ATI Pharmacology Practice Questions Hematologic, Cardiovascular, Pain and Inflammation,100% CORRECT

ATI Pharmacology Practice Questions Hematologic, Cardiovascular, Pain and Inflammation 1) A nurse is reinforcing teaching for a client who has angina pectoris and a new prescription to apply a nitroglycerin transdermal patch daily at home. Which of the following instructions should the nurse give the client? ANSWERS - Multiple Choice 1) Fold used patch with medication area to the inside and discard in a closed receptacle. Answer Rationale: It is important to prevent pets, children, and others in the client’s home from coming into contact with the medication on the nitroglycerin patch. Therefore, the client should be instructed to fold the patch in half with the medication area to the inside and to discard the patch in a closed receptacle rather than in an open trash can. INCORRECT 2) Put a second patch in place if angina pain occurs. Answer Rationale: Nitroglycerin transdermal patches are designed for prophylaxis of angina pain and are not to be used to stop an existing angina attack. Adding a second patch is not appropriate and could cause adverse effects, such as hypotension. The client should discuss strategies for treating an angina attack with the provider. INCORRECT 3) Keep a nitroglycerin patch in place 24 hr per day. Answer Rationale: Since clients can develop tolerance to nitroglycerin, the transdermal patch should be removed after 12 to 14 hr each day, and the client should have 10 to 12 hr of time without a patch during the evening and nighttime hours. INCORRECT 4) Shave excess hair from skin before applying a nitroglycerin patch. Answer Rationale: The client should be instructed to apply the patch to a different hairless area each day. If it is necessary to apply the patch to an area with hair, the hair should be clipped, not shaved, to avoid irritation to the skin. 2) A nurse is caring for a client who has a deep vein thrombosis, who received IV heparin for the past 5 days, and now has a new prescription for oral warfarin in addition to the heparin. The client asks the nurse if both medications are necessary. Which of the following is an appropriate response by the nurse? ANSWERS - Multiple Choice INCORRECT 1) "Heparin enhances the effects of the warfarin." Answer Rationale: Neither medication enhances the effects of the other. INCORRECT 2) "I will ask the charge nurse to call your provider and get an explanation." Answer Rationale: The charge nurse does not need to call the provider for an explanation at this time. INCORRECT 3) "Both heparin and warfarin work together to dissolve the clots." Answer Rationale: Neither heparin nor warfarin dissolves clots that have already formed. 4) "Heparin will be continued until the warfarin reaches a therapeutic level." Answer Rationale: Heparin and warfarin are both anticoagulants that decrease the clotting ability of the blood and help prevent thrombosis formation in the blood vessels. However, they work in different ways to achieve therapeutic coagulation and must be given together until therapeutic levels of anticoagulation can be achieved by warfarin alone, which usually takes about 3 days. Oral warfarin therapy may continue for several months following discharge. 3) A nurse in a provider’s office is reviewing the laboratory results of four clients who take digoxin. Which of the following clients is at risk for developing digoxin toxicity? ANSWERS - Multiple Choice INCORRECT 1) A client who takes glyburide for type 2 diabetes mellitus Answer Rationale: Glyburide is an oral antidiabetic medication to treat type 2 diabetes mellitus. Altered glucose levels have no effect on digoxin toxicity. 2) A client who take furosemide for hypertension Answer Rationale: Loop diuretics such as furosemide can cause hypokalemia, which greatly increases the risk of digoxin toxicity. INCORRECT 3) A client who takes ranitidine to reduce gastric acid secretion Answer Rationale: Ranitidine can reduce the absorption of some medications such as cefuroxime and ketoconazole, but it does not increase the risk for digoxin toxicity. INCORRECT 4) A client who takes azelastine for allergic rhinitis Answer Rationale: Azelastine can cause central nervous system depression, but it does not increase the risk for digoxin toxicity. 4) A nurse is caring for a client who is postoperative and receiving fentanyl via patient controlled analgesia. The client has a prescription for naloxone. The nurse understands that the purpose of naloxone is which of the following? ANSWERS - Multiple Choice INCORRECT 1) To suppress respiratory secretions Answer Rationale: Atropine suppresses respiratory secretions. 2) Block the effects of opioids on the central nervous system Answer Rationale: Naloxone is a narcotic antagonist that combines competitively with opiate receptors and blocks or reverses the action of narcotic analgesics. By blocking the effects of narcotics on the central nervous system (CNS), it prevents CNS and respiratory depression. INCORRECT 3) To treat nausea Answer Rationale: Ondansetron is used to treat postoperative nausea. INCORRECT 4) To treat urinary retention Answer Rationale: Bethanechol is used to treat postpartum and postoperative urinary retention. 5) A nurse is caring for a client who has thrombophlebitis and is receiving a continuous infusion of heparin. 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 make? ANSWERS - Multiple Choice INCORRECT 1) "It usually takes at least 2 to 3 days for heparin to dissolve a clot." Answer Rationale: Heparin does not dissolve established clots. Thrombolytic medications such as alteplase dissolve established clots. INCORRECT 2) "The time it takes heparin to dissolve clots varies between clients." Answer Rationale: Heparin does not dissolve established clots. Thrombolytic medications such as alteplase dissolve established clots. 3) "Heparin prevents new clots from forming rather than dissolving established clots." Answer Rationale: Heparin is an anticoagulant that prevents the formation of new clots by blocking the conversion of prothrombin to thrombin and fibrinogen to fibrin. It does not dissolve established clots. INCORRECT 4) "The time it takes for heparin to dissolve a clot depends on the size of the clot." Answer Rationale: Heparin does not dissolve established clots. Thrombolytic medications such as alteplase dissolve established clots. 6) A nurse is collecting data from a client prior to administering nifedipine. For which of the following findings should the nurse contact the provider? ANSWERS - Multiple Choice 1) Peripheral edema of the ankles Answer Rationale: Peripheral edema can occur due to the vasodilation principles of nifedipine. The nurse should monitor for edema of the feet and ankles and notify the provider if this occurs. INCORRECT 2) BP of 148/94 mm Hg Answer Rationale: The nurse should administer nifedipine to treat essential hypertension. The goal is to reduce the BP value below 140/90 mm Hg. The nurse does not need to contact the provider for this measurement. INCORRECT 3) Heart rate of 66/min Answer Rationale: Nifedipine will increase heart rate and can result in reflex tachycardia. A heart rate of 66/min is within the expected reference range. The nurse does not need to contact the provider for this measurement. INCORRECT 4) Increased alkaline phosphatase level Answer Rationale: Nifedipine can result in mild to moderate increases of alkaline phosphatase, CPK, LDH, AST and ALT levels. 7) A nurse is reinforcing teaching with a client who is to start taking enteric-coated naproxen for rheumatoid arthritis. Which of the following client statements by the client indicates a need for further teaching? ANSWERS - Multiple Choice INCORRECT 1) "I am taking this type of medication so it dissolves in my intestine, not my stomach." Answer Rationale: Naproxen tablets have an enteric coating that prevents them from dissolving in the stomach. Instead, the tablets pass into the intestine where they dissolve and the client absorbs it. This prevents gastric irritation. 