CAPSTONE PHARMACOLOGY 2 1. A nurse is caring for a client who reports using the herbal medication garlic along with prescribed warfarin. The nurse should
... [Show More] identify that which of the following is a p otential adverse effect of taking both of these products concurrently? • Altered renal perfusion • Elevated blood pressure • Increased ecchymosis- The nurse should identify that ecchymosis occurs when there is bleeding under the skin. Additionally, the nurse should recognize that, garlic has antiplatelets effects that can result in bleeding. When taken concurrently with an anticoagulant, such as warfarin, there is an increased risk for bleeding. 2. A nurse is providing teaching t a client who is starting to take aspirin. The nurse should instruct the client to monitor for which of the following findings as an adverse effect of this medication? • Black, tarry stools- A client who takes aspirin can have an increased risk for bleeding because aspirin suppresses platelet aggregation. The nurse should instruct the client to monitor for and report indications of bleeding, such as bruising, petechiae, and blood in stools or urine. • Nystagmus • Dry mouth 3. A nurse is caring for a client who has an infection and is starting to take gentamicin. Which of the following client laboratory tests should the nurse monitor to detect an adverse effect of the medication? • B-type natriuretic peptide (BNP) • Creatinine - The nurse should monitor creatinine, BUN and urine output for a client who is receiving gentamicin, and aminoglycoside antibiotic. Gentamicin is an aminoglycoside that has both nephrotoxic and ototoxic adverse effects. • Amylase level 4. A nurse is assessing a client who has diabetes insipidus and is starting intranasal desmopressin. Which of the following findings should indicate to the nurse that medication is effective? • The client has clear mucus • The client’s 24 hr urine output is 1.256 mL - Desmopressin is effective for the treatment of diabetes insipidus, a disorder of the posterior pituitary gland in which large amount of dilute urine are produced due to a deficiency in vasopressin. The action of desmopressin causes reabsorption of water and a decrease in urine volume. A urine output of 1.256 mL over 24 hr is within the expected reference range and indicates the medication is effective. 5. A nurse is assessing a client who has a prescription for haloperidol 0.5 mg PO three times daily. The medication administration record shows that the client received 5 mg per dose on the previous day. Which of the following manifestations is the nurse’s priority to assess? • Muscle stiffness - The nurse should recognize tha the greatest risk to the client is developing neuroleptic malignant syndrome, and adverse reaction to haloperidol that is potentially fatal if not treated promptly. Manifestations of neuroleptic malignant 1 syndrome include extreme muscle stiffness, sudden increase in temperature, diaphoresis, dysrhythmias, and fluctuations in blood pressure. • Blurred vision • Constipation 6. A nurse is assessing a client who received ondansetron 1 hr. ago. Which of the following findigns should the nurse identify as a therapeutic effect of the medication? • Decreased pain • Suppressed emesis – Ondansetron suppresses nausea and vomiting induced by chemotherapy, anesthesia, radiation therapy, or morning sickness by blocking serotonin receptors in the upper GI tract and in the CNS • Supresed cough • Decreased fever 7. A nurse is caring for a client who is receiving morphine. Which of the following assessments should the nurse perform first? • Apical heart rate • Blood pressure • Respiratory rate – When using the airway, breathing, circulation approach to client care, the nurse should determine that the priority assessment is respiratory rate. The nurse should withhold the morphine and notify the provider if the respiratory rate is less than 12/min. 8. A nurse is caring for a client who is at risk for alcohol withdrawal delirium. Which of the following medications should the nurse expect the provider to prescribe? • Naloxone • Bupropion • Methadone • Chlordiazepoxide – The nurse should expect the provider to prescribe chlordiazepoxide, a benzodiazepine, to a client who is at risk for alcohol withdrawal delirium. Chlordiazepoxide can prevent the client form experiencing seizures as a result of withdrawal and lessen the effects of withdrawal. 