ATI NR 293 Pharmacology Midterm, Verified And Correct Answers, Secure bettergrade
1. A nurse is caring for a 4-year-old child who is resistant to taking... [Show More] medication. Which of the following strategies should the nurse use to elicit the child’s cooperation?
a. Offer the child a choice of taking the medication with juice or water
b. Tell the child it is candy
c. Hide the medications in a large dish of ice cream
d. Tell the child he will have a shot instead
2. A nurse is caring for a client who has difficulty swallowing medications and is prescribed enteric-coated aspirin PO once daily. The client asks if the medication can be crushed to make it easier to swallow. Which of the following responses should the nurse provide?
a. "Crushing the medication might cause you to have a stomachache or indigestion.
i. Rationale: The pill is enteric-coated to prevent breakdown in the stomach and decrease the possibility of GI distress. Crushing destroys protection.
b. "Crushing the medication is a good idea, and I can mix it in some ice cream for you.”
c. "Crushing the medication would release all the medication at once, rather than over time."
d. "Crushing is unsafe, as it destroys the ingredients in the medication."
3. A nurse is caring for a client who has congestive heart failure and is taking digoxin daily. The client refused breakfast and is complaining of nausea and weakness. Which of the following actions should the nurse take first?
a. A. Check the client's vital signs.
i. Rationale: It is possible that the client's nausea is secondary to digoxin toxicity. Assess for bradycardia, a symptom of digoxin toxicity. The nurse should withhold the medication and call the provider if the client's heart rate is less than 60 bpm.
b. Request a dietitian consult.
c. Suggest that the client rests before eating the meal.
d. Request an order for an antiemetic.
4. A nurse is caring for a client who has thrombophlebitis and is receiving heparin by continuous IV infusion. The client asks the nurse how long it will take for the heparin to dissolve the clot. Which of the following responses should the nurse give?
a. "It usually takes heparin at least 2 to 3 days to reach a therapeutic blood level."
b. "A pharmacist is the person to answer that question."
c. "Heparin does not dissolve clots. It stops new clots from forming."
i. Rationale: This statement accurately answers the client's question.
d. "The oral medication you will take after this IV will dissolve the clot.
5. A nurse is caring for a client who has bipolar disorder and has been taking lithium for 1 year. Before administering the medication, the nurse should check to see that which of the following tests have been completed?
a. Thyroid hormone assay
i. Rationale: Thyroid testing is important because long-term use of lithium may lead to thyroid dysfunction.
b. Liver function tests:
i. Rationale: LFTs must be monitored before and during valproic acid therapy
c. Erythrocyte sedimentation rate
i. Rationale: This is not a necessary test related to lithium therapy.
d. Brain natriuretic peptide
6. A nurse is providing discharge teaching to a client who has asthma and new prescriptions for cromolyn and albuterol, both by nebulizer. Which of the following statements by the client indicates an understanding of the teaching?
a. “If my breathing begins to feel tight, I will use the cromolyn immediately.”
b. “I will be sure to take the albuterol before taking the cromolyn.”
i. Rationale: The client should always use the bronchodilator (albuterol) prior to using the leukotriene modifier (cromolyn). Using the bronchodilator first allows the airways to be opened, ensuring that the maximum dose of medication will get to the client's lungs.
c. “I will use both medications immediately after exercising.”
d. “I will administer the medications 10 minutes apart.”
7. A nurse is completing a medication history for a client who reports using over-the-counter calcium carbonate antacid. Which of the following recommendations should the nurse make about taking this medication?
a. Decrease bulk in the diet to counteract the adverse effect of diarrhea.
b. Take the medication with dairy products to increase absorption.
c. Reduce sodium intake.
d. Drink a glass of water after taking the medication.
i. Calcium carbonate is a dietary supplement used when the amount of calcium taken in the diet is not enough. Calcium carbonate may also be used as an antacid to relieve heartburn, acid indigestion, and stomach upset. The client should drink a full glass of water after taking an antacid to enhance its effectiveness.
8. A nurse is caring for a client who has deep vein thrombosis and has been on heparin continuous infusion for 5 days. The provider prescribes warfarin PO without discontinuing the heparin. The client asks the nurse why both anticoagulants are necessary. Which of the following statements should the nurse make?
a. "Warfarin takes several days to work, so the IV heparin will be used until the warfarin reaches a therapeutic level."
i. Rationale: However, these medications work in different ways to achieve therapeutic coagulation and must be given together until therapeutic levels of anticoagulation can be achieved by warfarin alone, which is usually within 1 to 5 days. When the client's PT and INR are within therapeutic range, the heparin can be discontinued.
b. "I will call the provider to get a prescription for discontinuing the IV heparin today.”
c. "Both heparin and warfarin work together to dissolve the clots."
d. "The IV heparin increases the effects of the warfarin and decreases the length of your hospital stay."