2) "It's okay to crush a tablet as long as I make sure it dissolves completely in water before swallowing it." Answer Rationale: The client should not crush an enteric-coated tablet, because this will interfere with the coating and allow the medication to dissolve in the stomach, resulting in gastric irritation. INCORRECT 3) "I can take these pills with my meals." Answer Rationale: The client can take the medication with meals to decease gastrointestinal distress. INCORRECT 4) "I might not get relief from my pain for 3 to 4 weeks." Answer Rationale: It is important for the client to understand that she might not get experience the therapeutic effect for 3 to 4 weeks and to continue taking the medication. 8) A nurse is collecting data from a client prior to the administration of digoxin. Which of the following findings should the nurse report to the provider? ANSWERS - Multiple Choice INCORRECT 1) BP of 132/82 mm Hg Answer Rationale: This BP reading is within the expected reference range. The nurse does not need to report this finding to the provider. 2) Potassium level of 3.0 mEq/L Answer Rationale: The nurse should report a potassium level of 3.0 mEq/L to the provider. This finding is an indication of hypokalemia, which can lead to cardiac dysrhythmias, the most serious adverse effect of digoxin. INCORRECT 3) Digoxin level of 1.2 ng/mL Answer Rationale: A digoxin level of 1.2 ng/mL is within the expected reference range. The nurse does not need to report this finding to the provider. INCORRECT 4) Heart rate of 66/min Answer Rationale: The nurse should withhold the medication and notify the provider if the heart rate is below 60/min. The nurse does not need to report this finding to the provider. 9) A nurse is collecting data from a client who has hypertension and a prescription for propranolol. A history of which of the following conditions should be reported to the provider? ANSWERS - Multiple Choice INCORRECT 1) Migraine Answer Rationale: The use of propranolol is not contraindicated for a client who has a history of migraines. INCORRECT 2) Glaucoma Answer Rationale: Beta-blockers, such as propranolol, can be safely used by a client who has glaucoma. INCORRECT 3) Depression Answer Rationale: Depression is not a contraindication for the use of propranolol, a beta-blocker. 4) Heart failure Answer Rationale: Propranolol is used with caution in clients who have heart failure due to the depressive effect on myocardial contractility; therefore, the nurse should report this finding to the provider. 10) A nurse is preparing to administer heparin intravenously to a client. Which of the following actions should the nurse take? ANSWERS - Multiple Choice 1) Obtain an infusion pump to regulate the continuous flow of the medication. Answer Rationale: Because of the risk for bleeding, an infusion pump must be used to prevent overdosage and its rate must be checked every 30 to 60 min. INCORRECT 2) Verify that a dose of vitamin K is available as an antidote. Answer Rationale: Protamine zinc is the antidote for heparin, not vitamin K. INCORRECT 3) Insert an indwelling catheter to monitor closely the client’s urine output. Answer Rationale: Heparin is an anticoagulant that has no effect on urine output. INCORRECT 4) Schedule the client’s prothrombin time (PT) to be drawn at regular intervals. Answer Rationale: The activated partial thromboplastin time (aPTT), not the PT, is measured to determine the effectiveness of a heparin drip. 11) A nurse is caring for a client who is taking celecoxib daily. The nurse should identify that a history of which of the following disorders indicates a need for this type of medication? ANSWERS - Multiple Choice INCORRECT 1) Depression Answer Rationale: Celecoxib is not indicated for the treatment of depression. 2) Osteoarthritis Answer Rationale: Celecoxib is a nonsteroidal anti-inflammatory, cyclooxygenase-2 (COX-2) inhibitor used to relieve the pain and inflammation caused by rheumatoid arthritis and osteoarthritis in adults. INCORRECT 3) Infection Answer Rationale: Celecoxib is not indicated for the treatment of infection. INCORRECT 4) Seizures Answer Rationale: Celecoxib is not indicated for the treatment of seizures. 12) A nurse is caring for a client who has a prescription for clopidogrel. Which of the following actions should the nurse plan to take? ANSWERS - Multiple Choice 1) Monitor the client for black, tarry stools. Answer Rationale: Clopidogrel is an antithrombotic and antiplatelet medication; therefore, it poses a risk of serious bleeding. The nurse should monitor for signs of bleeding such as black, tarry stools and report these findings to the provider. INCORRECT 2) Initiate contact precautions. Answer Rationale: Contact precautions protect staff from acquiring an illness that spreads by direct contact, such as a methicillin- resistant Staphylococcus aureus infection. INCORRECT 3) Administer the medication with each meal. Answer Rationale: The nurse should administer clopidogrel once daily, with or without food. INCORRECT 4) Have suction equipment at the bedside. Answer Rationale: The nurse should have suction equipment at the bedside for a client who requires seizure precautions; however, this is not necessary for a client who is receiving this medication and is not otherwise at an increased risk for aspiration. 13) A nurse is caring for an older adult client who is 5 days postoperative following a total hip arthroplasty and is receiving meperidine for pain. While the nurse is taking morning vital signs, the client begins to experience a seizure. Which of the following should the nurse recognize as the possible cause for this seizure? ANSWERS - Multiple Choice INCORRECT 1) Antagonistic effect Answer Rationale: An antagonistic effect is a drug-drug interaction that results in the decreased effectiveness of one or both of the medications given. 2) Cumulative effect Answer Rationale: A cumulative effect occurs with repeated doses of a medication are given and the rate of administration exceeds the rate of metabolism or excretion. Due to older adults decreased kidney function, meperidine can quickly reach a toxic level when given over several days, which can cause seizures. INCORRECT 3) Synergistic effect Answer Rationale: A synergistic effect is a drug-drug interaction that results in an increased effectiveness of one or both of the medications given. INCORRECT 4) Teratogenic effect Answer Rationale: A teratogenic effect is one that results in the congenital defect of a fetus during pregnancy when the mother is exposed to certain medications and chemicals. 14) A nurse is reinforcing discharge teaching with a client who has hyperlipidemia and a prescription for niacin. Which of the following statements should the nurse include in the teaching? ANSWERS - Multiple Choice INCORRECT 1) "Take this medication 30 min before you eat breakfast." Answer Rationale: The nurse should instruct the client to take niacin with meals to avoid gastrointestinal upset. 2) "You might experience flushing of the face after taking this mediation." Answer Rationale: The nurse should advise the client that niacin causes flushing of the face, neck, and ears in most clients within the first 2 hr of taking the medication. INCORRECT 3) "Your blood work will be monitored weekly for the first 3 months of treatment." Answer Rationale: The nurse should instruct the client that blood lipid levels will be monitored monthly early in the course of treatment and will continue to be monitored every 3 to 6 months thereafter. INCORRECT 4) "Store this medication in your refrigerator in a dark container." Answer Rationale: The nurse should instruct the client to store the medication at room temperature in a light and moisture-proof container. 