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NCLEX PHARMACOLOGY VATI, RN VATI
PHARMACOLOGY 2019
NCLEX Pharmacology VATI FORM A
A nurse is caring for a client who ingested a toxic amount of acetaminophen 36 hr ago. For which of the following findings should the nurse monitor? Select all that apply a. elevated troponin level b. diaphoresis c. hyperglycemia d. abdominal discomfort e. increased alanine aminotransferase (ALT) level - ANSWER-b. Diaphoresis is correct. The nurse should monitor the client for early manifestations of acetaminophen toxicity, which includes diaphoresis. Later manifestations of toxicity include liver failure, which manifest 48 to 72 hr following ingestion of the toxic dose. d. Abdominal discomfort is correct. The nurse should monitor the client for early manifestations of acetaminophen toxicity, which include abdominal discomfort, nausea, vomiting, and diarrhea. e. Increased alanine aminotransferase (ALT) level is correct. The nurse should monitor ALT levels because these enzymes may elevate with liver inflammation from acetaminophen overdose. A nurse is assessing a client who has a prescription for oral albuterol for the long-term management of asthma. For which of the following adverse effects should the nurse monitor? a. Nystagmus b. Tachycardia c. Drowsiness d. Oral fungal infections - ANSWER-b. Tachycardia Albuterol is a beta2-agonist, which can cause excessive stimulation of cardiac and skeletal muscle beta cells. Therefore, the nurse should monitor the client for tachycardia and dysrhythmias. A nurse is planning care for a client who has asthma and a prescription for methylprednisolone. Which of the following lab values should the nurse monitor? a. Aspartate aminotransferase (AST) b. Fibrin split products c. BUN d. Glucose - ANSWER-d. Glucose
Methylprednisolone therapy increases the synthesis of glucose and decreases the uptake of glucose by the muscles and adipose tissues, resulting in increased circulating glucose. Therefore, it is important for the nurse to regularly monitor blood glucose levels while clients are receiving corticosteroid therapy. A nurse planning care for a client who has a prescription for acetazolamide. Which of the following findings should the nurse plan to monitor for as an adverse effect of this medication? a. Bronchospasm b. Constipation c. Diplopia d. Electrolyte imbalance - ANSWER-d. Electrolyte imbalance Acetazolamide promotes renal excretion of sodium and potassium and reduces the formation of bicarbonate, increasing the client's risk of electrolyte and acid-base imbalances. Therefore, the nurse should monitor the client for findings of electrolyte imbalance. A nurse is caring for a client who reports an increase in migraine headaches over the past 2 weeks and asks if sumatriptan might be helpful. Which of the following conditions from the client's medical history should the nurse recognize as a contraindication for this medication? a. Gastrointestinal reflux b. Angina pectoris c. Routine acetylsalicylic acid use d. Eczema - ANSWER-b. Angina pectoris Sumatriptan is a vasoconstrictor and can cause angina from coronary vasospasm. The nurse should identify uncontrolled hypertension, coronary artery disease, ischemic heart disease, and angina pectoris as contraindications for receiving sumatriptan. A nurse on a telemetry unit is caring for a client who has a new prescription for digoxin. The nurse should identify that which of the following cardiac rhythms is a contraindication for administration of the medication? a. Atrial flutter b. Second-degree heart block c. Atrial fibrillation d. Narrow QRS complexes - ANSWER-b. Second-degree heart block A second-degree heart block results when there is a problem in the atrioventricular conduction system. Each atrial impulse takes progressively longer to go from the AV node to the ventricles until a QRS complex drops. Digoxin slows atrioventricular conduction and can cause progression to a complete heart block; therefore, the nurse should identify second-degree heart block as a contraindication for digoxin therapy.