9. A nurse is teaching a client who is to start taking methyldopa for the treatment of hypertension. Which of the following information should the nurse include in the teaching? • The medication can cause dizziness- Methyldopa can cause orthostatic hypotension and dizziness when the client is changing position. Therefore, the nurse should instruct the client to change position slowly while taking methyldopa. • This medication can cause insomnia • Expect to experience depression while taking this medication 10. A nurse is providing discharge instructions to a client who has a new prescription for omeprazole for the treatment of GERD. Which of the following statements by the client indicates an understanding of the teaching? • This medication kiss the bacteria in my stomach. • This medication neutralizes stomach acid • This medication coats the lining of my stomach. • This medication reduces stomach acid – GERD is a condition in which gastric acids reflux from the stomach to the esophagus. Omeprazole is a proton inhibitor that suppresses the production of gastric acid. The medication reduces baseline acid levels 2 and blocks production of nearly all stimulated acid production within 2 hrs. of an oral dose. 11. A nurse is caring for a client who requires a transfusion of one unit of packed RBCs. The nurse receives the following prescription: Diphenhydramine 50 mg by mouth once, one hour prior to transfusion. The nurse should identify this as which of the following types of prescription? • PRN prescription • Standing prescription • Stat prescription • Single prescription 12. A nurse is providing teaching to a client who has prostate cancer and a new prescription for leuprolide. The nurse should explain to the client that leuprolide treats prostate cancer by which of the following actions? • Leuprolide decreases the production of testosterone -- Leuprolide treats prostate cancer by decreasing the production of testosterone. It causes an initial increase in testosterone, which results in desensitization and a subsequent decrease in testosterone production. • Leuprolide kills cells at all stages of cellular division • Leuprolide increases estrogen levels in your body to counteract the cancer cells. 13. A nurse is reviewing the medical record of a client who has asthma and takes albuterol. Which of the following findings should the nurse identify as an adverse effect of albuterol? • Fasting blood glucose 68 mg/dL • Heart rate 110/min – Above the expected reference rage of 60 to 100/min. Albuterol can cause tachycardia because it increases the excitability of the beta 1 receptors in the heart. More serious cardiac effects include palpitations, chest pain, hypertension, and arrhythmia. The nurse should report these findings to the provider. 14. A nurse is caring for a client who has a systemic fungal infection and is receiving IV amphotericin B deoxycholate. During previous infusions, the client developed a fever and chills. Which of the following actions should the nurse take? • Apply a warming blanket prior to administration • Infuse the medication over 1 hr. • Administer diphenhydramine prior to administration—Infusion reactions often occur following the administration of amphotericin B. The nurse should administer an antipyretic, corticosteroid, antihistamine, or antiemetic prior to administration of amphotericin B to minimize these effects • Monitor vital signs once per hour following administration. 15. A nurse is assessing a client who is in preterm labor and is receiving magnesium sulfate via continuous IV infusion. Which of the followings should the nurse identify as the priority? • Flushing • Deep tendon reflexes 1+ -- When using the urgent vs. nonurgent approach to client care, the nurse should determine that the priority finding is deep tendon reflexes 1+ , which indicates a depressed CNS and possible magnesium sulfate toxicity. • Respiratory rate 22/min 3 16. A nurse is preparing to administer medications to a client who has type 1 diabetes mellitus. The client takes lispro insulin and has a new prescription for pramlintide. Which of the following actions should the nurse take? • Monitor the client for weight gain • Monitor for hypoglycemia for 3 hrs. after pramlintide administration – The nurse should monitor the client for manifestations of hypoglycemia for 3 hrs. after administering pramlintide. Pramlintide does not cause hypoglycemia. However, when combined with insulin, hypoglycemia can occur within 3 hors. Of administration. The client should take pramlintide before meals along with lispro insulin. • Inject the pramlintide in the client’s upper arm • Administer pramlintide 30 min prior to a meal. 17. A nurse is caring for an older adult client who is confirmed positive for HIV and will begin medication therapy. Which of the following instructions should