Pharm 9 23 22

Question 1

The nurse is caring for a client newly prescribed the combination of amlodipine and lisinopril. Which client statement is most concerning to the nurse?
a. “I hate these medications. I am so fatigued, and my ankles have started to swell.”
b. “I have noticed that I feel very dizzy when I get out of bed in the morning.”
c. My blood pressure measurements at home are much lower than usual.”
d. “ My tongue feels strange and thick for a while after I take these medications.”

Answer 1

d. “ My tongue feels strange and thick for a while after I take these medications.”

Question 2

The clinic nurse is assessing the effectiveness of pancrelipase therapy for a client with cystic fibrosis. Which client statement requires follow up related to pancrelipase therapy?
a. I have been having several formed bowel movements each day
b. I have been taking my pancrelipase with each meal and snack
c. I have gained approximately 4 pounds during the last 2 months
d. I have had increased stomach cramps and gas the past 3 days

Answer 2

d. I have had increased stomach cramps and gas the past 3 days

Question 3

The nurse is teaching a client who was newly prescribed methotrexate (chemotherapy/immunosuppressive medication). Which instructions are appropriate for the nurse to discuss with the client? Select all that apply.
a. Avoid drinking alcohol - hepatotoxic
b. Avoid yearly influenza vaccine injection
c. Do not take this drug with dairy products
d. Stop taking this drug if you become pregnant
e. Watch for signs and symptoms of infection

Answer 3

a. Avoid drinking alcohol - hepatotoxic
c. Do not take this drug with dairy products
d. Stop taking this drug if you become pregnant
e. Watch for signs and symptoms of infection

Question 4

The clinic nurse has received telephone messages from four clients, which client should the nurse call back first?
a. Client prescribed hydrocodone 3 days ago for pain from a fractured ankle who reports no bowel movement for 3 days
b. Client prescribed ibuprofen 1 month ago for osteoarthritis who reports dizziness upon standing since starting the medication
c. Client prescribed levothyroxine 3 days ago who reports no improvement of symptoms since the beginning of treatment
d. Client prescribed methylphenidate 1 month ago for attention deficit disorder who reports poor appetite and weight loss

Answer 4

b. Client prescribed ibuprofen 1 month ago for osteoarthritis who reports dizziness upon standing since starting the medication

Question 5

The clinic nurse is assessing a female client with hypertension reporting severe nausea and vomiting in the morning for the past week. Which statement by the client is the priority for the nurse to investigate further? Click the exhibit button for additional information.
a. I have been noticing that i feel dizzy when i stand up
b. I have noticed that i have a dry, hacking cough -› ACEs and ARBs adverse effect
c. My spouse and i have been trying to have a baby
d. When i cook, i will use small amounts of salt

Answer 5

c. My spouse and i have been trying to have a baby -› (possible pregnancy)

Question 6

The nurse is preparing to provide instructions to a client regarding newly prescribed oral terbinafine for a fungal infection of the toenails. What clinical data in the client’s medical history requires further clarification?
a. Client has a history of alcohol use disorder
b. Client smokes two packs of cigarettes a day
c. Client uses albuterol for asthma
d. Client uses insulin for diabetes mellitus management

Answer 6

a. Client has a history of alcohol use disorder

Question 7

The nurse is caring for a client receiving tamoxifen therapy following a mastectomy for breast cancer. Which statement by the client requires priority follow up?
a. I am walking more each day to work out the cramping in my right leg
b. I have noticed that i feel irritable and moody more often than before
c. I no longer enjoy sexual intercourse because my vagina is very dry
d. I wake up with my pajamas soaked with sweat 2 or 3 times each night

Answer 7

a. I am walking more each day to work out the cramping in my right leg

Question 8

The nurse is evaluating understanding after teaching a client with type 2 diabetes mellitus about newly prescribed glipizide. Which client statement indicates a need for further instruction?
a. I should not drink more than two alcoholic beverages each week.
b. I will be sure to carry sugar gel or tablets with me at all times
c. I will take this medicine at the same time each day, right before or with meals
d. Weight gain can occur with this medicine, so i will exercise regularly - true

Answer 8

a. I should not drink more than two alcoholic beverages each week.

