ATI PN PHARMACOLOGY PROCTORED EXAM 2023/2024 Latest Study Guide

ATI PN PHARMACOLOGY PROCTORED EXAM A nurse is administering subcutaneous heparin to a client who is at risk for deep vein thrombosis. Which of the following actions should the nurse take? 1. Administer the medication into the client's abdomen. 2. Inject the medication into a muscle. 3. Massage the site after administering the medication. 4. Use a 22-gauge needle to administer the medication. A nurse is providing teaching to a client who has a urinary tract infection and new prescriptions for phenazopyridine and ciprofloxacin. Which of the following statements by the client indicates the need for further teaching? 1. "If the phenazopyridine upsets my stomach, I can take it with meals." 2. "The phenazopyridine will relieve my discomfort, but the ciprofloxacin will get rid of the infection." 3. "I need to drink 2 liters of fluid per day while I am taking the ciprofloxacin." 4. "I should notify my provider immediately if my urine turns an orange color." A nurse is providing teaching to a group of new parents about medications. The nurse should include that aspirin is contraindicated for children who have a viral infection due to the risk of developing which of the following adverse effects? 1. Reye's syndrome 2. Visual disturbances 3. Diabetes mellitus 4. Wilms' tumor A nurse is preparing to administer lactated Ringer's (LR) 1,000 mL IV to infuse over 8 hr. The drop factor or the manual IV tubing is 10 gtt/mL. The nurse should set the manual IV infusion to deliver how may gtt/min? (Round the answer to the nearest whole number). 1 hr/60 min = 8 hr/X min X = 480 min 1,000 mL/480 min x 10 gtt/mL = X gtt/min X = 20.833 21 gtt/ min A nurse is caring for a client who has a new prescription for tamoxifen. The nurse should recognize that tamoxifen has which of the following therapeutic effects? ? 1. Antiestrogenic 2. Antimicrobial 3. Androgenic 4. Anti-inflammatory A nurse is preparing to administer furosemide 4 mg/kg/day PO divided into 2 equal doses daily to a toddler who weighs 22 lb. How many mg should the nurse administer per dose? (Round the answer to the nearest whole number) 2.2 lb/1 kg = 22 lb/X kg X = 10 kg 4 mg x 10 kg = 40 mg/day 20mg A nurse is assessing a client who is receiving IV gentamicin three times daily. Which of the following findings indicates that the client is experiencing an adverse effect of this medication? 1. Hypoglycemia 2. Proteinuria 3. Nasal congestion 4. Visual disturbances A nurse is providing teaching to a client who has cirrhosis and a new prescription for lactulose. The nurse should instruct the client that lactulose has which of the following therapeutic effects? 1. Increases blood pressure 2. Prevents esophageal bleeding 3. Decreases heart rate 4. Reduces ammonia levels A nurse is providing teaching to a newly licensed nurse about metoclopramide. The nurse should include in the teaching that which of the following conditions is a contraindication to this medication? 1. Hyperthyroidism 2. Intestinal obstruction 3. Glaucoma 4. Low blood pressure A nurse is teaching a newly licensed nurse about contraindications to ceftriaxone. The nurse should include a severe allergy to which of the following medications is a contraindication to ceftriaxone? 1. Gentamicin 2. Clindamycin 3. Piperacillin 4. Sulfamethoxazole-trimethoprim A nurse is caring for a client who has a new diagnosis of oral candidiasis after taking tetracycline for 7 days. The nurse should recognize that candidiasis is a manifestation of which of the following adverse effects? 1. Allergic response 2. Superinfection 3. Renal toxicity 4. Hepatotoxicity A nurse is reviewing the laboratory values for a client who is receiving a continuous IV heparin infusion and has an aPTT of 90 seconds. Which of the following actions should the nurse prepare to take? 1. Administer vitamin K 2. Reduce the infusion rate 3. Give the client a low-dose aspirin 4. Request an INR Final practice a nurse is planning to administer diltiazem via IV bolus to a client who has atrial fibrillation. When assessing the client, the nurse should recognize that which of the following findings is a contraindication to administration of diltiazem? hypotension tachycardia decreased level of consciousness history of diuretic use a nurse is planning to administer epoetin alfa to a client who has chronic kidney failure. Which of the following data should the nurse plan to review prior to administration of this medication ? blood pressure temperature blood glucose levels total protein levels a nurse is providing discharge teaching to a client who has heart failure and a new prescription for digoxin 0.215 mg PO daily and furosemide 20 mg PO daily. Which of the following statements by the client indicates an understanding of the teaching ? "I know that blurred vision is something I will expect to happen while taking digoxin." "I will measure my urine output each day and document it in my diary." "I will skip a dose of my digoxin if my resting heart rate is below 72 beats per minute." "I will eat fruits and vegetables that have high potassium content every day." a nurse is preparing to administer iron dextran IV to a client. Which of the following actions should the nurse plan to take? administer a small test dose before giving the full dose infuse the medication over 30 seconds monitor client closely for hypertension administer cyanocobalamin as an antidote if toxicity occurs A nurse is administering insulin glulisine 10 units subcutaneously at 0730 to an adolescent client who has type 1 diabetes mellitus. The nurse should anticipate onset of action of the insulin at which of the following times? Insulin glulisine has a very short onset of action of 15 min. The nurse should expect the onset of action around 0745 and ensure the client eats breakfast immediately following administration of the insulin. 0745 A nurse in an outpatient facility is assessing a client who is prescribed furosemide 40mg daily but the client reports she has been taking extra doses to promote weight loss. Which of the following indicates she is dehydrated? urine specific gravity of 1.035 Oliguria, increased urine concentration, and an increase in urine specific gravity greater than 1.030 are expected findings in clients who are dehydrated. A nurse is planning to administer chlorothiazide 20 mg/kg/day PO divided equally and administered twice daily for a toddler who weighs 28.6 lb. The amount available is chlorothiazide oral suspension 250 mg/5 mL. How many mL should the nurse administer per dose/ (Round to the nearest tenth) 2.6 mL 2.2 lb/1 kg = 28.6 lb/X kg X = 13 kg 20 mg x 13 kg = 260 mg/day 250 mg/5 mL = 130 mg/X mL X = 2.6 mL A nurse is preparing a discharge teaching plan for a client who is to begin long-term oral prednisone for asthma. Which of the following instructions should the nurse include in the plan? Stop taking the medication if a rash occurs. Take the medication on an empty stomach to enhance absorption. Schedule the medication on alternate days to decrease adverse effects . Treat shortness of breath with an extra dose of the medication. A nurse is administering ciprofloxacin and phenazopyridine to a client who has a severe urinary tract infection (UTI). The client asks why both medications are needed. Which of the following responses should the nurse make? "Phenazopyridine decreases adverse effects of ciprofloxacin hydrochloride." "Combining phenazopyridine with ciprofloxacin hydrochloride shortens the course of therapy." "The use of phenazopyridine allows for a lower dosage of ciprofloxacin hydrochloride." "Ciprofloxacin hydrochloride treats the infection, and the phenazopyridine treats pain." A nurse is preparing to administer ampicillin 500 mg in 50 ml of dextrose 5% in water (D5W) to infuse over 15 min. The drop factor of the manual IV tubing is 10 gtt/mL. The nurse should set the manual IV infusion to deliver how many gtt/min? (Round to the nearest whole number) 10 gtt/1 mL x 50 mL/15 min = X gtt/min X = 33.3333 33 gtt/min A nurse is caring for a client who has congestive heart failure and is taking digoxin. The client reports nausea and refuses to eat breakfast. Which of the following actions should the nurse take first? Encourage the client to eat the toast on the breakfast tray. Administer an antiemetic. Inform the client's provider. Check the client's apical pulse. A nurse is assessing a client who has a new prescription for chlorpromazine to treat schizophrenia. The client has a mask-like facial expression and is experiencing involuntary movements and tremors. Which of the following medications should the nurse anticipate administering? 