PN PHARMACOLOGY ONLINE PRACTICE 2023 A

A nurse is reinforcing teaching with a client who has a new prescription for omeprazole oral capsules. Which of the following instructions should the nurse include?

Swallow the medication whole.

The nurse should instruct the client to swallow the capsules or tablets whole and not chew or crush them. Omeprazole, a proton pump inhibitor, blocks the secretion of gastric acid. It is available in delayed-release capsules and over the counter in delayed-release tablets, as well as suspensions and powders.

A nurse is reinforcing teaching about comfort measures with the guardian of a 10-year-old child who has a viral infection. The nurse should plan to tell the parent that aspirin is contraindicated because of the risk for which of the following conditions?

Reye syndrome

Aspirin is contraindicated for children and adolescents who have a viral illness because it increases the risk for the development of Reye syndrome.

A nurse is caring for a client who has a prescription for an IM injection of penicillin G benzathine. The client asks why the injection must be given IM instead of through the IV line. Which of the following responses should the nurse make?

"Your medication can't be given IV because it is not water-soluble."

The nurse should inform the client this type of penicillin has poor water solubility and is never administered intravenously.

A nurse is planning to reinforce teaching about newborn immunizations with a client who is 24 hr postpartum. Which of the following information should the nurse plan to include?

"Your baby will receive the first hepatitis B vaccine before discharge."

The newborn should receive the first hepatitis B vaccine at birth, with the next dose at age 1 to 2 months.

A client comes to an urgent care clinic and announces with great enthusiasm, "I am an expert at all things medical as they apply to me, and I require zolpidem." The client's pupils are dilated, along with an elevated heart rate and blood pressure level. The nurse should suspect intoxication with which of the following substances?

Cocaine

The client who has cocaine toxicity typically has tachycardia, elevated blood pressure, dilated pupils, and displays delusions. This client's behavior and physiological data indicate cocaine intoxication.

A nurse is caring for a client who is receiving 0.9% sodium chloride 1,000 mL to infuse over 8 hr. The drop factor on the manual IV tubing is 15 gtt/mL. The nurse should ensure that the manual IV infusion is set to deliver how many gtt/min? (Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.)

31 gtt/min

A nurse is reinforcing teaching with a client who has a prescription for alendronate. Which of the following client responses indicates to the nurse an understanding of the teaching?

"I will take the medication with 8 ounces of water."

The client should take alendronate on an empty stomach with 240 mL (8 oz) of water to ensure it does not lodge in the esophagus, which can result in esophageal ulcerations.

A nurse is monitoring a client who has been receiving long-term hydrochlorothiazide therapy for recurring episodes of heart failure. Which of the following findings should the nurse identify as an adverse effect of this medication?

Hypokalemia

Hydrochlorothiazide is a thiazide diuretic that can cause hypokalemia due to excessive potassium excretion in the urine.

A nurse is performing the third check before administering hydromorphone to a client. After opening the unit-dose packet, the client tells the nurse they do not want to take the medication now. Which of the following actions should the nurse take?

Dispose of the medication with a second nurse as a witness.

The nurse is legally required to have a witness when disposing of a controlled substance.

A nurse is reinforcing teaching with a newly licensed nurse about using metoprolol to treat hypertension. Which of the following conditions should the nurse include as a contraindication for this medication?

Bradycardia

Metoprolol is a beta blocker that slows the conduction through the AV node. Therefore, it is contraindicated for clients who have bradycardia, or a heart rate that is consistently less than 60/min.

A nurse is caring for a client who is taking disulfiram and consumed alcohol 12 hr ago. Which of the following adverse reactions is the priority finding to report to the provider?

Respiratory depression

When using the urgent vs. nonurgent approach to client care, the nurse should determine that the priority finding is respiratory depression, which can indicate the client is experiencing acetaldehyde syndrome, a life-threatening event.

A nurse is reinforcing teaching about immunizations with a client who is pregnant. Which of the following vaccines should the nurse include in the teaching as safe to administer during pregnancy?

Tetanus and diphtheria (Td)

The nurse should include that either the Td vaccine or the tetanus, diphtheria, and pertussis (Tdap) vaccine is safe for administration during pregnancy. Tdap is the preferred vaccine.

A nurse is assisting in the care of a client who has a history of psychosis and is taking chlorpromazine. Which of the following actions should the nurse take to counteract the adverse effects of this medication?

Inform the client to apply sunblock before going outside.

