Pharm ATI Questions EXAM 1 (intro, pain & inflammation, MSK)

When instructing the client about alendronate, which of the following information should the health care provider include?

Select all that apply.

A. Take the medication on an empty stomach.

B. Take the medication before bedtime.

C. Take the medication with an antacid.

D Sit upright for 30 min following dosage.

E Take with a full glass of water.

A, D, E are correct. Alendronate should be taken in the morning on an empty stomach for optimal bioavailability. Alendronate should be taken first thing in the morning before breakfast. Clients should wait 30 min before taking calcium or an antacid that might reduce the absorption of alendronate. Following dosage, the client should sit or stand upright for at least 30 min to reduce the risk of esophagitis. Clients should wait 30 min before taking calcium or an antacid that may reduce absorption of alendronate. Alendronate should be taken with a full glass of water to reduce the risk of esophagitis.

A client asks a nurse about generic medications. Which of the following are true regarding generic medications?

Select all that apply.

A Have the potential for abuse and dependence 

B Have the same chemical composition as the brand-name medication 

C May have several brand names 

D May have several generic names 

E Are usually less expensive than a brand-name medication 

A, B, C, E are Correct. Generic and trade- or brand-name medications have the same chemical composition and the same effects. Generic medications are usually less expensive than brand-name medications. Each medication has only one generic name. The trade name is the brand or proprietary name the manufacturer gives a medication, so various manufacturers give the same medication different brand names. Brand names also differ with the various formulations or routes the same manufacturer provides. There is no difference in abuse potential between a generic and a brand-name medication. 

You note that a primary care provider prescribed morphine sulfate, an opioid agonist, to relieve a client’s postoperative pain. Which of the following actions describes the action of an agonist on a receptor?

A Destroys the receptor

B Competes with the receptor

C Activates the receptor

D Blocks the receptor

C is correct. An agonist activates a receptor by binding to it, producing a response that mimics the action of the body's natural substances. In this case, morphine sulfate activates opioid receptors to relieve pain.

A nurse is caring for a client who has a new prescription for a medication. After receiving the first dose of the medication, the client experiences anaphylaxis. The nurse should identify that anaphylaxis represents which of the following results of the medication?

A Adverse effect 

B Paradoxical effect

C Therapeutic effect

D Toxicity

A is correct.

A client who has glaucoma asks about taking oxybutynin, a muscarinic antagonist, to manage an overactive bladder. The nurse explains that glaucoma is a contraindication for taking oxybutynin. Primary care providers should not prescribe contraindicated medications because of their potential for which of the following?

A Serious adverse reactions

B Medication tolerance

C Medication dependence

D Interactions with other medications

A is correct. Some medications are unsafe for clients who have certain characteristics or disorders or who eat certain foods or take certain medications because they have the potential to cause serious or life-threatening adverse effects. Medication tolerance is a decreased response to a medication over a period of time. Medication dependence is a physiologic or psychological need for a medication. A medication interaction is an alteration in the expected pharmacologic action of a medication that results from an interaction with another medication.

A nurse is talking with a client about taking tetracycline along with an antacid. The nurse tells the client not to take these two medications at the same time because the antacid can reduce the absorption of tetracycline. Which of the following describes the action of one medication reducing the effect of another medication?

A Allergic reaction

B Synergistic effect

C Antagonistic effect

D Adverse reaction

C is correct. When one medication reduces the effect of another medication, it is an antagonistic effect. When the client’s body responds to a medication by releasing histamine and causing itching and hives, the client is having an allergic reaction to a medication. Medications that interact, causing greatly increased or exaggerated effects, are acting synergistically. The nontherapeutic, unintended effects of a medication that occur at a therapeutic dose are side or adverse effects or reactions.

A nurse is preparing to teach a client about a newly prescribed medication. Prior to providing teaching, the nurse should review the precautions section of a medication resource for which of the following reasons?

A Medication-food interactions

B If dosage modification is indicated ​​​​​​

C How the medication is absorbed

D Availability

B is correct. The precautions section includes diseases or clinical situations in which medication use involves particular risks or dosage modification might be necessary, such as the presence of a client condition or restrictions due to the client's age. The interactions section lists interactions the medication might have with other medications, foods, or herbal remedies. Medication absorption is included in the pharmacokinetics section of the handbook. Formulations available are listed in a separate section and can be found on the Food and Medication Administration's website. Availability, including the strength and concentrations of dosage forms, is not relevant to client education.

Primary care providers prescribe medication dosages for children using which of the following information?

Select all that apply.

A Body surface area

B Age

C Weight

D Developmental age

E Medication properties

A, B, C, E are correct. To avoid toxicity, overdose, or undertreatment, primary care providers adjust medications for children based on their body surface area, age, and weight, along with medication properties such as metabolism and excretion. The child’s developmental level may determine the method of administration but not the appropriate dosage.