1, Amantadine. 2, Bupropion 3, Phenelzine 4, Hydroxyzine A nurse is caring for an older adult client who has a prescription for zolpidem at bedtime to promote sleep. The nurse should plan to monitor the client for which of the following adverse effects? 4 1, ecchymosis 2, decrease urine output. 3, increase blood pressure. 4, dizziness A nurse on a medical unit is preparing to administer alendronate 40 mg PO for an older adult client who has Paget's disease of the bone. Which of the following actions should be the nurse's priority? 1, Administer the medication to the client before breakfast in the morning. 2, Ambulate the client to a chair prior to administering the medication. 3. Give the medication to the client with water rather than milk. 4. Teach the client how to take the medication at home. A nurse is caring for a client who has a new prescription for ergotamine. The nurse should recognize that ergotamine is administered to treat which of the following conditions? 2 1. Raynaud's phenomenon 2. Migraine headaches 3. Ulcerative colitis 4. Anemia A nurse is caring for a client who has peptic ulcer disease and reports a headache. Which of the following medications should the nurse plan to administer? 1. Ibuprofen 2. Naproxen 3. Aspirin 4. Acetaminophen A nurse is providing teaching to a parent of a child who has asthma and a new prescription for a cromolyn sodium metered dose inhaler. Which of the following statements by the parent indicates the need for further teaching? 1. "I will give my child a dose as soon as wheezing starts." 2. My child should rinse out his mouth after using the inhaler." 3. "My child should exhale completely before placing the inhaler in his mouth." 4. "If my child has difficulty breathing in the dose, a spacer can be used." A nurse is reviewing laboratory values for a client who reports fatigue and cold intolerance. The client has an increased thyroid stimulating hormone (TSH) level and a decreased total T3 and T4 level. The nurse should anticipate a prescription for which of the following medications? 1. Methimazole 2. Somatropin 3. Levothyroxine 4. Propylthiouracil A nurse is planning care for a client who has a seizure disorder and a new prescription for valproic acid. Which of the following laboratory values should the nurse plan to monitor? (Select all that apply) 1. PTT 2. Asparate aminotransferase (AST) 3. Alanine aminotransferase (ALT) A nurse is providing teaching to a client who has a new prescription for hydrochlorothiazide 50 mg PO daily to treat hypertension. Which of the following instructions should the nurse include in the teaching? 1. "Take hydrochlorothiazide as needed for edema." 2. Check your weight once each week." 3. "Take the hydrochlorothiazide on an empty stomach." 4. "Take the hydrochlorothiazide in the morning." A nurse is preparing to administer amoxicillin 250 mg liquid suspension PO every 8 hr to an older adult client. The amount available is amoxicillin 50 mg/mL. How many mL should the nurse administer per dose? (Round the answer to the nearest whole number) 50 mg/1 mL = 250 mg/X mL 250/ 50 = 5 X = 5 mL A nurse is providing teaching to a client who has gout and a new prescription for allopurinol. The nurse should instruct the client to discontinue taking the medication for which of the following adverse effects? 1. Nausea 2. Metallic taste 3. Fever 4. Drowsiness A nurse is providing teaching to a client who has ulcerative colitis and a new prescription for sulfasalazine. The nurse should instruct the client to monitor for which of the following adverse effects of this medication? 1. Jaundice 2. Constipation 3. Oral candidiasis 4. Sedation a nurse is providing teaching to a client who has rhematoid arthritis and a prescription for long term prednisone therapy. the nurse should instruct the client to monitor for which of the following adverse effects? 1. Stress fractures 2. Orthostatic hypotension 3. Gingival ulcerations 4. Weight loss Nurse is preparing to administer heparin 8,000 units subcutaneously every eight hrs. The amount available is heparin injection 10,000 units/mL. How many milliliters should the nurse administer per dose? (Round the answer to the nearest tenth) 8000/ 10000 = 0.8 mL A nurse is caring for a client who has a new prescription for enalapril. The nurse should monitor the client for which of the following adverse effects of this medication? 1. Ecchymosis 2. Jaundice 3. Hypotension 4. Hypokalemia A nurse is caring for a client who is at 28 weeks of gestation and is experiencing preterm labor. Which of the following medications should the nurse plan to administer? 1. Oxytocin 2. Nifedipine 3. Dinoprostone 4. Misoprostol A nurse is caring for a client who has a new prescription for amphotericin B. The nurse should plan to monitor the client for which of the following adverse effects? 1. Hyperkalemia 2. Hypertension 3. Constipation 4. Nephrotoxicity A nurse is administering subcutaneous epinephrine for a client who is experiencing anaphylaxis. The nurse should monitor the client for which of the following adverse effects? 1. Hypotension 2. Hyperthermia 3. Hypoglycemia 4. Tachycardia A nurse is caring for a client who has a prescription for clopidogrel. The nurse should monitor the client for which of the following adverse effects? 1. Insomnia 2. Hypotension 3. Bleeding 4. Constipation A nurse is caring for an older adult client who has a new prescription for amitriptyline to treat depression. Which of the following diagnostic tests should the nurse plan to perform prior to starting the client on this medication? 1. Hearing examination 2. Glucose tolerance test 3. Electrocardiogram 4. Pulmonary function tests A nurse is providing teaching to a client who has chronic kidney failure which an AV fistula for hemodialysis and a new prescription for epoetin alfa. Which of the following therapeutic effects of epoetin alfa should the nurse include in the teaching? 1. Reduces blood pressure 2. Inhibits clotting of fistula 3. Promotes RBC production 4. Stimulates growth of neutrophils A nurse is preparing to administer an enteral tube feeding through an NG tube at 250 mL over 4 hr. The nurse should set the pump to deliver how many mL/hr? (Round the answer to the nearest whole number) 250 mL/4 hr = X mL/hr X = 62.5 63mL/hr A nurse is providing teaching to a newly licensed nurse about caring for a client who has a prescription for gemfibrozil. The nurse should instruct the newly licensed nurse to monitor which of the following laboratory tests? 1. Platelet count 2. Electrolyte levels 3. Thyroid function 4. Liver function A nurse is caring for a client who has been taking isoniazid and rifampin for 3 weeks for the treatment of active pulmonary tuberculosis (TB). The client reports his urine is an orange color. Which of the following statements should the nurse make? 1. "Stop taking the isoniazid for 3 days and the discoloration should go away." 2. "Rifampin can turn body fluids orange." 