lOMoAR cPSD| 24220866
ATI PHARMACOLOGY QUESTIONS AND
CORRECT ANSWERS
1-A nurse has completed teaching a client who is being discharged on lithium for a bipolar disorder.
Which statement by the client indicates a need for further teaching?
1. "I need to drink 1-2 liters of fluid daily."
2. "I need to have my blood levels checked periodically."
3. "I should not limit my sodium intake."
4. "I should use ibuprofen for pain relief."
Explanation:
Lithium is a mood stabilizer most often used to treat bipolar affective disorders. It has a very narrow
therapeutic serum range of 0.6-1.2 mEq/L (0.6-1.2 mmol/L). Levels >1.5 mEq/L (1.5 mmol/L) are
considered toxic. Lithium toxicity usually occurs with the following:
1. Dehydration
2. Decreased renal function (eg, elderly clients)
3. Diet low in sodium
4. Drug-drug interactions (nonsteroidal anti-inflammatory drugs [NSAIDs] and thiazide
diuretics)
Lithium is cleared renally. Even a mild change in kidney function (as seen in elderly clients) can
cause serious lithium toxicity. Therefore, drugs that decrease renal blood flow (eg, NSAIDs) should
be avoided. Acetaminophen would be a better choice for pain relief (Option 4).
(Options 1 and 3) Sodium, water, and lithium are normally filtered by the kidneys. Restriction of
dietary sodium/water or dehydration signals renal sodium and water reabsorption which will also
increase lithium absorption, resulting in toxicity. Therefore, clients should never restrict their sodium
or water intake while taking lithium; instead, they should maintain a consistent sodium intake.
(Option 2) Blood should be drawn frequently to monitor for therapeutic lithium levels and toxicity.
Educational objective:
Dehydration, decreased renal function, diet low in sodium, and drug-drug interactions (eg, NSAIDs
and thiazide diuretics) can cause lithium toxicity.
2-A client with cancer pain is prescribed oxycodone. Which teaching is most essential to help
prevent long-term complications?
1. Teach the client how to assess blood pressure daily
2.
3. Teach theclient
client how to prevent constipation
4. Teach
Teach the
the client how
how to
to prevent
prevent itching
nausea
, lOMoAR cPSD| 24220866
Explanation:
Oxycodone is a morphine-like opioid medication. Opioid medications bind to opioid receptors in the
intestine, which slows peristalsis and increases water absorption, leading to constipation.
Constipation is an almost universally expected side effect from opioid medications. Clients will not
develop tolerance to this side effect. Although clients with idiopathic chronic constipation are not
commonly advised to take laxatives, opioid-induced constipation is treated with simultaneous use
of senna (stimulant) and docusate (stool softener).
(Options 1 and 3) Opioids cause the release of histamine, a vasodilator, which is responsible
for pruritus and flushing. Opioids can also cause peripheral vasodilation and nervous system
depression; both can lead to hypotension. These develop in some clients when the treatment is
initiated but usually resolve over time. Antihistamines (eg, diphenhydramine) can prevent the
pruritus. Lifestyle changes (eg, rising slowly from a seated position) and adequate hydration can
prevent hypotension.
(Option 4) Opioids stimulate the opioid receptors in the gastrointestinal tract and the chemoreceptor
trigger zone in the brain, producing nausea. This is also not seen with long-term use. Antiemetics
(eg, ondansetron) can be helpful.
Educational objective:
Constipation is an expected long-term side effect of opioid use; clients will not develop tolerance to
this side effect. It is important to teach aggressive preventive measures (eg, defecate when the urge
is felt, drink 2-3 L of fluid/day, high-fiber diet, exercise) and simultaneous use of a stool softener and a
stimulant.
3- The nurse is
reviewing prescriptions for the assigned clients. Which prescriptions should the nurse
question? Select all that apply.
1. Allopurinol for a client who developed tumor lysis syndrome from chemotherapy for acute
leukemia
2. Dicyclomine for a client with a history of irritable bowel syndrome who develops a
postoperative paralytic ileus
3. IV morphine for a client with severe acute renal colic pain who is scheduled for a
percutaneous nephrolithotripsy
4. Levofloxacin for a client with a urinary tract infection who has a history of anaphylaxis to
penicillin drugs
5. Simvastatin for a client with hypercholesterolemia who is reporting generalized
muscle aches and weakness
Explanation:
The nurse should question these prescriptions and contact the health care provider:
• Dicyclomine, an anticholinergic/antispasmodic drug prescribed to manage irritable bowel
syndrome, is contraindicated with paralytic ileus, as it decreases intestinal motility and
, lOMoAR cPSD| 24220866
would exacerbate the condition (Option 2).
