RN Live Review Pharmacology 2019
A nurse manager is supervising a staff nurse caring for a postoperative client who is receiving morphine via a patient-controlled analgesia (PCA) pump. Which of the following statements should the nurse manager identify as an indication that the nurse understands how to use this pain-mangement method? A. "I discarded the remaining 2 milligrams of morphine from the PCA pump. Please document that you witnessed it." B. "The client pushed the PCA button eight times in the last hour and it will ove
"I gave the client a bolus dose of morphine when I initiated the PCA pump." It is common practice for PCA prescriptions to begin with a bolus dose to establish a therapeutic blood level of the opioid. Following the bolus dose, the pump can deliver a demand dose and then have a delay or lockout of several minutes, during which time the client will not receive a dose even if the PCA button is pushed to trigger a demand dose. This helps prevent overdosing. Incorrect When a nurse discards a controlled substance, it must be in the presence of another nurse who witnesses the wasting, and both nurses should sign the controlled substances record. It is not unusual for a client to attempt more demand doses than the pump is set to deliver over a period of time; however, the pump will not deliver another dose until the lockout interval has elapsed. If the client attempts several more doses than the pump will deliver according to the current settings, the nurse should assess whether the client h
A nurse is providing discharge teaching to a client who has a new prescription for transdermal nitroglycerin. Which of the following statements should the nurse identify as an indication that the client understands the instructions? A. "I will apply the patch to the same location each time." B. "I should leave the patch in place until it is time for my next dose." C. "I might feel lightheaded when I get out of bed." D. "I will call the doctor if I develop headaches when I use the patches."
"I might feel lightheaded when I get out of bed." Nitroglycerin patches can cause orthostatic hypotension. These effects increase with alcohol consumption. Instruct the client to help avoid orthostatic hypotension by rising slowly and resting their feet on the floor for a few minutes before standing up. They should take precautions to avoid falling when using nitroglycerin patches. The client should not use nitroglycerin patches concurrently with erectile dysfunction medications, because the interaction can cause severe hypotension. Incorrect The client should rotate sites of application of the nitroglycerin patches to reduce skin irritation and enhance absorption. The client should place the patches on hairless, and scar- and lesion-free skin. For full effectiveness, the client should have approximately 10 to 12 hr of "nitrate-free" time. The client should apply the patch at the same time each day and remove the patch about 12 hr later. The client should have a period of 10 to 1
A nurse is teachhing a client who has a new prescription for amoxicillin-clavulanate to treat pharynitis. Which of the following statements should the nurse identify as an indication that the teaching has been effective? A. "I will take this medication until my sore throat goes away." B. "I should take this medication on an empty stomach between meals." C. "If I develop itching, I will stop taking the medication and call the doctor." D. "I should expect constipation when taking this medication.
"If I develop itching, I will stop taking the medication and call the doctor." Penicillin-derived medications are the most common cause of medication allergic reactions. Manifestations of allergic reactions include rashes, hives, and itchy and watery eyes. In rare cases, anaphylactic reactions can develop, and manifestations can include anxiety, fear, difficulty breathing, shortness of breath, stridor, and angioedema. The nurse should instruct the client to seek emergency assistance immediately for a severe allergic response. The client should complete the entire course of antibiotic therapy to avoid the potential for drug resistance and dormant infections. The sore throat might disappear prior to the completion of the antibiotics, but the client must continue taking the medication. The client may take amoxicillin-clavulanate with meals and at the beginning of the meal to minimize gastrointestinal upset and enhance absorption. Constipation is not an adverse effect of this medication.
A nurse is teaching a client who has diabetes mellitus and has a new prescription for prednisone. The nurse should identify that which of the following statements by the client indicates an understanding of the teaching? A. "I need to increase my food intake while taking this medication." B. "My doctor will slowly reduce my dosage when I am ready to discontinue the medication." C. "I should expect my blood glucose levels to be lower while taking this medication." D. "I might feel drowsy while o
"My doctor will slowly reduce my dosage when I am ready to discontinue the medication." Long-term treatment with a glucocorticoid can cause adrenal suppression. If the client suddenly stops taking prednisone, adrenal insufficiency or crisis can develop. Insufficient adrenal hormones can result in Addison's disease, Addisonian crisis, or profuse adrenal insufficiency. The client should taper off the medication to avoid adrenal crisis. Incorrect The nurse should instruct the client that weight gain is an adverse effect of prednisone. The client might need to reduce calorie intake while taking prednisone. Prednisone is a glucocorticoid and can increase serum glucose levels, especially in clients who have diabetes mellitus. The client might need to reduce calorie intake or increase the dosage of hypoglycemic medication while taking prednisone. Insomnia is a common adverse effect of prednisone. It is more likely that the client will report alertness during the course of glucocorticoid the
A nurse is teaching a client who has a new prescription for extended-release metformin. Which of the following instructions should the nurse include in the teaching? A. "Monitor your pulse while taking this medication." B. "Chew the tablet carefully before swallowing." C. "Withhold the medication if your blood glucose level is within the expected reference range." D. "Take the tablet once a day in the evening."
"Take the tablet once a day in the evening." The nurse should instruct the client to take metformin once a day with the evening meal to increase absorption because gastrointestinal transit time slows during the night. Incorrect The nurse should inform the client that metformin does not affect the cardiovascular system. Therefore, it is not necessary for the client to monitor their pulse while taking this medication. It can, however, cause gastrointestinal symptoms, including bloating and an unpleasant metallic taste. The nurse should instruct the client to swallow extended-release tablets whole. The nurse should instruct the client to continue taking the medication for long-term management of diabetes mellitus, a chronic illness. The goal of therapy is maintaining blood glucose levels within the expected reference range.
A nurse is assessing a client who is undergoing treatment for liver cancer. To determine the client's quality of pain, the nurse should ask which of the following questions? A. "What does your pain feel like?" B. "What makes your pain feel worse?" C. "Does your pain make it impossible for you to walk?" D. "How would you rate your pain on a scale from 0 to 10?"
