BIOLOGY 101 ATI PHARMACOLOGY FINAL EXAM REVIEW

BIOLOGY 101 ATI PHARMACOLOGY FINAL EXAM REVIEW. 1. A nurse is preparing to administer a dose of lactulose to a client who has cirrhosis. The client states, "I don't need this medication. I am not constipated." The nurse should explain that in clients who have cirrhosis, lactulose is used to decrease levels of which of the following components in the bloodstream? a. Glucose b. Ammonia c. Potassium d. Bicarbonate Rationale: Lactulose, a disaccharide, is a sugar that works as an osmotic diuretic. It prevents absorption of ammonia in the colon. Accumulation of ammonia in the bloodstream, which occurs in pathologic conditions of the liver, such as cirrhosis, may affect the central nervous system, causing hepatic encephalopathy or coma. 2. A nurse on a medical unit is planning care for an older adult client who takes several medications. Which of the following prescribed medications places the client at risk for orthostatic hypotension? (Select all that apply.) a. Furosemide b. Telmisartan c. Duloxetine d. Clopidogrel e. Atorvastatin 3. A nurse is caring for a client who has difficulty swallowing medications and is prescribed enteric-coated aspirin PO once daily. The client asks if the medication can be crushed to make it easier to swallow. Which of the following responses should the nurse provide? a. "Crushing the medication might cause you to have a stomach-ache or indigestion b. "Crushing the medication is a good idea, and I can mix it in some ice cream for you.” c. "Crushing the medication would release all the medication at once, rather than over time." d. "Crushing is unsafe, as it destroys the ingredients in the medication." Rationale: The pill is enteric-coated to prevent breakdown in the stomach and decrease the possibility of GI distress. Crushing destroys protection. 4. A nurse is providing teaching for a client who is newly diagnosed with type 2 diabetes mellitus and has a prescription for glipizide. Which of the following statements by the nurse best describes the action of glipizide? a. "Glipizide absorbs the excess carbohydrates in your system." b. "Glipizide stimulates your pancreas to release insulin." c. "Glipizide replaces insulin that is not being produced by your pancreas." d. "Glipizide prevents your liver from destroying your insulin." Rationale: Glipizide is an oral antidiabetic medication in the pharmacological classification of sulfonylurea agents. These medications help to lower blood glucose levels in clients who have type 2 diabetes mellitus using several methods, including reducing glucose output by the liver, increasing peripheral sensitivity to insulin, and stimulating the release of insulin from the functioning beta cells of the pancreas. 5. A nurse is caring for a client who has active pulmonary tuberculosis (TB) and is to be started on intravenous revamping therapy. The nurse should instruct the client that this medication can cause which of the following adverse effects? a. Constipation b. Black colored stools c. Staining of teeth d. Body secretions turning a red-orange color Rationale: Revamping is used in combination with other medicines to treat TB. revamping will cause the urine, stool, saliva 6. A nurse is caring for a client who has congestive heart failure and is taking digoxin daily. The client refused breakfast and is complaining of nausea and weakness. Which of the following actions should the nurse take first? a. A. Check the client's vital signs. b. Request a dietitian consult. c. Suggest that the client rests before eating the meal. d. Request an order for an antiemetic. Rationale: It is possible that the client's nausea is secondary to digoxin toxicity. Assess for bradycardia, a symptom of digoxin toxicity. The nurse should withhold the medication and call the provider if the client's heart rate is less than 60 bpm. 7. A nurse is caring for a client who has bipolar disorder and has been taking lithium for 1 year. Before administering the medication, the nurse should check to see that which of the following tests have been completed? a. Thyroid hormone assay i. Rationale: Thyroid testing is important because long-term use of lithium may lead to thyroid dysfunction. b. Liver function tests: i. Rationale: LFTs must be monitored before and during valproic acid therapy c. Erythrocyte sedimentation rate i. Rationale: This is not a necessary test related to lithium therapy. d. Brain natriuretic peptide 8. A nurse is caring for a client who has thrombophlebitis and is receiving heparin by continuous IV infusion. The client asks the nurse how long it will take for the heparin to dissolve the clot. Which of the following responses should the nurse give? a. "It usually takes heparin at least 2 to 3 days to reach a therapeutic blood level." b. "A pharmacist is the person to answer that question." c. "Heparin does not dissolve clots. It stops new clots from forming." d. "The oral medication you will take after this IV will dissolve the clot. Rationale: This statement accurately answers the client's question. 