PHARM1

The nurse is conducting an admission assessment on a client. When collecting data related to medications, the nurse asks, "What medications are you currently taking?" After collecting this information, what other questions should the nurse ask? Select all that apply.

"Do you take any herbs, vitamins, or supplements?""What over-the-counter (OTC) medications do you take?" Clients often neglect to mention OTC drugs or alternative therapies (e.g., herbals) because they do not consider them to be actual drugs or they may be unwilling to admit their use to the health care provider. Ask clients specifically about OTC drug and alternative therapy use. The nurse must assess whether the client is taking medications safely, but this cannot be determined simply by asking the client if this is so. The name of the prescriber and the client's perception of doses/quantities are not priorities.

The nurse is taking a health history of a 58-year-old man who is taking atorvastatin for high cholesterol. What assessment question should the nurse prioritize related to the safe use of this drug?

"How many alcoholic drinks do you have in a typical day or week?" Beta-hydroxy-beta-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors are contraindicated with active liver disease or a history of alcohol-related liver disease so it is important for the nurse to ask about the client's use of alcohol. For most clients, heavy alcohol use would be more dangerous than high caffeine intake or the use of OTC medications. Exercise has multiple benefits and should be addressed by the nurse, but it is unrelated to safe medication use.

The nurse is educating an adult client diagnosed with a nonproductive cough about the prescribed dextromethorphan. Which statement made by the client establishes the need for further clarification?

"I will dilute the drug syrup with an equal amount of water." The nurse needs to clarify the statement that the client made regarding diluting the drug with equal amount of water because this would decrease the soothing effect on pharyngeal mucosa. The other statements are correct. Eating or drinking decreases effectiveness of drug to soothe mucosa of the pharynx. The drug is only to be taken for nonproductive dry, hacking cough. If the cough becomes productive, the client should stop the drug and notify the prescriber. The drug should be taken only as directed on the package or by prescriber because exceeding the dosage can result in hallucinations.

When providing drug education about nitroglycerin to the client, what should the nurse include in the teaching plan about a nitroglycerin patch?

"One patch lasts an entire day." Transdermal nitroglycerin has a long 24-hour duration of action compared with the sublingual form that lasts 30 to 60 minutes or oral tablets that last 8 to 12 hours. Transdermal patches are neither more nor less effective, but rather it is the speed of onset and duration of action that differ.

A client has been prescribed losartan for hypertension. What client teaching points should the nurse include about this drug?

"Report onset of a fever or persistent cough to your health care provider." Losartan is an angiotensin II receptor blocker that is associated with a cough, back pain, fever, muscle weakness, and upper respiratory tract infections, so the client should be taught to report a fever or cough to his health care provider. Fluid intake should be normal and the drug is best taken in the morning. Blood pressure should be monitored daily, especially when first starting the drug when adverse effects are not yet known.

An older client diagnosed with hypertension is requesting a oral nasal decongestant for cold symptoms. Which statement by the nurse best describes the effect of decongestants on blood pressure?

"The administration of a nasal decongestant will increase blood pressure due to vasoconstriction of blood vessels." The administration of a nasal decongestant will increase blood pressure due to vasoconstriction of blood vessels" is indicative of good client teaching. Nasal decongestants are not known to cause bradycardia, decrease thyroid production, increase gastric reflux. The administration of a nasal decongestant does not act on the central nervous system.

What is the nurse's priority assessment question before giving a female client her prescription for an angiotensin II-receptor blocker (ARB)?

"When was your last menstrual period (LMP)?" It would be important to know when the client's LMP occurred and that the client was not pregnant. These drugs can cause fetal abnormalities and fetal death. Questions on food intake, physical activity, and weight are appropriate and would help the nurse plan care for the client; however, it would not be as important as assessing for the possibility of pregnancy before beginning of therapy. The nurse should teach the client the need to avoid pregnancy using a barrier contraceptive

A client asks, "why my prescription is being switched from furosemide to spironolactone?" What is the nurse's best response?