"What does your pain feel like?" Determining whether the client's pain is stabbing, dull, burning, throbbing, shooting, crushing, or sharp can help the nurse distinguish nociceptive pain (tissue damage) from neuropathic pain (nerve damage). Each requires unique pain management strategies. Incorrect Identifying what makes the client's pain better or worse helps the nurse determine the modulating factors affecting the client's pain, not its quality. Nevertheless, modulating factors are an important assessment for determining the client's need for pain medication. Asking about the effect the client's pain has on daily activities helps the nurse determine the impact of the pain, not its quality. Nevertheless, impact is an important assessment for determining the client's need for pain medication. Using a pain scale helps the nurse determine the severity of the client's pain, not its quality. Nevertheless, severity is an important assessment for determining the client's need for pain med
A nurse is preparing to administer ceftriaxone IM 50 mg/kg to an infant who weighs 12 lb 5 oz. Available is ceftriaxone injection 250 mg/mL. How many mL should the nurse administer? (Round the answer to the nearest tenth)
1.1 mL
A nurse is preparing to administer 0.9% sodium chloride 1 L IV to infuse over 8 hr. The drop factor of the manual IV tubing is 10 gtt/mL. The nurse should set the manual IV infusion to deliver how many gtt/min? (Round the answer to the nearest whole number)
21 gtt/min
A nurse is preparing to administer medications to a group of clients. Which of the following clients should the nurse administer medication to first? A. A client who has an oral temperature of 39.4° C (103° F) and is to receive piperacillin/tazobactam B. A client who has a hemoglobin level of 9 g/dL and is to receive epoetin alfa C. A client who has a potassium level of 5.8 mEq/L and is to receive sodium polystyrene sulfonate D. A client who has a platelet count of 145,000/mm3 and is to recei
A client who has a potassium level of 5.8 mEq/L and is to receive sodium polystyrene sulfonate The greatest risk to this client is injury from hyperkalemia; therefore, the first action the nurse should take is to administer the polystyrene sulfonate to the client. Elevated potassium levels can lead to ventricular dysrhythmias and cardiac arrest. Sodium polystyrene sulfonate is a potassium-excreting medication that exchanges potassium for sodium and allows for excretion of potassium through the stool. Incorrect The client is at risk for sepsis because they have an infection with an elevated temperature; however, there is another client the nurse should administer medication to first. Piperacillin/tazobactam is an anti-infective medication that treats community-acquired pneumonia. While this temperature is elevated and the administration of antibiotics is time-sensitive, this client is not at the greatest risk for injury. The client is at risk for fatigue because they have a decreased
A nurse is assessing a client who is taking temazepam. Which of the following statements should the nurse identify as an indication that the medication is effective? A. "I am not sick to my stomach." B. "My headache is gone." C. "The swelling has gone down in my feet." D. "I am sleeping through the night."
"I am sleeping through the night." Temazepam is a sedative-hypnotic benzodiazepine that promotes sleep and reduces anxiety. This statement indicates that the medication is having a therapeutic effect.
A nurse is reviewing the medication administration records of four clients. Which of the following situations should the nurse identify as an indication of a medication administration error? A. A nurse administers an aminoglycoside antibiotic via intermittent IV bolus over 30 min. B. A nurse administers medication from a dry-powder inhaler without the use of a spacer. C. A nurse injects an IM medication into the vastus lateralis site of an adult. D. A nurse crushes an extended-release tablet an
A nurse crushes an extended-release tablet and mixes it with applesauce. Extended- or sustained-release preparations release medication levels over a long period of time to sustain therapeutic relief. Crushing, breaking, or chewing an extended-release medication releases the medication all at once into the bloodstream and alters the pharmacokinetics of the medication, which can be life-threatening. Incorrect Aminoglycoside medications are bacterial antibiotics that target gram-negative bacteria. The nurse should administer them via intermittent IV bolus over at least 30 min. Nephrotoxicity and ototoxicity are two common toxicities with aminoglycosides. Ototoxicity, possibly irreversible, damages the cochlear hair cells; tinnitus is an early manifestation. Management of aminoglycoside therapy includes monitoring peak and trough serum levels. Dry-powder inhalers and breath-actuated metered-dose inhalers do not require spacers. Spacers are devices that increase the absorption of medicat
A nurse is teacing a client who has COPD about the benefits of using a spacer with a metered-dose inhaler (MDI). Which of the following statements should the nurse include in the teaching? A. "A spacer will help you receive more of the medicine." B. "A spacer increases the dispersion rate of the medication." C. "A spacer reduces the amount of medication you need." D. "A spacer provides humidity to reduce dryness."
A. "A spacer will help you receive more of the medicine." Spacers prevent depositing medication into the client's mouth. Reducing the deposit of medicine in the mouth increases the amount of medication in the lungs. Spacers also prevent a sudden inhalation of a medication, which can lead to bronchospasm.
A nurse is teaching a client who has a new prescription for chlorpromazine. Which of the following statements by the client indicates an understanding of the teaching? A. "I should not drive while taking this medication." B. "I am likely to have excessive salivation while taking this medication." C. "Abdominal pain is an indication that my medication dosages are too high." D. "I should stop taking the medication when I feel better."
A. "I should not drive while taking this medication." Chlorpromazine is a first-generation antipsychotic medication that treats schizophrenia. Chlorpromazine can increase central nervous system depression. The client should avoid alcohol and driving while taking these medications. Chlorpromazine can cause anticholinergic effects such as dry mouth, blurred vision, and photophobia. Chlorpromazine does not cause abdominal pain. The client should report a sore throat or a fever, because this medication can cause leukopenia. The client should not stop taking chlorpromazine abruptly due to the increased risk of withdrawal manifestations, including paresthesia, anorexia, diarrhea, dizziness, dyskinesia, myalgia, headache, diaphoresis, and tremors.