Question 9

The nurse is reviewing teaching about prescribed pancrelipase with the parent of a child with cystic fibrosis. Which statement by the parent indicates a correct understanding of the teaching?
a. If my child has frothy, foul smelling stools, i will stop the medication
b. The tables can be crushed and mixed with food if my child refuses it
c. This medication should be given just before each meal and snack
d. This medication will thin my child’s mucus so it can be coughed out

Answer 9

c. This medication should be given just before each meal and snack

Question 10

The nurse is caring for a client prescribed methimazole to treat hyperthyroidism. Which symptom reported by the client is the priority for further investigation?
a. Dizziness
b. Headache
c. Impaired taste sensation
d. Sore throat

Answer 10

d. Sore throat

Question 11

The nurse teaches a female client about newly prescribed isotretinoin for acne vulgaris. Which communication is the priority for the nurse to include?
a. You may require to take monthly pregnancy tests while on this medication
b. You may need to use lubricating eye drops if you wear contact lenses
c. You should notify your health care provider if you start having nosebleeds
d. Your skin will be more sensitive to the sun, so protect yourself against sun exposure

Answer 11

a. You may require to take monthly pregnancy tests while on this medication

Question 12

A client with type 2 diabetes mellitus and pulmonary sarcoidosis is prescribed oral prednisone. Which of the following statements should the nurse include when teaching the client about this medication? Select all that apply
a. Engaging in physical activity will help prevent weight gain, a common adverse effect of this medication
b. It is important to wash your hands because this medication can affect your ability to fight off infection
c. You should immediately stop this medication if you develop any signs or symptoms of infection
d. You should increase your intake of calcium and vitamin D because this medication can cause bone loss
e. Your health care provider may have to increase your insulin dose after starting this medication

Answer 12

a. Engaging in physical activity will help prevent weight gain, a common adverse effect of this medication
b. It is important to wash your hands because this medication can affect your ability to fight off infection
d. You should increase your intake of calcium and vitamin D because this medication can cause bone loss
e. Your health care provider may have to increase your insulin dose after starting this medication -› (causes glucose levels to spike up)

Question 13

The nurse has finished performing client assessments and is preparing to administer medications. Based on the morning assessments, which of the following prescriptions should the nurse hold and clarify with the health care provider? Select all that apply
a. Apixaban for a client with petechiae over the waist and torso
b. Digoxin for a client who reports yellow rings in the visual field
c. Diltiazem for a client with irregular apical pulse of 92/min
d. Enoxaparin for a client with bruising where previous doses were injected
e. Hydrochlorothiazide for a client with potassium level 3.0 mEq;L

Answer 13

a. Apixaban for a client with petechiae over the waist and torso
b. Digoxin for a client who reports yellow rings in the visual field
e. Hydrochlorothiazide for a client with potassium level 3.0 mEq;L

Question 14

A client with diabetic ketoacidosis is receiving continuous IV insulin, what possible adverse effect will the nurse monitor for as result of IV insulin
a. Elevated liver enzymes
b. Elevated pancreatic enzymes
c. Hypokalemia
d. Hyponatremia

Answer 14

c. Hypokalemia -› possible low potassium

Question 15

The nurse is reinforcing teaching from home management for a client with primary open angle glaucoma. Which of the following client statements indicate that teaching has been effective? Select all that apply.
a. I can expect my vision to be restored when i start using the eye drops
b. I should ask my health care provider before taking any cold medications
c. I should not be alarmed if i start to see halos around lights or have blurry vision
d. I will need to use prescription eye drops every day for the rest of my life
e. I will wear a medical alert bracelet that indicates I have glaucoma

Answer 15

b. I should ask my health care provider before taking any cold medications
d. I will need to use prescription eye drops every day for the rest of my life
e. I will wear a medical alert bracelet that indicates I have glaucoma

