6
ATI PHARMACOLOGY QUESTIONS AND
lOMoAR
7 cPSD|
67
0866
2422
CORRECT ANSWERS
1-A nurse67has67completed67teaching67a67client67who67is67being67discharged67on67lithium67for67a67bip
olar67disorder.67Which67statement67by67the67client67indicates67a67need67for67further67teaching?
1. "I67need67to67drink671-267liters67of67fluid67daily."
2. "I67need67to67have67my67blood67levels67checked67periodically."
3. "I67should67not67limit67my67sodium67intake."
4. "I67should67use67ibuprofen67for67pain67relief."
Explanation:
Lithium67is67a67mood67stabilizer67most67often67used67to67treat67bipolar67affective67disorders.67It67has67a67ver
y67narrow67therapeutic67serum67range67of670.6-1.267mEq/L67(0.6-
1.267mmol/L).67Levels67>1.567mEq/L67(1.567mmol/L)67are67considered67toxic.67Lithium67toxicity67usually
67occurs67with67the67following:
1. Dehydration
2. Decreased67renal67function67(eg,67elderly67clients)
3. Diet67low67in67sodium
4. Drug-drug67interactions67(nonsteroidal67anti-
inflammatory67drugs67[NSAIDs]67and67thiazide67diuretics)
Lithium67is67cleared67renally.67Even67a67mild67change67in67kidney67function67(as67seen67in67elderly6
7clients)67can67cause67serious67lithium67toxicity.6 7 Therefore,67drugs67that67decrease67renal67blood67fl
ow67(eg,67NSAIDs)67should67be67avoided.6 7 Acetaminophen67would67be67a67better67choice67for67pain
67relief67(Option674).
(Options67167and673)67Sodium,67water,67and67lithium67are67normally67filtered67by67the67kidneys.67R
estriction67of67dietary67sodium/water67or67dehydration67signals67renal67sodium67and67water67reabsor
ption67which67will67also67increase67lithium67absorption,67resulting67in67toxicity.6 7 Therefore,67clients67s
hould67never67restrict67their67sodium67or67water67intake67while67taking67lithium;67instead,67they67shou
ld67maintain67a67consistent67sodium67intake.
(Option672)6 7 Blood67should67be67drawn67frequently67to67monitor67for67therapeutic67lithium67levels67and67tox
icity.
Educational67objective:
Dehydration,67decreased67renal67function,67diet67low67in67sodium,67and67drug-
drug67interactions67(eg,67NSAIDs67and67thiazide67diuretics)67can67cause67lithium67toxicity.
2-A client67with67cancer67pain67is67prescribed67oxycodone.67Which67teaching67is67most67essen
tial67to67help67prevent67long-term67complications?
, 6
1. Teach67the67client67how67to67assess67blood 67pressure67daily
lOMoAR
7 cPSD|
67
0866
2422
2. Teach67the67client67how67to67prevent67constipation
, 6
lOMoAR
7 cPSD|
67
0866
2422
3. Teach67the67client67how67to67prevent67itching
, 6
lOMoAR
7 cPSD|
67
0866
2422
4. Teach67the67client67how67to67prevent67nausea
Explanation:
Oxycodone67is67a67morphine-
like67opioid67medication.67Opioid67medications67bind67to67opioid67receptors67in67the67intestine,67which67slo
ws67peristalsis67and67increases67water67absorption,67leading67to67constipation.
Constipation67is67an67almost67universally67expected67side67effect67from67opioid67medications.67Clie
nts67will67not67develop67tolerance67to67this67side67effect.67Although67clients67with67idiopathic67chro
nic67constipation67are67not67commonly67advised67to67take67laxatives,67opioid-
induced67constipation67is67treated67with67simultaneous67use67of67senna67(stimulant)67and67docus
ate67(stool67softener).
(Options67167and673)6 7 Opioids67cause67the67release67of67histamine,67a67vasodilator,67which67is
67responsible67for67pruritus67and67flushing.67Opioids67can67also67cause67peripheral67vasodilatio
n67and67nervous67system67depression;67both67can67lead67to67hypotension.6 7 These67develop67in
67some67clients67when67the67treatment67is67initiated67but67usually67resolve67over67time.67Antihista
mines67(eg,67diphenhydramine)67can67prevent67the67pruritus.67Lifestyle67changes67(eg,67rising67sl
owly67from67a67seated67position)67and67adequate67hydration67can67prevent67hypotension.
