Pharmacology CMS Study Guide UNITEK

A nurse is caring for a client who is experiencing acute alcohol withdrawal. The nurse should expect to administer which of the following medications

a. Disulfiram

b. Chlordiazepoxide

c. Methadone

d. Varenicline

b. Chlordiazepoxide

ANS: chlordiazepoxide is a benzodiazepine, which is a type of medication often used to facilitate withdrawal. It assists with decreasing withdrawal manifestations, stabilizing vital signs, and preventing seizures and delirium tremens

A nurse is caring for a client who has alcohol use disorder and is admitted with lower extremity fractures following a motor-vehicle crash. A few hours after admission, the client develops restlessness and tremors. Which of the following medications should the nurse anticipate administering to the client first?

a. Acamprosate

b. Naltrexone

c. Chlordiazepoxide

d. Disulfiram

c. chlordiazepoxide

ANS: Chlordiazepoxide, a long-acting oral benzodiazepine, is a first-line medication for manifestations of acute alcohol withdrawal. For clients who are nauseated or vomiting, another benzodiazepine such as lorazepam can be administered via IV. The nurse should apply the acute versus chronic priority-setting framework when caring for this client. In this framework, acute needs (i.e. manifestations of acute alcohol withdrawal) are typically the priority because they pose more of a threat to the client. Since chronic needs usually develop over a period of time, the client has more of an opportunity to adapt to the alteration in health.

A nurse is caring for a client who is receiving treatment for alcohol detoxification. Which of the following medications should the nurse expect to administer during this phase of the client's care?

a. Buprenorphine

b. Diazepam

c. Varenicline

d. Rimonabant

b. Diazepam

ANS: The nurse should expect to administer diazepam to a client during alcohol detoxification. Anti-anxiety agents such as chlordiazepoxide and diazepam are long-acting CNS depressants that are used to minimize the manifestations of alcohol withdrawal.

A nurse is reinforcing teaching with a client who has anxiety and a new prescription for diazepam. Which of the following statements should the nurse make?

a. "Feelings of sedation should resolve in about 1 week"

b. "There is no risk of physical dependence with this medication"

c. "You can increase the dose when you feel especially anxious"

d. "It will take several months for you to feel the maximum benefit of the medication"

a. "Feelings of sedation should resolve in about 1 week"

ANS: Adverse effects of diazepam and other benzodiazepines are sedation and psychomotor slowing. The nurse should inform the client that these effects should subside in 7 to 10 days.

A nurse is reviewing the medication administration record of a client who is receiving an opioid medication for pain. Which of the following prescriptions should the nurse identify as a contraindication to administering an opioid medication?

a. Metoprolol

b. Ondansetron

c. Lorazepam

d. Naloxone

c. Lorazepam

ANS: The nurse should identify that lorazepam can cause central nervous system depression, which can result in increased respiratory depression and sedation when administered with an opioid. The nurse should clarify the prescription with the provider.

A nurse is reinforcing teaching with a client who has a new prescription for lorazepam to treat alcohol withdrawal. Which of the following should the nurse identify as an adverse effect of lorazepam that the client should report to the provider?

a. Increased thirst

b. Sweating

c. Blurred vision

d. Facial flushing

c. Blurred vision

ANS: The nurse should inform the client that blurred vision is an adverse effect of lorazepam and instruct the client to notify the provider if this occurs.

A nurse is caring for a client who has alcohol use disorder. Following alcohol withdrawal, which of the following medications should the nurse expect to administer to the client during maintenance?

a. Methadone

b. Disulfiram

c. Chlordiazepoxide

d. Naloxone

b. Disulfiram

ANS: The nurse should expect to administer disulfiram as a deterrent to prevent future use of alcohol. The nurse must ensure the client has not had any alcohol intake for at least 12 hours prior to administration.

A nurse is reinforcing teaching with a client who has a new prescription for disulfiram to treat alcohol use disorder. Which of the following statements by the client indicates an understanding of the teaching?

a. "If i have a strong urge to drink alcohol, I should skip my dose for that day"

b. "Even when i'm not drinking alcohol, adverse effects can include seizures"

c. "Medication therapy can begin as soon as I enter the detoxification program"

d. "I should check the labels of my skin-care products, medications, and foods for alcohol"

d. "I should check the labels of my skin-care products, medications, and foods for alcohol"

ANS: The client should check products for the presence of alcohol when taking disulfiram. The nurse should inform the client that only 7 mL of alcohol is needed to precipitate adverse effects of the medication. Alcohol can be found in cough syrups, vinegar, and sauces. It might also be applied to the skin in aftershave, and colognes.

A nurse is collecting data from a client who is receiving disulfiram for alcohol aversion therapy. The client is experiencing palpitations and reports nausea, a headache, and extreme thirst. The nurse should identify that which of the following situations is occurring?

a. The client is experiencing mild acetaldehyde syndrome

b. The client is having delirium tremens

c. The client is experiencing disulfiram toxicity

d. The client is not having a therapeutic response to disulfiram

a. The client is experiencing mild acetaldehyde syndrome

ANS: The nurse should recognize that these manifestations are an indication of acetaldehyde syndrome, which occurs when alcohol consumption is combined with disulfiram use. The client's current manifestations represent the mild form of acetaldehyde syndrome that can occur by consuming as little as 7 mL (0.2 oz) of alcohol.

