08 Oct A client is to receive 50 mg of atenolol at 0800. Prior to administering the medication, the nurse reviews the medical records for past medical history and obtains the client’s apical pulse and blood pressure.

A client is to receive 50 mg of atenolol at 0800. Prior to administering the medication, the nurse reviews the medical records for past medical history and obtains the client’s apical pulse and blood pressure. What phase of the nursing process does this represent?

 

  Implementation

 

  Evaluation

 

  Assessment

 

  Diagnosis

 

  Planning

 

Question 2 Match each assessment finding with the correct type of data.

 

Pain rating at a 7 on a 0-10 scale

 

Complaints of nausea

 

Loose stool found in the collection device

 

Apical pulse rate of 120

 

Coffee ground emesis in the emesis basin

 

Complaints of shortness of breath

 

Question 3Place the phases of the nursing process in the correct order. 

 

[ Select ]

 

 [ Select ]

 

 [ Select ]

 

 , Implementation , 

 

[ Select ]

 

Question 4The nurse is assigned to a client who is newly diagnosed with type 1 diabetes mellitus. Which statement best illustrates an outcome criterion for this client?

 

  The client will not experience complications.

 

  The client will adhere to the new insulin treatment regimen.

 

  The client will demonstrate correct technique for insulin injections before discharge home.

 

  The client will follow dietary and medication instructions to manage disease process.

 

 

 

 

 

NURS3365 Pharmacology in Nursing Practice

 

Module 2 Practice Questions

 

Question 1 In order, list the 4 phases of pharmacokinetics. Phase 1 ____________, Phase 2 ____________

 

, Phase 3 _____________and Phase 4 _________________

 

Question 2Match the common terms with their definitions.

 

Bioavailability

 

“Free drug”

 

Prodrug

 

Nicotine

 

Grapefruit juice

 

Kidneys

 

Half-life

 

Paradoxical reaction

 

Peak effect

 

Drug polymorphism

 

Trough

 

Steady state

 

Onset

 

Liver

 

 Question 3A client has low albumin and will be prescribed a medication that is 99% protein bound. The medication is used to treat pain and can cause bleeding if the drug levels are elevated. What should the nurse assess for in this client?

 

  Increased formation of blood clots

 

  Increased signs of bleeding

 

  Decreased pain control

 

  Increased pain control

 

Question 4Drugs like heroin and LSD are considered Category II on the controlled substance Schedule

 

  True

 

  False

 

Question 5The normal range for albumin is ___________ to _________ grams/dL. (Enter a number only in the blank)

 

Question 6Grapefruit is a CYP 450 system inhibitor and will cause slower drug metabolism, which will result in increased drug levels. Nicotine is a CYP 450 system ______________ and will cause ___________ drug metabolism, which will result in ________ drug levels.

 

Question 7If the gastric pH level is high, this means the stomach is more acidic than normal.

 

  True

 

  False

 

Question 8At 2000 the nurse starts a 1000ml bag of D5 ½ (0.45%) saline at 125ml/hr. How many hours will it take for the bag of fluid to complete? (Answer to nearest whole number)

 

 Question 9A client is to receive 1 liter of 0.9% (normal) saline over 1 hour. The drop factor on the IV tubing label is 10gtt/ml. Calculate the drip rate per minute rounded to the nearest whole number.

 

Question 10A client is ordered 200mg methylprednisolone, IV, every 24 hours to be administered over 30 minutes. The label reads methylprednisolone 125mg/2ml.

 

Calculate the number of mL to be administered per dose. Answer to nearest tenths place, enter a numeric value only.

 

Calculate the IV flow rate in mL per hour. Answer to nearest tenths place, enter a numeric value only.

 

Question 11A client is diagnosed with a DVT and is ordered 1mg/kg enoxaparin, subcutaneous, every 12 hours. Your client weights 202 pounds. The enoxaparin label reads 100mg/1ml.

 

Calculate the number mg(s) to be administered per dose. Round to the nearest whole number. Enter a numeric value only.

 

Calculate the number of mL(s) to be administered per dose. Round to the nearest hundredths decimal place. Enter a numeric value only

 

Question 12The nurse practitioner orders 40mg/kg/day amoxicillin divided BID, oral, for an ear infection. Your client weighs 56 pounds. In the medication room you find amoxicillin 400mg/5ml.

 

Calculate the number of mg to be administered per dose. Round to the nearest whole number; enter a number only

 

Calculate the number of ml(s) to be administered per dose. Round to the nearest tenths decimal place; enter a number only

 

Question 13Your client is ordered 12.5 mg of hydroxyzine. In the medication room you find 25mg tablets of hydroxyzine. Calculate the number of tablet(s) to be administered to your client? Enter a number only.

 

Question 14Your client is ordered 200 mg of acetaminophen. In the medication room you find liquid acetaminophen the label notes 160 mg acetaminophen in 5 ml. Calculate the number of ml(s) to administer to your client. Round to the nearest tenth decimal place. Enter a number only.

 

Question 15Your client is ordered 8mg of ondansetron, oral, every 8 hours. In the medication room you find 4 mg tablets of ondansetron. Calculate the number of tablet(s) to be administered to your client?

 

Question 16Your client weighs 75kg and is diagnosed with a pulmonary embolus. The physician orders 1mg/kg of enoxaparin sodium, subcutaneously, every 12 hours. How many mg(s) will you administer every 12 hours to your client?

