Ramsussen Section 4 Module 11. Pharmocology For Professional Nursing
Total Questions : 79
Showing 25 questions, Sign in for moreAn adolescent client is taking a leukotriene blocker. Which of these statements by the client requires the most immediate intervention?
Explanation
a) Taking the medication to prevent asthma attacks is an appropriate use and does not require immediate intervention.
b) Using the rescue inhaler twice a month may indicate the need for further evaluation but does not pose an immediate threat.
c) Sleep disturbances are a known side effect of leukotriene blockers and may need attention, but it is not an urgent concern.
d) Expressing suicidal ideation and having a plan for self-harm is a critical situation that requires immediate intervention to ensure the client's safety and well-being.
A client with cancer has been taking an opioid analgesic four times daily for chronic pain and reports needing increased doses for pain. Which of the following is a proper response?
Explanation
a) Mentioning respiratory depression is not directly addressing the reported need for increased pain relief and might cause unnecessary concern about a side effect.
b) Accusing the client of addiction without further assessment or consideration of medical guidance is not appropriate and may damage the therapeutic relationship.
c) Developing tolerance to opioids is a common phenomenon, and discussing an increase in dosage with the healthcare provider is a reasonable response.
d) Advising the client to take the medication more often without consulting the healthcare provider can lead to unsafe practices and is not recommended.
What should the nurse advise a client on spironolactone regarding necessary self-care?
Explanation
a) Spironolactone is a potassium-sparing diuretic, and the use of salt substitutes, which often contain potassium chloride, can lead to increased potassium levels, posing a risk of hyperkalemia.
b) Continuing medication even when feeling well is generally advised, especially for chronic conditions. Discontinuing medication without medical guidance is not recommended. c) While a healthy diet is important, this option does not specifically address the unique considerations related to spironolactone use.
d) Checking the pulse is not directly related to self-care in terms of the medication's side effects or interactions.
A client, who just took his first dose of glipizide, is now experiencing tremors, pallor, and agitation. How should the nurse respond?
Explanation
a) The symptoms described are indicative of hypoglycemia, and addressing the client's emotional state or offering to listen does not address the immediate medical issue.
b) Checking the blood glucose level is crucial to determine if the symptoms are due to hypoglycemia, and providing carbohydrates can help raise the blood sugar level promptly.
c) Assuming a panic attack without assessing the potential hypoglycemic state could delay appropriate intervention.
d) The symptoms described are not consistent with an allergic reaction, so giving diphenhydramine is not the appropriate response.
A client weighs 214 lb. What is the clients weight in kg? (Record answer to the nearest tenth, or one decimal place. Do not use a trailing zero.)
Explanation
- To answer the question, we need to convert pounds (lb) to kilograms (kg) using the formula: 1 lb = 0.453592 kg
- Multiply the client's weight in lb by 0.453592 to get the weight in kg: 214 lb x 0.453592 kg/lb = 97.049648 kg
- Round the answer to the nearest tenth, or one decimal place: 97.049648 kg ≈ 97.0 kg - The final answer is: The client's weight in kg is 97.0 kg
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 action?
Explanation
a) Requesting central venous access is not the first-line response to signs of redness, pain, and irritation at the current infusion site. It's essential to address the immediate issue first.
b) Continuing the infusion while elevating the arm may exacerbate the symptoms and is not an appropriate action when there are signs of localized irritation.
c) Stopping the infusion and selecting an alternate intravenous site is the correct action to prevent further complications and assess the cause of the irritation.
d) Applying warm packs and infusing the medication at a slower rate may not be sufficient to address the observed redness and pain, and an alternate site should be considered.
A nurse is reviewing the chart of an adult male client who has been taking oral androgens. Which assessment would warrant notifying the provider?
Explanation
a) Jaundice may indicate liver dysfunction, which can be a serious side effect of androgen use. It requires prompt notification of the healthcare provider.
b) Acne, increased libido, and increased facial hair are common side effects of androgens but may not be considered as urgent or concerning as jaundice.
c) Increased libido and increased facial hair are expected effects of androgens and may not require immediate notification.
d) Increased facial hair is an expected effect of androgens and may not warrant immediate provider notification unless there are other concerning symptoms.