15) A nurse caring for a client who has a new prescription for atenolol. For which of the following adverse effects should the nurse monitor the client? ANSWERS - Multiple Choice INCORRECT 1) Neutropenia Answer Rationale: Neutropenia and risk for infection are not adverse effects of atenolol. 2) Bradycardia Answer Rationale: Atenolol, a beta adrenergic blocker, is used to treat hypertension and stable angina pectoris. This medication slows the pulse rate due to blockage of cardiac beta 1 receptors. The nurse should monitor for bradycardia in clients who are prescribed atenolol and other beta adrenergic blockers. INCORRECT 3) Hypokalemia Answer Rationale: Hypokalemia is not an adverse effect of atenolol. INCORRECT 4) Anemia Answer Rationale: Anemia is not an adverse effect of atenolol. 16) A nurse is reinforcing teaching with a client who has a prescription for simvastatin. Which of the following instructions should the nurse provide? ANSWERS - Multiple Choice INCORRECT 1) Follow each tablet with an antacid tablet. Answer Rationale: Simvastatin does not cause GI upset as an adverse effect and therefore does not require a follow-up antacid medication INCORRECT 2) Swallow the tablet with a glass of grapefruit juice. Answer Rationale: Statins have potential adverse effects when taken with grapefruit juice. 3) Take the medication in the evening hours. Answer Rationale: Statins are most effective if taken at bedtime or with the evening meal because this is when the peak production of cholesterol takes place. INCORRECT 4) Have a meal or a snack when taking the medication. Answer Rationale: Lovastatin can be taken with the evening meal; however, simvastatin can be taken without regard to meals. 17) A nurse is caring for a client who has a new prescription for warfarin. The nurse should use the results of which of the following diagnostic tests to monitor the effect of this therapy? ANSWERS - Multiple Choice 1) Prothrombin time (PT) Answer Rationale: The PT, reported as an INR, is used to monitor warfarin therapy. INCORRECT 2) Platelet count Answer Rationale: The platelet count is used to monitor for adverse effects of cancer chemotherapy. Warfarin does not affect the platelet count. INCORRECT 3) White blood cell count (WBC) Answer Rationale: The WBC is used to monitor antibiotic therapy for a client who has a bacterial infection. INCORRECT 4) Activated partial thromboplastin time (aPTT) Answer Rationale: The aPTT is used to monitor heparin therapy. 18) A nurse is collecting data for a client who has been receiving parenteral morphine 10 mg every 4 hr for the past week due to a serious traumatic injury to the pelvis and lower extremities. The client is awake and alert but states that the morphine no longer seems to be relieving her severe pain. Which of the following phenomena should the nurse realize the client is experiencing? ANSWERS - Multiple Choice 1) Opioid tolerance Answer Rationale: Opioid tolerance, as well as physical dependence, occurs over time when morphine is administered regularly for longer than 1 to 2 weeks. Tolerance occurs when a larger dose of opioid is required to relieve pain that was previously relieved by a smaller dose. For a client who has severe, ongoing pain, the dosage of morphine may need to be increased to control pain adequately. INCORRECT 2) Opioid addiction Answer Rationale: Opioid addiction is a rare phenomenon that means the client is experiencing a psychological craving for morphine despite a decreased need for the opioid. The client who has sustained a severe traumatic injury and has ongoing acute pain requires continued opioid treatment. Addiction is not an issue at this time. Fear of addiction might cause a nurse to administer less pain medication than the client requires and might cause the client to refuse needed pain relief. INCORRECT 3) Opioid toxicity Answer Rationale: Manifestations of opioid toxicity include decreased respiratory rate and sedation. There is no data to show that toxicity is being experienced by this client. In addition, a client who is experiencing severe pain is unlikely to experience opioid toxicity. INCORRECT 4) Opioid withdrawal Answer Rationale: Manifestations of opioid withdrawal include abdominal cramping, muscle pain, tremor, and irritability. A client who is administered morphine every 4 hours should not have manifestations of opioid withdrawal and there is no data to show that these manifestations are present. 19) A nurse is reviewing the morning laboratory results of electrolytes for four clients who are receiving digoxin. Which of the following clients should the nurse identify as being at risk for developing digoxin toxicity? ANSWERS - Multiple Choice 1) A client taking furosemide for chronic hypertension Answer Rationale: Loop diuretics, such as furosemide, might cause hypokalemia, which greatly increases the risk of digoxin toxicity. INCORRECT 2) A client taking chlorpropamide for type 2 diabetes mellitus Answer Rationale: Chlorpropamide is an oral hypoglycemic agent. Altered glucose levels have no effect on digoxin toxicity. INCORRECT 3) A client taking aluminum hydroxide for gastric upset Answer Rationale: Aluminum hydroxide and other antacids can decrease the absorption of digoxin, as well as other medications, if given concurrently. Digoxin toxicity is associated with an increased digoxin level rather than a decreased one. INCORRECT 4) A client taking a potassium supplement twice a day Answer Rationale: Hypokalemia, not hyperkalemia, is associated with an increased risk for digoxin toxicity. 20) A nurse is reinforcing teaching for a client who has a new prescription for sublingual nitroglycerin. Which of the following instructions should the nurse include? ANSWERS - Multiple Choice INCORRECT 1) "You may take up to five nitroglycerin sublingual tablets at 3 min intervals if chest pain occurs." Answer Rationale: The client should be instructed to take no more than a total of three sublingual nitroglycerin 5 min apart, if necessary, in a 15 min time period. INCORRECT 2) "If you experience a headache after taking nitroglycerin, stop taking the medication and notify your provider immediately." Answer Rationale: Up to half of clients who take nitroglycerin experience a headache following administration, especially during the first few weeks the medication is used. The client should not stop taking the medication and does not need to notify the provider if a headache occurs. The client should ask the provider about an appropriate analgesic to take if a headache occurs. INCORRECT 3) "You should keep an emergency supply of nitroglycerin tablets in a plastic container with other medications for each day." Answer Rationale: Nitroglycerin tablets should be kept in their original container with the top tightly closed and protected from moisture, light and heat. The client should be taught to discard outdated nitroglycerin and make sure to refill the prescription if the expiration date on the container has been reached. 4) "If your mouth is dry, take a sip of water before putting the tablet under your tongue.” Answer Rationale: Nitroglycerin tablets require moisture to dissolve completely. The client should be taught to take a sip of water before putting the tablet under the tongue if the mouth is very dry. 21) A nurse is reinforcing teaching with a young adult female client who has been prescribed lisinopril. Which of the following instructions should the nurse plan to include? (Select all that apply.) ANSWERS - Multiple Response 1) "Report the development of a persistent dry cough." 2) "Monitor your blood pressure on a regular basis." 