ATI Pharmacology Questions And Answers

ATI Pharmacology Questions And AnswersHematologic, 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 | P a g e2) 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 | P a g e3) 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 mellitusAnswer 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 hypertensionAnswer Rationale: Loop diuretics such as furosemide can cause hypokalemia, which greatly increases the risk of digoxin toxicity. 4 | P a g eINCORRECT 3) A client who takes ranitidine to reduce gastric acid secretionAnswer 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 rhinitisAnswer 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 5 | P a g eINCORRECT 1) To suppress respiratory secretionsAnswer Rationale: Atropine suppresses respiratory secretions. 2) Block the effects of opioids on the central nervous systemAnswer 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. 6 | P a g e5) 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. 7 | P a g e6) 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 anklesAnswer 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 HgAnswer 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. 8 | P a g eINCORRECT 3) Heart rate of 66/minAnswer 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 levelAnswer Rationale: Nifedipine can result in mild to moderate increases of alkaline phosphatase, CPK, LDH, AST and ALT levels. phosphatase 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 9 | P a g e1) "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. 10 | P a g e8) 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. 11 | P a g e9) 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 12 | P a g e1) 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 failureAnswer 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. 13 | P a g e10) 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. 14 | P a g e11) 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. 15 | P a g eINCORRECT 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 16 | P a g e1) 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 methicillinresistant 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. 17 | P a g e13) 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 effectAnswer 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 Rationale: effectAnswer 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. 18 | P a g eINCORRECT 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 19 | P a g e1) "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. 20 | P a g e15) 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) BradycardiaAnswer 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. 21 | P a g e16) 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 22 | P a g eINCORRECT 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. 23 | P a g e17) 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 countAnswer 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. 24 | P a g eINCORRECT 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 25 | P a g e