3. "I'll make an appointment for you to see the provider this afternoon." 4. Isoniazid can cause bladder irritation." A nurse is preparing to administer prochlorperazine 2.5 mg IV. Available is prochlorperazine injection 5 mg/mL. How many mL should the nurse administer? (Round the answer to the nearest tenth) 5 mg/1 mL = 2.5 mg/X mL X = 0.5 A nurse is reviewing the laboratory results for a client who has a prescription for filgrastim. The nurse should recognize that an increase in which of the following values indicates a therapeutic effect of this medication? 1. Erythrocyte count 2. Neutrophil count 3. Lymphocyte count 4. Thrombocyte count A nurse is caring for a client who has a prescription for chlorothiazide to treat hypertension. The nurse should plan to monitor the client for which of the following adverse effects? 1. Thrombophlebitis 2. Hyperactive reflexes 3. Muscle weakness 4. Hypoglycemia A nurse is providing teaching to a newly licensed nurse about administering morphine via IV bolus to a client. Which of the following information should the nurse include in the teaching? 1. Respiratory depression can occur 7 min after the morphine is administered. 2. The morphine will peak in 10 min. 3. Withhold the morphine if the client has a respiratory rate less than 16/min. 4. Administer the morphine over 2 min. A nurse is administering subcutaneous heparin to a client who is at risk for deep vein thrombosis. Which of the following actions should the nurse take? 1. Administer the medication into the client's abdomen. 2. Inject the medication into a muscle. 3. Massage the site after administering the medication. 4. Use a 22-gauge needle to administer the medication. A nurse is providing teaching to a client who has a urinary tract infection and new prescriptions for phenazopyridine and ciprofloxacin. Which of the following statements by the client indicates the need for further teaching? 1. "If the phenazopyridine upsets my stomach, I can take it with meals." 2. "The phenazopyridine will relieve my discomfort, but the ciprofloxacin will get rid of the infection." 3. "I need to drink 2 liters of fluid per day while I am taking the ciprofloxacin." 4. "I should notify my provider immediately if my urine turns an orange color." A nurse is providing teaching to a group of new parents about medications. The nurse should include that aspirin is contraindicated for children who have a viral infection due to the risk of developing which of the following adverse effects? 1. Reye's syndrome 2. Visual disturbances 3. Diabetes mellitus 4. Wilms' tumor A nurse is preparing to administer lactated Ringer's (LR) 1,000 mL IV to infuse over 8 hr. The drop factor or the manual IV tubing is 10 gtt/mL. The nurse should set the manual IV infusion to deliver how may gtt/min? (Round the answer to the nearest whole number). 1 hr/60 min = 8 hr/X min X = 480 min 1,000 mL/480 min x 10 gtt/mL = X gtt/min X = 20.833 21 gtt/ min A nurse is caring for a client who has a new prescription for tamoxifen. The nurse should recognize that tamoxifen has which of the following therapeutic effects? ? 1. Antiestrogenic 2. Antimicrobial 3. Androgenic 4. Anti-inflammatory A nurse is preparing to administer furosemide 4 mg/kg/day PO divided into 2 equal doses daily to a toddler who weighs 22 lb. How many mg should the nurse administer per dose? (Round the answer to the nearest whole number) 2.2 lb/1 kg = 22 lb/X kg X = 10 kg 4 mg x 10 kg = 40 mg/day 20mg A nurse is assessing a client who is receiving IV gentamicin three times daily. Which of the following findings indicates that the client is experiencing an adverse effect of this medication? 1. Hypoglycemia 2. Proteinuria 3. Nasal congestion 4. Visual disturbances A nurse is providing teaching to a client who has cirrhosis and a new prescription for lactulose. The nurse should instruct the client that lactulose has which of the following therapeutic effects? 1. Increases blood pressure 2. Prevents esophageal bleeding 3. Decreases heart rate 4. Reduces ammonia levels A nurse is providing teaching to a newly licensed nurse about metoclopramide. The nurse should include in the teaching that which of the following conditions is a contraindication to this medication? 1. Hyperthyroidism 2. Intestinal obstruction 3. Glaucoma 4. Low blood pressure A nurse is teaching a newly licensed nurse about contraindications to ceftriaxone. The nurse should include a severe allergy to which of the following medications is a contraindication to ceftriaxone? 1. Gentamicin 2. Clindamycin 3. Piperacillin 4. Sulfamethoxazole-trimethoprim A nurse is caring for a client who has a new diagnosis of oral candidiasis after taking tetracycline for 7 days. The nurse should recognize that candidiasis is a manifestation of which of the following adverse effects? 1. Allergic response 2. Superinfection 3. Renal toxicity 4. Hepatotoxicity A nurse is reviewing the laboratory values for a client who is receiving a continuous IV heparin infusion and has an aPTT of 90 seconds. Which of the following actions should the nurse prepare to take? 1. Administer vitamin K 2. Reduce the infusion rate 3. Give the client a low-dose aspirin 4. Request an INR Final practice a nurse is planning to administer diltiazem via IV bolus to a client who has atrial fibrillation. When assessing the client, the nurse should recognize that which of the following findings is a contraindication to administration of diltiazem? hypotension tachycardia decreased level of consciousness history of diuretic use a nurse is planning to administer epoetin alfa to a client who has chronic kidney failure. Which of the following data should the nurse plan to review prior to administration of this medication ? blood pressure temperature blood glucose levels total protein levels a nurse is providing discharge teaching to a client who has heart failure and a new prescription for digoxin 0.215 mg PO daily and furosemide 20 mg PO daily. Which of the following statements by the client indicates an understanding of the teaching ? "I know that blurred vision is something I will expect to happen while taking digoxin." "I will measure my urine output each day and document it in my diary." "I will skip a dose of my digoxin if my resting heart rate is below 72 beats per minute." "I will eat fruits and vegetables that have high potassium content every day." a nurse is preparing to administer iron dextran IV to a client. Which of the following actions should the nurse plan to take? administer a small test dose before giving the full dose infuse the medication over 30 seconds monitor client closely for hypertension administer cyanocobalamin as an antidote if toxicity occurs A nurse is administering insulin glulisine 10 units subcutaneously at 0730 to an adolescent client who has type 1 diabetes mellitus. The nurse should anticipate onset of action of the insulin at which of the following times? Insulin glulisine has a very short onset of action of 15 min. The nurse should expect the onset of action around 0745 and ensure the client eats breakfast immediately following administration of the insulin. 