VATI | PHARM
A nurse is caring for a client who is prescribed gentamicin sulfate. Which of the following side effects would indicate an adverse reaction to this medication?
Urinary output of 185 mL in an 8 hour shift.
A client experiencing pain has been prescribed meperidine 30mg IM every three hours, as needed for pain. The vial available is merperidine 75mg/1 mL. How much merperidine should the nurse administer?
0.4 ml 0.4 mL of merperidine will be administered by the nurse.30 mg / x = 75 mg / 1 mL30 = 75x30/75 = 0.4 ml
A client is prescribed phenytoin 5 mg/kg/day in 3 divided doses. The client weighs 36 lb. The drug is available at 50mg/mL. What is the total daily dosage in milliliters for this client?
1.6 mL 36 /2.2=16.4kg5 X 16.4 = 82 mg/day82/50=1.64 mL/day
A client has an order for an IV of 1000 ml of lactated ringers with 20 mEq of potassium/L to infuse at 40 ml/hr. The drip factor is 15 drops/ml. The nurse calculates the flow rate to be: ______ gtt/min.
10 drops/min ml/hr X drops/ml 40 ml/hr X 15 drops/ml time in mins 60 mins
A nurse notes the following prescription for a client with thrombophlebitis: Heparin sodium 25,000 units in 500 mL of D5W to infuse at 1,200 units/hour. What is the flow rate in mL per hour?
24 ml/hr Have 25000 units in 500 mL D5W25000 divide by 500cc = 50 units/mLNeed to infuse at 1200 units/hr1200 divide by 50 = 24 ml/hr
A nurse is evaluating a client's understanding of lithium. Which statement by the client indicates a need for further education?
"I should take the medication on an empty stomach." Lithium should be taken with meals or milk to decrease gastric upset.
A client has been prescribed spironolactone for treatment of heart failure. Which statement made by the client would indicate a need for further teaching?
"I will limit the use of salt in my diet and use a salt substitute instead." Correct: Spironolactone is a potassium sparing diuretic and caution should be taken when using this medication with anything that may increase potassium levels. Most salt substitutes contain potassium and should be avoided. Clients should also never take an oral potassium substitute, and be cautioned about large dietary changes that increase potassium. ACE inhibitors should also be used with cautions when on a potassium sparing diuretic.
A client is prescribed digoxin. Which of the following statements by the client indicates to the nurse the need for further teaching?
"If I see halos around lights there is no need to notify my provider."
A client with a recent myocardial infarction is prescribed digoxin. Which of the following findings indicate to the nurse that a therapeutic response to this medication has been attained?
A decrease in pulmonary crackles.
A client in the behavioral health unit began taking fluoxetine 20 mg per day three days ago for depression. Which of the following should the nurse immediately report to the health care provider?
Agitation and fever
A client ingested a full bottle of imipramine hydrochloride. Which of the following toxic effects is most important for the nurse monitor?
Arrhythmias With a Tricyclic antidepressant (TCA) overdose, there is a high risk for serious cardiac problems, including arrhythmias, tachycardia and myocardial infarction.
A client is admitted to the hospital with a diagnosis of diabetic ketoacidosis (DKA). An intravenous infusion of regular insulin has been started. Which of the following nursing interventions is most appropriate for this client?
Ensure glucagon is readily available Glucagon and D50 are used for rapid treatment of hypoglycemia which can occur when insulin is administered intravenously
A client is a Jehovah's Witness and is scheduled for an elective hysterectomy secondary to prolonged and heavy menses. Which medication would the nurse anticipate being ordered prior to surgery for this client?
Epoetin Alfa
A client diagnosed with bipolar disorder and prescribed lithium carbonate is being discharged from the hospital. Which of the following medication prescriptions should the nurse should question?
Furosemide 20 mg by mouth twice per day
The nurse is providing client education regarding the combined use of herbal supplements with prescribed medications. Which of the following statements indicates the client correctly understands the interaction of ginkgo biloba and warfarin?
Ginkgo increases the effects of warfarin so I will stop taking the ginkgo." When ginkgo biloba is taken with antiplatelet or anticoagulant medications, the effect of the antiplatelet/anticoagulant drug may be increased, resulting in uncontrolled bleeding
A nurse is monitoring client compliance with the diabetes mellitus treatment regimen. Which of the following values best indicates compliance with the regimen?
