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Pharmacology Practice HESI Exam
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Terms in this set (72)
The nurse is caring for a client who has taken atenolol for 2 years. The healthcare provider recently changed the medication to enalapril to manage the client's blood pressure. Which instruction should the nurse provide the client regarding the new medication?
A. Take the medication at bedtime.
B. Report presence of increased bruising.
C. Check pulse before taking medication.
D. Rise slowly when getting out of bed or chair. Correct
The client's new medication is an angiotensin-converting enzyme (ACE) inhibitor, which has the side effect oforthostatic hypotension. Instructing the client to rise slowly from a sitting or lying down position is important to teach the client to avoid dizziness and potentially falling.
A female client calls the clinic and talks with the nurse to inquire about a possible reaction after taking amoxicillin for 5 days. She reports having vaginal discomfort, itching, and a white discharge. The nurse should discuss which action with the client?
Discontinue the antibiotic because original symptoms have subsided.
Continue taking medication until finished until the symptoms subside.
Consult with healthcare provider about another treatment for this effect. Correct
Use an over-the-counter (OTC) vaginal wash to flush out the secretions.
A superinfection with normal flora yeast may occur during antibiotic therapy. If suspected, the new onset of findings should be reported to the healthcare provider for another prescribed treatment to treat the superinfection.
The nurse is making early morning rounds on a group of clients when a client begins exhibiting symptoms of an acute asthma attack. The nurse administers a PRN prescription for a Beta 2 receptor agonist agent. Which client response should the nurse expect?
Increased blood pressure.
Rapid resolution of wheezing. Correct
Improved pulse oximetry values. Correct
Reduce fever airway inflammation.
Beta 2 receptor agonist agents should provide immediate return of airflow and resolve wheezing and improve oxygenation.
A client prescribed atenolol has a blood pressure of 120/68 mmHg, displaying a sinus bradycardia with a rate of 58 beats/minute, and a P-R interval of 0.24. Which action should the nurse take?
Lower the head of the bed and assess the client for orthostatic vital sign changes.
Give the medication as prescribed and continue to monitor the client. Correct
Prepare to administer atropine sulfate IV push.
Hold the prescribed dose and contact the healthcare provider.
Since the client's blood pressure is within normal limits, and the pulse is above 50 beats/min with a first degree block, the medication can be administered. Atenolol is a beta-blocker that slows the heart rate and lowers the blood pressure; this drug is generally held if the heart rate is less than 50 beats/min or the client exhibits dizziness related to hypotension.
The nurse is preparing the 0900 dose of losartan (Cozaar), an angiotensin II receptor blocker (ARB), for a client with hypertension and heart failure. The nurse reviews the client's laboratory results and notes that the client's serum potassium level is 5.9 mEq/L. Which action should the nurse take first?
Withhold the scheduled dose. Correct
Check the client's apical pulse.
Notify the healthcare provider.
Repeat the serum potassium level.
The nurse should first withhold the scheduled dose of Cozaar because the client is hyperkalemic (normal range 3.5 to 5 mEq/l). Although hypokalemia is usually associated with diuretic therapy in heart failure, hyperkalemia is associated with several heart failure medications, including ARBs. Because hyperkalemia may lead to cardiac dysrhythmias, the nurse should check the apical pulse for rate and rhythm, and blood pressure.
Awarded 1.0 points out of 1.0 possible
Upon admission to the emergency center, an adult client with acute status asthmaticus is prescribed this series of medications. In which order should the nurse administer the prescribed medications? (Arrange from first to last.)
Albuterol (Proventil) puffs.
Salmeterol (Serevent Diskus).
Prednisone (Deltasone) orally.
Gentamicin (Garamycin) IM.
Status asthmaticus is potentially a life-threatening respiratory event, so albuterol, a beta2 adrenergic agonist and short acting bronchodilator, should be administered by inhalation first to provide rapid and deep topical penetration to relieve bronchospasms, dilate the bronchioles, and increase oxygenation. In stepwise management of persistent asthma, a long-action bronchodilator, such as salmeterol (Serevent Diskus), with a 12-hour duration of action should be given next. Prednisone, an oral corticosteroid, provides prolonged anti-inflammatory effects and should be given after the client's respiratory distress begins to resolves. Gentamicin, an antibiotic, is given deep IM, which can be painful, and may require repositioning the client, so should be last in the sequence.
An adult client is given a prescription for a scopolamine patch (Transderm Scop) to prevent motion sickness while on a cruise. Which information should the nurse provide to the client?
Apply the patch at least 4 hours prior to departure. Correct
Change the patch every other day while on the cruise.
Place the patch on a hairless area at the base of the skull.
Drink no more than 2 alcoholic drinks during the cruise.
Scopolamine, an anticholinergic agent, is used to prevent motion sickness and has a peak onset in 6 hours, so the client should be instructed to apply the patch at least 4 hours before departure on the cruise ship. The duration of the transdermal patch is 72 hours. Scolopamine blocks muscarinic receptors in the inner ear and to the vomiting center, so the best application site of the patch is behind the ear. Anticholinergic medications are CNS depressants, so the client should be instructed to avoid alcohol while using the patch.