"You will lose less potassium with spironolactone than with furosemide." Spironolactone promotes retention of sodium and water and excretion of potassium by stimulating the sodium-potassium exchange mechanism in the distal tubule. The client will not have greater potassium losses, water losses, or sodium losses with spironolactone rather than furosemide.

A client is scheduled to have serum triglyceride level assessed. How long should the client be without food or fluids prior to the serum triglyceride test?

12 hours For accurate interpretation of a client's lipid profile, blood samples for laboratory testing of triglycerides should be drawn after the client has fasted for 12 hours. A fasting state of 12 hours is essential for triglycerides estimation because the effects of recently ingested foods artificially raise the results for several hours after a meal. Twenty-four-hour fasting is not necessary and would be an undue burden on the client.

The client is a 34-year-old man who recently started taking theophylline. The nurse knows that medication teaching has been successful when he agrees to what activity?

Avoiding beverages that contain caffeine Both theophylline and caffeine are xanthenes. Theophylline increases cardiac output and heart rate. Caffeine also stimulates heart rate. This can have an additive effect. Eating foods high in potassium, limiting fluid intake, or taking the medicine on an empty stomach is not an indication that the client has understood the nurse's teaching.

An older adult client who is taking metformin has just been seen in the clinic. The health care provider has prescribed metoprolol for angina. What assessment data should the nurse prioritize due to this drug combination?

Blood glucose Metformin is an antidiabetic drug and the nurse should monitor the client's blood glucose frequently throughout the day because the client may not have the usual signs and symptoms of hypoglycemia or hyperglycemia. Urine specific gravity, leukocyte counts and intake and output are less likely to be affected by this drug-drug combination.

The nurse administers a medication to the client that induces the secondary action of hypoglycemia. What organ will be most acutely impacted by inadequate circulating glucose?

Brain While all cells require glucose to function, the brain uses the greatest amount. As a result, hypoglycemia has the greatest impact on the brain, which explains why hypoglycemia has so many neurological signs and symptoms including fatigue, drowsiness, anxiety, headache, shaking, lack of coordination, and numbness and tingling of the mouth, tongue, and/or lips; confusion and, in severe cases, seizures or coma may occur because the brain cannot function without adequate supplies of glucose.

A client with a diagnosis of renal failure is being treated with epoetin alfa. Frequent assessment of which laboratory values should be prioritized before and during treatment?

CBC With the use of hematopoietic and immune-stimulant drugs, a CBC with WBC differential and platelet count should be done before and during treatment to monitor response and prevent avoidable adverse reactions. It is less imperative to monitor liver enzymes or CRP levels.

A nurse is caring for a client taking multiple drugs and is concerned about a possible drug-drug interaction. How should the nurse best avoid a drug-drug interaction?

Consult a drug guide prior to drug administration Whenever two or more drugs are being given together, first consult a drug guide for a listing of clinically significant drug-drug interactions. There may be a possibility of changing administration times, but the nurse cannot unilaterally make this decision. Health assessment prior to administration has no direct effect on the likelihood of a drug-drug interaction. It is prudent to collaborate with the prescriber and/or the pharmacist, but this does not negate the need to consult reputable published information.

A client who has chronic bronchial asthma has had a mast cell stabilizer prescribed. What drug would the provider prescribe?

Cromolyn Cromolyn is the only mast cell stabilizer used in the treatment of asthma. Aminophylline is a xanthine. Ipratropium is an anticholinergic drug. Isoetharine is a sympathomimetic drug

The nurse is assessing a client who reports taking cholestyramine mixed with diet cola twice per day. What is the most appropriate nursing diagnosis for this client?

