ATI RN Pharmacology 2023 Guide

ATI RN Pharmacology 2023 Guide A nurse is instructing a client on the application of nitroglycerin transdermal patches. Which of the following statements by the client indicates an understanding of the teaching? a. "I should apply a patch every 5 mins if I develop chest pain." b. "I will take the patch off right after my evening meal." c. "I will leave the patch off at least 1 day each week." d. "I should discard the used patch by flushing it down the toilet." Ans- b. "I will take the patch off right after my evening meal." -clients should remove the patch each evening for a medication free time of 12-14 hr before applying a new patch to avoid developing a tolerance to the medication's effects -nitroglycerin sublingual tablets are used to treat new onset of angina pain. A client who uses sublingual tablets should place one tablet under their tongue at the onset of angina pain and continue taking a table every 5 min for a total of three doses of nitroglycerin. The effects of a nitroglycerin patch will take 30-60 min to occur and are not useful to prevent an ongoing angina attack -nitroglycerin is an antianginal medication that results in dilation of the coronary vessels. Clients should apply the patch daily to sustain prophylaxis -medication remains in the transdermal patch after removing it from the body and must be discarded safely. The nurse should instruct the client to fold the patch ends together with the medication on the inside and place the discarded patch in a closed container so that children and pets cannot gain access to the medication A nurse receives a verbal order from the provider to administer morphine five milligrams every 4 hours subcutaneously for severe pain as needed. The nurse should identify which of the following entries as the correct format for the medication administration record (MAR)? a. MSO4 5 mg subcut every 4 hr PRN severe pain b. Morphine 5 mg subcut every 4 hr PRN severe pain c. MSO4 5 mg SQ every 4 hr PRN severe pain d. Morphine 5.0 mg subcutaneously every 4 hr PRN severe pain Ans- b. Morphine 5 mg subcut every 4 hr PRN severe pain -the medication name is spelled out and there are not any abbreviations from The Joint Commission's "Do Not Use" list included in the transcript -the use of the abbreviation MSO4 is prohibited by The Joint Commission. The medication name morphine must be spelled out to reduce the risk for error -SQ is prohibited by The Joint Commission; this route should be written as subcut, subq, or subcutaneously -the trailing zero on 5.0 can be mistaken for 50 if the decimal point is missed A nurse is caring for a client who is taking acetazolamide for chronic open-angle glaucoma. For which of the following adverse effects should the nurse instruct the client to monitor and report? a. tingling of fingers b. constipation c. weight gain d. oliguria Ans- a. tingling of fingers -the nurse should instruct the client to report the adverse effect of paresthesia, a tingling sensation in the extremities, when taking acetazolamide -diarrhea is an adverse effect of acetazolamide due to gastrointestinal disturbances -weight loss is an adverse effect of acetazolamide due to GI disturbances causing reduced appetite -polyuria is an adverse effect of acetazolamide A nurse administers a dose of metformin to a client instead of the prescribed dose of metoclopramide. Which of the following actions should the nurse take first? a. report the incident to the charge nurse b. notify the provider c. check the client's blood glucose d. fill our an incident report Ans- c. check the client's blood glucose -the first action the nurse should take using the nursing process is to assess the client. The client is at risk for hypoglycemia. The nurse should monitor the client's blood glucose and provide the client with a snack to reduce the risk of hypoglycemia -the rest of these answers are also correct, but there is another action the nurse should take first A nurse is caring for a client who has cancer and is taking oral morphine and docusate sodium. The nurse should instruct the client that taking the docusate sodium daily can minimize which of the following adverse effects of morphine? a. constipation b. drowsiness c. facial flushing d. itching Ans- a. constipation -constipation is a common adverse effect of morphine that can be minimized by taking docusate sodium, a stool softener that promotes easier evacuation of stool by increasing water and fat in the intestines A nurse is assessing a client's vital signs prior to