NCLEX Pharmacology VATI Update 1, Exams of Nursing

Download NCLEX Pharmacology VATI Update 1 and more Exams Nursing in PDF only on Docsity! NCLEX Pharmacology VATI, RN VATI Pharmacology 2023 Update 1. A nurse is caring for a client who ingested a toxic amount of acetaminophen 36 hr ago. For which of the following findings should the nurse monitor? Select all that apply a. elevated troponin level b. diaphoresis c. hyperglycemia d. abdominal discomfort e. increased alanine aminotransferase (ALT) level -✓✓✓ b. Diaphoresis is correct. The nurse should monitor the client for early manifestations of acetaminophen toxicity, which includes diaphoresis. Later manifestations of toxicity include liver failure, which manifest 48 to 72 hr following ingestion of the toxic dose. 2. d. Abdominal discomfort is correct. The nurse should monitor the client for early manifestations of acetaminophen toxicity, which include abdominal discomfort, nausea, vomiting, and diarrhea. 3. e. Increased alanine aminotransferase (ALT) level is correct. The nurse should monitor ALT levels because these enzymes may elevate with liver inflammation from acetaminophen overdose. 4. A nurse is assessing a client who has a prescription for oral albuterol for the long-term management of asthma. For which of the following adverse effects should the nurse monitor? a. Nystagmus b. Tachycardia c. Drowsiness d. Oral fungal infections -✓✓✓ b. Tachycardia 5. Albuterol is a beta2-agonist, which can cause excessive stimulation of cardiac and skeletal muscle beta cells. Therefore, the nurse should monitor the client for tachycardia and dysrhythmias. 6. A nurse is planning care for a client who has asthma and a prescription for methylprednisolone. Which of the following lab values should the nurse monitor? a. Aspartate aminotransferase (AST) b. Fibrin split products c. BUN d. Glucose -✓✓✓ d. Glucose 7. Methylprednisolone therapy increases the synthesis of glucose and decreases the uptake of glucose by the muscles and adipose tissues, resulting in increased circulating glucose. Therefore, it is important for the nurse to regularly monitor blood glucose levels while clients are receiving corticosteroid therapy. 8. A nurse planning care for a client who has a prescription for acetazolamide. Which of the following findings should the nurse plan to monitor for as an adverse effect of this medication? a. Bronchospasm 15. The nurse should identify that the greatest risk to the client is renal insufficiency or renal toxicity, both of which are potential adverse effects of ketorolac. Therefore, oliguria, or decreased urine output, is the priority finding for the nurse to report to the provider. 16. A nurse is reviewing the laboratory report for a client who has been taking sodium polystyrene sulfonate. Which of the following findings indicates a therapeutic response to the medication? a. magnesium 1.5 mEq/L b. calcium 9.2 mg/dL c. sodium 140 mEq/L d. potassium 4.8 mEq/L -✓✓✓ d. potassium 4.8 mEq/L 17. Sodium polystyrene sulfonate is a cationic exchange resin administered to treat hyperkalemia. A potassium level of 4.8 is within the expected reference range of 3.5 to 5 mEq/L and indicates that the client has experienced a therapeutic response to the medication. The nurse should closely monitor the client's potassium level throughout treatment and notify the provider when the potassium level drops within 4 to 5 mEq/L. 18. A nurse is providing discharge teaching to a client who has a gastric ulcer and a new prescription for esomeprazole. Which of the following information should the nurse include in the teaching? a. Continue taking ibuprofen for pain relief. b. Crush the medication and mix it with applesauce. c. Take the medication 60 min before a meal. d. Insomnia is a common adverse effect of the medication. - ✓✓✓ c. Take the medication 60 min before a meal. 19. Food affects the absorption of esomeprazole. For optimal absorption, the client should take the medication at least 60 min before a meal 20. A nurse is planning care for a client who is taking tamoxifen for treatment of breast cancer. Which of the following interventions should the nurse include in the plan? (select all that apply) a. Monitor the client's calcium level. b. Monitor the client for pulmonary embolus. c. Advise the client of the potential for menstrual irregularities. d. Advise the client of the potential for peripheral neuropathy. e. Advise the client of the potential for hot flashes. -✓✓✓ a. Monitor the client's calcium level. 21. b. Monitor the client for pulmonary embolus. 22. c. Advise the client of the potential for menstrual irregularities. 23. e. Advise the client of the potential for hot flashes. 