Pharmacology Assignments Flashcards
1
Q
Five days after running out of medication, a client taking clonazepam tells the nurse, “I know I shouldn’t have just stopped the drug like that, but I’m OK.” What is the nurse’s most appropriate response?
A
“You could go through withdrawal symptoms for up to two weeks.”
2
Q
The nurse is planning discharge teaching for a client who will continue taking the prescribed warfarin at home. What early symptoms of occult blood loss should the nurse teach the client?
A
Increasing fatigue and shortness of breath.
3
Q
An adolescent client ingests a large number of acetaminophen tablets in an attempt to commit suicide. Which laboratory result is most consistent with acetaminophen overdose?
A
elevated liver enzyme levelselevated liver enzyme levels
4
Q
A neonate is admitted to the neonatal intensive care unit with persistent pulmonary hypertension. Which medication should the nurse anticipate for this neonate?v
A
inhaled nitric oxide
Inhaled nitric oxide is a potent selective pulmonary vasodilator
5
Q
A child with diabetes insipidus will be receiving injectable vasopressin when discharged from the hospital. What is the most important step when teaching injection techniques?
A
Teach injection techniques to anyone who will provide care for the child as well as to the child if the child is old enough to understand.
6
Q
At the end of the alteplase infusion, the nurse notes that the client’s tongue was swollen. What is the nurse’s priority action?
A
The client has orolingual angioedema, a rare allergic reaction to alteplase that is more common in those taking ACE inhibitors. The nurse should prepare to administer antihistamines, intravenous corticosteroids, or epinephrine per provider orders. When caught early, intubation can often be prevented. If the client is in respiratory distress, and swelling is significant, the nurse should prepare for immediate intubation to protect the airway.
7
Q
A client with chronic alcohol use is admitted to the hospital for detoxification. Later that day, the client’s blood pressure increases and the client is given lorazepam to prevent:
A
seizure
8
Q
Teaching children and parents about the potential adverse effects of treatment for leukemia is important. What is an adverse effect of taking prednisone?
A
increased blood glucose
9
Q
What herbal medication should you avoid taking with aspirin
A
Ginko Biloba
10
Q
What should you assess before giving digoxin
A
Apical heart rate
11
Q
Do you need more or less insulin in the post pregnancy phase - Type 2 diabetes
A
Need less insulin now then during pregnancy
12
Q
The nurse is caring for a client with a prescribed fentanyl 25 mcg/hr transdermal patch placed 72 hours prior. After performing safe medication checks, list in order the steps the nurse will take in placing a new patch. All options must be used.v
A
Assess the client’s vital signs and pain level.
Identify and prepare a new application site.
Remove the used patch and fold its adhesive edges together.
Remove the new patch from its packaging and remove the backing from the adhesive layer.
Press the new patch firmly to the application site with the palm of the hand for 30 seconds.
13
Q
The nurse is teaching the family of a client with a psychiatric disorder about traditional antipsychotic drugs and their effect on symptoms. Which symptom would be most responsive to these types of drugs?
A
delusions
14
Q
A client with joint pain, tenderness and swelling has been admitted to the hospital. A disease modifying anti-rheumatic drug (DMARD) is prescribed by the healthcare provider. Which medication should the nurse expect to administer?
A
Methotrexate is considered a first-line DMARD for most clients with rheumatoid arthritis (RA).
15
Q
The nurse is teaching a client with iron-deficiency anemia about ferrous gluconate therapy. Which statement, if made by the client, would indicate a correct understanding of the teaching?
A
“I will take the medication on an empty stomach with orange juice.”
16
Q
A client, diagnosed with asthma, is experiencing an anaphylactic reaction to a medication. After administering initial emergency care, the nurse would
A
administer bronchodilators.
17
Q
A client calls the clinic worried about experiencing new symptoms after taking antipsychotic medicine. The client reports persistent, uncontrollable restlessness of the limbs and head despite improvement in psychotic symptoms. What is the most appropriate intervention by the nurse?
A
Direct the client to see the provider for medication to address these side effects.
18
Q
When offered acetaminophen, the client’s parents tell the nurse that they would like their child to have something stronger. What is the nurse’s best response?
A
“Opioids are avoided following a head injury because they may hide a deteriorating condition.”
19
Q
A primipara who is Rho(D) negative has just given birth to a Rh-positive baby. The nurse is developing a plan of care. How should Rho(D) immune globulin be administered?
A
to the client within 3 days
20
Q
A client, with new onset of atrial fibrillation, is receiving warfarin to help prevent thromboembolism. The client will be discharged when the warfarin reaches therapeutic levels, and when the international normalized ratio (INR) ranges from
A
2 to 3 INR
In a client with atrial fibrillation, the warfarin is at a therapeutic level when the INR ranges from 2 to 3. A range of 3.5 to 4 is too high, and increases the risk of hemorrhage.
21
Q
After a thyroidectomy, the client develops a positive Trousseau’s sign. What is the nurse’s priority action?
A
administer calcium gluconate
Damage to the parathyroid glands can inadvertently occur during a thyroidectomy. This may cause a decrease in serum calcium, which causes muscle hyperexcitability and tetany. The treatment for a client who develops hypocalcemia and tetany following a thyroidectomy is calcium gluconate.
21
Q
Which antiparkinsonian drug can cause drug tolerance or toxicity if taken for too long?
A
Long-term therapy with levodopa-carbidopa can result in drug tolerance or toxicity manifested by confusion, hallucinations, or decreased drug effectiveness.
22
Q
A child with diabetic ketoacidosis is being treated for a blood glucose level of 738 mg/dl (41.0 mmol/L). The nurse should anticipate an order for:
A
normal saline with regular insulin.
Short-acting regular insulin is the only insulin used for insulin infusions. Initially, normal saline is used until blood glucose levels are reduced, then a dextrose solution may be used to prevent hypoglycemia.
23
Q
The nurse receives an order to administer morphine to a client with an acute myocardial infarction. What is the purpose of this medication?