 

Question 17Your client is ordered 2000 mg of ceftriaxone, IV, every 24 hours. In the medication room the label reads 2g ceftriaxone in 50ml. How many ml(s) should you administer your client?

 

Question 18Your client weighs 44 pounds and is ordered 1.25mg/kg of diphenhydramine, IV, every 6 hours. How many mg(s) of diphenhydramine should be administered to your client?

 

Question 19Your client is ordered 1000mg of vancomycin, IV, every 12 hours, over 2 hours. The vancomycin label reads 500mg in 250ml.

 

How many total ml will you administer to your client? Answer to the nearest whole number; enter a number only.

 

How many ml per hour will you sent the pump?  Answer to the nearest whole number; enter a number only

 

Question 20Your client is ordered ranitidine 50mg in 100ml, IV, every 24 hours, to be infused over 20 minutes. You have a micro drip tubing with a drop factor of 60gtt/ml. Calculate the gtt per minute to set as the IV flow rate rounded to the nearest whole number.

 

 

 

NURS3365 Pharmacology in Nursing Practice

 

Module 4 Practice Questions

 

Question 1Match the following items.

 

Naloxone

 

Opioid tolerance

 

 Hydromorphone

 

 Fentanyl

 

Meperidine

 

Gastric ulceration

 

Tinnitus

 

Central Nervous System Effects

 

Reye Syndrome

 

Allopurinol

 

Colchicine

 

Opioid naive

 

Question 2A patient is to  scheduled receive albuterol, ipratropium and fluticasone inhaled this morning. Please fill in the blanks with the order in which the medications should be administered and the time between each medication. First the   should be administered, wait   minutes, administer the   next, wait   minutes, and administer   last. (For the time, enter a number only, for the medications, remember that generic names are used in this course and that they are lower case).

 

Question 3Match the key terms with their definitions.

 

Antihistamines

 

 Antitussive

 

 Decongestants

 

 Expectorants

 

Rescue inhalers

 

Maintenance drugs

 

Question 4What is the biggest difference between traditional antihistamines and the newer antihistamines? Fill in the blank with your answer.

 

Question 5What diseases serve as contraindications or “Use caution with” for decongestants? SELECT ALL THAT APPLY

 

Narrow Angle Glaucoma

 

Cardiovascular disease

 

Hypertension

 

Hyperthroidism

 

Diabetes

 

Seasonal allergies

 

Question 6For adult clients, the recommended amount of acetaminophen in a 24 hours period is 3000 mg and the recommended amount of acetaminophen in a 24 hour period for a client with liver disease is 2000 mg .

 

Question 7A client is prescribed morphine. What currently prescribed medication would be most concerning to the nurse?

 

Lorazepam

 

Naloxone

 

Acetaminophen

 

Diphenhydramine

 

 

 

NURS3365 Pharmacology in Nursing Practice

 

Module 7 Practice Questions

 

Question 1Match the signs and symptoms with the disease process.

 

Intolerance to cold

 

Constipation

 

Bradycardia

 

Brittle nails and hair

 

Exopthalmus

 

Intolerance to heat

 

Diarrhea

 

Tachycardia

 

Hypoglycemia

 

Postural hypotension

 

Hyperkalemia

 

Bronze pigmentation

 

Hyperglycemia

 

Moon face

 

Sodium and fluid retention

 

Osteoporosis

 

Question 2Match hypoglycemia and hyperglycemia with their associated signs and symptoms. 

 

Shaking

 

Sweating

 

  Tachycardia

 

Irritable

 

Extreme thirst

 

Excessive urination

 

Dry skin

 

Nausea

 

Question 3Match the insulin with the corresponding onset, peak and duration times.

 

Onset of 10-15 minutes

 

Peak of 1-2 hours

 

Duration of 3-4 hours

 

Onset of 30-60 minutes

 

Peak of 2-4 hours

 

Duration of 5-7 hours

 

Onset of 2-4 hours

 

Peak of 4-10 hours

 

Duration of 10-16 hours

 

Onset of 3-4 hour

 

No peak action

 

Duration of 24 hours

 

Question 4The nurse teaches the diabetic patient that the goal for hemaglobin A1C is  less than _________and the fasting blood glucose is between ___________ and_______ .

 

Question 5 Match the key terms with their definitions.

 

Hyperthyroidism

 

Hypothyroidism

 

Thyroxine (T4)

 

Triiodothyronine (T3)

 

Diabetic ketoacidosis (DKA)

 

Lipodystrophy

 

Glucagon

 

Insulin

 

Hemoglobin A1C

 

Polydypsia

 

Polyphagia

 

Polyuria

 

Addison’s Disease

 

Cushing’s Syndrome

 

  Question 6Your client is ordered for insulin lispro, subcutaneously, 2 units, before meals. Prior to dinner your client’s blood glucose level is 81mg/dL. Using the adjustment scale below to calculate the number of units to be administered.

 

Blood glucose (mg/dL)   Units (insulin aspart)

 

< 70        Notify MD

 

70-99     – 1 unit

 

100-150                0 units

 

151-200                +2 units

 

201-250                +4 units

 

251-300                +6 units

 

301-350                +8 units

 

> 350     +10 units

 

 Question 7The nurse practitioner orders insulin aspart according to a sliding scale before each meal. Before lunch your client’s blood glucose is 212 mg/dL. Utilizing the sliding scale below to calculate the number of units to be administered to your client at this time.