24. A nurse is teaching a client who has a diagnoses of heart failure about furosemide. Which of the following instructions should the nurse include in the teaching about this medication? (select all that apply) a. Eat foods high in potassium regularly. b. Report any indications of hearing loss. c. Rise slowly from a sitting or lying position. d. Take the daily dose of furosemide at bedtime. e. Check weight daily. -✓✓✓ a. Eat foods high in potassium regularly. 25. b. Report any indications of hearing loss. 26. c. Rise slowly from a sitting or lying position. 27. e. Check weight daily. 28. A nurse is preparing to admin topotecan IV for a client with metastatic ovarian cancer. Which of the following meds should be expected to control adverse effects of topotecan? a. insulin lispro via subcutaneous injection b. granisetron via transdermal patch c. magnesium sulfate via intermittent IV bolus d. prednisone via oral administration -✓✓✓ b. granisetron via transdermal patch 29. Granisetron is an antiemetic medication that helps prevent nausea and vomiting for clients who are receiving chemotherapy medications such as topotecan. The client should apply the transdermal patch to the upper outer arm up to 48 hr prior to receiving topotecan and continue to wear the patch until 24 hr after the completion of chemotherapy to prevent chemotherapy- induced nausea and vomiting. report to the provider is agitation, which can indicate neurotoxicity resulting from overuse of of an opioid medication. 37. A nurse is providing discharge teaching to a client who has tuberculosis and is taking rifampin. Which of the following statements by the client indicates an understanding of the teaching? a. "Jaundice is a harmless adverse effect of this medication." b. "I shouldn't wear my soft contact lenses, because they will become discolored." c. "The best time to take this medication is when my stomach is full." d. "It is okay to drink alcohol while I'm on this medication as long as it is in moderation." -✓✓✓ b. "I shouldn't wear my soft contact lenses, because they will become discolored." 38. Rifampin administration causes harmless red-orange discoloration of feces, sputum, tears, and sweat. Therefore, the client should not wear soft contact lenses to prevent permanent staining and should consult with an ophthalmologist for alternative visual aids 39. A nurse assessing a patient prior to atenolol administration finds that client's heartrate is 61. What actions should the nurse do? a. administer half the dose b. withhold the medication and contact the provider for further instructions c. give the prescribed dose to the client d. prepare to administer atropine to the client -✓✓✓ c. give the prescribed dose 40. If the client's heart rate is less than 50/min, the nurse should withhold the medication and notify the provider. For a heart rate of 61/min, the nurse should administer the medication and continue to monitor the client. 41. A nurse is caring for a client who is postmenopausal and has a prescription for raloxifene. The nurse should instruct the client that raloxifene is prescribed for which of the following reasons? a. To treat irritable bowel syndrome b. To reduce the risk for breast cancer c. To reduce the occurrence of hot flashes d. To lower the risk of pulmonary embolism -✓✓✓ b. To reduce the risk for breast cancer 42. Raloxifene can lower the risk for breast cancer in postmenopausal clients who have a high risk for developing estrogen-receptive types of breast cancer. The medication also reduces the risk for and can treat postmenopausal osteoporosis 43. A nurse is preparing to administer mannitol via continuous IV infusion to a client. Which of the following findings should the nurse identify as an expected outcome of this medication therapy? a. improved urinary output b. resolution of diabetic ketoacidosis c. decreased brain natriuretic peptide levels d. increased intraocular pressure -✓✓✓ a. Improved urinary output 44. Mannitol is an osmotic diuretic, which acts by drawing fluid into the nephron and increasing urinary output. The nurse should monitor the client's fluid status during treatment with mannitol. 45. A nurse is administering haloperidol to a client who has schizophrenia. For which of the following adverse effects should the nurse monitor? a. Gingival hyperplasia b. Muscle rigidity c. Polyuria d. Bruising -✓✓✓ b. muscle rigidity 46. A client who is taking haloperidol, a first-generation antipsychotic agent, can develop extrapyramidal effects, such as parkinsonism, which manifests as tremors, bradykinesia, loss of balance, mask-like expression, shuffling gait, and muscle rigidity. nausea and vomiting. Which of the following should the nurse include in the teaching? a. restlessness is an expected effect of the medication b. take the medication 30 min after chemotherapy c. acute nausea resolves within 12 hr of chemo administration d. Additional meds can be required. -✓✓✓ d. Additional meds can be required. 