the nurse give the client? • You will be prescribed more than one medication to fight the virus. • Your medication dose will need to be slightly stronger than the recommended range. • Your medication plan can also include an antibiotic medication. • You will need to take medication for the rest of your life • You can take St. John’s wort to minimize medication adverse effects 18. A nurse is caring for a client who has a new diagnosis of adrenal insufficiency. Which of the following prescriptions should the nurse anticipate form the provider? • Phenytoin - anticonvulsant • Calcitonin – hormone med for Paget’s disease • Buspirone – Anxiolytic med to treat anxiety • Fludrocortisone – Fludrocortisone is a mineralcorticoid replacement medication used for the treatment of adrenal insufficiency. The nurse should monitor the client for hypertension and edema. 19. A nurse is providing teaching to a client who has erectile dysfunction and ahs a new prescription for tadalafil. Which of the following client statements indicates an understanding of the teaching? • I should crush this medication if I have difficulty swallowing • This medication can decrease my blood pressure—the client should understand that tadalafil can cause hypotension. The nurse should instruct the client to take this medication with nitrates because this can cause a sudden drop in blood pressure. • I can take this medication up to twice a day. 20. A nurse is assessing a group of clients. Which of the following findings is the priority to report to the provider? • A client who is receiving IM betamethasone and has a casual blood glucose of 198/dL • A client whose heart rate changes from 110/mine to 75/min after receiving IV amiodarone • A client who is receiving subcutaneous enoxaparin and report slight bruising at the injection site • A client who is receiving continuous IV lidocaine and has a respiratory rate of 10/min – Lidocaine is used to treat ventricular dysrhythmias. A decreased respiratory rate is a 4 manifestation of lidocaine toxicity. Therefore lidocaine and has a decreased respiratory rate is unstable and this finding is the highest priority to report to the provider. 21. A nurse is reviewing the medical history of a client who has myasthenia gravis and is asking about starting neostigmine. The nurse should identify which of the following client conditions as a potential contraindication for cholinesterase inhibitor therapy? • Cataracts • Hypertension • Hypothyroidism • Peptic ulcer disease—Neostigmine, a cholinesterase inhibitor, increases gastric secretions which would further exacerbate the peptic ulcer disease, thereby increasing the risk for erosion and perforation. 22. A nurse is providing teaching to a client who has angina and a new prescription for sublingual nitroglycerin tablet. Which of the following instructions should the nurse include in the teaching? • Repeat up to four doses until pain is relieved. • Store unused tablets at room temperature – The client should not expose tablets to moisture, heat, or air, and should replace the tablets 6 months after they are opened to retain potency. 23. A nurse is providing teaching to a client who has a duodenal ulcer and is starting to take sucralfate. Which of the following instructions should the nurse include in the teaching? • Take this medication with meals • Reduce dietary fiber while taking the medication • Administer an antacid with the medication • Increase fluid intake while taking the medication—The nurse should instruct the client to increase their fluid and dietary fiber intake to prevent constipation, a potential adverse effect of sucralfate. 24. A nurse is assessing a client who started taking furosemide 2 days ago and ahs a potassium level of 3.1 mEq/L. Which of the following findings should the nurse expect? • Muscle rigidity of the extremities • Bounding radial pulses • Depressed deep tendon reflexes—A potassium level of 3.1 mEq/L is lower thatn the expected reference range of 3.5 to 5 mEq/L and is an indication of hypokalemia. The nurse should expect depressed deep tendon reflexes in a client who has hypokalemia • Increased bowel motility 25. A nurse is administering bumetanide to a client who has ascites. The nurse should recognize that which of the following findings is an expected therapeutic effect of this medication? • Decreased excretion of urine sodium • Increased urinary output-- The primary action of bumetanide , a loop diuretic, is to increase the excretion of water and electrolytes through the urine. Bumetanide decreases edema associated with heart failure, liver disease, or renal compromise by