A nurse is assessing a client who receives a monthly injection of haloperidol to treat schizophrenia. The nurse should identify which of the following findings as an indication that the medication is effective? A. Decreased agitation B. Decreased appetite C. Decreased urinary output D. Decreased tremors
A. Decreased agitation Haloperidol is used to treat schizophrenia. Clients, especially those who have difficulty with adherence to their medication regimen, receive it every 4 weeks via IM injection to maintain therapeutic levels after achieving stabilization with the oral form. Haloperidol is a first-generation (typical) antipsychotic medication that helps control the positive manifestations of schizophrenia, such as agitation, hallucinations, delusions, and bizarre behavior. Returning to expected eating and sleeping patterns is an indication the medication is effective. Urinary output is not an expected adverse effect of haloperidol, but urinary hesitancy is an anticholinergic effect. Adverse effects of haloperidol include muscle spasms of the tongue, face, neck, and back, mask-like faces, tremors, muscle rigidity, and continuous, restless movement.
A nurse is reviewing the laboratory values of a client who has an acute kidney disease injury and has been taking polystyrene sulfonate for the past 2 days. Which of the following findings indicates to the nurse that the medication has been effective? A. Potassium 4.2 mEq/L B. Sodium 144 mEq/L C. Calcium 9.7 mg/dL D. Magnesium 1.8 mEq/L
A. Potassium 4.2 mEq/L The nurse should identify that polystyrene sulfonate is administered for a client who has hyperkalemia. Therefore, a potassium level of 4.2 mEq/L is within the expected reference range of 3.5 to 5 mEq/L and indicates the medication is working effectively.
A nurse is caring for a client who has a potassium level of 5.9 mEq/L. The nurse should prepare to administer which of the following medications? A. Regular Insulin B. Levothyroxine C. Vasopressin D. Hydrocortisone
A. Regular Insulin A potassium level of 5.9 mEq/L is above the expected reference range of serum potassium and can lead to cardiac dysrhythmias, confusion, anxiety, dyspnea, weakness, and potentially cardiac arrest. Intravenous, regular insulin lowers serum potassium levels by causing an intracellular shift of potassium into cells and out of the blood. It is used to treat hyperkalemia and hyperglycemia. Incorrect Levothyroxine is a synthetic thyroid hormone that treats hypothyroidism. It does not treat hyperkalemia. Vasopressin is an antidiuretic hormone that treats diabetes insipidus. It does not treat hyperkalemia. Hydrocortisone is an anti-inflammatory medication that treats many disorders, including asthma, adrenal insufficiency, and Stevens-Johnson syndrome. It does not treat hyperkalemia.
A nurse is preparing to administer propranolol to a client. For which of the following findings should the nurse withhold the medication? A. Apical heart rate of 48/min B. BP 138/76 mm Hg C. Termperature 37.2° C (99° F) D. Respiratory rate 20/min
Apical heart rate 48/min The nurse should identify that an apical heart of 48/min is below the expected reference range of 60 to 100/min. Propranolol is a beta-blocker medication, which decreases heart rate; therefore, the nurse should hold the medication and notify the provider. Incorrect The nurse should identify that a blood pressure of 138/76 mm Hg is above the expected reference range of 120/80 mm Hg. Propranolol is a beta-blocker medication that can be used to decrease blood pressure; therefore, this finding is not an indication for the nurse to hold the medication. The nurse should identify that a temperature of 37.2° C (99° F) is within the expected reference range of 36° to 38° C (96.8° F to 100.4° F); therefore, this finding is not an indication for the nurse to hold the medication. The nurse should identify that a respiratory rate of 20/min is within the expected reference range of 12 to 20/min; therefore, this finding is not an indication for the nurse to hold the m
A nurse is teaching a client who will start using transdermal fentanyl. Which of the following statements should the nurse identify as an indication that the client understands the teaching? A. "I can use an electric blanket while in bed." B. "I will replace the patch every day." C. "I should apply the patch to my upper thigh." D. "I can take an oral analgesic for breakthrough pain."
B. "I will replace the patch every day." Fentanyl is a transdermal opioid agonist for managing persistent, moderate-to-severe chronic pain. It takes up to 24 hr after the client applies the patch for medication levels to reach their peak. The client should use short-acting analgesics to treat acute or breakthrough pain. Heat causes an increase in the release of the medication from the patch, as well as vasodilatation, which can increase the absorption of the medication. A client using a fentanyl patch should avoid the use of heating pads, hot tubs, heated water beds, and electric blankets. The transdermal patch releases medication steadily over a period of 72 hr, although in some cases the client will need to change the patch every 48 hr. Following application to the skin, medication levels slowly rise and reach therapeutic levels within 24 hr. Medication levels will remain steady for the next 48 hr, after which the client should replace the patch. The client should apply the fentany
A nurse is assessing a client who is taking simvastatin/ezetimibe to treat hypercholesterolemia. Which of the following findings should the nurse identify as a potential adverse reaction to this medication? A. Weight loss B. Muscle weakness C. Hypoglycemia D. Facial flushing
B. Muscle weakness Both simvastatin and ezetimibe can lead to myopathy, which can include muscle aches, tenderness, and weakness. Myopathy can progress to rhabdomyolysis, which is a breakdown of muscle cells.
A nurse is assessing a client who is receiving vincristine for the treatment of breast cancer. Which of the following manifestations should the nurse identify as an adverse effect of the medication? A. Hematuria B. Numbness of fingers C. Anxiety D. Diarrhea
B. Numbness of fingers Vincristine can cause peripheral neuropathy, muscle atrophy, and numbness and tingling in the hands and feet. Incorrect Blood in the urine is an adverse effect of cisplatin, not vincristine. Anxiety is not an adverse reaction of vincristine; however, this medication can cause CNS depression, decreased reflexes, and motor difficulties. Constipation is an adverse effect of vincristine.