A client with giardiasis is taking metronidazole (Flagyl) 2 grams PO. Which information should the nurse include in the client's instruction?
Notify the clinic of any changes in the color of urine.
Avoid overexposure to the sun.
Stop the medication after the diarrhea resolves.
Take the medication with food. Correct
Flagyl, an amoebicide and antibacterial agent, may cause gastric distress, so the client should be instructed to take the medication on a full stomach. Urine may be red-brown or dark from taking Flagyl, but this side effect is an expectant finding and not necessary to report tot he healthcare provider.
A female client with rheumatoid arthritis takes ibuprofen (Motrin) 600 mg PO 4 times a day. To prevent gastrointestinal bleeding, misoprostol (Cytotec) 100 mcg PO is prescribed. Which information is most important for the nurse to include in client teaching?
Use contraception during intercourse. Correct
Ensure the Cytotec is taken on an empty stomach.
Encourage oral fluid intake to prevent constipation.
Take Cytotec 30 minutes prior to Motrin.
Cytotec, a synthetic form of a prostaglandin, is classified as pregnancy Category X and can act as an abortifacient, so the client should be instructed to use contraception during intercourse to prevent loss of an early pregnancy. A common side effect of Cytotec is diarrhea, so constipation prevention strategies are usually not needed. Cytotec and Motrin should be taken together to provide protective properties against gastrointestinal bleeding.
A client with osteoarthritis receives a new prescription for celecoxib (Celebrex) orally for symptom management. The nurse notes the client is allergic to sulfa. Which action is most important for the nurse to implement prior to administering the first dose?
Review the client's hemoglobin results.
Notify the healthcare provider. Correct
Inquire about the reaction to sulfa.
Record the client's vital signs.
Celebrex contains a sulfur molecule, which can lead to an allergic reaction in individuals who are sensitive to sulfonamides, so the healthcare provider should be notified of the client's allergies.
A client is admitted to the hospital for a new onset of supraventricular tachycardia (SVT) and is prescribed digoxin. For which laboratory finding should the nurse notify the healthcare provider immediately?
Potassium level of 3.1 mEq/L. Correct
Sodium level of 132 mEq/L.
Calcium level of 8.6 mg/dL.
Magnesium level of 1.2 mEq/L.
Hypokalemia affects myocardial contractility and places this client at greatest risk for dysrhythmias that may be unresponsive to drug therapy. Although an imbalance of serum sodium, calcium, and magnesium can effect cardiac rhythm, the greatest risk for a client receiving digoxin is low potassium.
The nurse is transcribing a new prescription for spironolactone (Aldactone) for a client who receives an angiotensin-converting enzyme (ACE) inhibitor. Which action should the nurse implement?
Verify both prescriptions with the healthcare provider. Correct
Report the medication interactions to the nurse manager.
Hold the ACE inhibitor and give the new prescription.
Transcribe and send the prescription to the pharmacy.
The concomitant use of an angiotensin-converting enzyme (ACE) inhibitor and a potassium-sparing diuretic such as spironolactone, should be given with caution because the two drugs may interact to cause an elevation in serum potassium levels. Although the client is currently receiving an ACE inhibitor, verifying both prescriptions alerts the healthcare provider about the client's medication regimen and provides the safest action before administering the medication.
The nurse admits a client with tumor-induced spinal cord compression. Which medication should the nurse anticipate to be prescribed to offer the best palliative treatment for this client?
Dexamethasone is a palliative treatment modality to manage symptoms related to compression due to tumor growth. Morphine sulphate is an opioid analgesic used in oncology to manage severe or intractable pain. Ibuprofen, a nonsteroidal antiinflammatory drug (NSAID), provides relief for mild to moderate pain, suppression of inflammation, and reduction of fever. Amitriptyline, a tricyclic antidepressant, is often prescribed for pain related to neuropathic origin and provides a reduction in opioid dosage.
The nurse is preparing an education session for a client prescribed opioids for intractable cancer pain. The nurse should include strategies to help prevent which common side effect associated with long-term use of opioids?
The client should be prepared to implement measures for constipation, which is the most likely persistent side effect related to opioid use. Tolerance to opiate narcotics is common, and the client may experience less sedation and respiratory depression as analgesic use continues. Opioids increase the tone in the urinary bladder sphincter, which causes retention but may subside. The most likely persistent side effect is constipation.
A client is prescribed controlled-release oxycodone. Which dosing schedule is best for the nurse to teach the client?
Every 12 hours. Correct
Every 24 hours.
Every 4 to 6 hours.
A controlled-release oxycodone provides long-acting analgesia to relieve moderate to severe pain, so a dosing schedule of every 12 hours provides the best around-the-clock pain management. Controlled-release oxycodone is not prescribed for breakthrough pain on a PRN or as needed schedule. Using a schedule of every 4 to 6 hours may jeopardize client safety due to cumulative effects of the medication.
