RN Pharmacology Online Practice 2016 B
A nurse is teaching a client about warfarin. The client asks if she can take aspirin while taking the warfarin. Which of the following responses should the nurse make?
"Aspirin will increase the risk of bleeding." Aspirin inhibits platelet aggregation and can potentiate the action of the anticoagulant warfarin. Therefore, it increases the risk for bleeding, so the client should avoid taking aspirin.
A nurse is teaching a client who is to start taking hydrocodone with acetaminophen tablets for pain. Which of the following information should the nurse include in the teaching?
"Decreased respirations might occur" The nurse should instruct the client that hydrocodone with acetaminophen might cause respiratory depression, which is an adverse effect of the medication. The client should avoid taking over-the-counter medications or newly prescribed medications without consulting her provider to avoid increased respiratory depression.
A nurse is teaching a client about the use of risedronate for the treatment of osteoporosis. The nurse should identify which of the following statements as an indication that the client understands the teaching?
"I should sit up for 30 minutes after taking the risedronate" Sitting upright for at least 30 min after taking risedronate will reduce the adverse gastrointestinal effects of esophagitis and dyspepsia. Risedronate is contraindicated for a client who cannot sit or stand upright for this length of time.
A nurse is providing teaching to a client who has depression and has a new prescription for fluoxetine. Which of the following statements by the client indicates an understanding of the teaching?
"I should take acetaminophen instead of ibuprofen for my headaches while taking this medication." Fluoxetine suppresses platelet aggregation, which increases the risk of bleeding when used concurrently with NSAIDs and anticoagulants. Therefore, clients who are taking fluoxetine should take acetaminophen for headaches or pain, since acetaminophen does not suppress platelet aggregation.
A nurse is providing discharge instructions to a client who has heart failure and a new prescription for captopril. Which of the following client statements indicates an understanding of the teaching?
"I should tell my provider if I develop a sore throat" The client should report a sore throat to the provider because this can indicate neutropenia, a serious adverse effect of captopril. Neutropenia can be reversed if it is recognized early and the medication is promptly discontinued.
A nurse is teaching a client who is starting to take diltiazem. Which of the following statements should the nurse identify as an indication that the client understands the teaching?
"I will check my heart rate before I take the medication" Diltiazem, a calcium channel blocker, has cardio-suppressant effects at the SA and AV nodes, which can lead to bradycardia. The client should check her heart rate before taking the medication and notify the provider if it falls below the expected reference range.
A nurse is instructing a client on the application of nitroglycerin transdermal patches. Which of the following statements by the client indicates an understating of the teaching?
"I will take the patch off right after my evening meal" Clients should remove the patch each evening for a medication free time of 12 to 14 hr before applying a new patch to avoid developing a tolerance to the medication's effects.
A nurse is providing teaching to a client who has a gastric ulcer and a new prescription for ranitidine. which of the following instructions should the nurse include?
"Report yellowing of the skin" Ranitidine can be hepatotoxic and cause jaundice. The nurse should instruct the client to monitor for and report yellowing of the skin or eyes to the provider.
A nurse is teaching about a new prescription for cipofloxacin to an older adult client who has a urinary tract infection. the nurse should identify which of the following statements as an indication that the clint understands the teaching?
"i will report any signs of tendon pain or swelling" Ciprofloxacin, a fluoroquinolone, is associated with a risk of tendon rupture. This risk is increased in older adult clients, so the client should notify the provider at the onset of tendon pain or swelling.
A nurse is preparing to administer dextrose 5% in water (D5W) 400 mL IV to infuse over 1 hr. The drop factor of the manual IV tubing is 15gtt/mL. The nurse should set the manual IV infusion to deliver how many gatt/min?
100gtt/min
A nurse is preparing to administer Ciprofloxacin 15mg/kg PO every 12 hr to a child who weighs 44lbs. how many mg should the nurse administer per dose?
300mg
A nurse is teaching a group of unit nurses about medication reconciliation. Which of the following information should the nurse include in the teaching?
A transition in care requires the nurse to conduct medication reconciliation. The nurse should conduct medication reconciliation anytime the client is undergoing a change in care (admission, transfer from one unit to another, discharge). A complete listing of all prescribed and over-the-counter medications should be reviewed.
A nurse in the emergency department is caring for a client who has myasthenia gravis and is in a cholinergic crisis. Which of the following medications should the nurse plan to administer?