56. Combinations of antiemetics are usually more effective than single-medication therapy at managing chemotherapy- induced nausea and vomiting. The combination of a serotonin antagonist, such as ondansetron, with a corticosteroid, such as dexamethasone, can be highly effective in preventing chemotherapy-induced nausea and vomiting. 57. A nurse is reviewing the medical history of a client who has a new diagnosis of diabetes mellitus and is asking about taking metformin. Which of the following client conditions should the nurse identify as a contraindication of this medication? a. a history of migraine headaches b. alcohol use disorder c. a history of peptic ulcer disease d. tobacco use -✓✓✓ b. alcohol use disorder 58. Metformin can inhibit the breakdown of lactic acid, causing life-threatening lactic acidosis. The nurse should identify alcohol use disorder as a contraindication because alcohol further inhibits the breakdown of lactic acid. 59. A nurse is providing teaching to a client who has a new prescription for beclomethasone and albuterol inhalers. Which of the following instructions should the nurse include in the teaching? a. "gargle with water after using beclomethasone". b. "it is not necessary to shake beclomethasone prior to use". c. "use beclomethasone for an acute asthma attack". d. "use beclomethasone before using albuterol to increase absorption". -✓✓✓ a. "gargle with water after using beclomethasone". 60. Beclomethasone is an inhaled corticosteroid that prevents bronchial inflammation. Because it can cause oral candida infections, the nurse should instruct the client to gargle with water after using beclomethasone. 61. A nurse is caring for a client who has a prescription for penicillin V. Which of the following adverse effects is the priority for the nurse to monitor after administration of the medication? a. laryngeal edema b. urticaria c. epigastric distress d. maculopapular rash -✓✓✓ a. laryngeal edema 62. when using ABCs, the nurse should determine that the priority adverse effect to monitor the client for is laryngeal edema, which indicates an anaphylactic reaction. This is a life- threatening reaction that compromises the client's airway and requires treatment with epinephrine. 63. A nurse notes that a client who has been receiving daunorubicin has suffered an extravasation at the IV site. What type of compress would the nurse most likely apply as treatment? a. a warm dry compress b. a moist warm compress c. a cold dry compress d. a moist cold compress -✓✓✓ d. a moist cold compress 64. extravasations are treated with moist cold compresses. 65. A nurse is caring for a 4-year-old child with sickle cell anemia who has new prescriptions cycrimine (Pagitane), folic acid, hydroxyurea, and penicillin. When reviewing the medications with the parents, which of the following is the appropriate nursing intervention? a. notify the doctor and ask to cancel cycrimine (Pagitane). b. provide instruction for home care and follow-up treatment c. notify the doctor and ask to cancel hydroxyurea d. provide instructions to report adverse reactions and prevent sickle cell crisis -✓✓✓ a. notify the doctor and ask to cancel cycrimine (Pagitane). born, which is the administration of Rh negative, type O blood into the umbilical vein. These transfusions can be administered as often as every 14 days until the fetus reaches 37 to 38 weeks of gestation and the fetus' lungs mature. 73. A client in the intensive care unit has developed short bowel syndrome and is receiving TPN. Which of the following potential metabolic complications should the nurse monitor for when administering TPN? (Select all that apply.) a. Hyperglycemia b. Hypertriglyceridemia c. Hypoglycemia d. Hypocalcemia e. Hyponatremia -✓✓✓ a. Hyperglycemia 74. b. Hypertriglyceridemia 75. c. Hypoglycemia 76. Total parenteral nutrition can cause some changes in the metabolic system because of the nutrients and electrolytes it contains. Clients receiving TPN are at higher risk of both hypo- and hyperglycemia. Because dextrose is usually a component of TPN, an ill client may have difficulties metabolizing the larger amounts of dextrose that are infused with the solution and may develop blood glucose abnormalities. Hypertriglyceridemia is also a risk with TPN: when lipid emulsions are administered for nutrition, the client may not be able to tolerate the extra lipid solution and may develop high cholesterol. 