Parents ask the nurse why an over-the-counter cough suppressant with sedative side effects is not recommended for infants. Which response by the nurse is correct?
Explanation
a) The taste of cough medicine is not the primary concern for not recommending it to infants. The key issue lies in potential adverse effects, especially on the central nervous system. b) Infants have an immature central nervous system and are more susceptible to the sedative effects of medications. This is a critical factor in avoiding medications with sedative side effects in infants.
c) Gastric emptying time and drug absorption are generally faster in infants, making them more susceptible to rapid drug effects rather than less. However, the central nervous system effects are of greater concern.
d) Infants may metabolize drugs differently, but this does not necessarily mean the drugs are less effective. The primary concern is the potential for increased susceptibility to adverse effects.
Which of these findings, from a client taking steroids, should the nurse report immediately?
Explanation
a) An elevated temperature could indicate an infection, which is a serious concern in a client taking steroids, as steroids can suppress the immune system. This finding should be reported immediately.
b) Blood pressure within this range is generally acceptable and may not be a cause for immediate concern.
c) A glucose level of 128 mg/dl is within a reasonable range and may not require immediate reporting unless there are other concerning factors.
d) A heart rate of 102 beats per minute is generally within an acceptable range and may not be an immediate cause for concern in the absence of other symptoms.
Parents ask the nurse why an over-the-counter cough suppressant with sedative side effects is not recommended for infants. Which response by the nurse is correct?
Explanation
a) The taste of cough medicine is not the primary concern for not recommending it to infants. The key issue lies in potential adverse effects, especially on the central nervous system. b) Infants have an immature central nervous system and are more susceptible to the sedative effects of medications. This is a critical factor in avoiding medications with sedative side effects in infants.
c) Gastric emptying time and drug absorption are generally faster in infants, making them more susceptible to rapid drug effects rather than less. However, the central nervous system effects are of greater concern.
d) Infants may metabolize drugs differently, but this does not necessarily mean the drugs are less effective. The primary concern is the potential for increased susceptibility to adverse effects.
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 response?
Explanation
a) Intravenous trimethoprim/sulfamethoxazole may still induce an adverse reaction, and withholding the oral medication is the more prudent initial action.
b) Administering the dose may worsen the client's condition, and addressing the symptoms requires notifying the provider first.
c) Withholding the treatment and promptly notifying the provider about the observed symptoms is the correct immediate response to potential adverse reactions.
d) Initiating probiotics and tapering off the medication may be considerations, but the urgent action is to withhold the medication and inform the provider.
A client with a new diagnosis of atrial fibrillation is receiving a continuous infusion of heparin. Which finding will the nurse report immediately?
Explanation
a) Concurrent use of acetaminophen is not directly related to heparin therapy for atrial fibrillation. It may need attention but does not warrant immediate reporting.
b) An aPTT of 80 seconds is significantly prolonged and may indicate a risk of bleeding due to excessive anticoagulation. This finding requires immediate notification to the healthcare provider.
c) An INR of 0.8 is within the normal range and does not pose an immediate concern in the context of heparin infusion.
d) Dark, tarry stools could indicate gastrointestinal bleeding but may not be directly related to heparin therapy. It sho
A client with a new diagnosis of atrial fibrillation is receiving a continuous infusion of heparin. Which finding will the nurse report immediately?
Explanation
a) Concurrent use of acetaminophen is not directly related to heparin therapy for atrial fibrillation. It may need attention but does not warrant immediate reporting.
b) An aPTT of 80 seconds is significantly prolonged and may indicate a risk of bleeding due to excessive anticoagulation. This finding requires immediate notification to the healthcare provider.
c) An INR of 0.8 is within the normal range and does not pose an immediate concern in the context of heparin infusion.
d) Dark, tarry stools could indicate gastrointestinal bleeding but may not be directly related to heparin therapy. It should be monitored and reported, but it's not an immediate concern for heparin infusion.
