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ATI RN PHARMACOLOGY NGN NEWEST 202 3 VERSION 3 COMPLETE
EXAM QUESTIONS AND CORRECT DETAILED ANSWERS WITH
RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+
- A nurse is caring for a client who has congestive heart failure and is taking digoxin daily. The client refused breakfast and is complaining of nausea and weakness. Which of the following actions should the nurse take first? A. Check the client's vital signs. Rationale: It is possible that the client's nausea is secondary to digoxin toxicity. By obtaining vital signs, the nurse can assess for bradycardia, which is a symptom of digoxin toxicity. The nurse should withhold the medication and call the provider if the client's heart rate is less than 60 bpm. B. Request a dietitian consult. Rationale: While the dietitian might be able to assist the client with making appropriate food choices, this is not the first action the nurse should take. C. Suggest that the client rests before eating the meal. Rationale: While this intervention might be appropriate, this is not the first action the nurse should take. D. Request an order for an antiemetic. Rationale: While this intervention might relieve the client's nausea, this is not the first action the nurse should take.
- A nurse is caring for a client who has thrombophlebitis and is receiving heparin by continuous IV infusion. The client asks the nurse how long it will take for the heparin to dissolve the clot. Which of the following responses should the nurse give? A. "It usually takes heparin at least 2 to 3 days to reach a therapeutic blood level." Rationale: The effects of heparin begin within minutes. This response does not accurately answer the client's question. B. "A pharmacist is the person to answer that question." Rationale: Contacting the pharmacist is not the appropriate answer for the nurse to give. C. "Heparin does not dissolve clots. It stops new clots from forming." Rationale: This statement accurately answers the client's question. D. "The oral medication you will take after this IV will dissolve the clot." Rationale: This is not a correct response. Warfarin, a PO medication that is often started after the client has been on heparin, does not dissolve clots.
- A nurse is caring for a client who has deep vein thrombosis and has been on heparin continuous infusion for 5 days. The provider prescribes warfarin PO without discontinuing the heparin. The client asks the nurse why both anticoagulants are necessary. Which of the following statements should the nurse make?
B. Hypotension Rationale: Verapamil, a calcium channel blocker, can be used to control supraventricular tachyarrhythmias. It also decreases blood pressure and acts as a coronary vasodilator and antianginal agent. A major adverse effect of verapamil is hypotension; therefore, blood pressure and pulse must be monitored before and during parenteral administration. C. Ototoxicity Rationale: Verapamil is not toxic to the ear. D. Muscle pain Rationale: Verapamil does not cause muscle pain.
- A nurse is caring for a client who is taking lisinopril. Which of the following outcomes indicates a therapeutic effect of the medication? A. Decreased blood pressure Rationale: Lisinopril, an ACE inhibitor, may be used alone or in combination with other antihypertensives in the management of hypertension and congestive heart failure. A therapeutic effect of the medication is a decrease in blood pressure. B. Increase of HDL cholesterol Rationale: This is not an intended effect of lisinopril. C. Prevention of bipolar manic episodes Rationale: This is not an intended effect of lisinopril. D. Improved sexual function Rationale: This is not an intended effect of lisinopril. Lisinopril may in fact cause sexual dysfunction and impotence.
- A nurse is caring for a client who has heart failure and a prescription for digoxin. Which of the following statements by the client indicates an adverse effect of the medication? A. "I can walk a mile a day." Rationale: Improving the client's cardiac output, which in turn will improve the client's exercise tolerance, is a therapeutic response to digoxin. B. "I've had a backache for several days." Rationale: Backaches are not an adverse effect of digoxin. C. "I am urinating more frequently." Rationale:
Improving the client's cardiac output, which in turn will increase blood flow to the kidneys and urination, is a therapeutic response to digoxin. D. "I feel nauseated and have no appetite." Rationale: Anorexia, nausea, vomiting, and abdominal discomfort are early signs of digoxin toxicity.