• Statins (eg, atorvastatin, simvastatin) lower LDL cholesterol. Myopathy, a possible
adverse effect, may lead to life-threatening rhabdomyolysis (Option 5).
(Option 1) Tumor lysis syndrome is due to rapid lysis of cells and the resulting release of intracellular
ions potassium and phosphorous into serum. Phosphorus binds calcium and causes hypocalcemia.
Metabolism (catabolism) of released cellular nucleic acids leads to severe hyperuricemia. IV
hydration and hypouricemic medications (eg, allopurinol) are usually prescribed to promote excretion
of purines and prevent acute kidney injury.
(Option 3) IV opioids (eg, morphine) or nonsteroidal anti-inflammatory agents (eg, ketorolac) are
used to treat severe renal colic pain. Percutaneous nephrolithotripsy breaks and removes stones and
can lead to severe pain. Therefore, pain medications are appropriate.
(Option 4) Levofloxacin, a fluoroquinolone antibiotic prescribed to treat urinary tract infections, has
no known cross-sensitivity to penicillin. However, cross-sensitivity with other fluoroquinolones can
occur.
Educational objective:
Dicyclomine is an antispasmodic drug that decreases intestinal motility and is contraindicated with
paralytic ileus. For clients with myopathy, statins should be withheld and the health care provider
called. Prior to and during chemotherapy, allopurinol helps prevent hyperuricemia in clients at risk for
tumor lysis syndrome.
4- Which client is at greatest risk for respiratory depression when receiving opioids for pain control?
1. 20-year-old client with bronchitis receiving inhaled bronchodilator therapy every 4 hours
2. 30-year-old client with heroin addiction with rotator cuff repair surgery this morning
3. 50-year-old client with sleep apnea and left foot cellulitis and scheduled for a bone scan
4. 70-year-old client with chronic obstructive pulmonary disease (COPD) with knee
replacement this morning
Explanation:
The following are at greatest risk for respiratory depression related to opioid use for analgesia: the
elderly; those with underlying pulmonary disease, history of snoring (with or without apnea), obesity,
or smoking (more than 20-pack-year history); the opiate naïve, especially if treated for acute pain;
and post surgery (first 24 hours).
The 70-year old client has 3 significant risk factors: advanced age, COPD, and surgery within 24
hours. COPD clients who have hypercarbia and hypoxemia are at even greater risk for respiratory
depression when receiving opioids.
(Option 1) This client has 1 risk factor, pulmonary disease.
(Option 2) This client has 1 risk factor, surgery within 24 hours. His addiction to heroin gives him a
higher tolerance for opioids.
(Option 3) This client has 1 risk factor, sleep apnea.
, lOMoAR cPSD| 24220866
Educational objective:
Factors that increase risk for respiratory depression related to opioid use for pain control include
advanced age, underlying pulmonary disease, snoring, obesity, smoking, opiate naïve, and surgery.
5- Which herbal supplements pose an increased risk for bleeding in surgical clients and should be
discontinued prior to major surgery? Select all that apply.
1. Black cohosh
2. Garlic
3. Ginger
4. Ginkgo biloba
5. Hawthorne
Explanation:
Clients are often aware of the need to discontinue prescription medications such as aspirin and
anticoagulants prior to elective surgery, but they may not know that some herbal supplements can
increase bleeding risk. The nurse should question the client specifically about the use of herbal
supplements.
Herbal supplements that can increase risk for bleeding include:
• Gingko biloba
• Garlic
• Ginseng
• Ginger
• Feverfew
(Option 1) Black cohosh is used for treatment of menopausal symptoms. The main side effect is
liver injury.
(Option 5) Hawthorne extract is used to control hypertension and mild to moderate heart failure.
Hawthorne use does not increase the risk of bleeding.
Educational objective:
Use of herbal supplements such as ginkgo biloba, garlic, ginseng, ginger, and feverfew should be
reported to the health care provider before surgery as they may increase the risk of bleeding.
6- The health care provider prescribes phenazopyridine hydrochloride for a client with a urinary tract
infection. What would the office nurse teach the client to expect while taking this medication?
