ATI Pharmacology 2019 B

Have the provider spell out the unfamiliar medication names. The nurse should ask the provider to spell out the name of the medication if the stated name is one the nurse is not familiar with.

Tinnitus Tinnitus is a manifestation of aspirin toxicity, also called salicylism. Other manifestations include sweating, headache, and dizziness.

Place monitoring cords and tubes in a stockinet. The nurse should place monitoring devices in a stockinet to prevent direct contact with the client's skin.

Increased blood pressure The therapeutic effect of epoetin alfa is an increase in hematocrit levels, which can result in an increase in a client's blood pressure. If the client's hematocrit level rises too rapidly, hypertension and seizures can result. The nurse should monitor the client's blood pressure and ensure hypertension is controlled prior to administering the medication.

Obtain the client's blood pressure. HCTZ is a thiazide diuretic administered to promote urine output and reduce blood pressure and edema. The nurse should obtain the client's blood pressure prior to administration of the medication.

Methadone The nurse should expect to administer methadone for treatment of opioid use disorder. Methadone can be administered for withdrawal and to assist with maintenance and suppressive therapy. The nurse should administer bupropion to assist the client with smoking cessation. The nurse should administer disulfiram as an aversion therapy to assist with maintaining abstinence from alcohol. The nurse should administer modafinil to assist with the fatigue and prolonged sleep from methamphetamine withdrawal.

Asthma Asthma is a contraindication for receiving propranolol. Propranolol is an adrenergic antagonist which blocks the beta2 receptors in the lungs, causing bronchoconstriction and leading to serious airway resistance and possibly respiratory arrest.

Doxycycline Doxycycline is a tetracycline antibiotic. The nurse should identify that doxycycline can cause teratogenic effects such as staining of the infant's teeth when exposed to this medication. Therefore, this medication is contraindicated for the client.

"I will remove the patch after 14 hours." The client should remove the patch after 12 to 14 hr to prevent tolerance of the medication.

Discontinue the medication IV infusion. The greatest risk to the client is respiratory arrest from anaphylaxis. Therefore, the first action the nurse should take is to discontinue the medication IV infusion to prevent the client from receiving more medication. However, the nurse should not remove the IV catheter. Instead, the nurse should change the tubing and administer 0.9% sodium chloride by continuous IV infusion.

The client reports shortness of breath. A severe penicillin allergy is a contraindication for taking ceftazidime, a cephalosporin antibiotic, due to the potential for cross-sensitivity. Shortness of breath can indicate the client is developing anaphylaxis.

Administers isosorbide mononitrate to a client who has BP 82/60 mm Hg Isosorbide mononitrate is a nitrate used for clients with angina. Taking isosorbide mononitrate leads to vasodilation, which can result in hypotension. The nurse should withhold the medication and notify the provider if the client's systolic blood pressure is below the expected reference range of 120/80.

Cromolyn Cromolyn sodium stabilizes mast cells, which inhibit the release of histamine and other inflammatory mediators. The client should use cromolyn 10 to 15 min before planning to exercise to prevent bronchospasms.

Creatinine kinase The client who is taking atorvastatin can develop an adverse effect called rhabdomyolysis, which causes muscle weakness or pain and can progress to myositis. Creatinine kinase levels rise in response to enzymes released with muscle injury.

Reconstitute the initial dose with 60 mL of sterile water without a bacteriostatic agent. The nurse should dilute the medication with 60 mL of sterile water without a bacteriostatic agent and inject rapidly.

Yellow-tinged vision The nurse should instruct the client to monitor for and report yellow-tinged vision, which is a sign of digoxin toxicity. Other manifestations of digoxin toxicity include nausea, vomiting, loss of appetite, and fatigue. As the digoxin levels increase, the client can experience cardiac dysrhythmias.

Chest pressure Sumatriptan is an antimigraine agent which can cause coronary vasospasms, resulting in angina. The client should report chest pressure or heavy arms to the provider.

"Drink a glass of milk with each dose of medication." The client should take furosemide with food or milk to reduce gastric irritation.

"I will use this medication for a short period of time." Zolpidem is used for short-term treatment of insomnia. Therefore, the provider should reassess the client before refilling the prescription.

Orange juice The absorption of ferrous sulfate is enhanced by a vitamin C source, such as orange juice.

"I will report any signs of tendon pain or swelling." Ciprofloxacin, a fluoroquinolone, is associated with a risk of tendon rupture. This risk is increased in older adult clients, so the client should notify the provider at the onset of tendon pain or swelling.

