Deck 8: Pharmacology

Question 1

A client is admitted with palpitations.  The ECG shows supraventricular tachycardia (SVT) with a rate of 220/min.  The nurse has received an order to administer adenosine 6 mg IV.  Which action should the nurse take?

A)Adenosine is contraindicated for SVT.  Verify the order with the health care provider
B)Administer medication only through a central venous access
C)Administer medication rapidly over 1-2 seconds followed by a saline flush
D)Mix medication in 50 mL normal saline and administer over 10 minutes

Answer 1

Administer medication rapidly over 1-2 seconds followed by a saline flush

Question 2

A nurse in the emergency department is titrating a continuous infusion of nitroglycerin to a client admitted for acute coronary syndrome.  The client's vital signs, including blood pressure (BP), heart rate (HR), and pain level, are being monitored frequently.  Which assessment findings indicate that the current rate of administration should be maintained?

A)BP 80/50 mm Hg, HR 110/min; client reports pain is 0 out of 10
B)BP 100/60 mm Hg, HR 90/min; client reports pain is 3 out of 10
C)BP 110/70 mm Hg, HR 80/min; client reports pain is 0 out of 10
D)BP 120/80 mm Hg, HR 70/min; client reports pain is 5 out of 10

Answer 2

BP 110/70 mm Hg, HR 80/min; client reports pain is 0 out of 10

Question 3

A client diagnosed with stable angina is being discharged home on the cholesterol-lowering drug rosuvastatin.  The nurse should teach the client to report which side effect to the health care provider (HCP) immediately?

A)Abdominal discomfort
B)Insomnia
C)Morning headache
D)Muscle aches or weakness

Answer 3

Muscle aches or weakness

Question 4

A client is taking morphine sulfate for acute pain.  Which statement will best assist the client worried about nausea and vomiting while taking this medication?

A)"Nausea and vomiting rarely occur with this medication."
B)"Nausea and vomiting rarely occur when you are up and walking."
C)"Take the medication on an empty stomach."
D)"Tolerance develops quickly and persistent nausea is rare."

Question 5

Which client is at greatest risk for respiratory depression when receiving opioids for pain control?

A)20-year-old client with bronchitis receiving inhaled bronchodilator therapy every 4 hours
B)30-year-old client with heroin addiction with rotator cuff repair surgery this morning
C)50-year-old client with sleep apnea and left foot cellulitis and scheduled for a bone scan
D)70-year-old client with chronic obstructive pulmonary disease (COPD) with knee replacement this morning

Question 6

A client is taking morphine sulfate for acute pain.  The client stands, is immediately "lightheaded," and calls for the nurse.  What is the nurse's priority action?

A)Assess the client's orthostatic blood pressure
B)Assist the client to a sitting position
C)Hold and walk with the client
D)Keep the client on bed rest

Question 7

A client with a diagnosis of atrial fibrillation has just been placed on warfarin therapy.  The registered nurse (RN) overhears a student nurse teaching the client about potential food-drug interactions.  Which statement made by the student nurse requires an intervention by the RN?

A)"Do you take any nutritional supplements?"
B)"You will need to monitor your intake of foods containing vitamin K."
C)"You will not be able to eat green, leafy vegetables while taking this medication."
D)"Your blood will be tested at regular intervals."

Question 8

The health care provider (HCP) prescribes naproxen for a client who has degenerative joint disease.  What instructions regarding this drug does the nurse include in the client's discharge plan?  Select all that apply.

A)Avoid driving while taking this medicine
B)Change positions slowly
C)Discontinue immediately if suicidal thoughts occur
D)Notify the HCP of tarry stools
E)Take the medicine with food

Question 9

The home health nurse visits a client with hand osteoarthritis whose health care provider has recommended topical capsaicin for pain relief.  Which instruction about capsaicin should the nurse provide the client?

A)Apply a heating pad or warm compress for 20 minutes after applying cream
B)Apply cream to hands and wait at least 30 minutes before washing them
C)Discontinue immediately if burning or stinging sensation occurs
D)Use only if oral pain medications have not been effective

Question 10

The nurse administers the prescribed dose of hydromorphone 2 mg to a client who is 2 days postoperative from a colostomy.  Which assessment finding is most important for the nurse to follow-up?