0745 A nurse in an outpatient facility is assessing a client who is prescribed furosemide 40mg daily but the client reports she has been taking extra doses to promote weight loss. Which of the following indicates she is dehydrated? urine specific gravity of 1.035 Oliguria, increased urine concentration, and an increase in urine specific gravity greater than 1.030 are expected findings in clients who are dehydrated. A nurse is planning to administer chlorothiazide 20 mg/kg/day PO divided equally and administered twice daily for a toddler who weighs 28.6 lb. The amount available is chlorothiazide oral suspension 250 mg/5 mL. How many mL should the nurse administer per dose/ (Round to the nearest tenth) 2.6 mL 2.2 lb/1 kg = 28.6 lb/X kg X = 13 kg 20 mg x 13 kg = 260 mg/day 250 mg/5 mL = 130 mg/X mL X = 2.6 mL A nurse is preparing a discharge teaching plan for a client who is to begin long-term oral prednisone for asthma. Which of the following instructions should the nurse include in the plan? Stop taking the medication if a rash occurs. Take the medication on an empty stomach to enhance absorption. Schedule the medication on alternate days to decrease adverse effects. Treat shortness of breath with an extra dose of the medication. A nurse is administering ciprofloxacin and phenazopyridine to a client who has a severe urinary tract infection (UTI). The client asks why both medications are needed. Which of the following responses should the nurse make? "Phenazopyridine decreases adverse effects of ciprofloxacin hydrochloride." "Combining phenazopyridine with ciprofloxacin hydrochloride shortens the course of therapy." "The use of phenazopyridine allows for a lower dosage of ciprofloxacin hydrochloride." "Ciprofloxacin hydrochloride treats the infection, and the phenazopyridine treats pain." A nurse is preparing to administer ampicillin 500 mg in 50 ml of dextrose 5% in water (D5W) to infuse over 15 min. The drop factor of the manual IV tubing is 10 gtt/mL. The nurse should set the manual IV infusion to deliver how many gtt/min? (Round to the nearest whole number) 10 gtt/1 mL x 50 mL/15 min = X gtt/min X = 33.3333 33 gtt/min A nurse is caring for a client who has congestive heart failure and is taking digoxin. The client reports nausea and refuses to eat breakfast. Which of the following actions should the nurse take first? Encourage the client to eat the toast on the breakfast tray. Administer an antiemetic. Inform the client's provider. Check the client's apical pulse. VERSION 2 Pharmacology ATI 1. A nurse is assessing a client who is receiving chloramphenicol (Chloromycetin). Which of the following findings is an adverse effect of this medication? (adverse affect is thrombocytopenia) o Ecchymos o Ototoxicity o Hypertensi on o Anxiety 2. A nurse is caring for a client who is to receive 1,500 mL of 0.9% sodium chloride IV over 8 hours. The nurse plans to use IV tubing with a drop factor of 10 gtt/mL. How many gtt/min of IV fluid should the client receive? (Round your answer to the nearest whole number). 31 gtt/min 3. A nurse is admitting a client to a long-term care facility. While reconciling the medication prescribed at home with those prescribed in the facility, the nurse discovers a discrepancy in the dosages. Which action should the nurse take? o Clarify the medication dosages with the provider. o Change the prescribed medication dosages to reconcile the discrepancy o Contact the pharmacist regarding the dosage discrepancies o Ask a family member to verify the medication dosages 4. A nurse is caring for a client who is receiving a fentanyl transdermal system (Duragesic). What is important to document in the client9s record? o Fluid intake o Skin integrity o Respiratory rate o Pulse rate 5. A nurse is caring for a client who has acute angina and has a prescription for nitroglycerin. Which of the following is an appropriate intervention for the nurse to take when administering this medication? o Massage the nitroglycerin ointment completely into the skin. o Replace the nitroglycerin transdermal patch every 4 hours. o Administer a sustained nitroglycerin tablet orally. o Administer a nitroglycerin tablet sublingually every 5 minutes. 6. A nurse is preparing to administer infliximab (Remicade) to a client who has rheumatoid arthritis. The nurse should watch the patient for which of the following adverse effects? (Select all that apply.) o Bradycard ia o Jaundice o Polyuri a o Urtipenia o Fever 7. A nurse is providing teaching to a client who was recently diagnosed as HIV positive. The client is beginning medication therapy with zidovudine (Retrovir). Which of the following statements should the nurse include in the teaching. (Select all that apply.) o Must be taken with other retroviral medicines. o Has few adverse effects o Cures an HIV infection o Prevents you from transmitting the HIV infection o Increases CD4+ cell count 8. A nurse is assessing a school age client who is experiencing seizure activity and is prescribed diazepam (Valium) IV. The nurse should should clarify the order if the client is receiving a continuous infusion of which of the following IV: o Lactated Ringers solution o 0.9% Sodium chloride with 100 units of regular insulin o 0.9% sodium chloride o 0.9% Sodium chloride with 20 mEq of potassium chloride 9. A nurse is assessing a client who is taking enalapril (Vasotec) for congestive heart failure. Which of the following indicates an expected finding? o Activity tolerance o Orthostatic hypotension o Loss of strength o Increase in blood pressure 10. A child with cerebral palsy is prescribed Baclofen (Lioresol). Which of the following therapeutic effects should the nurse monitor? o Increased urine output o Increased energy o Decreased anxiety o Decreased spacity 11. Clinical findings of a client who has a prescription for lithium carbonate (Lithobid). For which reasons should the nurse withhold the medication and notify the provider? o Lithium level 1.0 mEq/L o Potassium at 3.7 mEq/L o Sodium at 143 mEq/L o Lithium level 2.5 mEq/L 12. The nurse is caring for a client who has tuberculosis and is being treated with combination medication therapy. To test the effectiveness of the treatment, the nurse should periodically monitor which of the following laboratory results. o TT o ESD rate o Sputum culture o INR 13. A nurse is caring for a client who is taking amoxicillin (Amoxil) and is experiencing adverse effects. Which of the following instructions should the nurse give to this client? o <Stand up slowly after taking this medication.= o <Monitor for increased urine output.= o < Take this medication with a snack.= o <Administer the medication at bedtime.= 14. A nurse is reviewing the medication administration record for a client who has metastatic cancer and a fentanyl (Duragesic) transdermal patch for pain. The client reports a pain level of 10 on a scale of 0 to 10. Which of the following medications should the nurse anticipate administering? o Hydromorphone (Dilaudid) o Butorphanol (Stadol) o Alprazolam (Xanax) o Carbenezepine (Tegretol) 15. A nurse is caring for a client with PCA Morphine Sulfate. Which of the following statements is not true? o "I will not receive any pain medications during the lockout period" o "I should push the button when the pain becomes severe" o "I will be asked to rate my pain occasionally" o "I don't have to worry about getting an overdose of the medication" 16.A nurse is caring for a client who is to receive a series of allergy tests. The nurse should instruct the client to avoid which medications for up to 4 weeks before the procedure? o Acetemetaphen (Tylenol) o Diphenhyramine (Benadryl) o Albuterol (Accuneb) o Psuedoephedrine hydrochloride (Sudafed) 17. A nurse administered meperidine (Demerol) intramuscularly to a client with an ankle fracture. Which of the following actions should the nurse take next? o Assess the client9s respiratory status o Document on the clients medication record o Reassess the client's pain level o Check the client's blood pressure 18. A nurse is caring for a client who has an order for clozapine (Clozaril) 350 mg PO daily. The nurse should recognize that which of the following findings is a side effect of this medication? o WBC 8,000 mm3 o Serum sodium 136 mg/dL o Fasting blood glucose of 220 mg/dL o Weight loss of 2.26 kg (5 lb) in 2 weeks   19. A client with diabetes mellitus is admitted to the medical unit. The client has routine before- breakfast prescription for 8 units of regular insulin and 18 units ofNPH. The primary care provider adds an additional dose of Regular insulin based on the following: Blood Glucose Regular Insulin Dose 121 to 150 2 units 151 to 180 4 units 201. 