A client is prescribed propanolol. Which of the following client history findings would require the nurse to clarify this medication prescription?
1) Asthma
2) Hypertension
3) Tachydysrhythmias
4) Urolithiasis
answer
1) Asthma
Clients with asthma should avoid Beta2 Blockade agents such as propanolol. Brochoconstriction can occur. Clients with asthma should be administered a beta1 selective agent
question
A nurse is caring for a client prescribed montelukast. Which of the following should the nurse include in teaching related to this medication?
1) Advise client to take the medication once daily at bedtime
2) This medication is for acute management of asthma
3) Avoid dairy products while taking this medication
4) If the client forgets to take the medication for a few days he can double up on doses to catch up
answer
1) Advise client to take the medication once daily at bedtime
Clients should take montelukast once daily at bedtime
question
A 45-year-old client is taking methylprednisolone. What pharmacologic action should the nurse expect with this therapy?
1) Suppression of beta2 receptors
2)Suppression of airway mucus production
3) Fortification of bones
4) Suppression of candidiasis
answer
2) Suppression of airway mucus production
Corticosteroids, such as methylprenisolone will suppress airway mucus production
question
A nurse has just administered a wrong medication to a client. Which of the following actions should the nurse take next?
1) No action is needed
2) Report error to the provider
3) Complete an institutional incident report
4) Inform the client that the wrong medication was given
answer
2) Report the error to the provider
The nurse should acknowledge the error and report it to the provider for further orders. The nurse should also monitor the client for adverse effects. The nurse should also complete an incident report per institutional policy after notifying the health care provider
question
A nurse is caring for a client newly prescribed doxazosin mesylate. Which of the following instructions should the nurse include in client education regarding taking the first dose of this medication?
1) Change positions slowly and lie down if dizziness occurs
2) There is no need to avoid normal activities
3) Avoid dairy products while taking this medication
4) Do not eat green leafy vegetables
answer
1) Change positions slowly and lie down if dizziness occurs
First-dose orthostatic hypotension can occur with doxazosin. The nurse should instruct clients to change position slowly and to lie down if feeling dizzy, lightheaded or faint
question
A nurse is caring for a client prescribed ferrous sulfate for the treatment of anemia. Which of the following instructions should be included in client teaching about this medication?
1) Take the medication on an empty stomach to maximize absorption
2) Notify your provider if your stool becomes dark green
3) Decrease dietary fiber intake while taking this medication
4) Take prescribed antacids at the same time as this medication
answer
1) Take this medication on an empty stomach to maximize absorption
The nurse should instruct the clients to take iron on an empty stomach, such as 1 hr before meals to maximize absorption. Stomach acid increases absorption. If GI adverse effects occur, the client can take with food to increase adherence to therapy even though absorption is also decreased
question
A nurse have provided education to a client regarding prescribed levothyroxene sodium. What of the following client statements demonstrates understanding of medication administration?
1) "I should take my medication as needed to alleviate symptoms"
2) "I should take the medication in divided doses to ensure therapeutic drug levels"
3) "I should take the medication in the morning to prevent insomnia"
4) "I should take the medication on a full stomach"
answer
3) "I should take the medication in the morning to prevent insomnia"
Levothyroxene sodium should be taken once in the morning to prevent insomnia
question
A nurse is caring for a client prescribed digoxin. Which of the following should alert the nurse to possible digitalis toxicity?
1) anorexia and weakness
2) hyperactivity and hunger
3) tachycardia and increased urination
4) polyphagia and polydipsia
answer
1) anorexia and weakness
Anorexia, fatigue and weakness are signs of potential digitalis toxicity. GI effects of digitalis toxicity include anorexia, nausea, vomiting, and abdominal pain. CNS effects include fatigue, weakness, vision changes (diplopia, blurred vision, yellow-green or white halos around objects). Bradycardia is also commonly noted in digitalis toxicity
question
A client has been prescribed metoclopramide. Which of the following should the nurse include in client education regarding this medication?
1) Notify your provider if you experience restlessness or spasms of the face or neck
2) This medication can cause insomnia
3) Decrease your fluid intake while taking this medication
4) This medication can cause urinary frequency
answer
1) Notify your provider if your experience restlessness or spams of the face or neck
An adverse effect of metoclopramide is extrapyramidal symptoms. The client should stop the medication and notify the provider if these occur
question
Disulfiram is taken by a client daily for abstinence maintenance. What is an adverse effect of this therapy?
1) Hepatoxicity
2) Wernicke's aphasia
3) Suicidal ideations
4) Diarrhea
answer
1) Hepatoxicity
Hepatoxicity is an adverse effect of disulfiram
question
A nurse is caring for a client who has diabetes and a new prescription for 14 units of regular insulin and 28 units of NPH insulin subcutaneously at breakfast daily. What is the total number of units of insulin that the nurse should prepare in the insulin syringe?