A
to decrease myocardial oxygen demand
24
The nurse is preparing to administer I.V. insulin to a client diagnosed with diabetic ketoacidosis (DKA). What will the nurse monitor while the client is receiving this intervention?
hypokalemia and hypoglycemia
25
The serum calcium level remains low in a client with hypoparathyroidism despite taking calcium supplements. What should the nurse ask the client related to these findings?
A client with hypoparathyroidism has a decreased serum calcium level. Vitamin D enhances the absorption of calcium from the gastrointestinal tract and is the most important factor in improving the client's response to the calcium supplements.
26
A nurse is teaching a client with glaucoma the proper technique for instilling eye drops. The nurse determines that teaching is effective when the client states:
“I should instill the drop in the lower conjunctival sac.”
27
Which medication would the nurse anticipate as the provider’s treatment of choice for scarlet fever?
penicillin
The causative agent of scarlet fever is Group A beta-hemolytic streptococci, which is susceptible to penicillin. Erythromycin is used for penicillin-sensitive children
28
The nurse and occupational therapist are planning an outdoor volleyball game and picnic for eight mental health clients. What action should the nurse take for the two clients taking nortriptyline for depression?
Provide protective clothing and apply sunscreen before going out.
A common adverse effect of this drug is sensitivity to the sun. Protective clothing and sunscreen should be worn while the client is exposed to sunlight.
29
A nurse is providing instruction to a client undergoing treatment for anxiety and insomnia. The practitioner has prescribed lorazepam 1 mg PO t.i.d.. The nurse determines that teaching has been effective when the client states
Lorazepam is a benzodiazepine used to treat various forms of anxiety and insomnia. Caffeine is contraindicated because it is a stimulant and increases anxiety.
30
A client has just received a renal transplant, and has started cyclosporine therapy. What is the most important information for the nurse to share with this client?
Fever, a flushed feeling, or lethargy suggest an infection. The nurse should closely monitor these symptoms in clients taking cyclosporine because it is an immunosuppressive drug.
31
A team of nurses is preparing a trauma room for the arrival of a child with partial-thickness burns to both lower extremities and portions of the trunk. Which intravenous fluid should the nurse be prepared to administer to this client?
lactated Ringer’s solution
32
The nurse is providing education to a client diagnosed with hyperparathyroidism. The nurse determines further teaching is necessary when the client states that they will continue to take
thiazide diuretics
Thiazide diuretics shouldn’t be taken by a client with hyperparathyroidism as they decrease renal excretion of calcium, and increase serum calcium levels
33
Which medication will the nurse administer to a client who experienced a thrombotic stroke two days ago?
Aspirin
Antiplatelet medication, such as aspirin, should be given by day two in the absence of a bleeding complication. Alteplase is a potent medication that breaks down blood clots. It is approved by the U.S. Food and Drug Administration (FDA) for treatment within three hours of the onset of ischemic stroke.
34
What is the nurse’s priority action when administering phenytoin to a client intravenously?
mix phenytoin with saline solution only
35
A client with chronic obstructive pulmonary disease (COPD) and cor pulmonale had been prescribed a loop diuretic to treat peripheral edema. The nurse should monitor the client closely for what side effect of loop diuretic therapy that could worsen the client's hypercapnia?
hypokalemia
36
A newly admitted client diagnosed with delirium has a history of hypertension and anxiety. The client had been taking digoxin, furosemide, and diazepam. The nurse suspects that this client’s impairment may be the result of:
drug intoxication.
37
The nurse is caring for a client with Reye syndrome who is receiving pancuronium bromide. What is the most important intervention for the nurse to include in the plan of care?
applying artificial tears as needed
Pancuronium bromide suppresses the corneal reflex, making the eyes prone to irritation. Artificial tears prevent drying.
38
A nurse is teaching a client with bipolar disorder about the drug carbamazepine. The nurse determines teaching was effective when the client state
I need to have my blood counts checked periodically.”
The most dangerous adverse effect of carbamazepine is bone marrow depression.
39
A client with pancreatic cancer is prescribed fentanyl by patch with subcutaneous doses for breakthrough pain. The client asks the nurse why the fentanyl cannot just be provided by pill form. How should the nurse respond?
"This medication's effects are greatly reduced if taken in oral forms so topical and parenteral forms must be used."
40
A nurse is teaching a client diagnosed with a pulmonary embolism about the prescribed heparin therapy. The nurse determines that teaching has been effective when the client states heparin is given to
slow the development of other clots.
41
A laboring client in the latent stage of labor begins reporting pain in the epigastric area, blurred vision, and a headache. Which medication would the nurse anticipate for these symptoms?
magnesium sulfate
Magnesium sulfate is the drug of choice to treat hypertension of pregnancy because it reduces edema by causing a shift from the extracellular spaces into the intestines.
42
Terbutaline
smooth muscle relaxant used to relax the uterus.
43
A client with bipolar disorder tells the nurse that she just found out she is pregnant, and is concerned because she takes lithium. What is the most important information for the nurse to provide to this client?
Use of lithium usually results in serious congenital problems.
Use of lithium during pregnancy will result in congenital defects, especially cardiac defects.
44
A client with acute pulmonary edema has been taking an angiotensin-converting enzyme (ACE) inhibitor. The nurse explains that this medication has been ordered to
reduce blood pressure
ACE inhibitors are given to reduce blood pressure by inhibiting aldosterone production, which in turn decreases sodium and water reabsorption.
45
What is the most important assessment for the nurse to make when administering tamsulosin to a client with benign prostatic hyperplasia (BPH)?
voiding pattern
46
A nurse is reviewing the healthcare provider’s orders for a client admitted with systemic lupus erythematosus (SLE). Which medication would the nurse expect to find in this client’s plan of care?
hydroxychloroquine
47
A client with a subarachnoid hemorrhage is prescribed a 1,000 mg loading dose of I.V. phenytoin. What information is most important when administering this dose?
Rapid phenytoin administration can cause cardiac arrhythmias.
