RN 104 Pharm Exam 2
nurse is providing teaching to a client who has a prescription for pramlintide for type 1 diabetes mellitus. Which of the following should the nurse include in the teaching? (Select all that apply.) "Take oral medications 30 min before injection." "Use upper arms as preferred injection sites." "Mix pramlintide with the breakfast dose of insulin." "Inject pramlintide just before a meal." "Discard open vials after 28 days."
"Inject pramlintide just before a meal." Discard open vials after 28 days."
nurse administers pramlintide at 0800 to a client who has type 1 diabetes mellitus. At which of the following times should the nurse expect the drug to exert its peak action? 0820 0900 1030 1100
0820
nurse is reviewing the health record of a client who asks about using propranolol to treat hypertension. The nurse should recognize which of the following conditions is a contraindication for taking propranolol? • Asthma • Glaucoma • Hypertension • Tachycardia
Asthma Propranolol is a beta blocker = bronchi constriction
nurse is caring for a client who is about to begin insulin glargine therapy. The nurse should identify the need for additional precautions because the client also takes which of the following types of drugs? Oral contraceptives Calcium supplements Beta blockers Iron supplements
Beta blockers mask hypoglycemia by masking tremors & tachycardia. Increase hypoglycemic effects
A nurse is caring for a client who is taking propylthiouracil. Which of the following findings should the nurse monitor for as an adverse effect of this medication? bradycardia insomnia heat intolerance weight loss
Bradycardia
nurse is caring for a client who is taking for somatropin to stimulate growth. The nurse should plan to monitor the client's urine for which of the following? bilirubin protein potassium calcium
Calcium at risk for renal Calculi
Which of the following drugs should a nurse have available for a client who is experiencing insulin toxicity? Naloxone Diphenhydramine Acetylcysteine Glucagon
Glucagon
A nurse is reviewing the medical record of a client who takes desmopressin for diabetes insipidus. Which of the following findings is an adverse effect of desmopressin? hypovolemia hypercalcemia agitation headache
Headache can indicate water intoxication
nurse is planning to administer a first dose of captopril to a client who has hypertension. Which of the following medications can intensify first dose hypotension? (Select all that apply.) Simvastatin •Hydrochlorothiazide Phenytoin Clonidine Aliskiren
Hydrochlorothiazide ->diuretic Aliskiren -> renin inhibitor (antihypertensive)
nurse is teaching a client about self-administering regular insulin. The nurse should instruct the client to rotate injection sites to prevent which of the following? Rapid absorption Intradermal injection Injection pain Lipohypertrophy
Lipohypertrophy
nurse is caring for a client who has a new prescription for captopril for hypertension. The nurse should monitor the client for which of the following as an adverse effect of this medication? Hypokalemia • Hypernatremia • Neutropenia • Bradycardia
Neutropenia Monitor CBC
nurse is speaking with a client who is taking glipizide to treat type 2 diabetes mellitus and has called to report feeling shaky, hungry, and fatigued. Which of the following actions should the nurse instruct the client to take? Drink 16 oz of water. Perform a fingerstick blood glucose check. Take another glipizide tablet. Lie down and rest.
Perform finger stick
nurse in a provider's office is monitoring blood electrolytes for four clients who take digoxin. Which of the following electrolyte values increases a client's risk for digoxin toxicity? Calcium 9.2 mg/dL Calcium 10.3 mg/dL Potassium 3.4 mEq/L Potassium 4,8 mEq/L
Potassium 3.4 is below expected range = digoxin toxicity
nurse is providing teaching for a client who has a new prescription for metformin. Which of the following findings should the nurse instruct the client to report as an adverse effect of metformin? somnolence constipation fluid retention weight gain
Somnolence indicate lactic acidosis - manifested by drowsiness, hyperventilation, muscle pain
nurse is caring for a client who is about to begin taking propylthiouracil (PTU) to treat hyperthyroidism. The nurse should instruct the client to report which of the following adverse effects? (Select all that apply.) Sore throat Joint pain Insomnia Bradycardia Rash
Sore throat joint pain Bradycardia rash agranulocytosis =low WBC = sick easily
nurse is admitting a client for a total hip arthroplasty. The client takes hydrocortisone for Addison's disease. Which of the following actions is the nurse's priority? administering a supplemental dose of hydrocortisone instructing the client about cough & deep breathing collecting additional info about the clients history of Addison disease inserting an i dwelling urinary catheter
administering a supplemental dose of hydrocortisone acure renal insufficiency (renal crisis) occurs in Addisons disease pts
A nurse is teaching a client who has angina how to use nitroglycerin transdermal ointment. The nurse should include which of the following instructions? "Remove the prior dose before applying a new dose." "Rub the ointment directly into your skin until it is no longer visible." "Cover the applied ointment with a clean gauze pad." "Apply the ointment to the same skin area each time."
