Pharma Exam 2

The nurse determines that the client understands the correct administration of guaifenesin when the client states:

• A. I will take the medication with meals.

• B. I will take the tablet with a full glass of water.

• C. I will decrease my daily fluid intake while on this medication.

• D. I will take an extra dose if a fever develops.

Answer explanation

✅ Correct Answer: B. I will take the tablet with a full glass of water.

Rationale:
Guaifenesin is an expectorant that works best when taken with plenty of fluids to help thin and loosen mucus.

A: Taking with meals is not required.

C: Fluid intake should be increased, not decreased.

D: Taking extra doses is unsafe and should only be done under provider direction.

The nurse is administering albuterol to a client.
Which adverse effect should the nurse monitor for following administration of this medication?

• A. Increased heart rate

• B. Hyperkalemia

• C. Hyperglycemia

• D. Drowsiness

Answer explanation

✅ Correct Answer: A. Increased heart rate

Rationale:
Albuterol is a short-acting beta-2 adrenergic agonist (SABA) that may stimulate beta-1 receptors in the heart at higher doses, causing tachycardia, palpitations, and nervousness.

B. Hyperkalemia is incorrect — albuterol may actually lower potassium levels.

C. Hyperglycemia is not a common effect of albuterol.

D. Drowsiness is not expected; CNS stimulation (e.g., restlessness, tremors) is more typical.

A client is scheduled to receive acetylcysteine 20% solution diluted in 0.9% normal saline by nebulizer.
Which outcome should the nurse expect from the administration of this medication?

• A. Decreased wheezes

• B. Decreased coughing

• C. Bronchodilation

• D. Thinned secretions

Answer explanation

Correct Answer:
✅ D. Thinned secretions

Rationale:
Acetylcysteine is a mucolytic that breaks down mucus molecules, making secretions less thick and easier to expectorate.

It does not directly cause bronchodilation, suppress cough, or reduce wheezing.

Expectoration may increase temporarily due to thinner secretions becoming more mobile.

The nurse is monitoring a client who is taking metoprolol, a cardioselective beta-blocker.
Which finding indicates a potential adverse complication associated with this medication?

• A. Decrease in resting heart rate

• B. Complaint of nausea

• C. Audible expiratory wheezes

• D. Decrease in blood pressure

Answer explanation

Correct Answer:
✅ C. Audible expiratory wheezes

Rationale:
Although metoprolol is cardioselective (primarily affects β1 receptors in the heart), it can still affect β2 receptors in the lungs, especially at higher doses or in sensitive individuals.

Expiratory wheezes may indicate bronchospasm, an adverse effect that is especially concerning in clients with a history of asthma or COPD.

A decrease in heart rate and blood pressure are expected effects of metoprolol, not adverse complications.

Nausea is a mild, common side effect and not considered a significant complication.

A hypertensive client has been prescribed a clonidine hydrochloride transdermal patch. The nurse provides instructions on its proper use.
Which statement by the client indicates a need for further teaching?

• A. "I will apply the patch to a hairless body site."

• B. "I will apply the patch to the skin on the upper arm."

• C. "I will change the patch every 24 hours."

• D. "I will apply the patch to skin areas that are not broken."

Answer explanation

Correct Answer:
✅ C. "I will change the patch every 24 hours."

Rationale:
Clonidine patches are meant to be changed every 7 days, not daily.

Options A, B, and D reflect correct usage:

Apply to a hairless area to ensure good adhesion.

Upper arm is an acceptable site.

Avoid applying to broken or irritated skin.

A client statement about changing it daily indicates misunderstanding and requires clarification.

A client is seen in the clinic complaining of anorexia and nausea. The healthcare provider suspects digoxin toxicity. While waiting for test results, the nurse should assess the client for which additional signs or symptoms that support this diagnosis?

• A. Edema

• B. Anorexia

• C. Weakness

• D. Photophobia

• E. Constipation

Answer explanation

✅ Correct Answers:
B. Anorexia

C. Weakness

D. Photophobia

🔍 Rationale :
Digoxin toxicity presents with:

Gastrointestinal: anorexia, nausea, vomiting

Neurological: weakness, fatigue, confusion

Visual: blurred vision, photophobia, yellow-green halos, or scotomas

The nurse is reviewing clients prescribed lisinopril, an ACE inhibitor. Which client condition should be the priority for the nurse to assess first?

• A. 64-year-old complaining of insomnia

• B. 32-year-old with swelling of the tongue

• C. 53-year-old with new nausea

• D. 82-year-old with new dry cough

Answer explanation

✅ Correct Answer: B. 32-year-old with swelling of the tongue

🧠 Rationale:
Lisinopril, an ACE inhibitor, can cause angioedema, a potentially fatal reaction characterized by swelling of the tongue, lips, or airway. This client is showing signs of a life-threatening complication that can rapidly compromise the airway. Immediate assessment and intervention are necessary.

A nurse is reviewing the health history of a client newly prescribed ipratropium bromide (Atrovent). Which of the following findings should the nurse report to the healthcare provider?

• A. History of asthma

• B. History of glaucoma

• C. History of seasonal allergies

• D. History of hypertension

Answer explanation

Rationale:

Ipratropium is an anticholinergic that may increase intraocular pressure, worsening glaucoma. It should be used cautiously or avoided in patients with narrow-angle glaucoma.

A client with asthma is prescribed theophylline. Which of the following findings in the patient’s history is most concerning?

• A. Type 2 diabetes

• B. Hypothyroidism

• C. Seizure disorder

• D. Iron-deficiency anemia

Answer explanation

Rationale:

Theophylline has a narrow therapeutic index and can lower the seizure threshold, increasing the risk of seizures. Notify the provider before administration.

Which of the following patient statements indicates a need for further teaching about the use of montelukast (Singulair)?

• A. “I take this medication every night, even if I don’t have symptoms.”

• B. “This medication is used to stop asthma attacks.”

• C. “I’ll tell my provider if I feel sad or have trouble sleeping.”

• D. “I take this on an empty stomach.”

Answer explanation

Rationale:

Montelukast is not a rescue medication. It is for long-term management and prevention of asthma symptoms, not for acute attacks.