Which client should the nurse identify as being at highest risk for complications during the use of an opioid analgesic?
An older client with Type 2 diabetes mellitus.
A client with chronic rheumatoid arthritis.
A client with a open compound fracture.
A young adult with inflammatory bowel disease. Correct
The principal indication for opioid use is acute pain, and a client with inflammatory bowel disease is at risk for toxic megacolon or paralytic ileus related to slowed peristalsis, a side effect of morphine. Adverse effects of morphine do not pose as great a risk for clients with diabetes or a fracture as for the client with bowel disease.
Which medications should the nurse caution the client about taking while receiving an opioid analgesic?
Respiratory depression increases with the concurrent use of opioid analgesics and other central nervous system depressant agents, such as alcohol, barbiturates, and benzodiazepines. Antacids and antidiabetic agents do not interact with opiates to produce adverse effects. Antihypertensives may cause morphine-induced hypotension, but should not be withheld without notifying the healthcare provider.
A client is prescribed 1 mcg/kg/min of dobutamine hydrochloride via IV infusion. Which client's condition would benefit the most from an administration of dobutamine hydrochloride?
Heart failure. Correct
Dobutamine is a beta-1 adrenergic agonist that is indicated for short term use in cardiac decompensation or heart failure related to reduced cardiac contractility due to organic heart disease or cardiac surgical procedures.
A client is experiencing anaphylaxis from an insect sting. Which medication should the nurse administer?
Epinephrine is an adrenergic agent that stimulates beta receptors to increase cardiac automaticity in cardiac arrest and relax bronchospasms in anaphylaxis. Epinephrine is the medication of choice in treating anaphylaxis.
The healthcare provider prescribes a beta-1 agonist medication to be administered. The nurse should anticipate the medication to be prescribed for a client diagnosed with which condition?
Heart failure. Correct
Beta-1 agonists improve cardiac output by increasing the heart rate and blood pressure. They are indicated in heart failure, shock, atrioventricular block dysrhythmias, and cardiac arrest.
An older client with a decreased percentage of lean body mass is admitted to the hospital. Which pharmacokinetic process is affected and should be considered in the client's dosing of medication?
A decreased lean body mass in an older adult affects the distribution of drugs, which affects the pharmacokinetics of drug and how the medication is distributed throughout the body.
A Category X drug is prescribed for a young adult female client. Which instruction is most important for the nurse to teach this client?
Use a reliable form of birth control. Correct
Avoid exposure to ultra violet light.
Refuse this medication if planning pregnancy.
Abstain from intercourse while on this drug.
Drugs classified in the Category X place a client who is in the first trimester of pregnancy at risk for teratogenesis, so women in the childbearing years should be counseled to use a reliable form of birth control during drug therapy. If the client is planning to become pregnant, she should be encouraged to discuss plans for pregnancy with the healthcare provider, so a safer alternative prescription can be provided if pregnancy occurs.
A client being discharged home is prescribed an antibiotic with a dosage three times higher than it was administered when the client was in the hospital. Which route of administration should the nurse anticipate will be prescribed for the greatest first-pass effect?
The first-pass effect is a pharmacokinetic phenomenon that is related to the drug's metabolism in the liver. After oral medications are absorbed from the gastrointestinal tract, the drug is carried directly to the liver via the hepatic portal circulation, where hepatic inactivation occurs and reduces the bioavailability (strength/concentration) of the drug.
The healthcare provider prescribes naproxen (Naproxen) twice daily for a client with osteoarthritis of the hands. The client tells the nurse that the drug does not seem to be effective after three weeks. Which is the best response for the nurse to provide?
The frequency of the dosing is necessary to increase the effectiveness.
Therapeutic blood levels of this drug are reached in 4 to 6 weeks.
Another type of nonsteroidal antiinflammatory drug may be indicated. Correct
Systemic corticosteroids are the next drugs of choice for pain relief.
Individual responses to nonsteroidal antiinflammatory drugs are vary from person to person, so another nonsteroidal antiinflammatory drug (NSAID) may be indicated for this particular client.
After abdominal surgery, a client is prescribed low molecular weight heparin (LMWH). During administration of the medication, the client asks the nurse the reason for the medication. Which is the best response for the nurse to provide the client?
This medication is given to prevent blood clot formation. Correct
This medication enhances antibiotics to prevent infection.
This medication dissolves clots that develop in the legs.
This medication enhances the healing of wounds.
Unfractionated heparin or low molecular weight heparin (LMWH) is an anticoagulant that inhibits thrombin-mediated conversion of fibrinogen to fibrin and is given prophylactically to prevent postoperative venous thrombosis in order to prevent pulmonary embolism or deep vein thrombosis following knee and abdominal surgeries.
A client with heart failure is prescribed spironolactone (Aldactone). Which information is most important for the nurse to provide to the client about diet modifications?
Do not add salt to foods during preparation.