e. Advise the client of the potential for hot flashes. - ANSWER-a. Monitor the client's calcium level. b. Monitor the client for pulmonary embolus. c. Advise the client of the potential for menstrual irregularities. e. Advise the client of the potential for hot flashes. A nurse is teaching a client who has a diagnoses of heart failure about furosemide. Which of the following instructions should the nurse include in the teaching about this medication? (select all that apply) a. Eat foods high in potassium regularly. b. Report any indications of hearing loss. c. Rise slowly from a sitting or lying position. d. Take the daily dose of furosemide at bedtime. e. Check weight daily. - ANSWER-a. Eat foods high in potassium regularly. b. Report any indications of hearing loss. c. Rise slowly from a sitting or lying position. e. Check weight daily. A nurse is preparing to admin topotecan IV for a client with metastatic ovarian cancer. Which of the following meds should be expected to control adverse effects of topotecan? a. insulin lispro via subcutaneous injection b. granisetron via transdermal patch c. magnesium sulfate via intermittent IV bolus d. prednisone via oral administration - ANSWER-b. granisetron via transdermal patch Granisetron is an antiemetic medication that helps prevent nausea and vomiting for clients who are receiving chemotherapy medications such as topotecan. The client should apply the transdermal patch to the upper outer arm up to 48 hr prior to receiving topotecan and continue to wear the patch until 24 hr after the completion of chemotherapy to prevent chemotherapy-induced nausea and vomiting. A nurse is caring for a client who has a new prescription for an ipratropium inhaler to control COPD bronchospasm. For which of the following adverse effects should the nurse monitor? a. Xerostomia b. Periorbital edema c. Bradycardia d. Dental caries - ANSWER-a. Xerostomia (dry mouth) Ipratropium is an anticholinergic bronchodilator. The muscarinic blocking effects of the medication can cause the common adverse effect of xerostomia, or dry mouth. The nurse should encourage the client to drink fluids frequently, chew sugarless gum, or suck on sugarless, hard candy to minimize the effects of xerostomia
A nurse is planning care for a child who has a prescripton for somatropin. Which of the following interventions should the nurse include to evaluate the therapeutic effects of this medication? a. monitor the child's height monthly b. verify the child's thyroid function is within the expected reference range c. check the child's sodium level regularly d. measure the child's abdominal girth - ANSWER-a. Monitor the childs height monthly. Somatropin treats growth hormone deficiency until the client reaches an adult height within the expected reference range for gender, or until the epiphyseal plates close. Therefore, the nurse should monitor the child's height and weight monthly to evaluate the therapeutic effect of somatropin treatment. A nurse is reviewing the medical record of a client who is taking epoetin alfa. Which of the following laboratory tests should the nurse monitor to determine the effectiveness of the medication? (select all that apply) a. Thyroid-stimulating hormone b. Hemoglobin c. Blood glucose d. Alanine aminotransferase e. Iron - ANSWER-b. hemoglobin e. iron A nurse is assessing a client who is taking codeine to suppress a cough. Which findings is priority to report to provider? a. constipation b. dry mouth c. agitation d. urinary retention - ANSWER-c. agitation When using the urgent vs non-urgent approach to client care, the nurse should determine that the priority finding to report to the provider is agitation, which can indicate neurotoxicity resulting from overuse of of an opioid medication. A nurse is providing discharge teaching to a client who has tuberculosis and is taking rifampin. Which of the following statements by the client indicates an understanding of the teaching? a. "Jaundice is a harmless adverse effect of this medication." b. "I shouldn't wear my soft contact lenses, because they will become discolored." c. "The best time to take this medication is when my stomach is full." d. "It is okay to drink alcohol while I'm on this medication as long as it is in moderation."