- A nurse is caring for a client who has a new prescription for ferrous sulfate tablets twice daily for iron-deficiency anemia. The client asks the nurse why the provider instructed that she take the ferrous sulfate between meals. Which of the following responses should the nurse make? A. "Taking the medication between meals will help you avoid becoming constipated." Rationale: Taking the medication with food can reduce the GI symptoms associated with it. However, taking the medication between meals maximizes absorption. B. "Taking the medication with food increases the risk of esophagitis." Rationale: Reclining immediately after taking ferrous sulfate may lead to esophageal corrosion. Clients should remain upright for 15 - 30 min following administering. C. "Taking the medication between meals will help you absorb the medication more efficiently." Rationale: Ferrous sulfate provides the iron needed by the body to produce red blood cells. Taking iron supplements between meals helps to increase the bioavailability of the iron. D. "The medication can cause nausea if taken with food." Rationale: Taking ferrous sulfate with food can reduce the GI symptoms associated with it. However, taking the medication between meals maximizes absorption.
- A nurse is caring for a client who has chronic renal disease and is receiving therapy with epoetin alfa. Which of the following laboratory results should the nurse review for an indication of a therapeutic effect of the medication? A. The leukocyte count Rationale: Epoetin alfa does not affect the leukocyte, or WBC, count. B. The platelet count Rationale: An increase in platelets is not the therapeutic or desired effect of epoetin alfa. C. The hematocrit (Hct) Rationale: Epoetin alfa is an antianemic medication that is indicated in the treatment of clients who have anemia due to reduced production of endogenous erythropoietin, which may occur in clients who have end-stage renal disease or myelosuppression from chemotherapy. The therapeutic effect of epoetin alfa is enhanced red blood cell production, which is reflected in an increased RBC, Hgb, and Hct. D. The erythrocyte sedimentation rate (ESR) Rationale:
Liver disease is a contraindication for warfarin therapy. B. "Clients who have rheumatoid arthritis should not take warfarin." Rationale: Thrombocytopenia is a contraindication for warfarin therapy. C. "Clients who are pregnant should not take warfarin." Rationale: Warfarin therapy is contraindicated in the pregnant client because it crosses the placenta and places the fetus at risk for bleeding. D. "Clients who have hyperthyroidism should not take warfarin." Rationale: Peptic ulcer disease is a contraindication for warfarin therapy
- A nurse is assessing an older adult client who is receiving digoxin. The nurse should recognize that which of the following findings is a manifestation of digoxin toxicity? A. Anorexia Rationale: Anorexia, vomiting, confusion, headache, and vision changes are manifestations of digoxin toxicity. B. Ataxia Rationale: Ataxia (lack of muscle coordination) is a manifestation of benzodiazepine toxicity. C. Photosensitivity Rationale: Digoxin toxicity causes halos around lights. Photosensitivity is a manifestation of NSAID toxicity. D. Jaundice Rationale: Jaundice is a manifestation of sulfonylurea toxicity.
- A nurse is teaching a client who has a new prescription for colesevelam to lower his low-density lipoprotein level. Which of the following instructions should the nurse include? A. "Take this medication 4 hr after other medications." Rationale: The client should take this medication 4 hours after other medications to increase absorption of the medication. B. "Reduce fluid intake." Rationale: The client should increase fiber and fluid intake to reduce the risk for constipation. C. "Take this medication on an empty stomach." Rationale: The client should take the medication with meals.