Refrain for eating foods high in potassium. Correct
Restrict fluid intake to 1000 ml per day.
Increase intake of milk and milk products.
Spironolactone (Aldactone), an aldosterone antagonist, is a potassium-sparing diuretic, so a diet high in potassium should be avoided, along with table salt substitutes, which generally contain potassium chloride that can lead to hyperkalemia.
A client receiving doxorubicin (Adriamycin) intravenously (IV) complains of pain at the insertion site, and the nurse notes edema at the site. Which intervention is most important for the nurse to implement?
Assess for erythema.
Administer the antidote.
Apply warm compresses.
Discontinue the IV fluids. Correct
Doxorubicin is an antineoplastic agent that causes inflammation, blistering, and necrosis of tissue upon extravasation. First, all IV fluids should be discontinued at the site to prevent further tissue damage by the vesicant.
A client with acute myocardial infarction is admitted to the coronary care unit. Which medication should the nurse administer to lessen the workload of the heart by decreasing the cardiac preload and afterload?
Nitroglycerin is a nitrate that causes peripheral vasodilation and decreases contractility, thereby decreasing both preload and afterload.
Which instruction) should the nurse give to a female client who just received a prescription for oral metronidazole (Flagyl) for treatment of trichomonas vaginalis? (Select all that apply.)
Increase fluid intake, especially cranberry juice. Correct
Do not abruptly discontinue the medication; taper use.
Check blood pressure daily to detect hypertension.
Avoid drinking alcohol while taking this medication. Correct
Use condoms until treatment is completed. Correct
Ensure that all sexual partners are treated at the same time. Correct
Increased fluid intake and cranberry juice are recommended for prevention and treatment of urinary tract infections, which frequently accompany vaginal infections. It is not necessary to taper use of this drug or to check the blood pressure daily, as this condition is not related to hypertension. Flagyl can cause a disulfiram-like reaction if taken in conjunction with ingestion of alcohol, so the client should be instructed to avoid alcohol. All sexual partners should be treated at the same time and condoms should be used until after treatment is completed to avoid reinfection.
A client with hyperlipidemia receives a prescription for niacin (Niaspan). Which client teaching is most important for the nurse to provide?
Expected duration of flushing. Correct
Symptoms of hyperglycemia.
Diets that minimize GI irritation.
Comfort measures for pruritus.
Flushing of the face and neck, lasting up to an hour, is a frequent reason for discontinuing niacin. Inclusion of this effect in client teaching may promote compliance in taking the medication. While nutrition tips and managing pruritus are worthwhile instructions to help clients minimize or cope with normal side effects associated with niacin (Niaspan), flushing is intense and causes the most concern for the client.
The nurse is planning discharge instructions for a client prescribed cyclosporine following a liver transplant. Which adverse reactions should the nurse instruct the client to report to the healthcare provider?
Changes in urine color.
Presence of hand tremors. Correct
Increasing body hirsutism.
Nausea and vomiting.
Neurological complications, such as hand tremors, occur in about 50% of clients taking cyclosporine and should be reported. Although this drug can be nephrotoxic, changes in urine color typically does not occur. Nausea is a common side effects, but is not usually severe.
A client is taking hydromorphone (Dilaudid) PO every 4 hours at home. Following surgery, Dilaudid IV every 4 hours PRN and butorphanol tartrate (Stadol) IV every 4 hours PRN are prescribed for pain. The client received a dose of the Dilaudid IV four hours ago, and is again requesting pain medication. Which intervention should the nurse implement?
Alternate the two medications every 4 hours PRN for pain.
Alternate the two medications every 2 hours PRN for pain.
Administer only the Dilaudid every 4 hours PRN for pain. Correct
Administer only the Stadol every 4 hours PRN for pain.
Dilaudid is an opioid agonist. Stadol is an opioid agonist-antagonist. Use of an agonist-antagonist for the client who has been receiving opioid agonists may result in abrupt withdrawal symptoms, and should be avoided.
Which change in data indicates to the nurse that the desired effect of the angiotensin II receptor antagonist valsartan has been achieved?
Dependent edema reduced from +3 to +1.
Serum HDL increased from 35 to 55 mg/dL.
Pulse rate reduced from 150 to 90 beats/minute.
Blood pressure reduced from 160/90 mmHg to 130/80 mmHg. Correct
Valsartan is an angiotensin receptor blocker, prescribed for the treatment of hypertension. The desired effect is a decrease in blood pressure.
A client with coronary artery disease who is taking digoxin (Lanoxin) receives a new prescription for atorvastatin (Lipitor). Two weeks after initiation of the Lipitor prescription, the nurse assesses the client. Which finding requires the most immediate intervention?
Vomiting, anorexia, and abdominal pain are early indications of digitalis toxicity. Since Lipitor increases the risk for digitalis toxicity, this finding requires the most immediate intervention by the nurse.
The nitrate isosorbide dinitrate is prescribed for a client with angina. Which instruction should the nurse include in this client's discharge teaching plan?
