CMS
CMS
CMS
CMS
CMS
CMS
100
A client is prescribed amitriptyline (Elavil). Which of the following adverse effects should the nurse instruct the client to report?
DROWSINESS, dizziness, dry mouth, blurred vision, constipation, weight gain, or URINARY RETENTION. If any of these effects persist or worsen, notify your doctor or pharmacist promptly. To reduce the risk of dizziness and lightheadedness, get up slowly when rising from a sitting or lying position. ?
100
A nurse is caring for a client who has peptic ulcer disease and reports moderate headache. Which of the following medications should the nurse plan to administer?
A. Motrin
B. Acetaminophen
C. Diazepam
D. Toradol
B. Acetaminophen
Acetaminophen is an analgesic used for mild to moderate pain. It can be administered to a client who has peptic ulcer disease because it does not affect blood coagulation and does not increase the risk of gastrointestinal bleeding.
100
1. A nurse is reviewing a client's daily laboratory findings before administering 0.125 mg of digoxin (Lanoxin). The client's serum digoxin level is 0.8 ng/mL.
Which of the following actions should the nurse take?A) Give the medication
B) Request a dose increase
C. Request a dose decrease
A. Give the medication.
Therapeutic levels of digoxin are 0.8-2.0 ng/mL. The toxic level is >2.4 ng/mL
100
Yellow halos seen around light, bradycardia, blurred vision, nausea, vomiting, are common signs and symptoms associated with toxicity of this drug.
What is digoxin?
100
A nurse is assessing a client who has a new prescription for chlorpromazine to treat schizophrenia. The client has a mask-like facial expression and is experiencing involuntary movements and tremors. Which of the following medication should the nurse anticipate administering?
A. Amantadine
B. Neostigmine
C. Both A & B
D. None of the above. Continue chlorpromazine
A. Amantadine
▪ The client is experiencing parkinsonism, which is an adverse effect of the antipsychotic medication chlorpromazine. Amantadine is an antiparkinsonian medication used to treat the extrapyramidal manifestations in PD.
100
A nurse working for a home health agency is teaching a client who has diabetes mellitus about disease management. Which of the following glycosylated hemoglobin (HbA1c) values should the nurse include in the teaching as an indicator that the client is appropriately controlling his glucose levels?
A. 7.5%
B. 6.3%
C. 7%
D. 6.8%
B. 6.3%
The client who has diabetes mellitus needs to manage activity and diet while monitoring blood glucose levels. High levels of blood glucose cause damage to the macro and microcirculation, affecting such things as eyesight and kidney function. The goal for a client who has diabetes mellitus is to keep the HbA1c values at 6.5% or less.
200
A nurse is providing teaching to a client who has rheumatoid arthritis and is prescribed methotrexate (Rheumatrex). Which of the following statements by the client indicates an understanding of the teaching:
A. I should call my doctor if I develop sores in my mouth
B. I will have difficulty sleeping when I take this medication
C. I will have decreased sun sensitivity.
A. I should call my doctor if I develop sores in my mouth
Common side effects: Abdominal discomfort; chills; dizziness; fever; general feeling of illness; hair loss; headache; increased sun sensitivity; itching; liver problems; low blood counts; mouth sores; nausea; rash; shortness of breath; YEAST INFECTIONS.
200
The patient taking methimazole may need to increase their dosage in the following situations? SATA
A. If the patient has gained weight and is sleeping better
B. If the patient is still experiencing anxiety, tachycardia and other s/s of hyperthyroidism
C. If the patient still has increased levels of T4
D. Patient continues to lose weight
B & C & D
B. If the patient is still experiencing anxiety, tachycardia and other s/s of hyperthyroidism
C. If the patient still has increased levels of T4
D. Patient continues to lose weight
200
A nurse caring for a client that has undergone a liver transplant and is taking cyclosporine (Sandimmune). Which of the following laboratory findings indicates an adverse effect of the medication:
A) WBC count 8,000/mm3
B. Serum creatine 2.5 mg/dL
B. Serum creatine 2.5 mg/dL.
Cyclosporine is Nephrotoxic and creatine of 2.5mg/dL indicates toxicity,
200
Ataxia, sedation, nystagmus, diplopia, cognitive impairment are signs/symptoms associated with toxicity of this drug
What is phenytoin (Dilantin)?