1) 14 units
2) 28 units
3) 32 units
4) 42 units
answer
4) 42 units
Each order of for units of insulin is combined in the same syringe. The nurse should withdrawal the regular insulin into the syringe first
question
Before administering blood products, which action should be taken?
1) Assess the client's temperature
2) Document client response
3) Prime IV tubing with 0.45% sodium chloride
4) Administer epinephrine
answer
1) Assess the client's temperature
Assess the client's vital signs, obtain consent for the procedure and ensure compatibility. Prime the IV tubing with 0.9% sodium chloride. The nurse would not document client response or administer epinephrine prior to starting the transfusion
question
A nurse is caring for a client prescribed HMG CoA reductase inhibitor, atorvastatin. Which of the following should be monitored while this medication is prescribed?
1) Liver function tests
2) Renal function tests
3) Visual acuity screening
3) Hearing screenings
answer
1) Liver function tests
Statins (HMG CoA reductase inhibitors) like atorvastatin can cause hepatotoxicity. Prior to initiating therapy the client's baseline liver function should be determined then liver function tests should be checked after 12 weeks of therapy and then every 6 months. The nurse should advise the client to observe for symptoms of liver dysfunction (anorexia, vomiting, nausea, jaundice) and to notify the provider if these occur
question
A nurse is caring for a client receiving a dopamine infusion via a peripheral IV. Which of the following actions should the nurse take if the IV site appears infiltrated?
1) Slow the infusion and continue to monitor the site
2) Stop the infusion
3) Apply a warm compress to the site
4) Apply a cold compress to the site
answer
2) Stop the infusion
If infiltration is suspected, the infusion should be stopped. Necrosis can occur from extravasation of high doses of dopamine. Extravasation can be treated with local injection of an alpha-adrenergic blocking agent, such as phentolamine
question
A client has been prescribed lisinopril. Which of the following medication interactions should the nurse instruct this client about?
1) Potassium supplements
2) Ciprofloxacin
3) Escitalopram
4) Magnesium supplements
answer
1) Potassium supplements
Potassium supplements and potassium-sparing diuretics increase the risk of hyperkalemia in clients taking ACE inhibitors such as lisinopril. Clients should only take potassium supplements if prescribed by the provider. Clients should also avoid salt substitutes that contain potassium
question
Which of the following are contraindications to salicylate acid therapy? Select all that apply
*Third trimester pregnancy
*Thrombocytopenia
*Coronary artery disease
*Adolescents with chickenpox
*Deep vein thrombosis
answer
*Third trimester pregnancy
*Throbocytopenia
*Adolescents with chickenpox
Salicylate Acid Therapy Contraindications:
Salicylate acid is a category D agent and should not be administered to pregnant clients.
Salicylate acid is contraindicated in clients with bleeding disorders and thrombocytopenia.
Salicylate acid should not be given to children or adolescents with fever or recent chickenpox due to the risk of Reye's syndrome.
The therapy is used for the following types of clients:
Salicylate acid inhibits platelet aggregation and is often used in the treatment and prevention of thrombosis. Salicylate acid is commonly prescribed to clients with coronary artery disease to prevent thrombus formation
question
A client has been prescribed vasopressin for the treatment of diabetes insipidus. What is the expected pharmacologic actions of this medication?
1) To stimulate the pancreas to secrete insulin
2) To slow the absorption of glucose in the intestine
3) To increase reabsorption of water in the renal tubules
4) To increase blood pressure
answer
3) To increase reabsorption of water in the renal tubules
The expected pharmacologic action is to promote reabsorption of water within the kidney
question
A nurse is preparing to administer bisacodyl suppository to a client. Which of the following actions should the nurse take? Select all that apply
*Don sterile gloves
*Lubricate index finger
*Use a rectal applicator for insertion
*Position client supine with knees bent
*Insert suppository just beyond internal sphincter
answer
*Lubricate index finger
*Insert suppository just beyond internal sphincter
question
A nurse is reviewing the medication class benzodiazepines. The nurse would use cautions when administering benzodiazepines to which of the below clients?
1) A client with glaucoma
2) A client with renal failure
3) A client with hypertension
4) A client with insomnia
answer
1) A client with glaucoma
Benzodiazepines can increase intraocular pressure due to the pupil-dilating effects of the medication
question
A nurse is preparing to administer morphine sulfate 2 mg IV bolus. Available is morphine sulfate 10 mg/mL. How many mL should the nurse administer per dose? (Round the answer to the nearest tenth. Use a leading zero if it applies. Do not use a trailing zero.)
answer
0.2 mL
question
A 55-year-old client has levothyroxine ordered. Which of the below past medical history concerns may contraindicate with her medication management of hypothyroidism?