A. "Remove the prior dose before applying a new dose."
nurse is providing teaching to a client who has a new prescription for digoxin. The nurse should instruct the client to monitor and report which of the following adverse effects that is a manifestation digoxin toxicity? (Select all that apply.) Fatigue Constipation Anorexia Rash Blurred vision
Fatigue & anorexia
nurse is teaching a client who has a new prescription for verapamil to control hypertension. Which of the following instructions should the nurse include? -Increase the amount of fiber in the diet. -Drink grapefruit juice daily to increase vitamin C intake. -Decrease the amount of calcium in the diet. -Withhold food for 1 hr after the medication is taken.
Increase the amount of fiber in the diet
nurse is providing teaching to a client who is about to begin exenatide therapy to treat type 2 diabetes mellitus. Which of the following instructions should the nurse include? (Select all that apply.) Inject the drug subcutaneously. Expect the peak effect in 2 hr. Use the drug as a supplement to an oral hypoglycemic. Inject the drug 1 hr after a meal. Discard used pens 10 days after the first use
Inject the drug subcutaneously. Expect the peak effect in 2 hr. Use the drug as a supplement to an oral hypoglycemic.
nurse is teaching a client who has Grave's disease and a new prescription for propranolol. Which of the following client statements indicates effective teaching? "Propranolol helps increase blood flow to my thyroid gland." "Propranolol is used to prevent excess glucose in my blood." "Propranolol will decrease my tremors and fast heart beat." • "Propranolol promotes a decrease of thyroid hormone in my body."
Propranolol will decrease my tremors and fast heart beat."
nurse is teaching clients about the use of insulin to treat type 1 diabetes mellitus. 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? insulin glargine NPH insulin Regular insulin Insulin Lispro
Regular insulin
nurse is teaching a client who has a new prescription for nitroglycerin transdermal patch for angina pectoris. Which of the following instructions should the nurse include? Remove patch in evening Cut each patch in half if angina attacks are under control Take off the nitroglycerin patch for 30 minutes if a headache occurs Apply a new patch every 48 hrs
Remove the patch each evening Remove for 10-12 hrs every 24 hrs
nurse is caring for a client who takes repaglinide 15 to 30 min before each meal to treat type 2 diabetes mellitus. The client asks, "If I skip a meal, what should I do?" Which of the following responses should the nurse make? Double the dose before the next meal. Take half the dose. Skip the dose. Take the usual dose
Skip the meal
nurse is caring for a client who is about to begin taking somatropin. The nurse should explain the need to monitor which of the following laboratory values? (Select all that apply.) Blood amylase Creatinine clearance Urine calcium Blood glucose CBC
Urine calcium Blood glucose Can cause hyperglycemia & hypercalciuria
nurse is caring for a client who is taking desmopressin. The nurse should make which of the following assessments to evaluate the drug's effectiveness? Peripheral pulses Urine output Skin integrity Blood glucose
Urine output desmopressin -> diabetes insipidus, frequent urination due to kidney reabsorbing H2O
A nurse is caring for a client who is taking pioglitazone to treat type 2 diabetes mellitus. The nurse should monitor for which of the following findings? joint pain constipation weight gain dilated pupils
Weight gain
nurse is caring for a client who is taking metformin and is scheduled to undergo angiography using iodine-containing contrast dye. The nurse should identify that an interaction between metformin and the IV contrast dye increases the client's risk for which of the following conditions? hypokalemia hyperglycemia acute renal failure acute pancreatitis
Acute renal failure & lactic acidosis
nurse is teaching a client who has a prescription for pramlintide therapy to treat type 1 diabetes mellitus. Which of the following instructions should the nurse include? Mix pramlintide with insulin in the syringe. Administer pramlintide before meals. Take pramlintide once daily at bedtime. Inject pramlintide into the upper arm.