200
A nurse is caring for an older client who has a prescription for zolpidem at bedtime to promote
sleep. The nurse should plan to monitor the client for which of the following adverse effects?
A. Nausea
B. Vomiting
C. Tremors
D. Dizziness
D. Zolpidem can cause dizziness and daytime drowsiness. It can cause confusion in the older adult client.
200
A nurse is caring for a client with diabetes mellitus who is prescribed regular insulin via a sliding scale. After administering the correct dose at 0715, the nurse should ensure the client receives breakfast at which of the following times?
A. 7.30am
B. 7.45am
C. 8am
D. 0815am
B. 7.45am
Regular insulin should be given 20 to 30 minutes before eating because the onset of action is 30 minutes. There are circumstances when this lag time guide can be adjusted.
300
A client is receiving a heparin infusion for deep vein thrombosis. The nurse should discontinue the medication infusion for which client findings:
A. Hemoglobin 15 g/dL
B. Platelets 96,000/mm
C. Increased INR/PT
D. WBCs 5000 K/uL
B. Platelets 96,000/mm
300
When taking an ACE medication, what is the most life threatening side effect of this medication?
What is angioedema?
300
This medication is a sympathetic agonist that is used for bronchial asthma, exacerbation of some forms of COPD, allergic reactions and anaphylaxis.
What is epinephrine?
300
A nurse is providing teaching to a client who has gout and a new prescription for allopurinol. The
nurse should instruct the client to discontinue taking the medication for which of the following
adverse effects?
A. Fever
B. Hypothermia
C. Oliguria
D. Edema
A. Fever
Fever can indicate a potentially fatal hypersensitivity reaction. The client should
discontinue the allopurinol and notify the provider if a fever or rash develops.
300
A client with a-fib is receiving coumadin. Which of the following test results indicate this medication is at it's therapeutic effect?
INR 0.9
INR 2.5
INR 4
What is INR 2.5 ?
300
A nurse is caring for a client who has a new prescription for propranolol. The nurse should monitor the client for which of the following adverse reactions to this medication?
A. Ototoxicity
B. Tachycardia
C. Postural hypotension
D. Hypokalemia
C. Postural Hypotension
- Ototoxicity
Rationale: Propranolol can cause bronchoconstrictions in clients who have asthma.
- Tachycardia
Rationale: Bradycardia is an adverse reaction of beta-blockers. The nurse should withhold the medication if the client's heart rate is less than 50/min.
- Postural hypotension
Rationale: Propranolol can cause postural hypotension. The client should change positions slowly and the nurse should monitor the client's blood pressure from a lying to sitting to standing position.
- Hypokalemia
Rationale: Propranolol can mask tachycardia, an early manifestation of hypoglycemia in clients who have diabetes mellitus.
400
A nurse is planning teaching for a client who has a new diagnosis of exercise-induces asthma. Which of the following medications should the nurse instruct the client to use prior to physical activity?
A. Cromolyn sodium
B) Prednisone (Deltasone)
C. Betablockers
D. All betablockers except Metoprolol
A. Cromolyn sodium (Intal)
400
A nurse is planning care for a client who has a seizure disorder and a new prescription for valproic acid. Which of the following laboratory values should the nurse plan to monitor? SATA
A. Pt/INR
B. K+ levels
C. PTT
D. AST
C. PTT &
D. AST
Valproic acid can alter coagulation; therefore, PTT should be monitored
o Aspartate aminotransferase (AST)
Valproic acid can cause life-threatening hepatotoxicity. The client should have baseline liver function tests (LFTs) before starting this medication and LFTs should be repeated at regular intervals during therapy
400
A nurse is providing teaching to a client who has ulcerative colitis and a new prescription for sulfasalazine. The nurse should instruct the client to monitor for which of the following adverse effects of this medication?