increasing urinary output. • Decreased serum glucose 5 This study source was downloaded by 100000822442696 from CourseHero.com on 05-03-2021 09:53:00 GMT -05:00 28. A nurse is teaching a client who has a new prescription for benzonatate. Which of the following statements by the client indicates an understanding of the teaching? • I should not drive while taking this medication --- adverse effects of benzonatate can include sedation and dizziness. • This medication will help me cough up the mucus in my chest • I should decrease my dietary fiber intake while taking this medication 29. A nurse is teaching a client who has a new prescription for isoniazid to treat tuberculosis. Which of the following information should the nurse include in the teaching? • You will have frequent sputum tests to monitor the effectiveness of this medication – sputum specimen every 2 to 4 weeks to monitor the effectiveness of this medication. The client is no longer infectious following three consecutives negative sputum cultures. However, the client should continue the antibiotic treatment for 6 to 112 months. • You will be able to stop taking this medication after 1 month • You can take an antacid containing aluminum at the same time as this medication 30. A nurse is reviewing the health history of a client who experience migraine headaches and has asked about a prescription for sumatriptan. Which of the following condition should the nurse identify as a contraindication for taking sumatriptan? • Asthma • Kidney disease • Rheumatoid arthritis • Coronary artery disease – Client who has history or risk of coronary artery disease should not take sumatriptan. The mediation can cause coronary vasospasm, ECG changes, and hypertension. 31. A nurse is caring for a client who has chemotherapy- induced anemia. Thea nurse should expect to administer which of the following medications to treat the anemia? • Sargramostim • Filgrastim • Epoetin – This medication stimulates red blood cell production and can reduce the need for periodic blood transfusions. • Romiplostim 32. A nurse is teaching a client who has a seizure disorder and has a new prescription for phenytoin. Which of the following client statements indicates an understanding of the teaching? • I will expect to have dark urine while taking this medication • I will take an extra dose of the medication if I have a breakthrough seizure • I will have my blood checked to monitor the medication levels – The client should have serum phenytoin level tested to maintain therapeutic blood levels and prevent toxicity. Therapeutic phenytoin levels range from 10 to 20 mcg/mL. Once a safe and therapeutic dosage level is established, the client should continue to adhere to prescribed dosage schedule and continue routine monitoring. 33. A nurse is monitoring a client who is receiving a continuous IV infusion of dopamine. Which of the following findings requires immediate intervention by the nurse? • Hear rate 105/min • Increased blood pressure 6 • Infiltration of the peripheral IV – The greatest risk to this client is injury form infiltration and extravasation of the dopamine solution, which can cause tissue necrosis. Therefore, discontinue the infusion. After stopping the infusion, the nurse should treat the infiltration with phentolamine to prevent further tissue damage. 34. A nurse is caring for a client who has hypertension and nephropathy due to type 2 diabetes mellitus. The nurse should expect to administer which of the following medications to slow the progression of the nephropathy? • Sitagliptin- control glucose levels and decrease hemoglobin A1C levels • Glipizide - control glucose levels and decrease hemoglobin A1 C levels • Metoprolol- hypertension to decrease blood pressure and reduce heart rate • Losartan – An angiotensin II receptor blocker, for hypertension and type 2 diabetes mellitus to slow the progression of nephropathy. 35. A nurse is caring for a client who is having difficulty voiding following surgery. The nurse notes palpable bladder distention. Which of the following medications should the nurse anticipate administering to the client? • Furosemide • Lorazepam • Bethanechol – stimulates the muscarinic receptors of the genitourinary tract, which causes relaxation of the trigone and sphincter muscles and contraction of the detrusor muscle. • Atropine 36. A nurse is caring for a client who received excessive IV fluids in error. Which of the following actions should the nurse take? • Contact the provider • Report the error to the charge nurse • Place an incident report in the client’s chart • Auscultate the client’s lungs • Check the client for peripheral edema 38. A nurse is assessing a client who has been taking hydrochlorothiazide. Which of the following client statements indicates that the medication is effective? • The swelling in my feet has decreased.