Test Bank For Abrams’ Clinical Drug Therapy Rationales for Nursing Practice 12th Edition Geralyn by ACADEMIAMILL

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Test Bank For Abrams’ Clinical Drug Therapy Rationales for Nursing Practice 12th Edition Geralyn Frandsen - ISBN/ISSN 9781975136130

Table of Content SECTION 1 The Conceptual Framework of Pharmacology Chapter 1 The Foundation of Pharmacology: Quality and Safety Chapter 2 Basic Concepts and Processes Chapter 3 Medication Administration and the Nursing Process of Drug Therapy

SECTION 2 Drug Therapy Throughout the Lifespan Chapter 4 Pharmacology and the Care of Infants and Pediatric Patients Medication Administration in Pediatrics Chapter 5 Pharmacology and the Care of Adults and Geriatric Patients Chapter 6 Pharmacology and the Care of Pregnant or Lactating Woman Chapter 7 Pharmacology and Women’s Health Chapter 8 Pharmacology and Men’s Health

SECTION 3 Drugs Affecting the Hematopoietic and Immune Systems Chapter 9 Drug Therapy for Coagulation Disorders Chapter 10 Drug Therapy for Dyslipidemia Chapter 11 Drug Therapy for Hematopoietic Disorders Chapter 12 Drug Therapy: Immunizations Chapter 13 Drug Therapy to Decrease Immunity Chapter 14 Drug Therapy for the Treatment of Cancer

SECTION 4 Drugs Affecting Inflammation and Infection Chapter 15 Inflammation, Infection, and the Use of Antimicrobial Agents Chapter 16 Drug Therapy to Decrease Pain, Fever, and Inflammation Chapter 17 Drug Therapy With Corticosteroids Chapter 18 Drug Therapy With Beta-Lactam Antibacterial Agents Chapter 19 Drug Therapy With Aminoglycosides and Fluoroquinolones Chapter 20 Drug Therapy With Tetracyclines, Sulfonamides, and Urinary Antiseptics Chapter 21 Drug Therapy With Macrolides and Miscellaneous Anti-infective Agents Chapter 22 Drug Therapy for Tuberculosis and Mycobacterium avium Complex Disease Chapter 23 Drug Therapy for Viral Infections Chapter 24 Drug Therapy for Fungal Infections Chapter 25 Drug Therapy for Parasitic Infections

SECTION 5 Drugs Affecting the Cardiovascular System Chapter 26 Drug Therapy for Hypertension Chapter 27 Drug Therapy for Dysrhythmias Chapter 28 Drug Therapy for Coronary Heart Disease Chapter 29 Drug Therapy for Shock and Hypotension Chapter 30 Drug Therapy for Heart Failure

SECTION 6 Drugs Affecting the Respiratory System Chapter 31 Drug Therapy for Nasal Congestion and Cough Chapter 32 Drug Therapy to Decrease Histamine Effects and Allergic Response Chapter 33 Drug Therapy for Asthma and Bronchoconstriction

SECTION 7 Drugs Affecting the Renal and Digestive Systems Chapter 34 Drug Therapy for Fluid Volume Excess Chapter 35 Nutritional Support Products, Vitamins, and Mineral Supplements Chapter 36 Drug Therapy for Weight Management Chapter 37 Drug Therapy for Peptic Ulcer Disease and Hyperacidity Chapter 38 Drug Therapy for Nausea and Vomiting Chapter 39 Drug Therapy for Constipation and Elimination Problems Chapter 40 Drug Therapy for Diarrhea

SECTION 8 Drugs Affecting the Endocrine System Chapter 41 Drug Therapy for Diabetes Mellitus Chapter 42 Drug Therapy for Hyperthyroidism and Hypothyroidism Chapter 43 Drug Therapy for Pituitary and Hypothalamic Dysfunction Chapter 44 Drug Therapy to Regulate Calcium and Bone Metabolism Chapter 45 Drug Therapy for Addison’s Disease and Cushing’s Disease

Section 9 Drugs Affecting the Autonomic and Central Nervous System Chapter 46 Physiology of the Autonomic and Central Nervous Systems and Indications for the Use of Drug Therapy Chapter 47 Drug Therapy for Myasthenia Gravis, Alzheimer’s Disease, and Urinary Retention Chapter 48 Drug Therapy for Parkinson’s Disease, Urinary Spasticity, and Disorders Requiring Anticholinergic Drug Therapy Chapter 49 Drug Therapy With Opioids Chapter 50 Drug Therapy With Local Anesthetics

Chapter 51 Drug Therapy With General Anesthetics Chapter 52 Drug Therapy for Migraines and Other Headaches Chapter 53 Drug Therapy for Seizure Disorders and Spasticity Chapter 54 Drug Therapy for Anxiety and Insomnia Chapter 55 Drug Therapy for Depression and Mood Stabilization Chapter 56 Drug Therapy for Psychotic Disorders Chapter 57 Drug Therapy for Attention Deficit Hyperactivity Disorder and Narcolepsy Chapter 58 Drug Therapy for Substance Abuse Disorders

Section 10 Drugs Affecting the Eye, Ear, and Skin Chapter 59 Drug Therapy for Disorders of the Eye Chapter 60 Drug Therapy for Disorders of the Ear Chapter 61 Drug Therapy for Disorders of the Skin

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Chapter 1, The Foundation of Pharmacology: Quality and Safety 1. A woman diagnosed with obsessive–compulsive disorder has been prescribed oral paroxetine hydrochloride. What is the expected effect for this prescription? A. Curative effect on symptoms B. Systemic effect on symptoms C. Local effect on symptoms D. Parenteral effect on symptoms

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ANS: B Rationale: Drugs that produce systemic effects are taken into the body, circulated through the bloodstream to their sites of action in various body tissues, and eventually eliminated from the body. Curative agents are given to cure a disease process. In this case, paroxetine hydrochloride will control the symptoms but not cure the disorder. Drugs with local effects, such as sunscreen and local anesthetics, act mainly at the site of application. Paroxetine hydrochloride is not administered parenterally. Parenteral agents are administered subcutaneously, intramuscularly, or intravenously. PTS: 1 REF: p. 3, Introduction OBJ: 1 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 1: The Foundation of Pharmacology: Quality and Safety KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 2. A client has been prescribed an antibiotic. This medication is a naturally occurring substance that has been cheG mR icAalDlyEm haOt M is another name for this type of SoBdOifOieSd.TW .C medication? A. Synthetic drug B. Semisynthetic drug C. Biotechnology drug D. Prototype drug ANS: B Rationale: Semisynthetic drugs (e.g., many antibiotics) are naturally occurring substances that have been chemically modified. Synthetic drugs are more standardized in their chemical characteristics, more consistent in their effects, and less likely to produce allergic reactions. Biotechnology drugs involve manipulating DNA and RNA and recombining genes into hybrid molecules that can be inserted into living organisms. Prototype drugs are the first drug of a particular group to be developed. PTS: 1 REF: p. 3, Drug Sources OBJ: 1 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 1: The Foundation of Pharmacology: Quality and Safety KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 3. Which classification applies to morphine? A. Central nervous system depressant B. Central nervous system stimulant

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C. Anti-inflammatory D. Antihypertensive ANS: A Rationale: Drugs are classified according to their effects on particular body systems, their therapeutic uses, and their chemical characteristics. Morphine is classified as a central nervous system depressant and will produce this effect in the client. A central nervous system stimulant increases attention and raises mood. An anti-inflammatory agent decreases inflammation at the site of tissue or joint inflammation. An antihypertensive agent reduces blood pressure.

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PTS: 1 REF: p. 3, Drug Classifications and Prototypes OBJ: 1 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 1: The Foundation of Pharmacology: Quality and Safety KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Remember NOT: Multiple Choice 4. A client is administered amoxicillin. The generic name of this medication belongs to which drug group? A. Selective serotonin reuptake inhibitors B. Diuretics C. Penicillins D. ACE inhibitors ANS: C Rationale: The generic namG eR ofAteDnEinSdBicOaO teS s th eC drOuM g group (e.g., drugs with generic names T. ending in “cillin” are penicillins). Selective serotonin reuptake inhibitors are medications that have antidepressant effects; SSRI is a broad classification, not a generic name. Diuretics are medications that increase urine output; diuretic is a broad classification, not a generic name. ACE inhibitor is the broad classification for the angiotensin receptor blockers, not the generic name. PTS: 1 REF: p. 3, Drug Names OBJ: 2 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 1: The Foundation of Pharmacology: Quality and Safety KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 5. The administration of diphenhydramine is regulated by which U.S. government agency? A. Public Health Service B. Federal Trade Commission C. Occupational Safety and Health Administration D. Food and Drug Administration ANS: D

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Rationale: The Food and Drug Administration approves drugs for over-the-counter availability, including the transfer of drugs from prescription to OTC status, and may require clinical trials to determine the safety and effectiveness of OTC use. The Public Health Service is regulated by the state to maintain the health of individual citizens of the state. The Federal Trade Commission regulates imports and exports throughout the nation. The Occupational Safety and Health Administration regulates safety within the workplace.