A nurse in a substance use disorder treatment facility is reviewing the medication records for a group of clients. The nurse should expect to administer methadone for a client who has a substance use disorder for which of the following substances?

a. Amphetamines

b. Opiates

c. Barbiturates

d. Hallucinogenics

b. Opiates

ANS: The administration of methadone is indicated for the treatment of opiate use disorder. Opiates include opium, morphine, codeine, methadone, and heroin. Methadone is given as a substitute to prevent cravings and severe manifestations of opiate withdrawal.

A nurse working in a mental health facility is admitting a client with opioid use disorder who is experiencing withdrawal. The nurse should anticipate a prescription for which of the following medications from the provider?

a. Methylnaltrexone

b. Methadone

c. Naloxone

d. Hydromorphone

b. methadone

ANS: The nurse should anticipate a prescription from the provider for methadone for a client who is experiencing opioid withdrawal. Methadone is an opioid medication that is used for pain management and treatment of withdrawal manifestations in clients who have opioid use disorder.

A nurse is reinforcing teaching with the guardian of a school-aged child who has ADHD and a new prescription for clonidine. Which of the following statements by the guardian indicates an understanding of the teaching?

a. "I will not allow my child to eat anything within 2 hours of taking the medication"

b. "I can expect my child to be drowsy while taking this medication"

c. "I will give my child a dose of the medication at noon every day"

d. "I will cut the tablet in half before giving it to my child

b. "I can expect my child to be drowsy while taking this medication"

ANS: The nurse should instruct the guardian that clonidine can cause adverse effects like somnolence, fatigue, and hypotension.

A nurse is reinforcing teaching with a client who has hypertension and a new prescription for oral clonidine. Which of the following instructions should the nurse include in the teaching?

a. Discontinue the medication if a rash develops

b. Expect increased salivation during the first few weeks of therapy

c. Minimize fiber intake to prevent diarrhea

d. Avoid driving until the client's reaction to the medication is known

d. Avoid driving until the client's reaction to the medication is known

ANS: Clonidine can cause drowsiness, weakness, sedation, and other CNS effects. Until the client's response to the medication is known, the nurse should instruct the client to avoid driving or handling other potentially hazardous equipment. Over time, these effects are likely to decrease.

A nurse is assisting with the care of a client who has been in the PACU for more than 1 hour. He has a respiratory rate of 9/min and is difficult to arouse. The nurse should expect a prescription for which of the following medications?

a. Pentazocine

b. Naloxone

c. Naltrexone

d. Butorphanol

b. Naloxone

ANS: The nurse should expect a prescription for naloxone. This medication displaces opiate medications from receptor sites, reversing the respiratory depression, sedation, and analgesia that opiates cause.

A nurse is caring for a client who received naloxone for a suspected opioid overdose. Which of the following findings should the nurse identify as an adverse effect of this medication?

a. Report of pain

b. Respiratory rate 8/min

c. Report of numbness

d. Report of abdominal cramping and diarrhea

a. Report of pain

ANS: The nurse should identify that naloxone is used to reverse the effects of an opioid overdose administered for pain, sedation euphoria, and respiratory depression. Excess doses of naloxone can cause the return of pain but can improve the client's respiratory rate. REMEMBER NALOXONE ADVERSE EFFECT IS WITHDRAWAL SYMPTOMS!

A nurse in a provider's office is collecting data from a client who has been taking bupropion. Which of the following reports from the client indicate a therapeutic response to the medication?

A. The client is taking fewer opioid pain relievers.

B. The client no longer has delirium tremens.

C. The client has reduced cravings for cigarettes.

D. The client is less hyperactive.

C. The client has reduced cravings for cigarettes.

ANS: Bupropion is prescribed for the treatment of tobacco use disorder. A therapeutic response to the medication is a decrease in cravings for nicotine. Other medications prescribed for this disorder include varenicline and clonidine.

A nurse is reinforcing teaching with a client who has a new prescription for bupropion. The nurse should instruct the client to report which of the following findings as an adverse effect of bupropion?

a. Hypotension

b. blurred vision

c. tinnitus

d. Insomnia

d. Insomnia

ANS: The nurse should instruct the client to report insomnia, which is an adverse effect of bupropion. Other adverse effects can include anxiety, delusions, hypertension, dry mouth, nausea, weight loss or gain, and photosensitivity.

A nurse is caring for a client who requests information about smoking cessation using nicotine gum. For which of the following reasons should the nurse recommend another over-the-counter smoking cessation product to the client?

a. The client is overweight

b. The client follows a vegan diet

c. The client has dentures

d. The client has insomnia

c. The client has dentures

ANS: The nurse should explain to the client that nicotine gum is difficult for clients who wear dentures to use and that using the gum can damage dental work. The nurse should recommend the nicotine patch or nicotine lozenges as an over-the-counter alternative.

A nurse is reinforcing teaching with a client who wants to stop smoking by using nicotine gum. The nurse should inform the client that which of the following adverse effects can occur from using nicotine gum?

A. Itching

B. Throat irritation

C. Hiccups

D. Teary eyes

B. Throat irritation

ANS: The nurse should instruct the client that throat irritation is an adverse effect of chewing nicotine gum. Other adverse effects include mouth irritation, aching jaw muscles, and dyspepsia.

A nurse is collecting data from a client who has been using a nicotine transdermal patch for smoking cessation. The client reports itching of the skin where the patch is applied. Which of the following statements should the nurse make?

