ATI-P ATI Pharmacology - Set 4 - Part 1

Correct Answer: Reinsert the ring and use backup contraception.

If the ring is out longer than the recommended time, the client should rinse and reinsert it and use backup contraception for several days. The nurse should include this instruction in order to maintain the client's protection against pregnancy. Option a is incorrect because discarding the ring and waiting until the next cycle would leave the client unprotected. The correct step is to reinsert the ring and add a backup method of contraception during the catch-up period to prevent pregnancy. Option b is incorrect because taking no action would risk an unintended pregnancy when the ring has been out too long. The client should reinsert the ring and use backup contraception during the recommended period rather than doing nothing at all. Option c is incorrect because inserting a second ring is not the recommended action and could cause problems for the client. The proper instruction is to reinsert the single ring and use a backup method of contraception for several days.

Correct Answer: Uterine tachysystole

Oxytocin increases the frequency and strength of contractions and can cause uterine tachysystole. The nurse should monitor contraction frequency and the fetal heart rate closely in order to detect this complication during the induction of labor. Option b is incorrect because oxytocin increases uterine tone rather than decreasing it. A drop in tone is the opposite of its action, so the complication the nurse should watch for is excessive contraction activity rather than reduced uterine tone. Option c is incorrect because oxytocin stimulates contractions, so a slowing of contractions is not an expected complication. The danger the nurse should monitor for is overstimulation of the uterus, seen as uterine tachysystole during the induction. Option d is incorrect because hypoglycemia is not a recognized complication of oxytocin. The medication's uterine effects, such as tachysystole, are what the nurse must monitor during the induction of labor rather than changes in blood glucose.

Correct Answer: Avoid aspirin because it interferes with probenecid.

Salicylates such as aspirin lessen the effectiveness of probenecid and can precipitate gout. The nurse should advise the client to avoid aspirin, because it interferes with probenecid's therapeutic effect and could trigger a gout attack. Option a is incorrect because aspirin is a poor choice with probenecid, because it reduces the medication's effectiveness. Recommending it as the best option contradicts the interaction and could trigger gout, so this response would mislead the client. Option b is incorrect because limiting aspirin to nighttime does not avoid the interaction, because salicylates still interfere with probenecid. The client should avoid aspirin altogether during therapy rather than simply taking it at a different time of day. Option d is incorrect because aspirin decreases rather than increases probenecid's effectiveness. Stating that it boosts the medication is incorrect, and the client should avoid aspirin in order to keep probenecid working as intended

Correct Answer: Keep the client NPO until gag reflex returns.

Tetracaine numbs the pharynx and suppresses the gag reflex, which raises the aspiration risk. The nurse should keep the client NPO until normal pharyngeal sensation returns in order to protect the airway after the bronchoscopy is finished. Option a is incorrect because lying flat for hours applies after spinal anesthesia to prevent a headache, not after topical throat anesthesia. The priority for this client is preventing aspiration until the gag reflex comes back, so this action is not appropriate. Option b is incorrect because palpating the bladder addresses urinary retention seen with spinal anesthesia. A topical throat anesthetic does not cause retention, so airway protection by keeping the client NPO is the relevant concern instead of bladder assessment. Option c is incorrect because monitoring for a spinal hematoma fits epidural or spinal procedures, not a numbed throat. After tetracaine to the pharynx, the key action is keeping the client NPO until pharyngeal sensation returns t

Correct Answer: Dexamethasone

Dexamethasone is a glucocorticoid that decreases inflammation and swelling, reducing cerebral edema and the pressure that causes the headaches. The nurse should anticipate administering this adjuvant to relieve the client's tumor-related head pain. Option b is incorrect because methylphenidate is a stimulant used to lift mood and counter opioid sedation. It does not reduce cerebral swelling, so it would not relieve the headache caused by edema around the tumor in this client with brain cancer. Option c is incorrect because hydroxyzine is an antihistamine that eases anxiety, nausea, and insomnia. It does not decrease the inflammation and pressure behind these headaches, so it is not the adjuvant indicated for the client's cerebral swelling. Option d is incorrect because amitriptyline relieves neuropathic pain and elevates mood but does not reduce cerebral edema. The headaches here stem from swelling, which a glucocorticoid relieves far better than any tricyclic antidepressant

Correct Answer: Use an additional method of birth control.