(Option674)6 7 Opioids67stimulate67the67opioid67receptors67in67the67gastrointestinal67tract67and67the67ch
emoreceptor67trigger67zone67in67the67brain,67producing67nausea.67This67is67also67not67seen67with67lo
ng-term67use.67Antiemetics67(eg,67ondansetron)67can67be67helpful.
Educational67objective:
Constipation67is67an67expected67long-
term67side67effect67of67opioid67use;67clients67will67not67develop67tolerance67to67this67side67effect.67It67i
s67important67to67teach67aggressive67preventive67measures67(eg,67defecate67when67the67urge67is67felt
,67drink672-367L67of67fluid/day,67high-
fiber67diet,67exercise)67and67simultaneous67use67of67a67stool67softener67and67a67stimulant.
3- The67nurse67is67reviewing67prescriptions67for67the67assigned67clients.67Which67prescriptions67shoul
d67the67nurse67question?67Select67all67that67apply.
1. Allopurinol67for67a67client67who67developed67tumor67lysis67syndrome67from67chemotherap
y67for67acute67leukemia
2. Dicyclomine67for67a67client67with67a67history67of67irritable67bowel67syndrome67who67
develops67a67postoperative67paralytic67ileus
3. IV67morphine67for67a67client67with67severe67acute67renal67colic67pain67who67is67sc
heduled67for67a67percutaneous67nephrolithotripsy
4. Levofloxacin67for67a67client67with67a67urinary67tract67infection67who67has67a67history67of67
anaphylaxis67to67penicillin67drugs
5. Simvastatin67for67a67client67with67hypercholesterolemia67who67is67reporting67gen
eralized67muscle67aches67and67weakness
Explanation:
The67nurse67should67question67these67prescriptions67and67contact67the67health67care67provider:
ATI PHARMACOLOGY QUESTIONS AND
lOMoAR
7 cPSD|
67
0866
2422
CORRECT ANSWERS
1-A nurse67has67completed67teaching67a67client67who67is67being67discharged67on67lithium67for67a67bip
olar67disorder.67Which67statement67by67the67client67indicates67a67need67for67further67teaching?
1. "I67need67to67drink671-267liters67of67fluid67daily."
2. "I67need67to67have67my67blood67levels67checked67periodically."
3. "I67should67not67limit67my67sodium67intake."
4. "I67should67use67ibuprofen67for67pain67relief."
Explanation:
Lithium67is67a67mood67stabilizer67most67often67used67to67treat67bipolar67affective67disorders.67It67has67a67ver
y67narrow67therapeutic67serum67range67of670.6-1.267mEq/L67(0.6-
1.267mmol/L).67Levels67>1.567mEq/L67(1.567mmol/L)67are67considered67toxic.67Lithium67toxicity67usually
67occurs67with67the67following:
1. Dehydration
2. Decreased67renal67function67(eg,67elderly67clients)
3. Diet67low67in67sodium
4. Drug-drug67interactions67(nonsteroidal67anti-
inflammatory67drugs67[NSAIDs]67and67thiazide67diuretics)
Lithium67is67cleared67renally.67Even67a67mild67change67in67kidney67function67(as67seen67in67elderly6
7clients)67can67cause67serious67lithium67toxicity.6 7 Therefore,67drugs67that67decrease67renal67blood67fl
ow67(eg,67NSAIDs)67should67be67avoided.6 7 Acetaminophen67would67be67a67better67choice67for67pain
67relief67(Option674).
(Options67167and673)67Sodium,67water,67and67lithium67are67normally67filtered67by67the67kidneys.67R
estriction67of67dietary67sodium/water67or67dehydration67signals67renal67sodium67and67water67reabsor
ption67which67will67also67increase67lithium67absorption,67resulting67in67toxicity.6 7 Therefore,67clients67s
hould67never67restrict67their67sodium67or67water67intake67while67taking67lithium;67instead,67they67shou
ld67maintain67a67consistent67sodium67intake.