9. A nurse caring for a client who has hypertension and asks the nurse about a prescription for propranolol. The nurse should inform the client that this medication is contraindicated in clients who have a history of which of the following conditions? a) Asthma b) Glaucoma b) Depression c) Migraines Rationale: Propranolol, a beta-blocker, is contraindicated in clients who have asthma because it can cause bronchospasms. Propranolol blocks the sympathetic stimulation, which prevents smooth muscle relaxation. 19. A nurse is teaching a client who has a new prescription for colchicine to treat gout. Which of the following instructions should the nurse include? a. "Take this medication with food if nausea develops." b. "Monitor for muscle pain." c. "Expect to have increased bruising." d. "Increase your intake of grapefruit juice” Rationale: This medication can cause rhabdomyolysis. The client should monitor and report muscle pain. 20. A nurse is teaching a client who has a urinary tract infection (UTI) and is taking ciprofloxacin. Which of the following instructions should the nurse give to the client? a. "If the medicine causes an upset stomach, take an antacid at the same time." b. "Limit your daily fluid intake while taking this medication." c. "This medication can cause photophobia, so be sure to wear sunglasses outdoors." d. "You should report any tendon discomfort you experience while taking this medication." Rationale: The nurse should instruct the client to report any tendon discomfort as well as swelling or inflammation of the tendons due to the risk of tendon rupture. 21. A nurse is teaching a client who has a urinary tract infection (UTI) and is taking ciprofloxacin. Which of the following instructions should the nurse give to the client? a. "If the medicine causes an upset stomach, take an antacid at the same time." b. "Limit your daily fluid intake while taking this medication." c. "This medication can cause photophobia, so be sure to wear sunglasses outdoors." d. "You should report any tendon discomfort you experience while taking this medication." Rationale: The nurse should instruct the client to report any tendon discomfort as well as swelling or inflammation of the tendons due to the risk of tendon rupture. 22. 17. A nurse is caring for a client who has cancer and a new prescription for ondansetron to treat chemotherapy-induced nausea. For which of the following adverse effects should the nurse monitor? a. Headache b. Dependent oedema c. Polyuria. d. Photosensitivity Rationale: Headache is a common adverse effect of ondansetron. Analgesic relief is often required. 23. A nurse is preparing to administer verapamil by IV bolus to a client who is having cardiac dysrhythmias. For which of the following adverse effects should the nurse monitor when giving this medication? a. Hyperthermia b. Hypotension c. Ototoxicity d. Muscle pain Rationale: Verapamil, a calcium channel blocker, can be used to control supraventricular tachyarrhythmias. It also decreases blood pressure and acts as a coronary vasodilator and antianginal agent. A major adverse effect of verapamil is hypotension; therefore, blood pressure and pulse must be monitored before and during parenteral administration. 24. A nurse is providing teaching to a client who has renal failure and an elevated phosphorous level. The provider instructed the client to take aluminium hydroxide 300 mg PO three times daily. For which of the following adverse effects should the nurse inform the client? a. Constipation b. Metallic taste c. Headache d. Muscle spasms Rationale: Constipation is a common side effect of aluminum-based antacids. The nurse should instruct the client to increase fibre intake and that stool softeners or laxatives may be needed 25. A nurse is reviewing the medical record of a client who has been on levothyroxine for several months. Which of the following findings indicates a therapeutic response to the medication? a. Decrease in level of thyroxine (T4) b. Increase in weight c. Increase in hr of sleep per night d. Decrease in level of thyroid stimulating hormone (TSH). i. Levothyroxine OD = insomnia 26. A nurse is teaching a client who has been taking prednisone to treat asthma and has a new prescription to discontinue the medication. The nurse should explain to the client to reduce the dose gradually to prevent which of the following adverse effects? a. Hyperglycemia b. Adrenocortical insufficiency c. Severe dehydration d. Rebound pulmonary congestion Rationale: Prednisone, a corticosteroid, is similar to cortisol, the glucocorticoid hormone produced by the adrenal glands. It relieves inflammation and is used to treat certain forms of arthritis, severe allergies, autoimmune disorders, and asthma. Administration of glucocorticoids can suppress production of glucocorticoids, and an abrupt withdrawal of the drug can lead to a syndrome of adrenal insufficiency. 