RN Pharmacology Questions 2023

A nurse is monitoring a client who has diabetes insipidus and was administered desmopressin. Which of the following findings should indicate to the nurse the client is experiencing an adverse effect of this medication?

Headache Headaches are an indicator of the adverse effect of water intoxication, which can occur as a result of taking desmopressin. This medication causes fluid retention and places the client at risk of water intoxication.

A nurse is preparing to administer digoxin to a client. Which of the following findings should the nurse identify as a contraindication to the client receiving this medication?

Heart rate 51/min The nurse should identify that if the client's heart rate is less than 60/min, the medication should be withheld, and the provider should be notified.

A nurse is preparing to administer dantrolene to a client who has muscle spasticity. Which of the following findings from the client's medical history should the nurse identify as a contraindication to the administration of this medication?

History of cirrhosis The nurse should identify that dantrolene is contraindicated for clients who have active liver disease because it is hepatotoxic and can cause liver failure. Liver function tests are monitored for clients throughout treatment with this medication.

A nurse is caring for a client who is taking fludrocortisone. Which of the following findings indicates to the nurse that the client is experiencing an adverse effect of the medication?

Hypokalemia The nurse should identify that hypokalemia is an adverse effect of fludrocortisone due to excessive sodium and water retention, resulting in the loss of excessive amounts of potassium.

A nurse is caring for a client with benign prostatic hyperplasia who has a new prescription for doxazosin. Which of the following manifestations should the nurse monitor for as an adverse effect of doxazosin?

Hypotension Nonselective alpha1-adrenergic antagonists like doxazosin block sympathetic receptors in the blood vessels as well as receptors in the bladder. These agents promote vasodilation, which can cause decreased blood pressure.

A nurse is preparing to administer oxytocin to a client who is at 41 weeks gestation and is experiencing ineffective labor. Which of the following actions should the nurse plan to take?

Increase the dose of oxytocin to obtain uterine contractions that occur every 2 to 3 min Effective uterine contractions should occur every 2 to 3 minutes.

A nurse is preparing a continuous IV infusion of erythromycin lactobionate for a client who has a Bordetella pertussis infection. Which of the following actions should the nurse take to minimize the risk of thrombophlebitis?

Infuse the medication slowly The nurse should infuse erythromycin slowly to minimize the risk of thrombophlebitis, which is an inflammatory process resulting from the formation of a blood clot in a vein. These blood clots usually form in the legs.

A nurse is providing teaching to a newly licensed nurse about metoclopramide. The nurse should highlight that which of the following conditions is a contraindication to this medication?

Intestinal obstruction Metoclopramide reduces nausea and vomiting by increasing gastric motility and promoting gastric emptying. It is contraindicated for a client who has an intestinal obstruction or perforation.

A nurse is reviewing the medication administration record of a client who is receiving an opioid medication for pain. Which of the following prescriptions should the nurse clarify with the provider?

Lorazepam The nurse should identify that lorazepam can cause central nervous system depression, which can result in increased respiratory depression and sedation when administered with an opioid. The nurse should clarify the prescription with the provider.

A nurse is assessing a client who has multidrug-resistant tuberculosis and takes ethambutol. The nurse should identify which of the following findings as an adverse effect of this medication?

Loss of red/green color discrimination Ethambutol is an antitubercular medication that impairs ribonucleic acid synthesis. A common adverse reaction is the loss of red/green color discrimination due to optic neuritis. The nurse should notify the provider of this finding and expect to discontinue the medication.

A nurse is monitoring a client who is receiving terbutaline to suppress preterm labor. Which of the following findings should indicate to the nurse that the client is experiencing an adverse effect of the medication?

Maternal heart rate >120/min A client who is receiving terbutaline can experience tachycardia, which poses a significant risk to the mother. Therefore, when the maternal heart rate exceeds 120/min, the medication should be stopped. Adverse effects result from activating beta1 receptors as well as beta2 receptors.

A nurse working in a mental health facility is admitting a client with opioid use disorder who is experiencing withdrawal. The nurse should anticipate a prescription for which of the following medications from the provider?

Methadone The nurse should anticipate a prescription from the provider for methadone for a client who is experiencing opioid withdrawal. Methadone is an opioid medication that is used for pain management and treatment of withdrawal manifestations in clients who have opioid use disorder.

A nurse is reinforcing teaching with a newly licensed nurse about contraindications to vaccines. Which of the following examples should the nurse provide as a true contraindication for all vaccines?

Moderate illness without a fever The nurse should identify that a client who has a moderate or severe illness with or without a fever has a true contraindication to receiving a vaccine. The nurse should postpone the immunization until the client has recovered from the illness.

A nurse is caring for a client who has been in the PACU for more than 1 hr, has a respiratory rate of 9/min, and is difficult to arouse. The nurse should expect a prescription for which of the following medications?