200 6 units 201 to 250 8 units > 250 Call provider The client9s pre-breakfast glucose is 192 mg/dl. Which dosage of insulin should the nurse administer? o 8 units of Regular, 18 units of NPH o 8 units of Regular, 24 units of NPH o 14 units of Regular, 18 units of NPH o 14 units of Regular, 24 units of NPH 20. A nurse is caring for a client who has a new prescription of zolpidem (Ambien) 10 mg by mouth. Which comments by the client indicates understanding regarding this medication? o <I will take my medication at bedtime.= o <I will take this medication with food.= o <I will stop taking this medication in 1 week, so I don9t get addicted.= o <I will take vitamin C to increase the effectiveness of this medication.= 21. A nurse is monitoring a client who is taking fosinopril (Monopril). The nurse should understand that this has a beneficial effect on which of the body systems? o Gastrointesti nal o Cardiovascular o Pulmonary o Reproductive 22. A nurse is assessing a client who is taking naproxen (Naprosyn). Which of the following is an expected outcome for this client? o Increased appetite o Reduced bleeding o Improved breathing o Reduced pain 23. A nurse is providing teaching to a client who just started taking lithium (Eskalith). Which of the following statements indicates that the client understands the teaching? o 8I should inject this medication subcutaneously.9 o <I should expect to feel better in just a few days.= o <I should call my doctor if I develop hand tremors.= o <I should take this medication on an empty stomach.=   24.A nurse is administering verapamil (Calan) to a client via IV bolus. The nurse should monitor for which outcome? o A rapid increase in aPTT. o A sudden increase in heart rate. o A sudden decrease in heart rate. o A rapid decrease of aPTT. 25.A nurse is caring for a client who has rheumatoid arthritits. The client is prescribed methotrexate (Rheumatrex). Which of the following should the nurse instruct the client to monitor and report to the provider? o Sore throat o Urinary retention o Constipation o Insomnia 26.A nurse is caring for a client who has been prescribed Ceftriaxone (Rocephin). The nurse notes that the client9s chart lists a penicillin allergy. Which of the following actions should the nurse take first? o Notify the provider that the client is allergic to the medication. o Teach the client about signs of allergic response. o Question the client about previous allergic reactions. o Administer the medication and monitor the client for allergic response. 27.A nurse is teaching a client who has decided to quit smoking about using a nicotine transdermal system (Nicotrol). Which of the following instructions should the nurse include? o Cleanse the skin with alcohol before applying the patch. o Moisten the patch and hold it against the skin until it adheres. o Apply the patch first thing in the morning and remove it at bedtime. o Place the patch in the same skin area for the duration of the treatment. 28. A nurse is caring for a client who has been taking furosemide (Lasix) for 3 days to treat heart failure. Which of the following findings indicate that the medication is effective? o Reduced levels of HDL o Potassium within the expected reference range o Clear lung sounds o Increased level of consciousness 29. A client is questioning the nurse about why she is receiving frequent doses of IV antibiotics. Which of the following responses by the nurse is appropriate? o It helps to maintain a steady drug level o It helps to prevent the emergence of drug-resistant bacteria o It decreases the risk of an allergic reaction o It decreases the length of necessary treatment   30. A female adult client is scheduled to start a prescription for azathioprine (Imuran) for active Rheumatoid Arthritis. The nurse should inform the client about the need for which of the following diagnostic tests prior medication? o Erythrosedimentation rate o Bone density scan o Electrocardiogr am o Pregnancy Test 31.A nurse is caring for a client who has been taking ferrous sulfate for the past 2 months. Which of the following findings is expected? o Increased energy o Reduced frequency of coughing o Increased vision o Decreased inflammation 32. A nurse is caring for a client who has a prescription for Metformin (Glucophage) twice daily. Which of the following lab results projects the expected outcome? o Hemoglobin A1C 6.4% o Pre-meal plasma glucose 135mg/dl o Bedtime blood glucose 150 mg/dl o Systolic blood pressure 146 mm Hg 33. A nurse is teaching about IV betamethasone (Celestone Soluspan) with a client who is at 31 weeks of gestation and is in premature labor. Which of the following information should the nurse include in the teaching? o Prevents contractions of the uterus to avoid premature birth o Promotes the production of surfactant in the fetal lung o Decreases inflammation associated with an allergic reaction o Suppresses the immune system to prevent fetal respiratory distress. 34.A nurse is providing teaching to a client who had a total gastrectomy. The client has a new prescription for Cyanocobalamin (Vitamin B12). Which of the following client statements indicates understanding of the teaching? o <I will have to take this medication for the rest of my life.= o <After I receive injections for a week, I will be able to switch to a pill.= o <I need to have my vitamin B12 levels measured once a month.= o <Increasing my intake of green, leafy vegetables will increase my vitamin B12 levels.= 35. A nurse is planning teaching for a client who has leukemia and is receiving chemotherapy. The client is taking Allopurinal (Zyloprim). The nurse should instruct the client that this medication will? o Decrease blood glucose levels o Prevent cardiac toxicity. o Prevent urinary tract infections. o Decrease uric acid levels.   36.A nurse receives a phone call from a client who has heart failure and reports a dry cough for the last week. After reviewing the client9s medical record, the nurse asks the client to come to the provider9s office. The nurse should then instruct the client to stop taking which of the following daily medications until he sees his provider? o Isosorbide (Imdur) o Hydroclorothiazide (Hydrodiuril) o Nifedipine (Procardia) o Lisinopril (Zestril) 37.A nurse is planning discharge teaching for a client who is to start therapy with repaglinide (Prandin). Which of the following should the nurse include in the teaching? o <Take the medication 1 hour before mealtime.= o <Hold the medication if your blood glucose is less than 120 mg/dL.= o <Monitor for irritability and diaphoresis.= o <Increase your protein intake.= 38.A nurse is caring for a client who is receiving anticoagulant therapy with Warfarin (Coumadin). The client is prescribed Cefotetan (Cefotan) by intermittent IV bolus for pneumonia. The nurse should monitor the client for which of the following? o Hemorrhage o Hypoglyce mia o Hyperkalemia o Paresthesias 39. A nurse is assessing a client who has been taking anti-tuberculosis medications for the past 3 months. The nurse should instruct the client to notify the provider if which of the following occurs? o Weight gain o Jaundice o Alopec ia o Polyuria 40. A client who has supraventricular tachycardia (SVT) is receiving procainamide. The nurse recognizes that the primary pharmacological action of this medication is to: o Decrease cardiac preload o Promote systemic vasoconstriction o Decrease sinoatrial node conduction. o Control the rate of cardiac contraction. 