Pharmacology ATI Chapters 25 to 48

31. **Med Classification: Proton Pump Inhibitor**

**Select Prototype Med: Omeprazole ((Prilosec) *Pantoprazole (Protonix) *Lansoprazole (Prevacid) & dexlanspprazole (Dexilant) *Rabeprazole sodium (AcipHex) *Esomeprazole (Nexium)

7. **Medication Classification: Thrombolytic Medications*

**Select Prototype Meds: *Activase, Cathflo Activase (tPA- tissue Plasminogen Activator) **Other meds: *Tenectplase (TNKase) *Reteplase (Retavase) Dissolve clots already formed. Treats: Acute MI, Massive PE (alteplase only), Acute Ischemic stroke (Alteplase only), Restore patency to central IV catheters (Cathflo Activase only).

28. **Peptic Ulcer Disease** Chap 28* **Medication Classification: Antibiotics**30

**Select prototype Meds: a. Amoxicillin (Amoxi b. Bismuth (Pepto-Bismol) c. Clarithromycin (Biaxin) d. Metronidazole (Flagyl) e. Tetracycline (achromycin, Sumycin)

6. **Medication Classification: Antiplatelets**

*Antiplatelets/salicytic *Select Prototype Med: Aspirin (Ecotrin) *Antiplatelet/glycoprotein inhibitors *Select Prototype Med: Abciximab (Reopro) *Other meds: Eptifibatide (Integrilin), tirofiban (Aggrastat) *Antiplatelet/ADP inhibitors a. Select Prototype Meds: clopidogrel (Plavix) b. Other meds: ticlopidine (Ticlid) *Antiplatelet/arterial vasodilator a. Select Prototype med: pentoxifylline (Trental) b. Other meds: dipyridamole (Persantine), cilostazol (Pletal)

2. **Medication Classification: Anticoagulants - Parenteral *

*Select Prototype Med: Heparin *Low molecular weight heparins (LMWH) a. Select Prototype Med: enoxaparin (Lovenox) b. Other Meds: dalteparin (Fragmin) tinzaparin (Innohep) *Activated factor X (Xa) inhibitor: a. Select Prototype Med: fondaparinux (Arixtra)

4. **Medication Classification: Direct Thrombin Inhibitors**

*Select Prototype Med: dabigatran (Pradaxa) *Other meds: a. Hirudin analogs: bivalirudin (Angiomax) b. Lepirudin (Refludan) c. Argatroban (Acova)

15. **Medication Classification: Leukopoietic Growth Factors*

*Select Prototype Med: filgrastim (Neupogen) *Other Med: pegfilgrastim (Neulasta) *Purpose: Expected Pharmaceutical Action: Leukopoietic growth factors stimulate the bone marrow to increase neutrophil production. *Therapeutic Uses: -Decrease risk of infection in clients who have neutropenia, from cancer & the other conditions. -To build up numbers of hematopoietic stem cells prior to harvesting for autologous transplant.

29. **Med Classification: Histamine2-Receptor Antagonist**

*Select Prototype Med: ranitidine hydrochloride (Zantac) a. Cimetidine (Tagamet b. Famotidine (Pepcid) c. Nizatidine (Axid) - PO use only **Gastric & Peptic Ulcers, GERD, hypersecretory conditions, such as Zollinger-Ellison syndrome.

16. **Medication Classification: Granulocyte Macrophage Colony Stimulating Factor**

*Select Prototype Med: sargramostim (Leukine). *Purpose: * -Expected pharmaceutical Action - This med acts on the bone marrow to increase production of WBCs (neutrophils, monocytes, macrophages, eosinophils). *Therapeutic Uses: -Hastens bone marrow function after bone marrow transplant. -Used in treatment of failed bone marrow transplant.

5. **Medication Classification: Direct Inhibitor of Factor XA*

*Select Prototype Medication: rivaroxaban (Xarelto) *Expected Pharmaceutical Action: Provides anticoagulation selectively and directly by inhibiting Factor Xa. Therapeutic Uses: Prevents DVT and PE in clients who are undergoing total hip or knee arthroplasty surgery.

14. **Growth Factors** Chap. 26 *Medication Classification: Erythropoietic Growth Factors.*

*Select Prototype Meds: epoetin alfa (Epogen, Procrit). *Other Meds: Darbepoetin alfa (Aranesp) - Long acting erythropoietin. *Methoxy polyethylene glycol (MGEG)-epoetin beta (Mircera)-very long acting erythropoietin. *Purpose-Expected pharmaceutical Action - Hematopoietic growth factors act on the bone marrow to increase red blood cell production. *Therapeutic Uses - Anemia r/t chronic renal failure, use of zidovudine (Retrovir) in clients who have HIV infection, chemotherapy, and elective surgery.

17. **Medication Classification: Thrombopoietic Growth Factors.

*Select prototype Med: oprelvekin (Interleukin-11, Neumega). *Purpose: -Expected Pharmacological Action - Increases the production of platelets. *Therapeutic Uses - Decreases thrombocytopenia and the need for platelet transfusions in clients receiving chemotherapy.

3. **Medication Classification: Anticoagulant - Oral**

*Select prototype Med: warfarin (Coumadin) *Purpose: Expected Pharmaceutical Action: a. Oral anticoagulants antagonize vitamin K, thereby preventing the synthesis of four coagulation factors: VII, IX, X, and prothrombin. *Therapeutic Uses: a. Treatment of venous thrombosis b. Treatment of thrombus formation in clients who have A-FIB or prosthetic heart valves. c. Prevention of recurrent MI, TIAs, PEs, and DVT.

22. **A nurse is teaching a client who has chronic kidney injury and who is starting subcutaneous epoetin alfa (Epogen) three times weekly. What should the nurse teach the client about this med?