The nurse is obtaining a history from a client who discloses daily use of St. John's Wort in addition to prescription drugs. Which effect of this dietary supplement would most concern the nurse?
Explanation
a) St. John's Wort is known to increase the risk of bleeding, especially when used with anticoagulant medications. This effect is particularly concerning and may require adjustments in the treatment plan.
b) While St. John's Wort can interact with various drugs, increasing the risk of bleeding is a more immediate concern.
c) St. John's Wort does not counteract the effects of CNS depressants; it may actually enhance the effects of these drugs.
d) St. John's Wort is known to induce the metabolism of some drugs, potentially reducing their effectiveness, but this is not as immediately concerning as the risk of bleeding.
The diabetic client is scheduled for a computed tomography (CT) scan with intravenous contrast. What education will the nurse provide? (Select all that apply.)
Explanation
A) Hold metformin 24 hours to 48 hours before the CT. This is correct because it reduces the chance of metformin accumulating in the blood and causing lactic acidosis when combined with the contrast dye.
B) Hold metformin 48 hours after the CT. This is also correct because it allows time for the contrast dye to be eliminated from the body before resuming metformin.
C) Double the metformin dose after the CT. This is incorrect and dangerous because it can cause hypoglycemia, low blood sugar, which can lead to confusion, seizures, coma, or death. D) Take metformin as scheduled the day of the CT. This is incorrect and risky because it can result in high levels of metformin in the blood when mixed with the contrast dye, increasing the likelihood of lactic acidosis.
E) Resume metformin at half dose after the CT. This is incorrect and unnecessary because there is no evidence that reducing the dose of metformin after a CT scan with contrast dye has any benefit or reduces any harm.
A prescriber has ordered medication for a newborn that is eliminated primarily by hepatic metabolism. What would the nurse expect the prescriber to order?
Explanation
a) Increasing the frequency of medication dosing may lead to higher overall exposure and is not necessarily related to hepatic metabolism.
b) Ordering a dose that is higher than an adult dose could result in excessive drug levels, especially in a newborn with immature hepatic function.
c) Discontinuing the drug after one or two treatments may not be necessary if the dose is appropriately adjusted based on hepatic metabolism.
d) Ordering a lower dose is appropriate because hepatic metabolism in newborns is often immature, and lower doses are required to avoid toxicity.
The provider has ordered furosemide 10 mg PO stat. Furosemide is available in 20 mg/tablet. How many tablet(s) should the nurse administer? (Record the answer to the tenth, or one decimal place. Use a leading zero if it applies. Do not use a trailing zero.)
Explanation
- The formula is: (Desired dose / Available dose) x Quantity = Number of tablets - In this case: (10 mg / 20 mg) x 1 tablet = 0.5 tablet
- Round the answer to the tenth, or one decimal place, as instructed.
- The final answer is: 0.5 tablet
Naloxone is effective because of which action?
Explanation
a) Naloxone does not increase the excretion of opioids by altering serum pH; its primary action is at the receptor level.
b) Naloxone is an opioid receptor antagonist, meaning it blocks or prevents the activation of opioid receptors. This is how it counteracts the effects of opioids like morphine.
c) Naloxone does not regulate the sensitivity of opioid receptors by neurochemical alterations. Its action is more direct as an antagonist.
d) Naloxone is not an agonist; it does not produce opioid-like effects. Instead, it competes with opioids for receptor binding and blocks their effects.
The nurse is obtaining a history from a client who discloses daily use of St. John's Wort in addition to prescription drugs. Which effect of this dietary supplement would most concern the nurse?
Explanation
a) St. John's Wort is known to increase the risk of bleeding, particularly when used in conjunction with anticoagulant medications. This effect is of concern and may require adjustments in the treatment plan.
b) While St. John's Wort can interact with various drugs, increasing the risk of bleeding is a more immediate concern.
c) St. John's Wort does not counteract the effects of CNS depressants; it may actually enhance the effects of these drugs.
d) St. John's Wort is known to induce the metabolism of some drugs, potentially reducing their effectiveness, but the immediate concern is the risk of bleeding.
