Pharmacology III Patient Education and Drug Effects

PHARM III Q1) Which of these statements indicates the client’s understanding of nitroglycerine selfcare practices? (a) I should wait until I have taken 3 nitro’s before I call for help (b) I should stop what I am doing and sit down before I take nitroglycerine for chest pain (c) I should keep unopened bottle of nitroglycerine in the freezer (d) I can take nitroglycerine three times, but I need to space them three minutes apart Q2) Which statement by a client taking levothyroxine indicates a need for further teaching (a) I should report in Sonya tremors on an increased hardware to my provider (b) if I take a multivitamin with iron I should take it four hours after the levothyroxine (c) I should not take heartburn medication without consulting my provider (d) if I take calcium supplement, I may need to decrease my dose of levothyroxine Q3) Which side effect of clindamycin causes the most concern? (a) (b) (c) (d) Diarrhea Headache nausea vomiting Q4) A nurse teaching a client who has asthma the appropriate use of inhale fluticasone. What advice should the nurse give to help the client avoid complications with the use of inhaled steroids. (a) (b) (c) (d) Check the pulse after taking the medication take the medication before eating rinse your mouth after inhaling the medicine limit your caffeine intake Q5) A nurse is reviewing the chart of an adult male client who has been taking oral androgens. Which assessment would warrant notifying the provider? (a) (b) (c) (d) Acne and increased facial hair Breast enlargement Increased libido Jaundice Q6) The nurse reinforces instructions regarding when to take levothyroxine and determines teaching was effective when the client states the medications should be taken in which manner? (a) With an antacid (b) At bedtime (c) When they feel fatigued (d) 30 minutes before breakfast Q7) A client has infection caused by Pseudomonas aeruginosa, and the prescriber orders intravenous piperacillin and amikacin. What will the nurse do? (a) (b) (c) (d) Make sure to administer the drugs using different intravenous tubing Suggest giving more substantial doses of piperacillin and discontinuing the amikacin Suggest a fixed-dose combination of piperacillin and tazobactam Watch the client closely for allergic reactions because this risk increases with this combination Q8) A client who is recovering from total knee surgery is preparing for discharge. Which of these statements indicates the client needs further teaching? (a) Taking Acetaminophen often could mask any infection-related fever I might have (b) I can rotate acetaminophen with ibuprofen if needed for pain control, so I don’t take too much of either one (c) Taking more than 4000 mg of acetaminophen in a day can cause liver problem (d) If I still have pain 20 minutes after taking 1000 mg of acetaminophen, I should take two of oxycodone-acetaminophen. Q9) Which of a client’s medication is the most likely cause of a persistent dry cough? (a) (b) (c) (d) Enalapril Atorvastatin Nifedipine Hydrochlorothiazide Q11) Parent ask the nurse why an over-the-counter cough suppressant with sedative side effect is not recommended for infants. Which response by the nurse is correct? (a) Bables have a more rapid gastric emptying time and don’t absorb drugs well (b) Cough medication tastes bad, and infants usually won’t take it (c) Infants are more susceptible to central nervous system effect than are adults (d) Infants metabolize drugs too rapidly, so drugs aren’t effective Q12) What should the nurse include in discharge teaching regarding self-care for a client taking loop or thiazide diuretics? (a) Avoid fruits and potatoes (b) Weigh daily and report any loss or gain exceeding two pounds in 24 hours to your provider (c) Walk at least a mile a day (d) Take the medication after supper to avoid mid-day urgency Q13) The nurse will include which information when teaching a client about hydroxyzine? (a) The drug will reduce redness and itching but not edema (b) This medication is not likely to cause (c) The client should avoid drinking alcohol while on the drug (d) The client should report shortness of breath while taking the medication Q14) The nurse working on a high-acuity medical-surgical unit is prioritizing care for four clients who were just admitted. Which client should the nurse assess FIRST? (a) The NPO client with a blood glucose level of 80 mg/Dl who just received 20 units of insulin lispro (b) The client with a pulse of 62 beats/min, about to receive digoxin (c) The client with a blood pressure of 136/92 mm Hg. Who complains of having a headache (d) The client with an allergy to penicillin who is receiving an infusion of vancomycin Q15) A client who is taking calcium supplements receives a prescription for ciprofloxacin for a