- ANSWER-b. "I shouldn't wear my soft contact lenses, because they will become discolored." Rifampin administration causes harmless red-orange discoloration of feces, sputum, tears, and sweat. Therefore, the client should not wear soft contact lenses to prevent
A client who is taking haloperidol, a first-generation antipsychotic agent, can develop extrapyramidal effects, such as parkinsonism, which manifests as tremors, bradykinesia, loss of balance, mask-like expression, shuffling gait, and muscle rigidity. A nurse is administering medications to a client and realizes the client received clonidine rather than the prescribed clonazepam. After checking the client's BP, which of the following actions should the nurse take first? a. notify the client's provider of the incident b. review the possible adverse effects of clonidine c. complete an incident report describing the details of the incident d. administer clonazepam to the client as prescribed - ANSWER-b. review the possible adverse effects of clonidine The first action is to analyze the potential risks to the client. Clonidine is a centrally acting alpha2 agonist that decreases BP. By reviewing the adverse effects of clonidine, such as hypotension, bradycardia, drowsiness, anxiety, nightmares, as well as any possible interaction btw medications, the nurse can identify risks and develop a plan of care for the client to reduce the risk for further harm. A nurse is assessing a client who is receiving androgen therapy to treat endometriosis. The nurse should monitor the client for which of the following averse effects? a. Weight loss b. Hypotension c. Muscle hypertrophy d. Edema - ANSWER-d. Edema Androgens treat endometriosis and fibrocystic breast disease, and can cause fluid retention; therefore, androgen therapy should be used cautiously with clients who have existing cardiac or renal impairment. The nurse should monitor the client for edema and instruct the client to measure weight daily. A nurse is caring for a client who is receiving heparin by continuous IV infusion for treatment of venous thrombosis. Which of the following laboratory values should the nurse monitor for in order to titrate the heparin dose? a. Platelet function assay b. aPTT c. INR d. Amylase - ANSWER-b. aPTT The nurse should monitor the aPTT of a client who is receiving heparin by continuous IV infusion. When beginning heparin therapy, the nurse should monitor the aPTT every 4 to 6 hr. Once the client has achieved the desired range, the nurse should monitor the aPTT daily. which one for warfarin and which one for heparin? - ANSWER-Warfarin- INR Heparin- aPTT
A nurse providing teaching to a pt who is scheduled to receive chemotherapy and has a script for ondansetron for nausea and vomiting. Which of the following should the nurse include in the teaching? a. restlessness is an expected effect of the medication b. take the medication 30 min after chemotherapy c. acute nausea resolves within 12 hr of chemo administration d. Additional meds can be required. - ANSWER-d. Additional meds can be required. Combinations of antiemetics are usually more effective than single-medication therapy at managing chemotherapy-induced nausea and vomiting. The combination of a serotonin antagonist, such as ondansetron, with a corticosteroid, such as dexamethasone, can be highly effective in preventing chemotherapy-induced nausea and vomiting. A nurse is reviewing the medical history of a client who has a new diagnosis of diabetes mellitus and is asking about taking metformin. Which of the following client conditions should the nurse identify as a contraindication of this medication? a. a history of migraine headaches b. alcohol use disorder c. a history of peptic ulcer disease d. tobacco use - ANSWER-b. alcohol use disorder Metformin can inhibit the breakdown of lactic acid, causing life-threatening lactic acidosis. The nurse should identify alcohol use disorder as a contraindication because alcohol further inhibits the breakdown of lactic acid. A nurse is providing teaching to a client who has a new prescription for beclomethasone and albuterol inhalers. Which of the following instructions should the nurse include in the teaching? a. "gargle with water after using beclomethasone". b. "it is not necessary to shake beclomethasone prior to use". c. "use beclomethasone for an acute asthma attack". d. "use beclomethasone before using albuterol to increase absorption". - ANSWER-a. "gargle with water after using beclomethasone". Beclomethasone is an inhaled corticosteroid that prevents bronchial inflammation. Because it can cause oral candida infections, the nurse should instruct the client to gargle with water after using beclomethasone. A nurse is caring for a client who has a prescription for penicillin V. Which of the following adverse effects is the priority for the nurse to monitor after administration of the medication? a. laryngeal edema b. urticaria c. epigastric distress
