Pharm Exam 2 - Sensory, Cardiac, Hematology

Question 1

Salicylic acid is prescribed for a client with a diagnosis of psoriasis. The nurse monitors the client, knowing that which finding indicates the presence of systemic toxicity from this medication?

Tinnitus
Diarrhea
Constipation
Decreased respirations

Answer 1

Tinnitus
Symptoms of systemic toxicity (salicylism) include tinnitus, dizziness, hyperpnea, and psychosocial disturbances

Question 2

The health education nurse provides instructions to a group of clients regarding measures that will assist in preventing skin cancer. Which instructions should the nurse provide? Select all that apply.

Sunscreen should be applied every 8 hours.
Use sunscreen when participating in outdoor activities.
Wear a hat, opaque clothing, and sunglasses when in the sun.
Avoid sun exposure in the late afternoon and early evening hours.
Examine your body monthly for any lesions that may be suspicious.

Answer 2

Use sunscreen when participating in outdoor activities.
Wear a hat, opaque clothing, and sunglasses when in the sun.
Examine your body monthly for any lesions that may be suspicious.

Sunscreen should be applied 30 minutes to an hour before sun exposure. It should be reapplied every 2 to 3 hours.

Question 3

Silver sulfadiazine is prescribed for a client with a burn injury. Which laboratory finding requires the need for follow-up by the nurse?

Glucose levels of 99 mg/dL (5.65 mmol/L)
Platelet level of 300,000 mm^3 (300 x 10^9/L)
Magnesium level of 1.5 mEq/L (0.75 mmol/L)
White blood cell count of 3000 mm^3 (3.0 x 10^9/L)

Answer 3

White blood cell count of 3000 mm^3 (3.0 x 10^9/L)

Silver sulfadiazine is used for the treatment of burn injuries. Adverse effects of this medication include rash and itching, blue-green or gray skin discoloration, leukopenia, and interstitial nephritis. The nurse should monitor a complete blood count, particularly the white blood cells, frequently for the client taking this medication. If leukopenia develops, the primary health care provider is notified and the medication is usually discontinued. The white blood cell count noted in option 4 is indicative of leukopenia. The other laboratory values are not specific to this medication and are also within normal limits.

Question 4

A burn client is receiving treatments of topical mafenide acetate to the site of injury. The nurse monitors the client, knowing that which finding indicates that a systemic effect has occurred?

Hyperventilation
Elevated blood pressure
Local rash at the burn site
Local pain at the burn site

Answer 4

Hyperventilation

Mafenide acetate is a carbonic anhydrase inhibitor and can suppress renal excretion of acid, thereby causing acidosis. Clients receiving this treatment should be monitored for signs of an acid-base imbalance (hyperventilation). If this occurs, the medication will probably be discontinued for 1 to 2 days. Options 3 and 4 describe local rather than systemic effects. An elevated blood pressure may be expected from the pain that occurs with a burn injury.

Question 5

Isotretinoin is prescribed for a client with severe acne. Before the administration of this medication, the nurse anticipates that which laboratory test will be prescribed?

Potassium level
Triglyceride level
Hemoglobin A1C
Total cholesterol level

Answer 5

Triglyceride level

Isotretinoin can elevate triglyceride levels. Blood triglyceride levels should be measured before treatment and periodically thereafter until the effect on the triglycerides has been evaluated. There is no indication that isotretinoin affects potassium, hemoglobin A1C, or total cholesterol levels.

Question 6

A client with severe acne is seen in the clinic and the primary health care provider (PHCP) prescribes isotretinoin. The nurse reviews the client’s medication record and would contact the PHCP if the client is also taking which medication?

Digoxin
Phenytoin
Vitamin A
Furosemide

Answer 6

Vitamin A

Isotretinoin is a metabolite of vitamin A and can produce generalized intensification of isotretinoin toxicity. Because of the potential for increased toxicity, vitamin A supplements should be discontinued before isotretinoin therapy. There are no contraindications associated with digoxin, phenytoin, or furosemide.

Question 7

The nurse is applying a topical corticosteroid to a client with eczema. The nurse understands that it is safe to apply the medication to which body areas? Select all that apply.