77. A nurse is preparing to administer diclofenac to a client who has chronic bursitis. Which of the following actions should the nurse take? a. administer the medication at bedtime b. avoid administering the medication with antacids c. administer the medication with food d. crush the medication prior to administration -✓✓✓ Administer the medication with food 78. Diclofenac is an NSAID and can cause gastric irritation. Clients should take NSAIDs with food or milk to minimize gastric irritation.he nurse should not administer the medication at bedtime because the client should remain upright for 15 to 30 min after administration to prevent esophageal irritation. Diclofenac is available as an enteric-coated tablet for delayed release. Clients should not crush or chew sustained-release medications because doing so will increase gastrointestinal adverse effects and decrease the effectiveness of the medication. 79. A nurse is planning care for a client who has asthma and a prescription for methylprednisolone. Which of the following laboratory values should the nurse monitor while the client is receiving this medication? a. Aspartate aminotransferase (AST) b. Fibrin split products c. BUN d. Glucose -✓✓✓ Glucose 80. Methylprednisolone therapy increases the synthesis of glucose and decreases the uptake of glucose by the muscles and adipose tissues, resulting in increased circulating glucose. Therefore, it is important for the nurse to monitor blood glucose levels regularly while clients are receiving corticosteroid therapy. 81. Aspartate aminotransferase is an enzyme that is present in the heart, liver, skeletal muscles, and other highly metabolic tissues. AST levels are increased in conditions that cause cellular injury, such as liver disease; however, methylprednisolone therapy does not affect AST levels. Fibrin split products are present in the serum when thromboses are present. Increased levels of fibrin split products can increase disseminated intravascular coagulation (DIC); however, methylprednisolone therapy does not affect blood clotting. BUN levels reflect kidney function and glomerular filtration. Hydration status and nephrotoxic medications can alter BUN levels; however, methylprednisolone therapy does not affect renal function. 82. A nurse is caring for a client who is postmenopausal and has a prescription for raloxifene. The nurse should instruct the client that raloxifene is prescribed for which of the following reasons? a. sodium bicarbonate b. manesium sulfate c. calcium gluconate d. potassium chloride -✓✓✓ Calcium gluconate 89. The nurse should identify that a positive Trousseau's sign is a manifestation of hypocalcemia. Therefore, the nurse should plan to administer calcium gluconate to treat hypocalcemia. 90. Sodium bicarbonate is administered to treat metabolic acidosis. The nurse should recognize that sodium bicarbonate is not used to treat a positive Trousseau's sign.Magnesium sulfate is administered to treat hypomagnesemia. The nurse should recognize that magnesium sulfate is not used to treat a positive Trousseau's sign. Potassium chloride is administered to treat hypokalemia. The nurse should recognize that potassium chloride is not used to treat a positive Trousseau's sign. 91. A nurse is preparing to administer morphine 0.3 mg/kg PO to a school-aged child who weighs 88 lb. Available is morphine oral solution 2mg/ml. How many mL should the nurse administer? -✓✓✓ 6 mL 92. A nurse is administering haloperidol to a client who has schizophrenia. For which of the following adverse effects should the nurse monitor? a. gingival hyperplasia b. muscle rigidity c. polyuria d. bruising -✓✓✓ Muscle rigidity 93. A client who is taking haloperidol, a first-generation antipsychotic agent, can develop extrapyramidal effects, such as parkinsonism, which manifests as tremors, bradykinesia, loss of balance, mask-like facial expression, shuffling gait, and muscle rigidity. 94. Haloperidol is an antipsychotic agent that can cause akathisia (motor restlessness) within hours of receiving the first dose; however, gingival hyperplasia is not an adverse effect of haloperidol. Phenytoin is an example of a medication that causes gingival hyperplasia.Haloperidol has several genitourinary adverse effects, including urinary retention and impotence; however, urinary output does not typically increase.Haloperidol has significant cardiovascular effects, including dysrhythmias, myocardial infarction, severe heart failure, and hypotension; however, it does not affect blood coagulation. 