d. "Do not discontinue the medication suddenly." e. "Eat a high-sodium diet." - ANSWER-b. "Notify the provider of any illness or stress." c. "Report any episodes of weakness or dizziness." d. "Do not discontinue the medication suddenly." Physical and emotional stress increases the need for hydrocortisone. The provider might increase the dosage when stress occurs. Weakness and dizziness are indications of adrenal insufficiency. The client should report these manifestations to the provider. Rapid discontinuation can result in adverse effects, including acute adrenal insufficiency. If hydrocortisone is to be discontinued, the dose should be tapered. A nurse is preparing to administer Rho(D) immune globulin for a client who is postpartum. Which of the following criteria should the nurse identify for administering Rho(D) immune globulin? a. The client is Rh positive with a newborn who is Rh positive. b. The client is Rh negative with a newborn who is Rh negative. c. The client is Rh negative with a newborn who is Rh positive. d. The client is Rh positive with a newborn who is Rh negative. - ANSWER-c. The client is Rh negative with a newborn who is Rh positive. Rho(D) immune globulin contains antibodies to Rho(D). The nurse should identify the need to administer Rho(D) immune globulin to prevent antibody formation in a client who is Rh negative following exposure to Rh positive blood from their infant. Intrauterine transfusion can also occur before the infant is born, which is the administration of Rh negative, type O blood into the umbilical vein. These transfusions can be administered as often as every 14 days until the fetus reaches 37 to 38 weeks of gestation and the fetus' lungs mature. A client in the intensive care unit has developed short bowel syndrome and is receiving TPN. Which of the following potential metabolic complications should the nurse monitor for when administering TPN? (Select all that apply.) a. Hyperglycemia b. Hypertriglyceridemia c. Hypoglycemia d. Hypocalcemia e. Hyponatremia - ANSWER-a. Hyperglycemia b. Hypertriglyceridemia c. Hypoglycemia Total parenteral nutrition can cause some changes in the metabolic system because of the nutrients and electrolytes it contains. Clients receiving TPN are at higher risk of both hypo- and hyperglycemia. Because dextrose is usually a component of TPN, an ill client may have difficulties metabolizing the larger amounts of dextrose that are infused with the solution and may develop blood glucose abnormalities. Hypertriglyceridemia is also a risk with TPN: when lipid emulsions are administered for nutrition, the client may not be able to tolerate the extra lipid solution and may develop high cholesterol.
A nurse is preparing to administer diclofenac to a client who has chronic bursitis. Which of the following actions should the nurse take? a. administer the medication at bedtime b. avoid administering the medication with antacids c. administer the medication with food d. crush the medication prior to administration - ANSWER-Administer the medication with food Diclofenac is an NSAID and can cause gastric irritation. Clients should take NSAIDs with food or milk to minimize gastric irritation.he nurse should not administer the medication at bedtime because the client should remain upright for 15 to 30 min after administration to prevent esophageal irritation. Diclofenac is available as an enteric- coated tablet for delayed release. Clients should not crush or chew sustained-release medications because doing so will increase gastrointestinal adverse effects and decrease the effectiveness of the medication. A nurse is planning care for a client who has asthma and a prescription for methylprednisolone. Which of the following laboratory values should the nurse monitor while the client is receiving this medication? a. Aspartate aminotransferase (AST) b. Fibrin split products c. BUN d. Glucose - ANSWER-Glucose Methylprednisolone therapy increases the synthesis of glucose and decreases the uptake of glucose by the muscles and adipose tissues, resulting in increased circulating glucose. Therefore, it is important for the nurse to monitor blood glucose levels regularly while clients are receiving corticosteroid therapy. Aspartate aminotransferase is an enzyme that is present in the heart, liver, skeletal muscles, and other highly metabolic tissues. AST levels are increased in conditions that cause cellular injury, such as liver disease; however, methylprednisolone therapy does not affect AST levels. Fibrin split products are present in the serum when thromboses are present. Increased levels of fibrin split products can increase disseminated intravascular coagulation (DIC); however, methylprednisolone therapy does not affect blood clotting. BUN levels reflect kidney function and glomerular filtration. Hydration status and nephrotoxic medications can alter BUN levels; however, methylprednisolone therapy does not affect renal function. A nurse is caring for a client who is postmenopausal and has a prescription for raloxifene. The nurse should instruct the client that raloxifene is prescribed for which of the following reasons?