D. "Chew tablets before swallowing." Rationale: The client should swallow tablets whole to increase absorption.
- A nurse is assessing a client who is receiving dopamine IV to treat left ventricular failure. Which of the following findings should indicate to the nurse that the medication is having a therapeutic effect? A. Systolic blood pressure is increased Rationale: When dopamine has a therapeutic effect, it causes vasoconstriction peripherally and increases systolic blood pressure. B. Cardiac output is reduced Rationale: A therapeutic effect of low-dose dopamine is increased cardiac output. C. Apical heart rate is increased Rationale: Tachycardia is an adverse effect, not a therapeutic effect, of dopamine. D. Urine output is reduced Rationale: A therapeutic effect of low-dose dopamine is increased urine output. Decreased urine output at high doses is an adverse effect of dopamine. 16.A A nurse is preparing to administer heparin to a client. Which of the following actions should the nurse plan to take? A. Use a 22 - gauge needle to inject the medication. Rationale: The nurse should use a small needle, 25 - or 26 - gauge, to administer the heparin. B. Use a 1 - inch needle to inject the medication. Rationale: The nurse should use a short needle, 3/8 inch or smaller, to administer the heparin. C. Inject the medication into the abdomen above the level of the iliac crest. Rationale: The nurse should inject the medication into the abdomen above the level of the iliac crest, at least 2 inches from the umbilicus. D. Massage the injection site after administration of the medication. Rationale: The nurse should apply firm pressure without massage to the site for 1 to 2 min after administration. Massaging the area after injecting heparin can cause bleeding. 17.AA nurse in the emergency department is caring for a client who took 3 nitroglycerin tablets sublingually for chest pain. The client reports relief from the chest pain but now he is experiencing a headache. Which of the following statements should the nurse make?
B. Clopidogrel Rationale: Clopidogrel is an oral antiplatelet drug clients take to prevent stenosis of coronary stents and for some secondary prevention indications, not for the immediate anticoagulant effects a client who is postoperative hip arthroplasty requires. C. Enoxaparin Rationale: The nurse should anticipate a prescription for enoxaparin as prophylaxis therapy for venous thromboembolism. Clients following hip arthroplasty are usually on anticoagulants for 3 to 6 weeks after surgery. D. Alteplase Rationale: Alteplase is a thrombolytic agent used in clients experiencing an acute MI, acute ischemic stroke, or acute massive PE. 20.A A nurse is caring for a client who has thrombophlebitis and is receiving a continuous heparin infusion. Which of the following medications should the nurse have available to reverse heparin's effects? A. Vitamin K Rationale: Vitamin K reverses the effects of warfarin, not heparin, by promoting the synthesis of coagulation factors VI, IX, X, and prothrombin. B. Protamine sulfate Rationale: Protamine sulfate reverses the effects of heparin by binding with heparin to form a heparin-protamine complex that has no anticoagulant properties. C. Acetylcysteine Rationale: Acetylcysteine, a mucolytic, reduces the risk of hepatotoxicity after acetaminophen overdose. It does not reverse the effects of heparin toxicity. D. Deferasirox Rationale: A chelating agent such as deferasirox binds to iron to reduce iron toxicity from supplemental iron therapy. It does not reverse the effects of heparin toxicity. 21.AA nurse is teaching a client who has angina pectoris about starting therapy with SL nitroglycerin tablets. The nurse should include which of the following instructions regarding how to take the medication? A. "Take this medication after each meal and at bedtime." Rationale: The client should take nitroglycerin tablets on a PRN basis, not routinely at specific times. B. "Take one tablet every 15 min during an acute attack." Rationale: If one tablet does not relieve the client's pain, he should access emergency services and then take two more at 5 - min intervals if he still has pain. C. "Take one tablet at the first indication of chest pain." Rationale: The client should take nitroglycerin as soon as he feels pain, pressure, or tightness in his chest
and not wait until his chest pain is severe. D. "Take this medication with 8 ounces of water." Rationale: Nitroglycerin tablets are sublingual. The client should place them under the tongue, not swallow them with water.