A. Jaundice
B. Headache
C. Dizziness
A. Jaundice
Hepatotoxicity. Sulfasalazine, like other sulfonamides, causes a characteristic idiosyncratic liver injury that has features of drug-allergy or hypersensitivity. The typical onset is sudden development of fever and rash followed by jaundice within a few days or weeks of starting the medication
400
The nurse is administering vancomycin to a patient. What is important to assess prior to administration?
What is a trough level?
Normal is 5-15 mcg/mL
400
Give 3 food examples of food high in Vitamin k
What is asparagus, beans, broccoli, brussel sprouts, cabbage, kale, mustard greens, spinach, swiss chard ?
400
1. What is the normal BUN and Creatinine levels?
2. Drugs that are Nephrotoxic?
BUN levels are 10-20 mg/dL and Creatinine 0.6- 1.2?
2. Cyclosporine, aminoglycoside antibiotics, cisplatin, amphotericin B, beta-lactam antibiotics and indomethacin
500
A nurse is caring for a client who has a new prescription for amphotericin B. The nurse should plan to monitor the client for which of the following adverse effects?
A. Ototoxicity
B. Nephrotoxicity
C. Low WBCs
B. Nephrotoxicity
Amphotericin B is an antifungal medication used to treat severe fungal infections;
however, it can cause nephrotoxicity. The nurse should monitor the client’s
creatinine every 3-4 days and increase fluid intake. The dosage of amphotericin B
should be reduced if the client’s creatinine is 3.5 mg/dL or greater.
500
When taking Procardia the nurse should provide education to avoid which fruit and which herbal medication?
What is Grapefruit?
What is Ginkgo biloba, Ginseng, and St. John's wort?
500
1. Mechanism of action of atropine?
2. Herb used for BPH?
1.What is blocks acetylcholine and inhibits parasympathetic stimulation?
2. Saw Palmetto
500
Some signs and symptoms of toxicity for this mood stabilizing medication can include muscle stiffening, nausea, vomiting, tremors, and diarrhea
What is lithium?
A safe blood level of lithium is 0.6 and 1.2 milliequivalents per liter (mEq/L). Lithium toxicity can happen when this level reaches 1.5 mEq/L or higher. Severe lithium toxicity happens at a level of 2.0 mEq/L and above
Remember: Fine Tremors = side effects
Coarse Tremors = Adverse effects
500
This lab work needs to be monitored when giving Heparin?
What is hemoglobin, platelets, aPTT?
500
A nurse is assessing an older adult client who is receiving IV therapy. The nurse should recognize that which of the following findings indicates fluid volume excess? (Select all that apply.)
A. Bounding pulse
B. Pitting edema
C. Swelling at the IV site
D. Urine-specific gravity greater than 1.030
E. Crackles upon auscultation
A. B. E
A. Manifestations include increased blood pressure, pulse, and respirations. With fluid volume excess, the pulse is full and bounding. Pitting edema is correct.
B. Excess extracellular fluid can lead to pitting edema in dependent areas of the body.
C. Swelling at the IV site is incorrect. Edema at the IV site indicates a localized accumulation of fluid due to infiltration. Although this is a concern, this finding does not suggest fluid volume excess.
This finding would suggest infiltration. The nurse should discontinue the IV and restarted at another site.
D. Urine specific gravity greater than 1.030 is incorrect. Urine-specific gravity measures the concentration of all chemical particles in the urine. A therapeutic range is 1.005 to 1.030. A urine-specific gravity greater than 1.030 indicates dehydration, and a gravity of less than 1.010 indicates fluid volume excess.
E. Crackles upon auscultation is correct. Pulmonary edema can occur with fluid volume excess.
600
A nurse is caring for a client who has a new prescription for enalapril. The nurse should monitor the client for which of the following adverse effects of this medication?
A. Shortness of breath
B. Increased anxiety
C. Increased HR
D. Hypotension
D. Hypotension
Enalapril, an angiotensin-converting enzyme (ACE) inhibitor, can cause hypotension and postural hypotension, especially during the first 3 hrs. following the initial dosage.
600
Instructions the nurse will provide for a patient taking spironolactone?
Don't take of potassium supplements or potassium containing salt substitutes. Report palpitations, muscle twitching, MUSCLE WEAKNESS, or paresthesia in extremities.
600
Name this drug?