Deficient knowledge regarding drug therapy Cholestyramine should be mixed with water or other noncarbonated fluids so the nurse now recognizes the need for medication teaching and chooses the nursing diagnosis related to deficient knowledge. Nothing in this question indicates that the client is experiencing any adverse effects from the drug so constipation would not be optimal nursing diagnosis. This practice does not create a risk for infection or malnutrition.

A client tells the nurse that a friend has recommended the use of herbs to treat the client's asthma. The client wants to "give this a try before taking drugs." The nurse counsels the client to begin treatment immediately with the prescribed medications for what reason?

Delays in appropriate treatment can have serious, even fatal, consequences. Delays in appropriate treatment can have serious, even fatal, consequences. Natural products do not decrease the future effectiveness of adrenergic bronchodilators. Natural products have not been proven to be less toxic or more potent than prescribed asthma medications.

The nurse is caring for several patients prescribed propranolol [Inderal]. In which patient condition is propranolol [Inderal] used with caution?

Diabetes Propranolol inhibits glycogenolysis and thus can produce hypoglycemia, which can cause problems in patients with diabetes. It also suppresses tachycardia, which is an important warning sign of hypoglycemia in patients with diabetes. It is safe to use propranolol in dysrhythmias, hypertension, and angina.

A nurse is caring for a client who has been receiving a drug by the intramuscular route at a dose of 0.25 mg. After discharge, the client will be prescribed the same medication orally at a dose of 2.5 mg. What phenomenon should the nurse describe when explaining the reason for the increased dosage for the oral dose?

First-pass effect The first-pass effect involves drugs that are absorbed from the small intestine directly into the portal venous system, which delivers the drug molecules to the liver. After reaching the liver, enzymes break the drug into metabolites, which may become active or may be deactivated and readily excreted from the body. A large percentage of the oral dose is usually destroyed and never reaches tissues. Oral dosages account for the phenomenon to ensure an appropriate amount of the drug in the body to produce a therapeutic action. Passive diffusion is the major process through which drugs are absorbed into the body. Active transport is a process that uses energy to actively move a molecule across a cell membrane and is often involved in drug excretion in the kidney. Glomerular filtration is the passage of water and water-soluble components from the plasma into the renal tubule.

Which single drug class is known to be most effective in reducing the major types of dyslipidemia?

For single-drug therapy, a statin is preferred for the treatment of dyslipidemia. To lower cholesterol and triglycerides, a statin, a cholesterol absorption inhibitor, gemfibrozil, a fibrate, or the vitamin niacin may be used. To lower triglycerides, gemfibrozil, ezetimibe, a cholesterol absorption inhibitor, or niacin may be given.

A client presents to the clinic with a dry nonproductive cough. The client is diagnosed with bronchitis and it has been determined that assistance is needed in thinning the sputum so the cough can become productive. What does the nurse expect the provider will prescribe?

Guaifenesin Because this client needs to cough up respiratory secretions, he would likely be prescribed guaifenesin. This drug is an expectorant that liquefies lower respiratory secretions by reducing their viscosity and so making it easier for a client to cough them up. Benzonatate, dextromethorphan, and hydrocodone are antitussives and are given to suppress the cough reflex

A client, being treated in the hospital for a femoral fracture, is scheduled to receive a daily dose of metoprolol that was prescribed 3 years ago. Prior to administering this drug, the nurse should assess and document which client data? Select all that apply.

Heart rate, blood pressure Beta-blockers reduce heart rate and blood pressure; both parameters should be assessed prior to administration. Beta-blockers do not significantly affect potassium levels, oxygen levels, or peripheral circulation.

A 49-year-old client is admitted with uncontrolled chest pain. He is currently taking nitroglycerin. His physician orders nifedipine added to his regimen. The nurse should observe the client for what adverse effects?

Hypotension Both nitroglycerin and nifedipine have hypotension as a potential adverse effect so frequent assessment of blood pressure is important. Other cardiovascular effects include bradycardia, peripheral edema, and heart block. Skin effects include flushing and rash. Adverse effects do not include renal insufficiency, hypokalemia, or hypoglycemia.

