ATI-P ATI Pharmacology - Set 4 - Part 2

Correct Answer: Notify the provider and monitor liver enzymes.

Jaundice can occur with progestins and signals possible liver involvement. The nurse should notify the provider and monitor liver enzymes when yellowing of the skin and sclera appears in a client who is taking medroxyprogesterone for this concern. Option a is incorrect because jaundice is not an expected, harmless effect; it suggests liver injury that needs evaluation. Reassuring the client without acting would overlook a significant adverse effect of the medication and delay needed care. Option b is incorrect because increasing fluids alone does not address the liver involvement that jaundice indicates. The appropriate response for the nurse is to notify the provider and monitor the client's liver enzymes rather than simply pushing fluids. Option d is incorrect because documenting without further action fails to respond to a sign of possible liver toxicity. Jaundice in this client warrants notifying the provider and checking liver enzymes rather than only charting the finding and

Correct Answer: Stopping the raloxifene before immobility

Raloxifene increases the risk of deep-vein thrombosis and pulmonary embolism, so it is stopped before periods of prolonged immobility. The nurse should anticipate discontinuing it and resuming it once the client is fully mobile after surgery. Option a is incorrect because continuing raloxifene through surgery would leave the client exposed to a higher clot risk during immobility. Because of that danger, the medication is held rather than maintained while the client is unable to move freely. Option b is incorrect because doubling the dose would increase the thrombosis risk at the very time immobility already raises it. The appropriate action is to stop the medication before prolonged immobility, not to intensify it for the client before surgery. Option c is incorrect because adding aspirin is not the source-identified action for raloxifene before surgery. The correct step the nurse should anticipate is discontinuing raloxifene, because of its clot risk during the client's prolonged

Correct Answer: Mouth ulcers

Ulcerations in the mouth and throat are often the first manifestation of methotrexate toxicity. The nurse should inspect the client's mouth daily and stop the medication and notify the provider if these ulcers appear during therapy. Option b is incorrect because improved appetite is not a sign of methotrexate toxicity. Toxicity instead presents early with mouth ulcers, and clients may experience anorexia rather than an increased desire to eat while taking the medication for arthritis. Option c is incorrect because weight gain does not indicate methotrexate toxicity. The earliest warning the nurse should watch for is ulcerative stomatitis, which is found by inspecting the client's mouth, gums, and throat each day. Option d is incorrect because increased energy is unrelated to methotrexate toxicity. The defining early finding is mouth and throat ulceration, which signals the need to hold the drug and notify the provider for the client's safety.

Correct Answer: A history of thrombophlebitis

Estrogen increases the risk of thromboembolic events, so a history of thrombophlebitis is a contraindication. The nurse should recognize that estrogen should not be given to a client who has this history because of the danger of clots. Option a is incorrect because atrophic vaginitis results from estrogen deficiency and is actually treated with estrogen, not a reason to withhold it. It is a therapeutic use of the medication rather than a contraindication for the client. Option c is incorrect because postmenopausal osteoporosis is an indication for estrogen, which slows bone loss. It supports rather than contraindicates therapy, unlike a history of thrombophlebitis, which raises the client's risk of dangerous clots. Option d is incorrect because dysfunctional uterine bleeding can be treated with estrogen and is not a contraindication. The condition that bars estrogen use for this client is a history of thrombophlebitis, because of the thromboembolism risk.

Correct Answer: Numbness and tingling in the fingers

Numbness and tingling in the fingers can signal ergotism from ergotamine, which reflects peripheral ischemia. The nurse should instruct the client to stop the medication and report these findings to the provider so the dangerous vasoconstriction can be addressed. Option a is incorrect because mild nausea is a common migraine and medication effect that can be managed with an antiemetic. It does not signal the peripheral ischemia that makes numbness and tingling a reportable warning sign with ergotamine therapy. Option b is incorrect because a craving for sweets is unrelated to ergotamine and is not a warning sign. The reportable finding the client should watch for is numbness and tingling in the extremities, which suggests ergotism from the medication. Option d is incorrect because relief of the headache is the desired outcome, not a reason to call the provider. The client should instead report numbness and tingling in the fingers, because these point to dangerous vasoconstriction from