Naloxone The nurse should expect a prescription for naloxone. This medication displaces opiate medications from receptor sites, reversing the respiratory depression, sedation, and analgesia that opiates cause.

A nurse is reviewing the laboratory results for a client who has a prescription for filgrastim. An increase in which of the following values indicates a therapeutic effect of this medication? A

Neutrophil count Filgrastim increases neutrophil production. It is given to treat neutropenia and reduce the risk of infection in clients who are receiving chemotherapy for cancer or who have undergone bone marrow transplant.

A nurse is administering a prescription for nifedipine to a client who is pregnant. Which of the following pieces of information related to nifedipine should the nurse monitor and document?

Number of uterine contractions A client who is going into preterm labor can have a prescription for nifedipine, which is a calcium channel blocker that inhibits the entry of calcium into myometrial cells, which can delay labor.

A nurse is teaching the parent of a child who has severe reactive airway disease about glucocorticoid therapy. The parent asks why her child has to inhale the medication instead of taking it orally. Which of the following pieces of information should the nurse provide to the parent?

Oral glucocorticoids are more likely to slow linear growth in children. The chronic use of oral glucocorticoids in high doses by children can result in decreased linear growth. Inhaled glucocorticoids deliver the anti-inflammatory agent directly to the local target area (the client's airways), resulting in a decreased risk for adrenal suppression.

A nurse is caring for a client who has schizophrenia and a prescription for chlorpromazine. For which of the following adverse effects should the nurse monitor?

Orthostatic hypotension Orthostatic hypotension is an adverse effect of chlorpromazine. Other adverse effects include palpitations, tachycardia, constipation, sedation, and photosensitivity.

A nurse is teaching a newly licensed nurse about contraindications to ceftriaxone. A severe allergy to which of the following medications is a contraindication to ceftriaxone?

Piperacillin Clients who have a severe allergy to piperacillin, which is a penicillin, can have a cross-sensitivity reaction to ceftriaxone, a third-generation cephalosporin. Ceftriaxone is contraindicated for a client who has an allergy to cephalosporins or a severe allergy to penicillin.

A nurse is providing teaching to the parents of a child who has a new prescription for lamotrigine for a seizure disorder. The nurse should instruct the parents that which of the following adverse effects is the priority to report to the provider?

Rash The nurse should apply the safety and risk-reduction priority-setting framework, which assigns priority to the factor or situation posing the greatest safety risk to the client. When there are several risks to client safety, the one posing the greatest threat is the highest priority. The nurse should use Maslow's hierarchy of needs, the ABC priority-setting framework, and/or nursing knowledge to identify which risk poses the greatest threat to the client. The greatest risk to this client is an injury from Stevens-Johnson syndrome or toxic epidermal necrolysis, which are life-threatening reactions that manifest initially as a rash in the first 2 to 8 weeks of treatment with lamotrigine. The nurse should instruct the parents to report a rash immediately to the provider.

A nurse is caring for a client who has cancer involving the lumbar vertebrae and has been prescribed gabapentin. Which of the following therapeutic effects should the nurse identify for the client when taking this medication?

Reduced cramping, aching, and burning neuropathic pain The nurse should identify that gabapentin is administered to treat neuropathic pain that is sharp and darting. The medication can also decrease cramping, aching, and burning pain and suppress spontaneous neuronal firing that causes pain.

A nurse is preparing to administer IV nitroprusside for a client who had a myocardial infarction. Which of the following actions should the nurse take?

Regulate the infusion pump rate using the client's weight in the calculation The nurse should regulate the infusion pump rate based on the client's weight. Sodium nitroprusside is a potent vasodilator that works faster than any other medication available and is administered as a continuous IV infusion to clients who require a rapid reduction of blood pressure. The nurse should monitor the client's blood pressure either continuously with an arterial line or at least every 15 minutes with an electronic monitoring device because this medication can cause a rapid reduction of blood pressure that can be life-threatening if not managed properly.

A nurse is providing teaching to a client who has a gastric ulcer and a new prescription for famotidine, which of the following instruction should the nurse include?

Report yellowing of the skin Famotidine 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 providing teaching to a newly licensed nurse about administering morphine via IV bolus to a client. Which of the following pieces of information should the nurse include in the teaching?

Respiratory depression can occur 7 min after the morphine is administered. Respiratory depression can occur within 7 minutes of the administration of IV bolus morphine. The nurse should monitor the client's respirations and have naloxone available to reverse the effects of the morphine.

A nurse is caring for a client with asthma who has been taking an inhaled glucocorticoid and long-acting beta2-agonist combination dry-powdered inhaler (DPI) for maintenance therapy. The nurse should identify that which of the following is a disadvantage of this medication?

Restricted dosage flexibility The nurse should identify that a disadvantage of an inhaled glucocorticoid and a long-acting beta2-agonist being combined is that the dosages of these medications are fixed, so the dose cannot be adjusted.

