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ATI PHARM PROCTORED EXAM LATEST
REAL QUESTIONS AND CORRECT
ANSWERS GRADE A
A client receives a prescription for calcium channel blockers. The nurse should expect which of the following diagnostic tests to be prescribed to obtain baseline data prior to starting the medication? - CORRECT ANSWER Electrocardiogram (ECG) A client is being discharged with a prescription for warfarin (Coumadin) following treatment for deep vein thrombosis (DVT). The nurse recognizes that teaching has been effective when the client states, - CORRECT ANSWER "I will not take any aspirin for pain while I am on warfarin. I will take acetaminophen instead." A nurse should recognize that which of the following findings indicates the most serious side effect of vancomycin (Vancocin)?
- CORRECT ANSWER Impairment of hearing A client who was prescribed oral contraceptives comes to the clinic for her 4 week follow-up visit. After discussing the use of oral contraceptives with the client, the nurse recognizes a need for further client education when the client states, - CORRECT ANSWER "If I miss a dose, I should take two pills the next time the dose is due." A primary care provider has prescribed dextromethorphan
(Balminil DM) to a client with a persistent cough. - CORRECT ANSWER The nurse recognizes that the antitussive is used to stop or reduce the cough. A client with a diagnosis of gastroesophageal reflux disease (GERD) is prescribed famotidine (Pepcid) 20 mg twice a day. When teaching this client about the proper self- administration schedule for this medication, the nurse should inform the client that famotidine should be taken - CORRECT ANSWER 1 hr before meals. Which of the following assessment findings in a client receiving transdermal nitrate therapy for angina indicates an adverse effect? - CORRECT ANSWER Dizziness when the client stands up At 1130, a nurse administers aspart insulin (NovoLog) to a client with diabetes mellitus. When is the client at greatest risk for hypoglycemia? - CORRECT ANSWER 1345 A client with a diagnosis of cystic fibrosis is prescribed acetylcysteine (Mucomyst). - CORRECT ANSWER A nurse understands that the primary reason for giving this medication to the client is to thin respiratory secretions. A nurse is reinforcing teaching for a client who has colorectal cancer and is receiving the platinum compound oxaliplatin (Eloxatin). The client should be taught about which of the following nutritional interventions? - CORRECT ANSWER Increase the amount of fiber in the diet, such as whole grains.
The nurse assesses a client shortly after an intravenous infusion of the osmotic diuretic mannitol is started. Which finding represents an early adverse effect of mannitol? - CORRECT ANSWER Bounding pulse Compared to other beta adrenergic blockers, cardioselective beta adrenergic blockers: - CORRECT ANSWER are less likely to cause bronchoconstriction. A client who experiences motion sickness during airplane flights obtains a prescription for meclizine (Antivert). When is the best time to take the drug? - CORRECT ANSWER One hour before the flight Before prescribing a cephalosporin, the nurse practitioner asks if the client is allergic to penicillin. Why is this important to assess? - CORRECT ANSWER A client who is allergic to penicillin can have a cross sensitivity to cephalosporins. The use of which class of antibiotics should be avoided in children? - CORRECT ANSWER Tetracyclines In a walk-in clinic, clients are often given intramuscular injections. Which drug should be readily available in case a client has an anaphylactic reaction? - CORRECT ANSWER Epinephrine Thiazide and loop (high ceiling) diuretics are similar in that both: - CORRECT ANSWER decrease tubular reabsorption of sodium and water.
Which of the statements by the nurse most accurately describes the effects of declined plasma albumin levels in older adults? - CORRECT ANSWER "There is an increased risk for adverse effects." To prevent oral fungal infections, the nurse should instruct the client who uses a beclomethasone inhaler to take which action? - CORRECT ANSWER Rinse the mouth after each use. A client takes ethinyl estradiol/norgestimate (Ortho Tri-Cyclen) birth control pills. She calls the clinic and relates that she missed her medication yesterday. Which instructions will the nurse give? - CORRECT ANSWER "Take two pills today then continue on a daily basis." The nurse may administer acetylcysteine (Mucomyst) inhalation to: - CORRECT ANSWER facilitate mucus expectoration. Development of a chronic cough is an adverse effect associated with which class of anti-hypertensive drugs? - CORRECT ANSWER Angiotensin converting enzyme (ACE) inhibitors The nurse may administer baclofen (Lioresal) for the treatment of which condition? - CORRECT ANSWER Protracted muscle spasticity Oral diazepam (Valium), a benzodiazepine, has been prescribed for a client who has anxiety and muscle spasms. Which nursing intervention is appropriate for the care of this client? - CORRECT ANSWER Assess for incoordination and daytime drowsiness.