48
A client is receiving spironolactone to treat hypertension. Which instruction should the nurse provide?
avoid salt substitutes
Because spironolactone is a potassium-sparing diuretic, the client should avoid salt substitutes because of their high potassium content. The client should also avoid potassium-rich foods and potassium supplements.
49
A nurse is assessing a client with bipolar disorder. The client tells the nurse that the family health care provider prescribed lithium. Which symptom would indicate that the client is developing lithium toxicity?
lethargy
Nausea, vomiting, diarrhea, thirst, polyuria, lethargy, slurred speech, hypotension, muscle weakness, and fine hand tremors are signs of lithium toxicity.
50
The family of a client in rehabilitation following heroin withdrawal asks a nurse why the client is receiving naltrexone. What is the nurse’s best response?
to help reverse withdrawal symptoms
51
A 47-year-old client has been taking prescribed medication for an intestinal ulcer. During a routine office visit for blood pressure monitoring, the client reports he is no longer able to have sexual intercourse with his spouse. The nurse determines that this is most likely the result of:
ulcer medication.
52
One hour after receiving pyridostigmine bromide for myasthenia gravis, a client reports difficulty swallowing and excessive respiratory secretions. What medication would the nurse anticipate to reverse the effects of pyridostigmine bromide?
atropine
These symptoms suggest cholinergic crisis or excessive acetylcholinesterase medication, typically appearing 45 to 60 minutes after the last dose of acetylcholinesterase inhibitor. Atropine, an anticholinergic drug, is used to antagonize acetylcholinesterase inhibitors.
53
A 12-year-old child sustains a moderate burn injury. The parent reports that the child last received a tetanus injection at 5 years of age. Which immunization would the nurse anticipate for this child?
0.5 ml of tetanus toxoid I.M.
Tetanus prophylaxis is given to all clients with moderate to severe burn injuries if it has been longer than 5 years since the last immunization, or if there is no history of immunization. The correct dosage is 0.5 ml I.M., one time
54
A 20-month-old toddler has been treated with permethrin for scabies. The toddler’s parent asks, “Is this medication working? My child is still itching.” Which response by the nurse is most appropriate?
Pruritus can be present for weeks after treatment.
55
The nurse is preparing to administer vasopressin to a client who has undergone a hypophysectomy. What is the purpose of the medication?
to replace antidiuretic hormone (ADH) normally secreted from the pituitary
56
Which nursing intervention would help to decrease the adverse effects of radiation therapy on the gastrointestinal tract?
encouraging fluids and a soft diet
57
The nurse is caring for a newborn with unrepaired transposition of the great vessels. Which medication should the nurse anticipate giving first for treatment of this defect?
prostaglandin E1
Prostaglandin E1 is necessary to maintain patency of the patent ductus arteriosus, and improve systemic arterial flow in children with inadequate intracardiac mixing
58
The nurse is preparing discharge instructions for a client taking lithium. What is the most important information for the nurse to give the client?
Maintain a consistent fluid intake each day, avoiding great fluctuations in volumes consumed.
59
The nurse is instructing a client with vulvovaginal candidiasis on the use of the prescribed nystatin vaginal tablets. Which statement indicates that the client requires additional teaching?
“I can get up to do other activities after inserting the medicine.”
The client will need to lay down for at least 30 minutes after insertion of the vaginal tablets.
60
What is the most important information for the nurse to include when teaching a 17-year-old female client about the adverse effects of isotretinoin?
teratogenicity
The use of even small amounts of isotretinoin has been associated with severe birth defects
61
A client with atrial fibrillation is prescribed warfarin. How should the nurse explain the purpose of this medication to the client?
"Warfarin is prescribed to people with atrial fibrillation to reduce the risk of having a stroke."
62
The health care provider is preparing a plan of care for a client with borderline personality disorder. Which medication would the nurse anticipate for this client?
Selective serotonin reuptake inhibitors (SSRIs), along with an atypical antipsychotic, are used to treat mood instability and impulsivity.
63
A client is experiencing status asthmaticus. For which would the nurse anticipate an immediate order?
inhaled Beta-2 adrenergic agonist
64
The nurse understands that certain medications protect the ischemic myocardium by blocking catecholamines and sympathetic nerve stimulation. Which class of medications serve this function?
beta-adrenergic blockers
65
A client with terminal cancer is receiving large doses of opioids for pain control. The client becomes agitated and continues trying to get out of bed but can’t stand without the assistance of two people. To reduce the client’s risk of falling, which type of restraint should the nurse request for this client?
chemical restraints
Antianxiety medication can be used to calm the client. Chemical restraints are effective, especially with highly agitated clients receiving large doses of opioids. Other forms of restraint will increase the client’s agitation and hostility, thus increasing the risk of injury.
66
The health care provider has prescribed salicylates for an older adult client with osteoarthritis to relieve pain. The nurse knows to assess the client for what potential adverse reaction?
hearing loss
Many older adults already have diminished hearing, and salicylate use can lead to further or total hearing loss.
67
The nurse reviews information about how to take the prescribed tetracycline. Which statement by the client allows the nurse to determine that the client understands the information?
“I can take tetracycline 1 hour before or 2 hours after meals with plenty of water.”
Tetracycline must be taken on an empty stomach to increase absorption, and with ample water to avoid esophageal irritation. Milk products impede absorption.
68
Which medication would the nurse expect the provider to prescribe as prophylaxis against Pneumocystis carinii pneumonia for a client with leukemia?
co-trimoxazole
69
The nurse is caring for a client on a patient-controlled analgesia (PCA) pump. What additional interventions by the nurse would be effective for pain relief? Select all that apply.
gentle massage of the area with positioning
encouraging relaxing of inflamed muscles and performing distraction exercises
70
A client who is being discharged from the hospital with bacterial pneumonia discusses not completing all medication in antibiotic regimens in the past. Which statement should be a priority by the nurse?
“Taking only part of the prescription medication will result in antibiotic-resistant microbes.”