*Therapeutic Use: Erythropoietin, a substance that stimulates bone marrow to produce red blood cells, is produced by the kidney. In clients who have kidney failure, erythropoietin is no longer present and anemia results. Epoetin alfa stimulates RBC production in these clients. *Adverse Effects: -H/A, & myalgia (body aches). -Thrombotic events, such as MI, CVAs, HTN. -Too-rapid increase (Hgb > 1 /d/L over 2 weeks, or Hgb > 10 to 11 g/dL) can worsen HTN, increase risk of thrombosis, and cause seizures. Diagnostic Tests: -Baseline iron levels, CBC with diff, & platelet count. -Hgb & Hct 2x weekly until blood counts stabilize. Nursing Actions: -Calucate dosage carefully. SC & IV epoetin alfa have dosages based on client's weight.. Do not shake vial, & discard after one dose is removed. -Monitor BP carefully and report increases to the provider. Monitor frequency & duration of H/As.

1. **Meds Affecting Coagulation** Chap 25 **Pharmaceutical agents that modify coagulation are used to prevent clot formation or break apart an already formed clot. These meds work in the blood to alter the clotting cascade, prevent platelet aggregation or dissolve a clot.

*a. The goal of meds that alter coagulation is to increase circulation and perfusion, decrease pain, and prevent further tissue damage. *b. The groups of meds used include oral and parenteral anticoagulants, direct thrombin inhibitors, direct inhibitors of factor Xa, anti-platelet meds, and thrombolytic agents.

32. A nurse is providing instructions to a client who has a Rx for amoxicillin and clarithromycin to treat a peptic ulcer. Which of the following info should the nurse include in the teaching?

a. "Take these meds with food." b. "These meds can turn your stool black." c. "These meds can cause photosensitivity." d. The purpose of these meds is to decrease the pH of gastric juices in the stomach." ANS: A

13. **A nurse is teaching a client who has as new Rx for clopidogrel (Plavix) following AN MI. What should the nurse teach the client about this med?**

a. **Therapeutic Use: Clopidogrel inhibits platelet aggregation and prolongs bleeding time. It is used to prevent MI or stroke in clients who have already had a first MI or stroke. b. **Adverse Effects: Like other platelet inhibitors, clopidogrel may cause bleeding due to thrombi-cytopenia. It can also cause GI effects, such as abdominal pain, nausea, and diarrhea. c. **Diagnostic Tests: The nurse should plan to monitor the platelet count periodically while the client takes clopidogrel. d. **Nursing Actions: -Teach the client to monitor for bleeding. Watch for black stools, coffee-ground emesis, blood in the urine, nose bleeds, unusual bruising, or petechiae. Inform the provider of these & GI effects. -The nurse should be aware of meds the client is taking, because risk for bleeding increases if med is taken with anticoagulants or anti platelet meds. Clopidogrel is sometimes given with ASA, which increases bleeding risk. D/C med 7 days before any elective surgery.

Chap 41 99. A nurse is caring for several clients who came to the clinic for a seasonal flu immunization. The nurse should identify that which of the following clients is a candidate to receive the vaccine via nasal spray rather than an injection?

a. 1 year old who has no health problems b. 17 year old who has a hypersensitivity to PCN c. 25 year old who is pregnant d. 52 year old who takes multivitamin supplements . ANS: B

121. A nurse is administering gentamicin by IV infusion at 0900. The med will take 1 hr to infuse. When should the nurse plan to obtain a blood sample for a peak serum level of gentamicin?

a. 1000 b. 1030 c. 1100 d. 1130 ANS: B

44. A nurse is evaluating a group of clients at a health fair to identify the need for folic acid therapy. Which of the following clients require folic acid therapy? (Select all that apply.)

a. 12-year-old child who has iron deficiency anemia b. 24-year old female who has no health problems. c. 44-year old male who has HTN d. 55-year old female who has alcohol use disorder. e. 35-year-old male who has type 2 DM. ANS: B, D

54. A nurse is caring for a client who has preeclampsia and is receiving mag sulfate IV continuous infusion. Which of the following findings should the nurse report to the provider?

a. 2 + deep tendon reflexes b. 2 + pedal edema c. 24 mL/hr urinary output d. Respirations 12/min ANS: C

103. A nurse its caring for a group of clients who are not protected against varicella. The nurse should prepare to administer the varicella vaccine at this time to which of the following clients?

a. 24 year old woman in the 3rd trimester of pregnancy b. 12 year old child who has severe allergy to neomycin c. 2 month old infant who has no health problems d. 32 year old man who has essential HTN ANS: D

35. A nurse is caring for four clients who have peptic ulcer disease. The nurse should recognize misoprostol is contraindicated for which of the following clients?

a. A client who is pregnant b. A client who has osteoarthritis c. A client who has kidney stones d. A client who has a UTI ANS: A

47. A nurse is completing an assessment of a client's current meds. The client states she also takes gingko biloba. Which of the following meds is contraindicated for a client taking gingko biloba?

a. Acetaminophen b. Warfarin c. Digoxin d. Lisinopril ANS: B

69. A nurse is admitting a toddler to the hospital after an acetaminophen overdose. Which of the following meds should the nurse anticipate administering to this client?

a. Acetylcysteine b. Pegfilgrastim (Neulasta) c. Misoprostol (Cytotec) d. Naltrexone (Tx opioid/Alcohol dep.) ANS: A

42. Chap. 30 A nurse is teaching a client who has anemia and a new Rx for a liquid iron supplement. Which of the following info should the nurse include in the teaching? (Select all that apply.)

a. Add foods that are high in fiber to your diet b. Rinse your mouth after taking the med c. Expect stools to be green or black d. Take the med with a glass of milk e. Add red meat to your diet. ANS: A, B, C, E

10. A nurse is planning to administer IV alteplase (Activase) to a client who is demonstrating manifestations of a massive PE. Which of the following interventions is appropriate for the nurse to plan?

a. Administer IM enoxaparin along with alteplase dose b. Hold direct pressure on puncture sites up for up to 30 min. c. Administer aminocaproic acid (Amicar) IV prior to alteplase infusion d. Prepare to administer alteplase within 8 hr of manifestation onset. ANS: B

129. A nurse is planning to administer ciprofloxacin IV to a client who has cystitis. Which of the following actions should the nurse take?

a. Administer a concentrated solution b. Infuse med over 60 min. c. Infuse solution thru the primary IV fluid's tubing. d. Choose a small peripheral vein for administration. ANS: B

