ATI Pharmacology 2019 B REVISED Exam Question and Answers ATI Pharmacology 2019 B REVISED Exam Question and Answers

1) A nurse is planning care for a pt who is receiving Mannitol via continuous IV infusion. The nurse should monitor the pt for which of the following adverse effects. -Weight loss Mannitol is an osmotic diuretic used to promote diuresis, decrease intracranial pressure, and improve renal function. An expected therapeutic effect of mannitol is weight loss resulting from diuresis. -Increased intraocular pressure An indication for the use of mannitol is increased intraocular pressure. Mannitol decreases the intraocular pressure by creating an osmotic gradient between the intraocular fluid and the plasma. -Auditory hallucinations Mannitol has several neurologic adverse effects, including increased intracranial pressure, seizures, confusion, and headaches. However, it does not cause auditory hallucinations. -Bibasilar crackles = CORRECT ANSWER Mannitol, an osmotic diuretic, can precipitate heart failure and pulmonary edema. Therefore, the nurse should recognize lung crackles as an indicator of a potential complication and stop the infusion. 2) A nurse is planning to teach about inhalant medications to a pt who has a new diagnosis of exercise induced asthma. Which of the following medications should the nurse plan to instruct the pt to use prior to physical activity? -Cromolyn = CORRECT ANSWER Cromolyn sodium stabilizes mast cells, which inhibit the release of histamine and other inflammatory mediators. The client should use cromolyn 10 to 15 min before planning to exercise to prevent bronchospasms. -Beclomethasone Beclomethasone is a prophylactic glucocorticoid inhalant medication that suppresses the inflammatory and humoral immune responses. Beclomethasone should be administered with a fixed schedule, not for PRN use before physical exercise. -Budesonide Budesonide is a glucocorticoid medication used to treat asthma as a long-term inhaled agent. This medication is administered by inhalation twice daily, not prior to physical activity. -Tiotropium Tiotropium is an anticholinergic medication that decreases mucus production and produces bronchodilation. Tiotropium is used for maintenance therapy of bronchospasms and has a duration of 24 hr. 3) A nurse is caring for a pt who has acute acetaminophen toxicity. The nurse should anticipate administering which of the following medications? -Vitamin K Vitamin K is used to treat increased warfarin serum levels, indicated by elevated levels of PT/INR. -Acetylcysteine= CORRECT ANSWER Acetylcysteine is a specific antidote for acetaminophen toxicity. It can prevent severe injury when given orally or by IV infusion within 8 to 10 hr. -Benztropine Benztropine is an anticholinergic medication used to treat adverse effects of Parkinson's disease by reducing rigidity and tremors. -Physostigmine Physostigmine is an effective antidote for antimuscarinic poisoning from medications such as atropine, scopolamine, some antihistamines, phenothiazines, and tricyclic antidepressants. It has no effect on acetaminophen toxicity. 4) A nurse is assessing a client who is receiving Epoetin alfa to treat anemia. Which of the following findings should the nurse monitor? -Paresthesia Epoetin alfa stimulates the bone marrow to increase production of red blood cells. Adverse effects include neurological manifestations such as seizures, headache, and dizziness. However, epoetin alfa does not cause paresthesia. -Increased blood pressure = CORRECT ANSWER The therapeutic effect of epoetin alfa is an increase in hematocrit levels, which can result in an increase in a client's blood pressure. If the client's hematocrit level rises too rapidly, hypertension and seizures can result. The nurse should monitor the client's blood pressure and ensure hypertension is controlled prior to administering the medication. -Fever Adverse effects of epoetin alfa include neurological manifestations such as coldness and sweating. However, it does not cause fever. -Respiratory depression Heart failure is an adverse effect of epoetin alfa. The nurse should monitor the client's respiratory status and notify the provider if the client develops crackles or rhonchi. However, epoetin alfa does not cause respiratory depression. 5) A nurse is teaching a pt who is to start taking Hydrocodone with Acetaminophen tablets for pain. Which of the following information should the nurse include in the teaching? -The medication should be taken 1 hr prior to eating. The client should take hydrocodone and acetaminophen with food or milk to decrease gastric irritation. -It takes 48 hr for therapeutic effects to occur. The nurse should instruct the client that they should experience the effects of hydrocodone with acetaminophen within 20 min of administration and that pain relief should last for 4 to 6 hr. -Tablets should not be crushed or chewed. The client should avoid crushing, chewing, or breaking the extended release or immediate release hydrocodone tablets to prevent an immediate increase in CNS effects. Hydrocodone with acetaminophen tablets can be crushed if needed. -Decreased respirations might occur.