27. A nurse is teaching a client who has been taking prednisone to treat asthma and has a new prescription to discontinue the medication. The nurse should explain to the client to reduce the dose gradually to prevent which of the following adverse effects? a. Hyperglycemia b. Adrenocortical insufficiency c. Severe dehydration d. Rebound pulmonary congestion Rationale: Prednisone, a corticosteroid, is similar to cortisol, the glucocorticoid hormone produced by the adrenal glands. It relieves inflammation and is used to treat certain forms of arthritis, severe allergies, autoimmune disorders, and asthma. Administration of glucocorticoids can suppress production of glucocorticoids, and an abrupt withdrawal of the drug can lead to a syndrome of adrenal insufficiency. 28. A nurse is preparing a client for surgery. Prior to administering the prescribed hydroxyzine, the nurse should explain to the client that the medication is for which of the following indications? (Select all that apply.) a. Controlling emesis b. Diminishing anxiety c. Reducing the amount of narcotics needed for pain relief d. Preventing thrombus formation e.Drying secretions 29. A nurse is caring for a client who has acute respiratory distress syndrome (ARDS), and requires mechanical ventilation. The client receives a prescription for alcuronium. The nurse recognizes that this medication is for which of the following purposes? a. Decrease chest wall compliance b. Suppress respiratory effort c. Induce sedation d. Decrease respiratory secretions Rationale: Neuromuscular blocking agents, such as alcuronium, induce paralysis and suppress the client's respiratory efforts to the point of apnea, allowing the mechanical ventilator to take over the work of breathing for the client. This therapy is especially helpful for a client who has ARDS and poor lung compliance. 30. A nurse is reviewing the medical record of a client who has been on levothyroxine for several months. Which of the following findings indicates a therapeutic response to the medication? a. Decrease in level of thyroxine (T4) b. Increase in weight c. Increase in hour of sleep per night d. Decrease in level of thyroid stimulating hormone (TSH). 31. A nurse on an oncology unit is preparing to administer doxorubicin to a client who has breast cancer. Prior to beginning the infusion, the nurse verifies the client's current cumulative lifetime dose of the medication. For which of the following reasons is this verification necessary? a. An excess amount of doxorubicin can lead to myelosuppression. b. Exceeding the lifetime cumulative dose limit of doxorubicin might cause extravasation. c. An excess amount of doxorubicin can lead to cardiomyopathy. d. Exceeding the lifetime cumulative dose limit of doxorubicin might produce red tinged urine and sweat. Rationale: Doxorubicin is an antineoplastic antibiotic used in the treatment of various cancers. Irreversible cardiomyopathy with congestive heart failure can result from repeated doses of doxorubicin, and prolonged use can also cause severe heart damage, even years after the client has stopped taking it. The maximum cumulative dose a client should receive is 550 mg/m or 450 mg/m with a history of radiation to the mediastinum. 32. A nurse at an ophthalmology clinic is providing teaching to a client who has open angle glaucoma and a new prescription for timolol eye drops. Which of the following instructions should the nurse provide? a. The medication is to be applied when the client is experiencing eye pain. b. The medication will be used until the client's intraocular pressure returns to normal. c. The medication should be applied on a regular schedule for the rest of the client's life. d. The medication is to be used for approximately 10 days, followed by a gradual tapering off. 33. A nurse is caring for a client who is taking naproxen following an exacerbation of rheumatoid arthritis. Which of the following statements by the client requires further discussion by the nurse? a. "I signed up for a swimming class." b. "I've been taking an antacid to help with indigestion." c. "I've lost 2 pounds since my appointment 2 weeks ago." d. "The naproxen is easier to take when I crush it and put it in applesauce." Rationale: NSAIDs, like naproxen, can cause serious adverse gastrointestinal reactions such as ulceration, bleeding, and perforation. Warning manifestations such as nausea or vomiting, gastrointestinal burning, and blood in the stool reported by the client require further investigation by the nurse. The client might be taking an antacid because he is experiencing one or more of these manifestations. 34. A nurse is performing discharge teaching for a client who has seizures and a new prescription for phenytoin. Which of the following statements by the client indicates a need for further teaching? a. "I will notify my doctor before taking any other medications." b. "I have made an appointment to see my dentist next week." c. "I know that I cannot switch brands of this medication." d. "I'll be glad when I can stop taking this medicine." Rationale: Phenytoin is an anticonvulsant used to treat various types of seizures. Clients on anticonvulsant medications commonly require them for lifetime administration, and phenytoin should not be stopped without the advice of the client's provider. 