A)Client has 1 emesis of green fluid
B)Client has had no bowel movement for 2 days
C)Client falls asleep while talking to the nurse
D)Client reports experiencing pruritus

Question 11

A post-surgical client is unresponsive to painful stimuli and is given naloxone.  Within 5 minutes, the client is arousable and responds to verbal commands.  One hour later, the client is again difficult to arouse, with minimal response to physical stimuli.  Which actions should the nurse take?  Select all that apply.

A)Administer oxygen
B)Assess respiratory rate
C)Initiate rapid response or code team
D)Notify the health care provider
E)Prepare a second dose of naloxone

Question 12

During a routine office visit, the nurse documents the list of current medications of a client with a history of hypertension.  Which statement by the client would cause the most concern?

A)"I periodically take docusate sodium for constipation."
B)"I regularly take ibuprofen for chronic low back pain."
C)"I take hydrochlorothiazide to prevent swelling around my ankles."
D)"I take omeprazole daily to prevent heartburn."

Question 13

A postoperative client is prescribed IV patient-controlled analgesia (PCA) with morphine.  The client tells the nurse, "I am pushing the button, but I'm still having a lot of pain."  What is the priority nursing action?

A)Administer a bolus dose
B)Notify the health care provider (HCP) to request a higher dose
C)Perform a thorough pain assessment
D)Reinforce the proper use of the IV PCA pump

Question 14

The home health hospice nurse visits a client who is newly prescribed extended-release oxycodone 40 mg orally, scheduled every 12 hours to treat severe chronic cancer pain.  Which information is most important to reinforce to the client's caregiver?

A)Administer the medication around the clock even if the client denies having pain
B)Avoid administering with immediate-release opioids to prevent respiratory depression
C)Change the dosage and frequency to 20 mg every 6 hours if breakthrough pain occurs
D)Request a tapered dose from the health care provider if pain decreases to prevent tolerance

Question 15

The nurse is administering IV hydromorphone to a client every 3-4 hours as needed for postoperative pain.  Which interventions should the nurse implement?  Select all that apply.

A)Administer IV hydromorphone over 5-10 seconds
B)Administer PRN stool softener with daily medications
C)Hold hydromorphone if client is not practicing deep breathing exercises
D)Perform reassessment an hour after administration
E)Tell the client to call for assistance before getting out of bed

Question 16

The postoperative client on hydromorphone becomes hypoxic, and naloxone is administered per protocol.  What is most important for the nurse to consider in the follow-up care of this client?

A)Client's respiratory status 60 minutes later
B)Documenting the client's hypoxic event
C)Obtaining an order for a different analgesic
D)Potential for drug-drug interaction now

Question 17

The home health nurse visits a client with atrial fibrillation who is newly prescribed digoxin 0.25 mg orally on even-numbered days.  Which of the following client statements show that teaching has been effective?  Select all that apply.

A)"I need to call the health care provider (HCP) if I have trouble reading."
B)"I need to check my blood pressure before taking my medicine."
C)"I should call the HCP if I develop nausea and vomiting."
D)"I should check my heart rate prior to taking this medication."
E)"I will call the HCP if I feel dizzy and lightheaded."

Question 18

A client recently diagnosed with heart failure is being discharged with a prescription for lisinopril.  Which client teaching related to this new medication is important to review at discharge?

A)Instruct client to report for monthly blood work to monitor drug levels
B)Review foods high in potassium that client should include in diet
C)Teach client to count own pulse for 1 minute; hold medication if pulse <60/min
D)Teach client to rise slowly and sit on side of bed for several minutes before rising

Question 19

A client with chronic heart failure developed an intractable cough and an incident of angioedema after starting enalapril.  Which prescription does the nurse anticipate for this client?

A)Alprazolam
B)Dextromethorphan
C)Lisinopril
D)Valsartan

Question 20

A client with cancer pain is prescribed oxycodone.  Which teaching is most essential to help prevent long-term complications?

