Question

A nurse is providing teaching to a client who is receiving intermittent parenteral cyclosporine. Which of the following conditions should the nurse recognize as an indication for this medication?

Answer 1

Correct Answers:

Kidney transplant

Rationale :

🟦 Cyclosporine is an immunosuppressive medication classified as a calcineurin inhibitor used to prevent organ rejection following transplantation.

🟦 It works by suppressing T-lymphocyte activation, which is responsible for mounting an immune response against a transplanted organ.

🟦 This medication is commonly prescribed after a kidney transplant to maintain graft survival.

🟦 Parenteral administration is indicated when oral intake is not possible, such as in the immediate postoperative period.

🟦 Using cyclosporine in transplant clients significantly reduces the risk of acute and chronic rejection.

❌ Hypokalemia

🟦 Cyclosporine does not treat electrolyte deficiencies.

🟦 In fact, it is more commonly associated with hyperkalemia.

❌ Endocarditis

🟦 Endocarditis is treated with long-term antimicrobial therapy, not immunosuppressants.

🟦 Cyclosporine would worsen infection risk.

❌ Seizures

🟦 Cyclosporine does not have anticonvulsant properties.

🟦 Neurotoxicity, including seizures, can actually occur as an adverse effect.

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Answer 2

Correct Answers:

Clopidogrel

Rationale :

🟦 Clopidogrel is an antiplatelet medication that inhibits platelet aggregation and increases bleeding risk.

🟦 In a client with hematemesis, continued use can worsen active gastrointestinal bleeding.

🟦 The priority is to reduce further blood loss and stabilize hemostasis.

🟦 Discontinuing clopidogrel helps prevent continued hemorrhage.

🟦 Antiplatelet agents are routinely stopped during acute bleeding episodes.

❌ Furosemide

🟦 This medication affects fluid balance, not clotting.

🟦 It does not contribute to gastrointestinal bleeding.

❌ NPH insulin

🟦 Insulin does not increase bleeding risk.

🟦 It should be continued unless hypoglycemia is present.

❌ Pantoprazole

🟦 Proton pump inhibitors help reduce gastric acid.

🟦 They are commonly used to treat GI bleeding.

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Answer 3

Correct Answers:

Notify the pharmacy to send the medication immediately.

Rationale :

🟦 The term “NOW” indicates the medication must be administered immediately, not within a routine timeframe.

🟦 The nurse’s priority is ensuring rapid availability of the drug.

🟦 Contacting the pharmacy supports timely administration.

🟦 The order is clear, complete, and time-specific, requiring no clarification.

🟦 Delaying action could compromise client safety, depending on the indication.

❌ Administer the medication within 90 min

🟦 This is appropriate for routine orders, not urgent ones.

🟦 “NOW” requires immediate action.

❌ Inform the client there is a prescription available if needed

🟦 This delays treatment.

🟦 It does not meet the urgency of the order.

❌ Contact the provider to clarify

🟦 The prescription is already clear.

🟦 Unnecessary clarification causes delay.

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Answer 4

Correct Answers:

Decrease in respiratory rate

Rationale :

🟦 Propofol is a sedative-hypnotic commonly used for procedural sedation.

🟦 It causes central nervous system depression, which can suppress respiratory drive.

🟦 A decreased respiratory rate is a serious and common adverse effect.

🟦 Clients receiving propofol require continuous respiratory monitoring.

🟦 Early detection of hypoventilation prevents hypoxia and respiratory failure.

❌ Increase in bowel function

🟦 Propofol does not stimulate gastrointestinal motility.

🟦 Sedation typically slows bodily functions.

❌ Decrease in body temperature

🟦 Hypothermia is not a primary adverse effect.

🟦 Respiratory depression is the priority concern.

❌ Increase in heart rate

🟦 Propofol more commonly causes hypotension and bradycardia.

🟦 Tachycardia is not expected.

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Answer 5

Correct Answers:

Severe headache

Rationale :

🟦 A severe headache after epidural anesthesia can indicate a post–dural puncture headache, which occurs when cerebrospinal fluid leaks and reduces intracranial pressure.

🟦 This headache is typically positional, worsening when the client sits or stands and improving when lying flat.

🟦 It is a recognized complication of neuraxial anesthesia and requires prompt monitoring for severity and associated neurologic symptoms.

🟦 Early recognition supports timely management, which can include hydration, analgesia, caffeine, and possibly an epidural blood patch.

🟦 Monitoring for this manifestation improves safety and reduces complications following epidural anesthesia.

❌ Rapid rise in temperature

🟦 A sudden temperature rise suggests infection or malignant hyperthermia rather than an epidural complication.

🟦 It is not the typical hallmark adverse reaction expected from epidural anesthesia alone.

❌ Tachycardia

🟦 Tachycardia is more commonly related to pain, hypovolemia, or systemic reactions.

🟦 Epidural anesthesia more often causes bradycardia due to sympathetic blockade.

❌ Hypertension

🟦 Hypertension is not a common adverse effect of epidural anesthesia.

🟦 Epidurals typically cause vasodilation and can lead to hypotension instead.