Quit taking the medication if dizziness occurs.
Do not get up quickly. Always rise slowly. Correct
Take the medication with food only.
Increase your intake of potassium-rich foods.
An expected side effect of nitrates is orthostatic hypotension and the nurse should instruct the client to prevent it by rising slowly.
The nurse is reviewing admission prescriptions for a client with myxedema. The nurse should clarify with the healthcare provider which prescription for the client?
Liothyronine to replace iodine.
Furosemid for relief of fluid retention.
Pentobarbital sodium for sleep. Correct
Nitroglycerin for angina pain.
Clients with myxedema are dangerously hypersensitive to narcotics, barbiturates and anesthetics and should not be prescribed these medications if possible.
The nurse is providing care for a client prescribed propranolol. Which symptoms should the nurse report to the healthcare provider immediately?
Headache, hypertension, and blurred vision.
Wheezing, hypotension, and AV block. Correct
Vomiting, dilated pupils, and papilledema.
Tinnitus, muscle weakness, and tachypnea.
Wheezing, hypotension, and AV block represents the most serious adverse effects of beta-blocking agents. AV block is generally associated with bradycardia and results in potentially life-threatening decreases in cardiac output. Additionally, wheezing secondary to bronchospasm and hypotension represent life-threatening respiratory and cardiac disorders.
A client asks the nurse if glipizide (Glucotrol) is an oral insulin. Which response should the nurse provide?
"Yes, it is an oral insulin and has the same actions and properties as intermediate insulin."
"Yes, it is an oral insulin and is distributed, metabolized, and excreted in the same manner as insulin."
"No, it is not an oral insulin and can be used only when some beta cell function is present." Correct
"No, it is not an oral insulin, but it is effective for those who are resistant to injectable insulins."
An effective oral form of insulin has not yet been developed because when insulin is taken orally, it is destroyed by digestive enzymes. Glipizide (Glucotrol) is an oral hypoglycemic agent that enhances pancreatic production of insulin.
Which nursing intervention is most important when caring for a client receiving the antimetabolite cytosine arabinoside (Arc-C) for chemotherapy?
Hydrate the client with IV fluids before and after infusion.
Assess the client for numbness and tingling of extremities.
Inspect the client's oral mucosa for ulcerations. Correct
Monitor the client's urine pH for increased acidity.
Cytosine arabinoside (Arc-C) affects the rapidly growing cells of the body, therefore stomatitis and mucosal ulcerations are key signs of antimetabolite toxicity.
A 43-year-old female client is prescribed thyroid replacement hormone following a thyroidectomy. Which adverse effects should the nurse instruct the client to report immediately to the healthcare provider?
Tinnitus and dizziness.
Tachycardia and chest pain. Correct
Dry skin and intolerance to cold.
Weight gain and increased appetite.
Thyroid replacement hormone increases the metabolic rate of all tissues. Common signs and symptoms of toxicity include tachycardia and chest pain and should be reported to the healthcare provider immediately.
A client prescribed albuterol tablets reports nausea every evening with the 9:00 p.m. dose. Which action should the nurse perform to alleviate this side effect?
Change the time of the dose.
Hold the 9 p.m. dose.
Administer the dose with a snack. Correct
Offer an antiemetic with the dose.
Administering oral doses of albuterol with food helps minimize gastrointestinal discomfort such as nausea.
A peak and trough level is prescribed for a client receiving antibiotic therapy. When should the nurse should obtain the trough level?
Sixty minutes after the antibiotic dose is administered.
Immediately before the next antibiotic dose is given. Correct
Upon completion of the prescribed antibiotic regime.
An hour before the next antibiotic dose is given.
Trough levels are drawn when the blood level is at its lowest, which is typically just before the next dose is given.
A client is prescribed ampicillin sodium (Omnipen) for a sinus infection. The nurse should instruct the client to notify the healthcare provider immediately if which symptom occurs?
Rash is the most common adverse effect of all penicillins, indicating an allergy to the medication that could result in anaphylactic shock, a medical emergency.
While taking a medical history, the client states, "I am allergic to penicillin." What related allergy to another type of antiinfective agent should the nurse ask the client about when taking the nursing history?
According to research, there appears to be a cross sensitivity between penicillins and first generation cephalosporins; however, research shows there is no evidence of cross sensitivity between PCN and third or fourth generation cephalosporins.
A client receives a new prescription for sustained release levodopa/carbidopa PO BID for the treatment of Parkinson's disease. The client's previous prescription was levodopa PO TID. The client's last dose of levodopa was at 0800 hr. Which set of instructions should the nurse give to the client?
"Take the first dose of levodopa/carbidopa today, as soon as your prescription is filled."
"Since you already took your levodopa, wait until tomorrow to take the levodopa/carbidopa."
"Take both drugs for the first week, then switch to taking only the levodopa/carbidopa."
"You can begin taking the levodopa/carbidopa this evening, but do not take any more levodopa." Correct
Carbidopa combined with the levodopa significantly reduces the need for levodopa in clients with Parkinson's disease, so the new prescription should not be started until eight hours after the previous dose of levodopa, but can be started the same day.