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PTS: 1 REF: p. 4, Prescription and Nonprescription Drugs OBJ: 4 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 1: The Foundation of Pharmacology: Quality and Safety KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 6. In the U.S., the administration of anabolic steroids is regulated by which law? A. The Food, Drug, and Cosmetic Act of 1938 B. The Comprehensive Drug Abuse Prevention and Control Act C. The Harrison Narcotic Act D. The Sherley Amendment ANS: B Rationale: The Comprehensive Drug Abuse Prevention and Control Act regulates the manufacture and distribution of narcotics, stimulants, depressants, hallucinogens, and anabolic steroids. The Food, Drug, and Cosmetic Act of 1938 revised and broadened FDA powers and responsibilities, giving the FDA control over drug safety. The Harrison Narcotic Act restricted the importation, manufacture, sale, and use of opium, cocaine, marijuana, and Th.eCSOhM other drugs that the act defiG neRdAaD sE naSrcBoO tiO csS .T erley Amendment of 1912 prohibited fraudulent claims of drug effectiveness. PTS: 1 REF: p. 4, Prescription and Nonprescription Drugs OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 1: The Foundation of Pharmacology: Quality and Safety KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Remember NOT: Multiple Choice 7. A nurse is responsible for maintaining an accurate count and record of the controlled substances on the nursing division. This nursing action is regulated by which U.S. law or agency? A. The Food, Drug, and Cosmetic Act of 1938 B. The Public Health Service C. The Drug Enforcement Administration D. The Sherley Amendment ANS: C

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Rationale: The Drug Enforcement Administration enforces the Controlled Substances Act. Under this enforcement, nurses are responsible for storing controlled substances in locked containers, administering them only to the people for whom they are prescribed, recording each dose given, and maintaining an accurate inventory. The Food, Drug, and Cosmetic Act of 1938 revised and broadened FDA powers and responsibilities, giving the FDA control over drug safety. The Public Health Service is regulated by the state to maintain the health of individual citizens of the state. The Sherley Amendment of 1912 prohibited fraudulent claims of drug effectiveness.

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PTS: 1 REF: p. 7, Testing Procedure OBJ: 4 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 1: The Foundation of Pharmacology: Quality and Safety KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 8. In Phase 1 clinical trials, the potential uses and effects of a new drug are determined by which method? A. Administering doses to healthy volunteers B. Administering doses to people with the disease C. Administering in placebo-controlled design D. Calculating the risk-to-benefit ratio ANS: A Rationale: Phase 1 studies allow for the administration of the medication to healthy volunteers to determine safe dosages, routes of administration, absorption, metabolism, excretion, and toxicity. In Phase 2 studies, a few doses are given to a certain number of ApDtoEmSB subjects with the disease orGsR ym foOr O wS hiT ch.C thO eM drug is being studied and responses are compared with those of healthy subjects. Placebo-controlled designs are used in Phase 3 studies, in which half of the subjects receive the new drug and half receive the placebo. Calculating the risk-to-benefit ratio is used in Phase 2 studies to determine whether the potential benefits of the drug outweigh the risks. PTS: 1 REF: p. 7, Testing Procedure OBJ: 5 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 1: The Foundation of Pharmacology: Quality and Safety KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 9. A new medication for the treatment of Alzheimer’s disease is being administered to a group of subjects with the disease. The subjects receiving this medication are unaware of whether they are being administered the medication or a placebo. This testing occurs in which phase? A. Phase 1 B. Phase 2 C. Phase 3 D. Phase 4 ANS: C

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Rationale: In Phase 3, the drug is given to a larger and more representative group of subjects. In double-blind, placebo-controlled designs, half of the subjects receive the new drug and half receive a placebo (an inactive substance similar in appearance to the actual drug), with neither subjects nor researchers knowing which subjects receive which formulation. In Phase 1, a few doses are given to a certain number of healthy volunteers to determine safe dosages, routes of administration, absorption, metabolism, excretion, and toxicity. In Phase 2, a few doses are given to a certain number of subjects with the disease or symptom for which the drug is being studied and responses are compared with those of healthy subjects. In Phase 4, the FDA evaluates the data from the first three phases for drug safety and effectiveness, allows the drug to be marketed for general use, and requires manufacturers to continue monitoring the drug’s effects.

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PTS: 1 REF: p. 7, Testing Procedure OBJ: 5 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 1: The Foundation of Pharmacology: Quality and Safety KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 10. Which organization is responsible for approving new drugs in the United States? A. The American Medical Association (AMA) B. The American Pharmaceutical Association (APA) C. The Food and Drug Administration (FDA) D. The U.S. Pharmacopeia ANS: C Rationale: The Food and Drug Administration is responsible for approving new drugs in the United States. The AmericaGnRMAeD dE icS alBAOsO soS ciTat.ioCnOrM epresents the health care providers of the United States. The American Pharmaceutical Association represents the pharmacists of the United States. The U.S. Pharmacopeia was adopted in 1906 and is issued every 5 years under the supervision of a national committee of pharmacists, scientists, and health care providers to provide information concerning drug purity and strength. PTS: 1 REF: p. 7, Testing Procedure OBJ: 3 NAT: Client Needs: Safe and Effective Care Environment: Management of Care TOP: Chapter: 1: The Foundation of Pharmacology: Quality and Safety KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Remember NOT: Multiple Choice 11. A client with a long-standing dermatologic health problem has been advised to use a drug with a local effect. The nurse should recognize what characteristic of this drug? A. It affects only the organ system in which it is metabolized. B. The drug requires application at multiple sites. C. It is effective only as long as it is in contact with skin. D. The drug acts primarily at the site where it is applied. ANS: D

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Rationale: Drugs with local effects, such as sunscreen lotions and local anesthetics, act mainly at the site of application. Those with systemic effects are taken into the body, circulated through the bloodstream to their sites of action in various body tissues, and eventually eliminated from the body. A drug with local effect does not necessarily have to be applied at multiple sites, and its action may affect tissues long after contact.

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PTS: 1 REF: p. 3, Introduction OBJ: 1 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 1: The Foundation of Pharmacology: Quality and Safety KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice 12. What is the primary importance of a black box warning? A. It will result in the medication being removed from the market. B. It acknowledges that the medication has been tested on only a selected portion of the population. C. It suggests that the prescription of the medication be avoided when treating certain populations. D. It alerts health care professionals of the potential of serious adverse effects associated with the medication. ANS: D Rationale: Black box warnings identify the fact that a drug can cause serious adverse effects. Subsequent withdrawal of approved and marketed drugs has occurred, usually because of serious adverse effects that become evident only when the drugs are used in a large, diverse population. The warning does not address testing or target populations.

GRADESBOOST.COM PTS: 1 REF: p. 7, Testing Procedure OBJ: 4 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 1: The Foundation of Pharmacology: Quality and Safety KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice 13. A health care facility is complying with the mandates of U.S. The Drug Enforcement Administration (DEA) concerning Schedule II medications when implementing which nursing intervention? Select all that apply. A. Access to narcotics is controlled by key or codes. B. Narcotics are administered by prescriptions only. C. Only selected narcotics may be automatically renewed. D. The administration of individual narcotic doses is recorded in specific unit documentation. E. Any recognized discrepancy involving a narcotic must be reported to the appropriate facility authority. ANS: A, B, D, E Rationale: Nurses are responsible for storing controlled substances in locked containers, administering them only to the people for whom they are prescribed, recording each dose given on agency narcotic sheets and on the client’s medication administration record, maintaining an accurate inventory, and reporting discrepancies to the proper authorities. Prescriptions for Schedule II drugs cannot be refilled; a new prescription is required.