A. "You should change the location of the patch on your body."

B. "Decreasing the strength of the patch should stop the itching."

C. "You should discontinue using the patch."

D. "This is an adverse effect of the patch that will subside in time."

C. "You should discontinue using the patch."

ANS: The nurse should instruct the client to discontinue the patch if persistent local reactions such as erythema, itching, or edema are experienced.

A nurse is monitoring a client with pneumonia who has received penicillin G intramuscularly (IM). Which of the following findings should the nurse plan to evaluate first?

A. Pain at the injection site

B. Prolonged motor dysfunction

C. Laryngeal edema

D. Temperature 37.6C (99.7F)

C. Laryngeal edema

ANS. When using the urgent vs nonurgent approach to client care, the nurse should determine that the priority finding is laryngeal edema, which can indicate the client is experiencing an allergic reaction to penicillin G. The nurse should also consider that the client is experiencing an anaphylactic reaction, which can be life-threatening. Anaphylaxis is an immediate hypersensitivity reaction that requires the primary treatment of epinephrine in addition to respiratory support.

A nurse is preparing an in-service session for medical-surgical staff on infections and antibiotic use. Which of the following antibiotics should the nurse identify as having the highest rate of severe allergic reactions?

A. Trimethoprim

B. Erythromycin

C. Sulfonamides

D. Penicillin

D. Penicillins

ANS. Penicillins carry the highest rate of severe allergic reactions. If a client is allergic to a penicillin, he or she should be considered allergic to all of them. A client who is identified as having a severe allergic reaction to penicillins should not receive them again unless there is no other medication available to treat a life-threatening infection. Penicillins are broad-spectrum antibiotics used to treat most gram-positive and some gram-negative infections.

A nurse is caring for a client who has a pseudomonas infection and a new prescription for ticarcillin-clavulanate. Which of the following should the nurse collect before administering this medication?

A. Indications of superinfection

B. Peak and trough medication levels

C. Baseline BUN and creatinine

D. History of allergy to aminoglycoside antibiotics

C. Baseline BUN and creatinine

ANS. Ticarcillin-clavulanate is a penicillin antibiotic and is excreted by the kidneys. Therefore, any renal impairment could result in a toxic level of the medication. The nurse should assess the client's baseline BUN and creatinine levels and monitor these values throughout therapy.

A nurse is reinforcing teaching with a client who has a new prescription for doxycycline. The nurse should reinforce with the client the need to monitor for which of the following adverse effects of this medication?

A. Photosensitivity

B. Constipation

C. Ototoxicity

D. Blurry vision

A. Photosensitivity

ANS. An adverse effect of doxycycline, a tetracycline antibiotic, is photosensitivity. In this reaction, the skin responds abnormally to light, especially ultraviolet radiation or sunlight. Prevention involves avoiding direct exposure to sunlight and ultraviolet light, wearing protective clothing outdoors, and using sunscreen.

A nurse is caring for a client who has a new diagnosis of oral candidiasis after taking tetracycline for 7 days. The nurse should recognize that candidiasis is a manifestation of which of the following adverse effects?

A. Allergic response

B. Superinfection

C. Renal toxicity

D. Hepatotoxicity

B. Superinfection

ANS. A superinfection can develop from the overgrowth of fungus due to the antibacterial effect of tetracycline. The nurse should monitor the client for manifestations of a superinfection such as soreness of the mouth and a swollen tongue.

A nurse is reinforcing teaching with a client about taking tetracycline PO. Which of the following statements should the nurse include in the teaching?

A. "Take this medication on a full stomach."

B. "Limit your consumption of dairy products while taking this medicine."

C. "Take the medication with your regular iron supplement."

D. "Take antacids if you have an upset stomach from using tetracycline."

B. "Limit your consumption of dairy products while taking this medicine."

ANS. The nurse should tell the client to avoid or limit the consumption of dairy products while taking tetracycline. An interval of at least 2 hours should separate tetracycline ingestion and the ingestion of products that can chelate this medication such as milk or calcium.

A nurse is reviewing the laboratory results of a client who is taking tobramycin and notes that the medication's peak level is 7 mcg/mL. Which of the following actions should the nurse take?

A. Administer half of the prescribed dosage at the client's next scheduled dose

B. Tell the client that the medication seems to be effective

C. Advise the client to drink more water throughout the day

D. Continue to administer the medication as prescribed

D. Continue to administer the medication as prescribed

ANS. The nurse should identify that a peak level of 7 mcg/mL for a tobramycin is within the expected reference range of 5 to 10 mcg/mL. Therefore, the nurse should continue to administer the scheduled medication as prescribed.

A nurse is caring for a client who has tuberculosis and is taking rifampin. Which of the following client statements should indicate to the nurse that the client is experiencing an adverse effect of the medication?

A. "I have noticed my urine is orange in color."

B. "I sleep more than I used to."

C. "My tongue and mouth are sore."

D. "My voice seems hoarse."

A. "I have noticed my urine is orange in color."

ANS. The nurse should identify that an adverse effect of rifampin can be red-orange colored urine, saliva, sweat, and tears as the medication is excreted from the body. The nurse should also inform the client that permanent staining of contact lenses can occur. However, this adverse effect is harmless. The client should inform the provider if urine becomes dark in color since this can be an indication of hepatotoxicity.