b. manesium sulfate c. calcium gluconate d. potassium chloride - ANSWER-Calcium gluconate The nurse should identify that a positive Trousseau's sign is a manifestation of hypocalcemia. Therefore, the nurse should plan to administer calcium gluconate to treat hypocalcemia. Sodium bicarbonate is administered to treat metabolic acidosis. The nurse should recognize that sodium bicarbonate is not used to treat a positive Trousseau's sign.Magnesium sulfate is administered to treat hypomagnesemia. The nurse should recognize that magnesium sulfate is not used to treat a positive Trousseau's sign. Potassium chloride is administered to treat hypokalemia. The nurse should recognize that potassium chloride is not used to treat a positive Trousseau's sign. A nurse is preparing to administer morphine 0.3 mg/kg PO to a school-aged child who weighs 88 lb. Available is morphine oral solution 2mg/ml. How many mL should the nurse administer? - ANSWER-6 mL A nurse is administering haloperidol to a client who has schizophrenia. For which of the following adverse effects should the nurse monitor? a. gingival hyperplasia b. muscle rigidity c. polyuria d. bruising - ANSWER-Muscle rigidity A client who is taking haloperidol, a first-generation antipsychotic agent, can develop extrapyramidal effects, such as parkinsonism, which manifests as tremors, bradykinesia, loss of balance, mask-like facial expression, shuffling gait, and muscle rigidity. Haloperidol is an antipsychotic agent that can cause akathisia (motor restlessness) within hours of receiving the first dose; however, gingival hyperplasia is not an adverse effect of haloperidol. Phenytoin is an example of a medication that causes gingival hyperplasia.Haloperidol has several genitourinary adverse effects, including urinary retention and impotence; however, urinary output does not typically increase.Haloperidol has significant cardiovascular effects, including dysrhythmias, myocardial infarction, severe heart failure, and hypotension; however, it does not affect blood coagulation. A nurse receives a verbal prescription from the provider for hydrochlorothiazide 25 mg by mouth daily for a client who has hypertension. Which of the following indicates how the nurse should transcribe the prescription in the client's medical record? a. Hydrochlorothiazide 25.0 mg orally q.d.
b. Hydrochlorothiazide 25 mg PO daily c. HCTZ 25.0 mg by mouth daily d. HCTZ 25 mg PO OD - ANSWER-Hydrochlorothiazide 25 mg PO daily The nurse should transcribe the provider's prescription by spelling out the name of the medication, recording the dosage as a whole number, and spelling out the word "daily." The abbreviation PO is acceptable for use to indicate the route by mouth. The nurse should not transcribe a trailing zero after a decimal point because if the decimal point is not seen, it could be mistaken as 250 mg. The abbreviation q.d. is not acceptable because it could be mistaken for q.i.d. The nurse should write out the word "daily."The nurse should not transcribe the medication name abbreviated as HCTZ, because it could be mistaken for hydrocortisone. The nurse should not place a trailing zero after a decimal point because if the decimal point is not seen, it could be mistaken as 250 mg.The nurse should not transcribe the medication name abbreviated as HCTZ, because it could be mistaken for hydrocortisone. The abbreviation OD is not acceptable for use because it could be mistaken for "right eye." The nurse should write out the word "daily." A nurse is planning care for a client who is taking tamoxifen for treatment of breast cancer. Which of the following interventions should the nurse include in the plan? SATA a. Monitor the client's calcium level b. Monitor the client for pulmonary embolus c. Advise the client of the potential for menstrual irregularities d. Advise the client of the potential for peripheral neuropathy e. Advise the client of the potential for hot flashes - ANSWER-Monitor the clients calcium level, monitor the client for pulmonary embolus, advise the client for potential menstrual irregularities, advise the client of potential for hot flashes Tamoxifen increases the risk for hypercalcemia. The nurse should monitor the client's pulse and blood pressure, which are increased in mild hypercalcemia and decreased in severe or prolonged hypercalcemia. Other manifestations include cyanosis, pallor, muscle weakness, and decreased deep tendon reflexes. Tamoxifen increases the risk for pulmonary embolus. The nurse should instruct the client to report any chest pain or difficulty breathing. Tamoxifen can cause menstrual irregularities, pain, and bleeding. Therefore, the nurse should instruct the client to notify the provider. Hot flashes are a common occurrence in clients taking tamoxifen. The nurse should inform the client that hot flashes are reversible with discontinuation of the medication. Tamoxifen does not cause numbness or tingling of the extremities A nurse is caring for a client who is receiving meperidine. Which of the following is the nurse's priority assessment before administering the medication? a. urinary retention