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14. Which medication reference is considered to be an authoritative, well-respected source of information? Select all that apply. A. American Hospital Formulary Service B. Drug Facts and Comparisons C. Physicians’ Desk Reference D. Lippincott’s Nursing Drug Guide E. Package inserts provided with each medication ANS: A, B Rationale: An authoritative source is a work known to be reliable because its authority or authenticity is widely recognized by experts in the field. Both the American Hospital Formulary Service and the Drug Facts and Comparisons are authoritative sources of drug information that have been recognized as reliable sources of medication information. The Physicians’ Desk Reference is published yearly and contains manufacturers’ published inserts for selected drugs. The package inserts are produced by the drug manufacturers and do not necessarily contain the details included in the correct options. Lippincott’s Nursing Drug Guide is an example of a drug handbook, not a compilation of manufacturers’ inserts and intended as a student resource. PTS: 1 REF:GRpA . 1D1E, S SoBuOrcOeS s oTf.DCrO ugMInformation OBJ: 7 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 1: The Foundation of Pharmacology: Quality and Safety KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Select 15. A nursing student in a pharmacology class should be encouraged to study the medications according to which categorization? Select all that apply. A. Prototype B. Controlled substance C. Drug use D. Generic names E. Therapeutic classification ANS: A, E Rationale: The nursing student should concentrate on therapeutic classifications and their prototypes. Controlled substances limit the medications studied to one broad classification. Drug use is only one part of the broad classification. Generic names are only one aspect of the medication. PTS: 1 REF: p. 12, Strategies for Studying Pharmacology OBJ: 6 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 1: The Foundation of Pharmacology: Quality and Safety

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KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Select 16. A client diagnosed with an autoimmune disorder has just been prescribed a synthetic drug. Which characteristic is a noted advantage of synthetic drugs? A. The client is at a lesser risk for an allergic reaction. B. The client will require less frequent dosing. C. The medication will be available on an over-the-counter basis. D. The medication is available in a wider variety of administration routes.

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ANS: A Rationale: Synthetic drugs are more standardized in their chemical characteristics, more consistent in their effects, and less likely to produce allergic reactions. They do not necessarily require less frequent dosing and may or may not be available OTC. They are not noted to be available in a wider variety of administration routes than naturally occurring substances. PTS: 1 REF: p. 3, Drug Sources OBJ: 1 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 1: The Foundation of Pharmacology: Quality and Safety KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 17. A client is confused and has stated to the nurse, “I wasn’t sure whether I’m supposed to take Tylenol or acetaminophen.” To best address the client’s concern, the nurse should base the response on what information concerning generic and trade names? CeOsMin their recommendations and A. Prescribers should referGsR olAelDyEtoSgBeO neOrS icTn. am written prescriptions. B. A generic name is independent of any particular drug manufacturer. C. Generic names change frequently, but trade names are more consistent. D. Prescribers should refer solely to trade names in their recommendations and written prescriptions. ANS: B Rationale: A generic name is related to the chemical or official name and is independent of the manufacturer. Drugs may be prescribed and dispensed by generic or trade name. Generic names do not change, while trade names vary according to time and place. PTS: 1 REF: p. 3, Drug Names OBJ: 2 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 1: The Foundation of Pharmacology: Quality and Safety KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice 18. What is the primary purpose of American drug laws? A. To ensure maximum choice for consumers B. To expedite the workload of health care providers C. To protect the safety of the public D. To enhance the efficient delivery of health care

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ANS: C Rationale: The main goal of drug laws is to protect the public by ensuring that drugs marketed for therapeutic purposes are safe and effective. Efficiency and choice are valid considerations, but neither is the primary goal of American drug legislation. Workload is expedited when delivery of health care is efficient.

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PTS: 1 REF: p. 4, Prescription and Nonprescription Drugs OBJ: 3 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 1: The Foundation of Pharmacology: Quality and Safety KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice 19. A nurse who provides care on a postsurgical unit frequently administers Schedule II drugs to clients. Which aspect of administering these drugs falls under the auspices of the U.S. Drug Enforcement Administration? A. Performing a thorough client assessment prior to administration B. Recording each dose administration on an agency narcotic sheet C. Informing clients of the potential risks and benefits of such drugs prior to the first dose D. Assessing the client shortly after administration to ensure existence of the expected therapeutic effect ANS: B Rationale: Nurses are responsible for storing controlled substances in locked containers, administering them only to people for whom they are prescribed, recording each dose given on agency narcotic sheets aG ndRoAnDtE heScBliO enOt’Ss Tm.eC diO caMtion administration record, maintaining an accurate inventory, and reporting discrepancies to the proper authorities. The other given actions are appropriate nursing activities, but they are not within the scope of the DEA authority. PTS: 1 REF: p. 7, Testing Procedure OBJ: 5 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 1: The Foundation of Pharmacology: Quality and Safety KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze NOT: Multiple Choice 20. Trials of a new drug are scheduled to begin soon. The testing methodology will integrate the stipulations of the National Institutes of Health (NIH) Revitalization Act. According to this act, the manufacturer must address which requirement? A. Independently fund the entire testing process. B. Make the results of the testing process publicly available. C. Include women and minorities in the testing process. D. Exclude any potential for financial gain during the testing process. ANS: C

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Rationale: In 1993, the United States Congress passed the National Institutes of Health (NIH) Revitalization Act, which formalized a policy of the NIH that women and minorities be included in human subject research studies funded by the NIH and that women and minorities be included in clinical drug trials. This act does not specifically address the financial structure of testing or the accessibility of information.

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GRADESBOOST.COM PTS: 1 REF: p. 8, Rights of Medication Administration OBJ: 4 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 1: The Foundation of Pharmacology: Quality and Safety KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Remember NOT: Multiple Select 22. A client’s current medication administration record includes a drug that the nurse recognizes as an Institute for Safe Medication Practices (ISMP) high-alert medication. This designation signals the nurse to what characteristic of the drug? A. It can only be administered by a health care provider or advanced practice nurse. B. Administration must be cosigned by a second registered nurse or practical/vocational nurse. C. It is currently undergoing Phase 4 testing and is pending full FDA approval. D. Administration errors carry a heightened risk of causing significant client harm. ANS: D Rationale: The Institute for Safe Medication Practices (ISMP) identifies drugs that when used in error have a heightened risk of causing significant client harm. Such drugs are not limited to health care provider or advanced practice nurse administration. The drug would have completed the testing and approval procedure, and administration does not necessarily require a cosignature.

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PTS: 1 REF: p. 9, High-Alert Medications OBJ: 5 NAT: Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies TOP: Chapter: 1: The Foundation of Pharmacology: Quality and Safety KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand NOT: Multiple Choice

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Ch. 2

1. Which cellular structure stores hormones and other substances and packages these substances into secretory granules? A) Golgi apparatus B) Endoplasmic reticulum C) Mitochondria D) Lysosome Ans: A Feedback: The golgi apparatus stores hormones and other substances. The endoplasmic reticulum contains ribosomes, which synthesize proteins, including enzymes that synthesize glycogen, triglycerides, and steroids and those that metabolize drugs and other chemicals. The mitochondria generate energy for cellular activities and require oxygen. Lysosomes are membrane-enclosed vesicles that contain enzymes capable of digesting nutrients (proteins, carbohydrates, fats), damaged cellular structures, foreign substances (bacteria), and the cell itself.

2. A patient is suffering from a cough associated with an upper respiratory infection. Which oral medication will likely produce the most therapeutic effect? A) A tablet B) An expectorant C) A topical spray D) A timed-release tablet Ans: B Feedback: Liquid medications are absorbed faster than tablets or capsules. Expectorants are liquid medications. A tablet is an oral medication that has a slower onset of action than a liquid medication. A topical spray can be sprayed to the back of the throat and provides only a local effect. A timed-release tablet is an oral medication that has a slower onset and longer duration of action.

3. A patient is administered an oral contraceptive. Which of the following is the process that occurs between the time the drug enters the body and the time that it enters the bloodstream? A) Absorption B) Distribution C) Metabolism D) Excretion Ans: A Feedback: Absorption is the process that occurs from the time the drug enters the body to the time it enters the bloodstream to be circulated. Distribution involves the transport of drug molecules within the body. Metabolism is the method by which drugs are inactivated or biotransformed by the body. Excretion refers to elimination of a drug from the body.