Back
Axilla
Eyelids
Soles of the feet
Palms of the hands

Answer 7

Back
Soles of the feet
Palms of the hands

Topical corticosteroids can be absorbed into the systemic circulation. Absorption is higher from regions where the skin is especially permeable (scalp, axilla, face, eyelids, neck, perineum, genitalia), and lower from regions where permeability is poor (back, palms, soles). The nurse should avoid areas of higher absorption to prevent systemic absorption.

Question 8

The clinic nurse is performing an admission assessment on a client and notes that the client is taking azelaic acid to treat acne. The nurse determines that which client complaint may be associated with use of this medication?

Itching
Euphoria
Drowsiness
Frequent urination

Answer 8

Itching

Azelaic acid is a topical medication used to treat mild to moderate acne. Adverse effects include burning, itching, stinging, redness of the skin, and hypopigmentation of the skin in clients with a dark complexion. The effects noted in the other options are not specifically associated with this medication.

Question 9

Silver sulfadiazine is prescribed for a client with a partial-thickness burn, and the nurse provides teaching about the medication. Which statement made by the client indicates a need for further teaching about the treatments?

“The medication is an antibacterial.”
“The medication will help heal the burn.”
“The medication should be applied directly to the wound.”
“The medication is likely to cause stinging every time it is applied.”

Answer 9

“The medication is likely to cause stinging every time it is applied.”

Silver sulfadiazine is an antibacterial that has a broad spectrum of activity against gram-negative bacteria, gram-positive bacteria, and yeast. It is applied directly to the wound to assist in healing. It does not cause stinging when applied.

Question 10

The camp nurse asks the children preparing to swim in the lake if they have applied sunscreen. The nurse reminds the children that chemical sunscreens are most effective when applied at which times?

Immediately before swimming
5 minutes before exposure to the sun
Immediately before exposure to the sun
At least 30 minutes before exposure to the sun

Answer 10

At least 30 minutes before exposure to the sun

Sunscreens are most effective when applied at least 30 minutes before exposure to the sun so that they can penetrate the skin. All sunscreens should be reapplied after swimming or sweating.

Question 11

Betaxolol hydrochloride eye drops have been prescribed for a client with glaucoma. Which nursing action is most appropriate related to monitoring for side and adverse effects of this medication?

Assessing for edema
Monitoring temperature
Monitoring blood pressure
Assessing blood glucose level

Answer 11

Monitoring blood pressure

Hypotension, dizziness, nausea, diaphoresis, headache, fatigue, constipation, and diarrhea are side and adverse effects of the medication. Nursing interventions include monitoring the blood pressure for hypotension and assessing the pulse for strength, weakness, irregular rate, and bradycardia. Options 1, 2, and 4 are not specifically associated with this medication.

Question 12

Which medication, if prescribed for the client with glaucoma, should the nurse question?

Betaxolol
Pilocarpine
Erythromycin
Atropine sulfate

Answer 12

Atropine sulfate

Options 1 and 2 are miotic agents used to treat glaucoma. Option 3 is an anti-infective medication used to treat bacterial conjunctivitis. Atropine sulfate is a mydriatic and cycloplegic (also anticholinergic) medication, and its use is contraindicated in clients with glaucoma. Mydriatic medications dilate the pupil and can cause an increase in intraocular pressure in the eye.

Question 13

A miotic medication has been prescribed for the client with glaucoma, and the client asks the nurse about the purpose of the medication. Which response should the nurse provide to the client?

“The medication will help dilate the eye to prevent pressure from occurring.”
“The medication will relax the muscles of the eyes and prevent blurred vision.”
“The medication causes the pupil to constrict and will lower the pressure in the eye.”
“The medication will help block the responses that are sent to the muscles in the eye.”

Answer 13

“The medication causes the pupil to constrict and will lower the pressure in the eye.”

Miotics cause pupillary constriction and are used to treat glaucoma. They lower the intraocular pressure, thereby increasing blood flow to the retina and decreasing retinal damage and loss of vision. Miotics cause a contraction of the ciliary muscle and a widening of the trabecular meshwork. Options 1, 2, and 4 are incorrect.

Question 14

In preparation for cataract surgery, the nurse is to administer cyclopentolate eye drops at 0900 for surgery that is scheduled for 0915. What initial action should the nurse take in relation to the characteristics of the medication action?