 

Blood Glucose (mg/dL)  Units (insulin aspart)

 

70-130   0 units

 

131-180                2 units

 

181-240                4 units

 

241-300                6 units

 

301-350                8 units

 

351-400                10 units

 

>400      12 units

 

 

 

 

 

NURS3365 Pharmacology in Nursing Practice

 

Module 2 Quiz

 

Question 1A client receives 10 mg of morphine orally at home for pain management. The client is in the emergency department and is to receive 4 mg of morphine IV for severe pain. The client asks the nurse why they are only getting 4 mg of IV morphine when at home they take 10 mg of morphine. What is the best response by the nurse?

 

  “I will administer this dose now and if it does not work, I will double the dose next time in order to control your pain.”

 

  “I will clarify this order with the healthcare provider because 4 mg is not enough since you take such a large amount at home”

 

  “Because morphine is highly addictive and we are worried about the opioid crisis, the healthcare provider has ordered a smaller dose for you.”

 

  “Intravenous medications go directly into the bloodstream while oral medications must first go through the liver and some of the medication is made inactive.”

 

Question 2 A client with seasonal allergies takes diphenhydramine at bedtime to help their symptoms. The client becomes hyperactive and is unable to sleep. What type of reaction is the client experiencing?

 

  Adverse drug reaction

 

  Paradoxical reaction

 

  Hypersensitivity reaction

 

  Idiosyncratic reaction

 

Question 3 The nurse is providing discharge education to an older adult client who will be on 5 prescription drugs. What physiologic changes in the older adult population put this client at risk for drug interactions? Select All That Apply

 

  Glomerular Filtration Rate is decreased

 

  Number of working nephrons is decreased

 

  Blood flow to the gastrointestinal tract is reduced

 

  Fat content is increased

 

  Medication cost is increased

 

  Protein production by the liver is decreased

 

  Gastric pH is decreased

 

Question 4 A client is scheduled to receive two highly protein-bound drugs this morning. Assessment data is provided in the table below. Based on this information, what issue is likely to occur?

 

Vital Signs

 

Temperature     97.8

 

Respirations       14

 

Heart Rate          68

 

Blood Pressure 100/50

 

Pain       5

 

Blood chemistry Panel

 

Sodium 140 

 

Potassium           4

 

Chloride               99

 

BUN       19

 

Creatinine           0.7

 

Albumin               3

 

Total Protein      5.7

 

Glucose                145

 

   Increased risk of drug toxicity

 

  Increased half-life

 

  Decreased drug effect

 

  Decreased bioavailability

 

Question 5A client will start on an anticonvulsant drug that has a half-life of up to 42 hours, When will the client achieve steady state? Between _______ and_______ days. (Enter a number only, answer to the nearest whole day).

 

Question 6The nurse is providing discharge instructions to a female client who delivered a healthy, full-term infant. What information should the nurse provide about taking medications while breast feeding?

 

  It is unlikely that a large enough amount of medication will cross into the breast milk and cause harm to the infant.

 

  Many medications cross into the breast milk in small amounts and could cause harm to the infant

 

  The mother should not take any medication while breast feeding in order to prevent harm to the infant

 

  The mother should pump and discard breast milk 30 minutes after any oral medication is taken.

 

Question 7When discussing dosage calculation for pediatric clients with a clinical pharmacist, the nurse notes that which type of dosage calculation is used most commonly in pediatric calculations?

 

  Height-to-weight ratio

 

  West nomogram

 

  Milligram per kilogram of body weight formula

 

  Clark rule

 

Question 8A client is to receive 0.25 mg digoxin. On hand, the nurse has tablets labeled 125 mcg of digoxin. How many tablets will the nurse administer? (Enter a numeric value only, answer to the nearest whole number).

 

Question 9The nurse is to administer an IV medication of 200 mg in 100 mL of NS. It is to be infused at 300 mcg per minutes. At what rate (mL/hour) will the nurse set the IV pump? (Enter a numeric value only, round to the nearest whole number and enter only a numeric value).

 

Question 10The doctor prescribes phenytoin to be given 5 mg/kg/day in 2 divided doses. The client weighs 33 pounds. On hand is a vial labeled 26 mg/mL. How many mL will the nurse administer per dose? (Enter a numeric value only; round to the nearest tenths place)

 

Question 11A generic name is the proprietary name and is generally written with a capital first letter.

 

  True

 

  False

 

Question 12If the healthcare provider orders 25 mcg of levothyroxine and the nurse has several 12.5 mcg tablets available in the client’s medication drawer, the nurse will administer 2 tablets.