3) "Notify your doctor immediately if you become pregnant." INCORRECT 4) "Your cholesterol levels should be monitored monthly while taking this medication." INCORRECT 5) "Make sure your diet contains a lot of potassium-rich foods." Answer Rationale: Report the development of a persistent dry cough is correct. The development of a chronic dry cough is a common problem with the use of ACE inhibitors and is believed to be related to the accumulation of bradykinin. It is important that all clients be instructed to report the development of this side effect. Monitor your blood pressure on a regular basis is correct. Hypotension is a common side effect of lisinopril, so the client should be instructed in how to monitor their blood pressure on a regular basis. Notify your doctor immediately if you become pregnant is correct. Lisinopril is a known teratogenic agent and may cause serious harm to a developing fetus; therefore, lisinopril should not be taken by a woman who is pregnant or lactating. Your cholesterol levels should be monitored monthly while taking this medication is incorrect. Lisinopril does not affect cholesterol. The WBC should be monitored frequently during the first 6 months of therapy to check for neutropenia. Make sure your diet contains a lot of potassium-rich foods is incorrect. Lisinopril does not cause potassium depletion, so the client does not need to ensure the diet includes potassium-rich foods. 22) A nurse is reinforcing teaching for the parent of a toddler who has iron deficiency anemia and a new prescription for liquid iron solution. Which of the following instructions by the nurse is the priority? ANSWERS - Multiple Choice INCORRECT 1) Rinse the child's mouth after administration of iron. Answer Rationale: Rinsing the child's mouth with water after administration can help prevent staining the child's teeth; however, another option is the priority. INCORRECT 2) Dilute the iron solution with fruit juice. Answer Rationale: Diluting the iron solution with juice or water can help prevent staining the child's teeth and might help in increasing absorption of iron; however, another option is the priority. INCORRECT 3) Increase the child's consumption of iron-rich foods. Answer Rationale: Reinforcing teaching about ways to increasing the child's consumption of iron-rich foods can help treat iron deficiency and prevent its recurrence; however, another option is the priority. 4) Keep the iron solution stored in a locked cupboard. Answer Rationale: The greatest risk to this client is injury from iron toxicity which can be fatal in young children; therefore, the priority instruction the nurse should give is to keep the iron solution stored in a locked cupboard. The nurse should also instruct the parent to keep the medication in a child-proof container. 23) A nurse is collecting data from a female client who has osteoarthritis and reports she is thinking about taking aspirin for pain control. Which of the following data in the client's history should the nurse realize might be a contraindication to taking aspirin and should be reported to the provider? ANSWERS - Multiple Choice INCORRECT 1) Report of recent migraine headaches Answer Rationale: Migraine headaches are not a contraindication to the use of aspirin. 2) History of vitamin K deficiency Answer Rationale: Aspirin inhibits platelet aggregation and should not be taken by clients who have bleeding disorders, such as a history of vitamin K deficiency. Vitamin K must be present in order to synthesize several clotting factors and a deficiency of the vitamin causes bleeding tendencies. The nurse should report a history of vitamin K deficiency to the provider. INCORRECT 3) Current diagnosis of glaucoma Answer Rationale: Glaucoma is not a contraindication to the use of aspirin. INCORRECT 4) Prior reports of amenorrhea Answer Rationale: Amenorrhea is not a contraindication to the use of aspirin. 24) A nurse is reinforcing teaching for a client who has a new prescription for warfarin. Which of the following information should the nurse include? ANSWERS - Multiple Choice INCORRECT 1) Mild nosebleeds are common during initial treatment. Answer Rationale: Warfarin, an anticoagulant, increases the client's risk for bleeding. The nurse should instruct the client to stop the medication and notify the provider if bleeding occurs. 2) The client should use an electric razor while on this medication. Answer Rationale: Warfarin, an anticoagulant, increases the client's risk for bleeding. The nurse should teach the client safety measure, such as using an electric razor, to decrease the risk for injury and bleeding. INCORRECT 3) If he misses a dose, he should double the dose at the next scheduled time. Answer Rationale: Warfarin, an anticoagulant, should be taken at the same time each day and the client should not adjust the dose. Doubling a dose increases the client's risk for bleeding. INCORRECT 4) Warfarin increases the risk for deep vein thrombosis. Answer Rationale: Warfarin, an anticoagulant, is a medication for the prophylaxis and treatment of deep vein thrombosis. 25) A nurse is assisting in the education of a group of clients about the contraindications of warfarin therapy. Which of the following statements is appropriate to include in the instructions? ANSWERS - Multiple Choice INCORRECT 1) "Clients who have diabetes mellitus type 1 should not take warfarin." Answer Rationale: Diabetes mellitus is not a contraindication for warfarin therapy. INCORRECT 2) "Clients who have rheumatoid arthritis should not take warfarin." Answer Rationale: Rheumatoid arthritis is not a contraindication for warfarin therapy. 3) "Clients who are pregnant should not take warfarin." Answer Rationale: Warfarin therapy is contraindicated in the pregnant client because it crosses the placenta and places the fetus at risk. Warfarin is a pregnancy category X medication. INCORRECT 4) "Clients who have hypertension should not take warfarin." Answer Rationale: Hypertension is not a contraindication for warfarin therapy. 26) A nurse is reinforcing teaching for a client who has rheumatoid arthritis and a new prescription for aspirin 650 mg orally every 6 hr. The nurse should instruct the client to monitor for which of the following adverse effects of aspirin therapy? ANSWERS - Multiple Choice INCORRECT 1) Constipation Answer Rationale: Aspirin can cause diarrhea. Constipation is not an adverse effect of aspirin therapy. 2) Bleeding Answer Rationale: Aspirin can cause bleeding, tinnitus, gastric ulceration, nausea, and heartburn. Aspirin inhibits platelet aggregation and prolongs bleeding time. The client should be instructed to report blood in the stool, urine, or in emesis, and should also report unusual bruising or bleeding gums. INCORRECT 3) Blurred vision Answer Rationale: Aspirin can cause tinnitus and hearing loss. Blurred vision is not an adverse effect of aspirin therapy. INCORRECT 4) Insomnia Answer Rationale: Aspirin can cause dizziness and drowsiness. Insomnia is not an adverse effect of aspirin therapy. 27) A nurse is collecting data from an older adult client who has been taking digoxin for the past several months. For which of the following manifestations of digoxin toxicity should the nurse monitor? ANSWERS - Multiple Choice 1) Anorexia Answer Rationale: Clients who take digoxin are at risk for toxicity due to the medication’s narrow therapeutic range. Anorexia, nausea, and vomiting are some of the early manifestations of digoxin toxicity in adults. In children, cardiac dysrhythmias are often the first manifestation of digoxin toxicity. INCORRECT 2) Ataxia Answer Rationale: Weakness is a manifestation of digoxin toxicity; however, ataxia, a lack of muscle coordination, is not present with digoxin toxicity. INCORRECT 3) Hearing deficits Answer Rationale: Digoxin toxicity causes halos around lights, yellow vision, and blurred vision; however, hearing deficits are not a manifestation of digoxin toxicity. INCORRECT 4) Jaundice Answer Rationale: Jaundice is a sign of sulfonylurea toxicity in older adults; however, jaundice is not a manifestation of digoxin toxicity. 