A nurse is reviewing laboratory reports for a client who has Clostridium difficile infection and is receiving vancomycin. Which of the following results should the nurse report to the provider before administering the next dose?

Serum creatinine 2.5 mg/dL Vancomycin is nephrotoxic and can result in renal failure, which is indicated by elevated levels of creatinine above the expected reference range of 0.5 to 1.3 mg/dL. The nurse should report this laboratory value to the provider prior to administering any further doses of the medication.

A nurse is caring for a client who has cystic fibrosis (CF) and has a prescription for high-dose ibuprofen daily. The nurse should identify that which of the following is an expected outcome for the client receiving this medication?

Slowed progression of pulmonary damage The nurse should identify that clients who have CF are prescribed high-dose Ibuprofen, which is an NSAID, to slow the progression of pulmonary damage by suppressing the inflammatory response that causes pulmonary damage. CF is a genetic disorder that primarily affects the lungs, pancreas, and sweat glands.

The nurse is caring for a client who has had a levonorgestrel-releasing intrauterine device (IUD) in place for 1 year. Which of the following findings should indicate that the client is experiencing an adverse effect?

Spotting between menses cycles Light spotting and amenorrhea are common adverse effects for clients who use a levonorgestrel-releasing IUD. IUDs can alter menses, prompting spotting between menstruation periods.

A nurse is teaching a client who has chronic stable angina pectoris and a prescription for sublingual nitroglycerin tablets. What sequence of instructions should the nurse tell the client to use if he experiences chest pain? (Move the steps into the box on the right, placing them in the order of performance. Use all the steps.)

Step 1: The client should first stop all activity Step 2: Place a tablet under his tongue. Step 3: Next, he should wait 5 minutes. Step 4: If the chest pain is not relieved, he should call 911.

A nurse is administering subcutaneous epinephrine for a client who is experiencing anaphylaxis. The nurse should monitor the client for which of the following adverse effects?

Tachycardia Adverse effects of epinephrine, an adrenergic agonist, can include tachycardia and dysrhythmias due to cardiac stimulation.

A nurse is assessing an infant who is scheduled to receive the rotavirus vaccine. Which of the following criteria should the nurse identify as a potential contraindication for administering this vaccine?

The infant has a history of intussusception. The nurse should identify that the rotavirus vaccine is contraindicated for infants who have a history of intussusception. The rotavirus vaccine is also contraindicated for infants who have an uncorrected gastrointestinal congenital malformation that could result in intussusception.

A nurse is preparing to administer an IV injection to a client. For which of the following reasons should the nurse inject the medication slowly?

To reduce toxicity risk Prior to injecting an IV medication, the nurse should plan to infuse the medication slowly over 1 minute to reduce the risk for toxicity to the central nervous system (CNS). Manifestations of CNS toxicity can become evident as soon as 15 seconds after initiating the injection. If the injection is done slowly, only a small amount of the total dose will have been administered when manifestations of toxicity appear. If the nurse is able to discontinue the administration immediately, adverse effects can be much less severe than if the entire dose had been given quickly.

A nurse is assessing a client who has hypothyroidism and takes levothyroxine. Which of the following findings indicates that the client is experiencing acute levothyroxine overdose?

Tremor Tremors and anxiety are expected findings in acute levothyroxine overdose. These findings are similar to those seen in hyperthyroidism.

A nurse in a community health clinic is assessing a new client who has prescriptions for isoniazid and rifampin. Which of the following disorders should the nurse expect the client to have?

Tuberculosis Isoniazid and rifampin are first-line antitubercular medications used to treat active tuberculosis. The medications are used in combination therapy.

A nurse is assessing a client who reports using several herbal and vitamin supplements daily, including saw palmetto. The nurse should recognize that saw palmetto is a supplement used by clients to elicit which of the following therapeutic effects?

Urinary health promotion Saw palmetto is used primarily for manifestations related to prostatic conditions such as benign prostatic hypertrophy (BPH). Its effectiveness has not been scientifically verified, however. The nurse should instruct the client to check with the provider about interactions between saw palmetto and other medications.

A nurse is preparing to administer 100 units of insulin glargine and 4 units of NPH insulin subcutaneously to a client. Which of the following actions should the nurse plan to take?

Use separate syringes for administering insulin glargine and NPH insulin The nurse should not mix insulin glargine with any other insulin. The nurse should administer the NPH insulin and insulin glargine separately.

A nurse is assessing a client who has heart failure and is receiving digoxin. Which of the following findings should indicate to the nurse the client is experiencing digoxin toxicity?

Visual disturbances The nurse should recognize that nausea, vomiting, abdominal discomfort, fatigue, and visual disturbances are common manifestations that can indicate that the client is experiencing digoxin toxicity.

A nurse is caring for a client who takes warfarin to treat chronic atrial fibrillation and has early manifestations of Alzheimer's disease. The client's partner asks the nurse if the client would benefit from taking ginkgo biloba. Which of the following responses should the nurse make?