Drink 8 to 10 glasses of water daily. MY ANSWER The nurse should instruct the client to increase water intake to 1,920 to 2,400 mL (65 to 81 oz) a day to decrease the chance of kidney damage from crystallization. The nurse should instruct the client to take the medication on an empty stomach either 1 hr before or 2 hr after meals. The nurse should instruct the client to notify the provider if a rash develops, because this can be an indication of Stevens-Johnson syndrome. However, the client should not expect to have a fine, red rash as a transient effect. The nurse should inform the client to store trimethoprim/sulfamethoxazole in a light-resistant container at room temperature.

Take a stool softener on a daily basis. Constipation is an adverse effect of opioid use. Stool softeners can decrease the severity of this adverse effect.

Creatinine 2.6 mg/dL Ceftazidime is excreted primarily by the renal system. A serum creatinine level above 1.3 mg/dL can indicate a kidney disorder requiring a reduction in the dose administered. The nurse should notify the provider, who is likely to prescribe a lowered dose of medication. a total bilirubin value of 0.4 mg/dL is within the expected reference range. an alanine aminotransferase value of 26 units/L is within the expected reference range. platelet count of 360,000/mm3 is within the expected reference range.

Hyperventilation When using the urgent vs. nonurgent approach to client care, the nurse should determine that the priority finding is hyperventilation. This finding indicates the client might have acute salicylate poisoning, which causes respiratory alkalosis in the early stages.

Dry mouth The nurse should expect the client to have a dry mouth due to the blocking of acetylcholine receptors that cause anticholinergic responses.

Docusate sodium reduces the surface tension of the stools to change their consistency. Docusate sodium is a surfactant that softens stool by reducing surface tension, allowing water to penetrate more easily into the stool. Osmotic laxatives, such as glycerin suppositories, act by lubricating the lower colon and initiating reflex contractions of the rectum. Bulk-forming laxatives, such as methylcellulose, mimic the action of dietary fiber, forming a viscous compound that softens the fecal mass and increases its bulk, which stimulates peristalsis. Stimulant laxatives, such as bisacodyl, stimulate the intestinal wall to cause peristalsis by pulling water into the intestines.

Ensure flumazenil is available to administer for toxicity management. The nurse should monitor the client for manifestations of diazepam toxicity, such as respiratory depression and hypotension. The nurse should be prepared to administer flumazenil to reverse the effects of diazepam. When diazepam is administered IV for induction of anesthesia, the nurse should expect the client to develop the full effect of the medication in 2 min. The nurse should measure the capnography level every 15 to 30 min until the client is awake and oriented and vital signs have returned to baseline.

Calcium gluconate The nurse should expect to administer IV calcium gluconate to the client and prepare to provide ventilatory support. This client is at risk for respiratory depression and cardiac dysrhythmias because a magnesium level of 3.1 mEq/L is above the expected reference range of 1.3 to 2.1 mEq/L.

Decrease in flexor and extensor spasticity A client who has a spinal cord injury and takes baclofen can experience a decrease in the frequency and severity of muscle spasms and in flexor and extensor spasticity.

"I will check my heart rate before I take the medication." Diltiazem, a calcium channel blocker, has cardio-suppressant effects at the SA and AV nodes, which can lead to bradycardia. The client should check their heart rate before taking the medication and notify the provider if it falls below the expected reference range.

Disorientation The nurse should monitor the client for disorientation and confusion as manifestations of hypomagnesemia. The nurse should also assess the client for a positive Chvostek's and Trousseau's signs.

Perform a capillary blood glucose test. The greatest risk to this client is injury from hypoglycemia. Therefore, the nurse should perform a capillary blood glucose test to determine the client's blood glucose status. Manifestations of hypoglycemia include weakness, anxiety, confusion, sweating, and seizures.

Drink 2 L of water daily. The nurse should instruct the client to drink at least 2 L of water each day to prevent renal stone formation and kidney injury, because allopurinol is eliminated through the kidneys.

Client report of decreased paresthesia Paresthesia is a manifestation of hypocalcemia. A client report of a decrease in paresthesia is an indication of a therapeutic response to calcium citrate. The nurse should also monitor for a decrease in other manifestations of hypocalcemia, including muscle twitching and cardiac dysrhythmias. A calcium level of 8.8 mg/dL is below the reference range of 9.0 to 10.5 mg/dL and does not indicate a therapeutic response to calcium citrate.

"I will store my unopened bottles of insulin in the refrigerator." The client should store unopened vials of insulin in the refrigerator to maintain medication viability. Once opened, the insulin can remain at room temperature for up to 1 month.