4. Which of the following sites of drug absorption is considered to have an exceptionally large surface area for drug absorption? A) Rectum B) Fundus of the stomach C) Esophagus D) Lungs Ans: D Feedback: The lungs have a large surface area for absorption of anesthetic gases and a few other drugs. The rectum absorbs the medication through the mucous membranes and has a smaller surface area than the lungs. The fundus and esophagus have comparatively small surface areas.

5. A nurse is aware of the importance of adhering to the intended route of a medication. Which of the following drugs are formulated to be absorbed through the skin? A) Amoxicillin, tetracycline, and penicillin B) Clonidine, fentanyl, and nitroglycerin C) Digoxin, lidocaine, and propranolol D) Insulin, heparin, and morphine Ans: B Feedback: Some drugs are formulated in adhesive skin patches for absorption through the skin. Clonidine, fentanyl, and nitroglycerin are examples of drugs that are formulated in adhesive skin patch form to be absorbed through the skin. Amoxicillin, tetracycline, and penicillin are administered orally. Digoxin and propranolol are administered orally, and lidocaine can be administered intravenously, subcutaneously, or topically. Insulin and heparin are administered intravenously and subcutaneously. Morphine is administered orally, intramuscularly, and intravenously.

6. An 85-year-old patient has an elevated serum creatinine level, indicating impaired kidney function. When the patient is administered a medication, this patient is at risk for which of the following medication-related effects? A) Toxicity B) Increased absorption C) Delayed gastric emptying D) Idiosyncratic effects Ans: A Feedback: An elevated creatinine level is indicative of diminished kidney function, which will result in serum drug toxicity. The creatinine level indicates kidney function, does not affect absorption, and has no effect on gastric emptying.

7. Protein binding is an important aspect of pharmacokinetics. Protein binding ultimately has which of the following effects on drug action? A) Increases the drug's speed of action B) Decreases the drug's speed of action C) Increases the rate of excretion D) Averts adverse effects Ans: B Feedback: Protein binding allows part of a drug to be stored and released as needed. Drugs that are highly bound to plasma proteins or stored extensively in other tissues have a long duration of action. Protein binding does not increase the speed of action, increase the excretion rate, or avert adverse effects. Protein binding decreases the speed of action by storing the drug to be released when needed.

8. A patient is taking a medication that is metabolized by the CYP enzymes. Which of the following medications inhibits several of the CYP enzymes? A) Cisplatin B) Acebutolol hydrochloride C) Cimetidine D) Dicloxacillin sodium Ans: C Feedback: Cimetidine is a gastric acid suppressor that inhibits several CYP enzymes and can greatly decrease drug metabolism. The other listed drugs do not have this specific effect.

9. A nurse is aware that the dosing scheduling of a patient's new medication takes into account the serum half-life of the drug. What is the serum half-life of a medication? A) The time required for IV medications to penetrate the brain tissue B) The time needed for the serum level to fall by 50% C) The safest margin to prevent toxicity D) The dose adjustment that reduces the risk of adverse effects by one half Ans: B Feedback: Serum half-life is the time required for the serum concentration of a drug to decrease by 50%. Although many IV medications penetrate the brain tissue, this action does not describe the half-life. The safest margin to prevent toxicity depends on the rate of metabolism and excretion. The half-life of the medication does not relate directly to a specific reduction in adverse effects.

10. A patient has increased intracranial pressure and is ordered to receive a diuretic. Which of the following diuretics does not act on receptor sites to produce diuresis? A) Furosemide (Lasix) B) Hydrochlorothiazide (HCTZ)

C) D) Ans:

Spironolactone (Aldactone) Mannitol (Osmitrol) D Feedback: Mannitol (Osmitrol) is an osmotic diuretic that increases the osmolarity of plasma and pulls water out of the tissues into the bloodstream. It does not act on receptor sites. Furosemide (Lasix) is a loop diuretic that inhibits the reabsorption of sodium and chloride in the loop of Henle. Hydrochlorothiazide is associated with drug interference with absorption of sodium ions across the distal renal tubule. Spironolactone acts by competing with aldosterone for cellular receptor sites.

11. A patient older than 65 years is more likely to experience drug reaction than a much younger patient. Which of the following factors accounts for this variation? A) Drugs more readily crossing the bloodñbrain barrier in older people B) Age-related physiologic changes C) Increased drug-metabolizing enzymes in older people D) Diminished immune response Ans: B Feedback: In older adults (65 years and older), physiologic changes may alter all pharmacokinetic processes. Although drugs crossing the bloodñbrain barrier affect drug reaction, this factor is important in all ages. Increased drug-metabolizing enzymes are key in all ages and do not relate to age variations. A diminished immune response is important in all ages and does not affect all medications.

12. A patient who is 6 feet tall and weighs 280 pounds will require which of the following doses? A) Higher dose than a patient who weighs 180 pounds B) Lower dose than a patient who weighs 180 pounds C) Same dose as a patient who weighs 180 pounds D) A parenteral rather than oral dose Ans: A Feedback: In general, people heavier than average may need larger doses, provided their renal, hepatic, and cardiovascular functions are adequate.

13. A nurse has provided an oral dose of morphine, an opioid agonist, to a woman in early labor. The nurse should be aware of what characteristic of agonists? A) Agonists alter the normal processes of distribution and metabolism. B) Agonists counteract the action of specific neurotransmitters. C) Agonists block the action of specific neurotransmitters. D) Agonists bind to receptors and cause a physiological effect. Ans: D

Feedback: Agonists are drugs that produce effects similar to those produced by naturally occurring hormones, neurotransmitters, and other substances by activating (not blocking or counteracting) a receptor. Classification of a drug as an agonist does not denote a change to metabolism or distribution.

14. A nurse is preparing to simultaneously administer two drugs to a patient. The nurse knows that the drugs have been ordered to be given together because of their synergistic effect. This means that A) the adverse effects of one of the drugs are nullified by the other drug. B) the combined effects are greater than the effects of either one of the drugs alone. C) one of the drugs enhances metabolism, while the other drug enhances either distribution or absorption. D) both drugs are toxic in isolation but therapeutic when administered together. Ans: B Feedback: Synergism occurs when two drugs with different sites or mechanisms of action produce greater effects when taken together. This does not mean that potential toxicity or adverse effects are ìcanceled out.î The two drugs would not individually affect different aspects of pharmacokinetics.

15. A patient has been brought to the emergency department by ambulance, and his friend states that he has overdosed on methadone, a long-acting opioid. The care team is preparing to administer the appropriate antidote, naloxone, which has a shorter half-life than methadone. What are the implications of this aspect of pharmacokinetics? A) Repeated doses of naloxone will likely be necessary. B) A different antidote will be required after the serum level of naloxone decreases. C) An increased dose of naloxone will be required. D) The antidote is unlikely to have a therapeutic effect on the patient's symptoms. Ans: A Feedback: When an antidote is used, its half-life relative to the toxin's half-life must be considered. For example, the half-life of naloxone, a narcotic antagonist, is relatively short compared with the half-life of the longer-acting opioids such as methadone, and repeated doses may be needed to prevent recurrence of the toxic state.

16. A patient tells the nurse, ìI took my sleeping pill yesterday evening, but it didn't seem to work for me like it usually does.î The nurse should consider which of the following variables that can affect drug absorption? Select all that apply. A) GI function B) Blood flow to the site of administration C) The presence of other drugs

D) E) Ans:

Route of administration The presence of receptor agonists A, B, C, D Feedback: Numerous factors affect the rate and extent of drug absorption, including dosage form, route of administration, blood flow to the site of administration, GI function, the presence of food or other drugs, and other variables. Agonist activity is a relevant variable, but this is not an aspect of absorption.

17. A nurse has administered a dose of a drug that is known to be highly protein bound. What are the implications of this characteristic? A) The patient must consume adequate protein in order to achieve a therapeutic effect. B) The molecules of the drug that are bound to protein are inactive. C) Increased levels of serum protein will increase the effect of the drug. D) Each molecule of the drug must bind to a protein molecule to become effective. Ans: B Feedback: Drug molecules bound to plasma proteins are pharmacologically inactive because the large size of the complex prevents their leaving the bloodstream through the small openings in capillary walls and reaching their sites of action, metabolism, and excretion. Only the free or unbound portion of a drug acts on body cells. The patient's protein intake or levels of protein are not normally relevant.