respiratory infection. What must the nurse include in the client teaching? (a) Consume extra fluids while taking the ciprofloxacin to prevent hypercalciuria (b) Stop taking the calcium supplements while taking the ciprofloxacin (c) Take the two medications together to increase the absorption of both (d) Take the calcium either six hours before or two hours after taking the ciprofloxacin Q16) The nurse is caring for a client who is receiving vancomycin. The nurse notes the client is experiencing flushing, rash, pruritus, and urticaria. The client’s heart rates is 120 beats/min, and blood pressure is 92/57 mmHg. The nurse knows these findings are consistent with: (a) Allergic reaction (b) Redman syndrome (c) Rhabdomyolysis (d) Stevens-Johnson syndrome Q17) A client is admitted to the hospital and will begin taking cephalexin. The nurse learns that the client also takes warfarin. The nurse will notify the provider to discuss-------the----------dose (a) Reducing; cephalexin (b) Reducing; warfarin (c) Increasing; cephalexin (d) Increasing; warfarin Q18) Insulin lispro was given to a client at 7 a.m. by a night nurse who needed to leave early. At 7:30 am, the client is clammy and refusing breakfast, stating, “I don’t feel well. I need to lie down.” What is the nurse’s next best action? (a) Check the blood sugar convince the client to drink juice if possible (b) Document the findings and let the client sleep since the insulin lispro won’t peak until later in the morning. (c) Call the night nurse at home and tell her to come back and deal with the situation (d) Wait to offer breakfast until the client feel better. Q19) What should the nurse include in a client’s discharge teaching when going home with a prescription for digoxin-0.125 mg by mouth once daily? (a) Take the digoxin at bedtime (b) You must be able to check your pulse (c) Don’t take digoxin if your heart rate exceeds 90 beats per minute (d) Eat a diet high in bran fiber and calcium Q20) A person with type two diabetes is starting metformin therapy. Which comment by the client indicates a need for further teaching? (a) This medication may bother my stomach (b) I should not take metformin on the day I have contrast or on the two days after the dye study (c) This medication may be hard on my kidneys. I should take it with plenty of water (d) This medication makes my pancreas put out more insulin Q21) Which statement indicates an asthmatic client understands discharge teaching regarding leukotriene blockers? (a) This medication could cause me to develop a thrush infection (b) I should take this medication whenever I suddenly have difficulty breathing (c) I should expect this medication will make me agitated but I don't need to report that effect (d) this medication is taking once daily for the prevention of asthma Q22) a nurse is consent about renal function in an 84 year old client who is taking several medications. what is a priority for the nurse to assess ? (a) Specific gravity (b) sodium levels (c) troponin level (d) serum creatinine Q23) Which of these findings from a client taking steroids should the nurse report immediately? (a) Temperature of 100.2 degrees Fahrenheit (b) glucose 128 mg/dL (c) heart rate of 92 beats per minute (d) blood pressure of 144/68 mm Hg Q24) A client with cancer has been taking opioid analgesic for four times daily for several months and reports needing increased for doses for pain. What will the nurse tell the client? (a) dosing of the drug may be more effective on an as needed basis (b) The risk of respiratory depression increases with the provider (c) The client should discuss increasing the dose with the provider (d) The client should request the addition of a benzodiazepine to assist with pain relief Q25) A nurse is performing a preoperative drug history on a client who is admitted to the hospital for surgery. To evaluate the risk of bleeding, the nurse will ask the client about antiplatelet and anticoagulant medications as well as which dietary supplement? (a) (b) (c) (d) Coenzyme Q-10 Ginkgo biloba Ma Huang St. John’s wort Q26) A client is taking immunosuppressant medications develops a urinary tract infection. The causative organism is sensitive to sulfonamides and another, more expensive antibiotic. The prescriber orders the more expensive antibiotic. The nursing student assigned to this client asks the nurse why use more expensive medicine. Which response by the nurse is correct? (a) Immunosuppressed clients are folate deficient (b) Clients who are immunosuppressed are more likely to develop resistance (c) Sulfonamides are bacteriostatic (d) Sulfonamides intensify the effects of immunosuppression Q27) Which side effect is most often cause by atenolol? (a) Memory loss (b) Neuropathy (c) Bradycardia (d) Hyperglycemia Q28) A client taking warfarin develops hyperurkemia, and the provider orders prednisone for a flare-up of gout. The nurse will contact the provider to discuss---------the--------dose (a) Increasing prednisone (b) Increasing; warfarin (c) Reducing; prednisone (d) Reducing; warfarin Q29) A client will begin taking fexofenadine for hay fever. The nurse teaching this client will tell the client which of the following? (a) (b) (c) (d) Fexofenadine should be taken with food to prevent gastrointestinal symptoms The medication may be taken once or twice daily Tolerance to sedation will occur in a few weeks With renal impairment, this drug should be taken every other day Q30) The parent of a child with asthma ask the nurse why their child cannot use oral corticosteroids more often because they are so effective. What is the correct response by the nurse? (a) (b) (c) (d) Chronic steroid use can inhibit growth Frequent use of this drug may lead to decrease response A hypersensitivity reaction to this drug may occur Systemic steroids are more toxic in children Q31) When administering medication to infants it is essential to remember which of the following? (select all that apply) (a) Breast feeding infants are more likely to develop toxicity when given lipid-soluble drugs (b) Immaturity of renal function in infancy causes infant to excrete drugs less efficiently (c) Infants have immature livers, which slow drug metabolism (d) Infants are more sensitive to medications that act on the central nervous system (e) Oral medications are contraindicated in infants because the administration requires a cooperative client Q32) The nurse is caring for a pregnant client recently diagnose with hypothyroidism. The client tells the nurse she does not want to take medications while she is pregnant. What should the nurse explain to this client? (a) Hypothyroidism is a normal effect of pregnancy and usually is of no consequence (b) Neuropsychologic deficits in the fetus can occur if the condition is not treated (c) No danger to the fetus exists until the third trimester (d) Treatment is required if the client is experiencing symptoms Q33) The nurse is schedule to administer insulin lispro per sliding scale before meal. The serum blood glucose reading before lunch is 280 mg/Dl. Given the following sliding scale, how much Humalog insulin should be given before lunch? (select all that apply) (a) If below60, notify the provider (b) If 60 - 124, no coverage (c) If 125 - 150 give two unit (d) If 151 -200, give four unit (e) If 201 -250, give six unit (f) If 251 -300, give eight unit (g) If over 300 notify the provider Q34) A client with type one diabetes who takes insulin reports taking propranolol for hypertension. Why is the nurse concerned? (a) (b) (c) (d) Propranolol increases insulin requirements because of receptors blocking The beta-blocker can mask the symptoms of hyperglycemia The beta-blocker can cause insulin resistance Using the two agents together increases the risk of ketoacidosis Q35) A client who just took his first dose of glipizide, is now experiencing tremors, pallor, and agitation. How should the nurse respond? (a) (b) (c) (d) Ask the client’s family to come to sit with him until his panic attack subsides Acknowledge how hard diagnosis of diabetes can be, and offer to listen Check the blood glucose and give carbohydrates if he is hypoglycemic Give diphenhydramine per standing order. Q36) The nurse is doing discharge teaching with the parent of an asthmatic child who will be going home on steroids. Which of these comments by the parent would indicate an accurate understanding of discharge teaching regarding these medications? (a) Prolong steroid use causes children to grow prematurely tall because they enhance growth (b) Prolong steroid use may lead to tolerance. Doses will need to increase over time (c) My child may need to take a gastric acid suppressor while taking steroids (d) Steroids cause weight loss and dehydration in children because they cause type 1 diabetes Q38) A client is discharged from the hospital with a prescription for trimethoprim/sulfamethoxazole. What must the nurse include in the discharge teaching? (a) (b) (c) (d) Drink eight to ten glasses of water each day Eat foods that are high in potassium Take the medication with food Take folic acid supplements Q39) What should a nurse advice a client on spironolactone regarding necessary self-care? (a) (b) (c) (d) Continue taking this medication even if you feel well Avoid salt substitutes Add as many fruits and vegetables to your diet as possible Check your pulse before taking this medication Q40) The nurse will caution a client taking immunosuppressant drugs to avoid which dietary supplement? (a) (b) (c) (d) Black cohosh Echinacea Feverfew Glucosamine Q41) A client is taking oral itraconazole for a systemic fungal infection. The nurse reviews the medication record and notes that the client is also taking cimetidine for reflux disease which action should the nurse take? (a) Administer the cimetidine one hour before the itraconazole (b) Administer the cimetidine at least two hours after the itraconazole (c) Confer with the prescriber about a potentially hazardous interaction (d) Don’t give the cimetidine to a client receiving itraconazole Q42) A young client with type 2 diabetes is receiving insulin glargine (Lantus) once a day. When will the nurse anticipate administering this drug? (a) Approximately 15 to 30 minutes before each meal (b) After meals and at bedtime (c) At bedtime (d) In the morning and at 4:00 pm Q43) A client will receive oral ciprofloxacin to treat a urinary tract infection. The nurse provides teaching for this client. Which statement by the client indicates a need for further teaching? (a) (b) (c) (d) I may have abdominal pain and nausea, but these are usually mild I should take this medication with food or milk to improve absorption I should stop taking the medication immediately if I experience heel pain I will need to use sunscreen every time I go outdoors Q44) A client has been taking a glucocorticoid for several months arrives in the clinic. The nurse notes the client’s cheeks appear full, and a prominent hump of fat is present on the upper back. The nurse will ask the provider to order which of these laboratory test? (a) (b) (c) (d) Liver function test Serum electrolytes Tuberculin skin test Vitamin D levels Q45) A client who takes 324 mg of aspirin daily is schedule for surgery next week. Which of the following would the nurse expect the provider to order? (a) Continue to use aspirin as scheduled (b) Reduce the aspirin dosage by half unit after surgery (c) Stop using aspirin immediately (d) Stop using aspirin three days before surgery Q46) A client who is receiving a final dose of intravenous cephalosporin complains of pain and irritation at the infusion site. The nurse observes signs of redness at the intravenous insertion site and along the vein. What is the nurse’s priority action? (a) (b) (c) (d) Apply warm packs to the arm and infuse the medication at a slower rate Continue the infusion while elevating the arm Select an alternate intravenous site Request central venous access Q47) Which of these situation would cause the nurse to hold a dose of morphine? (a) The heart rate is above 90 beats per minute (b) The blood pressure is above 140 mmHg systolic (c) Respiratory rate of 10 breaths per minute with an oxygen saturation level of 86% (d) The temperature is above 38 degrees Celsius Q48) Which statement by the client indicates an understanding of self-care precautions when taking warfarin? (a) (b) (c) (d) I should eat spinach to increase my iron count if my INR goes below two Herbal remedies are fine, but I shouldn’t take aspirin without consulting my provider My coumadin dose may need to be readjusted when I take a course of antibiotics I should expect pink urine due to metabolic bi-products of the dye used in this medication Q49) Naloxone is effective because of which action? (a) Countering the effects of morphine sulfate by agonist (b) Increasing the excretion of morphine sulfate by altering serum pH (c) Preventing activation of opioid receptors through antagonist actions (d) Regulating the sensitivity of opioid receptors by neurochemical alterations Q50) A prescriber orders cefoxitin for a client who has an infection caused by gramnegative bacteria. The nurse notes in the medication history the client experienced a maculopapular rash when taking amoxicillin several years earlier. What is the nurse’s best response? (a) (b) (c) (d) Administer the cefoxitin and observe for any side effects Give the cefoxitin and have epinephrine and respiratory support available Request an order for a different, non-penicillin, non-cephalosporin antibiotic Request an order to administer a skin test before giving the cefoxitin Q51) The nurse is explaining why epidural analgesia is the recommended route for pain medication during labor. Which of these factors pertaining to infant kinetics explain the need to keep analgesia confined to the maternal neurological system? (select all that apply) (a) The infant blood-brain barrier is underdeveloped (b) The infant’s liver and renal system are underdeveloped (c) The infant will experience withdrawal syndrome when it is born, even if the mother is opiate naïve (d) The infant will be less able to tolerate respiratory suppression (e) The infant will develop a detachment syndrome that will affect its life-long development Q52) A prescriber has ordered medication for a newborn that is eliminated primarily by hepatic metabolism. What would the nurse expect the prescriber to order? (a) (b) (c) (d) Order a dose that is lower than an adult dose Order a dose that is higher than an adult dose Increase the frequency of the medication Discontinue the drug after one or two treatments. Q53) A nurse is caring for a client and her newborn immediately after delivery. The client’s medication history includes prenatal vitamins throughout pregnancy, one or two glasses of wine before knowing she was pregnant, occasional use of an albuterol inhaler in her last trimester, and intravenous morphine during labor. What is the nurse’s most appropriate action? (a) Administer opioids to the infant to prevent withdrawal syndrome (b) Monitor the infant’s respiratory and prepare to administer naloxone if needed (c) Note a high-pitched cry and irritability in the infant and observe for seizures (d) Prepare the client for motor delays in the infant caused by alcohol use Q54) Which of these statements best describes the concept of half-life? (a) It is the time it takes for half of the medication to be metabolized for elimination of the medication. (b) It is the time it takes for half of the medicinal effect effects to be achieved (c) It is the time it takes for half of the medication to be distributed to receptors (d) The term refers to the shelf life of the drug Q55) A pregnant client asks the nurse if she can take antihistamines for seasonal allergies during her pregnancy. What will the nurse tell the client? (a) Antihistamines should be avoided in pregnancy unless absolutely necessary (b) Second-generation antihistamines are completely safe to take during the first trimester (c) Antihistamines are safe to take during breast-feeding, but they cause spina bifida in pregnancy (d) The margin of safety for antihistamines is clearly understood for pregnant clients. Q56) A client who reports routine consumption more than three alcoholic beverages per day asks about taking acetaminophen when needed for occasional recurrent pain. What will the nurse tell the client? (a) (b) (c) (d) Do not take more than 2 gm of acetaminophen a day Do not take more than 3 gm of acetaminophen a day Do not take more than 4 mg of acetaminophen a day Do not take a fixed-dose preparation of acetaminophen with opioid analgesic. Q57) A cardiac client has been given a prescription for nifedipine extended-release. Which statement provided in the discharge teaching is incorrect? (a) You can crush the tablet and dissolve the particles under your tongue if chest pain occurs (b) Expect constipation with this medication (c) This medication can make your feet retain fluid (d) Limit your intake of grapefruit when taking this medicine to avoid toxicity Q58) A client who has had abdominal surgery has been receiving morphine sulfate via client-controlled- analgesia. The nurse assesses the client and notes that the client’s pupils are constricted and the client is drowsy and lethargic. Th client’s heart rate is 84 beats/min, their respiratory rate is 10 beats per minute, and their blood pressure is 90/50 mm Hg. What is the nurse’s best action? (a) (b) (c) (d) Encourage the client to turn over and cough and take deep breaths Discuss possible oplate dependence with the client’s provider Note the effectiveness of the analgesia in the client’s chart Prepare to administer naloxone and provide ventilatory support Q59) A nurse is administering morphine sulfate to a postoperative client. Which are the appropriate routine nursing actions when giving this drug? (select all that apply) (a) Requesting an order for methylnaltrexone to prevent constipation (b) Facilitating physical activity and offer fluids if GI functions have returned (c) Monitoring the client’s blood pressure closely for hypertension (d) Counting respirations before and after giving the medication (e) Assessing GI function every 4 to 6 hours Q60) Which of these findings would cause the nurse to hold the administration of oral metoprolol (a) Heart rate of 92 beats per minute (b) Respiratory rate of 26 breath per minute (c) Blood pressure of 92/44 mmHg (d) Oxygen saturation level of 95% on room air Q61) A client who has type two diabetes begin taking glipizide. Which statement by the client CONCERNS the nurse? (a) I will begin by taking this once daily with breakfast (b) I should not take this medication if I have a sulfate allergy (c) I will need to check my blood sugar once daily or more (d) I may continue to have a glass of wine with dinner Q62) A client with no known drug allergies is receiving amoxicillin PO twice daily. Twenty minutes after being given a dose, the client complains of shortness of breath with a blood pressure of 100/58 mmHg. What will the nurse do? (a) (b) (c) (d) Contact the provider and prepare to administer epinephrine Notify the provider if the client develops a rash Request an order for a skin test to evaluate possible penicillin allergy Withhold the next