A)Teach the client how to assess blood pressure daily
B)Teach the client how to prevent constipation
C)Teach the client how to prevent itching
D)Teach the client how to prevent nausea

Question 21

An elderly client with depression, diabetes mellitus, and heart failure has received a new digoxin prescription for daily use.  Which client assessment indicates that the nurse should follow up on serum digoxin levels frequently?

A)Apical heart rate is 62/min
B)Blood sugar level is 240 mg/dL (13.3 mmol/L)
C)Client is taking 20 mg fluoxetine daily
D)Serum creatinine is 2.3 mg/dL (203 µmol/L)

Question 22

A client with long-term hypertension and hypercholesterolemia comes to the clinic for an annual checkup.  The client takes nifedipine, simvastatin, and spironolactone and reports some occasional dizziness.  Which statement by the client would warrant intervention by the nurse?

A)"I've been better about walking for 20 minutes 3 days a week on my treadmill."
B)"I've been trying to eat more fruits and vegetables. I discovered that I really like grapefruit."
C)"I've heard that having a glass of red wine with dinner every night is good for my heart."
D)"We no longer add salt when preparing meals.  It has really been hard to get used to that."

Question 23

The nurse is providing discharge teaching to a client with a new prescription for warfarin.  The nurse should instruct the client to avoid excess or inconsistent intake of which foods?  Select all that apply.

A)Bananas
B)Broccoli
C)Liver
D)Oranges
E)Spinach

Question 24

The home health nurse visits a client with hypertension whose blood pressure has been well controlled on oral valsartan 320 mg daily.  The client's blood pressure is 190/88 mm Hg, significantly higher than it was 2 weeks ago.  The client reports a cold, a stuffy nose, and sneezing for 3 days.  Which question is most appropriate for the nurse to ask?

A)"Are you taking any over-the-counter medicines for your cold?"
B)"Are you taking extra vitamin C?"
C)"Did you babysit your granddaughter this past week?"
D)"Did you get a flu shot in the past week?"

Question 25

The nurse is assessing a client with hypertension and essential tremor 2 hours after receiving a first dose of propranolol.  Which assessment is most concerning to the nurse?

A)Client reports a headache
B)Current blood pressure is 160/88 mm Hg
C)Heart rate has dropped from 70/min to 60/min
D)Slight wheezes auscultated during inspiration

Question 26

What intervention is essential prior to starting a client on atorvastatin therapy?

A)Assessing for muscle strength
B)Assessing the client's dietary intake
C)Determining if the client is on digoxin therapy
D)Monitoring liver function tests

Question 27

Which prescriptions for these clients does the nurse question?  Select all that apply.

A)Client with Clostridium difficile colitis, prescribed vancomycin 125 mg PO
B)Client with diabetes and elevated mealtime glucose, prescribed lispro insulin scale 6 units subcutaneously
C)Client with gastrointestinal bleed and nasogastric tube, prescribed pantoprazole 40 mg intravenous
D)Client with hypertension and blood pressure (BP) 94/40 mm Hg, prescribed metoprolol succinate SR 50 mg PO
E)Client with otitis media and penicillin allergy, prescribed ampicillin 500 mg PO

Question 28

A client in the emergency department has an acute myocardial infarction.  The health care provider (HCP) has prescribed thrombolytic therapy.  Which assessment data should the nurse report immediately to the HCP?

A)Client has a history of cerebral arteriovenous malformation
B)Client is currently menstruating
C)Client rates chest pain as 8 on a scale of 0-10
D)Current blood pressure is 170/92 mm Hg

Question 29

A client with unstable angina and chronic kidney disease is receiving a continuous infusion of unfractionated heparin.  Which value for activated partial thromboplastin time (aPTT) would indicate to the nurse that the heparin therapy is at an optimal therapeutic level?

A)30 seconds
B)35 seconds
C)60 seconds
D)85 seconds

Question 30

A client with deep vein thrombosis (DVT) is receiving a continuous infusion of unfractionated heparin.  The client asks the nurse what the heparin is for.  How should the nurse respond?