_______ is used to improve muscle strength in patients with a certain muscle disease. It works by preventing the breakdown of a certain natural substance (acetylcholine) in your body. Acetylcholine is needed for normal muscle function.
Taking this medication with food or milk may help to decrease side effects.
Nausea, vomiting, DIARRHEA, abdominal cramps, increased saliva/mucus, decreased pupil size, increased urination, or increased sweating may occur. If any of these effects persist or worsen, tell your doctor or pharmacist promptly
What is Neostigmine (Prostigmin)?
600
Use caution with this antibiotic in patients with renal impairment, advanced age, dehydration, and prolonged use of this medication.
This medication has the potential for nephrotoxicity and ototoxicity (TINNITUS)
What is Gentamycin?
600
A nurse is providing teaching to a newly licensed nurse about metoclopramide. The nurse should
include in the teaching that which of the following conditions is a contraindication to this medication?
A. Gastric motility
B. Intestinal obstruction
B. Intestinal obstruction
▪ Metoclopramide reduces nausea and vomiting by increasing gastric motility and promoting gastric emptying. It is contraindicated for a client who has an intestinal obstruction or perforation.
600
A nurse is assessing a client who is taking levothyroxine. The nurse should recognize that which of the following findings is a manifestation of levothyroxine overdose?
A. Insomnia
B. Constipation
C. Drowsiness
D. Hypoactive deep-tendon reflexes
A. Insomnia
Rationale: Levothyroxine overdose will result in manifestations of hyperthyroidism, which include insomnia, tachycardia, and hyperthermia.
- Constipation
Rationale: Constipation is a manifestation of hypothyroidism and indicates an inadequate dose of levothyroxine.
- Drowsiness
Rationale: Drowsiness is a manifestation of hypothyroidism and indicates an inadequate dose of levothyroxine.
- Hypoactive deep-tendon reflexes
Rationale: Hypoactive deep-tendon reflexes are manifestations of hypothyroidism and indicate an inadequate dose of levothyroxine.
700
A nurse is caring for a client who has a prescription for Clopidogrel (Plavix). The nurse should monitor the client for which of the following adverse effects?
A. Hypertension
B. Bleeding
C. Frothy urine
B. Bleeding
Clopidogrel is an antithrombotic medication that inhibits platelet aggregation. It is used to prevent stenosis of coronary stents, MI’s, and strokes. The nurse should monitor for coffee ground emesis, black tarry stools, ecchymosis or any indication of bleeding.
700
What are the side effects of Epogen?
Headache, body aches, cough, or injection site irritation/pain may occur. If any of these effects last or get worse, tell your doctor or pharmacist promptly.
Epoetin alfa may sometimes cause or worsen HIGH BLOOD PRESSURE, especially in patients with long-term kidney failure. This effect may be caused by the number of red blood cells increasing too quickly, usually within the first 3 months of starting treatment. If you have high blood pressure, it should be well controlled before beginning treatment with this medication. Your blood pressure should be checked often. Ask your doctor if you should learn how to check your own blood pressure. If high blood pressure develops or worsens, follow your doctor's instructions about diet changes and starting or adjusting your high blood pressure medication. Lowering high blood pressure helps prevent thrombus, strokes, heart attacks, and further kidney problems.
700
A nurse is caring for a client who has been taking isoniazid and rifampin for 3 weeks for the treatment of active pulmonary tuberculosis (TB). The client reports his urine is a dark orange color. Which of the following statements should the nurse make?
A. Rifampin can turn body fluids orange.
B. Stop the medication immediately and go to ED.
C. Do not take the medication today, observe if urine color returns to normal.
D. Inform the physician immediately
A. Rifampin can turn body fluids orange.
▪ Rifampin can cause body fluids, such as tears, sweat, saliva, and urine to turn a reddish-orange color. The nurse should inform the client that this effect does not cause harm.
700
A nurse is caring for a client who has a prescription for chlorothiazide to treat hypertension. The nurse should plan to monitor the patient for which of the following adverse effects?