9. A nurse is providing teaching to a client who has asthma and a new prescription for inhaled beclomethasone. Which of the following instructions should the nurse provide?
a. Check the pulse after medication administration.
b. Take the medication with meals.
c. C. Rinse the mouth after administration.
i. Rationale: Use of glucocorticoids by metered dose inhaler can allow a fungal overgrowth in the mouth. Rinsing the mouth after administration can lessen the likelihood of this complication.
d. Limit caffeine intake.
10. A nurse is teaching a client who has a new prescription for colchicine to treat gout. Which of the following instructions should the nurse include?
a. "Take this medication with food if nausea develops."
b. B. "Monitor for muscle pain."
i. Rationale: This medication can cause rhabdomyolysis. The client should monitor and report muscle pain.
c. "Expect to have increased bruising."
d. "Increase your intake of grapefruit juice”
11. A nurse is caring for a client who has active pulmonary tuberculosis (TB) and is to be started on intravenous rifampin therapy. The nurse should instruct the client that this medication can cause which of the following adverse effects?
a. Constipation
b. Black colored stools
c. Staining of teeth
d. Body secretions turning a red-orange color
i. Rationale: Rifampin is used in combination with other medicines to treat TB. Rifampin will cause the urine, stool, saliva, sputum, sweat, and tears to turn reddish-orange to reddish-brown.
12. A nurse caring for a client who has hypertension and asks the nurse about a prescription for propranolol. The nurse should inform the client that this medication is contraindicated in clients who have a history of which of the following conditions?
a) Asthma
1. Rationale: Propranolol, a beta-blocker, is contraindicated in clients who have asthma because it can cause bronchospasms. Propranolol blocks the sympathetic stimulation, which prevents smooth muscle relaxation.
b) Glaucoma
c) Depression
d) Migraines
13. A nurse is teaching a client who has chronic kidney disease and a new prescription for epoetin alfa. The nurse should instruct the client to increase dietary intake of which of the following substances?
a. Iron
i. Rationale: Epoetin alfa is a synthetic form of erythropoietin, a substance produced by the kidneys that stimulates the bone marrow to produce red blood cells.
b. Protein
c. Potassium
d. Sodium
14. A nurse is assessing a client who is receiving IV vancomycin. The nurse notes a flushing of the neck and tachycardia. Which of the following actions should the nurse take?
a. A. Document that the client experienced an anaphylactic reaction to the medication.
b. Change the IV infusion site.
c. Decrease the infusion rate on the IV.
i. Rationale: This client is experiencing Red man syndrome, which includes a flushing of the neck, face, upper body, arms and back along with tachycardia, hypotension and urticaria. This can lead to an anaphylactic reaction if the IV infusion rate is not slowed down to run greater than 1 hour.
d. Apply cold compresses to the neck area.
15. A nurse is teaching a client who has a urinary tract infection (UTI) and is taking ciprofloxacin. Which of the following instructions should the nurse give to the client?
a. "If the medicine causes an upset stomach, take an antacid at the same time."
b. "Limit your daily fluid intake while taking this medication."
c. "This medication can cause photophobia, so be sure to wear sunglasses outdoors."
d. "You should report any tendon discomfort you experience while taking this medication."
i. Rationale: The nurse should instruct the client to report any tendon discomfort as well as swelling or inflammation of the tendons due to the risk of tendon rupture.
16. A nurse is preparing to administer verapamil by IV bolus to a client who is having cardiac dysrhythmias. For which of the following adverse effects should the nurse monitor when giving this medication?
a. Hyperthermia
b. Hypotension
i. Rationale: Verapamil, a calcium channel blocker, can be used to control supraventricular tachyarrhythmias. It also decreases blood pressure and acts as a coronary vasodilator and antianginal agent. A major adverse effect of verapamil is hypotension; therefore, blood pressure and pulse must be monitored before and during parenteral administration.
c. Ototoxicity
d. Muscle pain
17. A nurse is caring for a client who has a fungal infection and has a new prescription for amphotericin B. Which of the following laboratory values should the nurse report to the provider before initiating the medication?
a. Sodium 140 mEq/L
b. Potassium 4.5 mEq/L
c. BUN 55 mg/dL
i. Rationale: This BUN level is above the expected reference range (10-20 mg/dL). Amphotericin B is nephrotoxic and is contraindicated if BUN is > 40mg/dL.