1. Constipation
2. Difficulty sleeping
3. Discoloration of urine
ATI PHARMACOLOGY QUESTIONS AND
CORRECT ANSWERS
1-A nurse has completed teaching a client who is being discharged on lithium for a bipolar disorder.
Which statement by the client indicates a need for further teaching?
1. "I need to drink 1-2 liters of fluid daily."
2. "I need to have my blood levels checked periodically."
3. "I should not limit my sodium intake."
4. "I should use ibuprofen for pain relief."
Explanation:
Lithium is a mood stabilizer most often used to treat bipolar affective disorders. It has a very narrow
therapeutic serum range of 0.6-1.2 mEq/L (0.6-1.2 mmol/L). Levels >1.5 mEq/L (1.5 mmol/L) are
considered toxic. Lithium toxicity usually occurs with the following:
1. Dehydration
2. Decreased renal function (eg, elderly clients)
3. Diet low in sodium
4. Drug-drug interactions (nonsteroidal anti-inflammatory drugs [NSAIDs] and thiazide
diuretics)
Lithium is cleared renally. Even a mild change in kidney function (as seen in elderly clients) can
cause serious lithium toxicity. Therefore, drugs that decrease renal blood flow (eg, NSAIDs) should
be avoided. Acetaminophen would be a better choice for pain relief (Option 4).
(Options 1 and 3) Sodium, water, and lithium are normally filtered by the kidneys. Restriction of
dietary sodium/water or dehydration signals renal sodium and water reabsorption which will also
increase lithium absorption, resulting in toxicity. Therefore, clients should never restrict their sodium
or water intake while taking lithium; instead, they should maintain a consistent sodium intake.
(Option 2) Blood should be drawn frequently to monitor for therapeutic lithium levels and toxicity.
Educational objective:
Dehydration, decreased renal function, diet low in sodium, and drug-drug interactions (eg, NSAIDs
and thiazide diuretics) can cause lithium toxicity.
2-A client with cancer pain is prescribed oxycodone. Which teaching is most essential to help
prevent long-term complications?
1. Teach the client how to assess blood pressure daily
2.
3. Teach theclient
client how to prevent constipation
4. Teach
Teach the
the client how
how to
to prevent
prevent itching
nausea
, lOMoAR cPSD| 24220866
Explanation:
Oxycodone is a morphine-like opioid medication. Opioid medications bind to opioid receptors in the
intestine, which slows peristalsis and increases water absorption, leading to constipation.
Constipation is an almost universally expected side effect from opioid medications. Clients will not
develop tolerance to this side effect. Although clients with idiopathic chronic constipation are not
commonly advised to take laxatives, opioid-induced constipation is treated with simultaneous use
of senna (stimulant) and docusate (stool softener).
(Options 1 and 3) Opioids cause the release of histamine, a vasodilator, which is responsible
for pruritus and flushing. Opioids can also cause peripheral vasodilation and nervous system
depression; both can lead to hypotension. These develop in some clients when the treatment is
initiated but usually resolve over time. Antihistamines (eg, diphenhydramine) can prevent the
pruritus. Lifestyle changes (eg, rising slowly from a seated position) and adequate hydration can
prevent hypotension.
(Option 4) Opioids stimulate the opioid receptors in the gastrointestinal tract and the chemoreceptor
trigger zone in the brain, producing nausea. This is also not seen with long-term use. Antiemetics
(eg, ondansetron) can be helpful.
Educational objective:
Constipation is an expected long-term side effect of opioid use; clients will not develop tolerance to
this side effect. It is important to teach aggressive preventive measures (eg, defecate when the urge
is felt, drink 2-3 L of fluid/day, high-fiber diet, exercise) and simultaneous use of a stool softener and a
stimulant.
3- The nurse is
reviewing prescriptions for the assigned clients. Which prescriptions should the nurse
question? Select all that apply.
1. Allopurinol for a client who developed tumor lysis syndrome from chemotherapy for acute
leukemia
2. Dicyclomine for a client with a history of irritable bowel syndrome who develops a
postoperative paralytic ileus
3. IV morphine for a client with severe acute renal colic pain who is scheduled for a
percutaneous nephrolithotripsy
4. Levofloxacin for a client with a urinary tract infection who has a history of anaphylaxis to
penicillin drugs
5. Simvastatin for a client with hypercholesterolemia who is reporting generalized
muscle aches and weakness
Explanation:
The nurse should question these prescriptions and contact the health care provider:
• Dicyclomine, an anticholinergic/antispasmodic drug prescribed to manage irritable bowel
syndrome, is contraindicated with paralytic ileus, as it decreases intestinal motility and
, lOMoAR cPSD| 24220866
would exacerbate the condition (Option 2).