The nurse should inform the client to apply sunblock, which will counteract the adverse effects of photosensitivity. Chlorpromazine increases skin's sensitivity to ultraviolet light causing temporary pigmentation changes and increases the risk of sunburn.

A nurse is instilling timolol eyedrops for a client who has glaucoma. Which of the following actions should the nurse take after instilling the eyedrops?

Press the nasolacrimal duct.

The nurse should press the client's nasolacrimal duct after instilling the eye drops to prevent the medication from absorbing into systemic circulation.

A nurse is reinforcing teaching with a client who is receiving enalapril 20 mg PO daily. The nurse should instruct the client to monitor for which of the following adverse effects of this medication?

Dry cough

The nurse should identify that a persistent dry or nonproductive cough is an adverse effect of enalapril. The underlying cause of the dry cough is the accumulation of bradykinin from the medication. The client should notify the provider of this adverse effect.

A nurse is caring for a client who is taking phenylephrine. The nurse should plan to monitor the client for which of the following manifestations as an adverse effect of this medication?

Increased heart rate

Due to cardiac effects, phenylephrine can cause tachycardia and other cardiac dysrhythmias.

A nurse is caring for a client who has multiple sclerosis and a new prescription for baclofen. Which of the following findings indicates to the nurse that the medication is having a therapeutic effect?

Decreased muscle spasticity

The nurse should identify that baclofen is an antispasmodic that decreases muscle spasticity in a client who has multiple sclerosis.

A nurse is caring for a client who is receiving methylprednisolone. Which of the following laboratory values should the nurse plan to monitor? (Select all that apply.)

WBC count is correct. Methylprednisolone can increase the client's risk for infection and cause leukocytosis.

Serum potassium is correct. Methylprednisolone can cause hypokalemia, as well as fluid and sodium retention.

Creatine phosphokinase is incorrect. Methylprednisolone does not damage the muscles and, therefore, does not cause release of creatine phosphokinase.

Blood glucose is correct. Methylprednisolone can cause increased blood glucose levels.

Amylase is incorrect. Methylprednisolone does not affect pancreatic function.

A nurse is reinforcing teaching with a client who has a prescription for scopolamine transdermal patches to prevent motion sickness. Which of the following statements by the client indicates an understanding of the teaching?

"I should place the patch behind my ear."

The nurse should reinforce with the client to place the scopolamine patch on a hairless area of skin behind the ear.

A nurse is evaluating a male client who is receiving amphotericin B via intermittent IV bolus. Which of the following findings indicates an adverse reaction to this medication?

Hypotension

The nurse should identify that amphotericin B is considered a high-alert medication due to potentially serious adverse effects, including hypotension. Therefore, the nurse should report this or other adverse effects of amphotericin, such as nephrotoxicity, hypokalemia, and cardiac dysrhythmias.

At 0800 a nurse assists with initiating a 1,000 mL IV infusion for a client, which is running at 125 mL/hr. How much fluid is left in the IV bag at 1300? (Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.)

375

A nurse is reviewing the medical record of a client who has a new prescription for dimenhydrinate to treat motion sickness. Which of the following conditions in the client's medical record should the nurse report to the provider?

Benign prostatic hyperplasia

Clients who have diabetes mellitus can take dimenhydrinate, an antihistamine.

A nurse is reinforcing teaching with a client about the adverse effects of simvastatin. For which of the following adverse effects should the nurse instruct the client to notify the provider?

Muscle pain

The nurse should instruct the client to notify the provider if muscle pain or tenderness develops because this can indicate the client is developing rhabdomyolysis.

A nurse is reinforcing teaching with a client who has a new prescription for colchicine to manage gouty arthritis. Which of the following manifestations should the nurse include as an adverse effect of this medication?

Abdominal pain

Abdominal pain indicates cellular damage to the gastrointestinal tract. The nurse should notify the provider, and the client should discontinue the medication immediately.

A nurse is reviewing the history of a client who is to start taking cefotetan to treat a bacterial infection. Which of the following information from the client's medical record should the nurse report to the provider before the client begins receiving this medication?

Penicillin allergy

Cefotetan is a cephalosporin, an antibiotic structurally similar to penicillins. A client who has a severe allergy to penicillin can develop cross-reactivity and have an allergic reaction to cephalosporins. Therefore, the nurse should report this information to the provider before the client starts taking the medication.

A nurse is preparing to administer cefazolin 1 g in 100 mL 0.9% sodium chloride to infuse over 30 min. The drop factor of the manual IV tubing is 15 gtt/mL. The nurse should set the manual IV infusion to deliver how many gtt/min? (Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.)