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Answer 6

Correct Answers:

Fluid retention

Rationale :

🟦 Pioglitazone is a thiazolidinedione that improves insulin sensitivity but commonly causes fluid retention due to renal sodium reabsorption changes.

🟦 This effect can lead to weight gain and peripheral edema, especially in clients with underlying cardiac risk.

🟦 Fluid retention may worsen or precipitate heart failure, making monitoring for swelling, shortness of breath, and rapid weight changes essential.

🟦 Early detection allows providers to adjust therapy to prevent serious cardiopulmonary complications.

🟦 Monitoring for edema and sudden weight gain is a key nursing priority with pioglitazone therapy.

❌ Tinnitus

🟦 Tinnitus is more commonly associated with salicylates or ototoxic medications.

🟦 Pioglitazone does not typically affect auditory function.

❌ Orthostatic hypotension

🟦 Orthostatic hypotension is more associated with antihypertensives or dehydration.

🟦 It is not a primary adverse effect of pioglitazone.

❌ Insomnia

🟦 Insomnia is not a common adverse reaction with this medication class.

🟦 Pioglitazone primarily affects glucose metabolism and fluid balance.

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Answer 7

Correct Answers:

Fentanyl transmucosal

Rationale :

🟦 Fentanyl transmucosal is a rapid-onset opioid analgesic designed for breakthrough cancer pain, which requires fast relief.

🟦 Breakthrough pain occurs suddenly despite baseline long-acting opioid therapy, so short-acting potent opioids are indicated.

🟦 Transmucosal delivery allows quick absorption and rapid analgesic effect, matching the urgency of episodic severe pain.

🟦 This medication is specifically used in opioid-tolerant clients with cancer for controlled and predictable pain relief.

🟦 Including this in teaching supports safe management of acute episodic cancer pain.

❌ Aspirin rectal

🟦 Aspirin is an NSAID and is not first-line for severe breakthrough cancer pain.

🟦 It also increases bleeding risk and may be contraindicated in many oncology clients.

❌ Acetaminophen PO

🟦 Acetaminophen can help mild to moderate pain but is insufficient for breakthrough cancer pain.

🟦 It does not provide rapid opioid-level analgesia needed for severe episodes.

❌ Ketorolac IM

🟦 Ketorolac is an NSAID used for short-term moderate pain, not typical breakthrough cancer pain.

🟦 It carries risks of renal injury and GI bleeding, limiting its use in many cancer clients.

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Answer 8

Correct Answers:

The over-the-counter medications that the client takes at home.

Rationale :

🟦 Medication reconciliation must include all medications the client uses, including over-the-counter (OTC) drugs, because these can cause significant interactions and adverse effects.

🟦 OTC products such as NSAIDs, antihistamines, antacids, and herbal supplements may alter the effectiveness or safety of prescribed therapies.

🟦 Including home OTC medications prevents duplication, contraindications, and harmful drug-drug interactions during transitions of care.

🟦 Reconciliation aims to ensure the client’s medication list is complete, accurate, and current across settings.

🟦 This is essential for preventing medication errors and improving client safety.

❌ The client's medication allergies

🟦 Allergies are critical to document, but they are part of the allergy profile rather than the medication list itself.

🟦 Reconciliation focuses on identifying all medications taken to prevent discrepancies and interactions.

❌ The client's discontinued medications

🟦 Discontinued medications may be reviewed, but they are not the primary focus of the active reconciliation list.

🟦 The goal is to capture what the client is currently taking at home.

❌ The medications that the client has taken in the last 24 hr

🟦 A 24-hour window is too narrow and may miss chronic home medications.

🟦 Reconciliation requires a comprehensive home regimen review, not only recent doses.

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Answer 9

Correct Answers:

Tachycardia

Rationale :

🟦 Abrupt discontinuation of propranolol, a nonselective beta-blocker, can cause rebound sympathetic stimulation.

🟦 This rebound effect may lead to tachycardia and increased myocardial oxygen demand, raising the risk of angina or ischemia.

🟦 Long-term beta-blocker therapy increases beta-receptor sensitivity, making sudden withdrawal clinically significant.

🟦 The nurse should assess for palpitations, rapid pulse, chest discomfort, and elevated blood pressure.

🟦 Monitoring for tachycardia is essential to prevent complications associated with beta-blocker withdrawal.

❌ Bradypnea

🟦 Bradypnea is not a typical withdrawal finding from beta-blockers.

🟦 Respiratory slowing is more related to opioid or sedative effects.

❌ Hyperkalemia

🟦 Hyperkalemia is not a classic consequence of stopping propranolol.

🟦 Potassium changes are more commonly linked to renal dysfunction or certain diuretics/ACE inhibitors.

❌ Rhinitis

🟦 Rhinitis is not associated with beta-blocker withdrawal.

🟦 It is more consistent with allergic or infectious conditions.

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Answer 10

Correct Answers:

"You will need to take two or more medications to treat your disease."

Rationale :

🟦 Active pulmonary tuberculosis requires combination therapy to effectively eradicate Mycobacterium tuberculosis and prevent drug resistance.

🟦 Standard treatment includes multiple antibiotics such as isoniazid, rifampin, ethambutol, and pyrazinamide.