A)"Heparin is a blood thinner that will help to dissolve the clot in your leg."
B)"Heparin will help stabilize the clot in your leg and prevent it from breaking off and traveling to your lungs."
C)"Heparin will keep the current clot from getting bigger and help prevent new clots from forming."
D)"I'm sorry.  This is something that your health care provider (HCP) can answer better upon arriving."

Question 31

The nurse is caring for a client with chronic, stable angina.  The client takes the long-acting nitrate isosorbide mononitrate.  Which client outcome indicates that the drug is effective?

A)Client is able to shower, dress, and fix hair without any chest pain
B)Client reports a reduction in stress level and anxiety
C)Client reports being able to sleep through the night
D)Client's blood pressure is 128/78 mm Hg and heart rate is 82/min

Question 32

The nurse has just completed discharge teaching about sublingual nitroglycerin (NTG) tablets to a client with stable angina.  Which statement by the client indicates the need for further teaching?

A)"I will call 911 if my chest pain isn't relieved by NTG."
B)"If I have chest pain, I can take up to 3 pills 5 minutes apart."
C)"I'll call my doctor if I start having chest pain at night."
D)"I'll keep one bottle in the house and one in the car."

Question 33

A client is started on lisinopril therapy.  Which assessment finding requires immediate action?

A)Blood pressure 129/80 mm Hg
B)Heart rate 100/min
C)Serum creatinine 2.5 mg/dL (221 µmol/L)
D)Serum potassium 3.5 mEq/L (3.5 mmol/L)

Question 34

A client with stable angina is being discharged home with a prescription for a transdermal nitroglycerin patch.  The nurse has reviewed discharge instructions on the medication with the client.  Which statement by the client indicates that teaching has been effective?

A)"I can continue to take my prescription of sildenafil."
B)"I should take the patch off when I shower."
C)"I will remove the patch if I develop a headache."
D)"I will rotate the site where I apply the patch."

Question 35

A client with atrial fibrillation is being discharged home after being stabilized with medications, including digoxin.  Which of the following statements regarding digoxin toxicity indicates that further teaching is needed?

A)"I must visit my health care provider (HCP) to check my drug levels."
B)"I should report to my HCP if I develop nausea and vomiting."
C)"I should tell my HCP if I feel my heart skip a beat."
D)"I will need to increase my potassium intake."

Question 36

A client taking a diuretic for chronic heart failure experiences constipation.  What is the nurse's best recommendation?

A)Drink 2 extra glasses of water with each meal
B)Exercise for longer periods
C)Include more fiber in the diet
D)Take warm baths to relax the abdomen

Question 37

An African American client comes to the clinic for a follow-up visit 2 months after starting enalapril for hypertension.  Which client statement should be reported to the health care provider immediately?

A)"Is there anything I can take for my dry, hacking cough?"
B)"My blood pressure this morning was 158/84 mm Hg."
C)"Sometimes I feel somewhat dizzy when I stand up."
D)"Will you look at my tongue?  It feels thicker than normal."

Question 38

The nurse is preparing medications for a group of clients.  Which prescription should the nurse clarify with the health care provider before administering?

A)Client diagnosed with cirrhosis had 2 stools today; laxative lactulose prescribed daily
B)Client is prescribed lisinopril PO daily; serum potassium level is 5.6 mEq/L (5.6 mmol/L)
C)Client is receiving vancomycin IV; mild facial flushing noted after 30 minutes
D)Client with diabetes has insulin glargine prescribed; current blood glucose is 100 mg/dL (5.6 mmol/L)

Question 39

The nurse provides instructions to a client discharged on warfarin, after being treated for a pulmonary embolism (PE) following surgery.  Which statements made by the client indicate the need for further teaching?  Select all that apply.

A)"I will need to take my blood thinner for about 3-6 months."
B)"I will place small rugs on my wood floors to cushion a fall."
C)"I will take a baby aspirin if I have mild chest pain."
D)"I will use a soft-bristled toothbrush to clean my teeth."
E)"I will wear a blood thinner MedicAlert tag."

Question 40

The nurse admits a client with newly diagnosed unstable angina.  Which information obtained during the admission health history is most important for the nurse to report to the health care provider (HCP) immediately?