A nurse in a community health clinic is collecting data from a new client who has prescriptions for isoniazid and rifampin. Which of the following disorders should the nurse expect the client to have?

A. Tuberculosis

B. Hypertension

C. Diabetes

D. Cirrhosis

A. Tuberculosis

ANS. The nurse should recognize that isoniazid and rifampin are first-line antitubercular medications used to treat active tuberculosis in combination therapy.

A nurse is teaching a client who has type 1 diabetes mellitus about a new subcutaneous insulin infusion pump. Which of the following pieces of information should the nurse reinforce in the teaching?

A. Plan to use a type of short-duration insulin in the infusion pump

B. Replace the infusion pump set every 4 days

C. Turn off the infusion pump for at least 3 hours each day

D. Move the infusion pump catheter 1.27 cm (0.5 in) away from the old site

A. Plan to use a type of short-duration insulin in the infusion pump

ANS: The client should plan to use short-duration insulin such as regular, lispro, aspart, or glulisine insulin in the infusion pump to deliver a baseline infusion of insulin. The client should also administer bolus doses of insulin before each meal.

A nurse is caring for a client with type 1 diabetes mellitus who has a prescription to administer regular insulin subcutaneously. Which of the following insulin durations should the nurse identify for regular insulin?

A. Intermediate duration

B. Short duration, slow acting

C. Long duration

D. Short duration, rapid acting

B. Short duration, slow acting

ANS: The nurse should identify that regular insulin has a short duration with a slower acting time. The nurse should plan to administer regular insulin 30 minutes before meals.

A nurse is administering insulin glulisine 10 units subcutaneously at 0730 to an adolescent client who has type 1 diabetes mellitus. The nurse should anticipate the insulin's onset of action at which of the following times?

A. 0800

B. 0745

C. 0900

D. 1030

B. 0745

ANS: Insulin glulisine has a very short onset of action of 15 minutes. The nurse should expect the onset of action around 0745 and ensure the client eats breakfast immediately following the administration of the insulin.

A nurse is conducting a home visit with an older adult client who has diabetes mellitus and takes regular insulin subcutaneously before each meal. The client appears disoriented and weak and has slurred speech. Which of the following conditions should the nurse consider first when responding to these manifestations?

A. Dementia

B. Hypoglycemia

C. Infection

D. Transient ischemic attack

B. Hypoglycemia

ANS: Evidence-based practice indicates that the nurse should first check the client for hypoglycemia by drawing a blood glucose level. A client who has hypoglycemia can have slurred speech, disorientation, weakness, and confusion near mealtimes each day because regular insulin peaks in 2 to 4 hours, causing a drop in the client's blood glucose. Other manifestations of hypoglycemia include irritability, mental confusion, double vision, hunger, tachycardia, diaphoresis, and palpitations.

A nurse is reinforcing teaching about self-administration of NPH insulin with a client who has type 2 diabetes mellitus. Which of the following instructions should the nurse include?

A. Alternate injections between the abdomen and the thigh

B. Shake the vial before withdrawing the dosage

C. Rotate injection sites within the same area

D. Discard the vial if the insulin is cloudy

C. Rotate injection sites within the same area

ANS. To prevent lipodystrophy, the client should rotate injection sites, making them about 2.5 cm (1 in) apart, within the same anatomical area.

A nurse is preparing to administer 10 units of insulin glargine and 4 units of NPH insulin subcutaneously to a client. Which of the following actions should the nurse plan to take?

A. Verify giving insulin glargine at 1700 with the provider

B. Ensure the insulin glargine is a cloudy suspension

C. Request a prescription for insulin glargine twice daily

D. Use separate syringes for administering insulin glargine and NPH insulin

D. Use separate syringes for administering insulin glargine and NPH insulin

ANS. The nurse should not mix insulin glargine with any other insulin and should administer the NPH insulin and insulin glargine separately.

A nurse is caring for a client who has been taking taken metformin for 6 months. Which of the following findings should the nurse identify as an expected therapeutic effect of the medication?

A. Decreased vitamin B12 levels

B. Decreased blood glucose level

C. Abdominal bloating and diarrhea

D. Decreased LDL level

B. Decreased blood glucose level

ANS: A client who has taken metformin for 6 months should experience the expected therapeutic effect of a decrease in blood glucose levels. Metformin is a non-insulin medication for clients who have type 2 diabetes mellitus.

A nurse is collecting data from a client who has type 2 diabetes mellitus and is taking metformin. Which of the following findings should indicate to the nurse that the medication is having a therapeutic effect?

A. Tachycardia

B. Fasting blood glucose level of 118 mg/dL

C. Glycosylated hemoglobin (HbA1c) of 6.8%

D. Increased appetite

C. Glycosylated hemoglobin (HbA1c) of 6.8%

ANS: The nurse should identify that an HbA1c level of 6.8% is within the expected reference range of less than 7%, indicating the medication is having a therapeutic effect.

A nurse is reinforcing teaching with a client who has a new prescription for lisinopril. Which of the following should the nurse include in the teaching as an adverse effect of lisinopril?

A. Tongue swelling

B. Low potassium level

C. Runny nose

D. Bruising

A. Tongue swelling

ANS: Angioedema is a fatal response that occurs in about 1% of clients who use ACE inhibitors such as lisinopril. Manifestations of angioedema include swelling of the tongue, lips, or pharynx.