71
The nurse is assessing a client who is receiving an infusion of total parenteral nutrition (TPN). The infusion rate is now faster than prescribed. After adjusting the infusion rate, the nurse should assess the client for which adverse effect?
circulatory overload
72
A nurse is preparing a teaching plan for a client who was prescribed enalapril maleate for the treatment of hypertension. Which instructions would the nurse include in the teaching plan? Select all that apply.
Instruct the client to avoid salt substitutes.
Advise the client to report facial swelling or difficulty breathing immediately.
Advise the client not to change the position suddenly to minimize the risk of orthostatic hypotension.
73
A client is to receive intravascular chemotherapy for 10 days. Which equipment should the nurse use for this procedure?
peripherally inserted central catheter (PICC)
When the duration of intravascular therapy is likely to be more than 6 days, a midline catheter or a PICC is preferred
74
The nurse is reconstituting a powdered medication in a vial. After adding the solution to the powder, the nurse should
roll the vial gently between the palms.
75
Which technique is correct when administering a subcutaneous injection?
Insert the needle at a 45-degree angle to the skin
Subcutaneous injections are administered at an angle of 45 to 90 degrees, depending on the size of the client. Subcutaneous needles are typically to 1/2 to 5/8 inches (1.3 to 1.6 cm) in length. The skin should be pinched up at the injection site to elevate the subcutaneous tissue. Air is not drawn into the syringe for a subcutaneous injection.
76
Ear drops have been prescribed to be instilled in the adult client’s left ear to soften cerumen. To position the client, what should the nurse do?
Pull the auricle lobe up and back.
77
Which I.M. injection site is appropriate for a 6-month-old infant?
vastus lateralis muscle
The nurse should give the injection in the ventrogluteal area only in a child who has been walking for about 1 year. The deltoid and gluteus maximus muscles aren't appropriate injection sites in children.
78
Which assessment findings indicates that epoetin alfa is having a therapeutic effect?
hemoglobin 12 g/dL
Epoetin alfa is a colony-stimulating factor used help boost red blood cell count
79
Which statement indicates that a client understands discharge instructions about propranolol?
“I will assess my heart rate before I take my medication.”
80
Which action is a priority for the nurse when finding medications at a client’s bedside?
Remove the medications from the room and discard them into an appropriate disposal bin.
81
A client has an intravenous line in place for 3 days and begins to state discomfort at the insertion site. Based on the nurse’s progress note, what condition has most likely occurred?
infiltration
The assessment findings of pallor, swelling, skin that is cool to the touch at the intravenous insertion site, and a normal WBC count all indicate infiltration. The infusion would be discontinued and restarted in a different site. Phlebitis would be evidenced by redness at the cannula tip and along the length of the vein. Infection would be evidenced by an elevated WBC count.
82
A client with bacterial pneumonia is receiving an aminoglycoside antibiotic. To ensure safe use of the drug, the nurse should monitor which laboratory value?
serum creatinine
83
The client was admitted to the hospital with the diagnosis of iron overload. Over time, an excess of iron can damage the liver and cause heart problems. Which medication does the nurse anticipate the healthcare provider to order?
deferoxamine
84
Immediately after receiving an injection of bupivacaine, the client becomes restless and nervous and reports a feeling of impending doom. What should the nurse do next?
Assess the client's vital signs.
85
The client has come to the hospital emergency room reporting lethargy and vomiting. The healthcare provider makes a tentative diagnosis of Reye's syndrome. The client's history reveals a recent acute viral infection and the use of several medications. The nurse suspects which medication to be implicated in the development of Reye's syndrome?
Aspirin is implicated in the development of Reye's syndrome in children with a history of recent acute viral infection.
86
An Asian-American client with hyperglycemia is admitted to the healthcare facility. After the client is stable, the nurse discovers that the client has not had the prescribed medicines. The client believes that eating saffron will keep blood glucose level under control. The nurse determines that saffron is not known to influence blood glucose levels. What is the most appropriate response by the nurse?
"Why don't you take the medicines, too, and benefit from both?"
87
The health care provider has prescribed a saline lock for a client. In which order from first to last should the nurse implement this prescription? All options must be used.
Use the nondominant hand to stabilize the vein by pulling the skin taut.
Apply clean gloves, and locate and clean the venipuncture site.
Stabilize the catheter and apply dressing to secure the saline lock.
Insert an over-the-needle catheter, advancing the catheter once flashback is observed.
88
The nurse administers an intradermal injection to a client. Proper technique has been used if the injection site has which appearance?
evidence of a bleb
89
A client has sustained a head injury and is to receive mannitol by I.V. push. In evaluating the effectiveness of the drug, the nurse should expect to find:
decreased cerebral edema.
90
The nurse establishes the goal of preventing the development of a stress ulcer in a burn client. Which would most likely contribute to the achievement of this goal?
administering famotidine as ordered
Prevention is the best treatment, and clients are frequently treated prophylactically with antacids and H2 histamine blockers such as famotidine.
91
A client’s caretaker calls the home care nurse and states accidentally puncturing the central venous catheter after discontinuing the total parenteral nutrition. What instructions should the nurse provide to the caretaker?
Clamp the catheter.
92
What information should the nurse provide to the client who is receiving warfarin?
International Normalized Ratio (INR) is used to assess effectiveness.
93
The home care nurse is conducting a follow-up visit to a client who was recently discharged to home with intermittent total parental nutrition (TPN) therapy. What statement by the client leads the nurse to determine that additional teaching is needed?
"I will change the I.V. administration tubing every week."
94
Small air bubbles adhering to the interior surface of the syringe might have which effect on parenteral administration?
altered drug dose
95
A client is using patient-controlled analgesia (PCA) to manage postoperative pain. What should the nurse do when assisting the client with the PCA?
Document the client's response to pain medication.
96
A client is receiving warfarin for newly diagnosed atrial fibrillation. Which laboratory result would indicate that the nurse should withhold the medication and contact the health care provider?
INR of 4.8
97
What should a nurse expect to find while assessing the vital signs of a client who has abruptly stopped taking beta-adrenergic blocker?
irregular pulse
98
When positioned properly, the tip of a central venous catheter should lie in the
superior vena cava.