18. A patient requires a high dose of his new antihypertensive medication because the new medication has a significant first-pass effect. This means that the drug A) must pass through the patient's bloodstream several times to generate a therapeutic effect. B) passes through the renal tubules and is excreted in large amounts. C) is extensively metabolized in the patient's liver. D) is ineffective following the first dose and increasingly effective with each subsequent dose. Ans: C Feedback: Some drugs are extensively metabolized in the liver, with only part of a drug dose reaching the systemic circulation for distribution to sites of action. This is called the first-pass effect or presystemic metabolism. The first-pass effect is not related to renal function or the need to pass through the bloodstream multiple times.

19. A patient with a diagnosis of bipolar disorder has begun lithium therapy, and the nurse has explained the need for regular monitoring of the patient's serum drug levels. What is the primary rationale for the nurse's instruction? A) It is necessary to regularly test for bloodñdrug incompatibilities that may develop

B) C) D) Ans:

during treatment. It is necessary to ensure that the patient's drug levels are therapeutic but not toxic. It is needed to determine if additional medications will be needed to potentiate the effects of lithium. It is needed in order to confirm the patient's adherence to the drug regimen. B Feedback: Measuring serum drug levels is useful when drugs with a narrow margin of safety are given, because their therapeutic doses are close to their toxic doses. This is the case during lithium therapy. Serum levels are not commonly taken to monitor adherence to treatment. Bloodñdrug incompatibilities are not a relevant consideration.

20. A patient in cardiovascular collapse requires pharmacological interventions involving a rapid drug action and response. What route of administration is most likely appropriate? A) Intravenous B) Oral C) Rectal D) Topical Ans: A Feedback: For rapid drug action and response, the IV route is most effective because the drug is injected directly into the bloodstream.

Ch. 3

1. An infant's current weight indicates that the maximum safe dose of Tylenol is 30 mg by mouth. The physician orders 65 mg to be given, and the nurse administers Tylenol 65 mg. Who is legally responsible in the event that the infant has a toxic reaction to the medication? A) The nurse B) The pharmacist C) The physician D) The pharmacy technician Ans: A Feedback: When giving medications, the nurse is legally responsible for safe and accurate administration. This regulation means that the nurse may be held liable for not giving a drug or for giving a wrong drug or dose. The pharmacist is responsible for filling the medication order, but if an error exists in the order and the medication is still administered by the nurse, the nurse is the most responsible. If the physician writes the order but does not administer the medication, then the physician is not legally responsible. The pharmacy technician is not legally responsible.

2. An 80-year-old patient with risk factors for thrombophlebitis is to be administered heparin 5000 units subcutaneously. The heparin vial is labeled 10,000 units/mL. How many milliliters will the nurse administer to the patient? A) 50 mL B) 1.5 mL C) 5 mL D) 0.5 mL Ans: D Feedback: 5000 units/X = 10,000 units/1 mL.

3. The physician orders potassium chloride 40 mEq to be added to the patient's IV solution. The vial reads 10 mEq/5 mL. How many milliliters will be added to the IV solution? A) 0.25 mL B) 20 mL C) 200 mL D) 40 mL Ans: B Feedback: 40 mEq/X mL = 10 mEq/5 mL.

4. You have received an order for a medication to be administered buccally. Where is the medication administered? A) Eye

B) C) D) Ans:

Vagina Cheek Nose C Feedback: A medication that has been ordered to be administered buccally is given in the patient's cheek. The eye, vagina, and nose are not considered part of the buccal mucosa.

5. The nurse is repeatedly unsuccessful in starting an IV on a patient who requires antibiotic therapy. The physician then orders the patient to receive an oral antibiotic. What is the major disadvantage of the oral route over the parenteral route? A) Slower rate of action B) Greater adverse effects C) Increased risk of tolerance D) Dose must be larger. Ans: A Feedback: The oral route of administration has a slower rate of action. Oral antibiotics do not produce greater adverse effects. The risk of tolerance is equal in intravenous and oral antibiotics. The dose is not necessarily larger in oral versus intravenous antibiotics.

6. A patient has a gastrostomy tube, and the pharmacy has delivered an extended-release tablet. What is the most appropriate action taken by the nurse? A) Administer the medication orally. B) Administer the medication through the tube. C) Crush the medication and administer half of it at a time. D) Call the pharmacy to obtain an immediate-release form. Ans: D Feedback: The most important nursing action is to call the pharmacy to determine whether a liquid or a nonextended-release tablet can be substituted. Extended-release tablets should never be crushedóthe patient would be placed at risk for overdose or potentially serious adverse effects or death. If the patient has a gastrostomy tube, then he or she cannot swallow and cannot take the pill orally. The medication cannot be administered through the tube because it will obstruct the tube.

7. The nurse has measured a patient's capillary blood glucose and is preparing to administer NPH insulin. Which of the following actions should the nurse perform? A) Administer intramuscularly. B) Rotate the liquid. C) Vigorously shake the vial. D) Administer intradermally. Ans: B

Feedback: When administering NPH insulin, particles of active drug are suspended in a liquid; the liquid must be rotated. NPH insulin is administered subcutaneously, not intramuscularly or intradermally. The vial should be rotated or shaken, but not vigorously shaken.

8. A nurse begins a patient interaction by systematically gathering information on the patient's care and eventually evaluating the outcomes of care. Which of the following represents this continuum of care? A) Assessment process B) Outcomes analysis C) Nursing interventions D) Nursing process Ans: D Feedback: The nursing process is a systematic way of gathering and using information to plan and provide individualized patient care and to evaluate the outcomes of care. The assessment, outcomes, and nursing interventions are individual components of the nursing process.

9. Which of the following assessments should be made before administering a new medication? A) Determine the patient's past medication history. B) Evaluate the patient's health beliefs. C) Instruct the patient on the effect of the medication. D) Teach the patient about the desired outcomes of drug therapy. Ans: A Feedback: Assessment involves collecting data on patient characteristics known to affect drug therapy. This process includes observing and interviewing the patient, interviewing family members, completing a physical assessment, reviewing medical records for pertinent laboratory and diagnostic reports, and other methods. Initially (before drug therapy is started or on first contact), the patient should be assessed for age, weight, vital signs, health status, pathologic conditions, and ability to function in usual activities. It is not necessarily important to evaluate the patient's health beliefs at this point. Education is considered to be an intervention, not an assessment.

10. A patient states that she takes acetaminophen (Tylenol) four to five times daily when she is at home. Which of the following laboratory tests is a relevant response to this practice? A) Cardiac enzymes B) Peak and trough C) Liver enzymes D) White blood cell count

Ans:

C Feedback: Laboratory tests of liver, kidney, and bone marrow function are often helpful because some drugs may damage these organs. Cardiac enzymes are assessed in the event that the patient has had myocardial infarction symptoms. The peak and trough indicates the amount of medication when half the medication has been excreted and the serum level of the medication prior to the administration of the next dose. The white blood cell count is indicative in the event of agranulocytosis or infection.

11. A patient who has been diagnosed with type 2 diabetes mellitus is being instructed on her medication regimen, diet, and exercise. She is having difficulty grasping information about when exactly she should administer insulin. Which of the following nursing diagnoses is most appropriate for this patient? A) Deficient knowledge: drug therapy regimen B) Noncompliance: overuse C) Risk for injury related to adverse effects D) Acute confusion related to insulin regimen Ans: A Feedback: Deficient knowledge: drug therapy regimen is the most accurate nursing diagnosis for this patient. The question does not address noncompliance: overuse. The patient is not necessarily at risk for injury based on the stem of the question. Acute confusion does not relate to a lack of understanding or knowledge.

12. A patient is diagnosed with pneumonia and has been placed on antibiotics to treat the infection. Which of the following nursing actions will assist in increasing lung capacity? A) Promoting hand hygiene B) Increasing rest C) Frequent repositioning D) Promoting deep breathing Ans: D Feedback: Assisting the patient to cough and deep breathe will increase lung capacity and assist in fighting the infection. Promoting hand hygiene is important but will not increase lung capacity. Increasing rest will assist in recovery but will not increase lung capacity. Frequent repositioning does not increase lung capacity.

13. The nurse is providing care for a patient who has rheumatoid arthritis. Which of the following herbal supplements is often combined with chondroitin to repair cartilage? A) Ginkgo B) Glucosamine C) St. John's wort D) Saw palmetto

Ans:

B Feedback: Glucosamine is an herbal supplement that is usually combined with chondroitin to repair cartilage. Ginkgo is used to improve memory and cognitive function in people with Alzheimer's disease. St. John's Wort is used to treat depression. Saw palmetto is used to treat urinary symptoms in men with benign prostatic hyperplasia.