A nurse is assessing a client who began taking benazepril 24 hours ago. Which of the following findings is the priority for the nurse to report to the provider?

A. Report of a dry, hacking cough

B. Increased frequency of urination

C. Swelling of the tongue and lips

D. A metallic taste in the mouth

C. Swelling of the tongue and lips

ANS: Swelling of the lips, tongue, glottis, or pharynx is a sign of angioedema, a life-threatening adverse effect of ACE inhibitors like benazepril. Angioedema is caused by the accumulation of bradykinin, leading to increased vascular permeability. Using the ABC (Airway, Breathing, Circulation) framework, this is the priority because it can lead to total airway obstruction. The nurse must stop the medication immediately and prepare for emergency intervention (e.g., epinephrine, oxygen, or intubation).

A nurse is providing discharge teaching to a client who has a new prescription for benazepril. Which of the following instructions should the nurse include in the teaching?

A. "Stop taking the medication if you develop a dry, nonproductive cough."

B. "Limit your intake of foods high in potassium, such as bananas and spinach." C. "Expect to notice a swelling of the tongue and lips during the first week of therapy."

D. "Increase your intake of sodium to prevent low blood pressure."

B. "Limit your intake of foods high in potassium, such as bananas and spinach."

ANS: Benazepril is an ACE (Angiotensin-Converting Enzyme) inhibitor. ACE inhibitors block the release of aldosterone, which leads to the retention of potassium by the kidneys. This increases the risk for hyperkalemia. Clients should be instructed to avoid excessive intake of high-potassium foods and avoid salt substitutes, which often contain potassium chloride instead of sodium chloride.

A nurse is reinforcing teaching with a client about a new prescription for captopril to treat hypertension. Which of the following client statements indicates an understanding of the teaching?

A. "I might have a sore throat that will go away after a few days."

B. "I will take this medication with food to avoid an upset stomach."

C. "I might feel dizzy at times while taking this medication."

D. "I will take ibuprofen if I get a fever while taking this medication."

C. "I might feel dizzy at times while taking this medication."

ANS: Hypotension and dizziness are potential adverse effects of this medication. The nurse should monitor the client's blood pressure and instruct the client to change positions slowly.

A nurse is reinforcing teaching with a client who is about to start taking captopril to treat hypertension. Which of the following instructions should the nurse include to help the client manage this medication's adverse effects?

A. Use salt substitutes while taking this medication.

B. Take the medication on an empty stomach.

C. Expect a dry cough when taking this medication.

D. Expect to gain weight while taking this medication.

B. Take the medication on an empty stomach.

ANS: The client should take captopril on an empty stomach because food reduces the medications absorption by 30% to 40%

A nurse is caring for a client who has heart failure and is taking oral furosemide 40 mg daily. For which of the following adverse effects should the client be taught to monitor and notify the provider if it occurs?

A. Nasal congestion

B. Tremors

C. Tinnitus

D. Frontal headache

C. Tinnitus

ANS: Loop diuretics such as furosemide can cause ototoxicity. The client should be taught to notify the provider if tinnitus, a full feeling in the ears, or hearing loss occurs.

A nurse is caring for a client who is taking streptomycin. Which of the following medications should the nurse identify as increasing the risk of developing ototoxicity when taken with streptomycin?

A. Cefoxitin

B. Furosemide

C. Naproxen

D. Amphotericin B

B. Furosemide

ANS: Furosemide, a high-ceiling (loop) diuretic, increases the risk of developing ototoxicity when taken with streptomycin, an aminoglycoside.

A nurse is reinforcing teaching about sodium phosphate to a client who has a new prescription for sodium phosphate. The client is scheduled for a colonoscopy and is currently taking furosemide for hypertension. Which of the following client statements should indicate to the nurse that the teaching has been effective?

A. "I can take my water pill as prescribed." B. "I can experience an imbalance in my electrolytes from this medication."

C. "I should drink 8 ounces of bowel cleanser every 10 minutes until I drink a total of 4 liters."

D. "I can experience rebound constipation after using this medication."

B. "I can experience an imbalance in my electrolytes from this medication."

ANS: Sodium phosphate can cause excess fluid loss as a result of cleansing the bowel of stool. Therefore, the client is at risk for electrolyte imbalance and should be monitored closely.

A nurse is reviewing the morning laboratory results of an infant who is receiving digoxin and furosemide for the treatment of heart failure. Which of the following findings should the nurse report to the provider?

A. Sodium 140 mEq/L

B. Calcium 10.2 mg/dL

C. Chloride 100 mEq/L

D. Potassium 3.2 mEq/L

D. Potassium 3.2 mEq/L

ANS: The nurse should identify that a potassium level of 3.2 mEq/L is below the expected reference range of 4.1 to 5.3 mEq/L for an infant. Therefore, the nurse should report this finding to the provider.

A nurse is reinforcing teaching with a client with a new diagnosis of heart failure who has a prescription for furosemide. Which of the following statements should the nurse include in the teaching?

A. "You can take ibuprofen for headaches while taking this medication."

B. "You may experience increased swelling in your lower extremities while taking this medication."

C. "You should eat foods that are high in potassium while taking this medication."

D. "You should take this medication at bedtime."

C. "You should eat foods that are high in potassium while taking this medication."

ANS: The nurse should instruct this client who has a prescription for furosemide to consume foods that are high in potassium. Furosemide is a high-ceiling loop diuretic that depletes potassium, sodium, chloride, magnesium, and water.