= CORRECT ANSWER The nurse should instruct the client that hydrocodone with acetaminophen might cause respiratory depression, which is an adverse effect of the medication. The client should avoid taking over-the-counter medications or newly prescribed medications without consulting their provider to avoid increased respiratory depression. 6) A nurse is caring for a pt who is experiencing acute alcohol withdrawal. For which of the following pt outcomes should the nurse administer Chlordiazepoxide? -Minimize diaphoresis The client should take clonidine or a beta-adrenergic blocker, such as atenolol, to minimize autonomic components, such as diaphoresis, during alcohol withdrawal. -Maintain abstinence The client should take acamprosate to help maintain abstinence from alcohol by decreasing anxiety and other uncomfortable manifestations. -Lessen craving The client should take propranolol to decrease cravings during alcohol withdrawal. -Prevent delirium tremens = CORRECT ANSWER The client should take chlordiazepoxide to prevent delirium tremens during acute alcohol withdrawal. 7) A nurse is instructing a pt on the application of Nitroglycerin transdermal patches. Which of the following statements by the pt indicates an understanding of the teaching? -"I should apply a patch every 5 minutes if I develop chest pain." Nitroglycerin sublingual tablets are used to treat new onset of angina pain. A client who uses sublingual tablets should place one tablet under their tongue at the onset of angina pain and continue taking a tablet every 5 min for a total of three doses of nitroglycerin. The effects of a nitroglycerin patch will take 30 to 60 min to occur and are not useful to prevent an ongoing angina attack. -"I will take the patch off right after my evening meal." = CORRECT ANSWER Clients should remove the patch each evening for a medication free time of 12 to 14 hr before applying a new patch to avoid developing a tolerance to the medication's effects. -"I will leave the patch off at least 1 day each week." Nitroglycerin is an antianginal medication that results in dilation of the coronary vessels. Clients should apply the patch daily to sustain prophylaxis. -"I should discard the used patch by flushing it down the toilet." Medication remains in the transdermal patch after removing it from the body and must be discarded safely. The nurse should instruct the client to fold the patch ends together with the medication on the inside and place the discarded patch in a closed container so that children and pets cannot gain access to the medication. 8) A nurse is assessing a pt who is taking a Propylthiouracil for the treatment of Grave’s disease. Which of the following findings should the nurse identify as an indication that the medication has been effective? -Decrease in WBC count Propylthiouracil is a thyroid hormone antagonist used in the treatment of hyperthyroidism, or thyroid storms. A decreased WBC count is an adverse effect of propylthiouracil, which can cause myelosuppression. Therefore, a decrease in WBC count indicates the medication has not been effective. -Decrease in amount of time sleeping Graves' disease, a form of hyperthyroidism, has neurologic manifestations, including insomnia. Therefore, a decrease in the amount of time sleeping indicates the medication has not been effective. -Increase in appetite Graves’ disease can result in gastrointestinal manifestations such as increased appetite, weight loss, and increased gastrointestinal motility. Therefore, an increase in appetite indicates the medication has not been effective. -Increase in ability to focus = CORRECT ANSWER A client who has Graves' disease can experience psychological manifestations such as difficulty focusing, restlessness, and manic-type behaviors. Propylthiouracil is a thyroid hormone antagonist that decreases the circulating T4 hormone, reducing the manifestations of hyperthyroidism. An increased ability to focus indicates that the medication has been effective. 