35. A nurse is providing discharge teaching to a client who has asthma and new prescriptions for cromolyn and ibuterol, both by nebulizer. Which of the following statements by the client indicates an understanding of the teaching? a. “If my breathing begins to feel tight, I will use the cromolyn immediately.” b. “I will be sure to take the ibuterol before taking the cromolyn.” c. “I will use both medications immediately after exercising.” d. “I will administer the medications 10 minutes apart.” Also hold breath for 10 seconds Rationale: The client should always use the bronchodilator (ibuterol) prior to using the leukotriene modifier (cromolyn). Using the bronchodilator first allows the airways to be opened, ensuring that the maximum dose of medication will get to the client's lungs. 36. A nurse is caring for a client who has heart failure and a prescription for digoxin. Which of the following statements by the client indicates an adverse effect of the medication? b. "I can walk a mile a day." c. "I've had a backache for several days." d. "I am urinating more frequently." d."I feel nauseated and have no appetite." Rationale: Anorexia, nausea, vomiting, and abdominal discomfort are early signs of digoxin toxicity. 39. A nurse is caring for a client who has HIV-1 infection and is prescribed zidovudine as part of antiretroviral therapy. The nurse should monitor the client for which of the following adverse effects of this medication? a. Cardiac dysrhythmia b. Metabolic alkalosis c. Renal failure d. Aplastic anaemia 40.A nurse is caring for a client who has chronic renal disease and is receiving therapy with epoetin alfa. Which of the following laboratory results should the nurse review for an indication of a therapeutic effect of the medication? a. The leukocyte count b. The platelet count c. The haematocrit (Hct) d.The erythrocyte sedimentation rate (ESR) Rationale: Epoetin alfa is an antianemia medication that is indicated in the treatment of clients who have anaemia due to reduced production of endogenous erythropoietin, which may occur in clients who have end stage renal disease or myelosuppression from chemotherapy. The therapeutic effect of epoetin alfa is enhanced red blood cell production, which is reflected in an increased RBC, Hgb, and Hct. 41.A nurse is providing teaching for a client who is newly diagnosed with type 2 diabetes mellitus and has a prescription for glipizide. Which of the following statements by the nurse best describes the action of glipizide? d. "Glipizide absorbs the excess carbohydrates in your system." e. "Glipizide stimulates your pancreas to release insulin." f. "Glipizide replaces insulin that is not being produced by your pancreas." g. "Glipizide prevents your liver from destroying your insulin.” Rationale: Glipizide is an oral antidiabetic medication in the pharmacological classification of sulfonylurea agents. These medications help to lower blood glucose levels in clients who have type 2 diabetes mellitus using several methods, including reducing glucose output by the liver, increasing peripheral sensitivity to insulin, and stimulating the release of insulin from the functioning beta cells of the pancreas. 42. A nurse is caring for a client who is prescribed warfarin therapy for an artificial heart valve. Which of the following laboratory values should the nurse monitor for a therapeutic effect of warfarin? a. Haemoglobin b. Prothrombin time (PT) c. Bleeding time d. Activated partial thromboplastin time (aPTT) Rationale: This test is used to monitor warfarin therapy. For a client receiving full anticoagulant therapy, should typically be approximately two to three times the normal value, depending on the indication for therapeutic anticoagulation. 43. A nurse in a critical care unit is caring for a client who is postoperative following a right pneumonectomy. After extubating from the ventilator, in which of the following positions should the client be placed? a. Prone b. On the nonoperative side c. Sims' d. Semi-Fowler's 45. A nurse in a coronary care unit is admitting a client who has had CPR following a cardiac arrest. The client is receiving lidocaine IV at 2 mg/min. When the client asks the nurse why he is receiving that medication, the nurse should explain that it has which of the following actions? a. Prevents dysrhythmias b. Slows intestinal motility c. Dissolves blood clots d. Relieves pain Rationale: Lidocaine is an antidysrhythmic medication that delays the conduction in the heart and reduces the automaticity of heart tissue. 