A. Weight gain
B. Confusion and disorientation
C. Muscle weakness
C. Muscle weakness
Chlorothiazide is a thiazide diuretic used to treat HTN and CHF. It promotes excretion of water, sodium, and potassium and can cause hypokalemia. Manifestations of hypokalemia include muscle weakness, muscle cramps and dysrhythmias
700
Anti-lipemic agents: assessment prior to starting therapy with Lovastatin.
a. Try doing lifestyle changes
b. Monitor BP
c. Monitor triglyceride levels
d. Explain to patient to take medication before bed
e. Cholesterol metabolizes at night
All of the above
700
A nurse is caring for four clients. After administering morning medications, she realizes that the nifedipine prescribed for one client was inadvertently administered to another client. Which of the following actions should the nurse take first?
A. Notify the client's provider.
B. Check the client's vital signs.
C. Fill out an occurrence form.
D. Administer the medication to the correct client.
- Check the client's vital signs.
Rationale: The first action the nurse should take using the nursing process is to assess the client. The nurse should know that the action of nifedipine is to lower blood pressure. Immediately upon realizing the error, the nurse should check the client's vital signs (especially the client's blood pressure) to ensure that the client is not hypotensive as a result. Only after ensuring that the client is safe and has stable vital signs should the nurse take other actions.
Notify the client's provider.
Rationale: The nurse should notify the client's provider to inform her of the event; however, there is another action the nurse should take first.
Fill out an occurrence form.
Rationale: The nurse should fill out an occurrence form to report the event to hospital personnel; however, there is another action the nurse should take first.
Administer the medication to the correct client.
Rationale: The nurse should administer the medication to the correct client to fulfill the provider's prescription; however, there is another action the nurse should take first.
800
A nurse is teaching a newly licensed nurse about contraindications to ceftriaxone. The nurse should include a severe allergy to which of the following medications as a contraindication to ceftriaxone?
A. Vancomycin
B. Piperacillin
C. Gentamycin
B. Piperacillin
Clients who have a severe allergy to piperacillin, which is PCN, can have a cross sensitivity to ceftriaxone, a third-generation cephalosporin. Ceftriaxone is contraindicated for the client who has an allergy to cephalosporins or a severe allergy to PCN.
800
Patient education for Ferrous sulfate?
Take ferrous sulfate on an empty stomach, at least 1 hour before or 2 hours after a meal. Avoid taking antacids or antibiotics within 2 hours before or after taking ferrous sulfate .
Take this medication with a full glass of water.
Do not crush, chew, break, or open an extended-release tablet or capsule. Swallow the pill whole. Breaking or opening the pill may cause too much of the drug to be released at one time.
Shake the oral suspension (liquid) well just before you measure a dose. Measure the liquid with a special dose-measuring spoon or medicine cup, not with a regular table spoon. If you do not have a dose-measuring device, ask your pharmacist for one.
Ferrous sulfate can stain your teeth, but this effect is temporary. To prevent tooth staining, mix the liquid form of ferrous sulfate with water or fruit juice (not with milk) and drink the mixture through a straw. You may also clean your teeth with baking soda once per week to treat any tooth staining
800
Order is to infuse 40 mEq of Potassium Chloride?
What are the nursing interventions?
Never administer Potassium through IV bolus,
Do not give K+ through IV Push.
Use IV Pump.
Dilute Potassium and give no more than 40 mEq of iv solution
Cardiac monitoring
800
A nurse is reviewing the lab results for a client who has a prescription for Filgrastim. The nurse should recognize that an increase in which of the following values indicates a therapeutic effect of this medication?
A. RBCs count
B. Neutrophil count
C. Platelets' count
B. This medication increases the neutrophil production. It is given to treat neutropenia
and reduce the risk of infection for client who are receiving chemotherapy for cancer or who have undergone bone marrow transplant.
800
These herbal remedies have anti-platelet properties
What is gingko biloba, garlic, garlic. feverfew, primrose oils?
800
Steroids.
Side effects include all of the following? SATA
A. Hyperglycemia (check blood sugar and glucose in urine)
B. Bone loss (can occur with inhaled agents and oral agents)
C. Peptic ulcer disease
D. Disturbances of fluid and electrolytes (fluid
retention as evidenced by weight gain, and
edema- hypernatremia and hypokalemia as evidenced by muscle weakness)
E. Immunosuppression
All of the above are true.