A nurse is preparing to administer medications to a client. The client tells the nurse, "I will take the pills but not that liquid medication." Which of the following actions should the nurse take? a. Document the reason for the missed dose of medication in the nurse's notes. b. Ask an assistive personnel (AP) to ensure the client drinks the medication after breakfast. c. Notify the pharmacist that the client is refusing to take the medication. d. Mix the medication in juice on the client's breakfast tray. - ANSWER-a. document the reason for the missed dose of medication in the nurse's notes It is the responsibility of the nurse to respect the client's right to refuse to take a medication and to document the reason a medication dose is not administered. This should include the client's refusal to take the medication. Medication administration, regardless of the route, is not within the range of function for an AP. The client refused the medication so the nurse should not ask someone else to administer it at a later time. The nurse should notify the client's provider of the refusal; however, it is not necessary to notify the pharmacist. The nurse should respect the client's right to refuse to take the medication. The nurse cannot force the client to take any medication against their will, which includes mixing the medication in the client's juice without their knowledge. A nurse is assessing a client who is receiving androgen therapy to treat endometriosis. The nurse should monitor the client for which of the following adverse effects? a. weight loss b. hypotension c. muscle hypertrophy d. edema - ANSWER-edema Androgens treat endometriosis and fibrocystic breast disease, and can cause fluid retention; therefore, androgen therapy should be used cautiously with clients who have existing cardiac or renal impairment. The nurse should monitor the client for edema and instruct the client to measure weight daily. Androgen therapy can cause weight gain, not weight loss. Androgen therapy can also cause nausea, vomiting, and constipation. Cardiovascular adverse effects of androgen therapy include hypertension, myocardial infarction, tachycardia, and palpitations. Anabolic steroids, such as oxymetholone, have muscle-building properties; however, androgen therapy does not cause hypertrophy of the muscles. Androgens can, however, cause muscle cramps and spasms.
VATI PHARMACOLOGY NCLEX FORM B
A nurse is assessing a client who has ovarian cancer and is receiving paclitaxel. Which of the following findings is the priority for the nurse to report to the provider? - ANSWER-bradycardia A nurse is caring for a client who has a prescription for acyclovir IV three times daily. Which of the following actions should the nurse take? - ANSWER-Assess for an increase in creatinine. A nurse is assessing a client who has Parkinson's disease and is taking levodopa/carbidopa. The nurse observes that the client has tremors and twitching. Which of the following medications should the nurse anticipate administering? - ANSWER-Amantadine A nurse in the emergency department is caring for a client who accidentally doubled their last dose of diazepam. After assessing the client, which of the following medications should the nurse plan to administer? - ANSWER-Flumazenil A client with a digoxin level of 2.4 ng/ml has a heart rate of 39. The health care provider prescribes atropine sulfate. Which of the following best describes the intended action of atropine for this client? - ANSWER-To accelerate the heart rate by interfering with vagal impulses. A client is prescribed digoxin 1mg by mouth QID. The client states that the objects in his room have a yellowish tinge and he is nauseated. Select the most appropriate nursing action at this time. - ANSWER-Hold the drug and call the health care provider. This client is showing signs of digitalis toxicity. The most appropriate action is to hold the drug and call the health care provider. Severe arrhythmia may develop if action is not taken. A client diagnosed with preterm labor has been prescribed nifedipine. The client asks the nurse why this particular medication has been prescribed. Which of the following statements by the nurse is correct? - ANSWER-To relax your muscles of your uterus A client is admitted to the hospital with a diagnosis of diabetic ketoacidosis (DKA). An intravenous infusion of regular insulin has been started. Which of the following nursing interventions is most appropriate for this client? - ANSWER-Ensure glucagon is readily available Glucagon and D50 are used for rapid treatment of hypoglycemia which can occur when insulin is administered intravenously A nurse is evaluating a client's understanding of lithium. Which statement by the client indicates a need for further education? - ANSWER-"I should take the medication on an empty stomach."