"Ginkgo biloba will likely interfere with the effectiveness of his other medications. " Ginkgo biloba may delay the mental deterioration of Alzheimer's disease if taken in the early stages. Research has not demonstrated this, however. More importantly, ginkgo biloba increase the client's risk of bleeding when taken with warfarin.

A nurse is administering subcutaneous heparin to a client who is at risk for deep vein thrombosis. Which of the following actions should the nurse take?

Administer the medication into the client's abdomen The heparin should be administered into the client's abdomen.

A nurse is caring for a client who is receiving lidocaine for localized pain. The nurse should recognize that which of the following actions will help prevent systemic toxicity of this medication?

Applying the medication to intact skin Lidocaine applied to broken or irritated skin can increase the risk of systemic absorption.

A nurse is reviewing the medical record of a client who has postmenopausal osteoporosis and a prescription for raloxifene. Which of the following findings in the client's medical record should the nurse identify as a contraindication to receiving this medication?

History of deep-vein thrombosis (DVT) The nurse should identify that a history of DVT is a contraindication for receiving raloxifene because this medication can cause DVT in clients who have a prior history. Therefore, the nurse should notify the provider of this finding and request an alternative medication prescription for the client.

A nurse is caring for a client who is at 28 weeks gestation and is experiencing preterm labor. Which of the following medications should the nurse plan to administer?

Nifedipine Nifedipine is a tocolytic medication that is administered to stop preterm labor.

A nurse is caring for a client who has unstable angina. The nurse should anticipate a prescription from the provider for which of the following medications?

Nitroglycerin The nurse should anticipate a prescription for nitroglycerin, which is indicated for a client who has unstable angina. Nitroglycerin is an organic nitrate and a vasodilator that acts by relaxing or preventing spasms in the coronary arteries, thereby decreasing the oxygen demand of the heart along with ventricular filling.

A nurse is admitting a client who has unstable angina. Which of the following medications should the nurse anticipate administering to the client?

Nitroglycerin The nurse should anticipate administering nitroglycerin to a client who has unstable angina. This medication acts by relaxing or preventing spasms in the coronary arteries along with dilating the arteries, which increases oxygenation and blood flow.

A nurse is caring for a client who reports crushing chest pain. The nurse reviews the client's ECG results and notes ST changes. Which of the following medications should the nurse administer?

Nitroglycerin The nurse should identify the need to administer nitroglycerin, which is used to treat angina. Nitroglycerin acts directly on vascular smooth muscle to promote vasodilation.

A nurse is caring for a client who received spinal anesthesia 30 minutes ago. The client reports feeling dizzy, and the nurse notes that the client's blood pressure is 84/54 mmHg. Which of the following actions should the nurse take?

Place the client in the head-down position The nurse should identify the client is experiencing an adverse effect from receiving the spinal anesthesia. Hypotension is the common adverse effect of spinal anesthesia due to the loss of venous tone and decreased venous return to the heart. Therefore, the nurse should position the client in a 10° to 15°, head-down position to rapidly promote venous return to the heart, which increases the client's blood pressure.

A nurse is reviewing the EKG of a client who is receiving IV furosemide for heart failure. The nurse should identify which of the following findings as an indication of hypokalemia.

Presence of you waves. The nurse identify the presence of U-waves as a manifestation of hypokalemia and adverse effect of furosemide

A nurse is caring for a client at 39 weeks of gestation who has gestational hypertension. The client has a new prescription for misoprostol for cervical ripening and induction of labor. Which of the following findings in the client's medical history should the nurse identify as increasing the client's risk of complications due to the use of this medication?

Previous cesarean delivery The nurse should identify that misoprostol is a prostaglandin that promotes cervical ripening. An adverse effect of misoprostol is uterine tachysystole (excessively frequent uterine contractions). Therefore, this medication should be used with extreme caution and is contraindicated in clients who have experienced a previous cesarean delivery.

A nurse is providing discharge teaching about handling medication to a client who is to continue taking oral transmucosal fentanyl raspberry-flavored lozenges on a stick. Which of the following information should the nurse include in the teaching?

Store unused medication sticks in a storage container The nurse should instruct the client to store unused, used or partially used medication sticks in the safe storage container that comes in the kit, when the medication is initially prescribed.

A nurse is caring for a female client who has osteoporosis and is taking raloxifene. Which of the following findings should indicate to the nurse that the client is experiencing an adverse effect of this medication?

Sudden onset of dyspnea The nurse should identify that raloxifene is a selective estrogen receptor modulator (SERM), which can have estrogenic effects in some tissues and anti-estrogenic effect in other tissues. Clients who are taking raloxifene have an increased risk of thromboembolic events such as deep-vein thrombosis, pulmonary embolism, or stroke. Therefore, the nurse should notify the provider if the client is experiencing this adverse effect of raloxifene.