- A nurse is caring for a client who receives furosemide to treat heart failure. Which of the following laboratory values should the nurse monitor for this client due to this medication? A. Potassium Rationale: Furosemide is a loop diuretic that promotes the excretion of potassium. The nurse should monitor the client's potassium level to watch for hypokalemia. B. Albumin Rationale: Furosemide does not affect albumin levels. C. Cortisol Rationale: Furosemide does not affect cortisol levels, although it can lower serum sodium levels. D. Bicarbonate Rationale: Furosemide does not affect bicarbonate levels. 23.A A nurse is providing discharge teaching to a client who has a new prescription for verapamil for angina. Which of the following instructions should the nurse include? A. "Limit your fluid intake to meal times." Rationale: The nurse should instruct the client to increase fluid intake rather than limit intake to meal times due to the potential adverse effect of constipation. B. "Do not take this medication on an empty stomach." Rationale: The nurse should instruct the client that verapamil can be taken without food. C. "Increase your daily intake of dietary fiber." Rationale: The nurse should instruct the client to increase his daily intake of dietary fiber to reduce the risk of constipation associated with verapamil. D. "You can expect swelling of the ankles while taking this medication." Rationale: The nurse should instruct the client to report any swelling of the ankles or feet to the provider immediately, as these are manifestations of an adverse effect.
26.A A nurse is providing teaching to a client who has stable angina and a new prescription for nitroglycerin oral, sustained-release capsules. Which of the following instructions should the nurse include? A. Take 1 capsule at the onset of anginal pain. Rationale: Sustained-release capsules are not used for acute attacks of angina. B. Stop taking the medication if side effects are troublesome. Rationale: Abruptly discontinuing the use of long-acting nitroglycerin capsules can cause vasospasm. C. Take the medication with meals. Rationale: The client should take the medication on an empty stomach 1 hr before or 2 hr after a meal with 8 oz of water. D. Swallow the capsules whole. Rationale: The client should swallow the capsules whole and not chew or crush them or place them under the tongue. 27.A A nurse is caring for a client who is receiving heparin by continuous IV infusion. Which of the following medications should the nurse plan to administer in the event of an overdose? A. Iron Rationale: Iron treats anemia, not a heparin overdose. B. Glucagon Rationale: Glucagon treats severe hypoglycemia from an insulin overdose. C. Protamine Rationale: Protamine reverses the effects of heparin and is used in the event of an overdose. D. Vitamin K Rationale: Vitamin K reverses the effects of warfarin, not heparin.
- A nurse is providing teaching to a client who has hypertension and a new prescription for captopril. Which of the following instructions should the nurse provide? A. Do not use salt substitutes while taking this medication. Rationale: Captopril, an ACE inhibitor, can cause hyperkalemia due to potassium retention by the kidney. The client should avoid salt substitutes, as most of them are high in potassium. B. Take the medication with food. Rationale: The client should take captopril on an empty stomach, 1 hr before or 2 hr after a meal, in order
to not reduce the medication’s absorption. C. Count your pulse rate before taking the medication. Rationale: It is not necessary to count a pulse before taking captopril. D. Expect to gain weight while taking this medication. Rationale: Weight gain is not an adverse effect of captopril. 29.A A nurse is providing teaching to a client who has hypertension and a new prescription for verapamil. Which of the following beverages should the nurse tell the client to avoid while taking this medication? A. Milk Rationale: Milk has no known effect on the metabolism of verapamil; therefore, this is a safe beverage for the client to drink while on this medication. B. Orange juice Rationale: Orange juice has no known effect on the metabolism of verapamil; therefore, this is a safe beverage for the client to drink while on this medication. C. Coffee Rationale: Although coffee consumption should be limited while taking verapamil, it does not have to be avoided. D. Grapefruit juice Rationale: Grapefruit juice increases blood levels of verapamil, a calcium channel blocker, by inhibiting its metabolism. The excess amount of medication can intensify the medication's hypotensive effects, putting the client at risk for syncope and dizziness.