14. The nurse makes an effort to provide high-quality care to patients by obtaining and analyzing the best available scientific research. This activity demonstrates an important component of which of the following? A) Evidence-based nursing B) Medical justification C) Nursing data synthesis D) Scientific nursing Ans: A Feedback: Evidence-based nursing practice requires a conscientious and continuing effort to provide high-quality care to patients by obtaining and analyzing the best available scientific evidence from research. Then, the scientific evidence is integrated with the nurse's clinical expertise and the patient's preferences and values to yield ìbest practicesî for a patient with a particular disease process or health problem.

15. A patient has informed the nurse that he has begun supplementing his medication regimen with a series of herbal remedies recommended by his sister-in-law. Which of the following is the most important nursing responsibility regarding herbal supplements? A) Research for potential interactions with medications. B) Instruct the patient to discontinue them if taking prescription medications. C) Instruct the patient to take the supplements 1 hour before prescription medications. D) Instruct the patient to take the supplements 3 hours after prescription medications. Ans: A Feedback: Two major concerns are that the use of supplements may keep patients from seeking treatment from a health care provider and that products may interact with prescription drugs. Not all herbal supplements should be discontinued in combination with prescription medications. The herbal supplements should be administered in varying quantities and at varying times based on the medication regime. They are not always administered 1 hour before prescription medications or 3 hours after prescription medications.

16. A patient is being administered a selective serotonin reuptake inhibitor to treat depression. Which of the following herbal supplements is contraindicated?

A) B) C) D) Ans:

St. John's wort Glucosamine Chondroitin Melatonin A Feedback: St. John's wort should not be combined with monoamine oxidase inhibitors or selective serotonin reuptake inhibitor antidepressants.

17. A pediatric nurse confronts many challenges when providing medications to children and infants. Which of the following principles is most appropriate when administering medication to children? A) If a child is resistant to taking the medication, the nurse should tell the child that it is candy. B) Measurement by teaspoons is as accurate as milliliters. C) If a drug is not supplied in liquid form, the nurse can always crush the pill. D) Assess the child's weight prior to initial drug administration. Ans: D Feedback: It is imperative to determine a child's weight in order to ensure safe dosage. Never describe the medication to the child as candy. Liquid medications should always be measured by milliliters, not teaspoons. Some, but not all, medications may be safely crushed.

18. An 88-year-old woman has developed syncope (fainting) since an antihypertensive agent was added to her medication regime. The development of syncope may be related to which of the following physiologic processes? A) Interaction of other medications B) Ingestion of herbal supplements C) Diminished excretion of the medication D) Increased metabolism of the medication Ans: C Feedback: Adverse effects of medications in an elderly patient are likely because of physiologic changes associated with aging, pathologic changes due to disease processes, multiple drugs for acute and chronic disorders, impaired memory and cognition, and difficulty in complying with drug orders. The question does not address the interaction of other medications. The question does not identify any herbal supplements. Based on physiologic alterations, the patient will not have increased metabolism of the medication.

19. A nurse is preparing to administer a patient's scheduled beta-adrenergic blocker. The nurse is aware that the patient is receiving this drug for the treatment of hypertension.

A) B) C) D) Ans:

The nurse has addressed which of the following rights of safe medication administration? Right indication Right diagnosis Right reason Right history C Feedback: ìRight reasonî is one of the universally recognized rights of safe drug administration. The other listed ìrightsî are not used in practice.

20. A nurse is preparing to administer an intramuscular injection of an older adult's seasonal influenza vaccination. What size needle should the nurse use to administer the injection? A) 16 gauge B) 20 gauge C) 24 gauge D) 28 gauge Ans: B Feedback: Usually, a 25-gauge, 5/8-inch needle is used for Sub-Q injections and a 22- or 20-gauge, 1 1/2-inch needle is used for IM injections.

Ch. 4

1. A pediatric nurse is well aware of the many physiological variables that influence safe pharmacotherapy in patients younger than 18. Which of the following principles should the nurse integrate into care? A) The physiology of patients older than 15 can be considered to be the same as an adult patient. B) The younger the patient, the greater the variation in medication action compared to an adult. C) The larger the patient's body mass index, the more his or her physiology varies from that of an adult. D) Pediatric patients have a greater potential to benefit from pharmacotherapy than adult patients. Ans: B Feedback: The younger the patient, the greater the variation in medication action when compared to an adult. This does not necessarily equate into a greater potential for benefit, however. BMI is not the main or sole basis of variations between adults and children.

2. An infant who is 3 weeks old was born at full gestation but was just brought to the emergency department with signs and symptoms of failure to thrive. This pediatric patient will be classified into what pediatric age group? A) Full-term baby B) Young infant C) Neonate D) Early postnatal Ans: C Feedback: Neonates are considered to be infants from full-term newborn 0 to 4 weeks of age.

3. A pediatric nurse practitioner is aware that there are many knowledge gaps that still exist in the evidence base that underlies pediatric pharmacology. Many of these knowledge gaps are rooted in A) a lack of scientific understanding of the anatomy and physiology of children and infants. B) the historical lack of pediatric participation in the drug testing process. C) the fact that research grants in pharmacology have traditionally specified adult participation. D) assumptions that there are no physiological differences between adults and children. Ans: B Feedback: Historically, researchers used only adults to test medications, and prescribers simply

assumed that smaller doses would elicit the same results in smaller patients. The knowledge base surrounding anatomical and physiological differences between adults and children is substantial, and grant funding is not typically limited to adult participation.

4. A 3-year-old Asian American boy has had culture and sensitivity testing performed, and antibiotic treatment is indicated. The prescriber knows that the recommended antibiotic has not been extensively studied in pediatric patients. Consequently, the prescriber will be obliged to do which of the following? A) Administer subtherapeutic doses in order to mitigate the potential for adverse effects B) Choose a different antibiotic that has been extensively tested in children C) Apply vigilant clinical judgment when administering the antibiotic to the child D) Have the child's family sign informed consent forms absolving the care team from responsibility for adverse effects Ans: C Feedback: Prescribers must continue to treat pediatric patients with drugs for which they lack information; therefore, they must practice good assessment, dosing, and evaluation during the administration of any medication to a pediatric patient. Alternative drugs are not always an option, and a lack of data does not absolve the care team from responsibility for adverse outcomes.

5. A 9-year-old boy with severe influenza symptoms will be treated with ribavirin (Rebetol), an antiviral that is usually taken by adults twice daily in doses of 600 mg PO. After learning that the child's body surface area (BSA) is 1.10, the nurse will anticipate that the child will likely receive how much ribavirin for each dose? A) 110 mg B) 380 mg C) 545 mg D) 660 mg Ans: B Feedback: The prescriber calculates a dose based on a known adult dose by using the following equation: pediatric dose = BSA/1.73 × adult dose. Thus, 1.1 1.73 × 600 = 381.5 mg. This would likely be rounded to 380 mg.

6. Significant pharmacodynamic variations exist between adult patients and pediatric patients. Which of the following factors are known to contribute to differences in the ways that drugs affect target cells in children and infants? Select all that apply. A) Inability of children to accurately describe adverse effects

B) C) D) E) Ans:

Immaturity of children's organ systems Differences in the body composition of children The lack of active immunity in children Differences in the function of humoral immunity in children B, C Feedback: Immature organ systems and changing body compositions mean that drugs affect children differently. Causes of pharmacodynamic variability across the lifespan include differences in body composition, immature systems, and genetic makeup. Total body water, fat stores, and protein amounts change throughout childhood and greatly influence the effectiveness of drugs in the pediatric population. Children are indeed less able to describe adverse effects, but this is not a pharmacodynamics variation. Differences in the function of the immune system are not noted to significantly influence pharmacodynamics.

7. A 2-year-old girl with a recent history of idiopathic nausea and vomiting was prescribed promethazine (Phenergan) by her primary care provider. The immaturity of this child's gastrointestinal system will primarily influence what aspect of pharmacokinetics? A) Absorption B) Distribution C) Metabolism D) Elimination Ans: A Feedback: Gastric emptying and intestinal motility greatly affect the child's drug absorption. The GI tract is less directly involved in distribution, metabolism, and elimination.