Correct Answer: Rhabdomyolysis

Sudden muscle pain and tenderness can indicate rhabdomyolysis, a known risk with colchicine. The nurse should recognize this finding and notify the provider, because it reflects muscle breakdown that requires evaluation and possible discontinuation of the medication. Option a is incorrect because gingival hyperplasia is gum overgrowth associated with cyclosporine, not muscle pain from colchicine. It involves the gums rather than the muscle injury the client is describing, so it does not explain this finding. Option b is incorrect because hyperkalemia does not specifically explain sudden muscle pain and tenderness with colchicine. The finding the nurse should recognize instead points to rhabdomyolysis, which is a recognized complication of this medication for gout. Option c is incorrect because retinal damage is the signature risk of hydroxychloroquine and involves vision, not the muscles. The muscle pain and tenderness described here indicate rhabdomyolysis from colchicine rather than

Correct Answer: I will avoid aspirin during this illness.

Aspirin given to a child or adolescent who has a viral illness, such as chickenpox or influenza, can trigger Reye's syndrome. Avoiding aspirin in this setting shows the parent understands the teaching and will protect the child. Option b is incorrect because using aspirin to lower the fever is exactly what must be avoided here, because aspirin during a viral illness can lead to Reye's syndrome. A different antipyretic should be chosen instead, so this statement needs correction. Option c is incorrect because taking aspirin with food protects the stomach, but that does not address the real danger in this situation. The concern in a child who has a viral illness is Reye's syndrome, which food cannot prevent at all. Option d is incorrect because adjusting the timing or size of an aspirin dose does not make it safe for this child. Any aspirin during a viral illness carries the risk of Reye's syndrome, so the medication should be withheld entirely rather than rescheduled

Correct Answer: A decrease in contractions

Tocolytics relax uterine smooth muscle to suppress preterm labor, so a decrease in contractions is the expected therapeutic effect. The nurse should identify reduced contraction activity as the goal of this therapy for the client in preterm labor. Option a is incorrect because an increase in contraction frequency is the opposite of what tocolytics aim to achieve. Since these drugs suppress labor, the looked-for response is fewer contractions, not more frequent ones. Option c is incorrect because a rise in maternal temperature is not a therapeutic effect of a tocolytic. The drug works by calming uterine activity, so a drop in contractions, not a fever, signals success. Option d is incorrect because faster cervical dilation would mean labor is progressing, which a tocolytic is meant to slow. The therapeutic sign is easing of contractions rather than quicker opening of the cervix.

Correct Answer: Constipation

Morphine slows bowel motility and commonly causes constipation. The nurse should monitor for this effect and treat it prophylactically with a stimulant laxative, a stool softener, increased fluids, and fiber to keep the client comfortable. Option a is incorrect because morphine reduces gut motility, producing constipation rather than diarrhea. Loose stools would point to a different cause, because opioids characteristically slow the bowel instead of speeding it up in the client receiving cancer pain control. Option b is incorrect because opioids depress respiration and slow breathing; they do not speed it. A rapid respiratory rate is the opposite of the slowed, depressed breathing the nurse must watch for in a client who is receiving morphine. Option d is incorrect because morphine suppresses the cough reflex rather than triggering coughing. An irritating cough is not an opioid effect, so it would not be expected here during cancer pain treatment.

Correct Answer: A slow respiratory rate

Morphine causes respiratory depression, so the nurse should withhold the dose when the respiratory rate is slow and notify the provider. Protecting the client's breathing takes priority before giving any opioid for postoperative pain control. Option a is incorrect because moderate pain is the reason to give morphine, not a reason to hold it. The opioid is intended to relieve such pain, so this finding actually supports administration rather than withholding the dose from the client. Option b is incorrect because an elevated blood pressure does not require holding morphine, because the opioid more often lowers blood pressure. The breathing rate, not the blood pressure, is the parameter that determines whether the nurse should withhold the drug. Option c is incorrect because nausea is a common opioid side effect that can be managed with an antiemetic. It is uncomfortable for the client but does not signal the respiratory danger that would justify withholding the morphine before admi

Correct Answer: Administer the morphine on a fixed schedule.