—diuretic , reduces edema and blood pressure by increasing urine output. • My appetite has increased • I no longer feel depressed 39. A nurse is providing teaching to a client who has osteoporosis and is starting to take oral ibandronate. Which of the following instructions should the nurse include in the teaching? • Take the medication immediately after a meal • Drink 8 ounces of mild when taking the medication • Take the medication before bedtime • Take one table of the mediation on the same date each month. --- The nurse should instruct the client to take ibandronate on the same date each month to maintain therapeutic medication levels. 40. A nurse is providing teaching to the parents of a child who is starting to take liquid ferrous sulfate. Which of the following information should the nurse include in the teaching? 7 • Monitor your child for constipation—constipation is adverse effect of iron. Increase fluid intake to reduce it. • Milk increases the absorption of the medication • Administer the medication undiluted 41. A nurse is reviewing the mediation administration record (MAR) of a client who requires fluticasone MDI one puff and albuterol MDI two puffs. Which of the following actions should the nurse plan to take? • 1. Have the client take one puff of fluticasone • 2. Have the client rest for 5 mins. • 3. Have the client take one puff of albuterol • 4. Have the client rest for 1 min. • 5. Have the client take the second puff of albuterol 44. A nurse erroneously administered a prescribed medication IV instead of IM to a client. Which of the following actions is the nurse’s priority? • Assess the client – According to the nursing process, the first action is assess the client for injury due to the medication error. • Report the error • Document the error 46. A nurse is transcribing a telephone prescription for acetaminophen 650 mg. by mouth daily at bedtime. The nurse should identify that which of the following abbreviations are acceptable to use when transcribing the prescription? • Abbreviate “by mouth” as “PO” • Abbreviate “daily” as “QD” • Abbreviate “acetaminophen” as “APAP” 47. A nurse is reviewing laboratory data for a client who is taking niacin to correct plasma lipid levels. Which of the following findings should the nurse identify as an adverse effect of the therapy? • Elevated alanine aminotransferase (ALT)—An adverse effect of niacin is hepatotoxicity, indicated by an elevated ALT, aspartate aminotransferase, or lactic dehydrogenase level. Clients who take niacin should have regular screenings of liver function to monitor for hepatotoxicity. • Elevated troponin T • Elevated WBC count 48. A nurse is completing an admission assessment for a client who has been taking St. John’s wort. The nurse should identify that which of the following medications can interact with St. John’s wort? 8 This study source was downloaded by 100000822442696 from CourseHero.com on 05-03-2021 09:53:00 GMT -05:00 • Rifampin • Furosemide • Citalopram – St. John’s wort interacts with many mediations and can cause serotonin syndrome when combined with cocaine, amphetamines, and antidepressants, such as citalopram. St. John’s wort decreases effectiveness of birth control pills, warfarin, cyclosporine, digoxin, calcium channel blockers, steroids, HIV protease inhibitors, and some chemotherapy agents. • Allopurinol 49. A nurse is reviewing a medical record of a client who takes lithium. Which of the following findings is the priority to report to the provider? • WBC count 12,00/mm3 • Sodium 130 mEq/L -- Lithium toxicity. A sodium level of 130 mEq/L is below the expected reference range of 136 to 145 mEq/L and increases the risk of lithium toxicity. Therefore, this finding is the priority to report to the provider. The nurse should monitor for manifestations of lithium toxicity, such as vomiting, slurred speech, and muscle weakness. 50. A nurse is providing teaching to a client who has fibromyalgia and a new prescription for pregabalin. Which of the following instructions should the nurse include in the teaching? • Stop taking pregabalin immediately if you develop headaches • You should notify your provider if you experience facial swelling. --- A hypersensitivity reaction, such as angioedema, can be life-threatening. Therefore, report manifestations such as swelling of the face, tongue, or throat to the provider. 9 Show Less [Show Less]