 

  True

 

  False

 

Question 13It is a busy night in the Emergency Department and all the infusion pumps are in already in use. The nurse has an order to infuse normal saline at 100 mL/hour and a tubing set that says there are 15 drops/mL. Calculate the drops per minute needed to achieve 100 mL/hour. (Enter a numeric value only, round to the nearest whole number)

 

Question 14The healthcare provider orders 1 liter of normal saline to be infused in 8 hours. At what rate (mL/hour) should the nurse set the infusion pump? (Enter a numeric value only)

 

Question 15It is a busy night in the Emergency Department and all the infusion pumps are in already in use. The nurse has an order to infuse normal saline at 25 drops per minutes and a tubing set that says there are 15 drops/mL. How long will it take for 1 liter to infuse?  (Enter a numeric value only, answer in hours, not minutes)

 

 

 

NURS3365 Pharmacology in Nursing Practice

 

Module 5 Quiz

 

Question 1What are the side effects associated with amlodipine? SELECT ALL THAT APPLY

 

  Diarrhea

 

  Bradycardia

 

  Reflex tachycardia

 

  Flushing

 

  Hypotension

 

  Ankle edema

 

Question 2What information should the nurse include when providing education to a client newly prescribed furosemide? SELECT ALL THAT APPLY

 

  “When standing up ,rise slowly ,in stages.”

 

  “Increase dietary intake of potassium rich foods.”

 

  “Increase salt intake to prevent low sodium levels.”

 

  “Take the furosemide in the evening hours.”

 

  “Weigh yourself every day,in the same clothes and on the same scale.”

 

Question 3When providing education about  antihypertensive medications. What information should the nurse provide to the patient that is true for ALL antihypertensive medications? SELECT ALL THAT APPLY

 

  “Rise slowly from sitting to standing.”

 

  “Avoid grapefruit juice.”

 

  “Increase potassium rich foods in diet.”

 

  “Avoid the use of salt substitutes.”

 

  “Check your blood pressure prior to taking  your medication each morning.”

 

  “Do not stop the medication abruptly.”

 

Question 4A young female client of child-bearing age with hypertension is started on losartan. What information about family planning should the nurse include in the teaching plan?

 

  “Losartan is ineffective in controlling blood pressure in pregnancy and should be stopped prior to pregnancy for this reason.”

 

  “Losartan is a common medication used for hypertension in pregnant women, but fetal growth should be monitored.”

 

  “Losartan can cause birth defects in the developing fetus and should be stopped prior to becoming pregnant if possible.”

 

  “Losartan interacts with oral birth-control pills, making them less effect. Be sure to use a secondary birth control option.”

 

Question 5A client with hypertension and benign prostatic hyperplasia is prescribed tamsulosin. What data demonstrates the medication has achieved the therapeutic response?

 

  Client has less calf tenderness

 

  Client heart rate is 80 beats per minute.

 

  Client’s blood pressure is 110/76 mm/Hg

 

  Client is able to fully empty bladder.

 

Question 6The nurse is about to administer a prescribed dose of metoprolol to a client with a cardiac dysrhythmia.  What assessment data would be of most concern to the nurse?

 

  Blood pressure 104/68 mm/Hg.

 

  Past medication history of diabetes

 

  Past medical history of asthma

 

  Heart rate at 50 beats per minutes.

 

Question 7The nurse administered epinephrine to a client with a severe case of angioedema related to administration of ACE inhibitors. What side effects should the nurse monitor for in this client? SELECT ALL THAT APPLY

 

  Tremors

 

  Palpitations

 

  Bradycardia

 

  Agitation

 

  Impaired renal tissue perfusion

 

  Urinary retention

 

  Hypotension

 

Question 8The nurse is administering 80 mg of furosemide by intravenous push per the health care providers orders. The nurse will administer the furosemide over [blank1] minutes based on the recommended rate of administration. (Enter a number only in the blank)

 

Question 9A client received epinephrine for an anaphylactic reaction in the emergency department 6 hours ago. Since that time, the client has been unable to void. What priority assessment should the nurse perform to determine the cause of this urinary issue?

 

  Assess blood pressure to determine vasoconstriction

 

  Palpate peripheral pulse to determine adequate perfusion.

 

  Assess oral fluid intake for the last 24 hours

 

  Palpate the area above the symphysis pubis bone

 

Question 10Prior to assuming care on a client, you review the client’s medical records found below.

 

Admitting diagnosis: Hypertensive crisis, tachycardia

 

Past medical history: Hypertension, atrial fibrillation

 

Past surgical history: None

 

Admitting Medication orders:

 

Lisinopril 20 mg PO daily

 

Aspirin 81 mg PO daily

 

Spironolactone 50 mg PO every morning

 

Metoprolol 25 mg PO BID

 

Lab data and Vital Signs:

 

Vital signs

 

Temperature     98.5

 

Blood pressure 210/120

 

Pulse     130

 

Respiratory Rate              18

 

Chemistry Panel

 

Sodium 141 mEq/ L

 

Potassium           5.5 mEq/ L

 

Chloride               104 mEq/ L

 

Bicarbonate        20 mEq

 

BUN       55 mg/ dL

 

Creatinine           2.5 mg/dL

 

Calcium                8.7 mEq/L

 

Glucose                105 mg/dL

 

Based on the data listed above, what medication orders should the nurse question? SELECT ALL THAT APPLY

 

  Lisinopril

 

  Aspirin

 

  Metoprolol

 

  Spironolactone

 

Question 11A client with heart failure is receiving furosemide and digoxin at 0900. What assessment findings would indicate a need to withhold the morning dose of digoxin and furosemide? SELECT ALL THAT APPLY

 

  No bowel movement in 2 days

 

  Potassium level 2.8mEq/L

 

  100% of breakfast eaten

 

  Apical pulse 58 beats per minute

 

  Digoxin level 2.5 ng/mL

 

Question 12The nurse is providing education to a client being discharge on digoxin. What information should the nurse provide about symptoms to report to the healthcare provider? SELECT ALL THAT APPLY

 

  Blood pressure of 100/60 mm/Hg

 

  Heart rate greater than 120 beats per minute

 

  Visual disturbances of yellow, green, or purple halos

 

  Weight gain of 5 pounds in 2 days

 

  Shortness of breath and worsening ankle edema

 

Question 13A client diagnosed with heart failure is being taught about drug interactions that can occur with digoxin. Match the medication or herbal supplement with the resulting interaction. 

 

Potassium wasting diuretics

 

Saint John’s Wort

 

Beta blockers

 

Amiodarone

 

 

 

NURS3365 Pharmacology in Nursing Practice

 

Module 6 Quiz

 

Question 1A client is receiving heparin by intravenous infusion for treatment of a deep vein thrombosis. What lab data would require the nurse to hold the infusion of heparin and notify the prescriber?

 

  Platelets 180,000/mcL

 

  aPTT 120 seconds

 

  INR 3.1

 

  PT 39.5 seconds

 

 

 

Question 2Match each medication with the appropriate antidote.

 

Heparin

 

Warfarin

 

Dabigatran

 

Alteplase

 

Question 3A client is being discharged home with a new prescription for warfarin. What information should the nurse provide in the discharge teaching concerning this medication? SELECT ALL THAT APPLY

 

  “Increase your intake of vitamin K in order to off-set the chance of bleeding with warfarin.”

 

  “Use a soft bristle toothbrush to help prevent bleeding from your gums.”

 

  “Report any excessive bruising or bleeding to your health care provider.”

 

  “Use an electric shaver to help prevent bleeding from cuts from shaving.”

 

  “Keep your blood work appointments every 2-4 weeks once the therapeutic level of warfarin is reached”

 

Question 4Prior to administering heparin 5,000 units subcutaneously, the nurse reviews the chart. Find the laboratory results in the table below. Based on this data, what actions should the nurse take? SELECT ALL THAT APPLY

 

Laboratory Tests              Monday               Tuesday

 

White Blood Cell Count 5.2          5.6

 

Red Blood Cell Count      4.5          3.9

 

Hemoglobin       16           12

 

Hematocrit         40%        30%

 

Platelet Count   400,000 180,000

 

aPTT      35           38

 

  Notify the pharmacy of the need to switch the client from heparin to argatroban

 

  Withhold the scheduled dose of heparin

 

  Administer protamine sulfate

 

  Assess the client for signs and symptoms of bleeding

 

  Notify the health care provider of lab results

 

Question 5A client is newly prescribed clopidogrel to prevent clots from forming on an implanted cardiac stent. What information should the nurse provide the patient concerning this medication? SELECT ALL THAT APPLY

 

  “Notify any surgeon or dentist that you are on clopidogrel prior to any procedure.”

 

  “Limit your intake of green leafy vegetables.”

 

  “You must go get lab work drawn every 2-4 weeks while on this medication.”

 

  “Report any dark, tarry stools to your health care provider.”

 

  “Avoid the use of ibuprofen and naproxen as this can increase the chance of bleeding.”

 

Question 6 What information about side effects of simvastatin should the nurse include in client teaching? SELECT ALL THAT APPLY

 

  “Muscle pain and tenderness can be a sign of muscle breakdown.”

 

  “Dark, tea colored urine can be a symptom of liver damage.”

 

  “Sudden weight loss and weakness can be a sign of muscle breakdown.”

 

  “Right upper quadrant pain and tenderness can be a symptom of liver damage.”

 

  “Periodically while on this medication, the health care provider will monitor your liver enzymes to assess for liver damage.”

 

Question 7 A client with symptoms of myocardial infarction has received alteplase within the needed time-frame. What nursing intervention should the nurse implement to help keep the client safe?

 

  Implement strict bed rest and pad the side rails

 

  Insert a foley catheter so client will not need to go to bathroom

 

  Place a fall precautions armband on the client

 

  If bleeding occurs at IV site, hold pressure 5 minutes.

 

Question 8Based on potential adverse effects of the “statin” drugs, what labs should the nurse be prepared to monitor in a client receiving any “statin” drug? SELECT ALL THAT APPLY

 

  ALT

 

  Creatininekinase

 

  Creatinine phosphokinase

 

  AST

 

  INR

 

  aPTT

 

Question 9While performing medication reconciliation at discharge, the nurse notes that the client takes simvastatin 20 mg PO as a current home medication and the hospital physician has written a prescription for gemfibrozil. What potential adverse reaction can happen as a results of taking these medications concurrently?

 

  Rhabdomyolysis

 

  Low blood pressure

 

  Bleeding

 

  Liver damage

 

Question 10When planning medication administration to a client on cholestyramine, the nurse should administer the cholestyramine either _________ hour(s) before other medications or __________ hour(s) after other medications. (Enter number or number range only)

 

Question 11A client will be starting on a transdermal patch for treatment of chronic stable angina.  What education should the nurse provide the client? SELECT ALL THAT APPLY

 

  Cleanse the previous patch site to prevent irritation

 

  Avoid saunas and hot tubs because these increase vasodilation

 

  Remove the old patch before applying the new patch

 

  Do not apply the patch to the same location every day.

 

  Apply the patch at the same time each day

 

  Acceptable application sites include the forearm area, calf area, along with the torso

 

Question 12What medication can cause a fatal drop in blood pressure if taken with nitroglycerin?

 

  Sildenafil

 

  Carvedilol

 

  Digoxin

 

  Amlodipine

 

Question 13A client is experiencing chest pain and 2 doses of nitroglycerin have been administered. Which assessment finding would require the nurse to hold the third dose of nitroglycerin?

 

  Systolic blood pressure 88 mm/Hg

 

  Unrelieved chest pain, radiating into the left arm and jaw

 

  Head ache rating at 10 on a 0-10 pain scale

 

  Tingling sensation under the tongue with each SL tablet

 

Question 14The nurse is reviewing the client’s medical record before providing discharge instructions. Find the information below:

 

Admitting Diagnosis

 

Dehydration

 

Past Medical Diagnosis:

 

Heart Failure, chronic stable angina, hypertension

 

Discharge Medication Orders:

 

digoxin 0.125 mg PO daily

 

furosemide 40 mg PO BID at 0900 and 1700

 

metoprolol 25 mg PO daily

 

isosorbide dinitrate 20 mg PO daily

 

nitroglycerin 0.4 mg SL PRN chest pain.

 

What information should the nurse include in the discharge instructions? SELECT ALL THAT APPLY

 

  Store the nitroglycerin in original container,keeping it away from heat and moisture.

 

  Call 9-1-1 if pain is not relieved within 3 minutes of your first dose of nitroglycerin.

 

  Smoking cessation will help with disease management.

 

  If experiencing chest pain, place 1 nitroglycerin tablet under your tongue and allow it to dissolve; you may repeat up to 5 times, 3 minute apart.

 

  Weigh yourself weekly to monitor for fluid retention and report a weight gain of more than 5 pounds.

 

  Rise slowly, in stages, because metoprolol and isosorbide dinitrate can cause low blood pressure upon standing.

 

 

 

NURS3365 Pharmacology in Nursing Practice

 

Module 8 Quiz

 

Question 1 A client has taken several doses of intravenous gentamicin for a severe infection and is scheduled for another dose this morning. The client is unsteady while walking to the bathroom this morning and complains of having some trouble hearing the nurse. The nurse notes that this is new behavior from what was shared in shift report. What action should the nurse implement?

 

  Administer the scheduled dose on time to help maintain a steady state of the gentamicin

 

  Contact the health care provider and request trough level before giving the scheduled dose

 

  Request a physical therapy consultation to help with balance and gait training

 

  Contact the health care provider and request an order for the gentamicin to be discontinued

 

Question 2A client is receiving vancomycin and experiences a sudden drop in blood pressure and increase in heart rate. The nurse also notes that the client is red on their face, neck and chest. What is the best action by the nurse?

 

  Decrease the rate of infusion as this is a known reaction to rapid vancomycin infusions

 

  Elevate the lower extremities to help raise the blood pressure to a normal value

 

  Administer 0.3 mg of intravenous epinephrine to combat this anaphylactic reaction

 

  Contact the health care provider since the patient is sensitive to the vancomycin

 

Question 3A client is prescribed metronidazole for an infection. The nurse is providing education to the client prior to discharge. What information should the nurse include in the discharge instructions?

 

  Take the medication until the symptoms disappear, then contact prescriber for further information

 

  You do not need to increase your fluid intake with this medication because it is easily excreted from the body

 

  Avoid alcohol, including alcohol hand gel, while on this medication to prevent a known interaction

 

  Take this medication with a full glass of water, on an empty stomach, to help aid in drug absorption

 

Question 4The nurse is providing education to a client prescribed an antibiotic. What are some general teaching points to remember with any antibiotic? SELECT ALL THAT APPLY

 

  Take the entire course of the prescribed antibiotic.

 

  If your family is sick too,sharing the antibiotic to treat the illness is appropriate to prevent drug-resistant organisms.

 

  Increase fluids to help with excretion of the antibiotic

 

  Organ toxicity is a common adverse effect of antibiotics,knowing the signs of the specific organ toxicity is important to prevent long term organ damage.

 

  Taking an antibiotic puts you at risk for a super infection so you need to take action to re-establish your normal flora by taking probiotics, either with yogurt, buttermilk or oral probiotic supplements

 

Question 5The nurse is administering levofloxacin to a client with a severe infection. What issues are included in the black box warning for this classification of drugs? SELECT ALL THAT APPLY

 

  Peripheral neuropathy

 

  Achilles tendon rupture

 

  CNS effects

 

  Sudden cardiac arrest

 

  Exacerbation of myasthenia gravis

 

Question 6Which one of the generations of cephalosporins can be used to treat methicillin resistant Staphylococcus Aureus (MRSA)?

 

  1st generation

 

  3rd generation

 

  7th generation

 

  5th generation

 

Question 7A young-adult, female client is to start a tetracycline antibiotic for treatment of acne. What teaching points should the nurse include in the education provided to this client? SELECT ALL THAT APPLY

 

  Take at the same time as a glass of buttermilk or yogurt to prevent superinfection

 

  Take on an empty stomach with a full glass of water, either 1 hour before meals or 2 hours after meals.

 

  This medication can make oral contraceptives less effective and some other form of birth-control is recommended to prevent pregnancy.