99
A client's serum ammonia level is elevated, and the health care provider prescribes 30 mL of lactulose. The nurse should assess the client for which expected effect of this drug?
increased bowel movements
100
Which instruction should a nurse give a client with prostatitis who is receiving co-trimoxazole double strength?
"Drink 6 to 8 glasses of fluid daily while taking this medication."
101
Which type of solution raises serum osmolarity and pulls fluid from the intracellular and intrastitial compartments into the intravascular compartment?
hypertonic
102
The client's blood sugar is 210 mg/dL (11.7 mmol/L) this morning. The nurse verifies a dose of 8 units of regular insulin from the sliding scale. Which sites are acceptable for the nurse to administer the insulin? Select all that apply.
abdomen
upper outer arms
upper outer thighs
103
A client who is receiving multiple medications for a myocardial infarction reports severe nausea. Assessments reveal that the heartbeat is irregular and slow. The nurse should recognize these symptoms as toxic effects of which medication?
digoxin
104
Which type of solution, when administered I.V., would cause fluid to shift from body tissues to the bloodstream?
hypertonic
105
Before advising a 24-year-old client desiring oral contraceptives for family planning, the nurse would assess the client for which signs and symptoms?
hypertension
106
If a manual end-of-shift count of controlled substances isn't correct, the nurse's best action is to
immediately report the discrepancy to the nurse-manager, nursing supervisor, and pharmacy.
107
A client is prescribed buspirone 5 mg two times a day. Which statement(s) indicate that the client has understood the nurse's teaching about this drug? Select all that apply.
Buspirone will help me not to worry so much
I'll be able to focus better
108
A nurse has an order to administer an I.M. injection of iron dextran to a client. Which action is correct for an I.M. injection?
Withdraw the needle and release the skin.
109
A client has been taking intravenous furosemide for congestive heart failure. The client is ordered to start intravenous gentamicin. What intervention is the priority for the nurse?
monitor serum BUN and creatinine levels
110
A client is admitted to the neurologic intensive care unit for an intracranial hemorrhage. Which medication prescription should the nurse question for this client?
enoxaparin
111
A nurse is caring for a 3-year-old child admitted to the pediatric unit with acetaminophen poisoning. The nurse administers acetylcysteine every 4 hours for 72 hours. Which laboratory findings confirm the effectiveness of the drug therapy?
alanine aminotransferase and aspartate aminotransferase
112
A nurse is preparing to give an average-size 9-year-old child a preoperative I.M. injection. Which size needle should the nurse use?
22G, 1
113
When injecting an intravenous push medication into intravenous tubing with a solution infusing, the nurse should select which injection port?
the port closest to the client
114
After receiving an I.M. injection, a client complains of burning pain at the injection site. Which nursing action would be most appropriate at this time?
applying a warm compress to dilate the blood vessels
115
Which class of medication protects the ischemic myocardium by blocking catecholamines and sympathetic nerve stimulation?
beta-adrenergic blockers
116
The nurse should establish baseline data on a client who is starting on long-term gentamicin sulfate therapy. Which is least important for assessment screening in this client?
Visual acuity
Visual acuity is not affected by long-term gentamicin sulfate therapy. The nurse should establish baseline data for vestibular, renal, and auditory function because gentamicin sulfate is ototoxic and causes renal toxicity.
117
A primigravid client who was successfully treated for preterm labor at 30 weeks’ gestation had a history of mild hyperthyroidism before becoming pregnant. What instructions should the nurse include in the plan of care?
Continue taking low-dose oral propylthiouracil as prescribed.
118
The nurse is observing a new graduate nurse instill eyedrops into a client’s eyes. The nurse evaluates that the new graduate is using appropriate technique when which step is incorporated into the procedure?v
The nurse’s hand is stabilized on the client’s forehead while instilling the drops.
119
A client who is using a patient-controlled analgesia (PCA) pump after bowel surgery states, “I’m afraid that I’ll become addicted if I use too much morphine.” Which would be the best response by the nurse?
“When morphine is used to alleviate severe pain for 2 to 3 days, there is little likelihood of becoming addicted.”
120
A client is being switched from levodopa (L-dopa) to carbidopa-levodopa. The nurse should monitor for which possible complication during medication changes and dosage adjustments?
vital sign fluctuation
121
The nurse establishes the goal of preventing the development of a stress ulcer in a burn client. Which would most likely contribute to the achievement of this goal?
administering famotidine as ordered
122
Which statement by a student nurse demonstrates that further instruction about cytotoxic drugs is needed?
"Nurses who are pregnant must wear gloves during administration of cytotoxic drugs.”
Pregnant nurses should not administer cytotoxic drugs because long-term exposure to cytotoxic drugs may be associated with teratogenic effects. Nonpregnant nurses should wear double gloves and long sleeve disposable gowns while administering cytotoxic drugs.
123
The health care provider orders ibuprofen for a client reporting pain. What should the nurse include in the client's teaching concerning ibuprofen? Select all that apply.
Notify the health care provider immediately of dark tarry stools.
Do not take aspirin concurrently with ibuprofen.
Notify the health care provider of skin rash or jaundice immediately.
124
The nurse is monitoring a client who was given midazolam during a moderate sedation procedure. In the immediate postprocedure phase, the client becomes unresponsive to painful stimuli and apneic. The nurse should give which medication?
flumazenil
125
The client presents at the clinic for a cough and is ordered codeine. What should the nurse include in the client's teaching concerning the administration of codeine? Select all that apply.
Use of codeine can cause nausea
Use of codeine can cause constipation
Use of codeine can cause dizziness
126
Which moral principle is a nurse applying when the nurse decides what is best for a client and acting without consulting the individual?
paternalism
127
A nurse has just received a report on four clients. Which client should the nurse see first?
A client who underwent a thyroidectomy and has new onset hoarseness
128
A client who is receiving multiple medications for a myocardial infarction reports severe nausea. Assessments reveal that the heartbeat is irregular and slow. The nurse should recognize these symptoms as toxic effects of which medication?
digoxin
129
The healthcare provider has ordered chlorpromazine for a client diagnosed with schizophrenia. What should the nurse include in the client's teaching concerning the administration of chlorpromazine?