Question 16

The nurse is preparing to administer medications to a client with a history of hypertension, hypothyroidism, and congestive heart failure. After performing an assessment, which medication should the nurse clarify with the health care provider? Click exhibit
a. Amlodipine - CCB
b. Atorvastatin - contraindicated for low liver enzymes
c. Digoxin - contraindicated for hypokalemia
d. Levothyroxine - for hypothyroidism

Answer 16

c. Digoxin - contraindicated for hypokalemia

Question 17

The nurse receives new prescriptions for a client who has just undergone a femoral cardiac catheterization for treatment of myocardial infarction. Which prescription should the nurse clarify? Click the exhibit for additional information.
a. clopidogrel : 75 mg PO, once dailv
b. Dopamine:: 3 mcg/kg/min infusion
c. Metformin: 850 mg PO, bid hold for 48 hours
d. Morphine : 2 mg IV push, NOW

Answer 17

c. Metformin: 850 mg PO, bid hold for 48 hours

Question 18

The nurse is caring for a client in the adult medical surgical unit. After reviewing the client clinical data, which prescribed medication should the nurse question? Click on exhibit.
a. Aspirin enteric coated 325 mg PO, once daily
b. Atenolol : 50 mg PO, once daily
c. Lithium carbonate : 300 mg PO, tid
d. Salmeterol : 1 inhalation, q12h

Answer 18

c. Lithium carbonate : 300 mg PO, tid

Question 19

The clinic nurse assesses a 19 year old client who has been taking paroxetine for a month. Which question is most important for the nurse to ask?
a. Do you have thoughts about harming yourself?
b. Have you been attending your therapy sessions?
c. How has the quality of your sleep been lately?
d. How much alcohol do you drink per week?

Answer 19

a. Do you have thoughts about harming yourself?

Question 20

The nurse is preparing to administer prescribed medications to a client on a telemetry unit. After reviewing the clients telemetry monitor, which medication should the nurse clarify with the health care provider? Click on the exhibit
a. Atenolol
b. Captopril
c. Enoxaparin
d. Simvastatin

Answer 20

a. Atenolol

Question 21

The nurse is reviewing home medications and laboratory results for a female client who is establishing care with a new health care provider. Which laboratory result is most concerning to the nurse? Click on the exhibit
a. Positive urine human chorionic gonadotropin
b. Positive urine leukocyte esterase
c. Serum hemoglobin of 11 .4 g/dl (114g/L)
d. Serum potassium of 3.4 mEg/L (3.4 mmol/L)

Answer 21

a. Positive urine human chorionic gonadotropin - positive pregnancy

Question 22

The nurse reinforces teaching about a continuous subcutaneous insulin infusion pump for a 12 year old client with type 1 diabetes mellitus. Which statement by the client indicates appropriate understanding of teaching?
a. I can get rid of my insulin syringes now that i use the insulin infusion pump
b. I will get my parents to help me change the infusion site once a week
c. It is important to subtract my basal insulin rate from the bolus doses at meals
d. The insulin infusion pump continuously delivers small doses of insulin

Answer 22

d. The insulin infusion pump continuously delivers small doses of insulin

Question 23

The nurse reinforces teaching to a client with osteoporosis who is prescribed once monthly oral ibandronate. Which statement made by the client indicates the need for further instruction?
a. I should remain standing or sitting upright for at least 10 minutes after taking the medication
b. I should take my other morning medication at least 60 minutes after i take this new medication
c. I will regularly check on my teeth and gums and call of i notice pain, redness, or sores
d. I will take it in the morning before i eat my breakfast with 8 ounces (240 ml) of plain water

Answer 23

a. I should remain standing or sitting upright for at least 10 minutes after taking the medication- should be at least 60 min

Question 24

The oncology clinic nurse is reviewing laboratory results for a client who is scheduled to receive the second infusion of a second cycle of cisplatin today. Which finding is apriority for the nurse to report to the health care provider to administer the medication? Click the exhibit
a. Creatinine 2.4 nephrotoxic
b. Platelets 62,000 - at risk for bleeding
c. Potassium 3.4
d. WBC 3100/mm3