- A nurse on a telemetry unit is caring for a client who has unstable angina and is reporting chest pain with a severity of 6 on a 0 to 10 scale. The nurse administers 1 sublingual nitroglycerin tablet. After 5 min, the client states that his chest pain is now a severity of 2. Which of the following actions should the nurse take? A. Administer another nitroglycerin tablet. Rationale: Administration guidelines for sublingual nitroglycerin indicate that it is appropriate to administer another tablet 5 min after the first one if the client is still reporting pain. B. Initiate a peripheral IV. Rationale: As the first dose of nitroglycerin decreased the client's pain, there is no indication that an IV is necessary. C. Call the Rapid Response Team. Rationale: As the first dose of nitroglycerin decreased the client's pain, there is no indication that calling
33.A A nurse is receiving a client who is immediately postoperative following hip arthroplasty. Which of the following medications should the nurse plan to administer for DVT prophylaxis? A. Aspirin PO Rationale: Aspirin therapy is used for existing thromboembolic disorders, not for DVT prophylaxis. B. Enoxaparin subcutaneous Rationale: Enoxaparin is a low molecular heparin that inhibits thrombus and clot formation. Preventive doses of enoxaparin are low and the client does not require monitoring of prothrombin time or activated partial thromboplastin time, making it the preferred treatment for DVT prophylaxis following orthopedic surgery. C. Heparin infusion Rationale: Heparin therapy by infusion is used to treat existing DVT, not prophylaxis. D. Warfarin PO Rationale: Warfarin therapy is started after dosing with enoxaparin. Both medications are given to allow the warfarin time to reach therapeutic levels. 34.A A nurse is preparing to administer digoxin to a client who has heart failure. Which of the following actionsis appropriate? A. Withholding the medication if the heart rate is above 100/min Rationale: The nurse should withhold the medication if the client's heart rate is below 60/min. B. Instructing the client to eat foods that are low in potassium Rationale: The client should eat foods high in potassium to prevent hypokalemia, which increases the risk of digoxin toxicity. C. Measuring apical pulse rate for 30 seconds before administration Rationale: The nurse should measure the apical pulse rate for 1 min. D. Evaluating the client for nausea, vomiting, and anorexia Rationale: Loss of appetite, nausea, vomiting, and blurred or yellow vision may be signs of digoxin toxicity.
- A nurse is caring for a client who is taking digoxin for heart failure and develops indications of severe digoxin toxicity. Which of the following medications should the nurse prepare to administer? A. Fab antibody fragments Rationale: Fab antibody fragments, also called digoxin immune Fab, bind to digoxin and block its action.
B. Flumazenil The nurse should prepare to administer this antidote IV to clients who have severe digoxin toxicity. Rationale: Flumazenil, a benzodiazepine antagonist, reverses the effects of benzodiazepines. C. Acetylcysteine Rationale: Acetylcysteine, a mucolytic, reduces the risk of hepatotoxicity after acetaminophen overdose. D. Naloxone Rationale: Naloxone reverses the effects of opioid analgesics.
- A nurse is providing teaching to a client who has stable angina and a new prescription for transdermal nitroglycerin. Which of the following instructions should the nurse include? (Select all that apply.) A. Apply the patch to a hairless area and rotate sites. B. Apply a new patch each morning. C. Remove the patch for 10 to 12 hr daily. D. Apply the patch to dry skin and cover the area with plastic wrap. E. Apply a new patch at the onset of anginal pain. Rationale: Apply the patch to a hairless area and rotate sites is correct. Hair can interfere with the adhesion of the patch. Rotating sites helps prevent skin irritation. Apply a new patch each morning is correct. Therapeutic preventive effects of transdermal nitroglycerin patches begin 30 to 60 min after application and last up to 14 hr. Remove the patch for 10 to 12 hr daily is correct. Removing the patches for 10 to 12 hr each day helps prevent tolerance to the medication. Apply the patch to dry skin and cover the area with plastic wrap is incorrect. These instructions apply to topical nitroglycerin ointment, not to nitroglycerin patches. Apply a new patch at the onset of anginal pain is incorrect. Nitroglycerin patches prevent angina attacks. They do not treat acute angina attacks. 37.AA nurse is providing discharge teaching to a client who has a new prescription for warfarin. Which of the following statements by the client indicates an understanding of the teaching? A. "It's okay to have a couple of glasses of wine with dinner each evening." Rationale: Alcohol can alter the medication's effects. Excessive intake can increase its effects, while chronic intake can decrease its effects.