50

A nurse is reviewing medication prescriptions for a group of clients. The nurse should recognize that which of the following prescriptions can result in a medication administration error?

Furosemide 10.0 mg PO daily

The nurse should avoid using a trailing zero following a whole number. This prescription can result in a medication error because the nurse can mistake the dosage as 100 mg instead of 10 mg because the decimal point is not always recognized.

A nurse is reinforcing teaching with a client who has type 2 diabetes mellitus and is to start therapy with pioglitazone. The client asks the nurse how the medication works. Which of the following is an appropriate response?

"Your body should become more sensitive to insulin."

Pioglitazone is an oral antidiabetic agent that works by increasing the body's sensitivity to insulin.

A nurse is collecting data from a client who is asking about taking celecoxib for treatment of joint pain. The nurse should identify that which of the following findings is a contraindication to receiving celecoxib?

History of myocardial infarction

Celecoxib increases the risk of myocardial infarction caused by increased vasoconstriction and unimpeded platelet aggregation. It is contraindicated for a client who has a history of myocardial infarction or heart disease.

A nurse is collecting data from a client who received morphine IV for pain relief. Which of the following findings is the nurse's priority to report to the provider?

Respiratory rate 11/min

When using the airway, breathing, and circulation approach to client care, the priority finding is a respiratory rate of 11/min, which indicates respiratory depression.

A nurse is reviewing a client's medical history before administering hydromorphone for postoperative pain. The nurse should notify the provider of which of the following findings before administering this medication?

Benign prostatic hyperplasia

A client who has benign prostatic hyperplasia is at increased risk for developing acute urinary retention while taking opioids. Therefore, the nurse should notify the provider about this finding before administering hydromorphone.

A nurse is caring for a client who has kidney failure and has been taking epoetin. Which of the following is a therapeutic effect of this medication?

Increased Hgb

Epoetin is used to elevate the erythrocyte count for clients who have kidney failure. An increased Hgb is the desired therapeutic effect of this medication.

A nurse is reinforcing teaching with a client who is using phenylephrine nasal spray 3 times daily and reports rebound congestion. Which of the following instructions should the nurse include to reduce the effects of rebound congestion?

"Discontinue use in the left nostril, then in the right nostril."

Discontinuing the medication one naris at a time can overcome rebound congestion.

A nurse is collecting data from a client who has been taking levodopa/carbidopa. Which of the following findings should indicate to the nurse that the medication is effective?

The client is able to wash their face.

Levodopa works by activating dopamine receptors, restoring nerve transmission for clients who have Parkinson's disease. Carbidopa enhances these effects by inhibiting the breakdown of levodopa in the intestine and periphery. These therapeutic effects assist the client with moving freely and resuming ADLs.

A nurse is reinforcing teaching with a client who has seizures and a new prescription for valproic acid. The nurse should instruct the client to report which of the following adverse effects of valproic acid to the provider immediately?

Abdominal pain

The greatest risk to the client is hepatotoxicity and pancreatitis, which can cause abdominal pain. Therefore, the client should notify the provider immediately if experiencing a decrease in appetite, nausea, abdominal pain, or jaundice.

A nurse is collecting data from a client who has hyperthyroidism and a new prescription for propylthiouracil. The nurse should monitor the client for which of the following manifestations as an adverse effect of this medication?

Sore throat

The nurse should monitor for sore throat and fever because these are early indications of agranulocytosis, which is an adverse effect of propylthiouracil.

A nurse is reinforcing dietary teaching with a client who has a new prescription for phenelzine. Which of the following foods should the nurse include in the teaching as an appropriate food choice?

Yogurt

Clients taking phenelzine should avoid consuming tyramine, which can cause high blood pressure. Yogurt contains little or no tyramine. Therefore, the nurse should instruct the client that yogurt is an appropriate food choice.

A client who has rheumatoid arthritis weighs 132 lb and has a prescription for 2 mg/kg aspirin daily. The nurse requests the aspirin in liquid form because the client has difficulty swallowing. The pharmacy dispenses a container labeled 20 mg/mL. How many mL should the nurse administer? (Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.)

6

A nurse is reinforcing teaching with a client who is to start therapy with a nitroglycerin transdermal patch. Which of the following statements by the client indicates an understanding of the teaching?

"While using the patch, I will be careful when rising from a chair."

Nitroglycerin can cause orthostatic hypotension, which can result in dizziness. The client should change positions slowly to reduce the risk for injury.