28) A nurse is reinforcing teaching with a client who has increased cholesterol levels and a new prescription for colestipol granules 15 gm PO twice daily. The nurse should identify that which of the following statements by the client indicates an understanding of colestipol administration? ANSWERS - Multiple Choice INCORRECT 1) "I will take the granules along with my other medications in the morning and evening." Answer Rationale: The client should take other medication 1 hr before or 4 hr after colestipol, as colestipol decreases absorption of other medications. 2) "I can mix the granules with applesauce and take the mixture with a spoon." Answer Rationale: Colestipol granules can be mixed with a liquid, such as water, carbonated beverages, or soup. The granules can also be mixed with crushed fruit or a fruit sauce, such as applesauce, before swallowing them. This decreases the risk for irritation to the esophagus. INCORRECT 3) "I should check my blood sugar before meals while taking colestipol." Answer Rationale: Clients taking colestipol should have periodic monitoring of cholesterol levels and serum electrolytes, but colestipol does not cause changes in blood glucose levels. INCORRECT 4) "I need to mix the granules with a clear liquid and stir the solution until it becomes clear." Answer Rationale: If mixed with a clear liquid, colestipol mixture will remain cloudy because it is not a water-soluble solution. The client does not need to mix the granules with a clear liquid. 29) A nurse is caring for a postoperative client who is receiving fentanyl. Which of the following medications should the nurse plan to administer to the client if manifestations of fentanyl toxicity occur? ANSWERS - Multiple Choice INCORRECT 1) Protamine Answer Rationale: Protamine reverses the effects of heparin, not fentanyl. INCORRECT 2) Flumazenil Answer Rationale: Flumazenil, a benzodiazepine antagonist, reverses the sedative effects of benzodiazepines. It does not reverse the effects of fentanyl. INCORRECT 3) Atropine Answer Rationale: Atropine, an anticholinergic drug, treats bradycardia. It does not reverse the effects of fentanyl. 4) Naloxone Answer Rationale: Fentanyl is an opioid analgesic. The nurse should have the opioid reversal agent naloxone and resuscitation equipment available in the event that the client develops manifestations of opioid toxicity such as sedation. 30) A nurse is preparing to administer heparin subcutaneously to a client. Which of the following is an appropriate action by the nurse? ANSWERS - Multiple Choice INCORRECT 1) Use a 22-gauge needle to inject the medication. Answer Rationale: The nurse should use a small 25-gauge needle when administering a deep subcutaneous injection. INCORRECT 2) Use a 1-inch needle to inject the medication. Answer Rationale: The nurse should use a short needle, ½- to 5/8-inch, when administering a deep subcutaneous injection. 3) Inject the medication into the abdomen above the level of the iliac crest. Answer Rationale: The nurse should inject the medication into the abdomen above the level of the iliac crest, at least 2 inches from the umbilicus. INCORRECT 4) Massage the injection site after administration of the medication. Answer Rationale: The nurse should apply firm pressure without massage to the site for 1 to 2 min after administration. Massaging the area after injecting heparin can cause bleeding. 31) A nurse administered nitroglycerin sublingually to a client who has angina pectoris and experienced chest pain. The client states that his chest pain is relieved but now he has a headache. Which of the following responses by the nurse is appropriate? ANSWERS - Multiple Choice INCORRECT 1) "It sounds as if you are allergic to this medication." Answer Rationale: Allergic reactions typically manifest as itching and a rash. Severe reactions can include laryngeal edema and bronchospasm. 2) "A headache is a common adverse effect of this medication, but it will probably occur less often over time." Answer Rationale: The vasodilation nitroglycerin induces increases blood flow to the head and typically results in a headache. INCORRECT 3) "A headache indicates tolerance to the medication." Answer Rationale: With tolerance, the client needs more of the medication to achieve a therapeutic response. A headache is not a sign of this phenomenon. INCORRECT 4) "Your headache is probably a result of anxiety about the chest pain." Answer Rationale: The nurse has no reliable data for determining that anxiety produced the client’s headache. 32) A nurse is reinforcing teaching with a client who has a new prescription for transdermal nitroglycerin for angina pectoris. Which of the following instructions should the nurse include? ANSWERS - Multiple Choice INCORRECT 1) Apply a new patch each day. Answer Rationale: The client should apply a new transdermal patch at the same time each day. 2) Leave the patch in place for 24 hr. Answer Rationale: The client should remove the patch after 10 to 12 hr to prevent the client developing a tolerance to the medication. INCORRECT 3) Shave excessive hair before applying the patch to the chest. Answer Rationale: The client should remove excess hair by clip prior to applying the patch. INCORRECT 4) Apply the patch to a different site once a week. Answer Rationale: To reduce the risk of skin irritation, the client should change the application site every time he applies a patch. 33) A nurse is preparing to administer diphenhydramine to a client who is to receive a blood transfusion. The nurse should explain that the purpose of diphenhydramine is to prevent which of the following manifestations of a transfusion reaction? ANSWERS - Multiple Choice 1) Urticaria Answer Rationale: Antihistamines such as diphenhydramine are administered prior to blood administration to prevent mild allergic reactions such as itching, flushing, and hives. INCORRECT 2) Fever Answer Rationale: Fever is a manifestation of a nonhemolytic transfusion reaction, which is caused by antibodies to the donor’s WBCs. Leucocyte-poor blood products can be used for clients who have a history of nonhemolytic transfusion reactions. INCORRECT 3) Dyspnea Answer Rationale: Dyspnea, cough, headache, and distended neck veins are manifestations of fluid overload. The nurse should ensure that the rate of the transfusion is based on the client’s size and overall condition. INCORRECT 4) Low-back pain Answer Rationale: Low-back pain is a clinical manifestation of an acute hemolytic reaction. The nurse should ensure that strict compliance with the agency procedures throughout the blood transfusion process to prevent administration of the wrong unit of blood to the client. 34) A nurse is collecting data from a client who is postoperative from a mastectomy and was administered hydromorphone 1 hr ago. The nurse should identify that which of the following findings is an adverse effect of this medication? ANSWERS - Multiple Choice 1) Vomiting Answer Rationale: An adverse effect of opioid analgesics, which includes hydromorphone, is nausea and vomiting. The nurse can reduce the emetic effects of this medication by having the client lie still or administering an antiemetic medication prior to the administration of an opioid analgesic. INCORRECT 2) Diarrhea Answer Rationale: Opioid analgesics such as hydromorphone cause constipation. Paregoric is an opioid that is used to treat diarrhea. INCORRECT 3) Tremors Answer Rationale: Tremors are an adverse effect of the opioid antagonist naloxone. INCORRECT 4) Cough Answer Rationale: Hydromorphone is an antitussive and is used to treat cough. 