There are many agents that are useful in the treatment of gastric ulcers. Which agent reacts with hydrochloric acid to form a viscous protective barrier over the ulcer? - CORRECT ANSWER Sucralfate (Carafate) A client whose asthma has been poorly controlled is prescribed cromolyn sodium (Intal) for inhalation. Client teaching should include which statement by the nurse? - CORRECT ANSWER "Using this drug regularly will reduce the frequency of acute attacks." The combination of aluminum and magnesium in many antacids decreases the risk of: - CORRECT ANSWER diarrhea or constipation. A client who is taking one daily dose of a thiazide diuretic should be instructed to: - CORRECT ANSWER take the medication in morning to avoid nighttime voiding. Which phase of pharmacokinetics is affected most by abnormal liver function? - CORRECT ANSWER Metabolism A medication order is written for ciprofloxacin (Cipro). For which client should the nurse question use of this medication? - CORRECT ANSWER Child age 10 A home health client tells the nurse that she is taking triamterene (Dyrenium) for fluid retention. She tells the nurse she is using a salt substitute so she will not retain so much water. What is the most appropriate nursing response? - CORRECT ANSWER
"Using a salt substitute with this medication could cause you to have too much potassium." Orders are written for anticholinergic drugs for each of the following clients. Which order should the nurse question? - CORRECT ANSWER Atropine combined with opioid analgesics to relieve pain in a 30-year-old client with urinary calculi. A client with Type I diabetes mellitus is given an injection of neutral protamine hagedorn (NPH) insulin at 7:00 a.m. In order to prevent a hypoglycemic reaction, the client should have: - CORRECT ANSWER a mid-afternoon snack. Why is carbidopa-levodopa preferred over levodopa alone? - CORRECT ANSWER It decreases the amount of levodopa needed. Which findings are most likely in the client who has taken a toxic dose of a salicylate (aspirin)? - CORRECT ANSWER Tinnitus and dizziness Which nursing intervention is specifically important when a client is taking an alpha- blocker, such as doxazosin (Cardura) for hypertension? - CORRECT ANSWER Teach the client how to manage orthostatic hypotension. A client reports taking large amounts of vitamins because she believes they increase her energy level and will prevent various diseases. Client teaching should include which nursing response?
- CORRECT ANSWER "Large amounts of fat-soluble vitamins can be toxic."
The best laxative for clients who have chronic constipation and cannot or will not consume adequate dietary fiber is a: - CORRECT ANSWER saline cathartic. The presence of Helicobacter pylori is confirmed in a client with peptic ulcer disease. The nurse may anticipate the use of multiple antibiotics because: - CORRECT ANSWER Helicobacter pylori commonly develop resistance to single drugs. "A disease process characterized by the continued use of a specific psychoactive substance despite physical, psychologic, or social harm" is the definition of: - CORRECT ANSWER addiction. Which group may represent an increased risk for substance abuse? - CORRECT ANSWER Socioeconomically advantaged clients The only drug commonly used both to prevent and to treat tuberculosis is: - CORRECT ANSWER isoniazid The most serious adverse reaction to morphine is: - CORRECT ANSWER respiratory depression. A client who has received an injection of regular insulin at 0800 complains of feeling sweaty, weak, hungry, and shaky two hours after the injection. Which drug is indicated for this client? - CORRECT ANSWER Glucagon