A nurse is reinforcing teaching with a client who has rheumatoid arthritis and a new prescription for methotrexate. Which of the following information should the nurse include in the teaching?

Increase fluid intake.

Clients who are taking methotrexate should increase fluid intake to reduce the risk for renal damage and to increase medication excretion.

A nurse on a medical-surgical unit is preparing to administer medications to a client. Which of the following questions should the nurse ask the client to verify the client's identity?

"What is your phone number?"

Acceptable client identifiers include the client's name, telephone number, facility identification number, date of birth, and other client-specific identifiers. The nurse must use at least two identifiers to verify the client's identity and should compare the information to what is on the client's wristband or in the medical record.

A nurse in a community health clinic is preparing to administer the varicella vaccine to a young adult female client who has not previously had chickenpox or its vaccine. The nurse should withhold the vaccine and collect additional data when the client makes which of the following statements?

"I am allergic to neomycin."

A hypersensitivity to neomycin is a contraindication for receiving the varicella vaccine.

A nurse is caring for a client who has a new prescription for risperidone to manage schizophrenia. Which of the following laboratory tests should the nurse plan to obtain prior to administering the first dose?

Fasting blood glucose level

The development of hyperglycemia can be an adverse effect of risperidone. The nurse should obtain a fasting blood glucose level prior to administration of the first dose and periodically during treatment.

A client who has terminal cancer reports pain as 5 on a scale of 0 to 10. The client has a prescription for morphine 15 mg orally every 4 hr. The client's adult children express concern that the client is receiving too much of the medication. Which of the following responses should the nurse make?

"The dose should remain constant to prevent breakthrough pain."

Fixed or scheduled dosing around the clock offers the best pain control for clients who have severe and persistent pain.

A nurse is reinforcing teaching with a female client who has a new prescription for isotretinoin. Which of the following information should the nurse include in the teaching? (Select all that apply.)

"You will need to have your liver enzymes monitored after 1 month" is correct. The client should have their liver enzymes monitored 1 month after therapy and periodically thereafter because isotretinoin is metabolized in the liver.

"You can have nosebleeds while taking this medication" is correct. Due to the drying effects of isotretinoin, nosebleeds are very common.

"You should report any thoughts of harming yourself" is correct. Isotretinoin can cause depression, which can lead to suicide. The client or the client's family should report these thoughts to the provider.

"You will need to have two negative pregnancy tests prior to starting the medication" is correct. Due to the potential for severe birth defects, it is important to confirm the client is not pregnant.

"You will need to take a vitamin A supplement twice daily" is incorrect. Vitamin A enhances the risk of isotretinoin toxicity. The client should avoid taking vitamin A supplements because isotretinoin is a derivative of vitamin A.

A nurse is assisting in the care of a female older adult client on a medical-surgical unit.

When prioritizing hypothesis and using the urgent vs. nonurgent priority framework to client care, the nurse should recognize that the client is at greatest risk for developing medication toxicity. The client is receiving gentamicin IV and, therefore, requires monitoring of peak and trough levels to evaluate therapeutic levels. The client has an elevated trough level which places the client at risk for developing toxicity. The nurse should monitor the client for findings of gentamicin toxicity.

A nurse is assisting in the care of a client in a provider's office.

When taking actions, the nurse should include in the teaching that the client should complete the entire prescription of extended-release amoxicillin. The nurse should also include in the teaching that the adverse effects of the amoxicillin can include diarrhea and a rash. However, a rash should be reported to the provider immediately because this can be a manifestation of an allergic reaction to the medication.

A nurse is assisting in the care of a client in the provider's office.

When generating solutions for a client who has a new prescription for fluticasone propionate, the nurse should plan to reinforce teaching with the client about the medication. The nurse should reinforce with the client to use a saline nasal spray prior to administering medication to remove nasal crusting. The nurse should also reinforce to instill two sprays of fluticasone into each nostril to administer 100 mcg per nostril.

A nurse is assisting in the care of a client in a provider's office.

When taking actions, the nurse should identify manifestations of feeling tired, depressed, weakness, a rash, and bradycardia are adverse effects of the medication metoprolol. Metoprolol is a beta-blocker used to treat hypertension and angina. Therefore, these findings require immediate follow-up by the client's provider.

A nurse is assisting with the care of a client.

When analyzing cues, the nurse should identify a gastric pH greater than 7, a gastric residual greater than 500 mL, diminished lung sounds, and a cough, along with gurgled speech are manifestations of aspiration. Therefore, the nurse should stop the continuous feeding, hold the scheduled medications, and notify the provider.