RN VATI Pharmacology 2019 with Complete Solution

A nurse is preparing to administer diclofenac to a client who has chronic bursitis. Which of the following actions should the nurse take? a. administer the medication at bedtime b. avoid administering the medication with antacids c. administer the medication with food d. crush the medication prior to administration Administer the medication with food Diclofenac is an NSAID and can cause gastric irritation. Clients should take NSAIDs with food or milk to minimize gastric nurse should not administer the medication at bedtime because the client should remain upright for 15 to 30 min after administration to prevent esophageal irritation. Diclofenac is available as an enteric-coated tablet for delayed release. Clients should not crush or chew sustained-release medications because doing so will increase gastrointestinal adverse effects and decrease the effectiveness of the medication. A nurse is planning care for a client who has asthma and a prescription for methylprednisolone. Which of the following laboratory values should the nurse monitor while the client is receiving this medication? a. Aspartate aminotransferase (AST) b. Fibrin split products c. BUN d. Glucose Glucose Methylprednisolone therapy increases the synthesis of glucose and decreases the uptake of glucose by the muscles and adipose tissues, resulting in increased circulating glucose. Therefore, it is important for the nurse to monitor blood glucose levels regularly while clients are receiving corticosteroid therapy. Aspartate aminotransferase is an enzyme that is present in the heart, liver, skeletal muscles, and other highly metabolic tissues. AST levels are increased in conditions that cause cellular injury, such as liver disease; however, methylprednisolone therapy does not affect AST levels. Fibrin split products are present in the serum when thromboses are present. Increased levels of fibrin split products can increase disseminated intravascular coagulation (DIC); however, methylprednisolone therapy does not affect blood clotting. BUN levels reflect kidney function and glomerular filtration. Hydration status and nephrotoxic medications can alter BUN levels; however, methylprednisolone therapy does not affect renal function. 00:02 01:34 A nurse is caring for a client who is postmenopausal and has a prescription for raloxifene. The nurse should instruct the client that raloxifene is prescribed for which of the following reasons? a. To treat irritable bowel syndrome b. To reduce the risk for breast cancer c. To reduce the occurrence of hot flashes d. To lower the risk of pulmonary embolism To reduce the risk for breast cancer Raloxifene can lower the risk for breast cancer in postmenopausal clients who have a high risk for developing estrogen-receptive types of breast cancer. The medication also reduces the risk for and can treat postmenopausal osteoporosis.Raloxifene is a selective estrogen receptor modulator. In clients who are postmenopausal, it can reduce the risk for and treat osteoporosis and protect against breast cancer. Hot flashes are an adverse effect of raloxifene. Raloxifene reduces the occurrence of fractures related to osteoporosis and reduces the cholesterol level in clients who are postmenopausal.Raloxifene can cause several significant cardiovascular and respiratory adverse effects, such as thromboembolism, stroke, peripheral edema, pneumonia, and the development of pulmonary emboli. Clients should not take this medication prior to periods of prolonged immobilization, such as surgery. A history of thromboembolic events is a contraindication for taking this medication. A nurse is caring for a client who is receiving heparin by continuous IV infusion for treatment of venous thrombosis. Which of the following laboratory values should the nurse monitor for in order to titrate the heparin dose? a. platelet function assay b. aPTT c. INR d. Amylase aPTT The nurse should monitor the aPTT of a client who is receiving heparin by continuous IV infusion. When beginning heparin therapy, the nurse should monitor the aPTT every 4 to 6 hr. Once the client has achieved the desired range, the nurse should monitor the aPTT daily. The nurse should monitor the platelet function assay of a client who has a bleeding disorder. This test evaluates platelet function and ability to cause hemostasis; however, heparin does not affect it.The nurse should monitor a client's INR to evaluate the effects of warfarin therapy. The nurse should ensure the collection of the client's blood specimen prior to administering the daily warfarin dose.The nurse should review the