Atropine A cholinergic crisis is caused by an excess amount of cholinesterase inhibitor, such as neostigmine. The nurse should plan to administer atropine, an anticholinergic agent, to reverse cholinergic toxicity.
A nurse is planning care for a clienct who is receiving mannitol via continuous IV infusion. The nurse should monitor the client for which of the following adverse effects?
Bibasilar crackles Mannitol, an osmotic diuretic, can precipitate heart failure and pulmonary edema. Therefore, the nurse should recognize lung crackles as an indicator of a potential complication and stop the infusion.
A nurse is providing teaching for a client who has multiple sclerosis and a new prescription for methylprednisolone. Which of the following instructions should the nurse include?
Blood glucose levels will need to be monitored during therapy The nurse should instruct the client that his blood glucose levels will be monitored during therapy because corticosteroids, such as methylprednisolone, can raise blood glucose levels. avoid contact with persons who have known infections The nurse should instruct the client to avoid contact with persons who have known infections because corticosteroids, such as methylprednisolone, suppress the immune response and mask manifestations of infection. grapefruit juice can increase the blood levels of the medication. The nurse should instruct the client that grapefruit juice increases the absorption of the medication leading to toxicity and adrenal suppression.
A nurse is planning to teach about inhalant medications to a client who has a new diagnosis of exercise induced asthma. which of the following medications should the nurse plan to instruct the client o use prior to physical activity?
Cromolyn Cromolyn sodium stabilizes mast cells, which inhibit the release of histamine and other inflammatory mediators. The client should use cromolyn 10 to 15 min before planning to exercise to prevent bronchospasms.
A nurse is planning care for a client who has hypertension and is to start taking metoprolol. which of the following interventions should the nurse include in the plan of care?
Determine apical pulse prior to administering An adverse effect for this client is life-threatening bradycardia. Therefore, the nurse should assess the client's apical pulse prior to administering the medication. If the pulse rate is less than 60/min, the nurse should withhold the medication and notify the provider.
A nurse is teaching a client who has a new prescription for docusate sodium about the medications mechanism of action. Which of the following information should the nurse include in the teaching?
Docusate sodium reduces the surface tension of the stool to change their consistency Docusate sodium is a surfactant that softens stool by reducing surface tension, allowing water to penetrate more easily into the stool.
A nurse is assessing a client who is taking amitriptyline for depression. Which of the following findings should the nurse identify as an adverse effect of the medication?
Dry Mouth The nurse should expect the client to have a dry mouth due to the blocking of acetylcholine receptors that cause anticholinergic responses.
A nurse is providing teaching to a client who is to begin taking oxybutynin for urinary incontinence. The nurse should instruct the client to report which of the following findings as an adverse effect of the medication?
Dry Mouth Oxybutynin is an anticholinergic agent that can cause dry mouth. Blurred Vision Oxybutynin is an anticholinergic agent that can cause blurred vision due to an increase in intraocular pressure Dry Eyes Dry eyes is correct. Oxybutynin is an anticholinergic agent that can cause dry eyes and mydriasis, or pupil dilation.
A nurse is assessing a client after administering a second dose of cefazolin IV. The nurse notes the client has anxiety, hypotension, and dyspnea. Which of the following medications should the nurse administer first?
Epinephrine According to evidence-based practice, the nurse should first administer epinephrine to induce vasoconstriction and bronchodilation during anaphylaxis.
A nurse is providing teaching to a client who has peptic ulcer disease and is to start a new prescription for sucralfate. Which of the following actions of sucralfate should the nurse include in the teaching?
Forms a protective barrier over ulcers Secretions by the parietal and chief cells, hydrochloric acid and pepsin, can further irritate the ulcerated areas. Sucralfate, a mucosal protectant, forms a gel-like substance that coats the ulcer, creating a barrier to hydrochloric acid and pepsin.
A nurse is caring for a client who is receiving cefazolin IV. The nurse should identify that which of the following medications can potentiate nephrotoxicity if administered concurrently?
Gentamicin Gentamicin, an aminoglycoside antibiotic, can damage renal function. When combined with a penicillin or cephalosporin, such as cefazolin, the client is at increased risk for nephrotoxicity.
A nurse is caring for a patient who is taking tamoxifen for the treatment of breast cancer. The nurse should inform the client that which of the following side effects can develop?