"Chlorpromazine can cause involuntary movements of the face and jaw."
130
The nurse is teaching the client with a hiatal hernia about taking metoclopramide hydrochloride. Which medication should the client avoid while taking this drug?
central nervous system depressants
131
A nurse is teaching a client about taking antihistamines. Which information should the nurse include in the teaching plan? Select all that apply.
Operating machinery and driving may be dangerous while taking antihistamines.
Do not use alcohol with antihistamines
Increase fluid intake to 2000 mL per day.
132
A client is admitted to the emergency department after intentionally taking an overdose of amitriptyline hydrochloride. A nurse knows that giving the client activated charcoal will
bind with the ingested drug
133
A client complains of difficulty swallowing when the nurse tries to administer a medication in capsule form. What action should the nurse take next?
Check for availability of a liquid preparation.
134
What is the most important information for the nurse to include when teaching a 17-year-old female client about the adverse effects of isotretinoin?
teratogenicity
The use of even small amounts of isotretinoin has been associated with severe birth defects
135
A physician orders a loop diuretic for a client. When administering this drug, the nurse anticipates that the client may develop which electrolyte imbalance?
hypokalemia
136
The nurse just admitted a client to a skilled nursing facility and assumed care of this client. The client has a G-tube. When reviewing medication prescriptions, which formulation(s) of medications can the nurse give through the tube? Select all that apply.
Oral suspension
Simple compressed tablet
137
A client is receiving fluid replacement with lactated Ringer's solution after 40% of the body was burned 10 hours ago. The assessment reveals a temperature of 97.1°F (36.2°C), heart rate of 122 bpm, blood pressure of 84/42 mm Hg, central venous pressure (CVP) of 2 mm Hg, and urine output of 25 mL for the last 2 hours. The intravenous (IV) rate is currently at 375 mL per hour. Using the SBAR (Situation-Background-Assessment-Recommendation) technique for communication, the nurse should request which prescription from the health care provider?
IV rate increase
138
The nurse is assisting a client who just received an epidural during the first stage of labor. Which medication does the nurse know may be needed at this time?
oxytocin
An epidural can slow contractions, so many clients will need to have oxytocin to maintain contraction strength. Magnesium sulfate and terbutaline are tocolytic medications to decrease contractions, and methergine is used for postpartum hemorrhage.
139
A healthcare provider prescribes an antibiotic for a 6-year-old client with an upper respiratory tract infection. For what prescribed antibiotic will the nurse seek clarification from the healthcare provider?
Tetracycline should be avoided in children younger than age 8 because it may cause enamel hypoplasia and permanent yellowish gray to brownish tooth discoloration.
140
A client diagnosed with idiopathic thrombocytopenia purpura needs a peripherally inserted central catheter (PICC) placed. When explaining the catheter to the client, the nurse explains that one advantage of a catheter is that it can be used
to provide long-term access to central veins.
141
A client is requesting the medication bupropion to treat depression. The nurse alerts the healthcare provider if the client has a history of which conditions? Select all that apply.
seizures
eating disorders
142
The nurse is evaluating the effectiveness of colchicine, prescribed for a client recently been diagnosed with gout. What outcomes would indicate that this medication has been effective? Select all that apply.
decreased inflammation
fewer gout attacks
effective pain management
the client is able to perform daily living activities
143
A client in the intensive care unit has a critically low potassium level of 1.9 mEq/l (mmol/l). What would be the best way to replace this client's potassium?
Administer two potassium chloride 10 mEq (10 mmol) in 100 ml 0.9% sodium chloride IVPB, over 1 hour each
144
A client with cystic fibrosis develops pneumonia. To decrease the viscosity of respiratory secretions, the physician orders acetylcysteine. Before administering the first dose, the nurse checks the client's history for asthma. Acetylcysteine must be used cautiously in a client with asthma because it
may induce bronchospasm.
145
The client who is 28 weeks gestation is at the obstetric (OB) clinic reviewing lab work. The human immunodeficiency virus (HIV) test is positive, and treatment is indicated. Which medication should the nurse expect to administer that will help to prevent transmission of the virus to the fetus?
zidovudine
146
Select the actions the nurse will take to provide for safe IV medication administration Heparin
Verify the order with another nurse.Check infusion pump settings with two nurses.
Use two client identifiers prior to administering the medication.
Scan the bar code on the client's identification (ID) band and IV medication bag.
Monitor the activated partial thromboplastin time (aPTT).
Monitor the platelet count.
147
The client comes to the clinic and is prescribed a diuretic. The client asks the nurse, "What does a diuretic do?" What is the best response by the nurse? Select all that apply.
"A diuretic will inhibit the reabsorption of sodium.
"A diuretic will increase the loss of water."
148
A client who is receiving acetaminophen for osteoarthritis reports continuing pain. The healthcare provider prescribes celecoxib. What important information regarding this medication, should the nurse share with this client?
report black and tarry stools to the health care provider
149
The nurse assesses a client who is receiving a tube feeding. Which situation would require prompt intervention from the nurse?
The feeding that is infusing has been hanging for 8 hours
Feeding solutions that have not been infused after hanging for 8 hours should be discarded because of the increased risk for bacterial growth. Sitting the client upright during the feeding helps prevent aspiration of the feeding. A gastric residual of 25 mL is considered acceptable. A gastric residual of 100 to 150 mL, or a residual greater than 100% of the previous hour's intake, indicates delayed emptying. The feeding solution should be at room or body temperatur
150
A client at 6-weeks' gestation comes to the emergency department, and a transvaginal ultrasound confirms ectopic pregnancy with the tube intact. The client will be treated medically. What medication will the nurse prepare to administer to this client?
methotrexate
151
A client is prescribed a tricyclic antidepressant after other medications were ineffective. The nurse assesses for what outcome as evidence the new medication has been effective?
improved cognitive functioning
152
Which medication would the nurse expect the provider to prescribe as prophylaxis against Pneumocystis carinii pneumonia for a client with leukemia?