A client is admitted to the hospital for diagnostic testing for possible myasthenia gravis. The nurse prepares for intravenous administration of edrophonium chloride (Tensilon). What is the expected outcome for this client following administration of this pharmacologic agent?
Progressive difficulty with swallowing.
Decreased respiratory effort.
Improvement in generalized fatigue.
Decreased muscle weakness. Correct
Administration of edrophonium chloride (Tensilon), a cholinergic agent, will temporarily reduce muscle weakness, the most common complaint of newly-diagnosed clients with myasthenia gravis. This medication is used to diagnose myasthenia gravis due to its short duration of action. This drug would temporarily reverse difficulty in swallowing and respiratory effort.
The healthcare provider prescribes naloxone (Narcan) for a client in the emergency room. Which assessment data would indicate that the naloxone has been effective?
A client's statement that the chest pain is better.
Respiratory rate is 16 breaths/minute. Correct
Seizure activity has stopped temporarily.
Pupils are constricted bilaterally.
Naloxone (Narcan) is a narcotic antagonist that reverses the respiratory depression effects of opiate overdose, so assessment of a normal respiratory rate would indicate that the respiratory depression has been reversed.
A client is prescribed morphine 1 mg IV per hour basal rate with 1 mg IV every 15 minutes per patient-controlled analgesia (PCA) pump for a total of 5 mg IV maximally per hour. Which nursing action has the highest priority before initiating the PCA pump?
Assessment of the expiration date on the morphine syringe in the pump.
Assessment of the rate and depth of the client's respirations. Correct
Assessment of the type of anesthesia used during the surgical procedure.
Assessment of the client's subjective and objective signs of pain.
A life-threatening side effect of intravenous administration of morphine sulfate is respiratory depression. Prior to the initiation of the patient-controlled analgesia (PCA) pump, the nurse should assess the client's respirations to obtain a baseline of the client's respiratory rate and depth. Once the PCA pump is initiated, and if the client's respiratory rate falls below 12 breaths per minute, the PCA pump should be stopped and the healthcare provider notified immediately.
The nurse is assessing the effectiveness of high dose aspirin therapy for an 88-year-old client with arthritis. The client reports hearing non-stop ringing in the ears. Which action should the nurse implement?
Refer the client to an audiologist for evaluation of her hearing.
Advise the client that this is a common side effect.
Notify the healthcare provider of the finding immediately. Correct
Face the client directly and speak in a low, monotone voice.
Tinnitus (ringing in the ears) is an early sign of salicylate toxicity. The healthcare provider should be notified immediately, and the medication discontinued.
Which antidiarrheal agent should be used with caution in clients taking high dosages of aspirin for arthritis?
Bismuth subsalicylate (Pepto Bismol). Correct
Diphenoxylate hydrochloride with atropine (Lomotil).
Bismuth subsalicylate (Pepto Bismol) contains a subsalicylate that increases the potential for salicylate toxicity when used concurrently with aspirin (acetylsalicylic acid, another salicylate preparation).
When assessing an adolescent who recently overdosed on acetaminophen (Tylenol), it is most important for the nurse to assess for pain in which area of the body?
Acetaminophen toxicity can result in liver damage; therefore, it is especially important for the nurse to assess for pain in the right upper quadrant of the abdomen, which might indicate liver damage, along with nausea and vomiting.
A client's dose of isosorbide dinitrate (Imdur) is increased from 40 mg to 60 mg PO daily. When the client reports the onset of a headache prior to the next scheduled dose, which action should the nurse implement?
Hold the next scheduled dose of Imdur 60 mg and administer a PRN dose of acetaminophen (Tylenol).
Administer the 40 mg of Imdur and then contact the healthcare provider.
Administer the 60 mg dose of Imdur and a PRN dose of acetaminophen (Tylenol). Correct
Do not administer the next dose of Imdur or any acetaminophen until notifying the healthcare provider.
Imdur is a nitrate which causes vasodilation. This vasodilation can result in headaches, which can generally be controlled with acetaminophen until the client develops a tolerance to this adverse effect.
An adult client has prescriptions for morphine sulfate 2.5 mg IV every 6 hours and ketorolac (Toradol) 30 mg IV every 6 hours. Which action should the nurse implement?
Administer both medications according to the prescription. Correct
Hold the ketorolac to prevent an antagonistic effect.
Hold the morphine to prevent an additive drug interaction.
Contact the healthcare provider to clarify the prescription.
Morphine and ketorolac (Toradol) can be administered concurrently, and may produce an additive analgesic effect, resulting in the ability to reduce the dose of morphine, as seen in this prescription. Toradol is an antiinflammatory analgesic, and does not have an antagonistic effect with morphine.
A client is receiving methylprednisolone 40 mg IV daily. The nurse should monitor which laboratory value closely?
Serum glucose. Correct
Red blood cells.