Hot flashes The estrogen receptor blocking action of tamoxifen commonly results in the adverse effect of hot flashes.
A nurse is caring for a client who has heart failure and is prescribed enalapril. The nurse should monitor the client for which of the following findings as an adverse effect of the medication?
Hyperkalemia
A nurse is collecting a medication history from a client who has a new prescription for lithium. The nurse should identify that the client should discontinue which of the following over-the-counter medications?
Ibuprofen Most NSAIDs can significantly increase lithium levels. Therefore, the client should not take ibuprofen and lithium concurrently.
A nurse is assessing a client who is taking propylthiouracil for the treatment of Graves disease. Which of the following findings should the nurse identify as as an indication of the medication has been effective?
Increase in ability to focus A client who has Graves' disease can experience psychological manifestations such as difficulty focusing, restlessness, and manic-type behaviors. Propylthiouracil is a thyroid hormone antagonist that decreases the circulating T4 hormone, reducing the manifestations of hyperthyroidism. An increased ability to focus indicates that the medication is effective.
A nurse is providing discharge teaching to a a client who has a new prescription for furosemide twice daily. The nurse should include which of the following instructions in the teaching?
Increase intake of potassium-rich foods "Increase intake of potassium-rich foods" is correct. Loop diuretics, such as furosemide, act at the loop of Henle by blocking the resorption of sodium, water, and potassium. An adverse effect of the medication is the development of electrolyte imbalances such as hyponatremia, hypochloremia, and hypokalemia. To prevent hypokalemia, the client should increase intake of potassium-rich foods, such as potatoes, spinach, dried fruit, and nuts. Monitor for muscle weakness "Monitor for muscle weakness" is correct. Furosemide, a loop diuretic, causes a loss of potassium which can result in manifestations of hypokalemia such as difficulty concentrating, shallow respirations, hyporeflexia, and muscle weakness. The nurse should instruct the client to monitor for these manifestations and report them to the provider. Dangle legs for side of bed before standing "Dangle your legs from the side of the bed before standing" is correct. Loop diuretics, such as
A nurse is assessing a client who is receiving epoetin alfa to treat anemia. Which of the following findings should the nurse monitor?
Increased BP The therapeutic effect of epoetin alfa is an increase in hematocrit levels, which can result in an increase in a client's blood pressure. If the client's hematocrit level rises too rapidly, hypertension and seizures can result. The nurse should monitor the client's blood pressure and ensure hypertension is controlled prior to administering the medication.
A nurse is reviewing the health history of a client who has diabetes mellitus and will begin taking insulin. Which of the following dings should the nurse identify as a fact that might cause the client to have difficulty safely self administering insulin?
Macular degeneration A client who has macular degeneration loses central vision, making it difficult to accurately draw up insulin for self-administration or dial the insulin pen to the appropriate dosage. The nurse should determine that adaptive equipment is necessary for the client who has macular degeneration.
A nurse is planning to teach about the use of a spacer to a child who has a new prescription for a fluticasone inhaler to treat chronic asthma. the nurse should include that the spacer deceases the risk for which of the following adverse effect of the medication?
Oral candidiasis The adverse effects of inhaled corticosteroids can include dysphonia and oral candidiasis. Using a spacer and rinsing the mouth after inhalation will minimize the amount of medication remaining in the oropharynx, preventing the development of these adverse effects.
A nurse is providing follow up care to a client who is taking lisinopril. Which of the following manifestations should the nurse instruct the client to report as an adverse effect of lisinopril?
Persistent cough Lisinopril is an ACE inhibitor that can cause a persistent, dry, irritating, nonproductive cough from an excessive buildup of bradykinin. The client should report this adverse effect to the provider.
A nurse is reviewing laboratory results for a client who is receiving heparin via continuous IV infusion for deep-vein thrombosis. The nurse should discontinue the medication infusion for which of the following client findings?
Platelets 96,000/mm3 A platelet count less than 100,000/mm3 while receiving heparin can indicate heparin-induced thrombocytopenia, a potentially fatal condition, which requires stopping the infusion.
A nurse is caring for a client who is experiencing acute alcohol withdrawal. For which of the following client outcomes should the nurse administer chlordiazepoxide?
Prevent delirium tremens The client should take chlordiazepoxide to prevent delirium tremens during acute alcohol withdrawal.