D. "The INR is a standardized test that eliminates the variations between laboratories reports in prothrombin times." Rationale: The INR is a standardized test, which means that the result will be the same, no matter which laboratory performs it.
- A nurse is preparing to administer a transfusion of RBCs to a client who has heart failure. For which of the following manifestations should the nurse monitor to prevent fluid volume overload? (Select all that apply.) A. Dyspnea B. Gastrointestinal bloating C. Jugular vein distention D. Confusion E. Hypotension Rationale: Dyspnea is correct. Dyspnea is a clinical manifestation of fluid volume overload. Gastrointestinal bloating is incorrect. Gastrointestinal bloating is not a clinical manifestation of heart failure. Jugular vein distention is correct. Jugular vein distention is a clinical manifestation of fluid volume overload. Confusion is correct. Confusion is a clinical manifestation of fluid volume overload. Hypotension is incorrect. Hypertension, not hypotension, is a clinical manifestation of fluid volume overload. Hypotension is a manifestation of a hemolytic transfusion reaction. 41.AA nurse is teaching a client who has a new prescription for aspirin to prevent cardiovascular disease. Which of the following instructions should the nurse include in the teaching? A. Take the tablets on an empty stomach. Rationale: The client should take aspirin with a full glass of water or with food to reduce gastric distress. B. Expect stools to turn black. Rationale: The client should monitor for black, tarry stools and other manifestations of bleeding, such as bruising. C. Anticipate the tablets to smell like vinegar. Rationale: Discard aspirin tablets that smell like vinegar because these tablets are decomposing and are ineffective. D. Monitor for tinnitus. Rationale:
Tinnitus is a manifestation of salicylism, or aspirin toxicity. Other manifestations include sweating, headache, and dizziness.
- A nurse is teaching a client who has a new prescription for bumetanide. Which of the following instructions should the nurse include in the teaching? A. "Report changes in hearing." Rationale: Bumetanide is a high-ceiling loop diuretic. It promotes diuresis by inhibiting sodium and chloride reabsorption in the thick ascending limb of the loop of Henle. High-ceiling loop diuretics can cause ototoxicity. Concurrent use of aminoglycosides, such as gentamycin, increases the risk of ototoxicity. Inform clients about possible hearing loss, and instruct clients to notify the prescriber if a hearing deficit or tinnitus develops. B. "Avoid foods high in potassium." Rationale: Hypokalemia is an adverse effect of bumetanide due to potassium loss through the distal nephron. The client should consume foods high in potassium content (such as dried fruits, nuts, bananas, and potatoes) to minimize the risk for hypokalemia. The client should be taught to monitor for manifestations of hypokalemia, such as irregular heartbeat, muscle weakness, and leg cramps. C. "Take the prescribed second dose at nighttime." Rationale: Inform the client to expect increased urine volume and frequency of voiding. The client should take diuretics early in the morning when prescribed daily. When prescribed twice per day, the client should take the medication at 0800 and 1400 to avoid frequent diuresis during the night. D. "Limit your fluid intake to no more than 1.5 L a day." Rationale: The client should consume 2-3 L of fluid per day to prevent dehydration due to loss of sodium, chloride, and water. 43.AA nurse is caring for a client who has a new prescription for propranolol. The nurse should monitor the client for which of the following adverse reactions to this medication? A. Ototoxicity Rationale: Propranolol can cause bronchoconstrictions in clients who have asthma. B. Tachycardia Rationale: Bradycardia is an adverse reaction of beta-blockers. The nurse should withhold the medication if the client's heart rate is less than 50/min. C. Postural hypotension Rationale: Propranolol can cause postural hypotension. The client should change positions slowly and the nurse should monitor the client's blood pressure from a lying to sitting to standing position. D. Hypokalemia Rationale:
