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PN Pharmacology Online Practice 2014 B

1. A nurse is collecting data from a client who is asking about taking celecoxib for treatment of joint pain.
What is a contraindication to receiving celecoxib? History of myocardial infarction or heart disease
Rationale: Celecoxib increases the risk of MI because of increased vasoconstriction and platelet
aggregation.

2. A nurse is reinforcing teaching with a client who has bipolar disorder and a new prescription for lithium.
What instructions should the nurse include in the teaching? Maintain a consistent sodium intake
Rationale: The client should not take lithium on an empty stomach, this will help reduce GI upset.
Hypothyroidism and polyuria might occur while taking lithium. The client should maintain a consistent sodium
intake while taking lithium. Decreased serum sodium levels cause lithium excretion to decline which can lead to
toxicity
3. A nurse is caring for a client who has a history of psychosis and is taking chlorpromazine. What action
should the nurse take to counteract the adverse affects of this medicine? Help the client to apply sunblock before
going outside.
Rationale: Chlorpromazine increases skin sensitivity to ultraviolet light and to the risk of sunburn.
Applying sunblock will counteract this adverse affect. This drug also causes constipation, excessive sweating.
The client should also take with food or fluid to minimize GI upset.

4. A nurse is collecting data from a client who has been taking levodova/carbidopa. What finding should
indicate to the nurse that the medication is effective? The client is able to wash his face
Rationale: Levodopa works by activating dopamine receptors, restoring nerve transmission for clients
who have Parkinson's disease. Carbidopa enhances these effects by inhibiting the breakdown of levodopa in the
intestine and periphery. This allows the client to move freely and resume ADL's

5. A nurse is caring for a client who is receiving methylprednisolone sodium succinate. What laboratory
values should the nurse plan to monitor? White blood cells, Serum Potassium, Blood glucose
Rationale: methylprednisolone sodium succinate can increase the clients risk for infection (WBC)
methylprednisolone sodium succinate can cause hypokalemia along with fluid and sodium retention (K)
methylprednisolone sodium succinate can cause increased blood glucose levels (blood glucose)

6. A nurse is reinforcing teaching with a client who has a prescription for ciproflaxcin. What instructions
should the nurse include in the teaching? The client should drink 8 full glasses of water per day
Rationale: The nurse should instruct the client to drink plenty of water while taking this medication.
This will keep the client hydrated and prevent crystalluria of the urine. The client should also decrease exposure
to sunlight, avoid taking this medication with milk because calcium levels inhibit the absorption of this
medication.

7. A nurse is collecting data from a client who has a prescription for tobramycin. What findings should the
nurse immediately report to the provider? Oliguria
Rationale: Oliguria indicates the client is at greatest risk for nephrotoxicity. Therefore, this is a priority
that should be reported immediately.

8. A nurse is caring for a client who is having an acute asthma attack. What medication should the nurse
administer first? Albuterol
Rationale: Albuterol is a short-acting beta2 agonist with rapid onset. Therefore, the nurse should
administer albuterol to treat acute asthma. The nurse should administer prednisone, a glucocorticoid, after the
clients acute attack resolves. The client can take oral prednisone for 10 days following an acute attack to
decrease inflammation

9. The nurse is reinforcing teaching with a client who has a new prescription for theophylline. What should
the nurse instruct the client that is an expected outcome of this medication? Dilates bronchioles
Rationale: Theophylline is a bronchodilator, which affects smooth muscle relaxation leading to opened
airways
10. A nurse is reinforcing teaching with a client who is to start therapy with nitroglycerin transdermal patch.
Give a statement that the client would say to indicate an understanding of the use of this patch? "While using the
patch, I will be careful when rising from a chair"
Rationale: Nitroglycerin can cause orthostatic hypotension, which causes dizziness. The client should
also apply the patch each morning but should remove it after 12-14 hours and allow for 10-12 hours without any
medication. This will prevent the client from developing tolerance to this medication. The client should rotate the
site to avoid skin irritations. The client should use rapid onset, short acting nitroglycerin to treat acute angina.

11. The nurse is caring for a client who has chronic renal failure and has been receiving epoetin alfa for 2
weeks. What would indicate to the nurse that the medication is having the desired therapeutic effect? Hemoglobin
rises 0.5 g/dL
Rationale: Initial effects occur within the first 2 weeks of therapy. Hemoglobin reaches target levels (10-
12 g/dL) in 2-3 months

12. A nurse is reviewing the medication administration record for a client who has a history of Stevens-
Johnson syndrome when taking sulfamethoxazole-trimethoprim. What medication should the nurse withhold to
prevent an allergic reaction? Furosemide
Rationale: The client who has a history of Steven-Johnson syndrome when taking sulfonamides is at
risk for an allergic reaction to furosemide because the two medications are chemically related

13. A client is visiting her provider to follow-up on routine laboratory work related to warfarin therapy for
mitral valve replacement. The clients current INR is 5.0. What question should the nurse ask based on the clients
INR results? "Have you noticed any bruising"
Rationale: An INR expected range is 2.0-3.0. The clients current INR is above the expected range
which places the client at an increased risk for bleeding.

14. A nurse is monitoring a client who is to start therapy with spironolactone. What serum laboratory result
should the nurse report to the provider? Increased levels of Potassium
Rationale: Increased levels of potassium places the client at risk for muscle weakness, nausea, vomiting
and cardiac dysrhythmias and should be reported. Sodium range: 135-145, chloride range: 96-106 Magnesium
range: 1.5-2.5

15. A nurse is preparing to instill antibiotic ear drops for a client who has otitis externa. What actions
should the nurse take? Wiggle the earlobe after instilling the ear drops
Rationale: Wiggling the earlobe can help the ear drops move down the clients external auditory canal

16.A nurse is reinforcing teaching with a client who is to start therapy with metronidazole for a urinary tract
infection. What should the nurse include in the teaching? " Your urine may become reddish brown"
Rationale: The nurse should warn the client that urine may turn dark or reddish brown. The medication
can be kept at room temperature. Instruct client to finish the full course of treatment even if symptoms have
disappeared.

17. A nurse is reinforcing teaching about comfort measures with the parent of a 10 year old child who has a
viral infection. The nurse should plan to tell the parent that aspirin is contraindicated because of the risk for what
condition? Reyes Syndrome
Rationale: Aspirin is contraindicated for children and adolescents who have a viral illness because it is
associated with the development of Reyes Syndrome.

18. A nurse is caring for a client who is prescribed disulfiram and consumed alcohol 12 hours ago. What
adverse reaction is the priority finding to report to the provider? Respiratory Depression!
Rationale: Respiratory depression is a potentionally dangerous event and should be reported
immediately.
19. A nurse is reinforcing teaching with a client who has a new prescription for regular insulin. What would
give an indication that the client understands the teachings of the medication? The client should identify that the
insulin is clear prior to drawing it up
Rationale: Regular insulin is clear in appearance. Clients should discard the vial and use a new vial if
the insulin appears cloudy. Clients should administer insulin subcutaneously. The onset of regular insulin, a
short acting insulin is 30-60 minutes. Therefore, the client should wait at least 30 minutes before eating. When
taking insulin lispro, a rapid acting insulin, the client should eat within 15 minutes. Clients who take NPH
insulin, which is a cloudy suspension, should roll the vial to gently disperse the particles.

20. A nurse is reinforcing teaching about immunizations with a client who is pregnant. What vaccines
should the nurse include in the teaching as safe to administer during pregnancy? Tetanus, diphtheria and pertussis
(Tdap)
Rationale: Only Tetanus, diphtheria and pertussis (Tdap) vaccines are safe to administer during
pregnancy

21. A nurse is collecting data from a client who is taking exenatide to treat diabetes mellitus. What finding
should the nurse withhold the exenatide dose and notify the provider immediately? Abdominal pain
Rationale: The greatest risk to this client is pancreatitis, so if the client reports abdominal pain, the
nurse should withhold the medication and notify the provider immediately.

22. A nurse is preparing to administer cephalexin to a child who weighs 44 pounds. The provider
prescribes 50 mg/kg/day in 4 equal doses. How many mg should the nurse administer in each dose? 250 mg
Rationale: 44 pounds equals 20 kg, 50 mg/20kg equals 1000 mg, divided by 4 doses equals 250 mg

23. A nurse is caring for a client who has a prescription for sumatriptan(used to treat migraines). The nurse
notes that the client takes fluoxetine (an SSRI inhibitor that treats depression). The nurse should question the
provider about the new prescription because the combination of these medications puts the client at risk for what
adverse effects? Tremors
Rationale: Concurrent use of sumatriptan and fluoxetine can lead to excessive stimulation of serotonin
receptors, placing the client at risk for serotonin syndrome. The client can experience tremors, confusion, and
hallucinations.
24. A nurse is reinforcing teaching with a client with a client who is to start therapy with regular insulin and
NPH insulin. What interventions should the nurse include in the teaching? Keep the vial of insulin at room
temperature
Rationale: the client should keep vial in use at room temperature to minimize tissue injury. Aspiration of
the syringe is not recommended. Regular insulin and NPH insulin are both compatible and the client may
administer them in the same syringe.

25. A nurse is collecting data from a client who is scheduled to receive the varicella vaccine. The nurse
should withhold the vaccination of the client tells her he is allergic to what substances? Gelatin, pregnancy,
immuniodeficiency, and leukemia
Rationale: An anaphylactic reaction to gelatin is a contraindication for receiving varicella vaccine.
Other contraindications include pregnancy, immuniodeficiency, and leukemia.