the administration of PO digoxin. The client's BP is 144/86 mm Hg, heart rate is 55/min, and respiratory rate is 20/min. The nurse should withhold the medication and contact the provider for which of the following findings? a. diastolic BP b. systolic BP c. heart rate d. respiratory rate Ans- c. heart rate -digoxin slows the conduction rate through the SA and AV nodes, thereby decreasing the heart rate. The nurse should withhold the medication and notify the provider for a heart rate of 55/min because this is an early indication of digoxin toxicity -digoxin increased cardiac output and reduces the heart rate, a diastolic BP of 86, systolic BP of 140, and respiratory rate of 20/min is not cause for holding the medication and contacting the provider - A nurse is caring for a client who received 0.9% sodium chloride 1 L over 4 hr instead over 8 hr as prescribed. Which of the following information should the nurse enter as a complete documentation of the incident? a. IV fluid infused over 4 hr instead of the prescribed 8 hr. Client tolerated fluids well, provider notified b. 0.9% sodium chloride 1 L IV infused over 4 hr. Vital signs stable, provider notified c. 1 L of 0.9% sodium chloride completed at 0900. Client denies shortness of breath d. IV fluid initiated at 0500. Lungs clear to auscultation Ans- b. 0.9% sodium chloride 1 L IV infused over 4 hr. Vital signs stable, provider notified -the nurse should document the type and amount of fluid, how long it took to infuse, provider notification, and the client's physical status -the nurse should only chart factual information in the client's medical record without indicating the error that occurred A nurse is providing teaching to a client who has peptic ulcer disease and is to start a new prescription for sucralfate. Which of the following actions of sucralfate should the nurse include in the teaching? a. decreases stomach acid secretion b. neutralizes acids in the stomach c. forms a protective barrier over ulcers d. treats ulcers by eradicating H. pylori Ans- c. forms a protective barrier over ulcers -secretions by the parietal and chief cells, hydrochloric acid and pepsin, can further irritate the ulcerated areas. Sucralfate, a mucosal protectant, forms a gel-like substance that coats the ulcer, creating a barrier to hydrochloric acid and pepsin -peptic ulcer disease manifests as an erosion of the gastric or duodenal mucosa. The acid production in the stomach causes further irritation and pain. H2 receptor antagonists, such as famotidine, decrease stomach acid secretion -acid production in the stomach causes further irritation and pain to a client who has a peptic ulcer. Antacids, such as aluminum hydroxide, neutralize acids in the stomach and prevent pepsin formation, a digestive enzyme the can further damage the eroded epithelium -a common cause of peptic ulcers is a bacterial infection with Helicobacter pylori. Treatment of the ulcer includes a combination of antibiotics, such as metronidazole, tetracycline, clarithromycin, or amoxicillin, to eradicate the H. pylori infection A nurse is reviewing the ECG of a client who is receiving IV furosemide for heart failure. The nurse should identify which of the following findings as an indication of hypokalemia? a. tall, tented T-waves b. presence of U-waves c. widened QRS complex d. ST elevation Ans- b. presence of U-waves -the nurse should identify the presence of U-waves as a manifestation of hypokalemia, an adverse effect of furosemide -the nurse should identify tall, tented T-waves as a manifestation of hyperkalemia. Flattened or inverted T-waves are a manifestation of hypokalemia -the nurse should identify a widened QRS complex as a manifestation of hyperkalemia -the nurse should identify ST elevation as an indication of ischemia. ST depression is a manifestation of hypokalemia A nurse on the acute care unit is caring for a client who is receiving gentamicin IV. The nurse should report which of the following findings to the provider as an adverse effect of the medication? a. constipation b. tinnitus c. hypoglycemia d. joint pain Ans- b. tinnitus -aminoglycosides, such as gentamicin, are ototoxic, which can manifest as tinnitus and deafness. The nurse should monitor for high-pitched ringing in the ears and headaches and should notify the provider if these occur -gentamicin, an aminoglycoside used to treat serious infections, can cause several GI adverse effects, such as inflammation of the liver and spleen, but does not cause constipation -aminoglycosides, such as gentamicin, can