A nurse is preparing to mix and administer dantrolene via IV bolus to a client who has developed malignant hyperthermia during therapy. Which of the following actions should the nurse take?
Reconstitute the initial dose with 60 mL of sterile water without a bacteriostatic agent. The nurse should dilute the medication with 60 mL of sterile water without a bacteriostatic agent and inject rapidly.
Nurse is caring for a client who recently began taking oral amoxicillin and clavulanate potassium and reports urticaria which of the following intervention should the nurse take
Request a change in the type of antibiotic Manifestations of urticaria after taking a penicillin-based medication indicate a mild allergic reaction. Therefore, it is appropriate for the nurse to request a change in the type of antibiotic.
A nurse is providing care for a client who is postoperative following an open cholecystectomy with the placement of a closed suction drain and is receiving morphine via patient controlled analgesia for pain. Which of the following assessments is the nurse's priority?
Respiratory Rate When using the airway, breathing, circulation approach to client care, the nurse should determine that the priority assessment is the client's respiratory rate due to the risk of respiratory depression. Morphine and other opioid medication can cause respiratory depression, constipation, and urinary retention.
A nurse is planning care for a client who is prescribed metoclopramide following bowel surgery. For which of the following adverse effects should the nurse monitor?
Sedation Metoclopramide has multiple effects on the CNS, including dizziness, fatigue, and sedation.
A nurse at a clinic is providing follow-up care to a client who is taking fluoxetine for depression. Which of the following findings should the nurse identify as an adverse effect of the medication?
Sexual dysfunction Sexual dysfunction, including a decreased libido, impotence, and delayed orgasm, or anorgasmia, is a common adverse effect of fluoxetine and occurs in about 70% of clients who take this SSRI antidepressant.
A nurse is providing teaching to a client who has a prescription for ergotamine sublingual to treat migraine headaches. Which of the following information should the nurse include in her instructions?
Take one tablet at onset of migraine The client should take one tablet immediately after the onset of aura or headache.
A nurse is assessing a client 1 hr after administering morphine for pain. The nurse should identify which of the following findings as the best indication the morphine has been effective?
The client rates pain at a 3 on the 0 to 10 scale The client's description of the pain is the most accurate assessment of pain.
A nurse has administered 2 doses of betamethasone to a client in preterm labor. After delivery of the newborn, the nurse understands the medication was effective when she observes which of the following?
The newborn has normal respiratory patterns. The newborn having a normal respiratory pattern is an indication that the administration of betamethasone was effective. This medication stimulates surfactant production, which improves oxygenation and lung compliance in neonates.
A nurse on the acute care unit is caring for a client who is receiving gentamicin IV. The nurse should report which of the following findings to the provider as an adverse effect of the medication?
Tinnitus Aminoglycosides, such as gentamicin, are ototoxic, which can manifest as tinnitus and deafness. The nurse should monitor the client for high pitched ringing in the ears and headaches and should notify the provider if these occur.
A nurse is preparing to administer a new prescription of amoxicillin/clavulanic to a client. The client tells the nurse that he is allergic to penicillin. Which of the following actions should the nurse take first?
Withhold the medication When using the urgent vs nonurgent approach to client care, the nurse should determine that the priority action is to withhold the medication in order to prevent injury to the client.
A nurse is providing teaching to a client who is to start therapy with digoxin. For which of the following adverse effects should the nurse instruct the client to monitor and report to the provider?
Yellow-tinged vision The nurse should instruct the client to monitor for and report yellow-tinged vision, which is a sign of digoxin toxicity and should be reported to the provider. Other manifestations of digoxin toxicity include nausea, vomiting, loss of appetite, and fatigue. As the digoxin levels increase, the client can experience cardiac dysrhythmias.
A nurse is teaching a client who has tuberculosis about the adverse effects of isoniazid. The nurse should instruct the client to report to the provider which of the following finding as an adverse effect of the medication?
Yellowish skin tones Isoniazid is a hepatotoxic medication that can cause hepatitis. The nurse should instruct the client to monitor for and report signs of hepatitis, such as malaise, nausea, and yellowish skin tones, to the provider.
A nurse is caring for a client who has acute acetaminophen toxicity. The nurse should anticipate administering which of the following medications?
acetylcysteine Acetylcysteine is a specific antidote for acetaminophen. It can prevent severe injury when given orally or by IV infusion within 8 to 10 hr of overdose.