When a client is prescribed an aminoglycoside, such as gentamicin (Garamycin), which instruction should be included in the teaching plan? - CORRECT ANSWER "Report to your health care provider any ringing in your ears." When a client is being treated with trimethoprim-sulfamethoxazole (Bactrim) for a urinary tract infection, it is important to: - CORRECT ANSWER maintain good hydration. Histamine 2 receptor antagonists such as cimetidine (Tagamet) are used to treat peptic ulcers because they: - CORRECT ANSWER neutralize hydrochloric acid in the stomach. To administer eardrops to a child, the nurse should straighten the external ear canal by pulling the auricle: - CORRECT ANSWER down and toward the back of the head. A client who has a history of thrombophlebitis is taking warfarin to prevent new clot formation. He should be cautioned not to take salicylic acid because: - CORRECT ANSWER aspirin increases the effects of warfarin. Which statement by the nurse best explains why nausea, vomiting, and bone marrow suppression are common adverse effects of cytotoxic antineoplastic drugs? - CORRECT ANSWER Cytotoxic drugs affect the most rapidly dividing cells." Glucocorticoids, such as prednisone (Deltasone), are given cautiously to clients with: - CORRECT ANSWER peptic ulcer disease. Client teaching for the use of sublingual nitroglycerin tablets to relieve angina should include which nursing instruction: -
effect? - CORRECT ANSWER Central nervous system stimulation Fluconazole (Diflucan) is prescribed for the client with a fungal infection in the toenails. The nurse should instruct the client to contact the nurse practitioner immediately if which adverse effect occurs? - CORRECT ANSWER Bruising or sore throat The effects of epinephrine include: - CORRECT ANSWER increased pulse and blood pressure. To administer heparin subcutaneously, the nurse should: - CORRECT ANSWER use a 26-gauge, 1⁄2-inch needle to minimize trauma. Digoxin (lanoxin) - CORRECT ANSWER anti dysrhythmic] SE: blurred/double vision Guaifenesin - CORRECT ANSWER can cause drowsiness Estrogen (premarin) - CORRECT ANSWER SE: ↑ risk of Thromboembolism with s/s: SOB, severe headache, vomiting, sudden acute pain in the calves, legs, chest, abdomen. Doxepin (Sinequan) - CORRECT ANSWER [anticholinergic] SE: urinary retension, constipation, drying of nasal/oral secretons, ↑HR Albuterol (Proventil) - CORRECT ANSWER [sympathomimetic/ adrenergic beta-2 agonist] Contraindicated: with MAOIs (can↑ action of albuterol and → HTN crisis); β-blockers can inhibit the
therapeutic effects Use: invert canister, shake before use, rinse mouth after use, w/new inhaler perform test spray Levothryoxine (T4) Indication - CORRECT ANSWER hypothyroidism RT dysfxn of hypothalamus, pituitary, or thyroid gland Cephalosporins (Keflex - CORRECT ANSWER allergy to cephalosporins is considered a precaution for taking penicillins Phenobarbital [Barbiturates - CORRECT ANSWER interventions for anticonvulsant therapy: assess for resp. depression, excess sedation from toxic effects, IV at < 50mg/min, avoid extravasation (alkaline→skin damage) Sumatriptan (Imitrex): - CORRECT ANSWER Use: when migraine symptoms appear and again in 1 hr if symptoms persist Route—fastest/most effective: - CORRECT ANSWER intravenous Narcan [opioid antagonist]: - CORRECT ANSWER therapeutic action: improvement of respiratory rate. Baclofen (Lioresal - CORRECT ANSWER Therapeutic action: ↓ frequency & severity of muscle spasms Spironolactone (Aldactone) - CORRECT ANSWER [K sparing diuretic]—avoid foods w/ ↑ K such as salt substitutes Erythromycin (Erythrocin) - CORRECT ANSWER drug class macrolide SE: liver toxicity
Diphenoxylate & Atropine (Lomotil) - CORRECT ANSWER Caution: With Renal impairment ↓ elimination of atropine → ↑ anticholinergic effects of atropine like confusion Loperamide (Imodium) - CORRECT ANSWER Use: anti- diarrheal (poorly absorbed from GI tract; difficulty crossing the blood-brain barrier) Methylcellulose (Citrucel) - CORRECT ANSWER bulk-forming agent with minimal Side Effects (SE) Psyllium (Metamucil - CORRECT ANSWER bulk-forming agent with minimal Side Effects (SE) Acetazolamide (Diamox) - CORRECT ANSWER Indic.: edema, epilepsy, acute mountain sickness, glaucoma (↓ intraocular pressure by ↓ amount of aqueous humor in the eye) Contra: allergy to sulfonamides Metoprolol (Lopressor) - CORRECT ANSWER [β-blocker] Hold dose for dyspnea (sign of exacerbation of CHF) Propanolol - CORRECT ANSWER Use. Dysrhythmia, HTN, angina; SE: bronchoconstriction/bronchospasm; can block glyconeogenesis Norgestrel (Ovrette) - CORRECT ANSWER Use: contraception; SE: excess progestin →weight gain from ↑ appetite; deficiency of progestin: late breakthrough bleeding, amenorrhea; excess estrogen → edema Medroxyprogesterone (Provera); - CORRECT ANSWER