41. A client is receiving extended-release morphine sulfate (Avinza) 30mg PO every 12 hr. Three hours after the last dose, the client requests pain medication. Which of the following assessment finding is the best indicator of the patient9s need for more pain medication? o Facial grimacing o Elevated blood pressure o Flushed skin   o Self report 42. A nurse is caring for a client who has a systemic infection. During the infusion of vancomycin (Vancocin) the client develops a rash and becomes flushed. Which of the following is an appropriate action for the nurse to take? o Document a Penicillin allergy in the client9s chart. o Decrease the rate of administration. o Obtain a prescription for oral vancomycin. o Administer naloxone (Narcan) 1mg IV. 43. A nurse is caring for a client who has open angle glaucoma and was prescribed pilocarpine (Pilocar) 1 gtt of 3% solution. The nurse should recognize that which of the following findings indicates the client is developing systemic cholinergic toxicity? o Stinging and burning sensation in her eye o Hypertension o Tachycardia o Salivation and sweating 44. A client who has been taking atenolol (Tenormin) receives a new prescription for nifedipine (Procardia). For which of the following interactions should the nurse monitor? o Tachycard ia o Hypotensio n o Bleeding o Angina 45. A client has an IV infusion of nitroprusside (Nitropress) at 2 mcg/kg/min. The order reads to titrate the nitroprusside by 0.5 mcg/kg/min to maintain mean arterial pressure (MAP) to 70 to 110 mm HG. The client has a MAP of 120 mm Hg. The nurse should next titrate the nitroprusside to which of the following dosages? (Round to the nearest tenth.) 2.5 mcg 46. A nurse is reviewing the laboratory tests for a client who had an acute myocardial infarction. The client is prescribed warfarin (Coumadin) 10mg PO. The nurse notes an INR of 2.6. Which of the following actions should the nurse take? o Give the dose as prescribed. o Hold the next dose. o Increase the dose by 2.5mg o Decrease the dose by 5mg. 47. A nurse is caring for a client who has a new prescription for estrogen- progestin combination (Ortho-Novum). Which of the following medications may interact with this medication and require the use of additional non-hormonal birth control? o Thiamine ( Vitamin B 1) o Dilantin (Phenytoin) o Amalodipine (Norvasc) o Docusate sodium (colace)   48. A nurse is providing teaching to a school-age child and his parents. The child has a new prescription for methylphenidate (Concerta). For which of the following adverse effects should the nurse monitor? (Select all that apply.) o Nose bleed o Oliguria o Weight loss o Palpitation s o Insomnia 49. A nurse is caring for a postoperative client with PCA containing IV morphine. A nurse should recognize which is the following priority assessment? o Hypotensi on o Bradypnea o Drowsine ss o Urticaria 50. A nurse is caring for a client who is receiving therapy with the clonidine (Catapres) transdermal patch. The client reports light-headedness and drowsiness. Which of the following actions should the nurse take? o Administer a prescribed antiemetic o Remove the Patch o Elevate the head of the bed o Measure Blood pressure 51. A nurse is assessing a client who takes diphenoxylate with atropine (Lomotil) for inflammatory bowel disease. For which of the following should the nurse monitor? o Hearing loss o Increased oral secretions o Bradycardia o Urinary retention 52. A nurse is caring for a client with Parkinson9s disease. The client is taking carbidopa levadopa (Sinemet) and reports nausea. Which of the following instructions should the nurse include to reduce nausea? o Give medication 1 hr before meals. o Give medication with meals o Give medication 1 hr after meals o Give medication with high-protein snacks. 53. A nurse is caring for an older adult client who is receiving gentamicin (Garamycin) following abdominal surgery Which of the following physiological changes is most important for the nurse to consider when administering this medication? o Decreased serum albumin o Decreased renal blood flow   o Increased gastric pH o Increased body fat 54. A client has a new prescription for oral nitroglycerin sustained-release capsules once a day. During the nursing history the client reveals his usual medications. Which of the following medications should the nurse question at this time? o Diazepam (Valium) o Lansoprazole (Prevacid) o Gemfibrozil (Lopid) o Sildenafil (Viagra) 55. The nurse is caring for a client who is receiving muromonab-CD3 (orthoclode OKT3) and is experiencing fever and 3+ pitting edema in the lower extremities. Which of the following actions should the nurse take for the client? o Administer corticosteroids as prescribed. o Obtain a prescription for a WBC count o Auscultate the client9s lungs for adventitious sounds. o Maintain strict fluid intake and output measurements. 56. A nurse is admitting a client who has chest pain to the emergency department. What medication should the nurse anticipate administering to reduce cardiac demand? o Heparin o Pentazocine (Talwin) o Morphine o Butorphanol (Stadol) 57. A nurse is caring for four older adult clients who are taking digoxin (Lanoxin). Which of the following clients is at greatest risk for developing digoxin toxicity? o A client taking furosemide (Lasix) for edema o A client taking allopurinol (Zyloprim) for gout o A client taking fluoxetine (Prozac) for depression o A client taking pramipexole (Mirapex) for Parkinson9s disease 58. A nurse is caring for a 4 year old client, who is taking amoxicillin (Amoxil) 50 mg/ kg/day PO in three divided doses. Which of the following resources should the nurse consult to verify that the dose is safe for the client? o Medication administration record o The client9s health history o Physician9s desk reference o The client9s BMI record 59. A nurse is caring for a client who has a new prescription for sucraflate (Carafate). The client also takes several other medications and herbal supplements. Which of the following requires that the nurse provide additional teaching for this client? o Phentoin (Dilantin) o Burpropion (Wellbutrin)   o Ginko biloba o Valerian root 60. A nurse is caring for a client who has a prescription for levadopa carbidopa (Sinemet-CR). Which of the following should the nurse recognize as an adverse effect of this medication? o Constipati on o Weight gain o Hirsultism o Dyskinesia 61.A nurse is caring for a client who has received acetaminophen (Tylenol) 650 mg and Hydrocodone (Vicodin) 5 mg every 4 hr for the past 24 hr. Which of the following is an appropriate action for the nurse to take? o Complete an incident report o Stagger the medications every 2 hr o Suggest a time with the pharmacy. o Decrease acetaminophen to 325 mg every 4 hr. 62. A nurse is caring for a client who has a new prescription for buproion (Welbutrin). What should the nurse recognize as a contraindication for the use of this medication? o Xerostomia o GERD o Seizure o Bradycardia 63. A nurse is caring for a client with a urinary tract infection. Her past history reveals an allergy to thiazide diuretics. Which of the following medications is contraindicated? o Nitrofurantoin (Macrodantin) o Ciprofloxacin (Cipro) o Amoxicillin/ clavulanate (Augmentin) o Trimethoprim/ sulfamethoxazole (Bactrim) 64.A nurse is providing instruction to four clients regarding medication self- administration. Which of the following actions by a client indicates a need for further teaching? o Client rolls insulin suspension between o Client takes iron supplements at his palms bedtime. o Client uses cotton swab to apply antibiotic ointment. o Client allows 1 min between puffs when he uses a metered-dose inhaler. 