A)Drinks 6 cans of beers on the weekend
B)Gets up 4 times during the night to void
C)Smokes 1 pack of cigarettes daily
D)Uses sildenafil occasionally

Question 41

The nurse is preparing to administer 160 mg of furosemide via IV piggyback to a client with chronic kidney disease and fluid overload.  The nurse plans to give the dose slowly over 40 minutes to prevent which adverse effect?

A)Bradycardia
B)Hypokalemia
C)Nephrotoxicity
D)Ototoxicity

Question 42

A client with coronary artery disease and stable angina is being discharged home on sublingual nitroglycerin (NTG).  The nurse has completed discharge teaching related to this medication.  Which statement by the client indicates that the teaching has been effective?

A)"I can keep a few pills in a plastic bag in my pocket in case I need them while I'm out."
B)"I can still take this with my vardenafil prescription."
C)"I can take up to 3 pills in a 15-minute period if I am experiencing chest pain."
D)"I should stop taking the pills if I experience a headache."

Question 43

A hospitalized client has been treated for the past 48 hours with a continuous heparin infusion for a deep vein thrombosis (DVT).  When the nurse prepares to administer the evening dose of warfarin, the client's spouse says "Wait!  My spouse can't have that!  My spouse is already getting heparin for DVT."  How should the nurse respond?

A)"Both medications will be given for several days until the warfarin has time to take effect."
B)"I will be discontinuing the heparin infusion as soon as I give this dose of warfarin."
C)"The two medications work synergistically to help break down the clot in your spouse's leg."
D)"We will hold the medication until I can call the health care provider (HCP) for clarification."

Question 44

A male client with hypertension was prescribed amlodipine.  Which of these adverse effects is most important to teach the client to watch for?

A)Erectile dysfunction
B)Dizziness
C)Dry cough
D)Leg edema

Question 45

The nurse is performing discharge teaching for the parents of a 4-year-old with heart failure.  Which statement by the parents indicates the need for further teaching related to the administration of digoxin?

A)"If our child vomits after a dose, we won't give a second one."
B)"Symptoms of nausea and vomiting should be reported to our health care provider (HCP)."
C)"We will hold the dose if our child's heart rate is above 90/min."
D)"We will not mix the medication with other foods or liquids."

Question 46

A client is in the cardiovascular clinic for a 3-month follow-up visit.  At the first visit, the client was prescribed hydrochlorothiazide and amlodipine for hypertension.  Which statement by the client would be concerning to the nurse and should be reported to the primary health care provider (PHCP)?

A)"I like to have a banana every morning with my breakfast."
B)"I occasionally experience slight dizziness when I get up in the morning."
C)"I started taking licorice root for my occasional heartburn."
D)"I usually take my hydrochlorothiazide first thing in the morning."

Question 47

A client with coronary artery disease was discharged home with a prescription for sublingual nitroglycerin (NTG) to treat angina.  Which statement by the client indicates that further teaching is required?

A)"I may experience flushing but will continue to take the medication as prescribed."
B)"I should lie down before taking the medication."
C)"I should not swallow the tablet."
D)"I will wait to call 911 if I don't experience relief after the third tablet."

Question 48

The nurse is reviewing laboratory data of a client who is receiving warfarin therapy for atrial fibrillation.  Today's INR is 5.0.  What action should the nurse take?

A)Administer the next scheduled dose of warfarin
B)Anticipate infusing fresh, frozen plasma
C)Call the pharmacy to see if protamine is available
D)Request a prescription from the health care provider (HCP) for vitamin K

Question 49

A client is being discharged after having a stent placed in the left anterior descending coronary artery.  The client is prescribed clopidogrel.  Which client data obtained by the nurse would be concerning in relation to this new medication?  Select all that apply.

A)Blood pressure of 140/84 mm Hg
B)Heart rate of 98/min
C)Platelet count of 200,000/mm³ (200 x 10⁹/L)
D)Report of Ginkgo biloba use
E)Report of peptic ulcer disease

Question 50

A newly admitted client describes symptoms of dizziness and feeling faint on standing.  The client has a history of type 2 diabetes, coronary artery disease, and bipolar disorder.  Which medications may be contributing to the client's symptoms?  Select all that apply.