A nurse is reviewing the laboratory results of a client who has heart failure and is taking spironolactone. Which of the following laboratory values should the nurse report to the provider immediately?

A. Sodium 138 mEq/L

B. Potassium 5.8 mEq/L

C. Chloride 101 mEq/L

D. Magnesium 1.9 mEq/L

B. Potassium 5.8 mEq/L

ANS: Spironolactone is a potassium-sparing diuretic that acts by blocking the effects of aldosterone in the distal nephron. This causes the kidneys to retain potassium while excreting sodium and water. The most serious adverse effect of spironolactone is hyperkalemia (a potassium level greater than 5.0 mEq/L). A level of 5.8 mEq/L is significantly elevated and puts the client at high risk for life-threatening cardiac dysrhythmias or cardiac arrest. This is the priority finding.

A nurse is preparing to administer digoxin to a client. Which of the following findings should the nurse identify as a contraindication to the client receiving this medication?

A. Blood pressure 180/70 mmHg

B. Oxygen saturation rate 94%

C. Heart rate 51/min

D. Respiratory rate 21/min

C. Heart rate 51/min

ANS: The nurse should identify that if the client's heart rate is less than 60/min, the medication should be withheld, and the provider should be notified.

A nurse is collecting data from a client who has heart failure and is receiving digoxin. Which of the following findings should indicate to the nurse the client is experiencing digoxin toxicity?

A. Suppression of dysrhythmias

B. Increase in atrioventricular (AV) conduction

C. Visual disturbances

D. Weight gain

C. Visual disturbances

ANS: The nurse should recognize that nausea, vomiting, abdominal discomfort, fatigue, and visual disturbances are common manifestations that can indicate that the client is experiencing digoxin toxicity.

A nurse is reinforcing education about continuous heparin therapy with a client who is 18 hr postpartum and has developed a deep vein thrombosis (DVT). Which of the following statements should the nurse include in the teaching?

A. "An adverse effect of this medication is drowsiness."

B. "This medication will require frequent monitoring of WBC levels."

C. "Use a soft toothbrush to gently brush your teeth."

D. "Avoid taking acetaminophen while receiving this medication."

C. "Use a soft toothbrush to gently brush your teeth."

An adverse effect of heparin therapy is increased risk for bleeding. The client should use a soft toothbrush to prevent trauma and bleeding.

A nurse is administering subcutaneous heparin to a client who is at risk for deep vein thrombosis. Which of the following actions should the nurse take?

A. Use a 22-gauge needle to administer the medication

B. Inject the medication into a muscle

C. Massage the site after administering the medication

D. Administer the medication into the client's abdomen

D. Administer the medication into the client's abdomen

ANS: Subcutaneous injections should be administered in areas such as the abdomen, upper outer arms, or thighs.

A nurse is caring for a client who is 12 hours postoperative following a total hip arthroplasty. Which of following medications should the nurse anticipate administering to this client to prevent deep vein thrombosis (DVT)?

A. Aspirin

B. Warfarin

C. Ticagrelor

D. Enoxaparin

D. Enoxaparin

ANS: The nurse should anticipate the administration of enoxaparin for a client who is 12 hours postoperative following surgery. Enoxaparin is low-molecular-weight (LMW) heparin that is used to prevent a DVT by inhibiting the effects of antithrombin and thrombin.

A nurse is caring for a client who takes warfarin to treat chronic atrial fibrillation and has early manifestations of Alzheimer's disease. The client's partner asks the nurse if the client would benefit from taking ginkgo biloba. Which of the following responses should the nurse provide?

A. "Ginkgo biloba will probably interfere with the effectiveness of his other medications."

B. "You should ask his provider if ginkgo biloba is safe."

C. "Ginkgo biloba is most effective in the later stages of Alzheimer's disease."

D. "People who have Alzheimer's disease should adhere to the medication regimen their provider prescribes."

A. "Ginkgo biloba will probably interfere with the effectiveness of his other medications."

ANS: Some experts believe that ginkgo biloba can delay the mental deterioration of Alzheimer's disease if taken in the early stages. Research, however, has not demonstrated this; more importantly, ginkgo biloba increases the client's risk for bleeding when taken with warfarin.

A nurse is reinforcing discharge teaching with a client who has venous thrombosis and a prescription for warfarin. Which of the following instructions should the nurse include in the teaching?

A. Take ibuprofen as needed for headaches or other minor pains

B. Carry a medical alert ID card

C. Report to the laboratory weekly to have blood drawn for aPTT

D. Increase intake of dark green vegetables

B. Carry a medical alert ID card

ANS: A client who is taking warfarin is at increased risk of bleeding. In an emergency, medical personnel must be aware of the client's medication history.

A nurse is caring for a client who is taking warfarin. Which of the following laboratory values should the nurse recognize as an effective response to the medication?

A. Hct 45%

B. Hgb 15 g/dL

C. aPTT 35 seconds

D. INR 3.0

D. INR 3.0

ANS: Warfarin is an anticoagulant that prevents thrombus formation in susceptible clients. The INR measures its effectiveness. For most clients taking warfarin, an INR of 3.0 indicates effective therapy.

A nurse is reinforcing teaching with an older adult client who is scheduled to start taking warfarin. Which of the following statements indicates the client understands the teaching?