8. A neonate has been prescribed a water-soluble drug for the treatment of an acute infection. The nurse recognizes that the percentage of body water in an infant is significantly higher than that of an adult. What implication does this have for pharmacotherapy of an infant? A) The drug will need to be emulsified before administration. B) The infant's fluid intake will be reduced before and after administration. C) The infant will have a fat-soluble drug substituted. D) The infant may require an increased dose of the drug. Ans: D Feedback: In adults, total body water is approximately 60%, whereas in newborns, it is 80%. This difference means that water-soluble drugs are diluted easily and readily moved into intercellular tissue. As a result, serum drug concentrations are lower, and increased dosages of water-soluble drugs may be necessary to maintain therapeutic drug levels. Substitutes may not be available, and fluid restriction does not compensate for this physiological difference.

9. An infant with recent seizures is being treated in the neonatal intensive care unit with phenytoin (Dilantin). The infant's low plasma protein levels during the first year of life have what consequence? A) The infant may have an unpredictable drug response. B) The infant may have an increased risk of toxicity. C) The infant may experience impaired elimination of the drug. D) The infant will have an increased rate of drug metabolism. Ans: B Feedback: In infants, immature liver function leads to very low plasma protein levels, which limit the amount of protein binding by drugs. Consequently, the serum concentrations of highly protein-bound drugs may be higher, and toxicity may occur. This is not a result of differences in elimination or increased metabolism.

10. Which of the following laboratory tests relates most directly with the impaired drug elimination that is expected in neonates? A) C-reactive protein level B) Creatine kinase C) Serum albumin level D) Glomerular filtration rate Ans: D Feedback: Excretion of most drugs occurs via the kidneys, and elimination in the urine follows. Young children have immature kidneys, a reduced glomerular filtration rate, and slower renal clearance. Neonates are especially prone to increased levels of drugs that are eliminated primarily by the kidneys. CK, albumin, and C-reactive protein levels do not directly relate to this physiological characteristic.

11. The nurse has experienced challenges in administering a 3-year-old boy's oral antibiotics due to the boy's resistance. How can the nurse best ensure that this patient receives his necessary medication? A) Convince the boy that the medication is actually a treat, especially reserved for him. B) Mix the medication with pleasantly flavored syrup or pureed fruit. C) Withdraw some of the child's privileges if he refuses to take his medication. D) Distract the child with a toy and then put it in his mouth quickly. Ans: B Feedback: To make oral medications more palatable, the nurse may mix them with flavored syrups or fruit purees. It would be inappropriate to use negative reinforcement, and medications should not be characterized as candy or treats. Sneaking the medication into the child's

mouth will not ensure that it will be swallowed.

12. Oral acetaminophen has been ordered for a young child who has a fever. A liquid form has been obtained by the nurse to increase the chance of problem-free administration. Prior to administration, the nurse is going through the rights of medication administration. When confirming the right dose, what term is most appropriate? A) “160 mg” B) “One teaspoon” C) “One third of a tablespoon” D) “5 mL” Ans: A Feedback: To ensure accuracy and safety, the nurse should administer medications based on individual dosages in milligrams, micrograms, or units, not on variables such as tablets, teaspoons, or milliliters, for which the concentration may vary.

13. A nurse is preparing to administer a nebulized bronchodilator to a young child with asthma. The nurse should be aware that this child's dosage is based primarily on what characteristic of the child? A) Weight B) Age C) Body type D) Development stage Ans: A Feedback: Dosages of pediatric medications are calculated based on weight.

14. An emergency department nurse is confirming that a child's ordered dose of IV analgesia is congruent with her body surface area (BSA). In order to calculate the child's BSA, the nurse must know which of the following variables? Select all that apply. A) The child's height B) The child's percentage of body water C) The child's weight D) The usual adult dose of the drug E) The child's age in months Ans: A, C Feedback: BSA is calculated using the child's weight and height. The child's age and the normal adult dose are normally relevant to dosing, but not to the calculation of BSA.

15. An infant's antiseizure medication has been ordered after careful consideration of the

A) B) C) D) Ans:

unique pharmacokinetics among this population. What characteristic of neonates has the greatest bearing on drug metabolism? The undeveloped state of the blood–brain barrier Increased gastric motility in infants The infant's undeveloped renal function Immaturity of the infant's liver D Feedback: The enzyme cytochrome P450 (CYP450) in the liver metabolizes most drugs. In neonates, the ability to metabolize drugs is very low because of the immaturity of the liver and the resultant inability to break down drugs. Characteristics of the kidneys, the blood–brain barrier, and GI function do not primarily affect metabolism.

16. An infant's mother is reluctant for the nurse to administer a suppository to her baby, stating, “It just seems so terribly invasive.” What principle should guide the nurse's use of suppositories in infant patients? A) Suppositories are generally avoided unless absolutely necessary, due to the risk of injuring the rectal mucosa. B) Suppositories can be an effective means of administering medications to infants, since oral administration is often challenging. C) Suppositories should only be administered after the nurse manually clears the infant's rectum. D) Suppositories are poorly absorbed in infants due to their immature gastrointestinal tract. Ans: B Feedback: Suppositories are an effective way of administering medications to infants. They do not require manual clearing of the rectum prior to administration. Suppositories are well absorbed.

17. A public health nurse is preparing to administer an intramuscular injection of a vaccine to an 8-year-old girl. The nurse recognizes that the child is uncharacteristically quiet and appears tense. The nurse should recognize the possibility of what nursing diagnosis? A) Fear related to IM injection B) Acute confusion related to misunderstanding of the necessity of IM injection C) Risk for injury related to IM injection D) Ineffective coping related to reluctance to receive IM injection Ans: A Feedback: IM injections are frightening for older children, and they need praise and encouragement. Fear is a far more likely cause of this child's behavior than confusion or ineffective coping. There is risk for injury associated with IM injections, but the nurse can mitigate this risk through proper technique.

18. A 4-year-old boy is postoperative day one following surgery for trauma suffered in a motor vehicle accident. The boy is in pain, and the nurse is preparing to administer a dose of hydromorphone syrup as ordered. To administer this drug, the nurse should use A) a teaspoon. B) a transparent, 2-ounce medication cup. C) a parenteral syringe with the needle removed. D) an oral syringe. Ans: D Feedback: The nurse should administer oral medications only in oral syringes. Other methods have the potential to be inaccurate.

Ch. 5

1. An 80-year-old woman has sought care for a dermatological health problem that most often requires treatment with an oral corticosteroid. When considering whether to prescribe steroids to this patient, the care provider should prioritize which of the following questions? A) ìShould this patient receive a medication that was likely tested on younger adults? î B) ìDo the potential benefits of this medication outweigh the potential harm?î C) ìAre there plausible herbal or complementary alternatives to this medication?î D) ìIs there a younger adult who can oversee this patient's medication regimen?î Ans: B Feedback: The nurse and the prescriber must carefully consider the risk of associated adverse effects of those medications as well as possible benefits these medications might have in changing physiological processes related to disease. This consideration is a priority over the specifics of the drug's original testing procedure or the presence of herbal alternatives. Not every older adult requires another person to oversee his or her medications.

2. A nurse is teaching an 81-year-old man about the risk for potential adverse effects before he begins a course of antibiotics for an upper respiratory infection. What characteristic of older adults predisposes them to adverse drug reaction? A) Increased excretion time due to increased bowel motility B) Impaired distribution due to polypharmacy C) A decrease in overall body surface area D) A decrease in the number of receptors needed for distribution Ans: D Feedback: Older adults are prone to adverse drug reactions because of a decrease in the number of receptors needed for drug distribution. BSA does not change appreciably with age and bowel motility slows with age. Polypharmacy is a valid concern, but this phenomenon does not primarily involve distribution.

3. A nurse is conducting a medication reconciliation of a woman who is newly admitted to a long-term care facility. When appraising the woman's medication regimen in light of the Beers Criteria, the nurse will look for A) drugs that are known to cause adverse effects in older adults. B) drugs for which generic equivalents are available at lower cost. C) drugs that have been found to be ineffective in older adults. D) drugs that are known to exacerbate the aging process. Ans: A Feedback: Dr. Mark Beers developed the Beers Criteria list of potentially inappropriate medications used by the older adult population. The list confirms that toxic medication effects and drug-related problems affect the safety of older adults and names drugs that

cause problems in this population.