46. A nurse is providing teaching for a client who has anaemia and a new prescription for ferrous sulphate liquid. Which of the following instructions should the nurse provide? a. Take the medication on an empty stomach to decrease gastrointestinal irritation. b. Take the medication with orange juice to enhance absorption. c. Take the medication with milk. d. Rinse the mouth before taking the iron. Rationale. Take between meals for optimal absorption Ascorbic acid (vitamin C), which is found in orange juice, will enhance the absorption of iron and increase its bioavailability. This will also help to decrease the gastrointestinal side effects of iron. 47. A nurse in a provider's clinic is assessing a client who has cancer and a prescription for methotrexate PO. Which of the following actions should the nurse take when the client reports bleeding gums? a. Explain to the client that this is an expected adverse effect. b. Check the value of the client's current platelet count. c. Instruct the client to use an electric toothbrush. d. Have the client make an appointment to see the dentist. 48. A nurse is teaching a client who has bipolar disorder and a prescription for lithium to recognize the manifestations of toxicity. Which of the following statements by the client indicates an understanding of the teaching? a. "I will report any loss of appetite." b. "Increased flatulence is an indication of toxicity." c. "Vomiting is an indication of toxicity." d. "I will call my provider if I experience any headaches." 49. A nurse in a public clinic is planning a health fair for older adult clients in the community. In teaching medication safety, which of the following foods should the nurse advise the clients to avoid when taking their prescriptions? a. Carbonated beverage b. Milk c. OJ d. Grapefruit juice 50. A nurse is caring for a client who has developed gout. Which of the following medications should the nurse prepare to administer? a. Zolpidem b. Alprazolam c. Spironolactone d. Allopurinol 51. A nurse is caring for a client who has diabetes insipidus and is receiving vasopressin. The nurse should identify which of the following findings as an indication that the medication is effective? a. A decrease in blood sugar b. A decrease in blood pressure c. A decrease in urine output d. A decrease in specific gravity Rationale: The major manifestations of diabetes insipidus are excessive urination and extreme thirst. Vasopressin is used to control frequent urination, increased thirst, and loss of water associated with diabetes insipidus. A decreased urine output is the desired response. 52.A nurse on a medical unit is planning care for an older adult client who takes several medications. Which of the following prescribed medications places the client at risk for orthostatic hypotension? (Select all that apply.) a. Furosemide b. Telmisartan c. Duloxetine d. Clopidogrel e. Atorvastatin 53.A nurse is reviewing the health history for a client who has angina pectoris and a prescription for propranolol hydrochloride PO 40 mg twice daily. Which of the following findings in the history should the nurse report to the provider? a. The client has a history of hypothyroidism. b. The client has a history of bronchial asthma. c. The client has a history of hypertension. d. The client has a history of migraine headaches. Rationale: Beta-adrenergic blockers can cause bronchospasm in clients who have bronchial asthma; therefore, this is a contraindication to its use and should be reported to the provider. 56. A nurse is teaching a client about the adverse effects of cisplatin. Which of the following adverse effects should the nurse include in the teaching? a. Tinnitus b. Constipation c. Hyperkalaemia d. Weight gain 57. Nurse is caring for a client who is experiencing severe nausea and vomiting after a course of chemotherapy. The nurse should monitor the client for which of the following clinical manifestations? e. Metabolic acidosis f. Metabolic alkalosis g. Respiratory acidosis h. Respiratory alkalosis Rationale: Metabolic alkalosis can occur in clients who have excessive vomiting because of the loss of hydrochloric acid. 58.A nurse is completing a medical interview with a client who has elevated cholesterol levels and takes warfarin. The nurse should recognize that which of the following actions by the client can potentiate the effects of warfarin? a. The client follows a low-fat diet to reduce cholesterol. b. The client drinks a glass of grapefruit juice every day. c. The client sprinkles flax seeds on food 1 hr before taking the anticoagulant. d. The client uses garlic to lower cholesterol levels. Rationale: The nurse should recognize that garlic can potentiate the action of the warfarin. 