65. A nurse is caring for a client who is receiving penicillin by intermittent IV bolus. The client develops cyanosis and tachycardia. A nurse should administer which of the following medications first? o Epinephrine (Adrenalin) o Prednisone (Deltasone) o Hydrocortisone sodium succinate (Solu- Cortef) o Isoproterenol (Isuprel)   66. A nurse is preparing to administer insulin to a client with diabetes mellitus. The client is to receive insulin aspart (NovoLog) 5 units and NPH insulin (Humulin N) 15 units subcutaneously in the morning. Which of the following actions should the nurse take first? o Inject 5 units of air into the insulin aspart vial. o Inject 15 units of air into the NPH insulin vial. o Draw up 5 units of insulin aspart from the vial. o Draw up 15 units of NPH insulin from the vial. 67. A nurse is providing care to a client who has heart failure. While verifying the orders with the medication administration record the nurse notes that the prescription for digoxin (Lanoxin) was transcribed incorrectly. As a result, the client received an extra dose of the medication yesterday. Which of the following actions should the nurse take first? o Complete an incident report. o Notify the charge nurse. o Obtain a set of vital signs. o Withhold the next dose. 68. A nurse is caring for a client who is receiving haloperidol (Haldol). The nurse should document which of the following findings are dystonia? o Neck spasms o Lip smacking o Tremors o Pacing 69. A nurse is completing discharge teaching for a client who has hypertension. The client has a new prescription for spironolactone (aldactone). Which of the following statements by the client indicates an understanding of the teaching? o <I9ll increase my dietary fiber, because this medication causes constipation.= o <I9m aware that his medication can cause heart palpitations.= o <I9ll take aspirin every day, because it makes this medication more effective.= o <I realize that I should use sugar substitutes when taking this medication.= 70.A nurse is caring for a school age child who has been prescribed diphenhydramine (Benadryl). Which of the following adverse effects has highest priority? o Sedation o Dry mucous membranes o Ataxia o Diarrhea VERSION 3 ATI Pharmacology IMPORTANT LAB VALUES Sodium (Na): 136−145 mEq/L Calcium: 9.0−10 mg/dL Chloride: 98−106 mEq/L Bicarb HCO3: 21−28 mEq/L Potassium: 3.5−5.0 mg/L Phosphorus PO4 : 3.0−4.5 mg/dL Magnesium: 1.3− 2.1 mEq/L Cholesterol: o Total <200mg/dL o LDL ("bad") <100 o HDL ("good) >40 o Triglycerides <150mg/dL Liver enzymes o ALT/SGPT 8−20 units/L o AST/SGOT 5−40 units/L o ALP 42−128 units/L o Total protein 6−8 gm/dL Pancreatic enzymes o Amylase 56−90 IU/L o Lipase 0−110 units/L o Prothrombin time 0.8−1.2 Glucose: Preprandial (fasting) 70−110 mg/dL Postprandial 70−140 mg/dL RBC: Females 4.2−5.4 million/uL; Males 4.7−6.1 million /uL WBC: 5000 −10,000 Iron: Females 60−160 mcg/dL; Males 80−180 mcg/dL Platelets: 150,000−450,000 Hemoglobin (Hgb): Females 12−16 g/dL; Males 14−18 g/dL Hematocrit (Hct): Females 37−47%;Males 42−52% Prothrombin Time (PT): 11−14 seconds: therapeutic range 1.5−2x normal or control value Urine specific gravity: 1.015−1.030 Urine pH: average 6.0; range 4.6−8.0 BUN: 10−20 mg/dL Creatinine: female 0.5−1.1, males 0.6 − 1.2 mg/dL; Creatinine phosphokinase MB (CK-MB): normal 30−170 units/L *increase 4−6 hrs after MI and remains elevated 24−72hrs Troponin normal: <0.2 ng/dL *gold standard for MI - Safe Medication Administration and Error Reduction: Reviewing a Medication Administration Record (RN QSEN - Teamwork and Collaboration, Active Learning Template - Nursing Skill, RM Pharm RN 7.0 Ch. 2) 1) Report all errors, and implement corrective measures immediately 2) Complete an incident report within the time frame the facility specifies, usually 24 hr. 3) Do not reference or include this report in the client's medical record 4) Evaluate clients' responses to medications, and document and report them. 5) Identify side and adverse effects, and document and report them. Chapter 12 - Substance Use Disorders: Therapeutic effect of chlordiazepoxide (Ch. 12 pg.85) - Substance Use Disorders: Smoking cessation using bupropion (Ch. 12 pg. 87) - Substance Use Disorders: Treatment for Cocaine Toxicity (Active Learning Template - System Disorder, RM Pharm RN 7.0 Ch. 12) 1) First line treatment = Benzodiazepines (to reduce CNS & cardiovascular effects) 2) Chlordiazepoxide, diazepam, lorazepam, clorazepate, oxazepam 3) Provide seizure precautions 4) Manifestations include nausea; vomiting; tremors; restlessness and inability to sleep; depressed mood or irritability; increased heart rate, blood pressure, respiratory rate, and temperature; diaphoresis; and tonic-clonic seizures. Illusions are also common 5) Monitor vitals and neurological status on a regular basis Chapter 13 - Chronic Neurologic Disorders: Adverse effects of neostigmine (Ch. 13 pg. 91) Adverse effects: Excessive muscarinic stimulation Cholinergic crisis Chronic Neurologic Disorders: Medications that interact with Carbamazepine (Ch. 13 pg. 99) - − Carbamazepine causes a decrease in the effects of oral contraceptives and warfarin due to stimulation of hepatic medication−metabolizing enzymes. − Grapefruit juice inhibits metabolism, and thus increases carbamazepine levels. − Phenytoin and phenobarbital decrease effects of carbamazepine. - Chronic Neurologic Disorders: Adverse Effects of Phenytoin (RN QSEN - Safety, Active Learning Template - Medication, RM Pharm RN 7.0 Ch. 13) 1) CNS effects: Nystagmus, sedation, ataxia, double vision, cognitive impairment 2) Gingival hyperplasia: Softening and overgrowth of gum tissue, tenderness, and bleeding gums (consider folic acid supplement) 3) Skin rash (stop medication if rash appears) 4) Cardiovascular effects: dysrhythmias, hypotension (administer slow; 50 mg/min and in dilute solution) 5) Endocrine and other effects: Coarsening of facial features, hirsutism, and interference with vitamin D metabolism (consume enough Vitamin D) 6) Interference with vitamin K-dependent clotting factors causing bleeding in newborns. - Miscellaneous Central Nervous System Medications: Treating Malignant Hyperthermia (Active Learning Template - Medication, RM Pharm RN 7.0 Ch. 15) 1) Depolarizing neuromuscular blockers: Succinylcholine 2) Manifestations include muscle rigidity accompanied by increased temperature, as high as 43˚C (109.4˚) 3) Administer oxygen at 100%. 4) Initiate cooling measures including administration of iced 0.9% sodium chloride, applying a cooling blanket, and placing ice bags in groin and other areas 5) Administer dantrolene to decrease metabolic activity of skeletal muscle. - Airflow Disorders: Therapeutic Action of Montelukast (Active Learning Template - Medication, RM Pharm RN 7.0 Ch. 17) 1) Leukotriene modifiers: suppress the effects of leukotrienes, thereby reducing inflammation, bronchoconstriction, airway edema, and mucus production. 2) Long-term therapy of asthma in adults and children, and to prevent exercise-induced bronchospasm 3) Depending on therapeutic intent, effectiveness is evidenced by long-term control of asthma 4) Advise clients to take montelukast once daily at bedtime. 5) For exercise-induced bronchospasm, take 2 hr. before exercise. Instruct clients taking daily montelukast to not take an additional dose for exercise induced bronchospasm - Upper Respiratory Disorders: Client Teaching Prior to Allergy Testing (Active Learning Template - Medication, RM Pharm RN 7.0 Ch. 18) 1) Medications that can interfere with skin tests include: antihistamines, Tricyclic antidepressants, heartburn medications, asthma medication omalizumab (Xolair) 2) May need to discontinue certain meds 10 days prior 3) If you are running a fever or have an attack of hay fever or asthma, testing should be delayed 4) Do not change your diet before the test. - Medications Affecting Blood Pressure: Titrating Continuous Nitroprusside Infusion (RN QSEN - Safety, Active Learning Template - Medication, RM Pharm RN 7.0 Ch. 20) 1) Nitroprusside (centrally−acting vasodilator) 2) Direct vasodilation of arteries and veins resulting in rapid reduction of blood pressure (decreased preload and after load 3) Used for hypertensive crisis 4) Administer medication slowly because rapid administration will cause blood pressure to go down to rapidly 5) Prepare medication by adding to diluent for IV infusion. 