A nurse is reviewing a new prescription for fexofenadine for a 7-year-old client who has seasonal allergies. Which of the following findings should the nurse clarify with the provider?

The prescription says to take standard tablets. The nurse should identify that this 7-year-old client has been prescribed a standard tablet, which is appropriate for clients 12 years of age and older. Therefore, the nurse should clarify this aspect of the prescription with the provider because a client who is 7 years old should be administered orally disintegrating tablets or a suspension.

A nurse is teaching about levodopa with a family member of a client who has Parkinson's disease. Which of the following pieces of information should the nurse include?

"A full therapeutic response may take several months to happen." The nurse should inform the family member that although levodopa is the most effective medication for Parkinson's disease, a full therapeutic response might not occur for several months.

A nurse is caring for a client who is due to receive general anesthesia. The client asks the nurse, "What is the difference between an analgesic and anesthesia?" Which of the following statements should the nurse make?

"Anesthesia can cause loss of consciousness." General anesthesia reduces or causes a complete loss of consciousness.

A nurse is providing teaching to a client about a new prescription for captopril to treat hypertension. Which of the following client statements indicates an understanding of the teaching?

"I might feel dizzy at times while taking this medication." Hypotension and dizziness are potential adverse effects of this medication. The nurse should monitor the client's blood pressure and instruct the client to change positions slowly.

A nurse is providing teaching to a client who has a new prescription for a fentanyl transdermal patch. Which of the following statements by the client indicates an understanding of the teaching?

"I will have to stop drinking grapefruit juice while using the patch." The nurse should instruct the client to avoid drinking grapefruit juice while using the fentanyl transdermal patch. Grapefruit juice can increase the absorption of the medication, raising the amount of fentanyl in the client's blood. This effect can place the client at risk for CNS and respiratory depression.

A nurse is teaching a client who has osteoporosis about a new prescription for risedronate. Which of the following client statements indicates an understanding of the teaching?

"I will take this medication with a full cup of water." The nurse should instruct the client that risedronate should be taken with at least 180 to 240 mL (6 to 8 oz) of water.

A nurse is teaching a client about the adverse effects of omeprazole. Which of the following client statements indicates an understanding of the teaching?

"If I experience severe diarrhea, I will call my doctor." Clients who experience diarrhea while taking omeprazole or other proton pump inhibitors (PPIs) should report this finding to the provider immediately. Omeprazole and other PPIs are associated with a dose-related increase in the risk of infection with Clostridium difficile, which is a bacterium that can cause severe diarrhea.

A nurse is teaching a client who has type 2 diabetes mellitus about a prescription for insulin lispro. Which of the following statements should the nurse include in the teaching?

"Insulin lispro has an onset of about 15 minutes." Insulin lispro is a rapid-acting insulin and has an onset of 15 to 30 minutes.

A nurse is preparing to administer warfarin to a client who has a new onset of atrial fibrillation. The client asks the nurse, "What should this medication do?" Which of the following responses should the nurse make?

"It can reduce your risk of having a stroke." The nurse should identify that atrial fibrillation increases the client's risk of having a stroke due to clot formation in the atrium. Warfarin can prevent clot formation when used long-term, which will reduce the client's risk of having a stroke.

A nurse is providing discharge teaching to a client who has a bacterial infection about adverse effects of imipenem to report to the provider. Which of the following pieces of information should the nurse include?

"Seizures can occur with this medication." The nurse should tell the client that seizures can occur when receiving imipenem. The client should notify the provider immediately if these occur.

A nurse is teaching a client about a new prescription for extended-release oxycodone for pain management. Which of the following statements should the nurse include in the teaching?

"Swallow this medication whole." The nurse should tell the client that extended-release oxycodone is a long-acting opioid medication and should not be cut in half or crushed to prevent immediate absorption of the entire dose. This medication should be swallowed whole and is administered every 12 hours.

A nurse is teaching a client who is postmenopausal and has a prescription for alendronate. Which of the following statements should the nurse include in the teaching?

"Take this medication on an empty stomach." The nurse should instruct the client to avoid taking alendronate with food or liquids other than water because it can decrease absorption. The client should only take this medication with water 30 minutes before breakfast.

A nurse is providing teaching to a client who is scheduled to start taking hydrochlorothiazide for hypertension. The nurse instructs the client to eat foods that are rich in potassium. Which of the following statements by the client indicates an understanding of the teaching?

"This medication can cause a loss of potassium." Hydrochlorothiazide can result in hypokalemia caused by excessive potassium excretion from the kidneys. The client should supplement his diet with potassium-rich foods to avoid the occurrence of hypokalemia. Foods that are high in potassium include bananas, raisins, baked potatoes, pumpkins, and milk.

A nurse is providing teaching to a client who has a prescription for famotidine to treat a gastric ulcer. Which of the following statements should the nurse include in the teaching?