A nurse is caring for a client prescribed omeprazole. What information should the nurse provide to the client regarding administration of this medication? - ANSWER-Take the medication in the morning before breakfast. A client has an order for an IV of 1000 ml of lactated ringers with 20 mEq of potassium/L to infuse at 40 ml/hr. The drip factor is 15 drops/ml. The nurse calculates the flow rate to be: ______ gtt/min. - ANSWER-10 drops/min ml/hr X drops/ml 40 ml/hr X 15 drops/ml time in mins 60 mins A nurse is to administer nitroglycerin to a client for the treatment of angina. Which of the following should the nurse first advise the client? - ANSWER-To sit or lie down. Inform client to sit or lie down. This intervention is priority due to the orthostatic hypotension effects that can occur with nitroglycerin administration; including dizziness, light-headedness, and reduced cardiac output. This can cause a drop in blood pressure. Lying with feet elevated promotes venous return and thereby restores blood pressure. This is a safety concern and action needs to be taken before medication administration A clinic nurse is preparing to administer a Penicillin IM injection to a client who has never taken the medication before. Which of the following interventions should be included in the plan of care? - ANSWER-Instruct the client to sit in the clinic for 30 minutes after the injection. To ensure prompt treatment if anaphylaxis should develop, clients should remain in the prescriber's office for at least 30 minutes after drug injection. After 30 minutes, the risk of anaphylactic reaction is reduced. A nurse is caring for a client with a history of rheumatoid arthritis who is receiving methotrexate. Which of the following should be included in client education? - ANSWER-The complete blood count (CBC) will be monitored. Bone marrow suppression is a common side effect when using methotrexate for long term therapy in the treatment of rheumatoid arthritis. The client will have their complete blood count monitored periodically for evidence of anemia, neutropenia or thrombocytopenia. A client is prescribed digoxin. Which of the following statements by the client indicates to the nurse the need for further teaching? - ANSWER-"If I see halos around lights there is no need to notify my provider." A client experiences postural hypotension during initial drug therapy with diltiazem. Which of the following would be most important for the nurse to recommend to this client? - ANSWER-Rise slowly from a sitting or lying position. Rise slowly from a sitting or lying position. This will allow them to adjust to the upright position; slowly rising allows the heart to adjust the cardiac output to pump harder to maintain adequate BP to offset any orthostatic hypotension from occurring.
A client ingested a full bottle of imipramine hydrochloride. Which of the following toxic effects is most important for the nurse monitor? - ANSWER-Arrhythmias With a Tricyclic antidepressant (TCA) overdose, there is a high risk for serious cardiac problems, including arrhythmias, tachycardia and myocardial infarction. The nurse is providing client education regarding the combined use of herbal supplements with prescribed medications. Which of the following statements indicates the client correctly understands the interaction of ginkgo biloba and warfarin? - ANSWER-Ginkgo increases the effects of warfarin so I will stop taking the ginkgo." When ginkgo biloba is taken with antiplatelet or anticoagulant medications, the effect of the antiplatelet/anticoagulant drug may be increased, resulting in uncontrolled bleeding A client diagnosed with bipolar disorder and prescribed lithium carbonate is being discharged from the hospital. Which of the following medication prescriptions should the nurse should question? - ANSWER-Furosemide 20 mg by mouth twice per day A nurse notes the following prescription for a client with thrombophlebitis: Heparin sodium 25,000 units in 500 mL of D5W to infuse at 1,200 units/hour. What is the flow rate in mL per hour? - ANSWER-24 ml/hr Have 25000 units in 500 mL D5W25000 divide by 500cc = 50 units/mLNeed to infuse at 1200 units/hr1200 divide by 50 = 24 ml/hr A client with a recent myocardial infarction is prescribed digoxin. Which of the following findings indicate to the nurse that a therapeutic response to this medication has been attained? - ANSWER-A decrease in pulmonary crackles. During administration of vancomycin IV, the nurse notices the client's neck and face becoming flushed. Which of the following actions should the nurse take first? - ANSWER-Stop the infusion. Flushing of the face and neck are symptoms of red man or red neck syndrome occurring with too rapid infusion of Vancomycin. Vancomycin can cause two types of hypersensitivity reactions, the red man syndrome and anaphylaxis. Red man syndrome has often been associated with rapid infusion of the first dose of the drug and was initially attributed to impurities found in vancomycin preparations. First action should be to stop the infusion. Contacting the health care provider is necessary after the infusion is stopped. The client should be monitored for serious reactions such as hypotension, dyspnea, anaphylaxis, renal failure or hearing loss. Other minor reactions are chills, dizziness, fever, pruritis, and tinnitus. A client is prescribed lisinopril. Which of the following is most important for the nurse to assess before administering this medication to the client? - ANSWER-Serum electrolytes. A client experiencing pain has been prescribed meperidine 30mg IM every three hours, as needed for pain. The vial available is merperidine 75mg/1 mL. How much merperidine should the nurse administer? - ANSWER-0.4 ml