A nurse is preparing to administer diltiazem to a client. The nurse should plan to monitor the client for which of the following findings as an adverse effect of the medication? A. Nystagmus B. Hypoglycemia C. Dizziness D. Hypertension
C. Dizziness The nurse should monitor the client for the adverse effect of dizziness, which can indicate hypotension or cardiac dysrhythmia. Adverse effects of diltiazem: Blurred vision, hyperglycemia, and hypotension
A nurse is teaching a client who has a new prescription for sucralfate. The nurse should instruct the client to avoid taking which of the following over-the-counter medications within 30 min of taking sucralfate? A. Amoxicillin B. Diphenhydramine C. Magnesium hydroxide D. Aspirin
C. Magnesium hydroxide Antacids can reduce the therapeutic effects of sucralfate. The nurse should instruct the client to avoid taking antacids within 30 min of taking sucralfate. Incorrect Amoxicillin does not interact with sucralfate. Sucralfate does interact and interfere with the absorption of fluoroquinolone antibiotics, such as ciprofloxacin. Diphenhydramine does not interact with sucralfate. Sucralfate does interact and interfere with the absorption of theophylline. Aspirin does not interact with sucralfate. Sucralfate does interact and interfere with the absorption of digoxin and warfarin.
A nurse is assessing a client who is taking phenytoin to treat a partial seizure disorder. Which of the following findings should the nurse report to the provider immediately? A. Report of dizziness B. Swollen gums C. Measles-like rash D. Report of nausea
C. Measles-like rash A measles-like rash indicates that the client is at greatest risk for Stevens-Johnson syndrome, or toxic epidermal necrolysis, which is a life-threatening condition. Therefore, the nurse should report this finding to the provider immediately. Although phenytoin can cause dizziness and the nurse should document any adverse effects for the provider to review, there is a greater risk to the client than dizziness. Phenytoin can cause gingival hyperplasia. Manifestations of gingival hyperplasia include bleeding and swollen gums. Although the nurse should monitor for gingival hyperplasia and document any adverse effects for the provider to review, there is a greater risk to the client than swollen gums. Although phenytoin can cause nausea, and the nurse should document any adverse effects for the provider to review, there is a greater risk to the client than nausea.
A nurse is preparing to start a continuous IV infusion of heparin for a client. Which of the following actions should the nurse take? A. Monitor serum bilirubin daily. B. Check activated partial thromboplastin time (aPTT) every 4 hr. C. Have vitamin K available on the nursing unit. D. Use IV tubing specific for heparin when administering the infusion.
Check activated partial thromboplastin time (aPTT) every 4 hr. The nurse should monitor aPTT every 4 hr until the client has reached a therapeutic level. The therapeutic reference range of aPTT is 60 to 80 seconds, which is one and a half to two times the expected reference range. Heparin can cause thrombocytopenia by the fourth day of treatment but does not alter serum bilirubin. The nurse should monitor the platelet count every 2 to 3 days. Vitamin K is the antidote for warfarin. The nurse should have protamine sulfate available as the antidote for heparin overdose. IV heparin administration does not require special tubing. A few medications, such as nitroglycerin, adhere to the standard primary IV tubing and require the use of non-polyvinyl-chloride IV tubing specific for the administration of nitroglycerin, which is available in a glass infusion bottle.
A nurse is reviewing the medication record of a client and realizes that an incorrect dose of diltiazem was administered. Which of the following actions should the nurse take first? A. Check the client's blood pressure. B. Notify the client's provider of the error. C. Complete an incident report. D. Document findings in the medical record.
Check the client's blood pressure The greatest risk to this client is injury from an incorrect dose of the medication being administered; therefore, the first action the nurse should take is to obtain the client's vital signs, including blood pressure, and assess the client for adverse effects of hypotension. Incorrect The nurse should notify the client's provider of the error in case further intervention needs to be taken as a result of receiving an incorrect dose of medication; however, there is another action that the nurse should take first. The nurse should complete an incident report about the medication error. This report provides information about statistics and tracking for risk management. This information is intended to help prevent future errors; however, there is another action that the nurse should take first. The nurse should document the client's status and all findings, including blood pressure, in the client's medical record; however, there is another action that th
A nurse is reviewing the laboratory reports for a group of clients taking furosemide. The nurse should recognize that a new prescription for potassium chloride 40 mEq PO twice a day is contraindicated for which of the following clients? A. Client who has a potassium level of 2.8 mEq/L B. Client who has a calcium level of 9.3 mg/dL C. Client who has a PT of 11.5 seconds D. Client who has a potassium level of 5.2 mEq/L
Client who has a potassium level of 5.2 mEq/L A potassium level of 5.2 mEq/L is above expected reference range of 3.8 to 5 mEq/L and indicates hyperkalemia. Administering the KCl will increase the client's potassium level and can lead to bradycardia, muscle weakness, dyspnea, confusion, and cardiac arrhythmias.
A nurse is caring for a client who received midazolam IV for a colonoscopy 1 hr ago. Which of the following findings should the nurse identify as a potential adverse effect of the medication? A. Coughing B. Increase in flatulence C. Tachypnea D. Increased blood pressure
Coughing The nurse should identify that coughing or bronchospasms are a potential adverse effect for a client who has received midazolam for moderate sedation. The nurse should monitor the client's respiratory status and oxygenation to ensure the client is stable until the effects of medication subside.
A nurse is reviewing the medical history of a client who has mild dementia and reports taking the dietary supplement ginkgo biloba. Which of the following information in the client's medical history should the nurse identify as a contraindication for taking ginkgo biloba? A. Osteoarthritis B. Glaucoma C. Hyperthroidism D. Seizure disorder
D. Seizure disorder Ginkgo biloba is an herbal supplement some clients take to improve age-related memory loss and to decrease leg pain due to peripheral arterial disease. This dietary supplement interferes with coagulation and might provoke seizure activity. It interacts with medications such as anticonvulsants, antidepressants, decongestants, some antihistamines, and antipsychotics.
A nurse is assessing a client for pain who is 4 hr postoperative following surgery and still experiencing the effect of anesthesia. Which of the following findings should the nurse identify as an indication that the client might be experiencing pain and requires pain medication? A. Reduced blood glucose B. Pupil constriction C. Diaphoresis D. Facial flushing
Diaphoresis A client who has pain can become diaphoretic in an attempt to keep the body temperature under control during times of stress. Incorrect Blood glucose can increase in a client who has pain as the body attempts to make more energy available. Pupils can dilate in a client who has pain to help improve vision. A client who has pain can become pale as the body shifts blood to the central circulation and away from the peripheral circulation.