95. A nurse receives a verbal prescription from the provider for hydrochlorothiazide 25 mg by mouth daily for a client who has hypertension. Which of the following indicates how the nurse should transcribe the prescription in the client's medical record? a. Hydrochlorothiazide 25.0 mg orally q.d. b. Hydrochlorothiazide 25 mg PO daily c. HCTZ 25.0 mg by mouth daily d. HCTZ 25 mg PO OD -✓✓✓ Hydrochlorothiazide 25 mg PO daily 96. The nurse should transcribe the provider's prescription by spelling out the name of the medication, recording the dosage as a whole number, and spelling out the word "daily." The abbreviation PO is acceptable for use to indicate the route by mouth. 97. The nurse should not transcribe a trailing zero after a decimal point because if the decimal point is not seen, it could be mistaken as 250 mg. The abbreviation q.d. is not acceptable because it could be mistaken for q.i.d. The nurse should write out the word "daily."The nurse should not transcribe the medication name abbreviated as HCTZ, because it could be mistaken for hydrocortisone. The nurse should not place a trailing zero after a decimal point because if the decimal point is not seen, it could be mistaken as 250 mg.The nurse should not transcribe the medication name abbreviated as HCTZ, because it could be mistaken for hydrocortisone. The abbreviation OD is not acceptable for use because it could be mistaken for "right eye." The nurse should write out the word "daily." chemoreceptor trigger zone of the medulla, which results in nausea and vomiting. The nurse should assess the client for nausea prior to administering meperidine, pretreat for nausea, and encourage the client to remain in a supine position to minimize the medication's emetic effects; however, another assessment is the nurse's priority.Meperidine is an opioid analgesic that can cause somnolence and mental clouding. The nurse should assess the client's level of consciousness and ensure the client's safety prior to administering meperidine; however, another assessment is the nurse's priority. 104. A nurse is reviewing the laboratory results for a client who is taking warfarin following orthopedic surgery. Which of the following results should the nurse report to the provider? a. PT 12.5 seconds b. aPTT 36 seconds c. PTT 65 seconds d. INR 5.2 -✓✓✓ INR 5.2 105. A client who is taking warfarin following an orthopedic surgery should have a therapeutic INR between 2 to 3. The nurse should identify an INR greater than 5 as a critical value. Therefore, the nurse should report this laboratory value to the provider to have the client's warfarin dosage adjusted. 106. A PT of 12.5 seconds is within the expected reference range of 11 to 12.5 seconds. The nurse should expect the client who is taking coumadin to have a prolonged PT. An aPTT of 36 seconds is within the expected reference range of 30 to 40 seconds. The aPTT is used to monitor clients who are receiving heparin therapy. A PTT of 65 seconds is within the expected reference range of 60 to 70 seconds. This test is used to monitor clients who are receiving heparin therapy. 107. INR 5.2 108. A nurse is preparing to administer medications to a client. The client tells the nurse, "I will take the pills but not that liquid medication." Which of the following actions should the nurse take? a. Document the reason for the missed dose of medication in the nurse's notes. b. Ask an assistive personnel (AP) to ensure the client drinks the medication after breakfast. c. Notify the pharmacist that the client is refusing to take the medication. d. Mix the medication in juice on the client's breakfast tray. - ✓✓✓ a. document the reason for the missed dose of medication in the nurse's notes 109. It is the responsibility of the nurse to respect the client's right to refuse to take a medication and to document the reason a medication dose is not administered. This should include the client's refusal to take the medication. 110. Medication administration, regardless of the route, is not within the range of function for an AP. The client refused the medication so the nurse should not ask someone else to administer it at a later time. The nurse should notify the client's provider of the refusal; however, it is not necessary to notify the pharmacist. The nurse should respect the client's right to refuse to take the medication. The nurse cannot force the client to take any medication against their will, which includes mixing the medication in the client's juice without their knowledge. 111. A nurse is assessing a client who is receiving androgen therapy to treat endometriosis. The nurse should monitor the client for which of the following adverse effects? a. weight loss b. hypotension c. muscle hypertrophy d. edema -✓✓✓ edema 112. Androgens treat endometriosis and fibrocystic breast disease, and can cause fluid retention; therefore, androgen therapy should be used cautiously with clients who have existing cardiac or renal impairment. The nurse should monitor the client for edema and instruct the client to measure weight daily.