Carbamazepine can decrease the effectiveness of oral contraceptives, which raises the risk of an unintended pregnancy. The nurse should teach the client to use an additional method of birth control while taking this adjuvant medication for pain. Option a is incorrect because skipping contraceptive pills would further reduce protection rather than address the interaction. The correct step is to add a second method, because carbamazepine weakens the contraceptive's effect and leaves the client at risk for pregnancy. Option b is incorrect because carbamazepine reduces rather than strengthens contraceptive effectiveness. Because protection is lowered, a backup method is needed instead of relying on an unchanged or stronger effect from the oral contraceptive the client takes. Option d is incorrect because carbamazepine clearly does affect contraception by decreasing its reliability. Telling the client there is no effect would leave her unprotected, so the teaching must include using a

Correct Answer: Respiratory depression

An opioid given within a few hours of delivery can cross to the fetus and cause neonatal respiratory depression. The nurse should recognize this risk and ensure that naloxone is available at birth to reverse depressed newborn breathing. Option a is incorrect because opioids given near delivery do not increase birth weight. The concern the nurse should recognize is neonatal respiratory depression, which can occur when the drug reaches the newborn close to the time of birth. Option b is incorrect because a rapid newborn heart rate is not the characteristic risk of late opioid dosing. The danger the nurse should recognize is respiratory depression in the neonate from the opioid given near delivery, which naloxone can reverse. Option c is incorrect because a high newborn blood glucose is not associated with labor opioids given near delivery. The recognized risk for the newborn is respiratory depression, which the nurse should anticipate and prepare to reverse with naloxone at birth.

Correct Answer: Seizures

Local anesthetics such as lidocaine can cause central nervous system excitation that leads to seizures. The nurse should monitor the client for seizure activity and keep resuscitation equipment available during the repair of the laceration. Option b is incorrect because lidocaine tends to lower blood pressure rather than raise it. Hypertension is not the expected reaction, so the nurse should instead watch for central nervous system excitation that can progress to seizures in the client. Option c is incorrect because fever is not an adverse effect of lidocaine. The systemic reactions the nurse should monitor are central nervous system excitation and seizures, along with possible cardiac depression, rather than an elevated temperature. Option d is incorrect because lidocaine can cause a slow heart rate, not a fast one. Bradycardia and hypotension reflect its cardiac effects, while the neurologic concern the nurse should watch for is seizure activity during the procedure.

Correct Answer: Serotonin syndrome

Combining a triptan with an SSRI raises the risk of serotonin syndrome, which can include confusion, agitation, hyperthermia, and diaphoresis. The nurse should recognize this dangerous interaction and alert the provider before the client takes both medications. Option a is incorrect because reye's syndrome follows aspirin use in children who have a viral illness and has nothing to do with triptans or SSRIs. It does not arise from combining these two serotonergic medications in an adult client. Option b is incorrect because salicylism is salicylate toxicity from aspirin, not a consequence of a triptan and SSRI combination. The shared serotonergic action of these two medications points instead to serotonin syndrome as the risk for this client. Option d is incorrect because hepatic failure is the concern with an acetaminophen overdose, not this drug pairing. The danger of combining a triptan with an SSRI is excess serotonin activity in the body rather than injury to the client's

Correct Answer: I will report mouth sores to my provider.

Mouth ulcers are an early sign of methotrexate toxicity and should be reported to the provider immediately. This statement shows the client understands the teaching about recognizing and reporting this important warning finding during therapy. Option a is incorrect because methotrexate should be taken with food to reduce gastrointestinal distress, so taking it on an empty stomach is incorrect. This statement reflects a misunderstanding rather than correct teaching about how to take the medication. Option b is incorrect because methotrexate is teratogenic, so reliable contraception is essential and should not be stopped. Discontinuing birth control would dangerously increase the risk of fetal harm, so this statement indicates a need for further teaching. Option c is incorrect because methotrexate requires frequent blood monitoring for marrow suppression and liver injury, not just yearly labs. Limiting testing to once a year would miss developing toxicity, so this statement shows the cli

Correct Answer: A pregnant person should not handle crushed tablets.