A nurse is assessing a client who has Alzheimer's disease and is taking oral rivastigmine. Which of the following findings indicates the client is experiencing an adverse effect of the medication? A. Diarrhea B. Tachycardia C. Dry skin D. Weight gain
Diarrhea Diarrhea is an adverse effect of rivastigmine due to the peripheral cholinergic effects of the medication. Rivastigmine is a cholinesterase inhibitor, which causes cholinergic actions such as bradycardia, atrioventricular (AV) block, and cardiac arrest. Rivastigmine is a cholinesterase inhibitor, which causes cholinergic actions, such as diaphoresis. Rivastigmine is a cholinesterase inhibitor, which causes cholinergic actions, such as anorexia, nausea, vomiting, diarrhea, and abdominal pain, which can lead to weight loss.
A nurse is assessing a client who has been taking simvastatin and has alanine aminotransferase (ALT) and aspartate aminotransferase (AST) elevations. Which of the following findings is the nurse's priority assessment? A. Knowledge of the medication's adverse effects B. Dietary intake of grapefruit C. Changes in exercise routine D. Recent weight gain
Dietary intake of grapefruit The greatest risk to this client is injury from liver damage due to elevated simvastatin levels; therefore, finding out that the client drinks grapefruit juice should be the nurse's priority. Grapefruit juice inhibits the drug-metabolizing enzyme CYP3A4, predominantly in the small intestine, but at higher doses it also inhibits hepatic CYP3A4. The result is increased blood levels of simvastatin and the potential for serious adverse effects, such as elevated liver enzymes and rhabdomyolysis (potentially fatal disintegration of muscle tissue). Incorrect The nurse should evaluate the client's knowledge of adverse effects to make sure they know what to observe for and report; however, another assessment is the priority. The nurse should evaluate the client for changes in exercise routine to make sure they are following the recommendations for reducing cardiovascular risk factors; however, another assessment is the priority. The nurse should evaluate the clien
A nurse is teaching a client who has a new prescription for metoprolol. Which of the following findings should the nurse instruct the client to monitor for and report to the provider? A. Tinnitus B. Weight loss C. Dizziness D. Tachycardia
Dizziness The nurse should instruct the client to monitor and report dizziness to the provider because this can indicate hypotension and a need for a dosage adjustment. Incorrect Tinnitus is not an adverse effect of metoprolol. The nurse should instruct the client to monitor for and report blurred vision and stuffy nose, which are adverse effects of metoprolol. Weight loss is not an adverse effect of metoprolol. The nurse should instruct the client to monitor for and report weight gain or edema, which can indicate heart failure. Metoprolol, a cardioselective beta-adrenergic blocking agent, is more likely to cause bradycardia than tachycardia.
A nurse is preparing to administer enteric-coated aspirin to a client who has had a myocardial infarction. The client states, "I won't have another heart attack, so I don't want the medication." Which of the following actions should the nurse take? A. Document the client's decisions in the medical record. B. Discuss alternate medications with the client. C. Tell the client they must take the medication. D. Inform the client they will be required to sign a medication refusal form.
Document the client's decisions in the medical record The nurse should identify that the client has the right to refuse treatments or medications at any time. Therefore, the nurse should document the client's decision in the client's medical record and notify the client's provider. It is the responsibility of the client's provider to discuss alternate medications with the client and the risks for of taking the medication. The client has the right to refuse medications at any time and for any reason. Clients have the right to refuse a medication and are not required to sign any documentation. It is the nurse's responsibility to document the refusal in the client record.
A nurse is reviewing a prescription for a client who has hypertension. The prescription reads atenolol 250 mg PO once daily. Which of the following parts of the prescription should the nurse clarify with the provider? A. Dose B. Route C. Medication D. Frequency
Dose The nurse should clarify the dose of the medication with the provider. Atenolol is a beta blocker used to treat hypertension and angina. Atenolol dosage can range from 50 to 100 mg and should not exceed 100 mg in 24 hr for the treatment of hypertension.
A nurse is completing an incident report after discovering a client received the wrong dosage of medication. The nurse assessed the client and noted no harmful effects. Which of the following actions should the nurse take after completing the incident report? A. Place the incident report in the client's chart. B. File the incident report as soon as possible. C. Document that an incident report was filed. D. Send a copy of the incident report to the provider.
File the incident report as soon as possible. The nurse should complete and file the incident report as soon as possible following the occurrence to legally protect the nurse and facility. Generally, the incident report should be filed within 24 hr. Incorrect The incident report is an important part of the quality improvement program of the facility, and the nurse submits the document to the risk management department. The incident report is not a part of the client's medical record. The nurse should document objective information about the occurrence in the client's medical record but not that nurse completed and filed an incident report. The nurse should notify the provider of the error after assessing the client but should not send a copy of the report to the provider.
A nurse is assessing a client who takes beclomethasone to treat asthma. Which of the following findings should the nurse identify as an adverse effect of this medication? A. Excessive salivation B. Hoarseness C. Tremors D. Bitter taste
Hoarseness Dysphonia, which includes hoarseness and difficulty speaking, is an adverse effect of beclomethasone. The nurse should instruct the client to gargle with water after each use to prevent dysphonia and oral candidiasis. The provider can prescribe an antifungal medication if the client develops oral candidiasis. Incorrect The nurse should assess the client for dry mouth, not excessive salivation, as an adverse effect of beclomethasone. Tremors are not an adverse effect of beclomethasone. Systemic beta2-adrenergic agonists, such as albuterol, can cause tremors. Bitter taste is not an adverse effect of beclomethasone. Antihistamines and cromolyn can cause bitter taste.