Answer 24

a. Creatinine 2.4 nephrotoxic

Question 25

The nurse is reviewing the medical record of a newly admitted client with severe ulcerative colitis and a productive cough. Which prescription should the nurse clarify with the health care provider? Click on the exhibit
a. Ferrous sulfate
b. Infliximab
c. Metronidazole
d. Sulfasalazine

Answer 25

b. Infliximab -› (immunosuppressive drug)

Question 26

The nurse is educating a client with ascites from liver cirrhosis who has IV albumin scheduled for administration immediately after a paracentesis. Which statement by the client indicates a correct understanding of the teaching?
a. Albumin helps to decrease the roundness of my abdomen
b. Albumin stops my hands from flapping when i hold my arms out
c. I need albumin so i can breathe easier when im lying down
d. I receive albumin to keep my blood pressure from getting too low

Answer 26

d. I receive albumin to keep my blood pressure from getting too low

Question 27

The nurse is educating a client at 37 weeks gestation who has preeclampsia with severe features about magnesium sulfate therapy. Which statement by the client indicates a need for further education about magnesium sulfate?
a. I am receiving magnesium sulfate to prevent my blood pressure from being too high
b. It will be necessary to continue this medication for several hours after giving birth
c. Magnesium sulfate will help prevent from having a seizure
d. This medication may make me feel hot, tired, and weak

Answer 27

a. I am receiving magnesium sulfate to prevent my blood pressure from being too high

Question 28

The nurse is educating a client about safety measures to implement for newly prescribed clopidogrel. Which statement by the client indicates a need for additional instruction?
a. I need to stop taking the Gingko biloba that i use for my memory
b. I should remind my dentist about this medication at each visit
c. I take ibuprofen instead of acetaminophen for minor aches and pains
d. I will begin monitoring my bowel movements for any changes in color

Answer 28

c. I take ibuprofen instead of acetaminophen for minor aches and pains

Question 29

The nurse is providing discharge teaching to a client newly prescribed rivaroxaban after treatment for a left leg deep venous thrombosis. Which statement by the nurse is appropriate to include in discharge teaching?
a. Avoid increased intake of foods high in vitamin K, such as brussel sprouts, which makes rivaroxaban less effective
b. If you need to have a spinal procedure, notify the health care provider that you are taking rivaroxaban (blood thinner).
c. You should stop taking rivaroxaban once the swelling in your legs has gone away
d. You will need to schedule regular appointments to have your blood PT/IN levels checked - warfarin

Answer 29

b. If you need to have a spinal procedure, notify the health care provider that you are taking rivaroxaban (blood thinner).

Question 30

The nurse is administering influenza vaccinations to clients at a community health fair. For which client would it be appropriate to administer the intranasal live attenuates influenza vaccine?
a. 23 year old client who is at 25 weeks gestation - never
b. 32 year old client with a kidney transplant - immunocompromised
c. 48 year old client with a total knee replacement
d. 80 year old client with alzheimer disease

Answer 30

c. 48 year old client with a total knee replacement

Question 31

The nurse assesses a client with hypertension, hyperlipidemia, and type 2 diabetes mellitus who has returned to the clinic for follow up on the current medication regimen. Based on the clients data, what change to the plan of care should the nurse anticipate? Click on exhibit
a. Decrease of the hydrochlorothiazide dose
b. Decrease of the metformin dose
c. Increase of the lisinopril dose
d. Increase of the simvastatin dose

Answer 31

d. Increase of the simvastatin dose

Question 32

The nurse receives several new prescriptions for a client who reports crushing, substernal chest pain that radiates down the left arm and is rated as a 9 on a scale of 0-10. Which prescription should the nurse clarify with the health care provider? Click on the exhibit
a. aspirin : 325 mg PO once
b. Morphine sulfate: 4 mg IV push NOW
c. nitroglycerin : 0.4 mg SL q5min PRN
d. 02: 10 L/min via non rebreather mask