A client with a diagnosis of cardiovascular disease is taking atorvastatin to reduce serum cholesterol. What is the goal of therapy for LDL cholesterol for a client taking atorvastatin calcium?

In clients with a diagnosis of cardiovascular disease, the goal of therapy is an LDL below 130 mg/dL.

The nurse wants to evaluate the cardiac status of a patient with heart failure. Which laboratory result should the nurse check?

Levels of circulating B-natriuretic peptide (BNP) are an important index of cardiac status in heart failure (HF) patients and can be a predictor of long-term survival. High levels of BNP indicate poor cardiac health and can predict a lower chance of survival. Conversely, low levels of BNP indicate better cardiac health and can predict a higher chance of survival. While sodium and potassium can provide information on electrolyte status, they cannot predict cardiac status of heart failure. Digoxin level predicts only levels of digoxin, not cardiac status.

A client presents to the emergency department in acute respiratory distress. A quick assessment by the triage nurse indicates that the client has experienced difficulty breathing immediately after taking Combivent for the first time. The nurse suspects that the client may be allergic to what?

Peanuts Combivent is a combination drug of ipratropium and albuterol. The propellant used to make ipratropium has a cross-sensitivity to the antigen that causes peanut allergies. Aspirin, penicillin, and ragweed pollen allergies are not associated with this drug reaction.

A male client has been diagnosed with moderately increased LDL, and his primary care provider wishes to begin him on a statin. What is a potential disadvantage of statins that the care provider should consider? Select all that apply.

Statins are expensive, Statins require regularly scheduled blood work Because liver enzymes may be elevated during atorvastatin use, clients need liver function tests and repeat lipid profile testing on a routine basis. These drugs are also expensive. They are not nephrotoxic and do not suppress the immune system. Previous MI is an indication for their use, not a contraindication.

A stepped care management approach to treating hypertension includes weight loss, smoking cessation, decreased use of alcohol, reducing salt in the diet, and increased physical exercise. During a stepped-care management approach, when should the nurse teach about these changes in lifestyle?

Steps 1, 2, 3, and 4 Lifestyle changes are encouraged in all four steps and should be advocated for the maintenance of good health. These changes are stressed in steps 1 and 2 in the hope that drug therapy will not be necessary. However, these changes should occur in steps 3 and 4 as well.

A client who works on road construction has been diagnosed with hypertension. After attempting to decrease his blood pressure with lifestyle changes and a mild diuretic, it is determined that he will need to be placed on an angiotensin-converting enzyme (ACE) inhibitor. In an effort to prevent adverse effects, the nurse should address what client variable?

The client sweats excessively on the job. A client taking an ACE inhibitor should be sure to maintain fluid intake, so excessive sweating on the job places him at risk for a drop in fluid volume. Excessive sweating, vomiting, diarrhea, or dehydration need to be monitored and treated if they occur while taking an ACE inhibitor. Six smaller meals rather than three larger ones would be better and should be encouraged. However, this could be a problem with his job. The best treatment for constipation would be to increase fluid and fiber and one beer a night would be within reason when considering alcohol intake.

An adult client with a diagnosis of hypertension has been prescribed oral furosemide. What goal should the nurse identify when planning this client's medication teaching session?

The client will identify strategies for limiting his or her sodium intake. The reason for furosemide use should guide client teaching. In most instances, it is necessary to initiate measures to limit sodium intake. Key considerations should include not adding salt to food during preparation or at the dinner table, reading food labels carefully to be aware of hidden sources of sodium, and avoiding processed or high-sodium foods. Blood glucose monitoring is not indicated, and there is no need for increased fluid intake. Renal anatomy and physiology are not priority teaching points.

A client, diagnosed with heart failure, asks the nurse for further details about heart failure. Which statement is most accurate?