result in neuromuscular adverse effects such as twitching or flaccid paralysis. A nurse is preparing to administer heparin subcutaneously to a client. Which of the following actions should the nurse plan to take? a. administer the medication outside the 5 cm (2 in) radius of the umbilicus b. aspirate for blood return before injecting c. rub vigorously after the injection to promote absorption d. place a pressure dressing on the injection site to prevent bleeding Ans- a. administer the medication outside the 5 cm (2 in) radius of the umbilicus -the nurse should administer the heparin by subcutaneous injection to the abdomen in an area that is above the iliac crest and at least 5 cm (2 in) away from the umbilicus -the nurse should not aspirate by pulling back on the plunger of the heparin syringe to check for a blood return, because this will cause the injection site to bruise -the nurse should apply firm pressure to the injection site for 1-2 min after the administration of the heparin to prevent bruising A nurse at an urgent care clinic is collecting a history from a female client who has a urinary tract infection. The nurse anticipates a prescription for ciprofloxacin. The nurse should identify that which of the following client statements indicates a contraindication for administering this medication? a. "I have tendonitis, so I haven't been able to exercise." b. "I take a stool softener for chronic constipation." c. "I take medicine for my thyroid." d. "I am allergic to sulfa." Ans- a. "I have tendonitis, so I haven't been able to exercise." -the nurse should identify tendonitis as a contraindication for taking ciprofloxacin due to the risk of tendon rupture -diarrhea is an adverse effect of this medication -ciprofloxacin is a quinolone antibiotic A nurse is reviewing the laboratory results for a client who is receiving heparin via continuous IV infusion for deep-vein thrombosis. The nurse should discontinue the medication infusion for which of the following client findings? a. potassium 5.0 mEq/L b. aPTT 2 times the control c. hemoglobin 15 g/dL d. platelets 96,000 mm3 Ans- d. platelets 96,000 mm3 -a platelet count of 96,000 mm3 is below the expected range of 150,000-400,000 mm3. A platelet countless than 100,000 mm3 while receiving heparin can indicate heparin-induced thrombocytopenia, a potentially fatal condition that requires stopping the infusion -an Hgb of 15 g/dL is within the expected range or 14-18 g/dL for a male and 12-16 g/dL for a female and is not an indication to stop the heparin infusion A nurse is caring for a client who is in labor. The client is receiving oxytocin by continuous IV infusion with a maintenance IV solution. The external FHR monitor indicates late decelerations. Which of the following actions should the nurse take first? a. turn the client to a side-lying position b. disconnect the clients oxytocin from the maintenance IV c. apply oxygen to the client by face mask d. increase the client's maintenance IV infusion rate Ans- a. turn the client to a side-lying position -the greatest risk to the fetus experiencing late decelerations is injury from uteroplacental insufficiency. Therefore, the priority action the nurse should take is to place the client in a lateral position -the nurse should increase the client's maintenance IV infusion rate to maintain adequate blood flow and promote placental perfusion. However, another action is the nurse's priority -all of these answers are correct, however, turning the client to the side is the nurse's priority A nurse is preparing to administer medications to a client who tells the nurse, "I don't want to take my fluid pill until I get home today." Which of the following actions should the nurse take? a. document the refusal and inform the client's provider b. file an incident report with the risk manager c. contact the pharmacist to pick up the medication d. give the client the medication to take home and document that it was administered Ans- a. document the refusal and inform the client's provider -the nurse has the responsibility to verify that the client understands the risks of refusing the medication so that an informed decision can be made. The nurse should then document the refusal in the client's medical record and notify the HCP -an incident report is necessary for a medication error -the nurse should follow protocols for discarding the medication. It is not the role of the pharmacist to retrieve medications that a client refuses to take -the nurse should not give the client a scheduled