26. A nurse is reinforcing teaching with a client who is about to start using an ipratropium inhaler to treat
exercise-induced bronchospasm. what statements by the client should alert the nurse to intervene? " I have always
been allergic to peanuts"
Rationale: Clients who are allergic to peanuts or soybeans should not take anticholinergic drugs
because the medication preparation contains peanut oil and soy lecithin.

27. A nurse is preparing to hang an IV bag of cefazolin 1 g to be infused in 100 mL of NS to run over 30
minutes. If using tubing with a drop factor of 15 gtt/mL, at how many gtt/min will the nurse time this drip
rate? 50 gtt/min
Rationale: 100 mL divided by 30 minutes times 15gtt equals 50 gtt/min
28. A nurse is collecting data from a client who states he has been taking ibuprofen for joint pain. After
reviewing the clients medication administration record, what medication should the nurse discuss with the
provider? Lisinopril
Rationale: Concurrent use of ibuprofen, an NSAID, with lisinipril, an ace inhibitor, can decrease the
antihypertensive effects of lisinopril

29. A nurse is caring for a client who is taking phenylephrine (a vasocontrictor and decongestant). The
nurse should plan to monitor the client for what adverse effects? Increased Heart Rate
Rationale: Due to cardiac effects, phenylephrine can cause tacyhcardia and other heart irregularities.
Hypertension and insomnia is also a common adverse effect of taking phenylephrine

30. A nurse is reinforcing teaching with a client following placement of a cast for a fractured ankle. The
client is to take oxycodone for pain management. When reviewing the clients over-the-counter medications, what
should the murse instruct the client to avoid while taking this narcotic drug? Diphenhydramine
Rationale: Diphenhydramine(antihistamine Benadryl) and Oxycodone both cause CNS depression,
therefore when a client uses the two medications together, the client is at increased risk for sedation, respiratory
depression, and injury

31. A nurse is caring for a client who has schizophrenia and is to start therapy with risperidone. What
should the nurse monitor to determine whether treatment is effective? Improved Social Interactions
Rationale: Clients who have schizophrenia typically have difficulty interacting with others and
maintaining relationships. Manifestations can include dull affect and speech deficiency. Risperidone is an
atypical antipsychotic that helps to improve or minimize these symptoms, allowing these clients to have a more
positive interaction with others. Clients who have obsessive-compulsive disorders may take an SSRI, such as
fluoxetine to decrease obsessive-compulsive disorders. Clients who have overactive bladders may take oxybutynin
to reduce urinary urgency frequency, nocturia and urge incontinence. Clients who have parkinsons disease can
take leodopa/carbidova to decrease hand tremors.

32. A client has been taking digoxin for 1 month. The nurse should recognize that what is a manifestation of
digoxin toxicity? Vomiting
Rationale: the nurse should recognize vomiting, as an early indication of digoxin toxicity

33. A nurse is preparing to administer medication to a client. What client identifiers are acceptable for the
nurse to use prior to medication administration? Verify the clients telephone number
Rationale: Use proper verification before administering any medication to a client

34. A nurse is reinforcing teaching about nicotine polacrilex gum with a client who smokes three packs of
cigarettes per day. What should the nurse include in the teaching? : You should instruct the client to chew the gum
for a full 30 minutes before discarding.
Rationale: The full dose of nicotine from the gum occurs within 15-30 minutes

35. A nurse is collecting data from a client who received a tetanus and diphtheriatoxoids and acellular
pertussis (Tdap) booster immunization yesterday. What should alert the nurse to a potentially serious adverse effect
of this vaccine? feeling dazed and confused
Rationale: Fever is the most common side effect to this immunization, nurse may reinforce giving the
client ibuprofen. Any signs of dizziness or confusion should be reported immediately.

36. A nurse is reviewing a clients medication administration record and discovers that an additional dose of
captopril has been administered in error to the client. The nurse should monitor the client for what adverse
effect? Hypotension
Rationale: An additional dose of captopril can cause a decrease in BP, therefore the nurse should
monitor for hypotension. It can cause itching of the skin, so the nurse should monitor for pruritus.
It can cause an increase in the clients heart rate, so the nurse should monitor for tacycardia. It can
cause dizziness and fainting, so the nurse should monitor for and protect client from falls
37. A nurse is reinforcing teaching with a client who is receiving enalapril 20 mg PO daily. The nurse
should instruct the client to monitor for what adverse effect of this medication? Dry Cough

38. A client is taking ferrous sulfate orally. What finding reported by the client indicates that the
medication is achieving the desired outcome? Increased Tolerance to exercise
Rationale: The provider can prescribe ferrous sulfate to treat iron deficiency anemia. Clients who have
anemia experience fatigue and shortness of breath. Improvement in hemoglobin levels increases oxygen
transport to the tissues and increases activity intolerance.