Provide lubrication to the operative eye prior to giving the eye drops.
Call the surgeon, as this medication will further constrict the operative pupil.
Consult the surgeon, as there is not sufficient time for the dilative effects to occur.
Give the medication as prescribed; the surgeon needs optimal constriction of the pupil.

Answer 14

Consult the surgeon, as there is not sufficient time for the dilative effects to occur.

Cyclopentolate is a rapidly acting mydriatic and cycloplegic medication. Cyclopentolate is effective in 25 to 75 minutes, and accommodation returns in 6 to 24 hours. Cyclopentolate is used for preoperative mydriasis, not pupil constriction. The nurse should consult with the surgeon about the time of administration of the eye drops since 15 minutes is not adequate time for dilation to occur.

Question 15

A client with glaucoma is given a prescription for a pilocarpine ocular system. The nurse plans to provide which instruction to the client on how to use the medication?

Apply ½ inch into the eye at bedtime.
Apply 1 drop of the solution 4 times a day.
Remove and replace the ocular system every 48 hours.
Check the eye each morning to make sure that the system is in place.

Answer 15

Check the eye each morning to make sure that the system is in place.

The pilocarpine ocular system has a bilayered membrane surrounding a reservoir of pilocarpine solution. The tiny unit, which is placed in the conjunctival sac, slowly releases medication. The unit should be changed once a week. Because the unit may fall out during sleep, the client should check the eye each morning for its presence.

Question 16

The nurse is performing an admission assessment on a client who has a history of glaucoma and uses latanoprost eye drops. Which assessment finding would indicate a side/adverse effect of these eye drops?

Irregular pulse
Periorbital edema
Elevated blood pressure
Brown pigmentation of the iris

Answer 16

Brown pigmentation of the iris

Latanoprost is a topical medication used to lower intraocular pressure in clients with open-angle glaucoma and ocular hypertension. The most significant side/adverse effect is heightened brown pigmentation of the iris. Other side effects include blurred vision, burning, stinging, conjunctival hyperemia, and punctate keratopathy. The heightened pigmentation does not progress further once the medication is discontinued but does not regress. The other options are not noted with this medication.

Question 17

The home care nurse is reviewing the record of a client newly diagnosed with glaucoma who is scheduled for a home visit. The nurse notes that the primary health care provider (PHCP) has prescribed atropine sulfate and pilocarpine hydrochloride eye drops. The nurse should contact the PHCP before the home visit for which reason?

Clarify the prescription for the atropine sulfate.
Clarify the prescription for the pilocarpine hydrochloride.
Determine the date of the scheduled follow-up PHCP visit.
Determine the extent of the intraocular pressure caused by the glaucoma.

Answer 17

Clarify the prescription for the atropine sulfate.

Atropine sulfate is a mydriatic and cycloplegic medication that is contraindicated in clients with glaucoma. Mydriatic medications dilate the pupil and cause increased intraocular pressure in the eye. Pilocarpine hydrochloride is a miotic agent used in the treatment of glaucoma. It is unnecessary to contact the PHCP regarding the date for follow-up treatment. In fact, the client may know this date, which the nurse can ask about during the home care visit. It is unnecessary to know the extent of the intraocular pressure caused by the glaucoma in planning care for the client.

Question 18

The nursing student is assigned to care for a client with glaucoma for whom pilocarpine hydrochloride eye drops have been prescribed. The nursing instructor asks the student to describe the action of the eye medication. Which statement by the student indicates an understanding of the purpose of this medication?

“The medication prevents blurred vision by relaxing the muscles of the eyes.”
“The medication dilates the eye to prevent increased pressure from occurring.”
“The medication increases the blood flow to the retina and also will lower the pressure in the eye.”
“The medication blocks responses that are sent to the brain that direct the actions of the muscles in the eye.”

Answer 18

“The medication increases the blood flow to the retina and also will lower the pressure in the eye.”

Pilocarpine hydrochloride is a miotic that is used to lower the intraocular pressure, thereby increasing blood flow to the retina and decreasing retinal damage and loss of vision. Miotics cause a contraction of the ciliary muscle and a widening of the trabecular meshwork. The statements in the remaining options are incorrect.