35) A nurse is reinforcing discharge teaching with a client who is postoperative following hip arthroplasty and is to continue use of enoxaparin at home. Which of the following statements by the client indicates an understanding of the teaching? ANSWERS - Multiple Choice INCORRECT 1) "I will return to the clinic for laboratory testing weekly." Answer Rationale: Enoxaparin does not require weekly laboratory testing. The nurse should instruct the client to notify the provide4r if manifestations of bleeding occur, such as bruising or epistaxis. INCORRECT 2) "I will avoid eating foods that are high in vitamin K, such as broccoli and spinach." Answer Rationale: The nurse should instruct the client that no dietary changes are required while taking enoxaparin. 3) "I will need to give myself an injection in my abdomen twice a day." Answer Rationale: Enoxaparin is an anticoagulant used to prevent deep vein thrombosis after orthopedic and other types of surgery. It is administered only by the subcutaneous route and its duration of action is 12 hr. It is considered safe to allow the client to self-administer this medication. INCORRECT 4) "I will need to take this medication for two weeks." Answer Rationale: The recommendation for treatment with enoxaparin after hip arthroplasty is 7 to 10 days. 36) A nurse is caring for a client who has thrombophlebitis and is receiving a continuous heparin infusion. Which of the following medications should the nurse have available to reverse heparin’s effects? ANSWERS - Multiple Choice INCORRECT 1) Vitamin K Answer Rationale: Vitamin K reverses the effects of warfarin, not heparin, by promoting the synthesis of coagulation factors. 2) Protamine sulfate Answer Rationale: Protamine sulfate reverses the effects of heparin by binding with heparin to form a heparin-protamine complex that has no anticoagulant properties. INCORRECT 3) Acetylcysteine Answer Rationale: Acetylcysteine reduces the risk of hepatotoxicity after acetaminophen overdose. It does not reverse the effects of heparin toxicity. INCORRECT 4) Deferoxamine Answer Rationale: Deferoxamine binds to iron to reduce iron toxicity from supplemental iron therapy. It does not reverse the effects of heparin toxicity. 37) A nurse is reinforcing teaching with a client who uses a nitroglycerine patch to treat angina. The client now has a new prescription for nitroglycerin sublingual tablets. Which of the following instructions should the nurse include? ANSWERS - Multiple Choice INCORRECT 1) Swallow the tablet whole with an 8 oz glass of water. Answer Rationale: The client should place the tablet under his tongue and allow it to dissolve. INCORRECT 2) Store the medication in a pill box at the bedside. Answer Rationale: To promote chemical stability, the client should store the medication in a room with low moisture and in its original container. 3) Take the medication at the first indication of chest pain. Answer Rationale: The client should take nitroglycerin as soon as he feels pain, pressure, or tightness in his chest and not wait until his chest pain is severe. INCORRECT 4) Remove the nitroglycerine patch before taking the sublingual tablet. Answer Rationale: The client can take a sublingual tablet without removing the nitroglycerine patch. 38) A nurse is preparing to administer digoxin to a client who has heart failure. For which of the following findings should the nurse withhold the medication and report to the provider? ANSWERS - Multiple Choice INCORRECT 1) Heart rate 66/min Answer Rationale: Digoxin is a cardiac glycoside, which increases the force of ventricular contraction and thus increases cardiac output. This action reverses the manifestations of heart failure, resulting in decreased heart size, decreased heart rate, decreased vascular constriction, and reversal of water retention. 2) Report of blurred vision Answer Rationale: The nurse should monitor the client for cardiac and noncardiac adverse effects that can indicate toxicity. Nausea, vomiting, anorexia, fatigue and visual disturbances, such as blurred vision can be early indicators of toxicity. The nurse should withhold the medication and contact the provider. INCORRECT 3) Urine output 35 mL/hr Answer Rationale: The nurse should expect adequate urine output because digoxin increases renal blood flow, which increases urine production and output. A urine output of 35 mL/hr is within the expected reference range. INCORRECT 4) Serum potassium 4.8 mEq/L Answer Rationale: A serum potassium level of 4.8 mEq/L is within the expected reference range. Digoxin increases myocardial contractility by inhibiting the enzyme sodium, potassium-ATPase. Potassium and digoxin compete for the binding sites on this enzyme, so if serum potassium levels are low, more digoxin can bind to the enzyme and have a greater effect on the heart. To prevent cardiotoxicity, the nurse should monitor the client’s serum potassium level to ensure it is within the expected reference range. 39) A nurse is administering meperidine 100 mg IM for a client who is admitted with a pelvic fracture. Following the injection, which of the following data is the priority for the nurse to check? ANSWERS - Multiple Choice INCORRECT 1) Apical pulse rate Answer Rationale: Meperidine might affect the client’s apical pulse rate; however, it is not the priority data for the nurse to check. INCORRECT 2) Blood pressure Answer Rationale: Meperidine might lower the client’s blood pressure; however, it is not the priority data for the nurse to check. INCORRECT 3) Level of consciousness Answer Rationale: Meperidine might affect the client’s level of consciousness by causing sedation; however, it is not the priority data for the nurse to check. 4) Respiratory rate Answer Rationale: Meperidine, an opioid, can cause respiratory depression. The nurse should apply the ABC priority-setting framework. This framework emphasizes the basic core of human functioning—having an open airway, being able to breathe in adequate amounts of oxygen, and circulating oxygen to the body’s organs via the blood. An alteration in any of these can indicate a threat to life, and is therefore the nurse’s priority concern. When applying the ABC priority setting framework, airway is always the highest priority because the airway must be clear and open for oxygen exchange to occur. Breathing is the second-highest priority in the ABC priority setting framework because adequate ventilator effort is essential in order for oxygen exchange to occur. Circulation is the third-highest priority in the ABC priority setting framework because delivery of oxygen to critical organs only occurs if the heart and blood vessels are capable of efficiently carrying oxygen to them. 40) A nurse is caring for a client who is taking furosemide. For which of the following adverse effects should the nurse monitor? ANSWERS - Multiple Choice INCORRECT 1) Hypervolemia Answer Rationale: A client who is taking furosemide can develop hypovolemia because the medication is a high-ceiling loop diuretic that results in excessive sodium, chloride, and water loss. The nurse should monitor for dry mouth, thirst, and decreased urine output, which indicate dehydration. INCORRECT 2) Hypertension Answer Rationale: A client who is taking furosemide can develop hypotension, resulting from loss of blood volume and venous smooth muscle relaxation, which decreases venous return to the heart. The nurse should monitor for dizziness, lightheadedness, and fainting. 3) Hypokalemia Answer Rationale: A client who is taking furosemide can develop hypokalemia because the medication is a high-ceiling loop diuretic that promotes secretion of potassium in the distal nephron. The nurse should monitor for muscle weakness, decreased bowel sounds, abdominal distention, and constipation. INCORRECT 4) Hypoglycemia Answer Rationale: A client who is taking furosemide can develop hyperglycemia, resulting from decreased insulin release, glycogen synthesis, and increased glycogenolysis. 