6) Protect IV container and tubing from light & Discard medication after 24 hr. Angina Chapter 22 (pg. 169) Self-administration of nitroglycerine patch (pg. 170) Client teaching for a new prescription of sublingual nitroglycerin PROTOTYPE: Nitroglycerin (NTG) Oral extended−release capsules   Sublingual tablet Translingual spray Topical ointment Transdermal patch Intravenous Isosorbide dinitrate (Sublingual) Isosorbide mononitrate (PO) Adverse Effects: Headache: − Instruct clients to use aspirin or acetaminophen to relieve pain − Clients should notify the provider if headache does not resolve in a few weeks. Dosage can be reduced. Orthostatic hypotension: − Advise clients to sit or lie down if experiencing dizziness or faintness. − Clients should avoid sudden changes of position/rise slowly. Reflex Tachycardia: − Monitor vitals. − Administer a beta−blocker such as metoprolol if needed. Tolerance: − Use lowest dose needed to achieve effect. − Take all long−acting forms of nitroglycerin with a medication−free period each day. This action reduces the risk of tolerance. Contraindications/ Precautions: − Pregnancy Risk Category C. − This medication is contraindicated in clients who have hypersensitivity to nitrates. − Nitroglycerin is contraindicated in clients who have severe anemia, closed−angle glaucoma and traumatic head injury because the medication can increase intracranial pressure. − Use cautiously in clients taking antihypertensive medications and clients who have hyperthyroidism or renal or liver dysfunction. Nursing evaluation of medication effectiveness: − Prevention and termination of acute anginal attacks − Long−term management of stable angina. − Control of perioperative blood pressure. − Control of heart failure following acute MI. - In chronic stable exertional angina, nitroglycerin dilates veins and decreases venous return (preload), which decreases cardiac oxygen demand. - Use this rapid-acting nitrate at the first indication of chest pain. Do not wait until pain is severe. - Use prior to activity that is known to cause chest pain, such as climbing a flight of stairs. - Place the tablet under the tongue and allow it to dissolve - Store tablets in original bottles, and in a cool, dark place. - Medications Affecting Cardiac Rhythm: Ventricular Dysrhythmia (Active Learning Template - Medication, RM Pharm RN 7.0 Ch. 23) 1) Antidysrhythmic meds class IB (Lidocaine) 2) Decrease electrical conduction, Decrease automaticity, Increase rate of repolarization 3) Short-term use only for ventricular dysrhythmias 4) Administer phenytoin to control seizure activity.   5) Use cautiously in clients who have liver and kidney dysfunction, second-degree heart block, sinus bradycardia, and heart failure. Medications Affecting Coagulation (Chapter 25 page 191) Administering Heparin (pg. 193) Laboratory values to report to the provider Self- Administration of Enoxaparin (pg. 193) Adverse effects of clopidogrel (pg. 197) Monitoring for adverse effects of Warfarin Adverse effects of Heparin Medication safety with Warfarin (pg. 194) Reviewing client data during heparin infusion (pg. 192) PROTOTYPE: Heparin Low Molecular Weight: PROTOTYPE: Enoxaparin Other: Dalteparin Activated factor (Xa) Inhibitors: PROTOTYPE Medication: Fondaparinux Adverse Effects: Hemorrhage secondary to heparin overdose: − Monitor vital signs. − Advise clients to observe for bleeding (increase heart rate, decreased blood pressure, bruising, petechiae, hematomas, black tarry stools). − In the case of overdose, stop heparin, administer protamine, and avoid aspirin. − Monitor activated partial thromboplastin time (aPTT). Keep value at 1.5 to 2 times the baseline. Heparin induced thrombocytopenia Interventions: - Evidenced by low platelet count and increased development of thrombi: mediated by antibody development (white clot syndrome) − Monitor platelet count periodically throughout treatment, especially in the first month. − Stop heparin if platelet count is less than 100,000/mm^3; Nonheparin anticoagulants, such as lepirudin or argatroban, can be used as a substitute if anticoagulation is still needed. Hypersensitivity reaction (chills, fever urticaria): − Administer a small test dose prior to the administration of heparin. Toxicity/overdose: − Administer protamine, which binds with heparin−protamine complex that has no anticoagulant properties. − Protamine should be administered slowly IV, no faster than 20mg/min or 50mg in 10 min. − Do not exceed 100 mg in a 2−hr period. Administer carefully to prevent overdose (anticoagulation). Enoxaparin: Hemorrhage: − Monitor vital sings − Advise clients to observe for bleeding (increased heart rate, decreased blood pressure, bruising, petechiae, hematomas, black tarry stools) − Monitor platelet count. Instruct clients to avoid aspirin. Neurologic damage from hematoma formed during spinal or epidural anesthesia: − In clients who have spinal or epidural anesthesia: Assess insertion site for sings of hematoma formation, such as redness or swelling; Monitor sensation and movement of lower extremities; Notify provider of abnormal findings. Thrombocytopenia Interventions: − Monitor platelets. Discontinue medication for platelet count less than 100,000/mm^3. Toxicity/ Overdose − Administer protamine (heparin antagonist) − Protamine should be administered slowly intravenously, no faster than 20 mg/min or 50 mg in 10 min. Fondaparinux: −Hemorrhage −Neurologic damage from hematoma formed during spinal or epidural anesthesia. −Thrombocytopenia, as evidenced by low platelet count. Contraindications/Precautions: −Parenteral anticoagulants are contraindicated in clients who have low platelet counts (thrombocytopenia) or uncontrollable bleeding. −These medications should not be used during or following surgeries of the eyes, brain, or spinal cord; lumbar puncture; or regional anesthesia. −Use cautiously in clients who have hemophilia, increased capillary permeability, dissecting aneurysm, peptic ulcer disease, severe hypertension, hepatic or renal disease, or threatened abortion. Interactions: − Antiplatelet agents such as aspirin, NSAIDs, and other anticoagulants can increase the risk for bleeding. −Avoid concurrent use when possible −Monitor carefully for evidence of bleeding −Take precautionary measures to avoid injury (limit venipuncture and injections). Nursing Evaluation of Medication Effectiveness: − Heparin: aPTT levels of 60 to 80 seconds. − Heparin, enoxaparin, and fondaparinux sodium: No development or no further development of venous thrombi or emboli. Oral Anticoagulants PROTOTYPE: Warfarin Adverse Effects: Hemorrhage − Monitor VS. − Advise clients to observe for bleeding (increased heart rate, decreased blood pressure, bruising, petechiae, hematomas, black tarry stools). − Obtain baseline PT, and monitor PT levels of PT and INR periodically. − In the case of a warfarin overdose, discontinue administration of warfarin, and administer vitamin K. Hepatitis: − Monitor liver enzymes. Toxicity/ Overdose: − Administer Vitamin K, to promote synthesis of coagulation factors VII, IX, X, and prothrombin. − Administer IV vitamin K, slowly and in a diluted solution to prevent anaphylactoid−type reaction.   − Administer small doses of vitamin K to prevent development of resistance to warfarin. − If Vitamin K, cannot control bleeding, administer fresh plasma or whole blood. Contraindications/ Precautions: − Classified as