"I will fold the sticky sides of the old patch together before disposing it." The client should fold the sticky sides of the old patch together and then place it in a childproof container to ensure safe disposal of the patch. The client should apply the patch within 7 days of menses to prevent ovulation and the need for another contraceptive method. The client should remove and dispose the old patch before applying a new patch to prevent toxicity by combining the remaining medication on the old patch with the medication on the new patch. The client should apply the patch once a week for 3 weeks and then go without the patch for 1 week to promote menstruation.

Increased cardiac output Dopamine is an adrenergic that causes a receptor specificity effect, which increases cardiac output and improves perfusion. Tachycardia is an adverse effect of dopamine and does not indicate the medication's effectiveness. Dopamine is an adrenergic that causes a receptor specificity effect, which increases blood pressure. Dopamine does not affect serum potassium levels.

Bleeding gums The nurse should monitor the client for bleeding gums, which is an adverse effect of warfarin, an anticoagulant. The nurse should monitor for gastrointestinal irritation, which can include diarrhea, nausea, and vomiting. The nurse should monitor the INR daily until it increases to a therapeutic level. The nurse should monitor for hypotension, which can indicate bleeding.

Normal sinus rhythm Dysrhythmias are a life-threatening adverse effect of digoxin toxicity. The return of the heart to normal sinus rhythm indicates a therapeutic response to the antidote. Digoxin immune Fab is administered to a client who is experiencing severe digoxin toxicity. It binds with digoxin and works to reduce the client's blood digoxin level. A digoxin level of 2.5 ng/mL is above the expected reference range of 0.8 to 2 ng/mL. Therefore, this finding does not indicate a therapeutic response to the antidote. A decrease in blood pressure is not an indication of a therapeutic response to the antidote. A potassium level of 3.2 mEq/L is below the expected reference range of 3.5 to 5.0 mEq/L. A decreased potassium level can lead to toxicity in a client who is taking digoxin. However, digoxin immune Fab is administered only for severe toxicity.

"I should take acetaminophen instead of ibuprofen for my headaches while taking this medication." Fluoxetine suppresses platelet aggregation, which increases the risk of bleeding when used concurrently with NSAIDs and anticoagulants. Therefore, clients who are taking fluoxetine should take acetaminophen for headaches or pain, since acetaminophen does not suppress platelet aggregation. Concurrent use of St. John's Wort and fluoxetine can increase the client's risk for serotonin syndrome, a potentially life-threatening complication. Manifestations of serotonin syndrome include confusion, hallucinations, hyperreflexia, excessive sweating, and fever. Clients taking fluoxetine, a selective serotonin reuptake inhibitor, are not required to restrict their dietary intake of tyramine. A client who is taking an MAOI, such as selegiline, should avoid products containing tyramine. The nurse should inform the client that the therapeutic levels of fluoxetine can take between 1 and 4 weeks to achieve desired effects. The client should take the medication as prescribed and use other strategies to manage depression in the interim.

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"Blood glucose levels will be monitored during therapy" : The nurse should instruct the client that their blood glucose levels will be monitored during therapy because corticosteroids, such as methylprednisolone, can raise blood glucose levels. "Avoid contact with persons who have known infections": The nurse should instruct the client to avoid contact with persons who have known infections because corticosteroids, such as methylprednisolone, suppress the immune response and mask manifestations of infection. "Grapefruit juice can increase the blood levels of the medication": The nurse should instruct the client that grapefruit juice increases the absorption of the medication, which can lead to toxicity and adrenal suppression.

"I know smoking makes ranitidine less effective." The nurse should instruct the client that smoking decreases the effectiveness of ranitidine by exacerbating the ulcer manifestations.

Withhold the medication. When using the urgent vs nonurgent approach to client care, the nurse should determine that the priority action is to withhold the medication to prevent injury to the client.

Obtain WBC with absolute neutrophil count. The client who takes clozapine can develop lethargy and myalgia caused by the adverse effect of agranulocytosis. Therefore, monitoring the WBC with absolute neutrophil count weekly for the first 6 months of treatment is recommended. After 6 months, monitoring can occur every 2 weeks up to 1 year.

Orthostatic hypotension The nurse should identify that hydrochlorothiazide is an antihypertensive thiazide diuretic medication, which can cause orthostatic hypotension and light headedness. Therefore, the nurse should instruct the client to rise slowly when moving from a recumbent to a standing position. Hydrochlorothiazide is an antihypertensive thiazide diuretic medication, which can cause hyperglycemia. The nurse should identify palpitations as an adverse effect of hydrochlorothiazide, which is an antihypertensive thiazide diuretic medication. The nurse should identify that hydrochlorothiazide is an antihypertensive thiazide diuretic medication and has an adverse effect of blurred vision. Xanthopsia causes objects to appear yellow and is not an adverse effect of this medication.