Cancer pain is managed by dosing opioids on a fixed schedule around the clock, with extra doses for breakthrough pain. The nurse should administer the morphine on a fixed schedule in order to maintain steady pain control for the client. Option b is incorrect because giving morphine only when pain is severe leaves the client with uncontrolled pain between doses. Around-the-clock dosing on a fixed schedule is the recommended approach for cancer pain rather than waiting for severe pain. Option c is incorrect because withholding doses until the client requests them undertreats persistent cancer pain. A fixed, scheduled approach provides more consistent relief than waiting for the client to ask, so this action is not appropriate. Option d is incorrect because reserving morphine for bedtime only would leave the client in pain during the day. Cancer pain requires scheduled around-the-clock dosing rather than a single nightly dose, so this action would undertreat the pain.

Correct Answer: I will take calcium and vitamin D.

Glucocorticoids cause osteoporosis, so taking calcium and vitamin D helps protect the bones. This statement shows the client understands the teaching about reducing bone loss during long-term prednisone therapy for rheumatoid arthritis. Option a is incorrect because glucocorticoids must never be stopped abruptly, because of the risk of adrenal suppression. Stopping suddenly reflects a misunderstanding rather than correct teaching, so this statement indicates the client needs further instruction. Option c is incorrect because NSAIDs increase the risk of gastrointestinal ulceration when combined with glucocorticoids, so using them freely is unsafe. This statement indicates a need for further teaching rather than an understanding of the medication. Option d is incorrect because glucocorticoids can cause hypokalemia, so the client should eat potassium-rich foods rather than avoid them. This statement is incorrect rather than an indication that the client understands the teaching about pred

Correct Answer: Notify the provider about the lack of voiding.

Spinal anesthesia can cause urinary retention, so the nurse should notify the provider when the client has not voided within the expected time. Monitoring output and reporting retention protects the client from bladder complications after the procedure. Option a is incorrect because restricting fluids does not resolve urinary retention and could worsen the client's status. The appropriate action for the nurse is to notify the provider about the client's failure to void after the spinal anesthesia. Option b is incorrect because reassuring the client that voiding is optional ignores the retention that can follow spinal anesthesia. The nurse should report the lack of voiding to the provider rather than treat it as an acceptable finding for the client. Option d is incorrect because encouraging the client to ambulate alone is unsafe after spinal anesthesia, when leg strength must be confirmed first. The safer step is to report the client's inability to void so the provider ca

Correct Answer: A slow respiratory rate

Agonist-antagonist opioids can cause respiratory depression, so the nurse should withhold the medication when the respiratory rate is slow. Protecting the client's breathing is the priority before administering this analgesic for pain. Option a is incorrect because mild pain supports giving the analgesic rather than withholding it. The finding that warrants holding the medication is a slow respiratory rate, which signals respiratory depression in the client receiving the opioid. Option b is incorrect because an elevated blood pressure is not a reason to withhold an agonist-antagonist opioid. The breathing rate, not the blood pressure, determines whether the nurse should hold the dose for the client concerned about respiratory status. Option c is incorrect because dry mouth is a minor effect that can be eased with ice chips and does not require holding the drug. A slow respiratory rate is the finding that signals the nurse should withhold the medication from the client.

Correct Answer: A decrease in joint pain and swelling

Colchicine decreases the inflammation of an acute gout attack, so reduced joint pain and swelling is the expected therapeutic effect. The nurse should identify improvement in these findings as the goal of therapy for the client during a gout attack. Option b is incorrect because colchicine does not raise blood pressure as a therapeutic effect. Its purpose is to relieve gout inflammation, which the nurse should identify as decreased joint pain and swelling rather than any change in the client's blood pressure. Option c is incorrect because a rise in body temperature is not a therapeutic effect of colchicine. The expected benefit the nurse should identify is reduced inflammation, with less joint pain and swelling, in the client experiencing an acute gout attack. Option d is incorrect because increased urine output is not the therapeutic aim of colchicine. The medication relieves gout inflammation, producing a decrease in joint pain and swelling, which is the effect the nurse should