Contra: smoking/tobacco products; Risks: Thromboembolism & Cardiovascular complications; Interventions: use additional contraceptive measures w/antibiotic therapy IM injection site - CORRECT ANSWER locate dorsogluteal site Nausea tx - CORRECT ANSWER antiemetic plus cool, damp cloth to forehead, neck, and wrists. Allopurinol (Zyloprim) - CORRECT ANSWER Ind. Gout; MofA: ↓ serum uric acid levels & urinary uric acid secretion; Precaution: avoid foods that acidify urine such as corn TB - CORRECT ANSWER multi drug tx: Isoniazid(INH), Rifampin, pyrazinamide, ethambutol—to deal w/ resistant strains ACE Inhib. Lisinopril (Zestril) - CORRECT ANSWER SE: dry/persistent cough for 1-2 wks from ↑ bradykinin Synergistic drugs - CORRECT ANSWER Effect of giving both drugs > than the drugs individually Furosemide (Lasix - CORRECT ANSWER [loop diuretic] Intervention: check BP before giving to determine baseline; can cause ↓ BP by ↓ circulatory volume or by relaxing venous smooth muscle Ticlopidine (Ticlid) - CORRECT ANSWER prevent coronary artery thombosis; Intervention: check platelet count PRBC (packed red blood cells) - CORRECT ANSWER used as blood replacement when fluid overload is a concern
Montelukast (Singulair) - CORRECT ANSWER Indic: prevent asthma exacerbations;Dose: daily at bedtime; SE: well tolerated Metoclopramide (Reglan - CORRECT ANSWER has increased sedation when given with Morphine Mannitol - CORRECT ANSWER Caution with pts with heart disease (can precipitate CHF and pulmonary ededa) Diphenhydramine (Benadryl) Precaution - CORRECT ANSWER avoid other CNS depressants such as: alcohol, benzodiazepines, kava kava Anaphylaxis rxn S/S - CORRECT ANSWER S/S: bronchoconstriction, angioedema, hypotension Mafenide acetate (sulfamylon) Interventions: - CORRECT ANSWER Admin PRN analgesics 30 min prior to tx; apply after daily tubbing to remove previous cream; Monitor fluid & electrolyte/acid-base balances; schedule wound care > 1 hr before meals; wear sterile gloves when applying Zidovudine (AZT - CORRECT ANSWER Dose: take at the times prescribed to prevent resistance development SE: bone marrow suppression, hepatotoxic, nephrotoxic Thrombocytopenia - CORRECT ANSWER Assess: platelet count Prothrombin time - CORRECT ANSWER evaluate adequacy of extrinsic system&common pathway in clotting mechanism Sulfisoxazole (Gantrisin uses - CORRECT ANSWER Use: UTI
Cyclosporine (Neoral) - CORRECT ANSWER Intervention: Mix w/ orange juice or milk to ↑ palatability; mixed & dispense in a glass container(since drug binds to plastic); grapefruit juice ↑ cyclosporine levels & ↑ risk of toxicity; administer immediately after mixing (can separate & settle) Hexacholorphene (pHisoHex - CORRECT ANSWER [antiseptic solution] Caution: CNS stimulation if sufficient amts are absorbed through skin or mucous membranes; avoid if pregnant/breastfeeding Auranofin (Ridaura) - CORRECT ANSWER Indic: slows the progression of rheumatoid arthritis; takes 4-6 months of therapy to achieve therapeutic effect; SE: renal toxicity (less toxic through oral route than IM route), severe blood dyscrasias, GI rxns, Thiazides - CORRECT ANSWER SE: hyperuricemia (common SE); assess: uric acid levels Simvastatin (Zocor)— - CORRECT ANSWER SE: muscle weakness/aches; Assess: Creatine Kinase (released w/severe muscle injury)
- Amitriptyline (Elavil) - CORRECT ANSWER [tricyclic antidepressant] SE: orthostatic hypotension, sedation, & confusion
- Narcotic (opiate) analgesic - CORRECT ANSWER SE: papillary constriction, ↓BP, ↓HR, ↓ GI mobility
- Antihistamines - CORRECT ANSWER Indic: allergy-induced symptoms