Hyperkalemia Enalapril improves cardiac functioning in clients who have heart failure and can cause hyperkalemia due to potassium retention by the kidneys. Enalapril is an ACE inhibitor that has several cardiovascular adverse effects including hypotension, tachycardia, and dysrhythmias. Enalapril can cause several sensory adverse effects such as a loss of taste. However, it does not cause a loss of smell.

Total cholesterol The nurse should review the client's total cholesterol before administering clozapine, because this medication can cause hyperlipidemia.

"Increase intake of potassium-rich foods": Loop diuretics, such as furosemide, act at the loop of Henle by blocking the resorption of sodium, water, and potassium. An adverse effect of the medication is the development of electrolyte imbalances such as hyponatremia, hypochloremia, and hypokalemia. To prevent hypokalemia, the client should increase intake of potassium-rich foods, such as potatoes, spinach, dried fruit, and nuts. "Monitor for muscle weakness": Furosemide, a loop diuretic, causes a loss of potassium, which can result in manifestations of hypokalemia such as difficulty concentrating, shallow respirations, hyporeflexia, and muscle weakness. The nurse should instruct the client to monitor for these manifestations and report them to the provider. "Dangle your legs from the side of the bed before standing": Loop diuretics, such as furosemide, reduce vascular tone and increase fluid excretion. These effects decrease blood return to the heart and can manifest as dizziness and lightheadedness when going from a lying to a standing position. The client should change positions slowly to minimize orthostatic hypotension.

Akathisia An adverse effect associated with haloperidol is the development of extrapyramidal manifestations such as dystonia, pseudoparkinsonism, and akathisia.

WBC 3,500/mm3 A WBC count of 3,500/mm3 is below the expected reference range of 5,000 to 10,000/mm3. Leukopenia is an adverse effect of carbamazepine. The nurse should report this finding to the provider and monitor the client for manifestations of infection. A carbamazepine level of 7 mcg/mL is within the expected reference range of 5 to 12 mcg/mL and is an expected finding. A 24-hour urine glucose of 300 mg/day is within the expected reference range of 50 to 300 mg/day. The nurse should continue to monitor this value because carbamazepine can cause an elevation in urine glucose levels. A potassium level of 4.1 mEq/L is within the expected reference range of 3.5 to 5 mEq/L. The nurse does not need to monitor potassium levels for a client taking carbamazepine; however, the nurse should monitor sodium levels due to the potential adverse effect of hyponatremia.

Leg tenderness The greatest risk to this client is the development of a thromboembolism, which is an adverse effect of tamoxifen. The nurse should also monitor the client for other manifestations of a thromboembolism, including leg tenderness, redness, swelling, and shortness of breath.

Administered propranolol 80 mg PO at 1800 to the client who did not have a prescription for the medication. The incident report should clearly and thoroughly report the facts of the error.

"By not taking your furosemide, you might retain fluid and develop swelling." The nurse should respect the client's right to refuse the medication and inform the client of the risks of not taking the medication, notify the provider, and document the refusal. Furosemide is a loop diuretic given to reduce edema.

Blurred vision Blurred vision is an expected finding following the administration of atropine eye drops. This is due to the cycloplegic effects of the medication, which cause distant objects to appear blurry to the client. Dilation of pupils, or mydriasis, is an expected finding following the administration of atropine eye drops. A client who has received atropine eye drops can experience photosensitivity, which causes difficulty seeing in brightly lit areas due to the muscarinic receptors causing mydriasis. Excessive tearing is not an expected finding following the administration of atropine eye drops.

Urinary retention The nurse should instruct the client that amitriptyline causes the anticholinergic effect of urinary retention. A decrease in libido is an adverse effect of amitriptyline. Constipation is an adverse effect of amitriptyline.

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Hemoglobin 7.0 g/dL: A hemoglobin level of 7.0 g/dL indicates hydroxyurea toxicity. This hemoglobin level is below the expected reference range of 14 to 19 g/dL for a male client and 12 to 16 g/dL for a female client. Therefore, the nurse should report this finding to the provider. Platelets 75,000/mm3: A platelet level of 75,000/mm3 indicates hydroxyurea toxicity. This platelet level is below the expected reference range of 150,00 to 400,000/mm3. Therefore, the nurse should report this finding to the provider. Potassium 5.2 mEq/L: A potassium level of 5.2 mEq/L indicates tumor lysis syndrome. This potassium level is above the expected reference range of 3.5 to 5 mEq/L. Therefore, the nurse should report this finding to the provider.

​Change positions slowly. The nurse should instruct the client to change positions gradually to prevent orthostatic hypotension and syncope.