As prophylaxis against P. carinii pneumonia, continuous low dosages of co-trimoxazole are typically prescribed.
153
The nurse is developing a teaching plan for the client receiving clozapine. What aspects of follow-up care should the nurse include in the plan? Select all that apply.
weekly complete blood count (CBC) with differential
avoid driving
154
The nurse will assist with the sedation procedure for a client who is undergoing an ankle reduction. Which medication should the nurse prepare?
Ketamine
155
The nurse is working on a labor and delivery unit, and is precepting a new graduate nurse. The graduate asks the preceptor, "Is oxytocin used for pain in labor and delivery?" What is the best response by the preceptor? Select all that apply.
"Oxytocin is used to control postpartum bleeding.”
"Oxytocin is used to stimulate breast milk ejection.”
"Oxytocin is used for labor induction."
156
The nurse is teaching the parents of a child with growth hormone deficiency how to administer growth hormone to their child. At what time should the nurse suggest administration of this medication?
at bedtime
Optimal therapeutic effect is typically achieved when the prescribed growth hormone is administered at bedtime. Pituitary release of growth hormone occurs during the first 45 to 90 minutes after the onset of sleep, so normal physiological release is mimicked with bedtime dosing
157
The nurse is teaching a client about glaucoma treatments. What statement by a client demonstrates an understanding of the need for medication adherence?
If I don't take my medication as ordered, I will experience permanent vision loss."
158
The client was admitted to the hospital with the diagnosis of iron overload. Over time, an excess of iron can damage the liver and cause heart problems. Which medication does the nurse anticipate the healthcare provider to order?
deferoxamine
159
A client is taking paroxetine 20 mg PO every morning. The nurse should monitor the client for which adverse effect?
sexual problems
160
The client has been admitted to the hospital with generalized seizures and the healthcare provider ordered pentobarbital sodium. What discharge teaching will the nurse include about pentobarbital sodium?
Alcohol can cause drug toxicity with pentobarbital sodium."
161
A 25-year-old woman who is in the first stage of labor receives a continuous lumbar epidural block when the cervix is 6-cm dilated. After administration of this anesthesia, which assessment would be most important?
fetal heart rate
162
A nurse should assess the maturity of enzyme systems (kidney and liver) in which pediatric population before administering medications?
premature infants
163
During a home visit, the nurse assesses a client who is taking hydrochlorothiazide and lisinopril for the treatment of hypertension. Which finding would indicate the nurse should inform the health care provider of a possible need to change medication therapy?
A persistent cough is a side effect of the ACE inhibitor that may warrant a change to another antihypertensive medication.
164
A client with diabetes insipidus is receiving vasopressin. Which sign indicates that the drug is having the intended effect?
concentration of urine
165
One hour before a client is to undergo abdominal surgery, the physician orders atropine, 0.6 mg I.M. The client asks the nurse why this drug must be administered. How should the nurse respond?
"Atropine decreases salivation and gastric secretions."
166
A client with lung cancer is being cared for by their spouse at home. The client’s pain is increasing in severity. The nurse recognizes that teaching has been effective when the spouse uses which pain relief strategy? Select all that apply.
gives the client a long-acting or sustained-release oral pain medication regularly around the clock
uses an immediate-release medication (oxycodone) for breakthrough pain
uses music for distraction as well as heat or cold in combination with medications
has the client use a pain rating scale to measure the effectiveness of reaching their individual pain goal
167
An RN preceptor is assisting a new graduate to access a port-a-cath with a Huber needle. Which action by the new graduate would require intervention by the RN preceptor?
rotating the needle immediately after access
Accessing a port-a-cath is a sterile procedure which requires a mask and sterile gloves. The needle should be placed at a 90 degree angle and should NOT be rotated as this may damage the port.
168
The client was admitted to the hospital with the diagnosis of iron overload. Over time, an excess of iron can damage the liver and cause heart problems. Which medication does the nurse anticipate the healthcare provider to order?
deferoxamine
169
A client is prescribed phenelzine. Which food should the nurse tell the client to avoid while taking the medication?
Phenelzine is a monoamine oxidase inhibitor (MAOI). MAOIs block the enzyme monoamine oxidase, which is involved in the decomposition and inactivation of norepinephrine, serotonin, dopamine, and tyramine (a precursor to the previously stated neurotransmitters). Foods high in tyramine—those that are fermented, pickled, aged, or smoked—must be avoided because when they are ingested in combination with MAOIs, a hypertensive crisis occurs. Some examples include salami, bologna, dried fish, sour cream, yogurt, aged cheese, bananas, pickled herring, caffeinated beverages, chocolate, licorice, beer, red wine, and alcohol-free beer
170
A client develops hepatic encephalopathy 1 week after portal caval shunt surgery. The client's physician orders neomycin, 4 g by mouth daily in four divided doses. The client's partner asks how neomycin decreases the serum ammonia concentration. How should the nurse respond?
Neomycin decreases the amount of ammonia-producing bacteria in the GI tract.
171
After evaluating a client for hypertension, a physician orders atenolol, 50 mg P.O. daily. Which therapeutic effect should atenolol have?
decreased cardiac output and decreased systolic and diastolic blood pressure
172
The nurse observes a new parent give an oral medication to a 4-month-old infant. The parent instills the medication directly in the back of the infant’s throat. Which choice is the nurse's best action?
Instruct the parent to instill a small amount of the medication inside the baby’s cheek.
173
The nurse is starting a peripheral intravenous line. Place the steps in the order that the nurse should perform them. All options must be used.
Fill the extension tubing with normal saline and apply slide clamp.
Apply a tourniquet 3 to 4 in (7.5 to 10 cm) above the venipuncture site.
Cleanse site with antiseptic solution.
Perform venipuncture.
When blood returns through lumen of the needle, advance catheter into vein.
Place sterile transparent dressing over venipuncture site.
174
The clinic nurse is teaching caregivers of a 6-year-old client how to administer eye drops for bacterial conjunctivitis. Which will the nurse include in the plan of care? Select all that apply.
Remove any drainage from the eye prior to administration of the eye drops
After administration of the eye drops, keep the eye lid closed for several seconds.
175
A client recently gave birth. Two minutes before breast-feeding the baby, she administers one nasal spray (40 units/ml) of oxytocin into each nostril. Why is the client using this drug?
to stimulate lactation
176
Which foods should the nurse teach the client not to consume when taking phenelzine? Select all that apply.
When taking phenelzine, the client should not consume foods and beverages containing tyramine or tryptophan, or drugs containing pressor agents. Tyramine-containing foods/fluids include aged cheeses, tofu, beer, and smoked meats. Tryptophan-containing foods include chocolate, cottage cheese, milk, and yogurt. Strawberries and pasta are safe for this client to consume.
177
A client admitted to the telemetry unit with newly diagnosed atrial fibrillation has been started on warfarin. What should the nurse instruct the client to do when taking this medication? Select all that apply.
Avoid injury to prevent bruising
Be careful using a razor or fingernail clippers.
Report any change in color of urine or stool.
178
The nurse is reviewing the nurses' notes and lab reports for a client who is receiving total parenteral nutrition (TPN). Which finding is the best indication that the goals for TPN are being achieved for the client?
weight gain of 0.5 lb/day (0.2 kg/day)
Steady and progressive weight gain is the best indication that the client's nutritional goals are being met by TPN.
179
The nurse is instructing a client with acute asthma who is taking short-term corticosteroid therapy. The nurse should tell the client that steroids will have which expected outcome?
have an anti-inflammatory effect
180
The nurse treats pain in a child with leukemia. Which medication prescription should the nurse question?
Ibuprofen prolongs bleeding time and is contraindicated in clients with leukemia. Nonnarcotic drugs other than ibuprofen or aspirin, such as acetaminophen, may be prescribed to control pain and may be used in combination with codeine or hydrocodone if the pain is more severe. Hydromorphone may also be used for severe pain.
181
A child with nephrosis is taking prednisone. The nurse should teach the caregivers to report which adverse effect(s)? Select all that apply.
hematemesis
respiratory infection
vision problems
182
A client newly diagnosed with ulcerative colitis who has been placed on steroids asks the nurse why steroids are prescribed. What should the nurse tell the client?
Steroids are used in severe flare-ups because they can decrease the incidence of bleeding."
183
The nurse is caring for a client with a double lumen tunneled central catheter with ordered bloodwork and intermittent I.V. medications. What is the correct action by the nurse?
Dedicate the largest lumen for blood draws.
184
A client with chronic obstructive pulmonary disease (COPD) is receiving theophylline. What should the nurse include in the client's teaching concerning the side effects of theophylline? Select all that apply.
Theophylline can cause insomnia.”
"Theophylline can cause palpitations.”
"Theophylline can cause nausea."
185
The health care provider (HCP) has prescribed pseudoephedrine. The nurse should instruct the client about which possible adverse effect of this drug?
restlessness
186
A client admitted for alcohol detoxification is taking disulfiram. The nurse should instruct the client to avoid ingestion of which food(s) or liquid(s)? Select all that apply.
communal wine at church
beer
cough syrup
The client who is taking disulfiram is advised to avoid all forms of alcohol, including beer, communal wine at church, and cough syrup; these can trigger a serious physical reaction.
187
A nurse is monitoring a client for adverse reactions to atropine eyedrops. Systemic absorption of atropine sulfate through the conjunctiva can cause which adverse reaction?
tachycardia
188
A nurse discovers that an I.V. site in a client's hand has infiltrated, causing localized pain and swelling. Which intervention would relieve the client's discomfort most effectively?
elevating the hand and wrapping it in a warm towel
189
Which intramuscular (IM) sites are appropriate for the nurse to use in an adult client? Select all that apply.
dorsogluteal muscle
deltoid muscle
vastus lateralis muscle
rectus femoris muscle
190
A client who is using a patient-controlled analgesia (PCA) pump after bowel surgery states, “I’m afraid that I’ll become addicted if I use too much morphine.” Which would be the best response by the nurse?
“When morphine is used to alleviate severe pain for 2 to 3 days, there is little likelihood of becoming addicted.”
191
The nurse teaches the parents of a 2-year-old child how to instill antibiotic eardrops. Which statement about the direction to pull on the earlobe indicates that the child's parent has understood the teaching?
"I should pull the earlobe down and backward."
For children age 3 years and younger, the external auditory canal is straightened by gently pulling the earlobe down and backward. For an older child or an adult, the earlobe is gently pulled up and backward.
192
A multiparous client tells the nurse that she is using medroxyprogesterone injections for contraception. The nurse should instruct the client to increase her intake of which nutrient?
calcium
193
The nurse is to instill drops of phenylephrine hydrochloride into the client's eye before cataract surgery. What is the expected outcome?
dilation of the pupil and constriction of blood vessels
194
The client with preeclampsia asks the nurse why she is receiving magnesium sulfate. The nurse's most appropriate response to is to tell the client that the priority reason for giving her magnesium sulfate is to
prevent seizures.
195
A client with asthma controlled through the consistent use of medication is now pregnant for the first time. Which client statement concerning asthma during pregnancy indicates the need for further instruction?
“Bronchodilators should be used only when necessary because of the risk they present to the fetus.”
196
A client was discharged from an alcohol rehabilitation program on clonazepam 0.5 mg three times a day. Several months later, the client reports having insomnia, shakiness, sweating, and one seizure. The nurse should first assess the client for which possible cause of these symptoms?
stopping the clonazepam suddenly
197
A nurse is administering atropine sulfate to a client about to undergo electroconvulsive therapy (ECT). Which assessment indicates that the medication is effective?
The client reports having a dry mouth.
198
A nurse is caring for a client with a history of cardiac disease and type 2 diabetes. The nurse is closely monitoring the client's blood glucose level. Which medication is the client most likely taking?
carvedilol
199