A nurse is providing teaching for a client who has a new prescription for a medication with a high potential for toxicity. Which of the following information should the nurse include?

Select all that apply.

A Periodic laboratory tests are essential to measure serum medication levels and appropriate dosage.

B Monitoring for indications of toxicity is important.

C Taking the medication with an inducing agent will increase the possibility of toxicity.

D Taking the smallest effective dose is crucial.

E Increasing fluid intake is recommended to avoid toxicity.

A, B, D are correct. Clients who are taking medications that have a high potential for toxicity should undergo regular, periodic laboratory monitoring of serum medication levels to be certain the medication level stays within the therapeutic range. Medications that have a high potential for toxicity can quickly build up to toxic levels in the blood, resulting in effects that can be irreversible or life-threatening. Therefore, the nurse should monitor for manifestations of toxicity particular to the medication the client is taking. It is optimal to use the lowest effective dose of a medication to achieve therapeutic effects because doing so helps minimize the risk for toxicity. Inducing agents are medications that have the effect of increasing the metabolism of medications they are combined with, thereby reducing their efficacy and blood levels. Inducing agents can be prescribed to allow clients to take a lower dose of a medication, so the chances of medication toxicity are lessened. Increasing fluids will not reduce the risk for medication toxicity. Increasing fluids can change the urine's specific gravity, but it will not alter glomerular filtration, passive tubular reabsorption, or active tubular secretion, which are the three mechanisms by which medications are excreted renally.

A client who has rheumatoid arthritis is taking methotrexate. Which of the following reduces toxicity from this medication?

A Folic acid

B Magnesium sulfate

C Ferrous sulfate

D Niacin (Vitamin B)

A is correct. Folic acid may reduce the toxic effects of methotrexate. The client should take 5 milligrams or more of folic acid supplement per week. Magnesium sulfate helps relieve acute constipation. Ferrous sulfate corrects iron deficiency anemia. Vitamin B₃ has many therapeutic uses, including the prevention and treatment of pellagra, a nutritional deficiency with many dermatologic manifestations.

A client is about to start therapy with methotrexate for rheumatoid arthritis. Knowing the adverse effects of methotrexate, you advise the client to watch for which of the following?

A Dysphagia

B Sore throat

C Edema

D Paresthesia

B is correct. Methotrexate may cause bone marrow suppression. The client should report any sign of infection, such as a sore throat or fever. Dysphagia, edema, and paresthesia (numbness or tingling sensations on the skin) are not common adverse effects of methotrexate. Adverse effects of this medication include headache, mucositis, gastric ulcers, gingivitis, and hepatotoxicity.

A primary care provider prescribes etanercept to treat a client’s rheumatoid arthritis. Prior to beginning the treatment, the client requires testing for which of the following?

A Pancreatitis

B Hepatitis

C Tuberculosis

D Gastritis

C is correct. Primary care providers should test clients for tuberculosis prior to treatment with etanercept. Pulmonary tuberculosis in clients taking etanercept can spread to other organs and pose treatment challenges. They should also monitor clients for the development of tuberculosis during etanercept therapy.

A nurse is caring for a client taking etanercept. Which of the following adverse effects is most important to mention when educating this client?

A Injection site reaction can occur.

B Elevation of liver enzymes can occur.

C Gastric perforation can occur.

D Vision changes can occur.

A is correct. Injection site reaction occurs in 37% of clients taking etanercept. Teach the client to look for localized reaction manifestations, such as itching, erythema, swelling, and pain. Elevation of liver enzymes is an adverse effect of the medication leflunomide. Gastrointestinal perforation has been associated with the medication methotrexate. Change in vision is an adverse effect of alendronate.

Prior to starting alendronate, the nurse should assess which of the following in the client?

Select all that apply.

A Ability to swallow

B Baseline vision

C The client's ability to lay flat

D Absence of nasal dryness

A and B are correct. Alendronate is a contraindication in clients who have difficulty swallowing due to the risk of esophagitis. Alendronate can cause vision changes in some clients, so it would be important to know the client’s baseline vision to assess for changes during medication therapy. The client must be able to tolerate sitting in an upright position for 30 min following administration of alendronate. Alendronate is not administered intranasally and does not affect the client’s nostrils.

A primary care provider prescribes calcitonin salmon for a client who is post-menopause. When considering the adverse effects of calcitonin, which of the following actions should the nurse instruct the client to do?

A Increase fluid intake.

B Rise slowly from a reclining position.

C Increase calcium and vitamin D intake.

D Rest painful joints after exercise.

