ATI > LPN

Exam Review

Ati lpn pharmacology 2023 retake 1

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Total Questions : 57

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Question 1:

6 months ago:

The client was diagnosed with epilepsy during childhood. The client reports not having seizures for 2 years. The client has weaned off all seizure medications. The client was informed to return to the office for a follow-up in 6 months and to call the office if seizure activity resumes

 

Today:

The client reports having a seizure this morning. Provider aware and new prescription obtained.

Today:

The client is to be admitted to the hospital to receive long-term video electroencephalography monitoring and to initiate antiseizure medication therapy.

Loading dose:

  • Phenytoin 300 mg every 8 hr by mouth for 1 day
  • Maintenance dose
  • Phenytoin 100 mg every 8 hr by mouth
  • Temperature 36.4° C (97.6° F), oral
  • Heart rate 75/min
  • Respiratory rate 16/min
  • Blood pressure 100/74 mm Hg
  • Oxygen saturation 99% on room air

Client is a vegetarian and takes a multivitamin daily. Client reports having three to four alcoholic beverages a couple times per week. Skin color is consistent with genetic background. No rashes or lesions. The client has varicose veins. S1 S2 auscultated. No murmurs. All peripheral pulses 2+. Lung sounds clear bilaterally. Abdomen soft, nontender. Normoactive bowel sounds in all 4 quadrants. Last bowel movement was 3 days ago. Voids four to five times a day. Urine is clear, yellow, and odorless. Last menstrual period was 3 months ago. Alert and oriented to person, place, and time. Client takes diazepam as needed for anxiety. Client has full range of motion and is able to maintain flexion against resistance in all four extremities.

A nurse in a clinic is caring for a client.

Click to highlight the findings that require immediate follow-up as contraindications to the prescribed prescription. To deselect a finding click on the finding again.

 

Body System

Findings

Vital Signs/General History

  • Temperature 36.4° C (97.6° F), oral
  • Heart rate 75/min
  • Respiratory rate 16/min
  • Blood pressure 100/74mm Hg
  • Oxygen saturation 99% on room air
  • Client is a vegetarian and takes a multivitamin daily
  • Client reports having three to four alcoholic beverages a couple times per week

Integumentary

 

  • Skin color is consistent with genetic background. No rashes or lesions. The client varicose veins.

Cardiovascular/ Respiratory

  • S1 S2 auscultated. No murmurs. All peripheral pulses 2+ Lung sounds clear bilaterally

Gastrointestinal/Genitourinary

  • Abdomen soft, nontender. Normoactive bowel sounds in all 4 quadrants. Last bowel movement was 3 days ago. Voids four to five times a day. Urine is clear, yellow, and odourless. Last menstrual period was 3 months ago

Neurologic/Musculoskeletal

  • Alert and oriented to person, place, and time. Client takes diazepam as needed for anxiety. Client has full range of motion and is able to maintain flexion against resistance in all four extremities
Answer and Explanation

Explanation

  • Client reports having three to four alcoholic beverages a couple times per week. Phenytoin metabolism is significantly affected by alcohol consumption. Chronic alcohol use increases phenytoin clearance, leading to subtherapeutic drug levels and seizure breakthrough. Conversely, acute alcohol intake inhibits phenytoin metabolism, increasing the risk of toxicity. The client should be counseled to avoid alcohol while on phenytoin therapy.
  • Client takes diazepam as needed for anxiety. Diazepam is a CNS depressant that interacts with phenytoin, increasing sedation and the risk of respiratory depression. Both medications can cause drowsiness, dizziness, and impaired coordination, raising the risk of falls and injury. The provider should assess whether diazepam should be discontinued or adjusted when initiating phenytoin therapy.
  • Last menstrual period was 3 months ago. Phenytoin is Pregnancy Category D, meaning it poses a significant teratogenic risk, including fetal hydantoin syndrome. The missed menstrual period suggests a possible pregnancy, which must be evaluated before starting phenytoin. A pregnancy test should be performed, and alternative antiseizure medications may need to be considered if pregnancy is confirmed.
  • Client is a vegetarian and takes a multivitamin daily. Phenytoin interferes with the absorption of folic acid and vitamin D, both of which are crucial for bone health and red blood cell production. Vegetarians are already at higher risk for folate and vitamin B12 deficiency, making supplementation essential. However, multivitamins containing calcium, magnesium, or iron can decrease phenytoin absorption, reducing its effectiveness. The provider should review the multivitamin’s composition and adjust dosing schedules to prevent interactions.
  • Temperature 36.4°C (97.6°F), oral. The client’s temperature is within normal range and does not indicate infection or systemic concerns that would affect phenytoin therapy.
  • Heart rate 75/min, Respiratory rate 16/min, Blood pressure 100/74 mm Hg, Oxygen saturation 99% on room air.
    All vital signs are stable and do not indicate hemodynamic instability, respiratory depression, or cardiovascular issues that would contraindicate phenytoin administration.
  • Skin color is consistent with genetic background. No rashes or lesions. The client has varicose veins. There are no signs of drug hypersensitivity reactions or dermatologic conditions that would require stopping phenytoin therapy.
  • S1 S2 auscultated. No murmurs. All peripheral pulses 2+. Lung sounds clear bilaterally.
    There are no cardiopulmonary concerns that would indicate contraindications to phenytoin.
  • Abdomen soft, nontender. Normoactive bowel sounds in all 4 quadrants. Last bowel movement was 3 days ago. Voids four to five times a day. Urine is clear, yellow, and odorless. Mild constipation is noted, but this is not a contraindication for phenytoin. The client should be encouraged to increase fiber and fluid intake to prevent worsening constipation, which can sometimes be a side effect of phenytoin.
  • Alert and oriented to person, place, and time. Client has full range of motion and is able to maintain flexion against resistance in all four extremities. There are no neurological deficits requiring immediate intervention, and the client's baseline mental status is intact.

