who has asthma and new prescriptions for cromolyn and albuterol, both by nebulizer. Which of the following statements by the client indicates an understanding of the teaching? "If my breathing begins to feel tight, I will use the cromolyn immediately." "I will be sure to take the albuterol before taking the cromolyn." "I will use both medications immediately after exercising." "I will administer the medications 10 minutes apart."

"I will be sure to take the albuterol before taking the cromolyn." The client should always use the bronchodilator (albuterol) prior to using the leukotriene modifier (cromolyn). Using the bronchodilator first allows the airways to be opened, ensuring that the maximum dose of medication will get to the client's lungs

A nurse is caring for a client who has deep vein thrombosis and has been on heparin continuous infusion for 5 days. The provider prescribes warfarin PO without discontinuing the heparin. The client asks the nurse why both anticoagulants are necessary. Which of the following statements should the nurse make? "Warfarin takes several days to work, so the IV heparin will be used until the warfarin reaches a therapeutic level." "I will call the provider to get a prescription for discontinuing the IV heparin today." "Both heparin and warfarin work together to dissolve the clots." "The IV heparin increases the effects of the warfarin and decreases the length of your hospital stay."

"Warfarin takes several days to work, so the IV heparin will be used until the warfarin reaches a therapeutic level." Heparin and warfarin are both anticoagulants that decrease the clotting ability of the blood and help prevent thrombosis formation in the blood vessels. However, these medications work in different ways to achieve therapeutic coagulation and must be given together until therapeutic levels of anticoagulation can be achieved by warfarin alone, which is usually within 1 to 5 days. When the client's PT and INR are within therapeutic range, the heparin can be discontinued.

A nurse is caring for a child who is experiencing status asthmaticus. Which of the following interventions is the priority for the nurse to take? Administer a short-acting ß2 -agonist (SABA). Obtain a peak flow reading. Administer an inhaled glucocorticoid. Determine the cause of the acute exacerbation.

Administer a short-acting ß2 -agonist (SABA). When using the urgent versus non-urgent approach to client care, the nurse should determine that the priority action is to administer a nebulized high-dose SABA to relieve bronchoconstriction and improve ventilation.

A nurse is caring for a child who has asthma and a prescription for montelukast granules. Which of the following instructions should the nurse provide the client's parent on administering the medication? Give the medication in the morning daily. Administer the medication 2 hr before exercise. Give the medication at the onset of wheezing. Administer the granules mixed with 20 oz of water.

Administer the medication 2 hr before exercise. Montelukast should be given daily during the evening, except when being used for exercise-induced bronchospasm. It should then be given 2 hr before exercise, and not given again for 24 hr

A nurse is teaching a client who has been taking prednisone to treat asthma and has a new prescription to discontinue the medication. The nurse should explain to the client to reduce the dose gradually to prevent which of the following adverse effects? Hyperglycemia Adrenocortical insufficiency Severe dehydration Rebound pulmonary congestion

Adrenocortical insufficiency Prednisone, a corticosteroid, is similar to cortisol, the glucocorticoid hormone produced by the adrenal glands. It relieves inflammation and is used to treat certain forms of arthritis, severe allergies, autoimmune disorders, and asthma. Administration of glucocorticoids can suppress production of glucocorticoids, and an abrupt withdrawal of the drug can lead to a syndrome of adrenal insuciency.

A nurse is caring for a client who is receiving a continuous IV infusion of heparin. Which of the following actions should the nurse take? Administer 50,000 units of heparin by IV bolus every 12 hr. Check the activated partial thromboplastin time (aPTT) every 4 hr. Have vitamin K available on the nursing unit. Use IV tubing specific for heparin sodium when administering the infusion.

Check the activated partial thromboplastin time (aPTT) every 4 hr. Heparin is an anticoagulant. The activated partial thromboplastin time (aPTT) should be monitored every 4 hr and the infusion rate should be adjusted accordingly until the eective dose has been determined.

A nurse is providing discharge instructions to a client who has asthma and a new prescription for montelukast. The nurse should instruct the client to report which of the following adverse effects to the provider? Blurred vision Palpitations Constipation Depression

Depression Montelukast can cause neuropsychiatric effects such as depression, behavior changes, hallucinations, and suicide ideation. The nurse should instruct the client to report such adverse effects. A change in medication might be prescribed.

A nurse is teaching a client who takes aspirin daily for coronary artery disease about herbal supplements. The nurse should instruct the client that which of the following herbal supplements may interact adversely with aspirin? Cranberry juice Aloe vera Feverfew Flaxseed

Feverfew The nurse should instruct the client to avoid taking feverfew with aspirin because it suppresses platelet aggregation and places the client at risk for bleeding when taken with aspirin

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

Hypotension Verapamil, a calcium channel blocker, can be used to control supraventricular tachyarrhythmias. It also decreases blood pressure and acts as a coronary vasodilator and antianginal agent. A major adverse effect of verapamil is hypotension; therefore, blood pressure and pulse must be monitored before and during parenteral administration.