Question 19

Pilocarpine hydrochloride is prescribed for a client with glaucoma. The nurse checks the medication supply room to ensure that atropine sulfate is available for administration in the event that systemic toxicity occurs from the use of pilocarpine hydrochloride. The nurse also monitors for which sign of systemic toxicity?

Flushing
Anorexia
Bradycardia
Hypertension

Answer 19

Bradycardia

Systemic absorption of pilocarpine hydrochloride can produce toxicity, manifested as vertigo, bradycardia, tremors, hypotension, syncope, cardiac dysrhythmias, and seizures. Atropine sulfate is the antidote for systemic reactions that occur with pilocarpine. Flushing and anorexia are not specifically associated with this medication.

Question 20

Betaxolol eye drops have been prescribed for a client with glaucoma. The home health nurse preparing to visit the client develops a plan of care that includes monitoring for the side/adverse effects of this medication by taking which assessment action?

Monitoring body weight
Assessing the glucose level
Assessing peripheral pulses
Monitoring body temperature

Answer 20

Monitoring body weight

This medication is an antiglaucoma medication and a beta-adrenergic blocker. The nurse assesses for evidence of heart failure manifested by dizziness, night cough, peripheral edema, and distended neck veins. Intake greater than output, weight gain, and decreased urine output also may indicate heart failure. Hypotension (manifested as dizziness), nausea, diaphoresis, headache, fatigue, and constipation or diarrhea also are potential systemic effects of the medication. Nursing interventions include monitoring body weight; periodically evaluating blood pressure for hypotension; and assessing the apical or radial pulse for strength, weakness, irregular heart rate, and bradycardia.

Question 21

A client who is scheduled for cataract surgery requires preoperative instillation of cyclopentolate eye drops as prescribed. The client asks the nurse why this medication is needed, and the nurse provides education. Which statement by the client indicates that teaching has been effective?

“The medication dilates the pupil of the operative eye.”
“The medication constricts the pupil of the operative eye.”
“The medication is needed for the initiation of miosis in the operative eye.”
“The medication provides the necessary lubrication to the nonoperative eye.”

Answer 21

“The medication dilates the pupil of the operative eye.”

Cyclopentolate is a rapidly acting mydriatic and cycloplegic medication that is used preoperatively to dilate the eye. It is effective in 25 to 75 minutes, and accommodation returns in 6 to 24 hours. The statements in the other options are incorrect.

Question 22

The nurse working in a long-term care facility notes that several clients are taking pilocarpine hydrochloride eye drops. The nurse ensures that which medication is available on the nursing unit for use if a client should develop systemic toxicity from pilocarpine hydrochloride?

Disulfiram
Cyclopentolate
Atropine sulfate
Naloxone hydrochloride

Answer 22

Atropine sulfate

Pilocarpine hydrochloride is a cholinergic agent. Atropine sulfate must be available in the event of systemic toxicity from pilocarpine hydrochloride. Pilocarpine toxicity is manifested by vertigo, bradycardia, tremors, hypotension, syncope, cardiac dysrhythmias, and seizures. Disulfiram is an alcohol deterrent used in the management of alcoholism in selected clients. Cyclopentolate is a rapidly acting mydriatic and cycloplegic medication used preoperatively for surgical procedures on the eye. Naloxone hydrochloride is an opioid antagonist used to reverse opioid-induced respiratory depression.

Question 23

A client has been prescribed betaxolol eye drops for the treatment of glaucoma. The ambulatory care nurse determines that the client understands proper medication use if the client states the need to return to the office for monitoring of what item(s)?

Hearing acuity
Blood pressure
Blood glucose level
Presence of calf pain

Answer 23

Blood pressure

Betaxolol is an antiglaucoma medication and a beta-adrenergic blocker. Systemic effects of this medication are hypotension, dizziness, nausea, diaphoresis, headache, fatigue, constipation, and diarrhea. The client should have the blood pressure monitored for hypotension and the pulse assessed for strength, weakness, irregular rate, and bradycardia. Bowel activity and evidence of heart failure also should be assessed. The other options are incorrect and not associated with this medication.

Question 24

A client with glaucoma is receiving acetazolamide. The nurse educator provides education to a group of nurses about the indications for and effect of this medication. Which statement by one of the nurses indicates that the teaching has been effective?