The use of digoxin increases the force of myocardial contraction and prevents the development of congestive heart failure in clients whose heart cannot pump blood to meet tissue needs. Endothelial dysfunction allows processes that narrow the blood vessel lumen and lead to blood clot formation and vasoconstriction that further narrow the blood vessel lumen. These are major factors in coronary artery disease and hypertension, the most common conditions leading to heart failure. Hyperthyroidism, not hypothyroidism, is a cause of heart failure. The administration of diuretics decreases fluid volume, which prevents the symptoms of heart failure. A high-fat diet does not directly cause heart failure.

A client with hypertension has been started on losartan. After 6 weeks of therapy, it is decided that the losartan alone is not controlling the client's hypertension. What does the nurse anticipate will be added to the losartan regimen for better control of this client's hypertension?

When losartan therapy is started, maximal effects on blood pressure usually occur within 3 to 6 weeks. If losartan alone does not control blood pressure, a low dose of a diuretic may be added. A combination product of losartan and hydrochlorothiazide is available. Adding a second ARB such as candesartan or captopril would risk causing toxic adverse effects. ADH causes retention of water in the nephrons, which would further increase blood pressure.

Which client should not be administered an antihistamine?

a male client with prostatic hypertrophy Antihistamines are contraindicated in clients with prostatic hypertrophy. There is no current research to suggest that antihistamine agents cannot be administered to clients with Parkinson's disease, asthma, and diabetes mellitus.

A client is experiencing a cough associated with an upper respiratory infection. Which oral medication will likely produce the quickest therapeutic effect?

an expectorant Liquid medications are absorbed faster than tablets or capsules. Expectorants are liquid medications. A tablet is an oral medication that has a slower onset of action than a liquid medication. A topical spray can be sprayed to the back of the throat and provides only a local effect. A timed-release tablet is an oral medication that has a slower onset and longer duration of action.

On the advice of his brother, a 53-year-old man has made an appointment to request a prescription for sildenafil. The nurse who works at the clinic is reviewing the man's medical history and would recognize what health problem as being prohibitive to this treatment?

angina, treated with nitroglycerin Prescribers should not order sildenafil for men who also take organic nitrates, commonly used to treat angina, because the sildenafil-nitrate combination can cause severe hypotension resulting in dizziness, syncope, heart attack, or stroke. Metformin, metoprolol, and simvastatin are not likely to cause adverse effects.

When providing medication teaching to a client prescribed spironolactone, what foods should the client be instructed to avoid?

bananas Bananas are high in potassium and should be avoided with potassium-sparing diuretics. It is acceptable for the client to eat fish, apples, and crackers because of their low sodium content.

Which antihypertensive medications can be administered by transdermal patch?

clonidine Clonidine is available as a transdermal patch. Enalapril, candesartan, and amlodipine are not available by this route

A client, having an allergic reaction to mold, describes chest tightness and difficulty breathing. Which body effect is occurring?

contraction of smooth muscle in the bronchi An allergic reaction produces contraction of the smooth muscle in the bronchi and bronchioles. The client will have stimulation, not suppression, of the vagus nerve endings. The client will have increased, not decreased, permeability of the veins and capillaries. The client will have increased secretion from the mucous glands, producing nasal congestion.

An older adult client with a history of chronic obstructive pulmonary disease (COPD) and congestive heart failure (CHF) has begun tapering off of prednisone. The nurse should prioritize which assessment during this phase of care? Select all that apply.

daily weights, extremity edema, level of consciousness assessment

A client with angina is prescribed propranolol. Following absorption of the drug, the nurse should monitor the client for what desired effect?

decreased heart rate Beta-blockers cause a slowing of the heart rate referred to as negative chronotropy. They do not normally cause drowsiness, short-term relief from fatigue, or a notable increase in SaO2 since the action of this medication is to inhibit beta2 receptors in the bronchial and vascular musculature.