139. A nurse is administering IV acyclovir to a client who has varicella. Which of the following actions should the nurse take?

a. Administer a stool softener b. Decrease fluid intake following infusion c. Infuse acyclovir over 1 hr d. Monitor for hypotension ANS: C

Chap 43 110. A nurse is implementing a plan of care for a client who has a wound infection. Which of the following actions should the nurse perform first?

a. Administer antibiotic medication b. Obtain a wound specimen for culture c. Review WBC lab findings d. Apply a dressing to the wound ANS: B

19. A nurse is preparing to administer filgrastim (Neupogen), for the first time to a client who has just undergone a bone marrow transplant. Which of the following interventions is appropriate?

a. Administer intramuscularly in large muscle mass to prevent injury. b. Ensure that the med is refrigerated until just prior to administration. c. Shake vial gently to mis well before withdrawing dose. d. Discard vial after removing one dose of the med ANS: D

114. A charge nurse is teaching a group of nurses about the importance of prophylactic antimicrobial therapy. Which of the following info should the charge nurse include in the teaching? (Select all that apply.)

a. Administer prophylactic antimicrobial therapy to clients who report exposure to a sexually transmitted infection. b. Administer prophylactic antoimicrobial therapy to clients who are having orthopedic surgery. c. Instruct clients who have a prosthetic heart valve about the need for prophylactic antimicrobial therapy before dental work. d. Consult the provider for prophylactic antimicrobial therapy for clients who have recurrent UTIs. e. Instruct clients to request prophylactic antimicrobial therapy immediately when they have an upper respiratory infection. ANS: A, B, C, D

98. A nurse is admitting a client to an acute care facility for a total hip arthroplasty. The client takes hydrocortisone for Addison's disease. Which of the following actions is the nurse's priority?

a. Administering a supplemental dose of hydrocortisone b. Instructing the client about coughing and deep breathing c. Collecting additional info from the client about his history of Addison's disease. d. Inserting an indwelling urinary catheter ANS: A

77. A nurse is reviewing the medication administration record of a client who is receiving transdermal fentanyl for severe pain. Which of the following meds should the nurse expect to to cause an adverse effect when administered concurrently with fentanyl?

a. Ampicillin b. Diazepam c. Furosemide d. Prednisone ANS: B

113. A nurse is caring for a group of clients who are receiving antimicrobial therapy. Which of the following clients should the nurse plan to monitor for manifestations of ABX toxicity?

a. An adolescent who has a sinus infection b. An older adult who has prostatitis c. A client who is postpartum and has mastitis d. A middle adult who has a UTI ANS: B

Chap. 47 130. A nurse is caring for a client who has DM, pulmonary TB, and a new Rx for isoniazid. Which of the following supplements should the nurse expect to administer to prevent an adverse effect of INH?

a. Ascorbic acid b. Pyridoxine c. Folic acid d. Cyanocobalamin ANS: B

52. A nurse is caring for a client who has angina and asks about obtaining a Rx for sildenafil to treat erectile dysfunction. Which of the following meds is contraindicated with sildenafil?

a. Aspirin b. Isosorbide c. Clopidogrel d. Atorvastatin ANS: B

21. A nurse is assessing a client who has chronic neutropenia and who has been receiving filgrastim (Neupogen). Which of the following actions should the nurse take to assess for an adverse effect of filgrastim?

a. Assess for bone pain. b. Assess for right lower quadrant pain. c. Auscultate for crackles in the bases of the lungs. d. Auscultate the chest to listen for a heart murmur. ANS: A

Chap. 31 48. A nurse is reviewing the health care record of a client who is asking about conjugated equine estrogens. The nurse should inform the client this med is contraindicated in which of the following conditions?

a. Atrophic vaginitis b. Dysfunctional uterine bleeding c. Osteoporosis d. Thrombophlebitis ANS: D

96. A nurse is caring for a client who is taking somatropin to stimulate growth. The nurse should plan to monitor the client's urine for which of the following?

a. Bilirubin b. Protein c. Potassium d. Calcium ANS: D

138. A nurse is caring for a client who has a new Rx for enfuvirtide to treat HIV infection. The nurse should monitor the client for which of the adverse reactions of this meds? (Select all that apply)

a. Bleeding b. Pneumonia c. Cerebral edema d. Localized erythema e. Hypotension ANS: B, D, E

109. A nurse is caring for a client who receives rituximab to treat non-Hodgkin's leukemia and who asks the nurse how rituximab works. Which of the following should the nurse include?

a. Blocks hormone receptors b. Increases immune response c. Binds with specific antigens on tumor cells d. Stops DNA replication during cell division ANS: C

72. A nurse in an ER department is performing an admission assessment for a client who has severe aspirin toxicity. Which of the following findings should the nurse expect?

a. Body temp 35º C (95º F) b. Lung crackles c. Cool, dry skin d. Respiratory depression ANS: D

51. A nurse is providing teaching to a client who will start alfuzosin for treatment of BPH. The nurse should instruct the client that which of the following is an adverse effect of the medication?

a. Bradycardia b. Edema c. Hypotension d. Tremor ANS: C

Chap. 40 93. A nurse is caring for a client who is taking propylthiouracil (PTU). For which of the following adverse effects of this med should the nurse monitor?

a. Bradycardia b. Insomnia c. Heat intolerance d. Weight loss ANS: A

75. A nurse is preparing to administer butorphanol (Stadol) to a client who has a history of substance use disorder. The nurse should identify which of the following info as true regarding butorphanol.

a. Butorphanol has a greater risk for abuse than morphine. b. Butorphanol causes a higher incidence of respiratory depression than morphine. c. Butorphanol cannot be reversed with an opioid antagonist. d. Butorphanol can cause abstinence syndrome in opioid-dependent clients ANS: D

66. A nurse is caring for a young adult client whose serum calcium is 8.8. Which of the following meds should the nurse anticipate administering to this client?

a. Calcitonin-salmon b. Calcium carbonate c. Zoledronic acid d. Ibandronate ANS: B