 

  Tetracycline antibiotics can cause birth defects in developing fetuses.

 

  Avoid sunlight and wear sun block and protective clothing because this drug can increase the chance of severe sunburns, also known as, a photosensitive reaction.

 

  Complete the full course of therapy, as prescribed.

 

Question 8A client is receiving acyclovir by intravenous route for herpes zoster infection. What action should the nurse implement to help prevent phlebitis?

 

  Ask the prescriber to change the route to intramuscular

 

  Dilute further in 1 liter of normal saline

 

  Administer infusion slowly, over 60 minutes

 

  Administer by  intravenous push

 

Question 9A client with tuberculosis will be starting on isoniazid, rifampin, and kanamycin for the initial phase of treatment. What education should the nurse provide this client? SELECT ALL THAT APPLY

 

  Kanamycin can cause kidney and ear toxicity, therefore, report decrease urine output or hearing or balance disturbances.

 

  These anti-tubercular drugs will only be administered for about 7 days.

 

  Rifampin can cause discoloration of body fluids, which can stain clothing and soft contact lenses.

 

  Take the medications exactly as prescribed to help prevent multi-drug resistant tuberculosis

 

  Because isoniazid depletes vitamin B6, peripheral neuropathy can occur, and any numbness or tingling should be reported.

 

  Isoniazid and rifampin can cause liver damage, avoid acetaminophen and alcohol while on these medications.  

 

Question 10 A client has oral candida albicans infection with throat involvement. The nurse is teaching the client about taking their prescribed swish and swallow medication. What statement made by the client indicates a need for additional teaching?

 

  “I will take the nystatin exactly as my health care provider prescribed it to ensure medication effectiveness.”

 

  “I will swish the medication around my mouth ensuring contact with all oral mucosa and gargle before swallowing.”

 

  “I will drink some water directly after swallowing the nystatin to help with the bad flavor in my mouth.”

 

  “I will shake the nystatin container prior to taking the dose of medication since it is a suspension.”

 

 

 

NURS3365 Pharmacology in Nursing Practice

 

Module 9 Quiz

 

Question 1A client is to start zolpidem. What non-pharmacologic interventions can help promote sleep and rest to help this medication be more effective? SELECT ALL THAT APPLY

 

  Listen to music

 

  Read a book

 

  Drink green tea before bed

 

  Avoid caffeine 6 hours before bedtime

 

  Start a routine, get up at the same time every day.

 

  Take a nap during the day if you feel it is needed.

 

Question 2 A client is to start taking valproic acid. What labs should be monitored periodically throughout therapy? SELECT ALL THAT APPLY

 

  AST

 

  ALT

 

  Valproic acid level

 

  CBC

 

  Sodium levels

 

Question 3What is the primary use for butobarbital?

 

  Short-term treatment of insomnia

 

  Used as anesthesia for surgery

 

  Prevents seizures with epilepsy

 

  Long-term treatment of anxiety

 

Question 4An adolescent is newly prescribed phenytoin. What  information should the nurse provide in the teaching plan to the client and the parents? SELECT ALL THAT APPLY

 

  Brush and floss your teeth at least twice very day.

 

  Have dental exams done twice per year.

 

  Take the drug as close to the same time every day, if possible.

 

  Drug levels will be monitored periodically throughout therapy.

 

  Pad the corners of tables and try to clear any clutter that can cause harm if patient were to fall and have seizure

 

  This drug will make you more alert and awake and it will help increase your focus in school

 

Question 5A child is diagnosed with ADHD and is to start taking methylphenidate by mouth. What education should the nurse provide to the parents and child about this medication? SELECT ALL THAT APPLY

 

  Weigh the child 2 times per week to monitor for weight loss associated with methylphenidate

 

  Report fast heart rate to health care provider as this can be a serious adverse effect

 

  Take before breakfast and lunch

 

  Increase intake of caffeine to decrease need of methylphenidate

 

  Provide child with a nutritious breakfast as they may have decreased appetite for the rest of the day

 

  Take the last dose 2 hours before bedtime to help increase sleep at night.

 

Question 6Match each epileptic drug with it’s the desired therapeutic range.

 

phenytoin

 

carbamazepine

 

phenobarbital

 

Valproic acid

 

Question 7A client is experiencing status epilepticus and is in the emergency department. What is the correct order for administration of the prescribed medications?

 

Step 1

 

Step 2

 

Step 3

 

Step 4

 

Question 8A client asks the nurse “How does the sumatriptan work to stop my migraine?” What is the best response by the nurse?

 

  “It causes vasoconstriction of your cranial arteries.”

 

  “It causes central nervous system depression, making you relax.”

 

  “It lowers your blood pressure which decreases the throbbing pain.”

 

  “It is thought to stimulate your GABA receptors in your brain.”

 

Question 9 A client is beginning to take cyclobenzaprine for treatment of acute back spasms. Which statement indicates to the nurse that the client needs additional instructions?

 

  “I will take this drug in the evening with a glass of wine.”

 

  “I can take this medication with food if needed.”

 

  ” I should not drive after taking a dose of cyclobenzaprine.”

 

  “I will take this medication exactly as prescribed.”

 

Question 10A client has been prescribed topiramate. What education should the nurse provide?