Methylprednisolone is a corticosteroid with glucocorticoid and mineralocorticoid actions. These effects can lead to hyperglycemia, which is reflected as an increase in the serum glucose value. The client taking methylprednisolone is also at risk for hypocalcemia and hypokalemia. These medications also alter the some of the body's immune responses by suppressing the migration of white blood cells decreasing inflammation response.
A client is receiving clonidine 0.1 mg/24 hr via transdermal patch. Which assessment finding indicates the desired effect of the medication has been achieved?
Absence of nausea and vomiting.
Change in peripheral edema from +3 to +1.
Denial of anginal pain and shortness of breath.
Blood pressure from 180/120 mmHg to 140/70 mmHg. Correct
Clonidine acts as a centrally-acting analgesic and antihypertensive agent. A reduction of the blood pressure reading of 180/120 mmHg to 140/70 mmHg indicates a reduction in hypertension.
A client who was prescribed atorvastatin (Lipitor) one month ago calls the triage nurse at the clinic complaining of muscle pain and weakness in his legs. Which statement reflects the correct drug-specific teaching the nurse should provide to this client?
Increase consumption of potassium-rich foods since low potassium levels can cause muscle spasms.
Have serum electrolytes checked at the next scheduled appointment to assess hyponatremia, a cause of cramping.
Make an appointment to see the healthcare provider, because muscle pain may be an indication of a serious side effect. Correct
Be sure to consume a low-cholesterol diet while taking the drug to enhance the effectiveness of the drug.
Myopathy, suggested by the leg pain and weakness, is a serious and potentially life-threatening complication of Lipitor, and should be evaluated immediately by the healthcare provider.
Which nursing diagnosis is important to include in the plan of care for a client receiving the angiotensin-2 receptor antagonist irbesartan (Avapro)?
Fluid volume deficit.
Risk for infection.
Risk for injury. Correct
Impaired sleep patterns.
Avapro is an antihypertensive agent, which acts by blocking vasoconstrictor effects at various receptor sites. This can cause hypotension and dizziness, placing the client at high risk for injury.
A client has a continuous IV infusion of dopamine (Intropin) and an IV of normal saline at 50 mL/hour. The nurse notes that the client's urinary output has been 20 mL/hour for the last 2 hours. Which intervention should the nurse initiate?
Stop the infusion of dopamine.
Change the normal saline to a keep open rate.
Replace the urinary catheter.
Notify the healthcare provider of the urinary output. Correct
The main effect of dopamine is adrenergic stimulation used to increase cardiac output, which should also result in increased urinary output. A urinary output of less than 20 mL/hour is oliguria and should be reported to the healthcare provider, so the dose of dopamine can be adjusted. Depending on the current rate of administration, the dose may need to be increased or decreased.
Which action is most important for the nurse to implement prior to the administration of the antiarrhythmic drug adenosine (Adenocard)?
Assess pupillary response to light.
Instruct the client that facial flushing may occur.
Apply continuous cardiac monitoring. Correct
Request that family members leave the room.
Adenosine (Adenocard) is an antiarrhythmic drug used to restore a normal sinus rhythm in clients with rapid supraventricular tachycardia. The client's heart rate should be monitored continuously for the onset of additional arrhythmias while receiving adenosine.
A client with a dysrhythmia is prescribed procainamide (Pronestyl) in 4 divided doses over the next 24 hours. Which dosing schedule is best for the nurse to implement?
Every 6 hours. Correct
AC and bedtime.
PC and bedtime.
Pronestyl is a class 1A antidysrhythmic. It should be taken around the clock, so that a stable blood level of the drug can be maintained, thereby decreasing the possibility of hypotension (an adverse effect) occurring because of too much of the drug circulating systemically at any particular time of day. Pronestyl may be given with food if GI distress is a problem.
The nurse administers a dose of metoprolol for a client. Which assessment is most important for the nurse to obtain?
Blood pressure. Correct
It is most important to monitor the blood pressure of clients taking this medication because metoprolol is an antianginal, antiarrhythmic, antihypertensive agent.
A client is being treated for osteoporosis with alendronate (Fosamax), and the nurse has completed discharge teaching regarding medication administration. Which morning schedule would indicate to the nurse that the client teaching has been effective?
Take medication, go for a 30 minute morning walk, then eat breakfast. Correct
Take medication, rest in bed for 30 minutes, eat breakfast, go for morning walk.
Take medication with breakfast, then take a 30 minute morning walk.
Go for a 30 minute morning walk, eat breakfast, then take medication.
Alendronate (Fosamax) is best absorbed when taken thirty minutes before eating in the morning. The client should also be advised to remain in an upright position for at least thirty minutes after taking the medication to reduce the risk of esophageal reflux and irritation.
A postoperative client receiving a continuous IV infusion of meperidine 35 mg/hr for the past four days has become increasingly restless and irritable, and begins to hallucinate. Which action should the nurse take first?
Administer a PRN dose of the PO lithium.
Administer naloxone IV push.