Finasteride can cause fetal harm, so a person who is pregnant should not handle crushed or broken tablets. The nurse should include this safety instruction to prevent fetal exposure to the medication in the household. Option b is incorrect because cutting the tablets would expose a person who is pregnant to the drug, which is unsafe. Because finasteride can cause fetal harm, a pregnant household member should not handle crushed or broken tablets at all. Option c is incorrect because storage temperature is not the safety concern with finasteride here. What truly matters is keeping a pregnant household member from touching any tablet that has been split or damaged, which could expose the fetus to the drug. Option d is incorrect because whether the household member swallows the drug is beside the point, since it is prescribed for someone else. The real teaching protects a pregnant family member from handling broken or crumbled finasteride tablets.

Correct Answer: The fingers

Epinephrine added to a local anesthetic is contraindicated in areas with end arteries, such as the fingers, because vasoconstriction can cause gangrene. The nurse should recognize the fingers as an unsafe site for this combination in the client. Option a is incorrect because the thigh is not an end-artery site, so a local anesthetic with epinephrine can be used there. The contraindicated area the nurse should recognize is the fingers, because of the risk of gangrene from vasoconstriction. Option c is incorrect because the upper arm has adequate circulation and is not an end-artery region. Epinephrine with a local anesthetic is avoided in the fingers rather than the upper arm, because end arteries supply the digits. Option d is incorrect because the abdomen has rich collateral circulation and does not carry the gangrene risk seen in the digits. The contraindicated location is the fingers, where vasoconstriction could choke off the only blood supply.

Correct Answer: Osteoporosis

Long-term glucocorticoid use causes osteoporosis by promoting bone loss. The nurse should monitor for this effect and anticipate calcium, vitamin D, and possibly a bisphosphonate to protect the client's bones during prolonged prednisone therapy. Option a is incorrect because glucocorticoids raise blood glucose, producing hyperglycemia rather than hypoglycemia. The bone-thinning risk of long-term prednisone is osteoporosis, so a low glucose reading is not what this therapy threatens. Option b is incorrect because a slow heart rate is not a recognized prednisone effect. What long-term steroid therapy actually endangers is bone density, leading to osteoporosis rather than any change in pulse. Option d is incorrect because increased tearing reflects cholinergic activity and has nothing to do with prednisone. The true long-term hazard of this steroid is weakened, porous bone, not any problem affecting the eyes.

Correct Answer: Rise slowly from sitting or lying.

Tamsulosin is an alpha blocker that can cause hypotension and dizziness. The nurse should instruct the client to rise slowly from a sitting or lying position in order to reduce the risk of fainting and falls during therapy. Option a is incorrect because stopping the medication at any dizziness is not the instruction; clients are taught to change positions slowly instead. Abruptly discontinuing the drug is not the recommended response to mild dizziness for the client taking tamsulosin. Option b is incorrect because tamsulosin improves urinary flow rather than decreasing output. Expecting less urine reflects a misunderstanding, because the medication relaxes smooth muscle to ease voiding for the client with benign prostatic hyperplasia. Option c is incorrect because tamsulosin can lower blood pressure, not raise it, which is exactly why orthostatic precautions matter. Telling the client to expect a higher blood pressure is incorrect and would mislead the client about the medication'

Correct Answer: A reduction in body temperature

Acetaminophen slows prostaglandin production in the central nervous system, giving it antipyretic and analgesic action. A drop in the client's elevated temperature is therefore the expected therapeutic response the nurse should identify with this medication. Option b is incorrect because reduced swelling belongs to drugs with anti-inflammatory action, such as the NSAIDs. Acetaminophen relieves pain and fever but does not meaningfully target the inflammation that produces joint swelling, so this finding would not appear. Option c is incorrect because urine output is not influenced by acetaminophen in any reliable way. A change in voiding would point to a diuretic effect or a fluid-status problem, neither of which describes how this antipyretic actually works in the body. Option d is incorrect because acetaminophen has no meaningful effect on blood pressure. Lowering pressure is the role of antihypertensive agents, so this finding would not result from giving an antipyretic medicati

Correct Answer: A nitrate

Sildenafil taken with a nitrate can cause fatal hypotension, so the combination is contraindicated. The nurse should recognize that a client taking a nitrate for angina cannot safely use sildenafil because of the risk of a dangerous drop in pressure. Option a is incorrect because acetaminophen does not interact dangerously with sildenafil. The contraindicated combination for this client is sildenafil with a nitrate, which together can drop the client's blood pressure to fatal levels. Option c is incorrect because a general antibiotic is not the contraindicated drug with sildenafil. The serious interaction is with nitrates, which together with sildenafil can cause life-threatening hypotension in the client who has angina. Option d is incorrect because a multivitamin poses no contraindication with sildenafil. The danger lies in combining sildenafil with a nitrate, which can produce fatal hypotension, so a nitrate is the medication the nurse should recognize as unsafe.

Correct Answer: Acetylcysteine

Acetylcysteine is the specific antidote for acetaminophen toxicity because it protects the liver from the toxic metabolite. The nurse should anticipate administering acetylcysteine to a client who has overdosed on acetaminophen to limit hepatic injury. Option a is incorrect because naloxone reverses opioid effects such as respiratory depression and pinpoint pupils. It has no action against acetaminophen and cannot protect the liver from the hepatotoxic injury an overdose of acetaminophen produces in the body. Option b is incorrect because misoprostol protects the gastric mucosa during NSAID therapy and is used to prevent ulcers. It does nothing for the liver damage caused by an acetaminophen overdose, so it would not serve as the antidote in this situation. Option d is incorrect because calcium gluconate is the antidote for magnesium sulfate toxicity, not acetaminophen poisoning. It does not counter the hepatic injury that defines an acetaminophen overdose and would leave the liver com

Correct Answer: Respiratory depression

Severe aspirin toxicity progresses from salicylism to acidosis and respiratory depression as the salicylate level climbs. The nurse should expect slowed, depressed breathing and treat this presentation as a medical emergency that requires close monitoring and prompt intervention. Option a is incorrect because aspirin toxicity raises the body temperature rather than lowering it. The client typically develops a high fever, so a low temperature would be an unexpected and inconsistent finding for the nurse to assess during this emergency. Option b is incorrect because heavy sweating accompanies aspirin toxicity, which leaves the skin moist rather than cool and dry. Because diaphoresis is part of the clinical picture, dry skin does not fit the presentation the nurse should expect with this client. Option c is incorrect because crackles suggest fluid in the lungs, but aspirin toxicity instead causes dehydration from fever and sweating. The breathing problem here is depressed respiration, not

Correct Answer: A progestin

Estrogen used alone for postmenopausal therapy raises the risk of endometrial cancer, so a progestin is added to protect the endometrium. The nurse should anticipate the provider prescribing a progestin alongside the estrogen for this client. Option b is incorrect because a loop diuretic addresses fluid overload and has no role in protecting the endometrium. The medication added with estrogen to lower the client's endometrial cancer risk is a progestin rather than a diuretic. Option c is incorrect because an androgen is not used to counter the endometrial effects of estrogen. A progestin is the agent added to estrogen therapy in order to protect the client's uterine lining from the cancer risk of unopposed estrogen. Option d is incorrect because an NSAID relieves pain and inflammation but does nothing to shield the endometrium. The drug paired with estrogen to reduce the client's risk of endometrial cancer is a progestin, not an anti-inflammatory medication.

Correct Answer: A drop in urine output

A drop in urine output is associated with magnesium sulfate toxicity, because reduced output can allow magnesium to accumulate. The nurse should report this finding and prepare to discontinue the infusion if toxicity in the client is confirmed. Option a is incorrect because present deep tendon reflexes are a reassuring finding, whereas their loss would signal toxicity. Intact reflexes therefore do not need to be reported the way a falling urine output does in the client receiving magnesium sulfate. Option c is incorrect because mild pedal edema is expected in preeclampsia and is not a sign of magnesium toxicity. The reportable warning for the nurse is a decrease in urine output, which can allow magnesium to build up in the client. Option d is incorrect because a calm, restful state is acceptable, whereas magnesium toxicity brings depressed respirations and absent reflexes. A drop in urine output, not restfulness, is the finding the nurse should report to the provider for this client.