A. "If I miss a dose, I will double it the next day."

B. "I can continue to eat green salads."

C. "I will need to have laboratory blood testing every 6 months to monitor the effects of the warfarin."

D. "I should expect my urine to be pink-tinged while I am taking this medication."

B. "I can continue to eat green salads."

ANS: The client should have a diet that is consistent in foods containing vitamin K, (e.g. green, leafy vegetables). Sudden increases or decreases in consumption will alter the coagulation effects of warfarin. The nurse should report any alterations in the client's consumption of foods containing vitamin K.

A nurse is preparing to administer warfarin to a client who has a new onset of atrial fibrillation. The client states, "I forget what the other nurse told me this medication does." Which of the following pieces of information should the nurse reinforce with the client?

A. "It helps your heart return to a normal rhythm."

B. "It dissolves blood clots."

C. "It can reduce your risk of having a stroke."

D. "It helps prevent bleeding in atrial fibrillation."

C. "It can reduce your risk of having a stroke."

ANS: The nurse should identify that atrial fibrillation increases the client's risk of having a stroke due to clot formation in the atrium. Warfarin can prevent clot formation when used long-term, which will reduce the client's risk of having a stroke.

A nurse is reinforcing teaching to a client who is postpartum and has been prescribed warfarin therapy for a deep vein thrombosis. Which of the following instructions should the nurse include?

A. "You will need to use a reliable form of

contraception while on warfarin therapy." B. "You will need to take a baby aspirin every day while on warfarin therapy."

C. "You will need to use formula instead of breast milk while on warfarin therapy."

D. "You will need to massage your affected leg 3 times a day while on warfarin therapy."

A. "You will need to use a reliable form of contraception while on warfarin therapy."

Warfarin is teratogenic, and pregnancy should be avoided by using a reliable form of contraception.

A nurse is collecting data from a client who is experiencing chest pain. Which of the following medications should the nurse expect to administer to suppress the aggregation of platelets?

A. Nitroglycerin

B. Aspirin

C. Morphine

D. Metoprolol

B. Aspirin

ANS: Aspirin suppresses platelet aggregation, producing an immediate antithrombotic effect. The client should chew the first dose of aspirin to allow rapid absorption.

A nurse is reinforcing teaching with a group of new parents about medications. The nurse should include that aspirin is contraindicated in children who have a viral infection due to the risk of developing which of the following adverse effects?

A. Reye's syndrome

B. Visual disturbances

C. Diabetes mellitus

D. Wilms' tumor

A. Reye's syndrome

ANS: Aspirin should not be given to children or adolescents who have a viral infection such as chickenpox or influenza due to the risk of developing Reye's syndrome.

A nurse is reviewing the medical record of a client who might have hearing loss. Which of the following pieces of information from the client's medical record should the nurse identify as a risk factor for hearing loss?

A. Frequent use of steroids

B. Chronic use of salicylates

C. Intermittent use of antacids

D. Habitual use of laxatives

B. Chronic use of salicylates

ANS: Chronic use of salicylates such as aspirin can lead to ototoxicity, which can manifest as tinnitus or hearing loss.

A nurse is planning to administer diphenhydramine hydrochloride to an older adult client. Which of the following actions should the nurse take prior to administration?

A. Review the client's medical record for a history of glaucoma

B. Plan to administer the medication 30 minutes before a meal

C. Explain to the client that he will need to restrict his fluid intake once he takes the medication

D. Remind the client that his appetite might increase when starting the medication

A. Review the client's medical record for a history of glaucoma

The nurse should review the client's medical record for a history of glaucoma prior to administration. Diphenhydramine is contraindicated for clients who have narrow-angle glaucoma.

A nurse is caring for a client who is taking diphenhydramine for allergies. The client reports, "I feel sleepy during the day." Which of the following responses should the nurse make?

A. "You will find that all antihistamines cause sedation."

B. "You should avoid taking the antihistamine with food."

C. "The effects of sedation will occur with each dose."

D. "You should try antihistamines with non-sedative effects."

D. "You should try antihistamines with non-sedative effects."

ANS: The nurse should tell the client to try second-generation antihistamines that have no sedative effect, as these are large molecules with low lipid solubility that cannot cross the blood-brain barrier. Diphenhydramine is a first-generation antihistamine and has a common adverse effect of sedation.

A nurse in a provider's office is reinforcing medication teaching with a client who has developed asthma. Which of the following medications should the nurse identify as being prescribed for the short-term relief of asthma symptoms?

A. Fluticasone

B. Montelukast

C. Albuterol

D. Cromolyn

C. Albuterol

ANS: Albuterol is a beta-adrenergic agonist that is used as a short-acting medication for the control of asthma. It is administered by inhalation either through an inhaler or a nebulizer. Short acting beta-adrenergic agonists (SABAs) work by inducing bronchodilation to relieve bronchospasms. They also can suppress histamine relief and increase ciliary motility in the lungs. SABAs are the most effective medications for bronchospasm and exercise induced bronchospasm.

A nurse is monitoring a client who has asthma, takes albuterol, and recently started taking propranolol to treat a cardiovascular disorder. The client reports that the albuterol has been less effective. Which of the following factors should the nurse identify as a possible explanation for this change?