Hemoglobin A1c of 5% Glycosylated hemoglobin (HbA1c) is the best indicator of average blood glucose levels for the past 120 days. This test assists in evaluating treatment effectiveness and compliance. The target value is 4-6%. The value given is within the normal range.
A client is prescribed digoxin 1mg by mouth QID. The client states that the objects in his room have a yellowish tinge and he is nauseated. Select the most appropriate nursing action at this time.
Hold the drug and call the health care provider. This client is showing signs of digitalis toxicity. The most appropriate action is to hold the drug and call the health care provider. Severe arrhythmia may develop if action is not taken.
A nurse has just taught a client about the side effects of levodopa. Which client statement would indicate to the nurse that further instructions is needed?
I still can drive." Correct: This medication may cause sudden onset of sleep, drowsiness and dizziness. Instruct client to avoid driving and other activities that required alertness
A clinic nurse is preparing to administer a Penicillin IM injection to a client who has never taken the medication before. Which of the following interventions should be included in the plan of care?
Instruct the client to sit in the clinic for 30 minutes after the injection. To ensure prompt treatment if anaphylaxis should develop, clients should remain in the prescriber's office for at least 30 minutes after drug injection. After 30 minutes, the risk of anaphylactic reaction is reduced.
A nurse is providing discharge instructions for a client who is taking atenolol. Which instructions should the nurse give to the client to prevent postural hypotension?
Move slowly when changing from lying to standing Taking Tenormin at bedtime will help with symptoms of postural hypotension, which is a common side effect of beta blockers.
A nurse is caring for a client taking captopril who has started experiencing a frequent dry cough. What action should the nurse take?
Notify the provider of the client's symptom. An adverse effect of ACE inhibitors is a cough related to inhibition of kinase II which results in an increase in bradykinin. The provider should be notified if a dry cough occurs so that the medication can be discontinued.
A client admitted with an acute exacerbation of asthma has been prescribed methylprednisolone sodium succinate IV. Which of the following findings should the nurse report to the provider immediately?
Oral temperature of 100.5 F◦
A nurse is caring for a client taking captopril. Which finding would require immediate attention for this client?
Potassium 5.8 A potassium of 5.8 is elevated- normal is 3.5-5. One effect of Capoten is elevation of potassium levels because this drug inhibits the formation of angiotensin II and blocks the release of aldosterone. The blocking of the aldosterone results in sodium excretion and potassium retention. Hyperkalemia can result in cardiac arrhythmias and if untreated lead to cardiac arrest.
A nurse is reviewing the morning laboratory results while preparing to administer a client their dose of digoxin. Which result would the nurse need to report to the primary care provider?
Potassium level of 3.4 mEq/l Serum potassium is important to monitor for the client on digoxin. Hypokalemia can lead to digoxin toxicity while hyperkalemia can lead to a low therapeutic level. The normal range for potassium is 3.5-5.0 mEq/l.
A client experiences postural hypotension during initial drug therapy with diltiazem. Which of the following would be most important for the nurse to recommend to this client?
Rise slowly from a sitting or lying position. Rise slowly from a sitting or lying position. This will allow them to adjust to the upright position; slowly rising allows the heart to adjust the cardiac output to pump harder to maintain adequate BP to offset any orthostatic hypotension from occurring.
A client has been prescribed bupropion to assist with smoking cessation therapy. Which of the following findings would a nurse report to the health care provider immediately?
Seizures
A client is prescribed lisinopril. Which of the following is most important for the nurse to assess before administering this medication to the client?
Serum electrolytes.
A client is prescribed linsinopril. Which of the following findings indicates to the nurse that the client is experiencing an adverse effect of this medication?
Serum potassium 5.8 mEq/L
A client with Type 1 diabetes has the following values from the morning laboratory testing: fasting plasma glucose = 115 mg/dL and HgA1C = 7.5%. How would a nurse interpret these values with regard to the client's glucose control?