A)Atorvastatin
B)Metformin
C)Metoprolol
D)Olanzapine
E)Omeprazole

Question 51

The nurse is providing discharge teaching to several clients with new prescriptions.  Which instructions by the nurse are correct in regard to medication administration?  Select all that apply.

A)Avoid salt substitutes when taking valsartan for hypertension
B)Take levofloxacin with an aluminum antacid to avoid gastric irritation
C)Take sucralfate after meals to minimize gastric irritation associated with a gastric ulcer
D)When taking ethambutol, notify the health care provider (HCP) of any changes in vision
E)When taking rifampin, notify the HCP if the urine turns red-orange

Question 52

The health care provider has prescribed spironolactone to be given in addition to hydrochlorothiazide to a client with hypertension.  Which finding by the nurse indicates that the spironolactone is having the desired effect?

A)Blood glucose of 95 mg/dL (5.3 mmol/L)
B)Potassium level of 4.2 mEq/L (4.2 mmol/L)
C)Reduction in dizziness
D)Sodium level of 138 mEq/L (138 mmol/L)

Question 53

A client with hypertension and type 2 diabetes has recently started taking chlorthalidone.  Which report by the client is most concerning to the nurse?

A)Dizziness on standing
B)Fasting blood glucose of 160 mg/dL (8.9 mmol/L)
C)Presence of muscle cramps
D)Sunburn on both arms

Question 54

The health care provider prescribes simvastatin for a client with hyperlipidemia.  The nurse instructs the client to take this medication in which manner?

A)At noon with a meal
B)In the morning on an empty stomach
C)In the morning with breakfast
D)With the evening meal

Question 55

A client with hypertension is prescribed lisinopril.  The nurse instructs the client to notify the health care provider immediately if which adverse effect occurs when taking this medication?

A)Cough
B)Dizziness
C)Rapid-onset confusion
D)Swelling of the lips and tongue

Question 56

A client is receiving a continuous heparin infusion and the most recent aPTT is 140 seconds.  The nurse notices blood oozing at the surgical incision and IV insertion sites.  What interventions should the nurse implement?  Select all that apply.

A)Continue heparin infusion and recheck aPTT in 6 hours
B)Prepare to administer vitamin K
C)Redraw blood for laboratory tests
D)Review guidelines for administration of protamine
E)Stop infusion of heparin and notify the health care provider (HCP)

Question 57

The nurse evaluating a 52-year-old diabetic male client's therapeutic response to rosuvastatin would notice changes in which laboratory values?  Select all that apply.

A)Alanine aminotransferase from 20 U/L (0.33 µkat/L) to 80 U/L (1.34 µkat/L)
B)High-density lipoprotein cholesterol from 48 mg/dL (1.24 mmol/L) to 30 mg/dL (0.78 mmol/L)
C)Low-density lipoprotein cholesterol from 176 mg/dL (4.61 mol/L) to 98 mg/dL (2.54 mmol/L)
D)Total cholesterol from 250 mg/dL (6.47 mmol/L) to 180 mg/dL (4.66 mmol/L)
E)Triglycerides from 180 mg/dL (2.03 mmol/L) to 149 mg/dL (1.68 mmol/L)

Question 58

The nurse is monitoring a client who has been on clopidogrel therapy.  Which assessments are essential?  Select all that apply.

A)Assess for bruising
B)Assess for tarry stools
C)Monitor intake and output
D)Monitor liver function tests
E)Monitor platelets

Question 59

The nurse is caring for a client on IV heparin infusion and oral warfarin.  Current laboratory values indicate that the client's aPTT is 5 times the control value and the PT/INR is 2 times the control value.  What action does the nurse anticipate?

A)Clarify vegetable consumption with client
B)Decrease the heparin rate
C)Decrease the warfarin dose
D)Obtain an order for vitamin K injection

Question 60

The nurse teaches the client taking atorvastatin to call the health care provider (HCP) if experiencing which symptom associated with a serious adverse effect of atorvastatin?

A)Diarrhea
B)Headache
C)Muscle aches
D)Numbness in the feet

Question 61

A 45-year-old client with atrial fibrillation has been prescribed diltiazem.  Which client outcome would best indicate that the medication has had its intended effect?

