ATI Custom ASN Pharm NSG 1540 Final Exam Winter

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Free ATI Custom ASN Pharm NSG 1540 Final Exam Winter Questions

1. A client is receiving opioid therapy for pain control. The nurse explains that developing tolerance to the drug means which of the following?
  • The drug is no longer working.

  • Higher doses may be required for the same effect.

  • The client is becoming addicted.

  • The client will have withdrawal symptoms.

Explanation

Explanation
Correct Answer: B) Higher doses may be required for the same effect.
Drug tolerance is a pharmacological phenomenon where the body adapts to a medication over time, resulting in a diminished response to the same dose. This means progressively higher doses may be needed to achieve the same level of pain relief. Tolerance does not mean the drug has stopped working entirely, nor does it indicate addiction, which involves psychological dependence and drug-seeking behavior. Withdrawal symptoms occur with physical dependence when the drug is abruptly stopped, which is a separate concept from tolerance.
2. A nurse is reviewing medications with a client who has chronic diarrhea. Which over-the-counter medication slows intestinal motility to reduce the frequency of stools?
  • Loperamide

  • Docusate sodium

  • Bisacodyl

  • Magnesium hydroxide

Explanation

Explanation
Loperamide (Imodium) is an antidiarrheal medication that works by binding to opioid receptors in the intestinal wall, slowing peristalsis and intestinal motility, which reduces stool frequency and increases stool consistency. Docusate sodium is a stool softener used for constipation. Bisacodyl is a stimulant laxative that increases intestinal motility, promoting bowel movements. Magnesium hydroxide is an osmotic laxative that draws water into the intestine to promote elimination — all three of the latter options would worsen diarrhea, not treat it.
3. A nurse administers 10 mg of oral hydrocodone/acetaminophen to a client who reports postoperative pain rated 7/10. After giving the medication, the client asks, "When should I expect this to start helping my pain?" What is the most appropriate response from the nurse?
  • "It will take about 2 to 3 hours before you feel any change."

  • "You should feel relief within about 5 to 10 minutes."

  • "You should feel the full effect in less than 5 minutes."

  • "You should start noticing effects in about 60 minutes."

Explanation

Explanation
Correct Answer: D) "You should start noticing effects in about 60 minutes."
Oral hydrocodone/acetaminophen has an onset of action of approximately 30 to 60 minutes when taken by mouth, as it must first be absorbed through the gastrointestinal tract before entering the bloodstream. Telling the client effects will begin in about 60 minutes sets realistic expectations and promotes medication understanding. Onset of 2 to 3 hours is too long and inaccurate for this medication. Effects within 5 to 10 minutes or less than 5 minutes are characteristic of IV opioid administration, not oral, and would be misleading and incorrect.
4. A nurse is teaching a client how to administer neomycin, polymyxin B, and hydrocortisone otic drops for external otitis. Which instruction should the nurse include?
  • Insert the dropper tip deeply into the ear canal to ensure full delivery.

  • Warm the bottle in the hands before administration to reduce dizziness.

  • Administer the drops while the client is sitting upright.

  • Insert a cotton swab into the ear before each dose to remove debris.

Explanation

Explanation
Correct Answer: B) Warm the bottle in the hands before administration to reduce dizziness.
Otic (ear) drops should be warmed to body temperature by holding the bottle in the hands for a few minutes before administration. Instilling cold drops directly into the ear canal can stimulate the vestibular system, causing vertigo and dizziness. The dropper tip should never be inserted deeply into the ear canal to avoid injury or contamination. The client should lie on their side with the affected ear facing up during administration, not sit upright. Cotton swabs should never be inserted into the ear canal as they can push debris deeper and cause injury.
5. A nurse is evaluating the effectiveness of teaching provided to a client who has osteoarthritis and is prescribed naproxen. Which client statement indicates that the teaching has been effective?
  • "I take naproxen with aspirin to improve pain control."

  • "I take naproxen every 2 hours if my pain gets worse."

  • "I take naproxen on an empty stomach to help it absorb faster."

  • "I take naproxen with food to reduce the chance of stomach upset."

Explanation

Explanation
Correct Answer: D) "I take naproxen with food to reduce the chance of stomach upset."
Naproxen is an NSAID (non-steroidal anti-inflammatory drug) that can irritate the gastrointestinal lining, leading to nausea, ulcers, or GI bleeding. Taking it with food, milk, or antacids helps protect the stomach and reduce GI side effects, demonstrating correct understanding of medication instructions. Taking naproxen with aspirin increases the risk of GI bleeding as both are NSAIDs. Naproxen has a specific dosing schedule and should not be taken every 2 hours. Taking it on an empty stomach worsens GI irritation rather than improving absorption.
6. A nurse is teaching a client who has seasonal allergic rhinitis about the safe use of phenylephrine nasal spray. Which client statement indicates that the teaching has been effective?
  • "I don't need to worry about following the directions on the label."