118. A nurse is caring for a client who has a cerebrospinal fluid infection with gram-negative bacteria. Which of the following cephalosporin ABX should the nurse expect to administer IV to treat this infection?

a. Cefaclor b. Cefazolin c. Cefepime d. Cephalexin ANS: C

8. A nurse is planning to administer subcutaneous enoxaparin (Lovenox) to an adult client following hip arthroplasty. Which of the following actions should the nurse plan to take?

a. Choose a 22-gauge needle to administer the injection. b. Use a 5/8-inch needle to administer the injection c. Administer the injection in the client's thigh d. Aspirate carefully after inserting the needle into the client's skin. ANS: B

61. A nurse is caring for a client who has a new diagnosis for fibromyalgia. Which of the following meds should the nurse anticipate being prescribed for this client?

a. Colchicine b. Hydroxychloroquine c. Auranofin d. Duloxetine (Cymbalta) ANS: D

Chap 42. 104. A nurse is caring for a client who has breast CA and asks why she is receiving a combination therapy of cyclophosphamide (Cytoxan), methotrexate, and fluorouracil. The response by the nurse should include that combination chemotherapy is used to do which of the following? (Select all that apply.)

a. Decrease medication resistance b. Attack cancer cells at different stages of cell growth c. Block chemo agent from entering healthy cells d. Stimulate immune system e. Decrease injury to normal body cells ANS: A, B, E

82. A nurse is administering amitriptyline to a client who is experiencing cancer pain. For which of the following adverse effects should the nurse monitor?

a. Decreased appetite b. Explosive diarrhea c. Decreased pulse rate d. Orthostatic hypotension ANS: D

49. A nurse is providing teaching to a female client who is taking testosterone to treat advanced breast CA. The nurse should tell the client that which of the following are adverse effects of this med? (Select all that apply.)

a. Deepening voice b. Weight gain c. Low blood pressure d. Dry mouth e. Facial hair ANS: A, B, E

79. A nurse is planning care for a client who has brain CA and is experiencing headaches. Which of the following adjuvant meds are indicated for this client?

a. Dexamethasone b. Methylphenidate c. Hydroxyzine d. Amitriptyline ANS: A

116. A nurse is preparing to administer cefotaxime IV to a client who has a severe infection and has been receiving cefotaxime for the past week. which of the following findings indicates a potentially serious adverse reaction to this med that the nurse should report to the provider?

a. Diaphoresis b. Epistaxis c. Diarrhea d. Alopecia ANS: C

71. A nurse is taking a history for a client who reports that he us taking aspirin about four times daily for a sprained wrist. Which of the following prescribed meds taken by the client is contraindicated with ASA?

a. Digoxin b. Metformin c. Warfarin d. Nitroglycerin ANS: C

Chap 35 68. A nurse is assessing a client who has salicylism. Which of the following findings should the nurse expect? (Select all that apply.)

a. Dizziness b. Diarrhea c. Jaundice d. Tinnitus e. Headache ANS: A, D, E

36. A nurse is providing a client who has peptic ulcer disease with instructions about managing his condition. Which instructions should the nurse include? (Select all that apply.)

a. Eat a snack at bedtime b. Drink decaffeinated coffee c. Low-dose aspirin therapy should be avoided d. Seek measures to reduce stress e. Avoid smoking ANS: D, E

24. A nurse is preparing to transfuse a unit of PRBCs for a client who has severe anemia. Which of the following interventions will prevent an acute hemolytic reaction?

a. Ensure the client has a patent IV line before obtaining blood product from the refrigerator. b. Obtain help from another nurse to confirm the correct client and blood product. c. Take a complete set of vital signs before beginning transfusion and periodically during the transfusion. d. Stay with the client for the first 15 to 30 min of the transfusion. ANS: B

26. A nurse is assessing a client during transfusion if a unit of whole blood. The client develops a cough, SOB, elevated BP, and distended neck veins. The nurse should anticipate a Rx for which of the following meds?

a. Epinephrine (Adrenalin) b. Lorazepam (Ativan) c. Furosemide (Lasix) d. Diphenhydramine (Benadryl) ANS: C

123. A nurse is caring for a client who has subacute bacterial endocarditis and is receiving several ABXs, including streptomycin IM. For which of the following manifestations should the nurse monitor as an adverse effect of this med?

a. Extremity paresthesias b. Urinary retention c. Severe constipation d. Complex partial seizures ANS: A

136. A nurse is caring for a client who takes several antiretroviral meds, including the NRTI zidovudine, to treat HIV infection. The nurse should monitor for which of the following adverse effects of zidovudine? (Select all that apply.)

a. Fatigue b. Blurred vision c. Ataxia D. Hyperventilation (r/t lactic acidosis) e. Vomiting ANS: A, D, E

37. Chap 29***** A nurse is caring for a client who received prochlorperazine 4 hr ago. The client reports spasms of his face. The nurse should anticipate a Rx for which of the following meds?

a. Fomepizole b. Naloxone c. Phytonadione d. Diphenhydramine ANS: D

119. A nurse is preparing to administer PCN IV to a client who has a streptococcal infection. The client tells the nurse that she has difficulty swallowing tablets and doesn't "do well" with liquid or chewable meds because the taste gags her, even when the med is mixed with food. The nurse should request a Rx for what med?

a. Fosftomycin b. Amoxicillin c. Nafcillin d. Cefaclor ANS: C

134. A nurse is teaching a client who has active TB about his treatment regimen. The client asks why he must take four different meds. Which of the following responses should the nurse make?

a. Four meds decrease the risk for a severe allergic reaction b. Four meds reduce the chance that the bacteria will become resistant c. Four meds reduce the risk for adverse reactions d. Four meds decrease the chance of having a positive tuberculin skin test. ANS: B

43. A nurse is caring for a client who has increased liver enzymes and is taking herbal supplements. Which of the following herbal supplements should the nurse report to the provider?

a. Glucosamine b. Saw palmetto c. Kava d. St. John's wort ANS: C (Can lead to liver damage)

111. A nurse is caring for a client who has a UTI and a history of recurrence of this type of infection. The client asks why the provider has not yet prescribed an ABX. The nurse should explain that the provider has to wait for the results of which of the following lab tests to identify which ABX to prescribe?