A nurse is teaching a client who has asthma the appropriate use of inhaled fluticasone. What advice should the nurse give to help the client avoid complications with the use of inhaled steroids?
Explanation
a) Checking the pulse is not directly related to the use of inhaled steroids. It's important for assessing certain medications, but not for inhaled steroids.
b) Taking the medication before eating is not a specific recommendation for inhaled steroids. It's more important to follow the specific instructions provided for the particular medication.
c) Limiting caffeine intake is not a standard recommendation for the use of inhaled steroids. This action is not directly related to potential complications with these medications.
d) Rinsing the mouth after inhaling the medicine is crucial to prevent the development of oral candidiasis, a common complication associated with inhaled steroids.
The nurse is caring for four different clients. Which of these clients should the nurse assess first?
Explanation
a) Pain in a client with a history of rheumatoid arthritis is important but may not require immediate attention compared to potential complications of medication administration.
b) Preparing a client for a chlorhexidine scrub is important, but it is not an immediate priority compared to potential complications related to medication and vital signs.
c) A client who cannot have anything by mouth before surgery and received insulin glargine the night before needs monitoring, but it may not require immediate assessment compared to the potential complications of the client receiving digoxin with a blood pressure of 100/75 mmHg.
d) The client receiving digoxin with a blood pressure of 100/75 mmHg is at risk for toxicity, as low blood pressure may increase the concentration of digoxin. This client should be assessed first to prevent potential complications.
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?
Explanation
a) Taking digoxin at bedtime is not a critical instruction. The important aspect is to take it consistently at the same time each day.
b) A diet high in bran, fiber, and calcium is not specifically related to digoxin administration. Digoxin has specific dietary considerations related to potassium levels.
c) Checking the pulse is crucial for a client taking digoxin, as it helps monitor for potential toxicity. Digoxin can cause bradycardia, and the pulse rate is an essential parameter to assess before administering each dose.
d) While monitoring the heart rate is important, setting a specific threshold (e.g., not taking digoxin if the heart rate exceeds 90 beats per minute) is not a standard recommendation. It's generally more nuanced and individualized.
A nurse is talking to a client who wants to stop taking glucocorticoids after taking them for 3 months. Which statement by the client indicates a good understanding of the teaching about withdrawal?
Explanation
a) Monitoring for Cushing's symptoms is important, but it is not a statement indicating a good understanding of the withdrawal process from glucocorticoids.
b) Telling the client to never take steroids again is an overly generalized statement and does not reflect a nuanced understanding of the medication.
c) Not attempting to taper off the medication without consulting the provider is the correct approach. Abrupt discontinuation can lead to adrenal insufficiency, and the tapering schedule should be individualized.
d) Reducing the dose by half each day without proper guidance may result in withdrawal symptoms and is not a recommended strategy.
A client presents with tinea corporis, and the prescriber orders itraconazole. When educating the client about this medication, the nurse will include which statement?
Explanation
a) Itraconazole is typically administered orally for fungal infections, not applied topically. This statement is incorrect.
b) Using the medication for at least one week after symptoms have cleared is not a standard instruction for itraconazole. Treatment duration is usually prescribed by the healthcare provider.
c) Sun exposure does not minimize the effects of itraconazole. This statement is inaccurate.
d) Itraconazole is not usually applied topically, but this option is the closest to the correct information. However, the more accurate statement would be that itraconazole is effective when taken systemically for fungal infections.
A client arrives in the emergency department with localized swelling of the lips and tongue. The client's medication list includes the following medications. Which of these medications does the nurse anticipate the provider discontinuing?
Explanation
a) Amlodipine is a calcium channel blocker and is less likely to cause angioedema compared to ACE inhibitors like captopril.
b) Budesonide is a corticosteroid and is not typically associated with angioedema.
c) Simvastatin is a statin and is not known to cause angioedema.
d) Captopril is an ACE inhibitor, and angioedema is a known adverse effect. In the presence of localized swelling of the lips and tongue, discontinuation of captopril is likely indicated.
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