A client is diagnosed with hypertension and is being treated with captopril. A client with which diagnosis should be prescribed with captopril as the first-line treatment?

diabetes mellitus Captopril is the first-line agent for treating hypertension in diabetic clients, particularly those with type 1 diabetes. Captopril can be used for hypertension in clients with asthma, glaucoma, and angina pectoris but is not the first-line agent, as noted in diabetes mellitus.

An older adult client, who leads a sedentary lifestyle, has recently been diagnosed with dyslipidemia. The client is disappointed to learn about this condition, stating, "First it was the diabetes and then the arthritis, now this." The nurse has performed health education with the client and has described metabolic syndrome. In addition to the elevated cholesterol levels, what aspect of the client's health is congruent with a diagnosis of metabolic syndrome?

diabetes mellitus Diagnostic criteria for metabolic syndrome include a cluster of several cardiovascular risk factors linked with obesity: increased waist circumference, elevated triglycerides, reduced high-density lipoprotein cholesterol, elevated blood pressure, and elevated fasting glucose. Age, gender, and joint disorders are not among these criteria.

A client has edema of the lower extremities with crackles in the lung bases. What diuretic is most likely to be prescribed for a client assessed with lower extremity edema and bilateral lung crackles?

furosemide Acute pulmonary edema is an indication for the use of furosemide. HCTZ, spironolactone, and mannitol are not used for this purpose, largely due to their slower onset of action.

Which dietary choice is most appropriate and should be encouraged by the nurse for a client diagnosed with hypertension?

grilled chicken, green salad, and apple Potassium-sparing diuretics may precipitate hyperkalemia. Potassium-sparing diuretics would not precipitate hypernatremia, hyponatremia, or hypokalemia.

What electrolyte imbalance might a diabetic client be prone to develop when prescribed captopril?

hyperkalemia By blocking production of angiotensin II, the ACE inhibitors decrease aldosterone production (thus reducing retention of sodium and water and increasing the retention of potassium). Hyperkalemia may develop in clients who have diabetes mellitus or renal impairment. Hypokalemia is not a risk in clients with diabetes mellitus. Hypernatremia is not a major risk in clients with diabetes who are taking captopril. Hypermagnesemia is not a risk in clients with diabetes who are taking captopril.

To help liquefy cold-related secretions, the nurse should encourage the client to implement which measure?

increasing fluid intake Drinking plenty of water while taking guaifenesin may help loosen mucus in the lungs. Deep breathing, gargling with normal saline, and reducing salt intake do not necessarily help liquefy and mobilize secretions.

A nurse who provides care on a postsurgical unit frequently administers Schedule II drugs to clients. Which aspect of administering these drugs falls under the auspices of the Drug Enforcement Administration?

informing clients of the potential risks and benefits of such drugs prior to the first dose (THIS WAS INCORRECT) Nurses are responsible for storing controlled substances in locked containers, administering them only to people for whom they are prescribed, recording each dose given on agency narcotic sheets and on the client's medication administration record, maintaining an accurate inventory, and reporting discrepancies to the proper authorities. The other given actions are appropriate nursing activities, but they are not within the scope of the DEA authority.

A client has begun taking cholestyramine. Which are noted as the most common adverse effects?

nausea, flatulence, and constipation Cholestyramine is not absorbed systemically, so the main adverse effects are gastrointestinal (GI) ones (abdominal fullness, flatulence, diarrhea, and constipation). Constipation is especially common, and a bowel program may be necessary to control this problem.

A client has been diagnosed with chronic obstructive pulmonary disease. The client has been prescribed bronchodilators by nebulizer for home use. The nurse should teach the client to:

sit in a fully upright position when administering the medication. Clients should sit in the Fowler's position when inhaling nebulized medications. Compressed air (not oxygen) is used. Inhalers require a prescribed number of "puffs," not nebulizers. The client should rinse his or her mouth after administration, but an alcohol-based solution is not necessary.