a. Gram stain b. Culture c. Sensitivity d. Specific gravity ANS: C

Chap 46 125. A nurse reviewing a client's medication history notes an allergy to sulfonamides. This allergy is a contraindication for taking which of the following meds? (Select all that apply)

a. HCTZ b. Metoprolol c. Acetaminophen d. Glipizide e. Furosemide ANS: A, D, E

38. Nurse is planning to administer ondansetron IV for an older adult client who has a history of DM and cardiac myopathy and is receiving chemo for CA. For which adverse effects of ondansetron should the nurse monitor? (Select all that apply.)

a. Headache b. Diarrhea c. Shortened PR interval d. Hyperglycemia e. Prolonged QT interval ANS: A, B, E

18. A nurse is caring for a client who is receiving daily doses of oprelvekin (Interleukin-11). Which of the following lab values should the nurse monitor to determine effectiveness of this med?

a. Hemoglobin b. Absolute neutrophil count c. Platelet count d. Total white blood count ANS: C

Chap. 34 63. A nurse is providing teaching to a client who is taking raloxifene to prevent postmenopausal osteoporosis. The nurse should advise the client that which of the following are adverse effects of this med? (Select all that apply.)

a. Hot flashes b. Lump in the breast c. Swelling or redness in calf d. Shortness of breath e. Difficulty swallowing ANS: A, C, D

11. A nurse is monitoring a client who takes aspirin, 81 mg PO daily. Which of the following clinical manifestations are adverse effects of daily ASA therapy? (Select all that apply).

a. Hypertension b. Coffee-ground emesis c. Tinnitus d. Paresthesias of the extremities e. Nausea ANS: B, C, E

131. A nurse is infusing IV amphotericin B to a client who has a systemic fungal infection. The nurse should monitor the client for which of the following adverse effects to this med?

a. Hypoglycemia b. Constipation c. Fever d. Hyperkalemia ANS: C

97. A nurse is assessing a client who takes desmopressin (DDAVP) for diabetes insipidus. For which of the following adverse effects should the nurse monitor?

a. Hypovolemia b. Hypercalcemia c. Agitation d. Headache ANS: D

57. A nurse is reviewing a new Rx for terbutaline with a client who has a history of preterm labor. Which of the following client statements indicates understanding of the teaching?

a. I can increase my activity now that I have started on this med. b. I will increase my daily fluid intake to 3 quarts a day. c. I will report increasing intensity of contractions to my doctor. d. I am glad this will prevent preterm labor. ANS: C

62. A nurse is evaluating teaching for a client who has RA and a new Rx for methotrexate. Which of the following statements by the client indicates understanding of the teaching?

a. I will be sure to return to the clinic at least once a year to have my blood drawn while I'm taking methotrexate. b. I will take this med on an empty stomach. c. I will let the doctor know if I develop mouth sores while taking this med. d. I should stop taking oral contraceptives while I'm taking methotrexate. ANS: C

Chap 45 120. A nurse is teaching a client about taking tetracycline to treat a GI infection due to H-pylori. Which of the following statements should the nurse identify as an indication that the client understands the instructions?

a. I will take this med with 8 oz of milk b. I will let my doctor know if I start having diarrhea c. I can stop taking this med when I feel completely well d. I can take this med just before bedtime ANS: B

90. A nurse is providing teaching to a client who has type 2 DM and is starting repaglinide. Which of the following statements by the client indicates understanding of the administration of this med?

a. I'll take this med with my meals. b. I'll take this med 30 min before I eat. c. I'll take this med just before I go to bed. d. I'll take this med as soon as I wake up in the morning. ANS: B

137. A nurse is caring for a client who is taking ritonavir, a protease inhibitor, to treat HIV infection. The nurse should monitor for which of the following adverse effects of this med?

a. Increased TSH level b. Decreased ALT level c. Hypoglycemia d. Hyperlipidemia ANS: D

70. A nurse is teaching a client about a new Rx for celecoxib. Which of the following info should the nurse include in the teaching?

a. Increases the risk for MI b. Decreases the risk of stroke c. Inhibits COX-1 d. Increases platelet aggregation ANS: A

45. A nurse is preparing to administer potassium chloride IV to a client who has hypokalemia. Which of the following actions should the nurse take? (Select all that apply.)

a. Infuse med thru a large-bore needle b. Monitor urine output to ensure at least 20 mL/hr. c. Administer med via direct IV bolus. d. Implement cardiac monitoring e. Administer the infusion via an IV pump ANS: A, D, E

80. A nurse is preparing to administer pamidronate to a client who has bone pain r/t CA. Which of the following precautions should the nurse take when administering pamidronate?

a. Inspect the skin for redness and irritation when changing the intradermal patch. b. Assess the IV site for thrombophlebitis frequently during administration. c. Instruct the client to sit upright or stand for 30 min following oral admin. d. Watch for manifestations of anaphylaxis for 20min after IM admin. ANS: B

56. nurse is caring for a client who is in labor and receiving IV opioid analgesics. Which of the following actions should the nurse take?

a. Instruct the client to self ambulate every 2 hr b. Offer oral hygiene every 2 hr c. Anticipate med administration every 2 hr prior to delivery d. Monitor fetal HR every 2 hr ANS: B

Chap 39 88. A nurse is teaching clients in an outpatient facility about the use if insulin to treat type 1 DM. For which of the following types of insulin should the nurse tell the clients to expect a peak effect 1 to 5 hr after administration?

a. Insulin glargine b. NPH insulin c. Regular insulin d. Insulin lispro ANS: C

107. A nurse is teaching a client who has breast CA about tamoxifen. Which of the following adverse effects of tamoxifen should the nurse discuss with the client?

a. Irregular heart beat b. Abnormal uterine bleeding c. Yellow sclera or dark-colored urine d. Difficulty swallowing ANS: B

46. A nurse is caring for a client who requests info on the use of feverfew. Which of the following responses should the nurse make?