41) A nurse is caring for a client who has been taking warfarin and has a prothrombin time of 30 seconds. Which of the following medications should the nurse anticipate the provider to prescribe? ANSWERS - Multiple Choice 1) Vitamin K Answer Rationale: A prothrombin time of 30 seconds indicates the clotting time is prolonged and bleeding could occur. Vitamin K injection antagonizes the actions of warfarin and serves as an antidote to the medication; therefore, the nurse should anticipate the provider will prescribe vitamin K. INCORRECT 2) Heparin Answer Rationale: Heparin is an anticoagulant and should not be administered to a client who has an increased prothrombin time of 30 sec. INCORRECT 3) Prednisone Answer Rationale: The nurse should anticipate a prescription for prednisone for a client who has an inflammatory condition. A prolonged prothrombin time is not an indication of an inflammatory response. INCORRECT 4) Ferrous sulfate Answer Rationale: The nurse should anticipate a prescription for ferrous sulfate for a client who has iron-deficiency anemia. There is no indication this client is anemic. 42) A nurse is collecting data from a client who is to start taking digoxin for heart failure. The nurse should instruct the client to avoid taking which of the following herbal supplements? ANSWERS - Multiple Choice INCORRECT 1) Feverfew Answer Rationale: There are no interactions between feverfew and digoxin. 2) St. John’s wort Answer Rationale: Taking St. John’s wort concurrently with digoxin can increase excretion of the medication and thus decrease its effectiveness. INCORRECT 3) Echinacea Answer Rationale: There are no interactions between echinacea and digoxin. INCORRECT 4) Valerian Answer Rationale: There are no interactions between valerian and digoxin. 43) A nurse is reinforcing discharge teaching with a client who has pulmonary edema and is about to start taking furosemide. Which of the following instructions should the nurse include? ANSWERS - Multiple Choice INCORRECT 1) Take aspirin for headaches. Answer Rationale: The client should avoid aspirin and other NSAIDs because they can blunt the diuretic effects of furosemide. 2) Eat foods that contain plenty of potassium. Answer Rationale: Furosemide, a high-ceiling (loop) diuretic, can cause potassium loss. To prevent this, the client should add potassium-rich foods to his diet such as bananas and avocados. INCORRECT 3) Expect some swelling in the hands and feet. Answer Rationale: Furosemide is a loop diuretic that blocks the reabsorption of sodium and chloride, which in turn prevents reabsorption of water and promotes the excretion of these electrolytes and water. Therefore, the client should expect decreased swelling in the hands and feet. INCORRECT 4) Take the medication at bedtime. Answer Rationale: The client should take furosemide early in the day so that the medication’s action will not disturb his sleep. 44) A nurse is preparing to administer digoxin to a client who has heart failure. Before administering this medication, which of the following actions should the nurse take? ANSWERS - Multiple Choice INCORRECT 1) Offer the client a light snack. Answer Rationale: The client can take the medication with or without food, although giving it immediately after food can delay absorption slightly. INCORRECT 2) Check the client’s blood pressure. Answer Rationale: It is not necessary to check the client’s blood pressure immediately before dosing, although the nurse should check the client’s blood pressure routinely to monitor for worsening of heart failure. 3) Measure the client’s apical pulse. Answer Rationale: Digoxin decreases the heart rate, so the nurse should count the apical pulse for at least 1 min before administering it. The nurse should withhold the medication if the client’s heart rate is below designated parameters such as 50 to 60/min. INCORRECT 4) Weigh the client. Answer Rationale: It is not necessary to weigh the client immediately before dosing, although the nurse should weigh the client daily to monitor for worsening of heart failure. 45) A nurse is reinforcing teaching to a client who is to start using a nitroglycerine transdermal unit for angina. Which of the following instructions should the nurse include? ANSWERS - Multiple Choice INCORRECT 1) Cut the patches in half to save money. Answer Rationale: The client should never alter the size of the transdermal unit, because this will alter the amount of medication he will receive. 2) Remove the patch each evening to have 10 hr without medication. Answer Rationale: The client should remove the patch each evening to allow for 10 to 12 hr of medication free time. This will help prevent tolerance to the medication. INCORRECT 3) Apply an additional patch during an angina attack. Answer Rationale: Clients should use a transdermal delivery system for long-term management of angina and not as a rescue medication. INCORRECT 4) Remove the patch if you develop a headache. Answer Rationale: Headaches are a common adverse effect of nitroglycerin and usually decrease in intensity with time. The nurse can recommend the client use an over-the-counter mild analgesic such as aspirin or acetaminophen to manage pain. If the headaches persist, the client should report this finding to the provider, who might lower the dosage. 46) A nurse is talking with a client who is about to start taking nitroglycerin oral, sustained-release capsules. Which of the following instructions should the nurse include? ANSWERS - Multiple Choice INCORRECT 1) Take 1 capsule at the onset of anginal pain. Answer Rationale: The client should take nitroglycerin oral, sustained-release capsules to prevent angina attacks from occurring. INCORRECT 2) Stop taking the medication if you develop headaches. Answer Rationale: Abruptly discontinuing the use of long-acting nitroglycerin capsules can cause vasospasm. The nurse should inform the client that headaches will lessen with time but he can take an over-the-counter mild analgesic such as aspirin or acetaminophen to manage pain. If the headaches persist, the client should report this finding to the provider who may lower the dosage. INCORRECT 3) Take the medication with meals. Answer Rationale: The client should take the medication on an empty stomach with 240 mL (8 oz) of water. 4) Swallow the capsules whole. Answer Rationale: The client should swallow the capsules whole and not chew, crush them, or place them under the tongue because this will interfere with the sustained release effect of the medication. 47) A nurse is assisting with the care of a client who is receiving heparin by IV infusion. Which of the following medications should the nurse have available in the event of an overdose? ANSWERS - Multiple Choice INCORRECT 1) Ferrous sulfate Answer Rationale: The nurse should administer ferrous sulfate to a client who has anemia. INCORRECT 2) Glucagon Answer Rationale: The nurse should have glucagon available when caring for clients who have diabetes mellitus. The nurse should administer glucagon to a client who has hypoglycemia because it promotes the breakdown of glycogen to glucose in the liver and rapidly increases the blood glucose level. 3) Protamine Answer Rationale: Protamine combines with heparin to form a stable compound, which then neutralizes the anticoagulant effect of heparin. INCORRECT 4) Vitamin K Answer Rationale: Vitamin K reverses the effects of warfarin, not heparin. 48) A nurse is reinforcing teaching with a client who is about to start taking captopril to treat hypertension. Which of the following instructions should the nurse include to help the client manage this medication’s adverse effects? ANSWERS - Multiple Choice INCORRECT 1) Use salt substitutes while taking this medication. Answer Rationale: Captopril, an ACE inhibitor, can cause hyperkalemia due to potassium retention by the kidney. The client should avoid salt substitutes, as most of them are high in potassium. 