# Pharmacology Review

4.5 (2 reviews)
A client diagnosed with hypothyroidism has been taking levothyroxine in increasing doses over the past week. Which findings, if present, would indicate to the nurse that the drug dosage is too high?

Select all that apply.

1. Irritability
2. Weight gain
3. Tachycardia
4. Tremors
Click the card to flip 👆
1 / 58
Terms in this set (58)
A client diagnosed with hypothyroidism has been taking levothyroxine in increasing doses over the past week. Which findings, if present, would indicate to the nurse that the drug dosage is too high?

Select all that apply.

1. Irritability
2. Weight gain
3. Tachycardia
4. Tremors
1., 3., 4., & 5. Correct: When a nurse administers levothyroxine, there is an expected therapeutic response of an increase in energy, improved affect, improved gastric motility, weight loss, and less sensitivity to cold. If the levothyroxine dose is too high, the client may experience tachycardia, dysrhythmias, tremors, and a headache. When the levothyroxine level is too high, the symptoms are the same as hyperthyroidism.

2. Incorrect: Weight gain is a symptom of the decreased level of the thyroid hormones, T3 and/or T4. This is a symptom of hypothyroidism.

6. Incorrect: Bradycardia is a symptom of hypothyroidism. This is a result of a decrease in the thyroid hormones, T3 and/or T4 is a S/S of hypothyroidism.
A client with a head injury manifests symptoms of increasing intracranial pressure. The primary healthcare provider prescribes mannitol IV. How would the nurse plan to evaluate the effectiveness of this medication?

1. Monitor urine output hourly
2. Take vital signs every 15 minutes
3. Measure head circumference every 8 hours
4. Assess the level of consciousness (LOC) every hour
4. Correct: The stem of the question states the client manifests symptoms of increased ICP. Even if you do not know how mannitol works, the only answer that assesses the client for increased ICP is to assess the LOC. Change in LOC is the early sign for increased ICP.

1. Incorrect: Mannitol causes an osmotic diuresis effect. Urinary output is expected to increase, but this does not assess changes in ICP. Assessing LOC is the only answer that assesses for changes in ICP.

2. Incorrect: Taking frequent vital signs is an answer that sends the message to the NCLEX people that you don't know what to do, so you'll get a set of vital signs. Changes in V/S would indicate late changes as seen in Cushing's Triad.

3. Incorrect: Measuring head circumference is useful if your client is an infant, but frequently assessing the LOC is a more sensitive indicator.
A client is admitted to the surgical unit with cholelithiasis and a history of psychosis and a known allergy to phenothiazines. Which prescription should the nurse discuss with the primary healthcare provider?

Orders
- Clear liquid diet
- IV of LR with KCL 20 mEq at 125 ml/hr
- Thioridazine 50 mg PO TID
​- Ciprofloxicin 200 mg IVPB q 12 hours
- Haloperidol 5 mg PO BID
- Ondansetron 4 mg IM PRN for N/V

Allergies
- Phenothiazines
​- Penicillin

1. Thioridazine 50 mg PO tid
2. Ciprofloxicin 200 mg IVPB every 12 hours
3. Haloperidol 5 mg PO bid
4. Ondansetron 4 mg IM prn nausea or vomiting
1. Correct: The client is allergic to phenothiazines. Thioridazine is a phenothiazine and should not be given to this client.

2. Incorrect: Ciprofloxicin is an antibiotic but is not a penicillin drug; therefore, it can be administered to this client.

3. Incorrect: Haloperidol is an antipsychotic medication. The classification is butyrophenone, not a phenothiazine.

4. Incorrect: Ondansetron is an antiemetic and is an appropriate drug for this client.
The nurse instructs a client taking isoniazid for the treatment of tuberculosis (TB) regarding appropriate food choices. Which food choices indicate to the nurse that teaching has been successful?

1. Salad with bleu cheese dressing.
2. Smothered liver with onions.
3. Smoked salmon with crackers.
4. Correct: Pears are acceptable fruit. Foods high in tyramine can cause headaches, fast or irregular heartbeats, nausea and vomiting and sensitivity to light. Foods high in tyramine such as aged cheeses, certain meats, liver, moked fish, sour cream, raisins, bananas and avocados should not be eaten when taking isoniazid.

1. Incorrect: Avoid foods high in tyramine. Foods high in tyramine such as salad with bleu cheese dressing can result in severe reactions when client is taking isoniazid.

2. Incorrect: Avoid foods high in tyramine. Foods high in tyramine such as smothered liver with onions can result in severe reactions when client is taking isoniazid.

3. Incorrect: Avoid foods high in tyramine. Foods high in tyramine such as smoked salmon can result in severe reactions when client is taking isoniazid.
The nurse is caring for a client on the cardiac unit. Which assessments are most important for the nurse to perform prior to the administration of diltiazem?

Select all that apply

1. Note the rate and character of the apical pulse.
2. Ausculate the anterior and posterior breath sounds.
3. Check the morning results of serum calcium.
4. Review the last 24 hour urine output.
5. Monitor blood pressure.
6. Assess for chest pain.
1., 5., & 6. Correct: Diltiazem is a calcium channel blocker. It works by relaxing the muscles of the heart and blood vessels. Monitor blood pressure and pulse before and frequently during administration of diltiazem, as it causes systemic vasodilation and suppresses arrhythmias. Diltiazem is used to treat angina, so the nurse should assess for anginal pain.

2. Incorrect: Breath sounds need to be assessed to monitor for signs of heart failure, this would be a complication after diltiazem administration. Breath sounds are not necessarily assessed just prior to administration.

3. Incorrect: Diltiazem is a calcium channel blocker, but the total serum calcium concentration is not affected by it. Calcium channel blockers affect the flow of calcium into muscle cells.

4. Incorrect: A decrease in output would be an indicator of heart failure, which is a complication of diltiazem administration. This would be assessed after giving the medication.
2. Correct: Do not give potassium supplements, salt substitutes, or angiotensin-converting enzyme inhibitors to clients taking potassium sparing diuretics because these drugs can increase the risk of developing high to extremely high blood potassium levels.

1. Incorrect: This medication does not adversely interact with potassium sparing diuretics; however, the nurse should be on the alert for digoxin toxicity with hyper or hypokalemia.

3. Incorrect: Cimetadine is a H2 receptor antagonist indicated for ulcers and GI complaints. It does not adversely interact with potassium sparing diuretics.

4. Incorrect: This medication is a beta blocker, which may be given in addition to a diuretic for hypertension control.
The nurse is developing a teaching plan for a female client who is taking one of the thiazolidinediones for the treatment of type 2 diabetes. What instruction should be included in the teaching plan?

1. Make sure that you use effective contraception while taking this drug.
2. The drug may lead to weight loss.
3. Therapeutic effect is reached within one to two weeks.
4. Therapeutic effect is reached within one month.
1. Correct: Thiazolidinediones may reduce the plasma concentration of the contraceptives. Additionally, post-menopausal women may resume ovulation.

2. Incorrect: Thiazolidinediones may lead to weight gain and exacerbate congestive heart failure.

3. & 4. Incorrect: With thiazolidinediones therapy, therapeutic effect may not be reached until 8 to 12 weeks of treatment.
The nurse is caring for a trauma client who is receiving a unit of whole blood. The client begins to experience lower back pain. What actions should the nurse take?

Select all that apply

2. Collect a urine specimen.
3. Stop the transfusion.
4. Take the client's vital signs.
5. Change the IV tubing
2., 3., 4., & 5. Correct: Assume the worst, and stop the transfusion first, then continue with the assessment. Low back pain is a sign of an acute hemolytic reaction. This is the most dangerous and potentially life-threatening type of transfusion reaction. It occurs when the donor blood is incompatible with that of the recipient. Get lab tests such as a urinalysis to check for presence of hemoglobin, which indicates hemolytic reaction. Take vital signs. Change IV tubing to remove all blood and maintain the IV line with normal saline solution, with new IV tubing, at a slow rate.

1. Incorrect: Diphenhydramine is indicated for an allergic reaction to the blood component being transfused. It is not indicated for a hemolytic reaction.
The nurse is caring for a diabetic client. The client's glucose level at 0700 is 265. What is the nurse's best action?

- 40 units NPH insulin every AM
- Regular Insulin per Sliding Scale both AC and HS Sliding Scale:

Blood glucose < 200: 0 units
Blood glucose 200-249: 2 units
Blood glucose 250-299: 4 units
Blood glucose 300-349: 6 units
Blood glucose 350-399: 8 units
Blood glucose 400 or >: Call the PCP

1. Hold the NPH and regular insulin
2. Give 8 units of regular insulin and hold the NPH
3. Give the NPH and 4 units of regular insulin
4. Give 40 units of NPH and hold the regular insulin
3. Correct: According to the prescription and sliding scale, the client will need 40 units of NPH and 4 units of regular insulin for a glucose level of 250-299.

1., 2., & 4. Incorrect: According to the prescription and sliding scale, the client will need 40 units of NPH and 4 units of regular insulin for a glucose level of 250-299.
1., 4. & 5. Correct: Narcotics sedate and decrease the respiratory rate, which increases CO2 retention. Always monitor respiratory rate. Some antiemetics (such as promethazine) are very sedating and will decrease the respiratory rate while increasing CO2 retention. Sleeping pills can cause sedation to the point of hypoventilation, which leads to CO2 retention. Always monitor respiratory rate.

2. Incorrect: Diuretics do not affect breathing patterns.

3. Incorrect: Steroids do not affect breathing patterns.