a. It is used to treat skin infections b. It can decrease the frequency of migraine headaches. c. It can lessen the nasal congestion in the common cold. d. It can relieve nausea of morning sickness during pregnancy. ANS: B

124. A nurse is caring for a client who is undergoing preparation for extensive colorectal surgery. Which of the following oral ABXs should the nurse expect to administer specifically to suppress normal flora in the GI tract?

a. Kanamycin b. Gentamicin c. Neomycin d. Tobramycin ANS: C

84. A nurse is planning care for client who is to receive tetracaine prior to a bronchoscopy. Which of the following actions should the nurse include in the plan of care?

a. Keep the patient NPO until pharyngeal response returns. b. Monitor the insertion site for hematoma c. Palpate the bladder to detect urinary retention. d. Maintain the client on bed rest for 12 hr following the procedure. ANS: A

106. A nurse is preparing to administer leucovorin to a client who has CA and is receiving chemo with methotrexate. Which of the following responses should the nurse use when the client asks why leucovorin is being given?

a. Leucovorin reduces the risk of transfusion reaction from methotrexate. b. Leucovorin increases platelet production and prevents bleeding. c. Leucovorin potentiate the cytotoxic effects of methotrexate. d. Leucovorin protects healthy cells from methotrexate's toxic effect. ANS: D

20. A nurse is monitoring a client who is receiving epoetin (Epogen) for adverse effects. Which of the following is an adverse effect of this medication? (Select all that apply.)

a. Leukocytosis b. Hypertension c. Edema d. Blurred vision e. Headache ANS: B, E

40. A nurse is caring for a cline who has DM and is experiencing nausea due to gastroparesis. The nurse should anticipate a Rx for which of the following med?

a. Lubiprostone b. Meticlopramide c. Biscodyl d. Loperamide ANS: B

112. A nurse is preparing information for the unit's nurses about the effectiveness of antimicrobial therapy for clients who have bacterial infections. Which of the following host factors should the nurse include as conditions that affect antimicrobial effectiveness? (Select all that apply.)

a. Meningitis b. Pacemaker c. Endocarditis d. Pneumonia e. Pyelonephritis ANS: A, B, C

133. A nurse is teaching a client who is beginning a course of metronidazole to treat an infection. For which of the following adverse effects should the nurse instruct the client to stop taking this med and notify the provider?

a. Metallic taste b. Nausea c. Ataxia d. Dark-colored urine ANS: C

76. A nurse is planning to administer morphine IV to a client who is post-op. Which of the following actions should the nurse take?

a. Monitor for seizures and confusion with repeated doses. b. Protect the client's skin from severe diarrhea that occurs with morphine. c. Withhold this med if respiratory rate is less than 12. d. Give morphine intermittent via IV bolus over 30 seconds or less. ANS: C

81. A nurse is planning care for a client who has CA and taking a glucocorticoid as an adjuvant med for pain control. Which of the following interventions should the nurse include in the plan of care? (Select all that apply.)

a. Monitor for urinary retention b. Monitor serum glucose c. Monitor serum potassium d. Monitor for gastric bleeding e. Monitor for respiratory depression ANS: B, C, D

87. A nurse is providing teaching to a client who has migraine headaches and a new Rx for ergotamine. For which of the following adverse effects should the nurse instruct the client to stop taking the med and notify the provider? (Select all that apply.)

a. Nausea b. Visual disturbances c. Positive home pregnancy test d. Numbness and tingling in fingers e. Muscle pain ANS: C, D, E

Chap. 37 78. A nurse is caring for a client who has CA and is taking morphine and carbamazepine for pain. Which of the following effects should the nurse monitor for when giving the meds together? (Select all that apply.)

a. Need for reduced dosage of the opioid. b. Reduced adverse effects of the opioid. c. Increased analgesic effects. d. Enhanced CNS stimulation. e. Increased opioid tolerance. ANS: A, B, C

127. A nurse is teaching a female client who has severe UTI about ciprofloxacin. Which of the following info about adverse reactions should the nurse include? (Select all that apply.)

a. Observe for pain and swelling of the Achilles tendon b. Watch for vaginal yeast infection c. Expect excessive nighttime perspiration d. Inspect the mouth for cottage-cheese like lesions e. Take the med with a dairy product ANS: A, B, D

a. 126. A nurse is teaching a client who has a new Rx for nitrofurantoin. Which of the following information should the nurse include? (Select all that apply.)

a. Observe skin for bruising b. Take the med with milk or meals c. Expect brown, discoloration of urine d. Crush med if it is difficult to swallow ANS: A, B, C

100. A nurse is teaching a group of new parents about immunizations. The nurse should instruct the parents that the series for which of the following vaccines is completed prior to the 1st birthday?

a. Pneumococcal conjugate vaccine b. Meningococcal conjugate vaccine c. Varicella vaccine d. Rotavirus vaccine ANS: D

41. A nurse is providing info about probiotic supplements to a male client. Which of the following info should the nurse include? (Select all that apply.)

a. Probiotics are micro-organisms that are normally found in the GI tract. b. Probiotics are used to treat C-Diff. c. Probiotics are used to treat BPH. d. You can experience bloating while taking probiotic supplements e. If you are prescribed an antibiotic, you should take it at the same time you take the probiotic supplement. ANS: A, B, D

94. A nurse is teaching a client who has Graves' disease about her prescribed meds. Which of the following statements by the client indicates an understanding of the use of propranolol in the treatment of Graves' disease?

a. Propranolol helps increase blood flow to my thyroid gland. b. Propranolol is used to prevent excess glucose in my blood. c. Propranolol will decrease my tremors and fast heart rate. d. Propranolol promotes a decrease in thyroid hormone in the body. ANS: C

122. A nurse is caring for a client who is starting a course of gentamicin IV for a serious respiratory infection. For which manifestations should the nurse monitor as an adverse effect of this med? (Select all that apply.)

a. Pruritis b. Hematuria c. Muscle weakness d. Difficulty swallowing e. Vertigo ANS: A, B, C, E

102. A 12 month old child just received the first measles, mumps, and rubella (MMR) vaccine. For which of the following possible reactions to this vaccine should the nurse teach the parents to monitor? (Select all that apply.)