59.A nurse is caring for a client who has a new prescription for ferrous sulphate tablets twice daily for iron-deficiency anaemia. The client asks the nurse why the provider instructed that she take the ferrous sulphate between meals. Which of the following responses should the nurse make? a. "Taking the medication between meals will help you avoid becoming constipated." b. "Taking the medication with food increases the risk of esophagitis." c. "Taking the medication between meals will help you absorb the medication more efficiently." d. "The medication can cause nausea if taken with food." Rationale. Ferrous sulphate provides the iron needed by the body to produce red blood cells. Taking iron supplements between meals helps to increase the bioavailability of the iron. 60.A nurse is providing discharge teaching for a client who has a new prescription for warfarin. Which of the following instructions should the nurse include in the teaching? a. Mild nosebleeds are common during initial treatment. b. Use an electric razor while on this medication. c. If a dose of the medication is missed, double the dose at the next scheduled time. d. Increase fibre intake to reduce the adverse effect of constipation. Rationale: Warfarin, an anticoagulant, increases the client’s risk for bleeding. The nurse should teach the client safety measures, such as using an electric razor, to decrease the risk for injury and bleeding. 61.A nurse is preparing to initiate a transfusion of packed RBC for a client who has anaemia. Which of the following actions should the plan to nurse take? i. Leave the client 5 min after beginning the transfusion. j. Infuse the transfusion at a rate of 200 mL/hr c.Check the client's vital signs every hour during the transfusion. d.Flush the blood tubing with dextrose 5% in water. 62.A charge nurse is supervising a newly licensed nurse care for a client who is receiving a transfusion of packed RBC. The nurse suspects a possible haemolytic reaction. After stopping the blood transfusion, which of the following actions by the new nurse requires intervention by the charge nurse? a. The nurse initiates an infusion of 0.9% sodium chloride. b. The nurse collects a urine specimen. c. The nurse sends a blood specimen to the laboratory. d. The nurse starts the transfusion of another unit of blood product. Rationale. When suspecting a haemolytic reaction, the nurse should immediately stop the transfusion of all blood products. The transfusion of additional products can increase the client's risk for further complication. 63.A nurse is educating a group of clients about the contraindications of warfarin therapy. Which of the following statements should the nurse include in the teaching? a. "Clients who have glaucoma should not take warfarin." b. "Clients who have rheumatoid arthritis should not take warfarin." c. "Clients who are pregnant should not take warfarin." d. "Clients who have hyperthyroidism should not take warfarin." Rationale: Warfarin therapy is contraindicated in the pregnant client because it crosses the placenta and places the fetus at risk for bleeding. 64.A nurse is caring for a client who is receiving a transfusion of packed red blood cells and suspects that the client is experiencing a hemolytic reaction. Which of the following interventions is the priority? a. Collect a urine specimen. b. Administer 0.9% sodium chloride through the IV line. c. Stop the transfusion. d. Notify the blood bank. Rationale: The greatest risk to the client is injury due to further hemolysis; therefore, the priority action is to stop the transfusion. When suspecting a hemolytic reaction, the priority action by the nurse is to immediately stop the transfusion to prevent further hemolysis. 65.A nurse is planning care for a client who has a detached retina and is preoperative for a surgical repair. The nurse should prepare to administer which of the following medications? a. Phenylephrine b. Latanoprost c. Pilocarpine d. Timolol Rationale. Mydriatic medications, such as phenylephrine, are used preoperatively to dilate pupils to facilitate intraocular surgery. 66.A nurse is assessing a client who is receiving a parental lipid infusion. Which of the following findings is a manifestation of fat overload syndrome? a. Elevated temperature b. Hypertension c. Peripheral edema d. Erythema at the insertion site Rationale: An elevated temperature is an early manifestation of fat overload syndrome. The client is at risk for coagulopathy and multi-organ system failure due to fat overload syndrome. 67.A nurse is caring for a female client who has rheumatoid arthritis and asks the nurse if it is safe for her to take aspirin. The nurse should recognize which of the following findings in the client's history is a contraindication to this medication? e. Report of recent migraine headaches f. History of gastric ulcers g. Current diagnosis of glaucoma h. Prior reports of amenorrhea Rationale: Aspirin is contraindicated for clients who have a history of gastrointestinal bleeding and peptic ulcer disease because it impedes platelet aggregation. An adverse effect of aspirin is gastric bleeding. 68.A nurse is teaching a client who has a new prescription for colesevelam to lower his low density lipoprotein level. Which of the following instructions should the nurse include? a. "Take this medication 4 hr after other medications." b. "Reduce fluid intake." c. "Take this medication on an empty stomach.” d. "Chew tablets before swallowing." Rationale: The client should take this medication 4 hours after other medications to increase absorption of the medication. 