2) Take the medication on an empty stomach. Answer Rationale: The client should take captopril on an empty stomach because food reduces the medication’s absorption by 30 - 40%. INCORRECT 3) Expect a dry cough when taking this medication. Answer Rationale: Captopril can result in a dry, persistent cough from bradykinin buildup. This can lead to excessive vasodilation and hypotension. The client should report this finding and the provider will most likely discontinue the medication. INCORRECT 4) Expect to gain weight while taking this medication. Answer Rationale: Captopril is more likely to cause weight loss than weight gain. 49) A nurse is reinforcing teaching with a client who has hypertension and a new prescription for verapamil. The nurse should instruct the client to avoid taking this medication with which of the following foods? ANSWERS - Multiple Choice INCORRECT 1) Milk Answer Rationale: The nurse should instruct the client to take verapamil with food to reduce gastric irritation. Milk has no known effect on the metabolism of verapamil; therefore, the client can take verapamil with milk. INCORRECT 2) Orange juice Answer Rationale: The nurse should instruct the client to take verapamil with food to reduce gastric irritation. Orange juice has no known effect on the metabolism of verapamil; therefore, the client can take verapamil with orange juice. INCORRECT 3) Cranberry juice Answer Rationale: The nurse should instruct the client to take verapamil with food to reduce gastric irritation. Cranberry juice has no known effect on the metabolism of verapamil; therefore, the client can take verapamil with cranberry juice. 4) Grapefruit juice Answer Rationale: The nurse should instruct the client to avoid taking verapamil with grapefruit juice. Grapefruit juice can inhibit the metabolism of verapamil, a calcium channel blocker, and cause an increase in verapamil blood level. This excess amount of medication can cause severe hypotension and cardiotoxicity. 50) A nurse is reinforcing teaching with a client who has a new prescription for sublingual nitroglycerine. Which of the following instructions should the nurse include in the teaching? ANSWERS - Multiple Choice INCORRECT 1) Administer up to four tablets over 10 min. Answer Rationale: The nurse should instruct the client to take one tablet every 5 minutes until pain is relieved, and up to three tablets in 15 minutes, to prevent toxicity. 2) Lie down upon onset of chest pain. Answer Rationale: The nurse should instruct the client to lie down upon the onset of chest pain to prevent hypotension and reduce oxygen demand. INCORRECT 3) Store the tablets in the refrigerator. Answer Rationale: The nurse should instruct the client to store the tablets in the original container at room temperature to maintain effectiveness. INCORRECT 4) Swallow the tablets whole. Answer Rationale: The nurse should instruct the client to place the tablet under his tongue and allow it to dissolve completely to maximize effectiveness. 51) A nurse is caring for a client who is receiving warfarin therapy to prevent a deep vein thrombosis. Which of the following medications should the nurse have available in the event of an overdose? ANSWERS - Multiple Choice INCORRECT 1) Epinephrine Answer Rationale: The nurse should recognize that epinephrine is given to treat anaphylaxis. It does not reverse warfarin overdose. INCORRECT 2) Atropine Answer Rationale: The nurse should recognize that atropine is given to treat bradycardia. It does not reverse warfarin overdose. INCORRECT 3) Protamine Answer Rationale: The nurse should recognize that protamine is given to reverse the effects of heparin. It does not reverse warfarin overdose. 4) Vitamin K Answer Rationale: The nurse should have available vitamin K available to reverse the effects of warfarin in the event of an overdose. 52) A nurse is reinforcing teaching with a newly licensed nurse about caring for a client who has a prescription for enoxaparin. Which of the following instructions should the nurse include in the teaching? ANSWERS - Multiple Choice INCORRECT 1) Administer the medication into a large muscle. Answer Rationale: The nurse should instruct the new nurse to administer enoxaparin subcutaneously into the client’s abdomen. 2) Have protamine available in case of overdose. Answer Rationale: The nurse should instruct the new nurse to have protamine available to reverse the effects of enoxaparin in case of toxicity and bleeding. INCORRECT 3) Expel air bubble prior to administration of prefilled medication. Answer Rationale: The nurse should instruct the new nurse to administer the prefilled medication with the air bubble to ensure all of the medication is given with the injection. INCORRECT 4) Monitor the client’s potassium level. Answer Rationale: The nurse should instruct the new nurse to monitor the client’s platelet count. Enoxaparin is a low molecular weight heparin that inhibits thrombus and clot formation. It can cause thrombocytopenia and bleeding. It does not affect potassium level. 53) A nurse is assisting in the plan of care for a client who is receiving digoxin to treat heart failure. Which of the following actions should the nurse plan to take? ANSWERS - Multiple Choice INCORRECT 1) Withhold the medication if the client’s heart rate is above 100/min. Answer Rationale: The nurse should withhold the medication if the client’s heart rate is below 60/min because digoxin can cause bradycardia and other dysrhythmias. INCORRECT 2) Instruct the client to eat foods that are low in potassium. Answer Rationale: The client should eat foods high in potassium to prevent hypokalemia, which increases the risk of digoxin toxicity. INCORRECT 3) Measure the client’s apical pulse rate for 30 seconds before administration. Answer Rationale: The nurse should measure the apical pulse rate for 1 min to obtain an accurate reading. 4) Monitor the client for nausea, vomiting, and anorexia. Answer Rationale: Loss of appetite, nausea, vomiting, and blurred or yellow vision are manifestations of digoxin toxicity. Digoxin toxicity can cause cardiac dysrhythmias and should be reported immediately. 54) A nurse is reinforcing teaching a client who has a new prescription for transdermal nitroglycerin to treat angina pectoris. The nurse should include which of the following instructions in the teaching? (Select all that apply.) ANSWERS - Multiple Response 1) Apply the patch to a hairless area. 2) Apply a new patch each morning. 3) Remove the patch for 10 to 12 hr daily. INCORRECT 4) Apply a new patch to the same site each time. INCORRECT 5) Apply a new patch at the onset of anginal pain. Answer Rationale: Apply the patch to a hairless area is correct. Hair can interfere with the adhesion of the patch.Apply a new patch each morning is correct. Therapeutic preventive effects of transdermal nitroglycerin patches begin 30 to 60 min after application and last up to 14 hr. Remove the patch for 10 to 12 hr daily is correct. Removing the patches for 10 to 12 hr each day helps prevent tolerance to the drug. Apply a new patch to the same site each time is incorrect. The patch application site should be rotated to prevent skin irritation. Apply a new patch at the onset of anginal pain is incorrect. Nitroglycerin patches prevent angina attacks. They do not treat angina attacks. Sublingual nitroglycerine can be taken with the transdermal patch for angina. 55) A nurse is collecting data on a client who has a prescription for morphine. The nurse should recognize that which of the following data is a priority to obtain before administering this medication? ANSWERS - Multiple Choice