amylase levels of a client who has pancreatitis. Amylase is a pancreatic enzyme that increases in clients who have acute or chronic pancreatitis; however, heparin does not affect this enzyme. A nurse is assessing a client who has a positive Trousseau's sign. Wich of the following medications should the nurse plan to administer? a. sodium bicarbonate b. manesium sulfate c. calcium gluconate d. potassium chloride Calcium gluconate The nurse should identify that a positive Trousseau's sign is a manifestation of hypocalcemia. Therefore, the nurse should plan to administer calcium gluconate to treat hypocalcemia. Sodium bicarbonate is administered to treat metabolic acidosis. The nurse should recognize that sodium bicarbonate is not used to treat a positive Trousseau's sign.Magnesium sulfate is administered to treat hypomagnesemia. The nurse should recognize that magnesium sulfate is not used to treat a positive Trousseau's sign. Potassium chloride is administered to treat hypokalemia. The nurse should recognize that potassium chloride is not used to treat a positive Trousseau's sign. A nurse is preparing to administer morphine 0.3 mg/kg PO to a school-aged child who weighs 88 lb. Available is morphine oral solution 2mg/ml. How many mL should the nurse administer? 6 mL A nurse is administering haloperidol to a client who has schizophrenia. For which of the following adverse effects should the nurse monitor? a. gingival hyperplasia b. muscle rigidity c. polyuria d. bruising Muscle rigidity A client who is taking haloperidol, a first-generation antipsychotic agent, can develop extrapyramidal effects, such as parkinsonism, which manifests as tremors, bradykinesia, loss of balance, mask-like facial expression, shuffling gait, and muscle rigidity. Haloperidol is an antipsychotic agent that can cause akathisia (motor restlessness) within hours of receiving the first dose; however, gingival hyperplasia is not an adverse effect of haloperidol. Phenytoin is an example of a medication that causes gingival hyperplasia.Haloperidol has several genitourinary adverse effects, including urinary retention and impotence; however, urinary output does not typically increase.Haloperidol has significant cardiovascular effects, including dysrhythmias, myocardial infarction, severe heart failure, and hypotension; however, it does not affect blood coagulation. A nurse receives a verbal prescription from the provider for hydrochlorothiazide 25 mg by mouth daily for a client who has hypertension. Which of the following indicates how the nurse should transcribe the prescription in the client's medical record? a. Hydrochlorothiazide 25.0 mg orally q.d. b. Hydrochlorothiazide 25 mg PO daily c. HCTZ 25.0 mg by mouth daily d. HCTZ 25 mg PO OD Hydrochlorothiazide 25 mg PO daily The nurse should transcribe the provider's prescription by spelling out the name of the medication, recording the dosage as a whole number, and spelling out the word "daily." The abbreviation PO is acceptable for use to indicate the route by mouth. The nurse should not transcribe a trailing zero after a decimal point because if the decimal point is not seen, it could be mistaken as 250 mg. The abbreviation q.d. is not acceptable because it could be mistaken for q.i.d. The nurse should write out the word "daily."The nurse should not transcribe the medication name abbreviated as HCTZ, because it could be mistaken for hydrocortisone. The nurse should not place a trailing zero after a decimal point because if the decimal point is not seen, it could be mistaken as 250 mg.The nurse should not transcribe the medication name abbreviated as HCTZ, because it could be mistaken for hydrocortisone. The abbreviation OD is not acceptable for use because it could be mistaken for "right eye." The nurse should write out the word "daily." A nurse is planning care for a client who is taking tamoxifen for treatment of breast cancer. Which of the following interventions should the nurse include in the plan? SATA a. Monitor the client's calcium level b. Monitor the client for pulmonary embolus c. Advise the client of the potential for menstrual irregularities d. Advise the client of the potential for peripheral neuropathy e. Advise the client of the potential for hot flashes Monitor the clients calcium level, monitor the client for pulmonary embolus, advise the client for potential menstrual irregularities, advise the client of potential for hot flashes Tamoxifen increases the risk for hypercalcemia. The nurse should monitor the client's pulse and blood pressure, which are increased in mild hypercalcemia and decreased in severe or prolonged