(Option672)6 7 Blood67should67be67drawn67frequently67to67monitor67for67therapeutic67lithium67levels67and67tox
icity.
Educational67objective:
Dehydration,67decreased67renal67function,67diet67low67in67sodium,67and67drug-
drug67interactions67(eg,67NSAIDs67and67thiazide67diuretics)67can67cause67lithium67toxicity.
2-A client67with67cancer67pain67is67prescribed67oxycodone.67Which67teaching67is67most67essen
tial67to67help67prevent67long-term67complications?
, 6
1. Teach67the67client67how67to67assess67blood 67pressure67daily
lOMoAR
7 cPSD|
67
0866
2422
2. Teach67the67client67how67to67prevent67constipation
, 6
lOMoAR
7 cPSD|
67
0866
2422
3. Teach67the67client67how67to67prevent67itching
, 6
lOMoAR
7 cPSD|
67
0866
2422
4. Teach67the67client67how67to67prevent67nausea
Explanation:
Oxycodone67is67a67morphine-
like67opioid67medication.67Opioid67medications67bind67to67opioid67receptors67in67the67intestine,67which67slo
ws67peristalsis67and67increases67water67absorption,67leading67to67constipation.
Constipation67is67an67almost67universally67expected67side67effect67from67opioid67medications.67Clie
nts67will67not67develop67tolerance67to67this67side67effect.67Although67clients67with67idiopathic67chro
nic67constipation67are67not67commonly67advised67to67take67laxatives,67opioid-
induced67constipation67is67treated67with67simultaneous67use67of67senna67(stimulant)67and67docus
ate67(stool67softener).
(Options67167and673)6 7 Opioids67cause67the67release67of67histamine,67a67vasodilator,67which67is
67responsible67for67pruritus67and67flushing.67Opioids67can67also67cause67peripheral67vasodilatio
n67and67nervous67system67depression;67both67can67lead67to67hypotension.6 7 These67develop67in
67some67clients67when67the67treatment67is67initiated67but67usually67resolve67over67time.67Antihista
mines67(eg,67diphenhydramine)67can67prevent67the67pruritus.67Lifestyle67changes67(eg,67rising67sl
owly67from67a67seated67position)67and67adequate67hydration67can67prevent67hypotension.
(Option674)6 7 Opioids67stimulate67the67opioid67receptors67in67the67gastrointestinal67tract67and67the67ch
emoreceptor67trigger67zone67in67the67brain,67producing67nausea.67This67is67also67not67seen67with67lo
ng-term67use.67Antiemetics67(eg,67ondansetron)67can67be67helpful.
Educational67objective:
Constipation67is67an67expected67long-
term67side67effect67of67opioid67use;67clients67will67not67develop67tolerance67to67this67side67effect.67It67i
s67important67to67teach67aggressive67preventive67measures67(eg,67defecate67when67the67urge67is67felt
,67drink672-367L67of67fluid/day,67high-
fiber67diet,67exercise)67and67simultaneous67use67of67a67stool67softener67and67a67stimulant.
3- The67nurse67is67reviewing67prescriptions67for67the67assigned67clients.67Which67prescriptions67shoul
d67the67nurse67question?67Select67all67that67apply.
1. Allopurinol67for67a67client67who67developed67tumor67lysis67syndrome67from67chemotherap
y67for67acute67leukemia
2. Dicyclomine67for67a67client67with67a67history67of67irritable67bowel67syndrome67who67
develops67a67postoperative67paralytic67ileus
3. IV67morphine67for67a67client67with67severe67acute67renal67colic67pain67who67is67sc
heduled67for67a67percutaneous67nephrolithotripsy
4. Levofloxacin67for67a67client67with67a67urinary67tract67infection67who67has67a67history67of67
anaphylaxis67to67penicillin67drugs
5. Simvastatin67for67a67client67with67hypercholesterolemia67who67is67reporting67gen
eralized67muscle67aches67and67weakness
Explanation:
The67nurse67should67question67these67prescriptions67and67contact67the67health67care67provider:
