Capstone Pharm.

Assignment

1. A nurse is caring for a client with many different medications who is newly prescribed
acetazolamide. What medications can interact with acetazolamide?
a. High-dose aspirin: can cause metabolic acidosis
b. Quinidine: increases toxic effects, monitor for decreased heart rate
c. Lithium: decreases blood levels, monitor for increased mania
d. Phenytoin: increase osteomalacia, monitor for bone pain, weakness.
e. Sodium bicarbonate: increases risk for kidney stones

2. A nurse is caring for a client prescribed the inhaled glucocorticoid beclomethasone

(QVAR) for the treatment of asthma. What is a potential adverse effect of this
medication and what are two (2) teaching points to discuss to address these adverse
effects?
a. Adverse effect: difficulty speaking, hoarseness, and candidiasis
b. Advise clients to rinse mouth or gargle with water after use
c. Advise clients to monitor for redness, sores, or white patches and to report to
the provider if they occur.

3. A client has a new prescription for an albuterol inhaler and a beclomethasone inhaler.
What instructions should the nurse include concerning use of these inhalers?
a. Albuterol: inhaled, short-acting to prevent asthma and treatment for
bronchospasm. May cause tachycardia, angina, and tremors.
b. Beclomethasone: prevent inflammation, suppress airway mucus production, and
promote responsiveness of beta2 receptors in the bronchial tree. Does not
provide immediate effects, but promotes decreased frequency and severity of
exacerbations and acute attacks.
c. Teach: Inhale the albuterol before inhaling the beclomethasone. The beta-
agonist (albuterol) will promote bronchodilation and enhance absorption of the
glucocorticoid (beclomethasone).

4. A nurse is instructing a client who has a new prescription for nitroglycerin transdermal
patch about administration. What instructions should the nurse include?
a. This medication is for long-term prophylaxis against angina attacks
b. Do not cut the patch, to ensure appropriate dosing
c. Place the patch on a hairless area of the skin (chest, back, or abdomen)
d. Rotate sites to prevent skin irritation
e. Remove old patch, wash skin with soap and water, and dry thoroughly before
applying the new patch.
f. Remove the patch at night to reduce the risk of developing tolerance to
nitroglycerin.
g. Be medication-free between 10 and 12 hours per day
5. A nurse is administering gemfibrozil to a client with elevated cholesterol. Identify two
(2) adverse effects related to this medication.
a. GI distress which is usually mild and self-limiting
b. Gallstones, advise client to observe for right upper quadrant pain, fat
intolerance, bloating and notify HCP if symptoms occur.

6. A nurse is teaching a client who has a new prescription for alprazolam. What
instructions should the nurse include?
a. Take medication as prescribed and avoid abrupt discontinuation of treatment to
prevent withdrawal manifestations. Do not change the dose or frequency
without prior approval of provider.
b. When discontinuing benzodiazepines that have been taken regularly for long
periods and in high doses, taper the dose over several weeks.
c. Take the medication with meals or snacks if GI upset occurs.
d. Take the medication at bedtime if possible due to sedation.
e. Swallow sustained-release tablets and no do chew or crush.
f. Teach client of possible dependency during and after treatment and to notify
provider if indications of withdrawal occur.
g. Teach client to store medication in a safe place due to their abuse potential

7. A nurse is providing instructions to a client who has a prescription for methotrexate.

What should the nurse include in the client education?
a. Encourage 2 to 3 L of daily fluid intake from food and beverage sources.
b. Advice female clients to use birth control during treatment.
c. Advise clients to avoid use of alcohol during treatment.
d. Advise clients to monitor for dark urine and clay-colored stools.
e. Advise clients to practice good oral hygiene and to avoid mouthwash with
alcohol.

8. A nurse is preparing to administer a topoisonmerase inhibitor to a client with ovarian

cancer. What are adverse effects the nurse should monitor when administering this
medication?
a. Monitor for GI discomfort, nausea, and vomiting. Administer an antiemetic such
as ondansetron in combination with dexamethasone, granisetron, or
metoclopramide before beginning chemotherapy.
b. May cause bone marrow suppression 4-6 weeks after infusion.
c. May cause alopecia 7-10 days after infusion.

9. A nurse is preparing to educate a client with diabetes who has a new prescription for
metformin. What should the nurse included in the client instructions?
a. Metformin reduces the production of glucose within the liver through
suppression of gluconeogenesis, increases the muscles glucose uptake and use
and is the first choice medication for clients who have type 2 diabetes.
 b. May cause anorexia, nausea, and diarrhea, which usually subside with use.
c. May cause vitamin b12 and folic acide deficiency which may require
supplements.
d. May cause lactic acidosis (hyperventilation, myalgia, sluggishness, somnolence),
withhold medication if these symptoms occur and call your HCP immediately.
e. Avoid alcohol use while taking this medication due to increased risk for lactic
acidosis.
f. Discontinue metformin 24-48 hr. before procedure which will use iodine-
containing contrast media due to risk of acute kidney failure.
g. Take immediate release tablets two times per day with breakfast and dinner.
h. Take sustained-release tablets once a day with dinner.

10. A nurse has provided education to a client who has a new prescription for exenatide.
What statements by the client would indicate they understand the instructions?
a. This is supplemental glucose control for clients who have type 2 diabetes, used
in conjunction with an oral antidiabetic medication, usually metformin or
sulfonylurea.
b. This medication may cause GI effects (nausea, vomiting, diarrhea) and
pancreatitis (severe and intolerable abdominal pain). I should notify the provider
should I experience these symptoms.
c. I should take other oral medications 1 hour before injection of exenatide due to
delayed absorption.
d. I should administer subcutaneously in the thigh, abdomen, or upper arm with
prefilled injector pen.
e. I will give injection 60 min. before the morning and evening meal, never after a
meal.
f. I will keep the injection pen in the refrigerator and discard after 30 days.

11. A nurse has provided education to a client with hypothyroidism who has a new
prescription for levothyroxine. What statements by the client would indicate they
understand the instructions?
a. I will report indications of overmedication to my provider (anxiety, tachycardia,
palpitations, altered appetite, abdominal cramping, heat intolerance, fever,
diaphoresis, weight loss, menstrual irregularities).
b. I will have my TSH and T4 levels monitored at least once a year.
c. I will take this medication daily on a empty stomach 30 to 60 min. before
breakfast.
d. I will take this medication for the rest of my life. Even if symptoms improve I will
not stop taking this medication without consulting my provider.

12. A nurse is caring for a client who has a new prescription for alosetron. What are the
expected therapeutic effects of this medication?
 a. Relief of diarrhea, and decrease in urgency and frequency of defecation in
female patients diagnosed with irritable bowel syndrome-D that meets criteria
for treatment and sign consent form.

13. A nurse is placing an IV line on an older adult client. List three (3) considerations the
nurse should take when placing an IV line in this client?
a. Older adult clients have fragile veins
b. Avoid tourniquets. Use a blood pressure cuff to help visualize, but not over
distend, the veins to help prevent hematoma formation.
c. Do not slap the extremity to visualize veins.
d. Instruct the client to hold his band below the level of his heart to help distend
and thus visualize the veins.

14. A client with hypertension is prescribed verapamil. What are the three (3) expected
outcomes of this medication therapy?
a. Blocking of calcium channels in blood vessels leads to vasodilation of peripheral
arterioles and arteries/arterioles of the heart.
b. Blocking of calcium channels in the myocardium, SA node, and AV node leads to
a decreased force of contraction, decreased heart rate, and slowing of the rate
of conduction through the AV node.
c. Decrease in total peripheral resistance which will significantly lower blood
pressure.

15. A critical care client is in need of adenosine. What is the indication of this medication
and how is this medication administered?
a. Adenosine decreases electrical conduction through AV nodes. Indications of use
include paroxysmal supraventricular tachycardia, and Wolff-Parkinson-White
syndrome.
b. Administer via IV bolus, followed by saline flush.

16. A home health nurse is evaluating the client's knowledge of the medication terazosin.
Which statement by the client alerts the nurse the client needs further education on this
medication?
a. "I will take my medication at bedtime".
i. This medication should be taken at bedtime.
b. "This medication will help my urinary output."
i. This medication relaxes the smooth muscle of the prostatic capsule and
bladder neck thus decreasing manifestations of BPH (urgency, frequency,
dysuria)
c. "I will get out of bed slowly when waking."
i. May cause hypotension.
d. "I will take this medication after eating."
17. A nurse has an order to administer mannitol to a critical care client. What should the
nurse expect following mannitol administration?
a. Osmotic diuretics reduce intracranial pressure and intraocular pressure by
raising serum osmolality and drawing fluid back into the vascular and
extravascular space.
b. Effectiveness is evidenced by normal kidney function as demonstrated by urine
output of >30 mL/hr, serum creatinine 0.6 to 1.3 (M) and 0.5 to 1.1 (F), BUN
levels 10 to 20.
c. Decrease in intracranial pressure.
d. Decrease in intraocular pressure

18. A client has been prescribed oxybutynin for treatment of overactive bladder and has
been experiencing anticholinergic side effects. List two (2) actions the client will take to
prevent adverse effects of the medication therapy.
a. Increase dietary fiber
b. Consume 2 to 3 L/day fluid from beverage and food sources, sip throughout day

19. A client is to take metronidazole. List three (3) teaching points to review with the client
prior to administering the first dose.
a. Ensure the client does not have any active CNS disorders, blood dyscrasias,
lactating, or in the first trimester of pregnancy.
b. Instruct client this may cause GI discomfort such as nausea, vomiting, dry mouth,
and metallic taste, and darkening of urine which is harmless.
c. If the client experiences neurotoxicity or CNS effects such as numbness in
extremities, ataxia, or seizures or pseudomembranous colitis (fever, diarrhea,
abdominal pain, or blood stool) stop the medication and notify the provider.

20. A nurse is preparing to administer acetylcysteine. What are indications for therapy?
a. Mucolytics are used in clients who have acute and chronic pulmonary disorders
exacerbated by large amount of secretions.
b. Cystic fibrosis.
c. Antidote for acetaminophen poisoning.