dose until symptoms subside Q63) What must a nurse include in a client education for an arthritic client taking high doses of aspirin . (select all that apply) (a) Aspirin causes gastric erosion, so take it with food (b) Report bruises, bleeding gums, tarry stools, and pink urine (c) Call your provider for ringing in the ears (d) Aspirin is nephrotoxic (e) Aspirin is preferred to acetaminophen in the control of fevers in children Q64) A nurse is educating a client regarding the use of pantoprazole. What statement by the client shows a proper understanding of how to take this medication? (a) (b) (c) (d) I should chew the medication when my heartburn is bad, so it absorbs more rapidly I should plan to take this medication for the rest of my life I should take this medication on an empty stomach before I eat I should take this medication with an antacid to maximize its effects Q65) A nurse is providing client education for the application of transdermal estrogen spray. Where should the client be advice to apply the topical spray? (a) Apply it to the axilla (b) Apply it to the breast (c) Apply it to the genitals (d) Apply it to the inner forearm Q66) A nurse is talking with client who has peptic ulcer disease and is starting therapy with sucralfate. What must the nurse include in the client education? (a) Take it with an antacid (b) Take 30 to 60 minutes before meals (c) Take it whenever indigestion occurs (d) Take it immediately after meals Q67) A client who has erectile disfunction asks a nurse whether sidena…. Would be a suitable medication. Which aspect of this client’s history would be of most concern? (a) (b) (c) (d) Benign prostate hypertrophy Mild hypertension Occasional use of nitroglycerin Taking finasteride Q68) A client is starting to take furosemide and ask the nurse, “when is the best time to take this medication?” (a) (b) (c) (d) 2200 1600 0800 1900 Q69) A nurse is providing teaching for an adult client with arthritis who has been instructed to take ibuprofen for discomfort. Which statement by the client indicates a need for further instruction/ (a) I may experience tinnitus with higher doses of this medication (b) I may take up to 800 mg four times daily for pain (c) I should limit alcohol intake to fewer than three drinks a day (d) I will take this medication with meals to help prevent stomach upset Q70) A nurse understands that a bronchodilator would be most therapeutic in which situation? (a) (b) (c) (d) Shallow breath sounds with wheezing sounds in the upper lobes Course crackles in the right lower lobe Fine, scattered crackles heard bilaterally in the bases Irregular respiration, snoring and intermittent episodes of apnea Q71) A client with chronic gout has been taking colchicine for several months and is admitted for acute gout pain. The prescriber plans to begin therapy with probenecid. What will the nurse do? (a) (b) (c) (d) (e) Give the medication as ordered and observe the client for gastrointestinal side effect Request an order to lower the dose of the colchicine Restrict the client’s fluid intake to minimize the risk of renal injury Suggest delaying probenecid therapy until the acute episode has subsided Suggest delaying probenecid therapy until the acute episode has subsided Q72) A nurse tells a nursing student glucocorticoids given for rheumatoid arthritis are nearly ldentical to substances produced naturally by the body. The student remarks that the drug must be very safe. Which response by the nurse is correct? (a) (b) (c) (d) As long as the drug is taken as prescribed, side effects usually do not occur By interrupting the inflammatory process, these drugs inhibits side effects Side effects can occur and are dependent on the dose and duration of treatment The negative feedback loop prevents side effects. Q73) The nurse is talking with a new mother about medications that can safely be resumed now that she is no longer pregnant. All of the following medications are forbidden during pregnancy, but which one may be ingested while breastfeeding, without causing known infant harms? (a) Methotrexate (b) Ibuprofen (c) Lithium (d) Nicotine Q74) The nurse is caring for a client receiving intravenous acyclovir. To prevent nephrotoxicity. What is the nurse’s best action? (a) Hydrate the client during the infusion and after the infusion. (b) Increase the client’s intake of foods rich in vitamin C. (c) Monitor urinary output every 30 minute (d) Provide a low-protein diet for one day (e) Provide a low-protein diet for one day before and two days after the acyclovir infusion Q75) A client is taking a drug that has known toxic side effects. What will the nurse do? (a) (b) (c) (d) Discontinue the drug at the first signs of toxicity Ensure that complete blood counts are ordered periodically Monitor the function of all organs potentially