🟦 Using more than one medication targets the organism at different stages of replication.

🟦 Combination therapy also reduces the risk of treatment failure and relapse.

🟦 Teaching this concept improves medication adherence and treatment success.

❌ Monthly kidney function tests

🟦 TB medications primarily require liver monitoring, not routine kidney testing.

🟦 Renal monitoring is not the main focus of TB therapy.

❌ Taking medication for 3 years

🟦 Standard TB treatment lasts 6–9 months, not years.

🟦 Prolonged therapy is unnecessary with adherence.

❌ Tuberculin skin tests every 6 months

🟦 Skin tests are for screening, not treatment monitoring.

🟦 They remain positive after infection.

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RN Pharmacology 2023 Dec 17

No.

1 :
A nurse is providing teaching to a client who is receiving intermittent parenteral cyclosporine. Which of the following conditions should the nurse recognize as an indication for this medication?

2 :
A nurse in the emergency department is reviewing a medication record for a client who reports vomiting blood. The nurse should anticipate that the provider will discontinue which of the following medications?

3 :
A nurse is transcribing a new prescription for a client which states, "Diphenhydramine 50 mg NOW." Which of the following actions should the nurse take?

4 :
A nurse is caring for a client who has received propofol during a colonoscopy. The nurse should monitor for which of the following as an adverse effect of the medication?

5 :
A nurse is caring for a client who received epidural anesthesia during hip surgery. Which of the following manifestations should the nurse monitor as an adverse reaction?

6 :
A nurse is caring for a client who has diabetes mellitus and is taking pioglitazone. The nurse should plan to monitor the client for which of the following adverse effects?

7 :
A nurse is teaching a newly licensed nurse about medications used to treat breakthrough cancer pain. Which of the following medications should the nurse include in the teaching?

8 :
A nurse is creating a medication reconciliation list for a client. Which of the following information should the nurse include in the reconciliation?

9 :
A nurse is caring for a client who reports taking propranolol for several years but has recently stopped for financial reasons. The nurse should assess the client for which of the following findings?

10 :
A nurse is teaching a client who has active pulmonary tuberculosis about management of medication for the disease. Which of the following statements is appropriate for the nurse to make?

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RN Pharmacology 2023 Dec 17

No.

1 : A nurse is providing teaching to a client who is receiving intermittent parenteral cyclosporine. Which of the following conditions should the nurse recognize as an indication for this medication?

2 : A nurse in the emergency department is reviewing a medication record for a client who reports vomiting blood. The nurse should anticipate that the provider will discontinue which of the following medications?

3 : A nurse is transcribing a new prescription for a client which states, "Diphenhydramine 50 mg NOW." Which of the following actions should the nurse take?

4 : A nurse is caring for a client who has received propofol during a colonoscopy. The nurse should monitor for which of the following as an adverse effect of the medication?

5 : A nurse is caring for a client who received epidural anesthesia during hip surgery. Which of the following manifestations should the nurse monitor as an adverse reaction?

6 : A nurse is caring for a client who has diabetes mellitus and is taking pioglitazone. The nurse should plan to monitor the client for which of the following adverse effects?

7 : A nurse is teaching a newly licensed nurse about medications used to treat breakthrough cancer pain. Which of the following medications should the nurse include in the teaching?

8 : A nurse is creating a medication reconciliation list for a client. Which of the following information should the nurse include in the reconciliation?

9 : A nurse is caring for a client who reports taking propranolol for several years but has recently stopped for financial reasons. The nurse should assess the client for which of the following findings?

10 : A nurse is teaching a client who has active pulmonary tuberculosis about management of medication for the disease. Which of the following statements is appropriate for the nurse to make?

1 :
A nurse is providing teaching to a client who is receiving intermittent parenteral cyclosporine. Which of the following conditions should the nurse recognize as an indication for this medication?

2 :
A nurse in the emergency department is reviewing a medication record for a client who reports vomiting blood. The nurse should anticipate that the provider will discontinue which of the following medications?

3 :
A nurse is transcribing a new prescription for a client which states, "Diphenhydramine 50 mg NOW." Which of the following actions should the nurse take?

4 :
A nurse is caring for a client who has received propofol during a colonoscopy. The nurse should monitor for which of the following as an adverse effect of the medication?

5 :
A nurse is caring for a client who received epidural anesthesia during hip surgery. Which of the following manifestations should the nurse monitor as an adverse reaction?

6 :
A nurse is caring for a client who has diabetes mellitus and is taking pioglitazone. The nurse should plan to monitor the client for which of the following adverse effects?

7 :
A nurse is teaching a newly licensed nurse about medications used to treat breakthrough cancer pain. Which of the following medications should the nurse include in the teaching?

8 :
A nurse is creating a medication reconciliation list for a client. Which of the following information should the nurse include in the reconciliation?

9 :
A nurse is caring for a client who reports taking propranolol for several years but has recently stopped for financial reasons. The nurse should assess the client for which of the following findings?

10 :
A nurse is teaching a client who has active pulmonary tuberculosis about management of medication for the disease. Which of the following statements is appropriate for the nurse to make?