A nurse is reviewing the medical history of a client who reports taking pseudoephedrine. The nurse should identify that which of the following findings indicates the client should use caution when taking this medication? A. Hypothyroidism B. Migraines C. Hypertension D. Diverticulitis
Hypertension Pseudoephedrine, a decongestant, causes vasoconstriction and can cause tachycardia and an increase in blood pressure. It requires caution for clients who have hypertension or acute coronary syndrome. Contraindications include closed-angle glaucoma and hypersensitivity to sympathomimetic medications.
A nurse is caring for a client who has primary hypothyroidism and has been taking levothyroxine for 8 weeks. The current thyroid stimulating hormone (TSH) level is 5.2 microunits/mL. The nurse should expect which of the following prescriptions regarding the client's medication? A. Decrease in the dosage B. Discontinue the medication C. Increase in the dosage D. Maintain the current dosage
Increase in the dosage A TSH of 5.2 microunits/mL is above the expected reference range, which indicates the thyroid hormone level is not adequate. The nurse should expect a prescription to increase the dosage of the medication to achieve a therapeutic TSH level for the client. The client should undergo laboratory testing in 6 to 8 weeks after the dosage increase to reassess the TSH level.
A nurse is caring for a client who has alcohol use disorder and whose last alcohol intake was 12 hr ago. The client reports consuming 400 mL of vodka daily for the past 15 years. Which of the following manifestations of withdrawal should the nurse expect? A. Increased temperature B. Weight gain C. Pinpoint pupils D. Respiratory depression
Increased temperature Depending on the amount of chronic alcohol consumption, alcohol withdrawal often begins anywhere from 12 to 72 hr following the last alcohol intake and can last up to 7 days. Manifestations seen in clients who have high dependency include neurologic manifestations, such as tremors, seizures, hallucinations, disorientation, and loss of insight. Physical manifestations include tachycardia, hypertension, elevated temperature, abdominal cramping, and vomiting. Left untreated, severe cases can result in cardiovascular collapse and death. Weight gain is a manifestation of abstinence syndrome seen in clients who are withdrawing from nicotine use. Manifestations begin within 24 hr of the last use of tobacco and can last several months. Neurologic manifestations include craving, nervousness, restlessness, increased agitation, hostility, insomnia, and a decreased ability to concentrate. Physical manifestations include increased appetite leading to weight gain. Pinpoint pu
A nurse is teaching a client who is a resident of a long-term care facility about testing for tuberculosis (TB) with the intradermal Mantoux test. Which of the following information should the nurse include in the teaching? A. A raised, reddened area of 3 mm indicates a positive result. B. The injection site requires evaluation within 24 hr. C. Individuals who are at high risk should receive a Mantoux test annually. D. A positive result confirms active infectious disease.
Individuals who are at high risk should receive a Mantoux test annually The nurse should instruct the client that individuals at high risk, such as those residing in a long-term care facility, health care workers, or individuals who are homeless, should receive a Mantoux test annually. A raised, reddened area smaller than 10 mm in diameter is a negative response, indicating no exposure to TB. An indurated area (palpable, raised, and hard) that is 10 mm or larger in diameter is a positive reaction, indicating exposure to TB and the possible presence of a TB infection. In clients who have HIV, a reaction of 5 mm or larger is positive. The nurse should evaluate Mantoux test results 48 to 72 hr after administration. The client might have to return for a reading at 72 hr if the 48-hr result is questionable. A 72-hr reading is the most accurate. A positive response indicates that the client has developed an immune response to the bacillus due to exposure to Mycobacterium tuberculosis. A po
A nurse is administering methotrexate to a client who has lymphosacrcoma. The nurse should encourage the client to maintain an adequate fluid intake to prevent which of the following adverse effects of the medication? A. Kidney damage B. Alopecia C. Thrombocytopenia D. Dermatitis
Kidney damage The client should have a fluid intake of 2,000 to 3,000 mL per day to promote medication excretion and prevent kidney damage. Maintaining an adequate fluid intake will not reduce the risk of alopecia, which is an adverse effect of methotrexate. Maintaining an adequate fluid intake will not reduce the risk of thrombocytopenia, which is an adverse effect of methotrexate. Maintaining an adequate fluid intake will not reduce the risk of dermatitis, which is an adverse effect of methotrexate.
A nurse is caring for a client who has a continuous epidural infusion. Which of the following actions should the nurse take? A. Use clean technique when changing the infusion tubing. B. Measure the client's blood pressure frequently. C. Change the dressing over the insertion site daily. D. Secure the catheter to the client's gown.
Measure the client's blood pressure frequently. The nurse should monitor the client's blood pressure for at least 1 hr and frequently after following insertion of an epidural catheter and during the infusion of medication due to the risk of hypotension. Incorrect The nurse should use surgical asepsis when changing the infusion tubing to prevent an infection. The nurse should avoid routinely changing the dressing over the insertion site unless it is damp or soiled to prevent the introduction of an infection. The nurse should secure the catheter to the client's skin to prevent catheter displacement.
A nurse is teaching a client who has a new prescription for verapamil. Which of the following instructions should the nurse include in the teaching? A. Take the medication on an empty stomach. B. Use aspirin to relieve facial flushing. C. Begin a low-residue diet. D. Monitor for weight gain.
Monitor for weight gain The nurse should instruct the client to monitor for weight gain and edema. The client might need a prescription for a diuretic. The nurse should instruct the client to take verapamil with food to reduce gastric distress. The nurse should instruct the client to avoid taking aspirin due to an increased risk for bleeding and because NSAIDs can reduce verapamil's antihypertensive action. The nurse should instruct the client to increase fluid and fiber intake to prevent constipation.
A nurse is assessing a client who is dehydrated. Which of the following findings is an indication of hypokalemia? A. Muscle weakness B. Hyperactive bowel sounds C. Positive Chvostek's sign D. Red tongue
Muscle weakness The nurse should recognize that muscle weakness, fatigue, and lethargy are manifestations of hypokalemia. Hypokalemia occurs when serum potassium levels are less than 3.5 mEq/L. Incorrect The nurse should recognize that hypoactive bowel sounds and decreased bowel motility is a manifestation of hypokalemia. Hyperactive bowel sounds are a manifestation of hyperkalemia. The nurse should recognize that a positive Chvostek's sign is a manifestation of hypocalcemia and hypomagnesemia. This sign is tested by the nurse tapping the client's cheek just in front of the ear to see if the client exhibits twitching of the facial muscle. The nurse should recognize that a dry, swollen, red tongue is a manifestation of hypernatremia.