affected by the drug Teach the client how to treat the symptoms if they develop. Q76) A nurse is teaching a client who has taken glucocorticoids for over a year about glucocorticoid withdrawal. Which statement by the client indicates a need for further teaching? (a) (b) (c) (d) I should reduce the dose by half each day until I stop taking the drug I will need to have cortisol levels monitored during the withdrawal process The withdrawal schedule may take several months If I have surgery, I may need to resume taking the drug. Q77) A client receiving a cephalosporin develops a secondary intestinal infection caused by clostridium difficile. What is an appropriate treatment for this client? (a) Adding an antibiotic, such as tobramycin, to the client’s regimen (b) Discontinuing the cephalosporin and beginning metronidazole (c) Stopping all antibiotics and providing fluid replacement (d) Increasing the dose of the cephalosporin and providing isolation measures Q78) A nurse is giving discharge instruction to a client who is beginning theophylline. The nurse should tell the client that this medication might cause which of the following adverse effects? (a) (b) (c) (d) Drowsiness Constipation Oliguria Tachycardia Q79) A nurse is teaching a group of nursing students about administering medication to older adult clients. Which statement by a student indicate a need for further teaching? (a) Alteration in hepatic function requires more frequent drug dosing (b) Changes in gastrointestinal function in older adult clients lead to lower serum drug levels (c) Adverse drug reactions in older adult clients are related to altered renal function (d) Nonadherence for medications among older adult clients is due to the cost of medications Q80) A pregnant client stopped using a prescription medication she takes for asthma because she doesn’t want to harm her baby. What will the nurse tell the client? (a) Asthma medications will not affect the fetus (b) Stopping medications for asthma doubles the chances of a stillbirth (c) Avoid taking medications during her pregnancy (d) Resume the medications in her second trimester Q81) Which actions occur in fatal medication errors? (select all that apply) (a) (b) (c) (d) (e) Confusing drugs with similar packaging Giving a drug intravenously instead of intramuscularly Complicated drugs with name that look or sound alike Using barcode scanning to verify patients’ name and birthdate Writing a prescription illegibly Q82) In which situation would the nurse hold digoxin/ (a) When the lab reports a digoxin level of 1.2 ng/ml (b) When the client is edematous (c) When the client is pacing and very thirsty (d) When the pulse is 54, and the client complains of nausea and altered vision Q83) A client taking warfarin presents with bruises, dark tarry stool, and an INR of 4.3. What is the nurse’s best response? (a) Give the warfarin with a dark green salad and check the next stool for blood (b) Give an ampule of vitamin K, then call the physician to report client status (c) Explain to the client you may ask the provider to order a test for leukemia (d) Hold the warfarin and consult the provider regarding the next steps Q84) A client with bronchitis is taking trimethoprim/sulfamethoxazole, 160/800 mg orally, twice daily. Before administering the third dose, the nurse observes the client has a widespread rash, a temperature of 103 F, and a heart rate of 100 beats/min. The client looks ill and reports not feeling well. What is the nurse’s best response? (a) (b) (c) (d) Administer the dose and request an order for an antipyretic medication Withhold the dose and request an order for an antihistamine to treat the rash Withhold the treatment and notify the provider of the symptoms Request an order for intravenous trimethoprim/sulfamethoxazole Q85) A client who is pregnant has a history recurrent genital herpes virus. The client ask the nurse what will be done to suppress an outbreak when she is near term. What is the nurse’s best response? (a) Antiviral medications are not safe during pregnancy (b) Intravenous antiviral agents will be used if an outbreak occurs (c) Oral acyclovir must be used to control outbreaks (d) Topical acyclovir must be used to control outbreaks Q86) Which of these comments by a client taking a calcium channel blocker would indicate the need for additional teaching? (a) I will rise slowly from lying, sitting to standing (b) I will take the medication with grapefruit juice (c) I will elevate my legs if edema occurs (d) I can limit my risk for constipation by increasing fluid and fiber Q87) A nurse is caring for a client who was recently started on lithium and is training a new nurse. What comment by the new nurse would require further teaching? (a) (b) (c) (d) Lithium is used to treat bipolar depression Lithium is used to