Answer 32

a. aspirin : 325 mg PO once - too much should be a baby aspirin 81 mg

Question 33

The nurse is preparing to administer 8 AM insulin to a client with type 2 diabetes mellitus whose blood glucose level was 180 mg/dL (10 mmol/L) at 7:45 am. Within what time frame is the client at highest risk for hypoglycemia? Click on the exhibit
a. 8:30 - 11 am
b. 10 am - 1 pm
c. 11 am - 10 pm
d. 12-8 pm

Answer 33

a. 8:30 - 11 am

Question 34

The nurse is reinforcing instructions to a client newly prescribed diclofenac for chronic back pain. Which statement by the client causes the nurse to question the prescription?
a. I breastfeed my 9 month old, so is this safe to take?
b. I hope this helps my back because steroid injection did not
c. I occasionally get bad migraines. Will this help?
d. I take baby aspirin daily to prevent another heart attack

Answer 34

d. I take baby aspirin daily to prevent another heart attack

Question 35

The nurse is rounding on a client who underwent an open reduction and internal fixation of the left tibia 2 hours ago and is receiving IV hydromorphone via patient controlled analgesia pump. The client is unresponsive to sternal rub and has pinpoint pupils. Which of the following actions by the nurse are appropriate? Select all that apply. Click on the exhibit
a. Administering prescribed IV naloxone
b. Calling the rapid response team
c. Infusing a prescribed IV fluid bolus
d. Providing ventilation with a bag valve mask and 100% oxygen \
e. Suspending and disconnecting the patient controlled analgesia pump

Answer 35

a. Administering prescribed IV naloxone
b. Calling the rapid response team
c. Infusing a prescribed IV fluid bolus
d. Providing ventilation with a bag valve mask and 100% oxygen \
e. Suspending and disconnecting the patient controlled analgesia pump

Question 36

The clinic nurse is preparing to teach a client about newly prescribed sucralfate (Antacid) for the treatment of a duodenal ulcer. Which statement is the priority for the nurse to include in the teaching?
a. Drink plenty of fluids because this medication may cause constipation
b. If the tablet is difficult to swallow, it can be broken and dissolved in water
c. Some people experience dry mouth and drowsiness with this medication
d. This medication should be taken 1 hour before meals at bedtime

Answer 36

d. This medication should be taken 1 hour before meals at bedtime

Question 37

The nurse is conducting a staff education conference about alteplase infusion for clients with acute ischemic stroke. Which of the following statements by attendees indicates a proper understanding? Select all that apply.
a. I will assess for a decrease in level of consciousness, visual changes, and severe headache during the infusion
b. I will notify the health care provider if a client’s blood pressure is greater than 185/110 mm Hg prior to administration
c. If clients become tachycardic and hypotensive during therapy, i will perform a full assessment to identify possible findings
d. Invasive procedures and subcutaneous and IM injections should be avoided. if possible, during the infusion
e. Two nurses must calculate and verify the dosage, infusion rate, and IV pump setting before initiating alteplase infusion.

Answer 37

a. I will assess for a decrease in level of consciousness, visual changes, and severe headache during the infusion
b. I will notify the health care provider if a client’s blood pressure is greater than 185/110 mm Hg prior to administration
c. If clients become tachycardic and hypotensive during therapy, i will perform a full assessment to identify possible findings
d. Invasive procedures and subcutaneous and IM injections should be avoided. if possible, during the infusion
e. Two nurses must calculate and verify the dosage, infusion rate, and IV pump setting before initiating alteplase infusion.

Question 38

The nurse is reviewing the chart of a client with heart failure. Which prescription should the nurse clarify with the health care provider? Click on the exhibit
a. Atorvastatin 40 mg PO once daily
b. Captopril 25 mg three times daily
c. Furosemide 20 mg twice daily
d. Spironolactone 25 mg PO once daily - potassium sparing

Answer 38

c. Furosemide 20 mg twice daily

Question 39

The nurse is caring for a client with rheumatoid arthritis who is being treated with tofacitinib. Which client statement requires immediate follow up?
a. Even though my Tb test was negative, i may need another soon
b. I am scheduled to have my intranasal flu vaccine tomorrow morning
c. I will call my health care provider if i develop a fever
d. I will continue to have my blood cell levels checked frequently