A nurse is assessing a client who has preeclampsia and is receiving magnesium sulfate IV therapy. The nurse should identify which of the following findings as an indication that the client is having a therapeutic response? A. Increase in contractions B. No seizure activity C. No uterine bleeding D. Decrease deep-tendon reflexes
No seizure activity Magnesium sulfate is indicated to prevent seizures resulting from preeclampsia or severe eclampsia. The nurse should identify that no seizure activity is an indication that the magnesium sulfate therapy has been therapeutic. Incorrect Evidence-based practice does not indicate that magnesium sulfate increases or decreases contractions. Low doses of magnesium sulfate can help prevent spina bifida. Magnesium sulfate is not indicated for uterine bleeding. A client who has uterine atony can receive oxytocin to promote uterine contractility and prevent bleeding. Adverse effects of magnesium sulfate includes loss of deep-tendon reflexes, muscle weakness, decreased urine output, and respiratory depression. The nurse should monitor the client's neurological, renal, and respiratory function.
A nurse is caring for a client who has a new prescription for enoxaparin. Which of the following laboratory tests should the nurse plan to monitor? A. Platelets B. aPTT C. INR D. PT
Platelets Enoxaparin can cause thrombocytopenia. The nurse should monitor the client's platelet count for thrombocytopenia because this can be a life-threatening condition. Enoxaparin does not affect the client's aPTT level. An aPTT level is used to monitor the effects of heparin. Enoxaparin does not affect the client's INR level. An INR level is used to monitor the effects of warfarin. Enoxaparin does not affect the client's PT level. A PT level is used to monitor the effects of warfarin.
A nurse is reviewing the laboratory report of a client who is taking furosemide. Which of the following findings should the nurse report to the provider immediately? A. Potassium 2.8 mEq/L B. Calcium 9.3 mg/dL C. Sodium 142 mEq/L D. Magnesium 1.8 mEq/L
Potassium 2.8 mEq/L The nurse should identify that a client who is taking furosemide can experience hypokalemia as an adverse effect. A potassium level of 2.8 mEq/L is below the expected reference range of 3.5 to 5 mEq/L, and severe hypokalemia can cause dysrhythmias. Therefore, the nurse should notify the provider immediately.
A nurse is assessing a client who is receiving morphine via a patient-controlled analgesia (PCA) pump and finds the client sedated and difficult to arouse. Which of the following actions should the nurse take? A. Raise the head of the bed B. Prepare to administer diphenhydramine C. Decrease the demand dosage D. Prepare to administer flumazenil
Raise the head of the bed The nurse should raise the head of the bed for a client who is difficult to arouse following opioid administration to help improve ventilation. The nurse should administer diphenhydramine to treat adverse effects, such as itching, and administer epinephrine for anaphylaxis. The nurse should stop the PCA so that the client receives no further morphine and notify the provider so adjustments can be made to the prescription. Flumazenil treats benzodiazepine toxicity. The nurse should prepare to administer naloxone, an opiate antagonist, to a client who has opioid toxicity.
A nurse is teaching a client who has a new prescription for levodopa-carbidopa. Which of the following instructions should the nurse include in the teaching? A. Report muscle twitching to your provider. B. Reduce your daily fluid intake. C. Take the medication with a high-protein meal. D. Discontinue the medication if your urine turns a dark color.
Report muscle twitching to your provider. The nurse should instruct the client that levodopa-carbidopa can cause dyskinesias with toxicity and to report muscle twitching, tremors, and spastic winking. Incorrect Reducing fluid intake can increase the risk of orthostatic hypotension. The nurse should instruct the client to drink at least 2 to 3 L of fluid daily to maintain adequate blood volume. Protein reduces the absorption of levodopa-carbidopa. The nurse should instruct the client to avoid taking levodopa-carbidopa with a high-protein meal. The nurse should inform the client that levodopa-carbidopa can cause urine and sweat to become dark in color; however, this is a harmless effect and is not an indication to discontinue the medication.
A nurse is assessing a client who has chronic pain disorder and is requesting pain medication. Which of the following findings should the nurse identify as the most reliable indicator of the client's pain? A. The client's behavior B. Changes in the client's vital signs C. The client's facial expression D. The client's verbal report
The client's verbal report According to evidence-based practice, the nurse should identify the client's verbal report as the most reliable indicator of pain because pain is subjective and individualistic. The nurse should ask the client about the location, quality, and intensity of the pain.
A nurse is reviewing the medical record of a client who is receiving vancomycin for sepsis. For which of the following findings should the nurse withhold the medication and notify the provider? A. Trough level 25 mcg/mL B. Temperature 101.2°F (38.4°C) C. Peak level 48 mcg/mL D. Enlarged lymph nodes
Trough level 25 mcg/mL The nurse should withhold the medication and notify the provider of a trough level that is outside the expected reference range. For severe infections, the trough level should be 15 to 20 mcg/mL. A higher concentration of medication is an indication of toxicity; therefore, the nurse should withhold the medication and notify the provider. The nurse should identify that physiological responses to a serious infection include fever and increased respiratory and pulse rates; therefore, the nurse should administer the antibiotic as prescribed. The nurse should identify that medications such as vancomycin require close monitoring of peak and trough levels to ensure therapeutic levels while maintaining client safety with regard to toxicity. A peak level of 48 mcg/mL is within the expected reference range of 18 to 50 mcg/mL. The nurse should identify that physiological responses to a serious infection include enlarged lymph nodes and increased respiratory and pulse rate
A nurse is teaching a client who has a new prescription for sulfamethoxazole-trimethoprim. The nurse should instruct the client to monitor for and report which of the following manifestations as an adverse effect of the medication? A. Vomiting B. Double vision C. Constipation D. Tingling in the extremities
Vomiting The nurse should instruct the client to monitor for and report vomiting after taking sulfamethoxazole-trimethoprim, which can indicate an adverse effect of the medication. Incorrect Double vision, also known as diplopia, is not an adverse effect of sulfamethoxazole-trimethoprim. However, this medication can cause tinnitus. MY ANSWER Diarrhea is an adverse effect of sulfamethoxazole-trimethoprim. Paresthesia, or tingling in the hands and feet, is not an adverse effect of sulfamethoxazole-trimethoprim. It can, however, cause vertigo, hallucinations, and seizures.