a. Rash b. Swollen glands c. Bruising d. Headache e. Inconsolable crying ANS: A, B, C

117. A nurse is obtaining a medication history from a client who is to receive imipenem-cilastatin IV to treat an infection. Which of the following meds the client also receives puts him at risk for medication interaction?

a. Regular insulin b. Furosemide c. Valproic acid (Anti-seizure med) d. Ferrous sulfate ANS: C

85. A nurse is caring for a client who receives a local anesthetic of lidocaine during the repair of a skin laceration. For which of the following adverse reactions should the nurse monitor the client?

a. Seizures b. Tachycardia c. Hypertension d. Fever ANS: A

Chap 44 115. A nurse in an outpatient facility is preparing to administer nafcillin IM to an adult client who has an infection. Which of the following actions should the nurse plan to take? (Select all that apply.)

a. Select a 25-gauge, 1/2-inch needle for the injection b. Administer the medication deeply into the ventrogluteal muscle c. Ask the client about an allergy to PCN before administering the med. d. Monitor the client for 30 min following the injection. e. Tell the client to expect a temporary rash to develop following the injection. ANS: B, C, D

132. A nurse is administering IV amphotericin B to a client who has a systemic fungal infection. The nurse should monitor which of the following lab values? (Select all that apply.)

a. Serum calcium b. Serum amylase c. Serum potassium d. Hematocrit e. Serum creatinine ANS: C, D, E

65. A nurse is caring for a client who has a new Rx for calcitonin-salmon for osteoporosis. Which of the following tests should the nurse tell the client to expect before beginning this med?

a. Skin test for allergy to this med b. ECG to rule out cardiac dysrhythmias c. Mantoux test to r/o exposure to TB d. Liver function tests to assess risk for medication toxicity. ANS: A

39. A nurse is providing instructions about the use of laxatives to a client who has heart failure. The nurse should tell the client he should avoid which of the following laxatives?

a. Sodium phosphate b. Psyllium c. Biscodyl D. Polyethylene glycol ANS: A

91. A nurse is providing teaching to a client who has a new Rx for metformin. Which of the following adverse effects of metformin should the nurse instruct the client to report to the provider?

a. Somnolence b. Constipation c. Fluid retention d. Weight gain ANS: A

Chap. 33 58. A nurse is providing teaching for a client who has gout and a new Rx for allopurinol. For which of the following adverse effects should the client be taught to monitor? (Select all that apply.)

a. Stomatitis b. Insomnia c. Nausea d. Rash e. Increased gout pain ANS: C, D, E

27. A nurse is transfusing a unit of PRBCs for a client who has anemia due to chemotherapy. The client reports a sudden H/A and chills. The client's temp is 2º F higher than her baseline. In addition to notifying the HCP, which of the following actions should the nurse take? (Select all that apply.)

a. Stop the transfusion b. Place the client in an upright position with feet down. c. Remove the blood bag and tubing from the client's IV catheter. d. Obtain a urine specimen from the client. e. Infuse dextrose 5% in water thru the client's IV. ANS: A, C, D

67. A nurse is providing instruction to a client who has a new Rx for calcitonin-salmon for post-menopausal osteoporosis. Which of the following instructions should the nurse include in the teaching?

a. Swallow tabs on an empty stomach with plenty of water. b. Watch for skin rash and redness when applying this med topically. c. Mix the liquid med with juice and take it after meals. d. Alternate nostrils each time calcitonin-salmon is inhaled. ANS: D

34. A nurse is teaching a client who is taking sucralfate PO for peptic ulcer disease has a new Rx for phenytoin to control seizures. Which instruction should the nurse include?

a. Take an antacid with the sucralfate b. Take sucralfate with a glass of milk c. Allow a 2-hr interval between these meds d. Chew the sucralfate throughly before swallowing. ANS: C

Chap 38 83. A nurse is providing teaching to a client who is experiencing migraine headaches. Which of the following instructions should the nurse provide? (Select all that apply.)

a. Take ergotamine as a prophylaxis to prevent a migraine headache. b. Identify and avoid trigger factors. c. Lie down in a dark quiet room at the onset of a migraine. d. Avoid foods that contain tyramine. e. Avoid exercise that can increase HR. ANS: B, C, D

64. A nurse is teaching a client who has osteoporosis and a new Rx for alendronate. Which of the following instructions should the nurse provide? (Select all that apply.)

a. Take med the in the AM before eating. b. Chew tabs to increase bioavailability. c. Drink 8 oz water with each tablet. d. Take med with an antacid if heartburn occurs. e, Avoid lying down after taking this med ANS: A, C, E

92. A nurse is providing teaching to a client who has a Rx for pramlintide (Symlin) for type 1 DM. Which of the following should the nurse include in the teaching? (Select all that apply.)

a. Take oral meds 1 hr before injection. b. Use upper arms as preferred injection sites. c. Mix pramlintide with breakfast dose of insulin. d. Inject pramlintide just before a meal e. Discard open vials after 28 days. ANS: D, E

33. A nurse is teaching a client who has a new Rx for omeprazole for management of heartburn. Which info should the nurse include in the teaching?

a. Take the med at bedtime b. This med decreases the production of gastric acid. c. Take this med 2 hr after eating d. This med can cause hyperkalemia ANS: B

128. A nurse is planning discharge teaching for a female client who has a new Rx for trimethoprim- sulfamethoxazole. Which of the following should the nurse include?

a. Take the med even if pregnant b. Maintain a fluid restriction while taking it. c. Take it on an empty stomach d. Stop taking it when manifestations subside ANS: C

140. A nurse is teaching a client who is beginning highly active antiretroviral therapy (HAART) for HIV infection about ways to prevent medication resistance. Which of the following info should the nurse teach the client about resistance?

a. Taking low dosages of antiretroviral med minimizes resistance b. Taking one antiretroviral med at a time minimizes resistance. c. Taking med at the same times daily without missing doses minimizes resistance. d. Changing the med regimen when adverse effects occur minimizes resistance. ANS: C