Correct Answer: An increase in gout attacks

Allopurinol can increase gout attacks during the first months of treatment. The nurse should monitor for this and knows that colchicine or an NSAID may be prescribed alongside allopurinol to help prevent these early flares for the client. Option a is incorrect because permanent hearing loss is not associated with allopurinol. The early concern the nurse should monitor for with this medication is a temporary rise in gout attacks, not any damage to the client's hearing during therapy. Option c is incorrect because allopurinol does not turn the urine blue. During the first months of therapy, the finding the nurse should anticipate is an increase in gout attacks as the client's uric acid levels shift during treatment. Option d is incorrect because increased hair growth is linked to finasteride, not allopurinol. The expected early effect of allopurinol that the nurse should monitor for is more frequent gout attacks rather than any change in the client's hair.

Correct Answer: I will take this with my SSRI freely.

Combining a triptan with an SSRI raises the risk of serotonin syndrome, so taking them together freely indicates a need for further teaching. The nurse should reinforce that this combination can be dangerous and requires provider guidance for the client. Option a is incorrect because taking sumatriptan at the first sign of a migraine is appropriate for an abortive medication. This statement reflects correct understanding rather than a need for more teaching about how the client should use the medication. Option b is incorrect because reporting continuous chest pain is correct, because of the risk of coronary vasospasm with a triptan. This statement shows the client understands an important warning sign rather than needing further teaching. Option d is incorrect because telling the provider about heart disease is appropriate, because triptans are dangerous in coronary artery disease. This statement reflects correct understanding of the teaching rather than a misunderstanding by the clie

Correct Answer: Stop the oxytocin infusion.

More than five contractions in ten minutes indicates uterine tachysystole, which can compromise the fetus. The nurse should first stop the oxytocin infusion in order to reduce uterine stimulation and protect the well-being of the fetus. Option a is incorrect because increasing the rate would intensify the overstimulation already present with tachysystole. The first action for the nurse is to stop the oxytocin, not to deliver more of it to the client during this dangerous contraction pattern. Option b is incorrect because documenting and continuing ignores a dangerous contraction pattern that can harm the fetus. Tachysystole requires the nurse to stop the infusion rather than simply observe the client and chart the finding without acting. Option c is incorrect because ambulation does not correct uterine tachysystole and only delays the needed response. Stopping the oxytocin infusion is what reduces the excessive contractions threatening the fetus, making movement the wrong choice.

Correct Answer: A decrease in uric acid levels

Allopurinol inhibits uric acid production, so a decrease in uric acid levels is the expected therapeutic effect. The nurse should identify lower uric acid and fewer gout attacks as evidence that the medication is working for the client. Option b is incorrect because allopurinol does not raise blood pressure as a therapeutic effect. Its purpose is to lower the client's uric acid, which reduces gout attacks over time, rather than to change the client's blood pressure. Option c is incorrect because a rise in blood glucose is not a therapeutic effect of allopurinol. The expected outcome the nurse should identify is decreased uric acid levels in the client being treated for chronic gout with this medication. Option d is incorrect because an increased heart rate is not the goal of allopurinol therapy. The therapeutic effect the nurse should identify is a reduction in uric acid levels for the client who has chronic gout.

Correct Answer: Sit upright after taking it.

Alendronate can cause esophagitis, so the client should sit upright or ambulate for a period after taking it. This keeps the medication from irritating the esophagus and reduces the client's risk of esophageal ulceration during therapy. Option a is incorrect because chewing alendronate tablets can cause esophageal ulcers, so the tablets should be swallowed whole. This instruction is the opposite of safe technique for an oral bisphosphonate and would put the client's esophagus at risk. Option c is incorrect because calcium decreases alendronate absorption, so it should be separated from the dose rather than taken together. Combining them would reduce the medication's effectiveness, so this instruction is not appropriate for the client. Option d is incorrect because alendronate is taken first thing in the morning with a full glass of water, not at bedtime with a sip. Lying down afterward would also raise the client's risk of esophagitis, so this instruction is incorre