Answer 39

b. I am scheduled to have my intranasal flu vaccine tomorrow morning

Question 40

The nurse is caring for a client who has been newly prescribed digoxin. Which of the following symptoms indicates potential toxicity?
a. Apical pulse of 65/min
b. Easy bruising and bleeding
c. Nausea and vomiting
d. Ringing in the ears

Answer 40

c. Nausea and vomiting

Question 41

A new graduate nurse is providing discharge instructions to a client with stable angina who was prescribed sublingual nitroglycerin. Which statement by the new nurse would cause the precepting nurse to intervene?
a. Call emergency medical services if symptoms persist after 3 doses
b. Nitroglycerin can be taken prophylactically before stressful activities
c. Sit or lie down when taking a tablet of sublingual nitroglycerin
d. Tablets should cause a tingling sensation under the tongue

Answer 41

a. Call emergency medical services if symptoms persist after 3 doses

Question 42

The nurse is caring for a client with end stage liver disease. The client has become increasingly confused and is now somnolent. The nurse receives several new prescriptions. Which prescription should the nurse administer first?
a. Furosemide 20 mg IV push
b. Lactulose enema 30 g in 500 mL sterile water
c. Pantroprazole 40 mg IV push
d. Rifaximin 550 mg via nasogastric tube

Answer 42

b. Lactulose enema 30 g in 500 mL sterile water

Question 43

The labor and delivery nurse plans care for several clients admitted for medically indicated labor instructions. The nurse recognizes that administration of dinoprostone gel for cervical ripening is appropriate for which client?
a. Client with a history of cesarean birth due to breech presentation, Bishop score of 6
b. Client with insulin controlled gestational diabetes, Bishop score of 3
c. Client with late decelerations on fetal heart rate monitor, Bishop score of 10
d. Client with poorly controlled chronic hypertension, Bishop score of 9

Answer 43

b. Client with insulin controlled gestational diabetes, Bishop score of 3

Question 44

The nurse is instructing a client who is newly prescribed nortriptyline for major depressive disorder. Which of the following statements made by the nurse are appropriate? Select all that apply
a. Avoid taking over the counter cold and allergy medications
b. Call the clinic if you feel like your heart is beating fast or skipping beats
c. Is this medicine causes you to feel sleepy, it may be taken at bedtime
d. This medication may cause your mouth to become very dry
e. Your mood will be improved after taking this medication for 2-3 days

Answer 44

a. Avoid taking over the counter cold and allergy medications
b. Call the clinic if you feel like your heart is beating fast or skipping beats
c. Is this medicine causes you to feel sleepy, it may be taken at bedtime
d. This medication may cause your mouth to become very dry

Question 45

The nurse is talking to a client during a follow up clinic visit after initiation of warfarin therapy a month ago. Which of the following client statements indicates a need for further teaching? sata
a. I bought and have been using my new soft bristle toothbrush and electric razor
b. I decreased the amount of leafy green vegetables i eat every day since my last visit
c. I have been using over the counter ibuprofen when i get headaches or joint pain
d. I started using garlic and ginger to season my foods instead of using table salt
e. I talked to my boss about how i will need to be absent periodically for routine blood work

Answer 45

b. I decreased the amount of leafy green vegetables i eat every day since my last visit
c. I have been using over the counter ibuprofen when i get headaches or joint pain
d. I started using garlic and ginger to season my foods instead of using table salt

Question 46

The charge nurse is assisting in the care of a client with acute decompensated heart failure who has been receiving a continuous IV infusion of sodium nitroprusside for the past 3 days. Which action by the primary nurse requires immediate intervention by the charge nurse?
a. Collects blood samples regularly to monitor thiocyanate levels
b. Frequently monitors the client’s pulse quality and level of consciousness
c. Plans to reassess blood pressure 1 hour after titrating the sodium nitroprusside
d. Protects the sodium nitroprusside infusion bag from exposure to light

Answer 46

c. Plans to reassess blood pressure 1 hour after titrating the sodium nitroprusside