ATI RN 46 C9 Pharmacology Detailed Answer Key

1. A nurse is caring for a client who has active pulmonary tuberculosis (TB) and is to be started on intravenous rifampin therapy. The nurse should instruct the client that this medication can cause which of the following adverse effects? A. Constipation Rationale: Rifampin does not cause constipation. More common gastrointestinal effects are diarrhea and nausea. B. Black colored stools Rationale: It is most commonly iron supplements that cause stools to turn black, not rifampin. C. Staining of teeth Rationale: Teeth may be stained from taking liquid iron preparations, not from taking rifampin. D. Body secretions turning a red-orange color Rationale: Rifampin is used in combination with other medicines to treat TB. Rifampin will cause the urine, stool, saliva, sputum, sweat, and tears to turn reddish-orange to reddish-brown. 2. 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. Check the client's vital signs. Rationale: It is possible that the client's nausea is secondary to digoxin toxicity. By obtaining vital signs, the nurse can assess for bradycardia, which is 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. B. Request a dietitian consult. Rationale: While the dietitian might be able to assist the client with making appropriate food choices, this is not the first action the nurse should take. C. Suggest that the client rests before eating the meal. Rationale: While this intervention might be appropriate, this is not the first action the nurse should take. D. Request an order for an antiemetic. Rationale: While this intervention might relieve the client's nausea, this is not the first action the nurse should take. 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 stomachache or indigestion." Rationale: The pill is enteric-coated to prevent breakdown in the stomach and decrease the possibility of GI distress. Crushing the pill destroys that protection. B. "Crushing the medication is a good idea, and I can mix it in some ice cream for you." Rationale: Crushing the pill will destroy the enteric coating, and the client should be advised against this. The client should be told not to break, crush, or chew enteric-coated tablets. C. "Crushing the medication would release all the medication at once, rather than over time." Rationale: Crushing the pill will destroy the enteric coating, and the client should be advised against this, but the enteric coating does not prevent the release of medication. Sustained release preparations disburse the medication over time. D. "Crushing is unsafe, as it destroys the ingredients in the medication." Rationale: Many medications can safely be crushed to make them easier to swallow. The client should check with his provider for information about which medications can be safely crushed. 4. A nurse is caring for four clients for whom she has to administer oral medications in the morning. The nurse should administer which of the following medications before breakfast? A. Alendronate Rationale: The client must take alendronate first thing in the morning on an empty stomach and wait at least 30 minutes before eating, drinking, or taking other medications. B. Digoxin Rationale: Digoxin treats hearts failure and dysrhythmias. While it is important that the client get the morning dose in a timely manner, the nurse does not have to administer it before a meal. C. Mycostatin mouthwash Rationale: Any mouthwash or rinse is most effective after a meal. D. Divalproex Rationale: Divalproex, an anticonvulsant, helps control seizures and treats the manic phase of bipolar disorder. The client should take the dose on time, but not necessarily before a meal. 5. 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 Rationale: Thyroid testing is important because long-term use of lithium may lead to thyroid dysfunction. B. Liver function tests Rationale: LFTs must be monitored before and during valproic acid therapy, not lithium therapy. C. Erythrocyte sedimentation rate Rationale: This is not a necessary test related to lithium therapy. D. Brain natriuretic peptide Rationale: Brain natriuretic peptide (BNP) is not a necessary test related to lithium therapy. The BNP is used to monitor heart failure. 6. 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." Rationale: The effects of heparin begin within minutes. This response does not accurately answer the client's question. B. "A pharmacist is the person to answer that question." Rationale: Contacting the pharmacist is not the appropriate answer for the nurse to give. C. "Heparin does not dissolve clots. It stops new clots from forming." Rationale: This statement accurately answers the client's question. D. "The oral medication you will take after this IV will dissolve the clot." Rationale: This is not a correct response. Warfarin, a PO medication that is often started after the client has been on heparin, does not dissolve clots. 7. A nurse is providing discharge teaching to a client who has asthma and new prescriptions for cromolyn and albuterol, 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." Rationale: Cromolyn, a leukotriene modifier, is used for prophylaxis treatment of asthma, not acute attacks. Albuterol, a short acting bronchodilator, should be used for the treatment of acute bronchospasms. B. "I will be sure to take the albuterol before taking the cromolyn." Rationale: The client should always use the bronchodilator (albuterol) 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. C. "I will use both medications immediately after exercising." Rationale: Both albuterol and cromolyn are used to prevent exercise-induced bronchospasm, but administration should be made prior, not after, exercising. D. "I will administer the medications 10 minutes apart." Rationale: Inhalations of different medications should be administered 2 to 5 minutes apart. 8. A nurse is completing a medication history for a client who reports using over-the-counter calcium carbonate antacid. Which of the following recommendations should the nurse make about taking this medication? A. Decrease bulk in the diet to counteract the adverse effect of diarrhea. Rationale: The major adverse effect of calcium carbonate is constipation. The nurse should recommend the client increase bulk in the diet. B. Take the medication with dairy products to increase absorption. Rationale: Taking calcium carbonate with milk predisposes the client to milk alkali syndrome, which is characterized by headache, confusion, nausea, vomiting, alkalosis, and hypercalcemia. C. Reduce sodium intake. Rationale: Clients who take aluminum hydroxide, not calcium carbonate, antacids should be advised against excessive sodium intake in the diet. D. Drink a glass of water after taking the medication. Rationale: Calcium carbonate is a dietary supplement used when the amount of calcium taken in the diet is not enough. Calcium carbonate may also be used as an antacid to relieve heartburn, acid indigestion, and stomach upset. The client should drink a full glass of water after taking an antacid to enhance its effectiveness. 9. A nurse is caring for a client who has deep vein thrombosis and has been on heparin continuous infusion for 5 days. The provider prescribes warfarin PO without discontinuing the heparin. The client asks the nurse why both anticoagulants are necessary. Which of the following statements should the nurse make? A. "Warfarin takes several days to work, so the IV heparin will be used until the warfarin reaches a therapeutic level." 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, these medications 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 is usually within 1 to 5 days. When the client's PT and INR are within therapeutic range, the heparin can be discontinued. B. "I will call the provider to get a prescription for discontinuing the IV heparin today." Rationale: Discontinuing the IV heparin is not indicated at this time. C. "Both heparin and warfarin work together to dissolve the clots." Rationale: Neither medication dissolves clots that have already formed. D. "The IV heparin increases the effects of the warfarin and decreases the length of your hospital stay." Rationale: Neither medication increases the effects of the other. 10.A A nurse is providing teaching to a client who has asthma and a new prescription for inhaled beclomethasone. Which of the following instructions should the nurse provide? A. Check the pulse after medication administration. Rationale: Beclomethasone, an inhaled glucocorticoid, does not cause cardiac side effects. B. Take the medication with meals. Rationale: Oral, not inhaled, glucocorticoids should be administered with food. C. Rinse the mouth after administration. Rationale: Use of glucocorticoids by metered dose inhaler can allow a fungal overgrowth in the mouth. Rinsing the mouth after administration can lessen the likelihood of this complication. D. Limit caffeine intake. Rationale: Caffeine does not interact with beclomethasone and is not contraindicated.