A)Atrial fibrillation is converted to sinus rhythm
B)Blood pressure is 126/78 mm Hg
C)No signs or symptoms of stroke
D)Ventricular rate decreased from 158/min to 88/min

Question 62

The nurse teaches a client about the use of regular and neutral protamine Hagedorn (NPH) insulin.  Which statement by the client indicates that further teaching is needed?

A)"I will always check my blood glucose prior to using the sliding scale."
B)"I will eat breakfast 30 minutes after taking my morning NPH and regular insulin."
C)"I will use a new insulin syringe each time I give myself an injection."
D)"I will use the sliding scale to determine my NPH dose 4 times a day."

Question 63

The nurse is assessing a client 15 minutes after initiating nitroglycerin infusion for suspected acute coronary syndrome.  Which clinical finding is the priority?

A)The client reports a headache
B)The client reports feeling dizzy and lightheaded
C)The client reports feeling flushed
D)The client reports feeling nervous

Question 64

A client is being discharged with a prescription for apixaban after being treated for a pulmonary embolus.  Which clinical data is most concerning to the nurse?

A)Client eats a vegetarian diet
B)Client has chronic atrial fibrillation
C)Client takes indomethacin for osteoarthritis
D)Client's platelet count is 176 x10³/mm³ (176 x10⁹/L)

Question 65

A client with primary hypothyroidism has been taking levothyroxine for a year.  Laboratory results today show high levels of TSH.  Which statement by the nurse to the client is appropriate?

A)"A new prescription will likely be issued for a decreased dose of levothyroxine."
B)"Dosages of levothyroxine may need to be increased to improve TSH levels."
C)"Levothyroxine should be held, and the TSH levels will be reassessed in 3 months."
D)"Start taking your levothyroxine with dietary fiber or calcium to increase its effectiveness."

Question 66

A hospitalized client with thyrotoxicosis receives atenolol 50 mg PO daily.  Which statement by the nurse accurately reinforces the client's understanding of this medication's purpose?

A)"Atenolol is an iodine-based medication that blocks the release of thyroid hormones."
B)"It is used to treat some of the symptoms of hyperthyroidism, such as increased heart rate."
C)"This drug is radioactive and damages or destroys the thyroid tissue."
D)"This first-line antithyroid drug inhibits the synthesis of thyroid hormones."

Question 67

A client with uncontrolled hypertension is prescribed clonidine.  What instruction is most important for the clinic nurse to give this client?

A)Avoid consuming high-sodium foods
B)Change positions slowly to prevent dizziness
C)Don't stop taking this medication abruptly
D)Use an oral moisturizer to relieve dry mouth

Question 68

The nurse assesses pitting edema of the extremities, dyspnea, bilateral crackles posteriorly, and a serum sodium level of 130 mEq/L (130 mmol/L) in a client with chronic heart failure.  The nurse should question which prescription?

A)Furosemide 20 mg IV push twice daily
B)Maintenance IV line of 0.9% normal saline at 85 mL/h
C)Potassium chloride 20 mEq orally twice daily
D)Sodium-restricted diet

Question 69

The nurse administers a dose of radioactive iodine to a female client for treatment of hyperthyroidism.  Which of the following precautions should the nurse teach the client to follow on discharge?  Select all that apply.

A)"Avoid close contact with pregnant women, infants, and children."
B)"If applicable, you may resume breastfeeding when you return home."
C)"If possible, use a separate toilet from your family, and flush 2 or 3 times after each use."
D)"Use disposable cups, plates, and utensils, and do not share food items with others."
E)"Wash your clothing and towels separately from the rest of the laundry in your home."

Question 70

A nurse teaches a client who is being discharged on warfarin for atrial fibrillation.  Which client statements indicate that teaching has been effective?  Select all that apply.

A)"Antibiotics can affect my INR value."
B)"I am going to eat more leafy greens."
C)"I will shoot for my INR value to be between 4 and 5."
D)"I will take warfarin at the same time daily."
E)"If I miss a dose, I can double it on the following day."