Decrease the IV infusion rate of the meperidine. Correct
Increase the IV infusion rate of the meperidine.
The client is exhibiting symptoms of meperidine toxicity, which is consistent with the large doses of meperidine received over four days. Decreasing the infusion rate of the meperidine as per protocol is the most effective action to immediately decrease the amount of serum meperidine. The next nursing action is for the nurse to notify the healthcare provider.
A client being discharged is prescribed warfarin for the treatment following a pulmonary embolism. Which diagnostic test should the nurse instruct the client to receive once a month?
Prothrombin Time (PT). Correct
Activated partial thromboplastin (aPTT).
Serum Coumadin level (SCL).
When used for a client with pulmonary embolus, the therapeutic goal for warfarin therapy is a PT 1 to 2 times greater than the control, or an INR of 2 to 3. A client prescribed warfarin should have the PT or INR levels checked at a minimum once a month.
A client with Parkinson's disease is taking carbidopa-levodopa (Sinemet). Which observation by the nurse would indicate that the desired outcome of the medication is being achieved?
Decreased blood pressure.
Lessening of tremors. Correct
Increased attention span.
Sinemet increases the amount of levodopa to the CNS (dopamine to the brain). Increased amounts of dopamine improve the symptoms of Parkinson's, such as involuntary movements, resting tremors, shuffling gait, etc. Decreased drooling would be a desired effect, not increased salivation.
A client being treated for hyperthyroidism with propylthiouracil (PTU) asks the nurse how the medication works. Which is the best response to give the client?
It decreases the amount of thyroid-stimulating hormone circulating in the blood.
It increases the amount of thyroid-stimulating hormone circulating in the blood.
It enhances the amount of T4 and diminishes the amount of T3 produced by the thyroid.
It inhibits the synthesis of T3 and T4 by the thyroid gland. Correct
Propylthiouracil (PTU) is an adjunct therapy used to control hyperthyroidism by inhibiting the production of thyroid hormones. It is often prescribed in preparation for thyroidectomy or radioactive iodine therapy.
A client with heart failure is being discharged with a new prescription for the angiotensin-converting enzyme (ACE) inhibitor captopril (Capoten). The nurse's discharge instructions should include reporting which problem to the healthcare provider?
Dry mucous membranes.
Angiotensin-converting enzyme (ACE) inhibitors are used in heart failure to reduce afterload by reversing vasoconstriction common in heart failure. This vasodilation can cause hypotension and resultant dizziness. Weight loss is desired if fluid overload is present, and may occur as the result of effective combination drug therapy such as diuretics with ACE inhibitors. It does not require reporting to the healthcare provider. Unlike ACE inhibitors, diuretics may result in hypokalemia and excessive diuretic administration may result in fluid volume deficit manifested by symptoms of dehydration.
Following the administration of sublingual nitroglycerin to a client experiencing an acute anginal attack, which assessment finding indicates to the nurse that the desired effect has been achieved?
Client states chest pain is relieved. Correct
Client's pulse decreases from 120 to 90.
Client's systolic blood pressure decreases from 180 to 90.
Client's SaO2 level increases from 92% to 96%.
Nitroglycerin reduces myocardial oxygen consumption which decreases ischemia and reduces chest pain.
The healthcare provider prescribes digitalis (Digoxin) for a client diagnosed with heart failure. Which intervention should the nurse implement prior to administering the digoxin?
Observe respiratory rate and depth.
Assess the serum potassium level. Correct
Obtain the client's blood pressure.
Monitor the serum glucose level.
Hypokalemia (decreased serum potassium) will precipitate digitalis toxicity in persons receiving digoxin. The nurse should monitor the client's serum potassium levels. Blood pressure and respiratory rate will not inform the nurse about potential safety issues with digitalis.
In evaluating the effects of lactulose (Cephulac), which outcome would indicate that the drug is performing as intended?
An increase in urine output.
Two or three soft stools per day. Correct
Watery, diarrhea stools.
Increased serum bilirubin.
The medication lactulose can be administered for either chronic constipation or for portal-systemic encephalopathy in clients with hepatic disease. Two to three stools a day indicate that lactulose is performing as intended for chronic constipation. This would also indicate it should be effective for the clients with encephalopathy because the lactulose's action prevents absorption of ammonia in the colon as it increases water absorption and softens the stool. The efficacy of the use for ammonia absorption would have to be verified by a serum ammonia level and observation of clearing of the client's mental status.
A client is prescribed aluminum hydroxide for peptic ulcer disease. Which statement by the client demonstrates an understanding of the action of the medication?
It decreases the production of gastric secretions.
It produces an adherent barrier over the ulcer.
It helps maintain a gastric pH of 3.5 or above. Correct
It slows down the gastric motor activity.
The objective of antacids is to neutralize gastric acids and keep a gastric pH of 3.5 or above, which is necessary for pepsinogen inactivity.
The nurse is reviewing admission prescriptions for a client with myxedema. The nurse should clarify with the healthcare provider which prescription for the client?
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