900
A nurse is administering subcutaneous heparin to a client who is at risk for deep vein thrombosis.
Which of the following actions should the nurse take?
A. Administer the medication into the client’s abdomen.
B. Administer the medication into the client’s arm
A. Administer the medication into the client’s abdomen.
900
1. A client is prescribed amitriptyline (Elavil). Which of the following adverse effects should the nurse instruct the client to report:
A) Urinary retention
B) Decreased libido
A. Urinary retention.
People with the following conditions should avoid tricyclic antidepressants (Amitriptyline)
- angle-closure glaucoma.
- enlarged prostate.
- urinary retention.
900
A nurse is providing teaching to a parent of a child who has asthma and a new prescription for a
cromolyn sodium metered dose inhaler. Which of the following statements by the parent indicates
the need for further teaching?
A. I will given this medication at bedtime only.
B. I will give my child a dose as soon as wheezing starts.
C. Cromolyn is a mast cell inhibitor that has a slow onset and is given as a prophylactic treatment of asthma. It is not a rescue medication.
B. Cromolyn is a mast cell inhibitor that has a slow onset and is given as a prophylactic treatment of asthma. It is not a rescue medication.
900
Client come in with cocaine toxicity, what should the nurse do?
Benzodiazepine may be used to treat cocaine toxicity
Chordiazepozide use if the patient is able to tolarete oral intake
Diazepam and Lorazepam parenteral route if oral intake is not tolerate
900
What is the indication for the use of Eliquis?
Treat PE, DVT, used to reduce the risk re- occurrence of PE or DVT
900
Education for clients on Antibiotics?
A. Complete the entire course of antibiotics even if symptoms subside
B. BUN and creatinine clearance to determine baseline functioning for elderly clients
C). LFTs for baseline info
D) Instruct clients to take penicillin V, amoxicillin, and amoxicillin‑clavulanate with meals. All others antibiotics with 8 oz of water an hour before or two hour
E) Instruct clients to report any signs of an allergic response such as dyspnea, stridor, wheezing and hives
F. Monitor QT interval
All of the teachings are correct
1000
A nurse is providing teaching to a client who has rheumatoid arthritis and a prescription for long term prednisone therapy. The nurse should instruct the client to monitor for which of the following adverse effects?
A. Hypoglycemia
B. Stress Fractures
C. MI
D. Neurological deficits
B. Stress fractures
Prednisone can cause demineralization of the bones and can lead osteoporosis and stress fractures.
1000
A patient is receiving a high dose of nitroglycerin IV . What side effect would the nurse anticipate the client may complain of?
What is headache?
1000
What is the priority nursing diagnosis for a client receiving a cholinergic (parasympatholytic) drugs?
A. Risk for injury related to excessive CNS stimulation.
B. Impaired gas exchange related to thickened respiratory secretions
C. Urinary Retention related to loss of bladder tone, D. Knowledge deficit related to pharmacology regimen
B. What is impaired gas exchange related to thickened respiratory secretions?
1000
A nurse is caring for an older adult client who has a new prescription for amitriptyline to treat depression. Which of the following diagnostic tests should the nurse plan to perform prior to starting the client on this medication?
A. Assess neurological system
B. Draw ABGs
C. Sent sputum cultures to lab
D. Electrocardiogram
D. Electrocardiogram
This medication can cause tachycardia and ECG changes. The older adult is at risk for cardiovascular effects. This should be done prior to the start of therapy to obtain a baseline.
1000
S/S of Magnesium Sulfate toxicity?
When given in high doses, magnesium sulfate can cause cardiac arrest and respiratory failure
When levels become too high, the dose can be lowered.
Common sign of toxicity: Loss of knee jerke reflex
Calcium gluconate can help reverse effects of magnesium sulfate
1000
Endocrine disorders: evaluating therapeutic effect of levothyroxine
a. ↓TSH levels
b. normal T4 levels
c. absence of hypothyroidism symptoms (depression, weight gain, bradycardia, anorexia, cold intolerance, dry skin, menorrhagia)
All of the above