9) A nurse is caring for a client who recently began taking oral Amoxicillin / Clavulanate and reports urticaria. Which of the following actions should the nurse take? -Request a change in the type of the antibiotic. = CORRECT ANSWER Manifestations of urticaria after taking a penicillin-based medication indicate a mild allergic reaction. Therefore, it is appropriate for the nurse to request a change in the type of antibiotic. -Ask for a change in the route of the administration. The client is experiencing a mild allergic reaction to the medication. Changing the route of administration puts the client at risk for further manifestations of the allergy. -Check for pitting edema. Pitting edema is not an expected manifestation of a mild allergic reaction. The nurse should assess the client's heart rate and pulmonary status when the client is experiencing a mild allergic reaction. -Check the client's WBC count. The client is experiencing a mild allergic reaction to the medication and checking the client's WBC count does not indicate why the client is having urticaria. 10) A nurse is reviewing the health history of a client who has Diabetes Mellitus and will begin taking insulin. Which of the following findings should the nurse identify as a factor that might cause the client to have difficulty safely self administering insulin? -Macular degeneration = CORRECT ANSWER A client who has macular degeneration loses central vision, making it difficult to accurately draw up insulin for self-administration or dial the insulin pen to the appropriate dosage. The nurse should determine that adaptive equipment is necessary for the client who has macular degeneration. -Right-sided heart failure A client who has right-sided heart failure has hypertension and peripheral edema because the right ventricle is unable to completely empty. However, this condition will not affect the client's ability to prepare and administer insulin. -Hyperlipidemia A client who has hyperlipidemia has developed an accumulation of plaques and fat within the venous system placing the client at risk for hypertension, stroke, or myocardial infarction. However, this condition will not affect the client's ability to prepare and administer insulin. -Stage II chronic kidney disease A client who has diabetes mellitus can also have chronic kidney disease due to changes in the microvasculature caused by hyperglycemia. However, this condition will not affect the client's ability to prepare and administer insulin. 11) A nurse is collecting a med history from a client who has a new prescription for Lithium. The nurse should identify that the client should discontinue which of the following over the counter OTC medications? -Aspirin Although most NSAIDs interact with lithium to increase lithium levels, aspirin does not interact with lithium. -Ibuprofen= CORRECT ANSWER Most NSAIDs can significantly increase lithium levels. Therefore, the client should not take ibuprofen and lithium concurrently. -Ranitidine There are no known medication interactions between ranitidine and lithium. -Bisacodyl There are no known medication interactions between bisacodyl and lithium. 12) A nurse is providing teaching to a pt who has a prescription for Ergotamine sublingual to treat migraine headaches. Which of the following info should the nurse include in the instructions? -"Take one tablet three times a day before meals." Ergotamine, an alpha-adrenergic blocking medication, is not used prophylactically because this can result in ergotamine dependence. -"Take one tablet at onset of migraine."= CORRECT ANSWER The client should take one tablet immediately after the onset of aura or headache. -"Take up to eight tablets as needed within a 24-hour period." The client can take up to a maximum of three tablets in a 24-hr period. Excessive dosing can lead to ergotism, which can cause peripheral gangrene due to vasoconstriction and ischemia. -"Take one tablet every 15 minutes until migraine subsides." The client can take one sublingual tablet every 30 min for a maximum of three tablets in a 24-hr period to manage a migraine. 13) A nurse on the acute care unit is caring for a pt who is receiving Gentamicin IV. The nurse should report which of the following findings to the provider as an adverse effect of the medication? -Constipation Gentamicin, an aminoglycoside used to treat serious infections, can cause several gastrointestinal adverse effects, such as inflammation of the liver and spleen. However, it does not cause constipation. -Tinnitus= CORRECT ANSWER Aminoglycosides, such as gentamicin, are ototoxic, which can manifest as tinnitus and deafness. The nurse should monitor the client for high-pitched ringing in the ears and headaches and should notify the provider if these occur. -Hypoglycemia Gentamicin, an aminoglycoside used to treat serious infections, can cause alternations in the functions of the liver and spleen. However, pancreatic function, mainly insulin production, is not affected by this medication. -Joint pain Aminoglycosides, such as gentamicin, can result in neuromuscular adverse effects such as twitching or flaccid paralysis. However, joint pain is not an adverse effect of gentamicin