A nurse is preparing to administer the first dose of spironolactone to a client. Before administering the medication, which of the following parameters should the nurse assess? A. Visual acuity B. Weight C. Temperature D. Peripheral pulses
Weight Spironolactone affects the client's fluid balance; therefore, the nurse should assess a baseline weight before administering this medication. Changes in weight help the provider determine the need for adjusting the dosage.
A nurse is preparing to administer methylphenidate 20 mg PO to a client who reports taking selegiline. Which of the following actions should the nurse take? A. Reduce the dosage of methylphenidate. B. Give methylphenidate and monitor for adverse effects. C. Administer nifedipine prior to methylphenidate. D. Withhold methylphenidate and clarify the prescription.
Withhold methylphenidate and clarify the prescription. The nurse must inform the provider about the client's use of selegiline before administering methylphenidate. Methylphenidate, in combination with an MAOI such as selegiline, can cause hyperpyrexia, seizures, delirium, excitation, and eventually coma and death. The provider should discontinue an MAOI 2 weeks before the client begins receiving other medications that can interact. Combining these medications can cause a hypertensive crisis regardless of the administration of nifedipine, an antihypertensive. The provider should discontinue an MAOI 2 weeks before the client begins receiving other medications that can interact.
A nurse is assessing a client who is taking esomeprazole. Which of the following statements by the client should the nurse identify as an indication that the medication is having an effect therapeutic response? A. "My headaches are gone." B. "My mouth isn't so dry anymore." C. "The burning in my throat is gone." D. "I have regular bowel movements."
"The burning in my throat is gone." Esomeprazole is a proton-pump inhibitor and works in the parietal cells of the stomach by inhibiting the proton-pump enzyme that generates gastric acid secretion. It treats gastric ulcers, duodenal ulcers, and GERD. An expected finding with effective treatment is a decrease in the client's manifestations of an ulcer or GERD. Heartburn is a common manifestation of GERD, so the absence of burning is an indication that the medication is working effectively.
A nurse is preparing to apply nitroglycerin ointment to a client. Identify the sequence of actions the nurse should follow. (Move the steps into the box on the right, placing them in the order of performance. Use all the steps.)
- Don a pair of clean gloves - Remove prior medication - Squeeze the dose onto the application paper - Apply the medication to the client - Cover the site with a transparent dressing First, the nurse should perform hand hygiene and don a pair of clean gloves before removing the prior dose of nitroglycerin. The nurse should exercise caution when removing or applying a dose of nitroglycerin. If the nurse comes in contact with the nitroglycerin, the medication can cause vasodilatation, headache, decreased blood pressure, and syncope. The nurse should completely remove the previous dose before applying the second dose. The effect of leaving more than one dose in place simultaneously can increase the effective dose and cause an unsafe drop in blood pressure with adverse outcomes. Next, the nurse should spread the nitroglycerin ointment over the applicator paper in a 2.5- to 3.5-inch area. Then, the nurse should use the paper to apply the nitroglycerin to the client's chest, abdomen, or an
A nurse is teaching a client who has diabetes mellitus about self-administration of NPH and regular insulin. Which of the following actions by the client should the nurse identify as an indication that the teaching was effective? (select all that apply) - Shake the bottle of NPH insulin briskly - Inject air into the bottle of NPH insulin and then into the bottle of regular insulin. - Withdraw the regular insulin before the NPH insulin. - Add a small air bubble to the syringe after withdrawing t
- Inject air into the bottle of NPH insulin and then into the bottle of regular insulin. - Withdraw the regular insulin before the NPH insulin. Shake the bottle of NPH insulin briskly is incorrect. The client should mix the vial of NPH insulin, rather than shaking it, to distribute its contents uniformly before withdrawing the dose. Shaking the vial can result in foaming of the medication, which can result in inaccurate dosing of the insulin. Inject air into the bottle of NPH insulin and then into the bottle of regular insulin is correct. The client should inject air into the bottle of NPH insulin first because it will be the last bottle from which the client will withdraw insulin and it will facilitate withdrawing the insulin from that vial. Withdraw the regular insulin before the NPH insulin is correct. When mixing regular insulin with NPH insulin, the client should withdraw the regular insulin first to avoid contaminating the vial of regular insulin with the longer-acting NPH i
A nurse is preparing to administer digoxin elixir 0.16 mg PO to a client. Available is digoxin elixir 0.05 mg/mL. How many mL should the nurse administer? (Round the answer to the nearest tenth.)
3.2 mL
A nurse is documenting assessment findings from a client who is taking donepezil. Which of the following findings should the nurse identify as an adverse effect of this medication? A. Tachycardia B. Dyspepsia C. Pitting edema D. Urinary retention
B. Dyspepsia Gastrointestinal adverse effects of donepezil include dyspepsia, abdominal pain, nausea, vomiting, anorexia, and diarrhea. Frequent urination, rather than urinary retention, is an adverse effect of donepezil.
A nurse is assessing a client who is taking interferon beta-1b for treatment of multiple sclerosis. The nurse should monitor for which of the following findings as an adverse effect of this medication? A. Hepatotoxicity B. Hyperglycemia C. Thrombophlebitis D. Pulmonary edema
Hepatotoxicity The nurse should monitor the client's liver function tests at frequent intervals to assess for hepatotoxicity, an adverse effect of interferon beta-1b.