Administer pramlintide before meals 20min before a meal containing 30g carbs
nurse is caring for a client who is about to begin taking pioglitazone to treat type 2 diabetes mellitus. The nurse should explain to the client about the need to monitor which of the following laboratory values? (Select all that apply.) Thyroid-stimulating hormone (TSH) Alanine aminotransferase (ALT) LDL CBC Creatinine clearance
Alanine aminotransferase (ALT) LDL pioglitazone can cause liver damage (check 3-6months) ^ LDL = bad
nurse is teaching a client who has a prescription for glipizide therapy to treat type 2 diabetes mellitus. Which of the following instructions should the nurse include? Avoid drinking alcohol. Sit or stand for 30 min after taking the drug Urinate every 4 hr. Take the drug 2 hr after a meal.
Avoid alcohol drinking interacts w -> glipizide, sulfonylurea = nausea, palpitations, & flushing. drinking also increases hypoglycemia effects
nurse is teaching a client who has angina pectoris and is learning how to treat acute anginal attacks. The clients asks, "What is my next step if I take one tablet, wait 5 minutes, but still have anginal pain?" Which of the following responses should the nurse make? "Take two more sublingual tablets at the same time." -"Call the emergency response team." -"Take a sustained-release nitroglycerin capsule." "Wait another 5 minutes then take a second sublingual tablet."
Call emergency response team Then take second tab
nurse is teaching a client who has a new prescription for digoxin to treat heart failure. Which of the following instructions should the nurse include in the teaching? Contact provider if HR is less than 60/min Check pulse rate for 30 seconds & multiply result by 2 Increase intake of sodium Take w food If nausea occurs
Contact provider if HR is less than 60/min
nurse in an acute care facility is caring for a client who is receiving IV nitroprusside for hypertensive crisis. Which of the following conditions should the nurse monitor the client for as an adverse effect of this medication? Intestinal ileus • Neutropenia Delirium • Hyperthermia
Delirium Due to thiocyanate toxicity -> nitro infused at high dosage, monitor thiocyanate levels (10 mg/dL & below =good)
A nurse is taking a medication history from a client who has angina and is to begin taking ranolazine. The nurse should report which of the following medications in the client's history that can interact with ranolazine? (Select all that apply.) Digoxin Simvastatin Verapamil Amlodipine Nitroglycerin transdermal patch
Digoxin -> taken w ranolazine = increase blood levels of digoxin = digoxin toxicity Simvastatin -> taken w ranolazine = increase blood levels of Simvastatin = liver toxicity Verapamil -> inhibits CYP3A4 = increase ranolazine = causes dysthymia
nurse is teaching a client about acarbose therapy to treat type 2 diabetes mellitus. Which of the following instructions should the nurse include? Eat more iron-rich foods. Avoid drinking grapefruit juice. Increase fiber intake. Avoid drinking green tea.
Eat more iron rich food acarbose causes iron deficiency anemia red meat, spinach, grains, monitor CBC
nurse is providing teaching to a client who is about to begin levothyroxine therapy to treat hypothyroidism. Which of the following instructions should the nurse include? Take levothyroxine with food to increase absorption. Take levothyroxine with an antacid to reduce gastrointestinal effects. Expect life-long therapy with the drug. Carry a carbohydrate snack at all times.