  • "I can use the spray as often as I want to relieve congestion."

  • "If my symptoms don't improve after a single use, I should double the dose."

  • "I will use the spray for no more than 3 days to avoid rebound congestion."

Explanation

Explanation
Correct Answer: D) "I will use the spray for no more than 3 days to avoid rebound congestion."
Phenylephrine nasal spray is a decongestant that should not be used for more than 3 consecutive days. Prolonged use can lead to rhinitis medicamentosa, commonly known as rebound congestion, where nasal passages become more congested than before once the medication wears off, creating a cycle of dependency. Using the spray as often as desired, doubling the dose, or ignoring label directions are all unsafe practices that increase the risk of rebound congestion and systemic side effects such as elevated blood pressure and heart rate.
7. A nurse is caring for a client who is receiving a continuous heparin infusion and has developed thrombocytopenia. Which is the most important concern for the nurse?
  • Bleeding

  • Hypertension

  • Infection

  • Bradycardia

Explanation

Explanation
Correct Answer: A) Bleeding
When a client on heparin develops thrombocytopenia — a significant drop in platelet count — the nurse's greatest concern is bleeding. This condition is known as Heparin-Induced Thrombocytopenia (HIT), where the immune system destroys platelets, paradoxically increasing clotting risk while simultaneously reducing the platelet count available to stop bleeding. With fewer platelets and an anticoagulant already on board, the client is at extreme risk for uncontrolled bleeding. Hypertension, infection, and bradycardia are not the primary concerns associated with HIT or heparin-induced thrombocytopenia.
8. A nurse is assessing a client's pain 30 minutes after administering IV morphine for postoperative pain. The client reports adequate pain relief but is now difficult to arouse. The nurse notes a respiratory rate of 8 breaths per minute and shallow respirations. Which action should the nurse take first?
  • Encourage the client to take deep breaths.

  • Document the client's response to morphine.

  • Place the client in a supine position and continue to monitor.

  • Administer naloxone (Narcan) per protocol.

Explanation

Explanation
Correct Answer: D) Administer naloxone (Narcan) per protocol.
The client is exhibiting classic signs of opioid-induced respiratory depression — a respiratory rate of 8 breaths per minute, shallow breathing, and decreased level of consciousness. This is a life-threatening emergency requiring immediate intervention. Naloxone (Narcan) is the opioid antagonist that rapidly reverses opioid toxicity and must be administered first per protocol. Encouraging deep breaths and repositioning are insufficient interventions for this severity of respiratory depression. Documentation is never the priority during an acute emergency and should only occur after the client is stabilized.
9. A client who has hypertension is prescribed losartan. Which action should the nurse take to ensure the medication's effectiveness?
  • Advise the client to take the medication on an empty stomach.

  • Instruct the client to avoid potassium-rich foods.

  • Suggest the client monitor blood glucose levels regularly.

  • Encourage the client to increase sodium intake.

Explanation

Explanation
Losartan is an angiotensin II receptor blocker (ARB) that lowers blood pressure by blocking the effects of angiotensin II, which also causes potassium retention. Because losartan increases serum potassium levels, clients should be advised to avoid excessive intake of potassium-rich foods such as bananas, oranges, and potatoes to prevent hyperkalemia. Losartan can be taken with or without food, so empty stomach administration is not required. Monitoring blood glucose is not relevant to losartan therapy. Increasing sodium intake would counteract the antihypertensive effects of the medication.
10. A nurse is preparing to administer spironolactone to a client who has hypertension and a serum potassium level of 3.5 mEq/L (normal: 3.5–5.0 mEq/L). Which action should the nurse take?
  • Withhold the spironolactone and notify the provider.

  • Administer the spironolactone as prescribed.

  • Administer a potassium supplement along with spironolactone.

  • Increase the dose of spironolactone.

Explanation

Explanation
Correct Answer: B) Administer the spironolactone as prescribed.
Spironolactone is a potassium-sparing diuretic, meaning it retains potassium rather than excreting it. The client's potassium level of 3.5 mEq/L falls exactly at the lower limit of the normal range (3.5–5.0 mEq/L), which is acceptable for administration. There is no indication to withhold the medication, as the level is not below normal. Administering a potassium supplement alongside spironolactone would risk hyperkalemia, as the drug already conserves potassium. Increasing the dose is not indicated based on the potassium level alone and requires a provider order.

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