"This medication is less effective for people who smoke." The nurse should instruct the client that smoking interferes with the effectiveness of famotidine. If a client taking famotidine smokes, the nurse should encourage the client to quit smoking or, if unable quit, to avoid smoking after the last dose of the day.

A nurse is caring for a client who is taking diphenhydramine for allergies. The client reports, "I feel sleepy during the day." Which of the following responses should the nurse make?

"You should try antihistamines with non-sedative effects." The nurse should tell the client to try second-generation antihistamines that have no sedative effect, as these are large molecules with low lipid solubility that cannot cross the blood-brain barrier. Diphenhydramine is a first-generation antihistamine and has a common adverse effect of sedation.

An 18-month-old toddler who has Kawasaki disease (KD). The child is receiving intravenous immune globulin (IVIG). The guardian asks the nurse to administer the child's scheduled measles, mumps, and rubella (MMR) vaccine before discharge. Which of the following responses should the nurse provide?

"Your child will not be able to receive the MMR vaccine for at least 3 months after discharge." The nurse should explain to the guardian that IVIG given for the treatment of KD contains antibodies that can interfere with the action of live-virus vaccines like MMR. The MMR immunization should be postponed for 3 to 6 months.

A nurse is administering insulin glulisine 10 units subcutaneously at 0730 to an adolescent client who has type 1 diabetes mellitus. The nurse should anticipate the onset of action of the insulin at which of the following times?

. 0745 Insulin glulisine has a very short onset of action of 15 minutes. The nurse should expect the onset of action around 0745 and ensure the client eats breakfast immediately following the administration of the insulin.

A nurse is caring for a client who receives gastrostomy tube feedings and insulin. The client is scheduled to receive a tube feeding at 0700. At which of the following times should the nurse plan to administer insulin lispro subcutaneously?

0645 Lispro is a rapid-acting insulin with an onset of 15 minutes. The nurse should administer the insulin dose 15 min prior to the feeding.

A nurse is planning care for a client who is receiving gentamicin IM and has a new prescription to obtain gentamicin peak and trough levels. At which of the following times should the nurse plan to obtain a blood sample to evaluate the gentamicin peak?

1 hour after administering the IM injection Timing is important when drawing blood samples for aminoglycoside levels. The nurse should obtain blood samples for peak levels 1 hour after administering an IM injection or 30 minutes after completing an IV infusion.

A nurse is preparing to administer meperidine 100 mg IM to a client who has a BMI of 23. Which of the following needle lengths should the nurse use to administer the medication?

1 ½ inch In general, needle lengths for IM injections are 1 to 1 ½ inches, unless the client is obese. A BMI of 23 is considered to be an optimal weight.

A nurse is preparing to administer heparin 500 units/hr to a client who has a deep-vein thrombosis. Heparin is available at 25,000 units in 500 mL of 5% dextrose in water. The nurse should set the IV pump to deliver how many mL/hr?

10

A nurse is preparing to administer dextrose 5% in water (D5W) 1,000 mL to infuse over 12 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? (Fill in the blank with the numeric value only, round the answer to the nearest whole number, and use a leading zero if applicable. Do not use a trailing zero.)

14

A nurse is preparing to administer benztropine 8 mg PO daily in 2 divided doses to a client who has Parkinson's disease. The amount available is benztropine 2 mg tablets. How many tablets should the nurse administer with each dose? (Fill in the blank with the numeric value only, round the answer to the nearest whole number, and use a leading zero if applicable. Do not use a trailing zero.)

2

A nurse is preparing to administer chlorothiazide 20 mg/kg/day PO divided equally and administered twice daily for a toddler who weighs 28.6 lb. The amount available is chlorothiazide oral suspension 250 mg/5 mL. How many mL should the nurse administer per dose? (Fill in the blank with the numeric value only, round the answer to the nearest tenth, and use a leading zero if applicable. Do not use a trailing zero.)

2.6

A nurse is preparing to administer cefepime 1g in 5% dextrose in water (D5W) 50 mL over 30 min to a client who has pneumonia. The drop factor of the manual IV tubing is 15 gtt/mL. The nurse should set the manual IV infusion to deliver how many gtt/min? (Fill in the blank with the numeric value only, round to the nearest whole number, and use a leading zero if applicable. Do not use a trailing zero.) Fill in the blank

25

A nurse is evaluating how a client who is pregnant is responding to a medication. Which of the following physiological effects of pregnancy should the nurse take into consideration?

Accelerated excretion of fluids There are physiological changes in the kidneys with pregnancy, including accelerated excretion from increased renal blood flow. This results in increased glomerular filtration. To compensate for accelerated excretion, dosages of medications that glomerular filtration eliminates must be increased to achieve a comparable therapeutic effect.

A nurse is caring for a client who has asthma and a prescription for zileuton. Which of the following laboratory values should the nurse monitor while the client is taking this medication?