 

  Avoid alcohol intake within 6 hours of scheduled dose

 

  Therapeutic range is 4-12 mcg/mL

 

  This drug increases mental focus and alertness

 

  Grapefruit juice will cause toxicity

 

 

 

NURS3365 Pharmacology in Nursing Practice

 

Module 10 Quiz

 

Question 1A client is prescribed a cholinergic medication. What assessment finding would be of most concern to the nurse?

 

  Heart rate of 50 beats per minute

 

  Urinary frequency

 

  Increased tear production

 

  Blood pressure 104/64

 

Question 2The family of a client diagnosed with Alzheimer’s disease asks how the newly prescribed donepezil works. What is the best response by the nurse?

 

  “It prevents the breakdown of the neurotransmitter responsible for memory recall.”

 

  “It stimulates the receptor sites in the brain responsible for memory recall.”

 

  “By allowing more acetylcholine in the brain, this medication cures Alzheimer’s disease.”

 

  “It blocks the cholinergic receptor sites in the brain which allows for memory recall.”

 

Question 3A client is prescribed an anticholinergic medication. What information in the past medical history would be of most concern to the nurse?

 

  Glaucoma

 

  Asthma

 

  Diabetes

 

  Bradycardia

 

Question 4You are caring for a client post-operatively. The indwelling urinary catheter was removed in the post-anesthesia care unit per the surgeon’s orders. The client is unable to urinate, and a bladder scan reveals 500 mL in in the bladder. What prescribed medication should you administer?

 

  Bethanechol

 

  Metoclopramide

 

  Atropine

 

  Tolterodine

 

Question 5A client is to have a major in-patient surgery and the nurse administered scopolamine transdermal patch behind the ear. The client asks, “What is that for? Why do I need a band aid behind my ear?” What is the best response by the nurse?

 

  “This medication is used to help dry up secretions to prevent aspiration during surgery.”

 

  “The patch behind your ear will help decrease motion sickness on your ride home.”

 

  “This medication helps with pain control after your surgery is completed.”

 

  “The patch behind your ear will help prevent complications of glaucoma.”

 

Question 6A client was brought into the emergency department with symptomatic bradycardia and has received multiple doses of atropine.  What clinical manifestations would the nurse identify as being potential symptoms of atropine toxicity? SELECT ALL THAT APPLY

 

  Confusion

 

  Flushing of the face and neck

 

  Diaphoresis

 

  Miosis

 

  Excessive salivation

 

  Urinary frequency

 

Question 7A client has been diagnosed with myasthenia gravis and is placed on pyridostigmine. Thirty minutes after taking the first dose of medication, the nurse suspects cholinergic crisis. What clinical manifestations would the nurse identify as being potential symptoms of cholinergic crisis? SELECT ALL THAT APPLY

 

  Confusion

 

  Miosis

 

  Diaphoresis

 

  Mydriasis

 

  Excessive salivation

 

  Lacrimation

 

Question 8A client is prescribed scopolamine transdermal patch to help with motion sickness while on a cruise. What education should the nurse provide the client to alleviate the common side effects of the medication? SELECT ALL THAT APPLY

 

  Wear sunglasses when going outside

 

  Chew sugar free gum

 

  Increase fluid and fiber

 

  Urinary incontinence may occur, use caution

 

  Avoid exercise to avoid fatigue

 

Question 9A client has been placed on high-dose therapy of selegiline. What foods should the nurse educate the client to avoid or limit while on this treatment regimen?  SELECT ALL THAT APPLY

 

  Sharp cheddar cheese

 

  Summer sausage

 

  Red wine

 

  Hamburger and french fries

 

  Fish and chips

 

Question 10A client is prescribed carbidopa-levodopa and the nurse is providing education on this new medication. What information should the nurse provide to help prevent injury?

 

  Rise slowly, in stages

 

  Drink 3 liters of fluid each day

 

  Increase intake of foods high in protein

 

  Decrease intake of dietary fiber

 

 

 

NURS3365 Pharmacology in Nursing Practice

 

Medication Reconciliation Assignment

 

Purpose:

 

The purpose of this assignment is to help pre-nursing students apply the concept of medication reconciliation to a client scenario.  This activity is designed to help the pre-nursing student develop clinical reasoning skills and develop safe medication practices that relate to the process of medication reconciliation. Remember from the lecture that a complete medication reconciliation can save the lives of your future clients. 

 

Objectives:

 

Explain the process of medication reconciliation

 

Identify best-practices for medication reconciliation

 

Apply the concept of medication reconciliation to the client scenario

 

Explain how to identify and reconcile medication discrepancies

 

Identify who should be involved in the medication reconciliation process

 

Assignment instructions:

 

This assignment is meant to help you apply the concept of medication reconciliation. 

 

Review the information provided in Canvas concerning Medication Reconciliation: Module 3 Notes Page 7.

 

Using the client scenario provided on the assignment document and your Davis Drug Guide for Nurse’s, conduct medication reconciliation. Be sure to include the following in your final submission:

 

Explain the medication reconciliation process

 

Analyze the client scenario for any omissions, additions, or duplications of medications and discuss the implications to the client.

 

Analyze the client scenario for potential risks associated with the client’s current condition and currently prescribed home medications

 

Identify potential drug interaction and prioritize the drug interactions that are most concerning to you.

 

Identify actions that the nurse should implement and provide a reason for each action.

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