“This works to prevent hypertension.”
“This works to prevent hyperthermia.”
“This works to decrease intraocular pressure.”
“This works to maintain an adequate blood pressure for cerebral perfusion.”

Answer 24

“This works to decrease intraocular pressure.”

Acetazolamide is a carbonic-anhydrase inhibitor used to treat glaucoma. The medication decreases the formation of aqueous humor. The statements in the remaining options are not indicative of the purpose of this medication.

Question 25

In preparation for cataract surgery, the nurse is to administer prescribed eye drops. The nurse reviews the primary health care provider’s prescriptions, expecting which type of eye drops to be prescribed?

A miotic agent
A thiazide diuretic
An osmotic diuretic
A mydriatic medication

Answer 25

A mydriatic medication

A mydriatic medication produces mydriasis or dilation of the pupil. Mydriatic medications are used preoperatively in the client with a cataract. These medications act by dilating the pupils; they also constrict blood vessels. A miotic medication constricts the pupil. An osmotic diuretic may be used to decrease intraocular pressure. A thiazide diuretic is not likely to be prescribed for a client with a cataract.

Question 26

The preoperative medication sheet identifies that cyclopentolate is prescribed for a client before cataract surgery. The client asks the nurse what the medication is for, and the nurse provides education. Which statement by the client indicates that teaching has been effective?

“It lubricates the eye.”
“It makes my pupils smaller.”
“It paralyzes the muscles in my eye.”
“It causes my vessels to become smaller.”

Answer 26

“It paralyzes the muscles in my eye.”

Cyclopentolate is used for preoperative mydriasis. It is a rapid-acting mydriatic and cycloplegic medication. Cycloplegics are medications that paralyze the ciliary muscle, and mydriatics are medications that dilate the pupil. Cyclopentolate becomes effective in 25 to 75 minutes, and the effects last for 6 to 24 hours. The statements in the remaining options are not actions of this medication.

Question 27

The nurse would question the primary health care provider if which medication were prescribed for a client with glaucoma?

Carbachol
Atropine sulfate
Pilocarpine nitrate
Pilocarpine hydrochloride

Answer 27

Atropine sulfate

Pilocarpine and carbachol are examples of miotic agents used in the treatment of glaucoma. Atropine sulfate is a mydriatic and cycloplegic medication that is contraindicated for use in clients with glaucoma. Mydriatic medications dilate the pupil and can cause an increase in intraocular pressure in the eye.

Question 28

When teaching a client with glaucoma about the effects of a miotic medication, the nurse should tell the client that the medication will produce which effect?

Reshape the lens to eliminate blurred vision.
Dilate the pupil to reduce intraocular pressure.
Interrupt the drainage of aqueous humor from the eye.
Lower intraocular pressure and improve blood flow to the retina.

Answer 28

Lower intraocular pressure and improve blood flow to the retina.

Miotics are used to lower the intraocular pressure, which then increases blood flow to the retina. This in turn decreases retinal damage and loss of vision. Miotics cause a contraction or constriction of the ciliary muscle and widen the trabecular meshwork. The other options are incorrect.

Question 29

Betaxolol eye drops have been prescribed for a client with glaucoma. The nurse monitoring this client for side/adverse effects of the medication would place highest priority on which assessment?

Pulse rate
Blood glucose
Respiratory rate
Oxygen saturation

Answer 29

Pulse rate

Betaxolol is a beta-blocking agent as well as an antiglaucoma medication. Nursing assessments include monitoring the blood pressure for hypotension and assessing the pulse for strength, weakness, irregular rate, and bradycardia. The nurse also assesses for evidence of heart failure as manifested by dizziness, night cough, peripheral edema, and distended neck veins.

Question 30

A client with chronic glaucoma is being started on medication therapy with acetazolamide. The nurse teaches the client that which can occur early with the use of this medication?

Fatigue
Diuresis
Headache
Loss of libido

Answer 30

Diuresis

Diuresis is an early side effect of acetazolamide that usually subsides with continued treatment. This is because the medication is also a weak diuretic, although it is no longer prescribed for that purpose. Fatigue, headache, and loss of libido are common side effects of therapy, but these may not subside spontaneously.

Question 31

The nurse is reviewing the record of a client who arrives at the health care clinic. The nurse notes that irbesartan has been prescribed for the client. The nurse should suspect that the client has which condition?