d. D. Glucose 120 mg/dL
e. Glucose 120 mg/dL
18. A nurse is providing teaching to a client who has renal failure and an elevated phosphorous level. The provider instructed the client to take aluminum hydroxide 300 mg PO three times daily. For which of the following adverse effects should the nurse inform the client?
a. Constipation
i. Rationale: Constipation is a common side effect of aluminum-based antacids. The nurse should instruct the client to increase fiber intake and that stool softeners or laxatives may be needed
b. B. Metallic taste
c. Headache
d. Muscle spasms
19. A nurse is teaching a client who has been taking prednisone to treat asthma and has a new prescription to discontinue the medication. The nurse should explain to the client to reduce the dose gradually to prevent which of the following adverse effects?
a. Hyperglycemia
b. Adrenocortical insufficiency
Rationale: Prednisone, a corticosteroid, is similar to cortisol, the glucocorticoid hormone produced by the adrenal glands. It relieves inflammation and is used to treat certain forms of arthritis, severe allergies, autoimmune disorders, and asthma. Administration of glucocorticoids can suppress production of glucocorticoids, and an abrupt withdrawal of the drug can lead to a syndrome of adrenal insufficiency.
c. Severe dehydration
d. Rebound pulmonary congestion
20. A nurse is preparing a client for surgery. Prior to administering the prescribed hydroxyzine, the nurse should explain to the client that the medication is for which of the following indications? (Select all that apply.)
a. Controlling emesis
b. Diminishing anxiety
c. Reducing the amount of narcotics needed for pain relief
d. Preventing thrombus formation
e. Drying secretions
21. A nurse is caring for a client who has streptococcal pneumonia and a prescription for penicillin G by intermittent IV bolus. 10 minutes into the infusion of the third dose, the client reports that the IV site itches and that he feels dizzy and short of breath. Which of the following actions should the nurse take first?
a. Stop the infusion.
i. Rationale: When using the airway, breathing, circulation approach to client care, the nurse should place the priority on stopping the infusion. The client is exhibiting signs of penicillin anaphylaxis and the first action that should be taken is to withdraw the medication.
b. Call the client's provider.
c. Elevate the head of the bed.
d. Auscultate the client's breath sounds.
22. A nurse is caring for a client who is taking lisinopril. Which of the following outcomes indicates a therapeutic effect of the medication?
a. Decreased blood pressure
i. Rationale: Lisinopril, an ACE inhibitor, may be used alone or in combination with other antihypertensives in the management of hypertension and congestive heart failure. A therapeutic effect of the medication is a decrease in blood pressure.
b. Increase of HDL cholesterol
c. Prevention of bipolar manic episodes
d. Improved sexual function
23. A nurse is caring for a client who has poison ivy and is prescribed diphenhydramine. Which of the following instructions should the nurse give regarding the adverse effect of dry mouth associated with diphenhydramine?
a. "Administer the medication with food."
b. "Chew on sugarless gum or suck on hard, sour candies."
i. Rationale: Clients who report dry mouth can get the most effective relief by sucking on hard candies (especially the sour varieties that stimulate salivation), chewing gum, or rinsing the mouth frequently. It is the local effect of these actions that provides comfort to the client.
c. "Place a humidifier at your bedside every evening."
d. “discontinue the medication and notify your provider”
24. A nurse is caring for a client who has an infection and a prescription for gentamicin intermittent IV bolus every 8 hr. A peak and trough is required with the next dose. Which of the following actions should the nurse take to obtain an accurate gentamicin serum level?
a. Draw a trough level at 0900 and a peak level at 2100.
b. Draw a peak level 90 min prior to administering the medication and a trough level 90 min after the dose.
c. Draw a trough level immediately prior to administering the medication and a peak level 30 min after the dose.
i. Rationale: Timing of the peak and trough is based on the pharmacokinetics of absorption and the half-life of the medication. The trough level is the lowest serum level after pharmacokinetic effects have taken place. For divided doses, correct timing for the trough is just before administering the next dose. The peak is the highest serum level of the medication; if this level is too low, then the medication will not be effective. Correct timing for the peak is between 30 and 60 min after the dose has finished infusing.
d. Draw a peak level at 0900 and a trough level at 2100.
25. A nurse in a substance abuse clinic is assessing a client who recently started taking disulfiram. The client reports having discontinued the medication after experiencing severe nausea and vomiting. Which of the following reasons should the nurse suspect to be a likely cause of the client's distress?
a. The client demonstrated an allergic response to the medication.
b. The client experienced a common side effect to the medication.
c. The client consumed alcohol while taking the medication.
i. Rationale: Disulfiram is given to clients who have a history of alcohol abuse. It produces a sensitivity to alcohol that results in a highly unpleasant
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