A nurse in an emergency department is preparing to administer theophylline by continuous intravenous (IV) infusion to a client who is experiencing an asthma attack. Which of the following actions should the nurse take? Infuse the medication with an IV pump. Cover the IV container with dark paper. Administer a test dose first. Infuse the medication at 35 mg/min.

Infuse the medication with an IV pump. Theophylline should be administered slowly on an infusion pump. Rapid administration may cause hypotension and death.

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

Prevents dysrhythmias Lidocaine is an antidysrhythmic medication that delays the conduction in the heart and reduces the automaticity of heart tissue

A nurse is providing discharge instructions to a client who has asthma and is about to start taking theophylline (Theo-24). The nurse should tell the client that this medication might cause which of the following adverse effects? Drowsiness Constipation Oliguria Tachycardia

Tachycardia Theophylline can increase cardiac stimulation and cause tachycardia.

A nurse is caring for a client who asks how albuterol helps his breathing. Which of the following responses should the nurse make? (Select all that apply.) The medication will stimulate flow of mucus. The medication will prevent wheezing. The medication will open the airways. The medication will reduce inflammation. The medication will decrease coughing episodes.

The medication will prevent wheezing. The medication will open the airways. The medication will decrease coughing episodes.

A nurse is preparing to administer dabigatran to a client who has atrial fibrillation. The nurse should explain that the purpose of this medication is which of the following? To convert atrial fibrillation to sinus rhythm To dissolve clots in the bloodstream To slow the response of the ventricles to the fast atrial impulses To reduce the risk of stroke in clients who have atrial fibrillation

To reduce the risk of stroke in clients who have atrial fibrillation Clients who have atrial fibrillation are at an increased risk for thrombus formation and subsequent embolization to the brain. Anticoagulants, such as dabigatran, help prevent thrombus formation

A nurse is caring for a client who is on warfarin therapy for atrial fibrillation. The client's INR is 5.2. Which of the following medications should the nurse prepare to administer? Epinephrine Atropine Protamine Vitamin K

Vitamin K Vitamin K reverses the effects of warfarin.

A nurse is teaching a client who has a new prescription for clopidogrel. Which of the following instructions should the nurse include? "Take this medication with food." "You might have to stop taking this medication 5 days before any planned surgeries." "Take this medication three times daily." "Expect to have black-colored stools while taking this medication."

"You might have to stop taking this medication 5 days before any planned surgeries." Clopidogrel inhibits platelet aggregation and can cause bleeding. The client should report taking this medication to providers to determine whether to discontinue the medication prior to elective procedures to reduce the risk for bleeding

A nurse in an emergency department is preparing to administer alteplase accelerated therapy to a client who is having a myocardial infarction. Which of the following actions should the nurse plan to take? (Select all that apply.) Administer the medication within 30 min of the client's arrival to the department. Reconstitute the medication with sterile water. Administer a 15 mg IV bolus. Tell the client that the purpose of the medication is to keep a new clot from forming. Assess the client for back pain.

Administer the medication within 30 min of the client's arrival to the department. Reconstitute the medication with sterile water. Administer a 15 mg IV bolus. Assess the client for back pain.

A nurse is developing a plan of care for a client who has COPD. The nurse should include which of the following interventions in the plan? Restrict the client's fluid intake to less than 2 L/day. Provide the client with a low-protein diet. Have the client use the early-morning hours for exercise and activity. Instruct the client to use pursed-lip breathing

Instruct the client to use pursed-lip breathing. Pursed-lip breathing lengthens the expiratory phase of respiration and also increases the pressure in the airway during exhalation. This action reduces airway resistance and decreases trapped air for clients who have COPD

A nurse is caring for a client who has thrombophlebitis and is receiving a continuous heparin infusion. Which of the following medications should the nurse have available to reverse heparin's effects? Vitamin K Protamine sulfate Acetylcysteine Deferasirox

Protamine sulfate Protamine sulfate reverses the effects of heparin by binding with heparin to form a heparin-protamine complex that has no anticoagulant properties.

A nurse is providing discharge teaching to a client who has asthma and a new prescription for fluticasone/salmeterol. For which of the following adverse effects should the nurse instruct the client to report to the provider? Sedation Increased appetite White coating in the mouth Dry oral mucous membranes

White coating in the mouth Fluticasone/salmeterol is an inhaled glucocorticoid and long acting beta adrenergic agonist combination inhalation medication that is used for daily management of asthma. It is not a rescue medication. An adverse effect of the medication is oropharyngeal candidiasis. The nurse should instruct the client to gargle after each use, use a spacer to reduce the amount of drug in the mouth and throat, and report any white patches inside the mouth or on the tongue to the provider.