reduce euphoria Lithium will cause sedation Lithium reduces hyperactivity Q88) A nurse is preparing discharge teaching for a client who will be going home on warfarin. Which of these client statements indicate the need for further instruction? (a) I should avoid alcohol and herbal remedies while I am taking warfarin (b) I should be consistent with my intake of leafy greens because they reverse warfarin effects (c) I should stop taking my warfarin if I get bruises or black stools (d) I should have my bleeding time checked when I am taking antibiotics Q89) A third grader is starting methylphenidate. What counseling should the nurse provide for the child’s parents? (a) Give the medication at bedtime (b) Give the medication as needed (c) Store the medicine in a safe place; it is a controlled substance (d) If you notice weight loss, switch dosing to every other day Q90) A client with type 1 diabetes is eating breakfast at 7:30 AM. Which of these insulins would the nurse anticipate being ordered for a sliding scale and has an onset within 15 minutes? (a) (b) (c) (d) Insulin as part protamine suspension 70%, insulin as part 30% NPH Lantus Insulin lispro Q92) Which of these self-care measures should be emphasized in client education regarding phenytoin? (a) (b) (c) (d) Brush after every meal and floss teeth daily Instill mineral oil into both ears once a week Gradually reduce prescribed dose if seizure do not occur for one month Expect green urine due to medication metabolites Q93) The diabetic client receives a morning NPH insulin injection. What time should the client and nurse expect the NPH to reach its peak action? (a) Within 15 minutes (before breakfast) (b) Within two to four hours (before lunch) (c) Within six to fourteen hours (before supper) (d) Within 18-24 hours (in the middle of the night) Q94) A 50-year-old postmenopausal client who has had a hysterectomy has moderate to severe vasomotor symptoms and is discussing estrogen therapy with the nurse. What will the nurse tell the client regarding the adverse effects of estrogen therapy? (a) The side effect will go away in exactly three days on their own (b) Why did you ask me? I don’t know what you need (c) Side effects of estrogen therapy are uncommon among women of her age. You shouldn’t have any side effects. Are you sure these are side effects? (d) Please discuss this with your provider. There are transdermal preparations that lower the risk of side effects. Q95) A client with an infection is being treated with vancomycin. The nurse providing care reviews the client’s laboratory reports and notes that the client’s blood urea nitrogen and serum creatinine levels are newly elevated. What would be the priority nursing action? (a) (b) (c) (d) Watch the client urine output and report it if it drops below 30ml/hr Remind the provider t draw a peak and trough level Consult the provider about the need for less nephrotoxic medication Instruct the client to notify you if they have any tingling in their toes Q96) A client presents with tinea corporis and the prescriber orders itraconazole. When educating the client about this medication, the nurse will include which statement? (a) (b) (c) (d) Apply the medication over the entire body twice daily for two weeks Sun exposure will minimize the drug’s effects This drug is effective after a single application Use the medication for at least one week after the symptoms have cleared Q97) The nurse is providing client education for a postmenopausal client, which risks associated with estrogen/progestin therapy should the nurse discuss with the client? (select all that apply) (a) Increase colon cancer (b) Stroke (c) Deep vein thrombosis (d) Ovarian cancer (e) Decreased bone density Q98) A client has had emergency surgery for a ruptured appendix. Before surgery, the client was taking dexamethasone for three years. Since the client was on this medication before surgery, the nurse would be most concerned about which complication in the recovery phase? (a) Bradycardia (b) Post-operative blood clots (c) Pre-surgical dehydration (d) Impaired wound healing Q99) A male client tells the nurse he awakens once or twice each night to void and has difficulty starting his stream of urine. He describes these symptoms as “annoying”. The client’s provider examines him and notes that the prostate is moderately enlarge. The client is sexually active and tells the nurse that he does not want to take any medication that will interfere with sexual function. The nurse anticipates the provider will order which of the following? (a) (b) (c) (d) Doxazosin Finasteride Silodosin A transurethral prostatectomy Q100) Which factors can alter a client’s physiologic response to a medication? (select all that apply) (a) Ability to swallow pills (b) Age (c) Genetic factors (d) Gender (e) height