A
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Question 2:

1630:

Called to client's room by emergency call bell. Client is alert and oriented to person, place, and time. Client is short of breath, intercostal retractions visible. Wheezing auscultated throughout lung fields. Diffuse, raised rash present on trunk. Abdomen soft. nontender.

1400:

Client reports severe left ear pain that has been worsening for 3 days. Also reports sinus congestion and chills. No tonsillar enlargement or exudate. Lungs clear bilaterally, Left tympanic membrane erythematous and bulging. Past medical history significant for amoxicillin allergy.

1430:

Cefdinir 300 mg PO administered

1400:

Temperature 38.3° C (101° F)

Heart rate 90/min

Respiratory rate 20/min

Blood pressure 125/75 mm Hg

Oxygen saturation 97% on room air

 

1630:

Temperature 38.3°C (101°F)

Heart rate 110/min

Respiratory rate 30/min

Blood pressure 90/55 mm Hg

Oxygen saturation 91% on room air

A nurse in the emergency department is assisting in the care of a client.

Click to highlight the findings that require immediate follow-up. To deselect a finding click on the finding again.

Nurses Notes

1630:

Called to client's room by emergency call bell. Client is alert and oriented to person, place, and time. Client is short of breath, intercostal retractions visible. Wheezing auscultated throughout lung fields, Diffuse, raised rash present on trunk. Abdomen soft, nontender

Vital Signs

1630:

Temperature 38.3°C (101°F)

Heart rate 110/min

Respiratory rate 30/min

Blood pressure 90/55 mmHg

Oxygen saturation 91% on room air

Answer and Explanation

Explanation

  • Shortness of breath. The client is experiencing respiratory distress, which could indicate a severe allergic reaction (anaphylaxis). Immediate intervention is needed to prevent airway compromise and respiratory failure.
  • Intercostal retractions. Retractions occur when breathing is labored, suggesting airway obstruction or bronchoconstriction. This is a sign of worsening respiratory distress, requiring urgent medical attention.
  • Wheezing auscultated throughout lung fields. Wheezing suggests bronchospasm, which is common in anaphylaxis and asthma attacks. The presence of diffuse wheezing indicates that the airways are narrowing, making breathing more difficult.
  • Diffuse, raised rash present on trunk. A new-onset rash following antibiotic administration raises suspicion for anaphylaxis or a severe allergic reaction. Immediate treatment with antihistamines and corticosteroids may be required.
  • Respiratory rate 30/min. The increased respiratory rate indicates that the client is compensating for airway constriction and hypoxia. This is an early warning sign of impending respiratory failure if not treated promptly.
  • Blood pressure 90/55 mmHg. The drop in blood pressure suggests anaphylactic shock, where vasodilation and fluid leakage from capillaries lead to hypotension. Immediate administration of epinephrine is necessary to prevent cardiovascular collapse.
  • Oxygen saturation 91% on room air. A decrease in oxygen saturation indicates impaired gas exchange, likely due to airway swelling and bronchospasm. Supplemental oxygen therapy should be provided to prevent further desaturation.

A
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Question 3:

A nurse is preparing to administer medications to a client through an enteral feeding tube. Which of the following interventions is appropriate?

Answer and Explanation

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Question 4:

A nurse is collecting data from a client who reports nausea and has vomited clear emesis. Which of the following medications should the nurse administer?

Answer and Explanation

A
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Question 5:

A nurse is caring for a client who has ulcerative colitis and is receiving sulfasalazine. Which of the following findings requires immediate intervention?

Answer and Explanation

A
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Question 6:

A nurse in a clinic receives a telephone call from a client who has tuberculosis and was prescribed rifampin 3 days ago. The client reports, "My saliva and tears are red. What should I do?" Which of the following responses by the nurse is appropriate?

Answer and Explanation

A
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Question 7:

A nurse is collecting data from a client before administering a hepatitis B immunization. The nurse should withhold the immunization if the client is allergic to which of the following substances?

Answer and Explanation

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Question 8:

A nurse is collecting data from a client who received diphenhydramine 1 hr ago after developing an allergic reaction to trimethoprim- sulfamethoxazole. Which of the following statements by the client should indicate to the nurse that the medication is effective?

Answer and Explanation

A
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Question 9:

A nurse is collecting data from a client who has a new prescription for nitrofurantoin to treat a urinary tract infection. The nurse should monitor the client for which of the following adverse effects?

Answer and Explanation

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Question 10:

A nurse in a provider's office is collecting data from a client who continues to have a migraine headache after taking sumatriptan orally 2 hr ago. Which of the following findings is the priority for the nurse to report?

Answer and Explanation

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