Alanine aminotransferase (ALT) The nurse should identify that ALT is a liver function test. Zileuton is a leukotriene modifier that can affect the liver, causing increased ALT levels. The nurse should monitor this laboratory value closely while the client is taking the medication.

A nurse is reviewing the medication history of a client who has mild intermittent asthma. The nurse should anticipate a prescription for which of the following inhalers for the client?

Albuterol sulfate The nurse should anticipate a client who has mild intermittent asthma to be prescribed albuterol sulfate. Albuterol sulfate is a short-acting beta2-agonist that activates beta2-receptors in the smooth muscle of the lung, allowing the client's airway and lungs to dilate, thereby relieving bronchospasm and allowing the client to breathe.

A nurse in a provider's office is assessing a client who has been taking amoxicillin for 10 days and reports diarrhea and cramping. The nurse should recognize that these manifestations occur secondary to which of the following adverse effects?

Alterations in gastrointestinal flora The typical gastrointestinal flora are often destroyed by broad-spectrum antibiotics like amoxicillin, causing poor digestion and possible superinfection with other bacteria.

A nurse on a medical unit is preparing to administer alendronate 40 mg PO for an older adult client who has Paget's disease of the bone. Which of the following actions should be the nurse's priority?

Ambulate the client to a chair prior to administering the medication The nurse should ambulate the client to a chair and ensure that the client is sitting upright before administering the alendronate to prevent esophagitis from occurring. The client must also be able to sit or stand upright for 30 minutes after taking the medication. The nurse should apply the safety and risk-reduction priority-setting framework, which assigns priority to the factor or situation posing the greatest safety risk to the client. When there are several risks to safety, the one posing the greatest threat is the highest priority. The nurse should use Maslow's Hierarchy of Needs, the ABC priority-setting framework, and/or nursing knowledge to identify which risk poses the greatest threat to the client.

A nurse is assessing a client who is experiencing chest pain. Which of the following medications should the nurse expect to administer to suppress the aggregation of platelets?

Aspirin Aspirin suppresses platelet aggregation, producing an immediate antithrombotic effect. The client should chew the first dose of aspirin to allow rapid absorption.

A nurse is caring for a client and realizes after administering the 0900 medications that she administered digoxin 0.25 mg PO to the client instead of the prescribed digoxin 0.125 mg PO. Which of the following actions should the nurse take first?

Assess the client's apical pulse Caring for this client requires application of the nursing process priority-setting framework. The nurse can use the nursing process to plan client care and prioritize nursing actions. Each step of the nursing process builds on the previous step, beginning with an assessment. Before the nurse can formulate a plan of action, implement a nursing intervention, or notify a provider about a change in the client's status, she must first collect adequate data from the client. An assessment will provide the nurse with the knowledge needed to make an appropriate decision.

A nurse is planning care for a client who is receiving mannitol via continuous Ivy infusion. The nurse should monitor the client for which of the following adverse effects.

Bibasilar crackles Mannitol, and I've osmotic diuretic can precipitate heart failure and pulmonary edema. Therefore, the nurse should recognize lung crackles as an indicator of a potential complication and stopped infusion.

A nurse is providing teaching to a client who has multiple sclerosis and a new prescription for methylprednisolone. which of the following instructions should the nurse include? Select all that apply

Blood glucose levels will be monitored during therapy. Methylprednisolone, increase serum glucose levels and can require management with insulin or antihyperglycemics Avoid contact with people who have known infections. Methylprednisolone, depressed immune system, placing the client at increased risk for developing an infection. Grapefruit juice can increase the effects of this medication. Grapefruit juice can increase the levels of methylprednisolone in the body.

A nurse is caring for a client who has a prescription for a QT interval medication. Which of the following conditions should the nurse identify as an adverse effect of this medication?

Bradycardia The nurse should identify that an adverse effect of a QT interval medication is bradycardia. This medication should be used with caution for clients who have hypotension or heart failure, older adult clients, or clients who have low potassium or magnesium levels.

A nurse is planning discharge teaching for a client who has major depressive disorder and a new prescription for phenelzine. Which of the following foods should the nurse include in the plan as safe for the client to consume while taking phenelzine?

Broiled beef steak Phenelzine, an MAOI, is an antidepressant. This medication interacts with a variety of foods to produce a hypertensive crisis. Beef steak and other meats that are fresh do not interact with phenelzine and are safe to consume.

A nurse is monitoring a client who is receiving phenytoin IV for the treatment of status epilepticus. Which of the following findings should the nurse identify as an adverse effect of the medication?

Cardiac dysrhythmias The nurse should identify cardiac dysrhythmias as an adverse effect of phenytoin IV. As a result of this potential complication, cardiac monitoring is required.

A nurse is checking a client who is receiving an IV infusion of telavancin for Streptococcus pyogenes. Which of the following actions should the nurse include?