1) Scleroderma
2) Osteoporosis
3) Asthma
4) Peripheral Vascular Disease
answer
2) Osteoprosis
There is an increased risk for fracture, especially in older adults
question
A nurse is preparing to administer a measles, mumps, and rubella vaccine (MMR) to an adult client. Which of the following is a contraindication to this vaccine?
1) The possibility of pregnancy within 4 weeks
2) Client allergy to strawberries
3) Client history of genital herpes
4) The possibility of overseas travel in the next month
answer
1) The possibility of pregnancy within 4 weeks
Pregnancy or the possibility of pregnancy with 4 weeks is a contraindication to the MMR vaccine
question
A nurse is preparing to administer 10 units of regular insulin and 20 units of NPH insulin to a client. What is the sequence of events the nurse should follow? (Move the steps of mixing insulin on the left into the box on the right, placing them in the selected order of performance. All steps must be used.)
*Inject air into NPH insulin vial
*Withdraw short-acting insulin into syrgine
*Roll NPH vial between palms of hands
*Inspect vials for contaminants
*Inject air into regular insulin vial
*Add intermediate insulin to syringe
answer
*Inspect vials for contaminants
*Roll NPH vial between palms of hands
*Inject air into NPH insulin vial
*Inject air into regular insulin vial
*Withdraw short-acting insulin into syringe
*Add intermediate insulin to syringe
question
A nurse is providing care to a client with staphylococcus epidermidis, who is prescribed vancomycin. Identify the adverse effect associate with the antibiotic therapy?
1) Hepatotoxicity
2) Constipation
3) Infusion reaction
4) Immunosuppression
answer
3) Infusion reaction
Red Man Syndrome or an infusion reaction that results in rashes, flushing, tachycardia and hypotension can occur as an adverse reaction. For this reason, vancomycin should be administered over a 60 minute period
question
A client has been prescribed isosorbide monoitrate. Which of the following should the nurse include in this client's education related to this medication?
1) This medication is prescribed for long-term therapy prophylaxis against anginal attacks
2) You can crush this medication if needed
3) Take the medication in the evening after dinner
4) Take an additional tablet if you experience chest pain
answer
1) This medication is prescribed for long-term prophylaxis against anginal attacks
Isosorbide mononitrate is used for long-term prophylaxis against anginal attacks
question
A 52-year-old client with a history of angina has been prescribed transdermal nitroglycerin. Which of the following adverse effects is not seen with this therapy?
1) Tolerance
2) Orthostatic hypotension
3) Headache
4) Productive cough
answer
4) Productive cough
Nitroglycerin therapy does not directly have an effect lung function. Physiologically, vasodilation should effect capillary perfusion and decrease lung secretions
question
A nurse is caring for a client prescribed hydromorphone for severe pain. The client's respiratory rate has decreased from 16 breaths per minute to 6. Which of the following medication should the nurse prepare to administer?
1) Flumazenil
2) Naloxone
3) Activated charcoal
4) Aluminum hydroxide
answer
2) Naloxone
The client is experiencing respiratory depression likely related to over administration of hydromorphone (Dilaudid). Naloxone (Narcan) and nalmefene (Revex) are opioid antagonsists used to reverse an overdose of opioids.
question
A nurse is preparing to administer an intramuscular injection to an adult client. At what angle should the nurse administer the medication using the ventrogluteal site?
1) a 45 degree angle
2) a 60 degree angle
3) a 75 degree angle
4) a 90 degree angle
answer
4) a 90 degree angle
IM injections should be administered at a 90 degree angle
question
A nurse is caring for a client receiving patient-controlled analgesia (PCA). Which of the following interventions should the nurse take while caring for this client?
1) Advise the client to use the pump sparingly to prevent addiction
2) Encourage the client to use the PCA before dressing changes
3) Encourage the client's family to administer PCA while client is sleeping
4) Increase client's 4-hr limit as needed
answer
2) Encourage the client to use the PCA before dressing changes
The nurse should encourage the client to use the PCA prophylactically prior to activities that are likely to augment pain levels
question
A nurse is caring for a client who is prescribed warfarin therapy for an artificial heart valve. Which of the following laboratory values should the nurse monitor for a therapeutic effect of warfarin?
1) Hemoglobin (Hgb)
2) Prothrombin tie (PT)
3) Bleeding time
4) Activated partial thromboplastin time (aPTT)
answer
2) Prothrombin time (PT)
This test is used to monitor warfarin therapy. For a client receiving full anticoagulant therapy, the PT should typically be approximately two to three times the normal value, depending on the indication for therapeutic anticoagulation
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