86. A nurse is reviewing the health history of a client who has migraine headaches and is to begin prophylaxis therapy with propranolol. Which findings in the client history should the nurse report to the provider?

a. The client had a prior MI. b. The client takes warfarin for A-Fib. c. The client takes SSRI for depression. d. An ECG indicates first-degree heart block. ANS: D

95. A nurse is caring for an older adult client in a long-term care facility who has hypothyroidism and a new Rx for levothyroxine. Which of the following dosage schedules should the nurse expect for this client?

a. The client will start at a high dose, and the dose will be tapered as needed. b. The client will remain on the initial dosage during the course of treatment. c. The client's dosage will be adjusted daily based on blood levels. d. The client will start on a low dose, which will be gradually increased. ANS: D

74. A nurse is caring for a client who has end-stage CA and is receiving morphine. The client's daughter asks why the provider prescribed methylnaltrexone. Which of the following responses should the nurse make?

a. The med will increase your mother's respirations. b. The med will prevent dependence on the morphine. c. The med will relieve your mother's constipation. d. The med works with the morphine to increase pain relief. ANS: C

59. A nurse is caring for a client who has a new Rx for adalimumab for RA. Based on the route of administration of adalimumab, which of the following should the nurse plan to monitor?

a. The vein for thrombophlebitis during IV administration. b. The subQ site for redness following injection. c. The oral mucosa for ulceration after oral administration d. The skin for irritation following removal of transdermal patch. ANS: B

Chap 48 135. A nurse is teaching a client who has a new Rx for combination oral NRTIs (abacavir, lamivudine, and zidovudine) for treatment of HIV. Which of the following statement should the nurse include?

a. These meds work by blocking HIV entry into cells. b. These meds work by weakening the cell wall of the HIV virus. c. These meds work by inhibiting enzymes to prevent HIV replication. d. These meds work by preventing protein synthesis within the HIV cell. ANS: C

50. A nurse is explaining the mechanism of action of combination oral contraceptives to a group of clients. The nurse should tell the clients that which of the following actions occur with the use of combination oral contraceptives? (Select all that apply.)

a. Thickening the cervical mucus b. Inducing maturation of ovarian follicle c. Increasing development of the corpus luteum d. Altering the endometrial lining e. Inhibiting ovulation ANS: A, D, E

Chap 32 53. A nurse is teaching a client about terbutaline. Which of the following statements by the client indicates understanding of the teaching?

a. This med will stop my contractions b. This med will prevent vaginal bleeding c. This med will promote blood flow to my baby d. This med will increase my prostaglandin production. ANS: A

108. A nurse is caring for a client who is being treated with interferon alfa-2b for malignant melanoma. For which of the following adverse effects should the nurse monitor? (Select all that apply.)

a. Tinnitus b. Muscle aches c. Peripheral neuropathy d. Bone loss e. Depression ANS: B, C, E

Chap 36 73. A nurse is preparing to administer an opioid agonist to a client who has acute pain. Which of the following complications should the nurse monitor?

a. Urinary retention b. Tachypnea c. HTN d. Irritating cough ANS: A

105. A nurse is preparing to administer cyclophosphamide IV to a client who has Hodgkin's disease. Which of the following meds should the nurse expect to administer concurrently with the chemotherapy to prevent an adverse effect of cyclophosphamide?

a. Uroprotectant agent, such as mesna b. Opioid, such as morphine c. Loop diuretic, such as furosemide d. H1 receptor antagonist, such as diphenhydramine. ANS: A

55. A nurse is caring for a client who has a new Rx for oxytocin to simulate uterine contractions. Which of the following interventions should the nurse make? (Select all that apply.)

a. Use an infusion pump for the med administration. b. Obtain V/S frequently and with every dosage change. c. Stop infusion if uterine contractions occur every 4 min and last 45 seconds. d. Increase med infusion rate rapidly e. Monitor fetal HR continuously. ANS: A, B, E

9. A nurse is caring for a hospitalized client receiving heparin for DVT. The client begins vomiting blood. After the heparin has been stopped, which of the following meds should the nurse prepare to administer?

a. Vitamin K, (Phytonadione) b. Atropine c. Protamine d. Calcium Gluconate ANS: C

12. A nurse is caring for a client who has A-Fib and has a new Rx for dabigatran (Pradaxa) to prevent development of thrombosis. Which of the following meds is prescribed concurrently to treat as adverse effect of dabigatran?

a. Vitamin K, (Phytonadione) b. Protamine c. Omeprazole (Prilosec) d. Probenecid (Benemid ANS: C

89. A nurse is caring for a client in an outpatient facility who has been taking acarbose for type 2 DM. Which of the following lab tests should the nurse plan to monitor?

a. WBC b. Serum potassium c. Platelet count d. Liver functions tests ANS: D

60. A nurse is preparing to administer belimumab for a client who has systemic lupus erythematous. Which of the following actions should the nurse plan to take?

a. Warm the med to room temp. over 1 hr before administering b. Administer the med by IV bolus over 5 min. c. Dilute the med in 5% dextrose and water solution. d. Monitor the client for hypersensitivity reactions. ANS: D

25. A nurse is caring for a hospitalized client who has an activated partial prothrombin time (aPTT) > 1.5 times the expected reference range. Which of the following blood products should the nurse prepare to transfuse?

a. Whole blood b. Platelets c. Fresh frozen plasma d. Packed RBCs ANS: C

**Blood and Blood Products: Chap 27* 23. A nurse is preparing to administer an infusion of 300 mL of platelet concentrate. The nurse should plan to administer the infusion over which of the following time frames?

a. Within 30 min/unit b. Within 60 min/unit c. Within 2 hr/unit d. Within 4 hr/unit ANS: A

101. A nurse in a provider's office is preparing to administer RV, DTaP, Hib, PCV13, and IPV immunizations to a 4month old infant. Which of the following actions should the nurse plan to take? (Select all that apply.)

a. a. Administer IPV orally b. Administer subQ injections in the anterolateral thigh c. Administer IM injections in the deltoid muscle d. Give the infant his pacifier during vaccine injections e. Teach parents to give ASA on a schedule for 24 hr after immunization ANS: B, D