• Statins (eg, atorvastatin, simvastatin) lower LDL cholesterol. Myopathy, a possible
adverse effect, may lead to life-threatening rhabdomyolysis (Option 5).
(Option 1) Tumor lysis syndrome is due to rapid lysis of cells and the resulting release of intracellular
ions potassium and phosphorous into serum. Phosphorus binds calcium and causes hypocalcemia.
Metabolism (catabolism) of released cellular nucleic acids leads to severe hyperuricemia. IV
hydration and hypouricemic medications (eg, allopurinol) are usually prescribed to promote excretion
of purines and prevent acute kidney injury.
(Option 3) IV opioids (eg, morphine) or nonsteroidal anti-inflammatory agents (eg, ketorolac) are
used to treat severe renal colic pain. Percutaneous nephrolithotripsy breaks and removes stones and
can lead to severe pain. Therefore, pain medications are appropriate.
(Option 4) Levofloxacin, a fluoroquinolone antibiotic prescribed to treat urinary tract infections, has
no known cross-sensitivity to penicillin. However, cross-sensitivity with other fluoroquinolones can
occur.
Educational objective:
Dicyclomine is an antispasmodic drug that decreases intestinal motility and is contraindicated with
paralytic ileus. For clients with myopathy, statins should be withheld and the health care provider
called. Prior to and during chemotherapy, allopurinol helps prevent hyperuricemia in clients at risk for
tumor lysis syndrome.
4- Which client is at greatest risk for respiratory depression when receiving opioids for pain control?
1. 20-year-old client with bronchitis receiving inhaled bronchodilator therapy every 4 hours
2. 30-year-old client with heroin addiction with rotator cuff repair surgery this morning
3. 50-year-old client with sleep apnea and left foot cellulitis and scheduled for a bone scan
4. 70-year-old client with chronic obstructive pulmonary disease (COPD) with knee
replacement this morning
Explanation:
The following are at greatest risk for respiratory depression related to opioid use for analgesia: the
elderly; those with underlying pulmonary disease, history of snoring (with or without apnea), obesity,
or smoking (more than 20-pack-year history); the opiate naïve, especially if treated for acute pain;
and post surgery (first 24 hours).
The 70-year old client has 3 significant risk factors: advanced age, COPD, and surgery within 24
hours. COPD clients who have hypercarbia and hypoxemia are at even greater risk for respiratory
depression when receiving opioids.
(Option 1) This client has 1 risk factor, pulmonary disease.
(Option 2) This client has 1 risk factor, surgery within 24 hours. His addiction to heroin gives him a
higher tolerance for opioids.
(Option 3) This client has 1 risk factor, sleep apnea.
, lOMoAR cPSD| 24220866
Educational objective:
Factors that increase risk for respiratory depression related to opioid use for pain control include
advanced age, underlying pulmonary disease, snoring, obesity, smoking, opiate naïve, and surgery.
5- Which herbal supplements pose an increased risk for bleeding in surgical clients and should be
discontinued prior to major surgery? Select all that apply.
1. Black cohosh
2. Garlic
3. Ginger
4. Ginkgo biloba
5. Hawthorne
Explanation:
Clients are often aware of the need to discontinue prescription medications such as aspirin and
anticoagulants prior to elective surgery, but they may not know that some herbal supplements can
increase bleeding risk. The nurse should question the client specifically about the use of herbal
supplements.
Herbal supplements that can increase risk for bleeding include:
• Gingko biloba
• Garlic
• Ginseng
• Ginger
• Feverfew
(Option 1) Black cohosh is used for treatment of menopausal symptoms. The main side effect is
liver injury.
(Option 5) Hawthorne extract is used to control hypertension and mild to moderate heart failure.
Hawthorne use does not increase the risk of bleeding.
Educational objective:
Use of herbal supplements such as ginkgo biloba, garlic, ginseng, ginger, and feverfew should be
reported to the health care provider before surgery as they may increase the risk of bleeding.
6- The health care provider prescribes phenazopyridine hydrochloride for a client with a urinary tract
infection. What would the office nurse teach the client to expect while taking this medication?
1. Constipation
2. Difficulty sleeping
3. Discoloration of urine