A nurse is precepting a newly licensed nurse who is caring for four clients. The nurse should complete an incident report for which of the following actions by the newly licensed nurse?
administers isosorbide mononitrate to a client who has a BP 82/60 mm Hg Isosorbide mononitrate is a nitrate used for clients with angina. Taking isosorbide mononitrate leads to vasodilation, which can result in hypotension. The nurse should withhold the medication and notify the provider if the client's systolic blood pressure is below the expected reference range.
A nurse is caring for a client who is receiving haloperidol. The nurse should observe for which of the following findings as an adverse effect of the medication?
akathisia A significant adverse effect associated with haloperidol is the development of extrapyramidal symptoms such as dystonia, pseudoparkinsonism, and akathisia.
A nurse is caring for a client who is receiving heparin therapy via continuous IV infusion to treat a pulmonary embolism. Which of the following findings should the nurse identify as an adverse effect of the medication and report to the provider?
blood in the urine The nurse should report blood in the urine to the provider because this can be a manifestation of heparin overdose. Other manifestations can include bruising, hematomas, hypotension, and tachycardia.
A nurse is reviewing laboratory results for a client who is to receive a dose of ceftazadime via intermittent IV bolus. Which of the following laboratory finding is the priority for the nurse to report to the provider before administering the medication?
creatinine 2.6 mg/dL Ceftazadime is excreted primarily by the renal system. A serum creatinine level above 1.3 mg/dL can indicate a kidney disorder requiring a reduction in the dosage administered. The nurse should notify the provider, who is likely to prescribe a lowered dose of medication.
A nurse is caring for a client who is taking atorvastatin for hyperlipidemia. Which of the following client laboratory values should the nurse monitor?
creatinine kinase The client can develop an adverse effect called rhabdomyolysis, which causes muscle weakness or pain and can progress to myositis. Creatinine kinase (CK) levels rise in response to enzymes released with muscle injury.
A nurse is teaching a client who is taking allopurinol for the treatment of gout. Which of the following information should the nurse include in the teaching?
drink 2 L of water daily The nurse should instruct the client to drink at least 2 L of water each day to prevent renal stone formation and kidney injury because allopurinol is eliminated through the kidneys.
A nurse is administering donepezil to a client who has Alzheimer's disease. Which of the following findings should the nurse report to the provider immediately?
dyspnea The first action the nurse should take when using the airway, breathing, circulation approach to client care is to report the adverse effect of dyspnea, caused by bronchoconstriction, to the provider. Bronchoconstriction, dyspepsia, diarrhea, and dizziness are caused by the increase in acetylcholine levels, which is a primary effect of donepezil.
A nurse is caring for a client in the emergency department following a diazepam overdose. Which of the following medications should the nurse anticipate administering to the client?
flumazenil Flumazenil is a benzodiazepine receptor antagonist that can decrease the sedative effects of benzodiazepines, such as diazepam. The nurse should administer the medication via IV bolus, titrating doses as needed, for a maximum of 3 mg. However, the medication can precipitate seizures and might not reverse respiratory depression, so airway support may be necessary.
A nurse is teaching about neural tube defects to a client who is planning a pregnancy. Which of the following vitamins should the nurse instruct the client to start taking before becoming pregnant?
folic acid The nurse should instruct all female clients who could become pregnant to take at least 400 mcg of folic acid daily in addition to foods containing folic acid to prevent neural tube defects in the developing fetus. Enriched rice and breakfast cereals are good sources of folic acid but might not provide enough folic acid without supplements.
A nurse is caring for a client who is receiving oprelvekin. Which of the following findings should the nurse document to indicate the effectiveness of the therapy?
increased platelet count Oprelvekin stimulates the bone marrow to produce platelets. For clients receiving chemotherapy, thrombocytopenia is minimized so these clients will require fewer platelet transfusions.
A nurse is providing teaching to a client who is taking bupropion as an aid to quit smoking. which of the following finding should the nurse identify as an adverse effect of the medication?
insomnia Bupropion, an atypical antidepressant, has stimulant properties, which can result in agitation, tremors, mania, and insomnia.
A nurse in a clinic is caring for a client who is taking aspirin for the treatment of arthritis. The nurse should identify which of the following findings as an indication that the client is beginning to exhibit salicylism?
tinnitus Tinnitus is a manifestation of aspirin toxicity, also called salicylism. Other manifestations include sweating, headache, and dizziness.