hypercalcemia. Other manifestations include cyanosis, pallor, muscle weakness, and decreased deep tendon reflexes. Tamoxifen increases the risk for pulmonary embolus. The nurse should instruct the client to report any chest pain or difficulty breathing. Tamoxifen can cause menstrual irregularities, pain, and bleeding. Therefore, the nurse should instruct the client to notify the provider. Hot flashes are a common occurrence in clients taking tamoxifen. The nurse should inform the client that hot flashes are reversible with discontinuation of the medication. Tamoxifen does not cause numbness or tingling of the extremities A nurse is caring for a client who is receiving meperidine. Which of the following is the nurse's priority assessment before administering the medication? a. urinary retention b. vomiting c. respiratory rate d. level of consciousness Respiratory Rate When using the airway, breathing, and circulation (ABC) approach to client care, the nurse should determine that the priority assessment is to check the client's respiratory rate. Opioid therapy can result in respiratory depression, which can lead to respiratory arrest. The nurse should withhold the opioid medication and notify the provider if the client's respiratory rate is below 12/min. Meperidine is an opioid analgesic that can cause urinary retention, although to a lesser degree than other opioids. The nurse should monitor the client's intake and output, palpate the bladder or perform a bladder scan, and notify the provider of any voiding difficulties or bladder distention; however, another assessment is the nurse's priority.Meperidine stimulates the chemoreceptor trigger zone of the medulla, which results in nausea and vomiting. The nurse should assess the client for nausea prior to administering meperidine, pretreat for nausea, and encourage the client to remain in a supine position to minimize the medication's emetic effects; however, another assessment is the nurse's priority.Meperidine is an opioid analgesic that can cause somnolence and mental clouding. The nurse should assess the client's level of consciousness and ensure the client's safety prior to administering meperidine; however, another assessment is the nurse's priority. A nurse is reviewing the laboratory results for a client who is taking warfarin following orthopedic surgery. Which of the following results should the nurse report to the provider? a. PT 12.5 seconds b. aPTT 36 seconds c. PTT 65 seconds d. INR 5.2 INR 5.2 A client who is taking warfarin following an orthopedic surgery should have a therapeutic INR between 2 to 3. The nurse should identify an INR greater than 5 as a critical value. Therefore, the nurse should report this laboratory value to the provider to have the client's warfarin dosage adjusted. A PT of 12.5 seconds is within the expected reference range of 11 to 12.5 seconds. The nurse should expect the client who is taking coumadin to have a prolonged PT. An aPTT of 36 seconds is within the expected reference range of 30 to 40 seconds. The aPTT is used to monitor clients who are receiving heparin therapy. A PTT of 65 seconds is within the expected reference range of 60 to 70 seconds. This test is used to monitor clients who are receiving heparin therapy. INR 5.2 A nurse is preparing to administer medications to a client. The client tells the nurse, "I will take the pills but not that liquid medication." Which of the following actions should the nurse take? a. Document the reason for the missed dose of medication in the nurse's notes. b. Ask an assistive personnel (AP) to ensure the client drinks the medication after breakfast. c. Notify the pharmacist that the client is refusing to take the medication. d. Mix the medication in juice on the client's breakfast tray. a. document the reason for the missed dose of medication in the nurse's notes It is the responsibility of the nurse to respect the client's right to refuse to take a medication and to document the reason a medication dose is not administered. This should include the client's refusal to take the medication. Medication administration, regardless of the route, is not within the range of function for an AP. The client refused the medication so the nurse should not ask someone else to administer it at a later time. The nurse should notify the client's provider of the refusal; however, it is not necessary to notify the pharmacist. The nurse should respect the client's right to refuse to take the medication. The nurse cannot force the client to take any medication against their will, which includes mixing the medication in the client's juice without their knowledge.