Check the client for pruritus The nurse should monitor a client who receives telavancin for pruritus, which can occur if the client develops generalized exfoliative dermatitis from infusing the medication too rapidly. Manifestations of this condition can include flushing, rash, pruritus, urticaria, tachycardia, and hypotension.

A nurse is completing the admission history for a client who reports drinking 1 pint of whiskey every day for 6 years. The client's last drink was 10 hr ago. Which of the following medications should the nurse plan to administer upon admission?

Chlordiazepoxide The nurse should anticipate the client will experience manifestations of alcohol withdrawal. Benzodiazepines are the most effective medications used to facilitate alcohol withdrawal, and chlordiazepoxide is preferred because it has a longer half-life than other benzodiazepines. Benzodiazepines are safe and can stabilize vital signs, reduce the intensity of symptoms, and decrease the risk of seizures and delirium tremens.

A nurse is caring for a client who is experiencing acute alcohol withdrawal. The nurse should expect to administer which of the following medications?

Chlordiazepoxide The nurse should expect to administer chlordiazepoxide to a client who is experiencing manifestations of acute alcohol withdrawal. Chlordiazepoxide is a benzodiazepine; this class of medications is often used to facilitate withdrawal. Chlordiazepoxide assists with decreasing withdrawal manifestations, stabilizing vital signs, and preventing seizures and delirium tremens.

A nurse is caring for a client who has cancer and is taking oral morphine and. docusate sodium. The nurse should instruct the client that taking the docusate sodium daily can minimize which of the following adverse effects of morphine?

Constipation Constipation is a common adverse effect of morphine that can be minimized by taking docusate sodium, a stool softener that promotes easier evacuation of stool by increasing water and fat in the intestines.

A nurse is caring for a client who has a new prescription for meperidine 500 mg PO q 4 to 6 hr to manage pain. Which of the following actions should the nurse take?

Contact the provider for clarification of the prescription The nurse should call the provider and request clarification of the prescription. This dose is significantly outside the recommended range of 50 mg every 3 to 4 hours, not to exceed 600 mg within 24 hours. Only the provider can clarify this prescription.

A nurse is teaching a client who is premenopausal and has a prescription for a combination oral contraceptive. Which of the following findings should the nurse include as an adverse effect of oral contraceptives?

Deep-vein thrombosis The nurse should include in the teaching that clients who are premenopausal and have a prescription for a combination oral contraceptive containing estrogen are at an increased risk for developing a deep-vein thrombosis, which is an adverse effect of this medication.

A nurse is caring for an older adult client who has a prescription for zolpidem at bedtime to promote sleep. The nurse should plan to monitor the client for which of the following adverse effects?

Dizziness Zolpidem can cause dizziness and daytime drowsiness. It can cause confusion in the older adult client.

A nurse is preparing to administer amlodipine to a client who has hypertension. The nurse should plan to monitor the client for which of the following adverse effects of the medication? (Select all that apply.)

Dizziness Palpitations Peripheral edema The nurse should monitor this client who is taking amlodipine for dizziness, palpitations, and peripheral edema as adverse effects of the medication. The nurse should advise the client to avoid activities that require alertness until the effect of the medication is known and to notify the provider if any of these adverse effects occur.

A nurse is administering oral hydroxyzine to a client. Which of the following adverse effects should the nurse instruct the client to expect?

Dry mouth Hydroxyzine has anticholinergic properties. Dry mouth is a common adverse effect of this medication. The nurse should instruct the client to take sips of water or suck hard candies to minimize this effect.

A nurse is administering adenosine via IV bolus for a client who has developed paroxysmal atrial tachycardia. For which of the following findings should the nurse assess the client during the administration of adenosine?

Dyspnea Dyspnea can occur during the administration of adenosine due to bronchoconstriction. Since adenosine has a short half-life of about 10 seconds, this effect should be short-lived.

A nurse is caring for a male client who has been taking cimetidine for the treatment of a duodenal ulcer. Which of the following manifestations related to the medication should the nurse report to the provider?

Emesis that looks like coffee grounds The nurse should identify that coffee-ground emesis is a manifestation of a gastrointestinal bleed as a result of the duodenal ulcer and can indicate that treatment with cimetidine has been ineffective. Therefore, the nurse should report this finding to the provider immediately.

A nurse is caring for a client who has hyperlipidemia and is receiving simvastatin 40 mg PO daily. Which of the following items should the nurse remove from the client's breakfast tray before it is delivered to the room?

Grapefruit juice Grapefruit juice is contraindicated for a client who is taking simvastatin because it raises blood levels of the medication significantly by inactivating a liver enzyme that is responsible for metabolism.

A nurse is teaching a newly licensed nurse about caring for a client who is receiving patient-controlled analgesia (PCA). Which of the following actions by the newly licensed nurse indicates an understanding of the teaching?

Having a second nurse check the PCA setting The nurse should have a second nurse check the PCA settings to ensure the correct amount of medication is being administered to the client.