Question 71

The clinic nurse is reviewing telephone messages from four clients.  Which client's call should the nurse return first?

A)Client who has just taken albuterol and reports a heart rate of 108/min and a coarse tremor in both arms
B)Client who is prescribed azithromycin and reports frequent, foul-smelling, liquid stools and abdominal cramping
C)Client who is prescribed metformin and reports a blood glucose of 284 mg/dL (15.76 mmol/L) and frequent urination
D)Client who takes amiodarone and reports a dry cough and increased dyspnea when walking around the house

Question 72

The nurse administers 15 units of aspart insulin subcutaneously to a hospitalized client with type 1 diabetes mellitus at 7:00 AM for a fasting blood glucose of 180 mg/dL (10 mmol/L).  Which nursing action is a priority?

A)Ensure that the client continues to fast for at least 30 more minutes
B)Give the client breakfast within 15 minutes
C)Recheck the blood glucose in 1 hour
D)Teach the client about the signs and symptoms of hyperglycemia

Question 73

A home health nurse is preparing to start a milrinone infusion via a peripherally inserted central catheter for a client with end-stage heart failure.  What equipment is most important to be present in the home?  Select all that apply.

A)Bathroom scale for daily weights
B)Blood pressure cuff
C)Central line dressing change kits
D)Infusion pump
E)Intermittent urinary catheterization kits

Question 74

The nurse reinforces teaching a client on prescribed dabigatran for chronic atrial fibrillation.  Which statement by the client indicates a need for further teaching?

A)"I will call my health care provider if I notice red urine or blood in my stool."
B)"I will not stop taking dabigatran even if I get a stomachache."
C)"I will place capsules in my pill box so I will not forget to take a dose."
D)"I will swallow the capsule whole with a full glass of water."

Question 75

The nurse administers 8 units of regular insulin subcutaneously at 11:30 AM to a client with type 1 diabetes mellitus and serves the client lunch 30 minutes later.  The client eats a few bites, becomes nauseated, and is unable to finish the meal.  When is the client at highest risk for experiencing an insulin-related hypoglycemic reaction?

A)12:30 PM
B)2:00 PM
C)5:00 PM
D)6:00 PM

Question 76

The nurse is caring for a child with Kawasaki disease who is receiving IV immunoglobulin.  The child's parent wants to know why this treatment is required.  The nurse explains that this therapy is given to:

A)Fight the infection
B)Minimize rash
C)Prevent heart disease
D)Reduce spleen size

Question 77

The nurse should call the primary health care provider to obtain a new prescription prior to administering which medication to a client with type 1 diabetes mellitus?

A)10 units regular insulin IV push for blood glucose >250 mg/dL (13.9 mmol/L)
B)14 units glargine insulin subcutaneous injection every night at 8:00 PM
C)18 units aspart insulin subcutaneous injection 15 minutes before breakfast
D)20 units NPH insulin IV push administered every morning at 7:00 AM

Question 78

A client is 6 hours postoperative from hip surgery after receiving regional anesthesia and has epidural continuous anesthesia in place.  Which is the most important reason for the nurse to contact the health care provider?

A)Client reports paresthesia bilaterally since the surgery
B)Fondaparinux is prescribed for STAT administration
C)Lower-extremity muscle strength is 3/5 bilaterally
D)Postoperative laboratory results show hemoglobin of 9.9 g/dL (99 g/L)

Question 79

The nurse prepares to administer morning medications to assigned clients.  Which prescription should the nurse clarify with the health care provider?

A)Clopidogrel for client with history of stroke and platelet count of 154,000/mm³ (154 × 10⁹/L)
B)Losartan for client with hypertension who is 8 weeks pregnant
C)Prednisone for client with herpes simplex lesions and Bell palsy
D)Tiotropium for client with pneumonia and chronic obstructive pulmonary disease

Question 80

A client with a history of heart failure calls the clinic and reports a 3-lb (1.4-kg) weight gain over the past 2 days and increased ankle swelling.  The nurse reviews the client's medications and anticipates the immediate need for dosage adjustment of which medication?

A)Bumetanide
B)Candesartan
C)Carvedilol
D)Isosorbide