Expect life long therapy with the drug
When considering replacement therapy options for a client who has chronic adrenocortical insufficiency, a nurse should recognize that the provider will choose which of the following drugs? Somatropin Hydrocortisone Glucagon Desmopressin
Hydrocortisone
nurse at a provider's office is assessing a client who has been taking hydrocortisone for adrenal insufficiency. The client reports fatigue and feeling overwhelmed by personal responsibilities. Which of the following findings should the nurse identify as an indication the provider might need to increase the client's dosage? Hypotension Hyperglycemia Weight gain Fat redistribution
Hypotension hypotension & fatigue - s/s of adrenal insufficiency - during stressful times usually increase dose
A nurse is caring for a client who is taking propylthiouracil (PTU) and reports weight gain, drowsiness, and depression. The nurse should identify that the client is experiencing which of the following adverse reactions to the drug? thyrotoxicosis hypothyroidism lactic acidosis radiation sickness
Hypothyroidism PTU treats thyrotoxicosis -> weight loss, anxiety, palpitations PTU can cause hypothyroidism, -> drowsiness, weight gain, edema, bradycardia
nurse is providing teaching to a client who has type 2 diabetes mellitus and is starting repaglinide. Which of the following statements by the client indicates understanding of the administration of this medication? "'Il take this medication after I eat." "I'll take this medicine 30 minutes before I eat." "'II take this medicine just before I go to bed." "I'll take this medication at least 1 hour before I eat."
I'll take this med 30 mins before I ea
A nurse is administering a dopamine infusion at a low dose to a client who has severe heart failure. Which of the following findings is an expected effect of this medication? Low HR Increased urine output Decreased conduction through AV node Vasoconstriction of renal blood vessels
Increase urine output
nurse is caring for a client who is taking metformin to treat type 2 diabetes mellitus and reports muscle pain. Which of the following adverse reactions should the nurse suspect? Lactic acidosis Anticholinergic effects Extrapyramidal effects Hypophosphatemia
Lactic acidosis manifests as -> muscle aches, sleepiness, malaise (discomfort), hyperventilation
nurse is caring for a client who has been taking acarbose for type 2 diabetes mellitus. Which of the following laboratory tests should the nurse plan to monitor? WBC Amylase Platelet count Liver Function test
Liver function test can cause liver toxicity when taking longer term
A nurse is caring for a client who is prescribed isosorbide mononitrate for chronic stable angina and develops reflex tachycardia. Which of the following medications should the nurse expect to administer? Furosemide Captopril Ranolazine Metoprolol
Metoprolol Used to decrease HR in clients w tachycardia
nurse is providing teaching to a client about taking fludrocortisone to treat adrenocortical insufficiency. Which of the following instructions should the nurse include? (Select all that apply.) Obtain weight measurement daily. Report weakness or palpitations Have blood pressure checked regularly. Eat more iron-rich foods. Avoid drinking grapefruit juice.
Obtain weight measurement daily. Report weakness or palpitations Have blood pressure checked regularly.
nurse is assessing a client who has a new prescription for levothyroxine. The nurse should identify which of the following findings as a contraindication for this drug? Bacterial skin infections Diabetes insipidus Immunosuppression Recent myocardial infarction
Recent myocardial infarction Levothyroxine -> thyroid hormone replacement, causes -> tachycardia, palpitations, hypertension.
nurse should recognize that a provider will prescribe a lower dose of sitagliptin for a client who has type 2 diabetes mellitus and who also has which of the following? Thyroid disease bronchitis heart failure renal impairment
Renal impairment
nurse is caring for an older adult client who has hypothyroidism and a new prescription for levothyroxine. Which of the following dosage schedules should the nurse expect for this client? The client will start at a high dosage, and the amount will be tapered as needed. The client will remain on the initial dosage during the course of treatment. The client's dosage will be adjusted daily based on blood levels. The client will start on a low dosage, which can be gradually increased.
The client will start on a low dosage, which can be gradually increased.
A nurse is caring for a client who has a new prescription for digoxin and takes multiple other medications. The nurse should recognize that concurrent use of which of the following medications places the client at risk for digoxin toxicity? Phenytoin Verapamil Warfarin Aluminum hydroxide
Verapamil Calcium chancel blocker
nurse is educating the parents of a child who has a new diagnosis of Prader-Willi Syndrome (PWS) and has been prescribed somatropin. Which of the following statements by a parent indicates understanding of the teaching? "We will use a different spot for injection each time we give the medication." *We'll give the shot in the thigh muscle rather than fatty tissue to decrease injection pain." "We'll watch our child for signs of low blood sugar while using somatropin." "We should stop the medication if our child loses weight."
We will use a different spot for injection each time we give the medication."