69.A nurse is assessing a client who is receiving dopamine IV to treat left ventricular failure. Which of the following findings should indicate to the nurse that the medication is having a therapeutic effect? a. Systolic blood pressure is increased b. Cardiac output is reduced c. Apical heart rate is increased d. Urine output is reduced Rationale: When dopamine has a therapeutic effect, it causes vasoconstriction peripherally and increases systolic blood pressure. 70.A nurse is teaching a client who has diabetes mellitus and receives 25 units of NPH insulin every morning if her blood glucose level is above 200 mg/dL. Which of the following information should the nurse include? a. Discard the NPH solution if it appears cloudy. b. Shake the insulin vigorously before loading the syringe. c. Expect the NPH insulin to peak in 6 to 14 hr. d. Freeze unopened insulin vials. 71.A nurse is teaching a client who has a new prescription for fluoxetine to treat depression. Which of the following statements by the client indicates an understanding of the teaching? a. "I should expect to feel better after 24 hours of starting this medication." b. "I should not take this medicine with grapefruit juice." c. "I'll take this medicine with food." d. "I'll take this medicine first thing in the morning." 72.A nurse is instructing the parents of a client who has a new prescription for methylphenidate. Which of the following instructions should the nurse include? a. Avoid activities that require alertness such as driving. b. Increase caffeine intake. c. Take this medication before bedtime. d. Reduce calorie intake. Rationale: The client should avoid driving and other activities that require alertness until the effects of this medication are known. 73.A nurse is teaching a client who has a new prescription for aluminum hydroxide to treat heartburn. The nurse should instruct the client to monitor for and report which of the following adverse reactions? a. Constipation b. Flatulence c. Palpitations d. Headache Rationale: Aluminum hydroxide can cause constipation. The nurse should tell the client to increase fluid and fibre intake to reduce the risk for constipation. 74.A nurse in a substance abuse clinic is assessing a client who recently started taking disulfiram. The client reports having discontinued the medication after experiencing severe nausea and vomiting. Which of the following reasons should the nurse suspect to be a likely cause of the client's distress? a. The client demonstrated an allergic response to the medication. b. The client experienced a common side effect to the medication. c. The client consumed alcohol while taking the medication. d. The client took an overdose of the medication. Rationale: Disulfiram is given to clients who have a history of alcohol abuse. It produces a sensitivity to alcohol that results in a highly unpleasant reaction when the client ingests even small amounts of alcohol. When combined with alcohol, disulfiram produces nausea and vomiting. 75.A nurse is reviewing the medication list for a client who has a new diagnosis of type 2 diabetes mellitus. The nurse should recognize which of the following medications can cause glucose intolerance? a. Ranitidine b. Guaifenesin c. Prednisone d. Atorvastatin Rationale: Corticosteroids such as prednisone can cause glucose intolerance and hyperglycaemia. The client might require increased dosage of a hypoglycaemic medication. 76.A nurse in the emergency department is caring for a client who took 3 nitro- glycerine tablets sublingually for chest pain. The client reports relief from the chest pain but now he is experiencing a headache. Which of the following statements should the nurse make? a. “A headache is is an indication of an allergy to the medication." b. “A headache is an expected adverse effect of this medication” c. “A headache indicates tolerance to this medication” d. “A headache is likely due to the anxiety about the chest pain” 77.A nurse is preparing to administer nalbuphine to a postoperative client who is experiencing pain. The nurse should monitor the client for which of the following potential adverse effects of this medication? a. Miosis b. Joint pain c. Diarrhea d. Oliguria . Rationale: Adverse effects of nalbuphine include visual disturbances such as miosis, blurred vision, and diplopia. 78.A nurse is reviewing the laboratory results of a client who has liver failure with ascites and is receiving spironolactone. Which of the following findings should the nurse expect? a. Decreased sodium level Rationale: The nurse should expect a decreased sodium level. Spironolactone is a potassium- sparing diuretic that inhibits the action of aldosterone, resulting in an increased excretion of sodium. 28 b.Decreased phosphate level c.Decreased potassium level d.Decreased chloride level