C is correct. Calcitonin can cause hypocalcemia due to increased excretion of calcium. The client should increase calcium and vitamin D intake and watch for indications of hypocalcemia, such as muscle cramps and numbness in the fingers or toes. Increasing fluid intake will not prevent adverse effects; in fact, the human form of calcitonin can worsen one of its adverse effects: urinary frequency. Calcitonin does not cause orthostatic hypotension, although it can cause weakness and shortness of breath. Calcitonin is more likely to cause headache than joint pain.

Which of the following medications are effective in disease prevention as well as treatment of osteoporosis?

Select all that apply.

A Raloxifene

B Calcitonin salmon

C Alendronate

D NSAIDs

A and D are correct. The selective estrogen receptor modulator (SERM) raloxifene is used in both the prevention and treatment of postmenopausal osteoporosis. Alendronate, a bisphosphonate, is used in the prevention and treatment of postmenopausal osteoporosis, age-related osteoporosis in men, and glucocorticoid-related osteoporosis in clients taking glucocorticoids long term. Calcitonin salmon is used in the treatment, not prevention, of established postmenopausal osteoporosis. NSAIDs treat manifestations of a disease and are not effective in prevention.

A client who is menopausal is taking a calcium supplement to prevent osteoporosis. The nurse should instruct the client to watch for which of the following indications of hypercalcemia?

A Eye twitching

B Bleeding gums

C Tinnitus

D Nausea

D is correct. Manifestations of hypercalcemia include anorexia, nausea, vomiting, and constipation. Hypocalcemia can cause twitching, tetany, and muscle spasms. Vitamin C deficiency can cause bleeding gums and gingivitis.

The health care provider explains to the client that there may be a medication interaction between the glucocorticoid and the calcium supplement. Which of the following may occur?

A The glucocorticoid may cause reduced absorption of the calcium supplement.

B The glucocorticoid may potentiate the effects of the calcium supplement.

C The oral calcium supplement used with the glucocorticoid may cause bradycardia.

D The calcium supplement may increase the risk for peptic ulcer disease.

A is correct. Because glucocorticoids can reduce the absorption of calcium, clients should take the calcium supplement 1 hr before or 1 to 2 hr after they take the glucocorticoid. Glucocorticoids can increase potassium loss, but they are unlikely to affect calcium levels without supplements. Parenteral calcium given to clients who are on digoxin can cause severe bradycardia. The calcium supplement should not increase the risk of peptic ulcer disease; however, it can increase the risk of renal calculi (kidney stones).

Which of the following information in the client’s history causes the health care provider to suspect the client has osteoporosis?

Select all that apply.

A Menopause

B Calcium supplements

C Long-term corticosteroid use

D Weight

E Loss of height

A, C, E, are correct. Menopause and long-term corticosteroid use are causes of osteoporosis due to increased bone resorption. Loss of height may be an indication of a compression fracture in the spine due to diminished bone density. Osteoporosis is more common in individuals assigned female at birth who are thin and have a low body mass index (BMI). This client’s BMI is 31.2, which is classified as overweight. Calcium supplements are not an indication of osteoporosis. Calcium supplements can help prevent osteoporosis.

The health care provider instructs the client about the importance of taking the prescribed 1,500 mg/day dosage of calcium carbonate. Which of the following instructions should the health care provider recommend?

A Set up a simple reminder system.

B Take the three tablets at the same time.

C Reduce fluid intake to increase effectiveness.

D Take the medication with meals to reduce gastric irritation.

A is correct. If the client’s nonadherence is unintentional, the health care provider can work with them to devise a reminder system that will work for them, such as a calendar, a tablet counter, or a watch alarm routine. Clients should take no more than 600 mg of calcium at one time for optimal absorption. Clients should take calcium carbonate that is supplied in a chewable form on an empty stomach followed by a full glass of water. Calcium carbonate is also used as an antacid to neutralize gastric acid. It is not necessary to take it with meals to reduce gastric irritation.

The health care provider prescribes alendronate to reduce bone resorption and instructs the client to monitor for which of the following indications of a serious adverse effect of this medication?

A Calf inflammation

B Chest pain

C Dizziness

D Dysphagia

D is correct. Dysphagia (difficulty swallowing) can indicate esophagitis, a rare but serious effect of alendronate. The client must understand that they have to notify the provider of any pain or difficulty swallowing and worsening heartburn. Alendronate is unlikely to cause deep vein thrombosis. This serious adverse effect is more likely with raloxifene. Alendronate is more likely to cause musculoskeletal pain than chest pain. Alendronate is unlikely to cause dizziness. Dizziness might accompany bradycardia, a potentially serious adverse effect of neostigmine and parenteral calcium interaction with digoxin.