Short term values normal, long-term values elevated. Fasting plasma glucose is normal. Normal fasting plasma glucose range for the diabetic client is 90-130 mg/dl. HgA1C level is elevated. HgA1C normal level range is less than 7% with the optimal range being 4-6% in the diabetic. HgA1C level indicates the client's glucose average over the last 120 day period and is considered to be the best indicator of long term glycemic control.
During administration of vancomycin IV, the nurse notices the client's neck and face becoming flushed. Which of the following actions should the nurse take first?
Stop the infusion. Flushing of the face and neck are symptoms of red man or red neck syndrome occurring with too rapid infusion of Vancomycin. Vancomycin can cause two types of hypersensitivity reactions, the red man syndrome and anaphylaxis. Red man syndrome has often been associated with rapid infusion of the first dose of the drug and was initially attributed to impurities found in vancomycin preparations. First action should be to stop the infusion. Contacting the health care provider is necessary after the infusion is stopped. The client should be monitored for serious reactions such as hypotension, dyspnea, anaphylaxis, renal failure or hearing loss. Other minor reactions are chills, dizziness, fever, pruritis, and tinnitus.
A nurse is caring for a client with a history of rheumatoid arthritis who is receiving methotrexate. Which of the following should be included in client education?
The complete blood count (CBC) will be monitored. Bone marrow suppression is a common side effect when using methotrexate for long term therapy in the treatment of rheumatoid arthritis. The client will have their complete blood count monitored periodically for evidence of anemia, neutropenia or thrombocytopenia.
A nurse is administering mannitol to the client with increased intracranial pressure. What supplies are necessary when administering this medication?
Syringe, filter needle, IV filter tubing Correct: Mannitol is an osmotic diuretic, indicated for treatment of increased intracranial pressure, increased intraocular pressure and in certain cases of acute kidney injury. Mannitol is an injectable medication, given slow IV push or via continuous IV infusion. Mannitol may crystalize (form white or icy looking precipitate) in the vial if exposed to extreme temperatures, and this precipitate could be dangerous to the client. For this reason, all mannitol must be drawn up with a filter needle, and then the nurse should remove the filter needle and use the injection port to administer the medication.
A client diagnosed with depression has been prescribed fluoxetine. Which of the following information should the nurse emphasize?
Take the medication in the morning
A nurse is caring for a client prescribed omeprazole. What information should the nurse provide to the client regarding administration of this medication?
Take the medication in the morning before breakfast.
A nurse is caring for a client receiving total parenteral nutrition (TPN). Which of the following outcomes best demonstrates that TPN therapy is effective?
The client maintains an albumin level of 5.0 g/100mL. When clients are on TPN therapy, laboratory values such as electrolytes, CBC, BUN, and plasma glucose should be monitored closely. All laboratory values should be within normal range. Normal range for albumin is 4.5-5.0 g/100ml.
A client with a digoxin level of 2.4 ng/ml has a heart rate of 39. The health care provider prescribes atropine sulfate. Which of the following best describes the intended action of atropine for this client?
To accelerate the heart rate by interfering with vagal impulses.
A client diagnosed with preterm labor has been prescribed nifedipine. The client asks the nurse why this particular medication has been prescribed. Which of the following statements by the nurse is correct?
To relax your muscles of your uterus
A nurse is to administer nitroglycerin to a client for the treatment of angina. Which of the following should the nurse first advise the client?
To sit or lie down. Inform client to sit or lie down. This intervention is priority due to the orthostatic hypotension effects that can occur with nitroglycerin administration; including dizziness, light-headedness, and reduced cardiac output. This can cause a drop in blood pressure. Lying with feet elevated promotes venous return and thereby restores blood pressure. This is a safety concern and action needs to be taken before medication administration
A nurse is to administer morphine sulfate 10 mg intramuscular (IM) to an adult client for post-operative pain. Which injection site is the most appropriate?
Ventrogluteal This site is a deep site, situated away from the major nerves and blood vessels. This site is preferred for medications (such as antibiotics) that are larger in volume, more viscous, and irritating for adults, children, and infants. This site is safe for all clients with large muscle development.
A nurse is teaching a client with gout who is starting allopurinol. Which of the following should the nurse include in the client teaching?
b. Drink 2-3 liters of fluid per day. Correct: The client should be encouraged to drink 2-3 liters of fluid per day to prevent kidney injury, an adverse effect of this medication therapy