A. Potentiative interaction

B. Detrimental inhibitory interaction

C. Increased adverse reaction

D. Toxicity-reducing inhibitory interaction

B. Detrimental inhibitory interaction

ANS: A detrimental inhibitory interaction can occur with the concurrent use of propranolol and albuterol. When a client takes propranolol and albuterol together, propranolol can interfere with albuterol's therapeutic effects.

A nurse is teaching a client who has asthma about the proper use of an albuterol inhaler. Which of the following client statements indicates an understanding of the teaching?

A. "I should rinse my mouth right before I use the inhaler."

B. "After the first puff, I will wait 10 seconds before taking the second puff."

C. "I will shake the inhaler well right before I use it."

D. "I will tilt my head forward while inhaling the medication."

C. "I will shake the inhaler well right before I use it."

ANS: The nurse should instruct the client to shake the inhaler vigorously for 3 to 5 seconds, which will mix the medication within the inhaler evenly.

A nurse is reinforcing teaching with a client who has a prescription for scopolamine patches for the treatment of motion sickness. Which of the following client statements should indicate to the nurse that the teaching has been effective?

A. "I should apply this patch behind my ear."

B. "This patch should be replaced every 7 days."

C. "Before putting on my patch, I should wipe the area with an alcohol swab."

D. "I can use a second patch if a single patch is not effective."

A. "I should apply this patch behind my ear."

ANS: The nurse should identify that scopolamine patches should be applied behind the ear.

A nurse is caring for a client who takes sulfasalazine twice daily for rheumatoid arthritis. Which of the following values should the nurse review prior to the administration of the medication?

A. Respirations

B. Serum creatinine level

C. Blood pressure

D. Complete blood count

D. Complete blood count

ANS: The nurse should identify that sulfasalazine can cause bone marrow suppression, which can lead to agranulocytosis, hemolytic anemia, and macrocytic anemia. As a result, the client's complete blood count should be periodically monitored, and the nurse should review it prior to administering this medication.

A nurse is reinforcing teaching with a client who has ulcerative colitis and a new prescription for sulfasalazine. The nurse should instruct the client to monitor for which of the following adverse effects of this medication?

A. Arthralgia

B. Constipation

C. Stomatitis

D. Sedation

A. Arthralgia

ANS: Sulfasalazine can cause nausea, vomiting, and arthralgia (joint pain or stiffness).

A nurse is reinforcing teaching with a client who has bipolar disorder and a new prescription for lithium. Which of the following directions should the nurse provide?

A. Decrease sodium intake while taking lithium

B. It may take 5 days before the medication is effective

C. Take the medication on an empty stomach

D. Increase fluid intake to 2000 mL (67.6 oz) daily

D. Increase fluid intake to 2000 mL (67.6 oz) daily

ANS: The client should consume 1500 to 3000 mL (50.7 to 101.4 oz) of fluid daily.

A nurse is reinforcing discharge teaching about lithium toxicity with a client who has a new prescription for this medication. Which of the following statements by the client indicates an understanding of the teaching?

A. "I should take naproxen if I have a headache because aspirin can cause lithium toxicity."

B. "I can develop lithium toxicity if I eat foods with lots of sodium."

C. "I can develop lithium toxicity if I experience vomiting or diarrhea."

D. "I might need to take a daily diuretic along with my lithium to prevent lithium toxicity."

C. "I can develop lithium toxicity if I experience vomiting or diarrhea."

ANS: Vomiting or diarrhea can cause electrolyte imbalances. If serum sodium decreases, lithium is retained by the kidneys, increasing the risk of lithium toxicity.

A nurse is collecting data from a client who is taking lithium to treat bipolar disorder and has a lithium level of 2.2 mEq/L. Which of the following findings should the nurse expect?

A. Muscle weakness

B. Oliguria

C. Vomiting

D. Blurry vision

D. Blurry vision

ANS: Manifestations of lithium toxicity with levels between 2 and 2.5 mEq/L include blurry vision, ataxia, clonic twitching, severe hypotension, and polyuria.

A nurse is teaching a client who has bipolar disorder and a new prescription for lithium. The nurse should identify that which of the following statements by the client indicates an understanding of the teaching?

A. "I should take my lithium on an empty stomach."

B. "I can take ibuprofen for headaches while taking lithium."

C. "I need to limit my salt intake while taking lithium."

D. "I am likely to gain weight while taking lithium."

D. "I am likely to gain weight while taking lithium."

ANS: The nurse should instruct the client about eating a low-calorie diet while taking lithium because this medication can cause weight gain.

A nurse is collecting data from a client who is receiving clozapine to treat schizophrenia. The nurse should identify that an increase in which of the following parameters is an early indication of agranulocytosis?

A. Urine specific gravity

B. Urine output

C. Blood pressure

D. Temperature

D. Temperature

ANS: Antipsychotic medications such as clozapine can cause agranulocytosis, which is the depletion of WBCs. This increases the client's risk of infection. A fever is an early indication that the client should have a WBC count check to detect agranulocytosis.

A nurse is reinforcing teaching with a client who has a prescription for clozapine. Which of the following statements should the nurse include in the teaching?

A. "You should have your white blood cell count checked once per week for 6 months."

B. "You should check your weight every 3 days for weight loss."

C. "You might experience frequent loose stools."

D. "You might experience ringing in your ears."

A. "You should have your white blood cell count checked once per week for 6 months."

ANS: The nurse should instruct the client to complete laboratory testing of WBCs and neutrophils every week for 6 months.