4. A nurse has noted that an older adult patient on an acute care for elders (ACE) unit has an exceptionally lengthy medication administration record. The nurse has alerted the pharmacist because one of the patient's long-standing medications appears on the Beers list. What medication is the nurse likely addressing? A) Low-dose enteric-coated ASA B) Metoprolol (Lopressor) C) Digoxin (Lanoxin) D) Vitamin D Ans: C Feedback: Digoxin appears on the list of Beers Criteria due to the risk of adverse effects in older adults. ASA, metoprolol, and vitamin D do not appear on this list.

5. A nurse has called an elderly patient's surgeon to question the order for meperidine hydrochloride (Demerol) for pain control. The nurse's action is prompted by the possibility of what adverse effect associated with the use of Demerol in older adults? A) Confusion B) Blood dyscrasias C) Gastrointestinal bleeding D) Hepatotoxicity Ans: A Feedback: Demerol is associated with confusion in older adults. It is not noted to cause blood dyscrasias, GI bleeding, or hepatotoxicity.

6. A gerontological nurse is aware that older adults' abilities to excrete medications diminish with age. When appraising an older adult's ability to excrete medications, what laboratory or diagnostic finding should the nurse prioritize? A) Renal ultrasound B) Complete blood count (CBC) C) Serum bilirubin and albumin levels D) Blood urea nitrogen and creatinine levels Ans: D Feedback: The nurse should assess an older adult's blood urea nitrogen and creatinine clearance (CrCl) levels to determine the patient's ability to excrete the medications. Renal ultrasound identifies structural abnormalities in the kidneys but is less useful in diagnosing function. The patient's CBC and bilirubin and albumin levels do not help the nurse assess the patient's ability to excrete medications.

7. A 90-year-old patientís most recent blood work includes the following data: alanine aminotransferase (ALT) 1.99 kat/L (high) and aspartate aminotransferase (AST) 3.1 kat/L (high). What implication do these data have for the patient's pharmacokinetics? A) Distribution of drugs may be erratic. B) Absorption of drugs may be incomplete. C) Excretion of drugs may be delayed. D) Metabolism of drugs may be impaired. Ans: D Feedback: AST and ALT levels are used to determine the patient's liver function and ability to metabolize drugs.

8. A 72-year-old woman with a 60-pack-year history of cigarette smoking has developed chronic obstructive pulmonary disease (COPD) and has consequently been prescribed albuterol, a beta2-adrenergic agonist. When administering this medication, the nurse should be aware that A) the drug carries a higher potential for hepatotoxicity in this patient than in a younger patient. B) the drug may be less effective than in a younger patient due to decreased beta-receptor function. C) the patient will need to take a beta-adrenergic blocker concurrently to mitigate the likelihood of adverse effects. D) the patient will need to have serial complete blood counts (CBCs) drawn following the initiation of therapy. Ans: B Feedback: Beta-adrenergic agonists are less effective in older adults as a result of the decreased function of the beta-receptor system. The potential for hepatotoxicity is not increased, and a beta-blocker is not indicated. Serial blood work is not necessary.

9. The daughter of an 80-year-old woman states that her mother has been taking alendronate (Fosamax) for several years for the treatment of osteoporosis. The daughter tells the nurse that her mother never had any complaints of nausea after taking this medication until recently. How should the nurse respond to the daughter's statement? A) ìIt could be that your mother's stomach empties more slowly than it used to, which is a normal result of aging.î B) ìAs your mother gets older, the medication travels down her esophagus more slowly than it used to. This can cause nausea.î C) ìBecause your mother processes drugs more slowly than when she was younger, there is more time during which they can cause nausea.î D) ìAs your mother ages, she has more of the receptors that trigger nausea. This is a normal change that accompanies the aging process.î Ans: A Feedback:

Diminished gastric emptying also plays a role by causing the medication to be in the stomach for a longer period. This factor increases the risk of developing nausea and vomiting, thus causing elimination of the medication in emesis and promoting fluid volume deficit. This phenomenon is not attributable to receptor changes or decreased esophageal motility.

10. An older adult's most recent blood work reveals that his serum albumin level is 21 g/L (low). This will most influence what aspect of pharmacokinetics? A) Absorption B) Distribution C) Metabolism D) Excretion Ans: B Feedback: Many medications require serum albumin to bind, transport, and distribute the medication to the target organ. In the event that the amount of serum albumin is insufficient, the amount of free drug rises and the effect of the drug is more intense.

11. Laboratory testing of an 80-year-old patient who is well-known to the clinic nurse indicates that his liver function has been gradually decreasing over the last several years. How will this age-related physiological change influence drug metabolism? A) The patient will metabolize drugs more quickly but derive less of a therapeutic benefit from them. B) The liver will sequester drug molecules in the hepatocytes, and they will be released at unpredictable times. C) Many of the patient's medications will remain in his body for a longer time. D) The patient's kidneys will be forced to metabolize a disproportionate quantity of medications. Ans: C Feedback: The hepatic enzymes of the liver are decreased in the older adult, altering the ability to remove metabolic by-products. It is important to understand that because older adults have a reduced metabolism, medications with a long half-life will remain in the body for a greater amount of time. The kidneys do not compensate for this loss of function. Drugs are not normally sequestered in the liver tissue.

12. A gerontological nurse is aware that age is a salient variable that must be considered during pharmacotherapy in adults. However, the nurse knows that many other important variables must also be considered, including ethnicity. Members of which of the following ethnic groups typically require lower doses of many common medications? A) Native Americans B) Caucasian Americans C) Asian Americans

D) Ans:

African Americans C Feedback: Caucasian Americans and African Americans are poor metabolizers of medication compared with Asian Americans; Asian Americans have the ability to metabolize and excrete medications more quickly than those of Caucasian and African descent. This often means that Asian Americans require lower doses.

13. A nurse is reviewing a new patient's admission blood work, which indicates that the patient's glomerular filtration rate is 51 mL/min/1.73 m2 (low). What implication does this have for the patient's subsequent pharmacotherapy? A) The patient may need lower-than-normal doses of some medications. B) The patient may require a fluid challenge prior to medication administration. C) The patient may need IV administration of a hypotonic solution to aid medication excretion. D) The patient may need to receive medications by topical and subcutaneous routes rather than parenteral. Ans: A Feedback: With a decreased GFR, it is necessary to reduce the dosage of the medication. IV fluid administration and alternative routes do not adequately compensate for this change in pharmacokinetics.

14. A 69-year-old man has been prescribed a nitrate and a calcium channel blocker for the treatment of unstable angina. When performing health education to promote adherence to his medication regimen, the nurse should emphasize which of the following? A) The fact that the patient will likely need medications until he no longer experiences the signs of angina B) The fact that the patient should take his medications as ordered even if he feels well in the short term C) The fact that inconsistent medication use will likely cause the onset of hypertension D) The fact that he should gauge his day's dose based on how he feels that morning Ans: B Feedback: Being asymptomatic may contribute to nonadherence to a medication regimen. Many patients begin to feel better with the initiation of therapy and then discontinue medications altogether or miss individual doses. Patients and their families should be educated about adherence to medication regimens and taught to not skip doses, even if they feel well. Inconsistent use of nitrates and calcium channel blockers does not normally lead to hypertension.

15. Mrs. James has been taking a diuretic and a beta-blocker for the treatment of

A) B) C) D) Ans:

hypertension for the past several months. During her latest clinic visit, she states that she has been measuring her blood pressure regularly at her local drug store and she claims that it is usually in the range of 130/80 mm Hg. As a result, she states that she has cut down on her doses of both drugs. Mrs. James' actions should indicate what nursing diagnosis to the nurse? Risk for poisoning related to unilateral changes to medication regimen Acute confusion related to the necessity for medication adherence Readiness for enhanced decision making related to management of drug therapy Deficient knowledge related to self-management of drug regimen D Feedback: Mrs. James is evidently unaware of the need to take her medications consistently. She is presuming that symptom control means that the medication is no longer indicated. The nurse should address this lack of knowledge. There is no associated risk of poisoning, and the patient's decision making is deficient, a fact that she may or may not be willing to address. Acute confusion denotes a deficit in cognitive processes, not a lack of information.

16. A nurse at a long-term care facility is surprised to learn that a new resident's medication administration record runs four pages in length. The nurse knows that polypharmacy carries which of the following risks for older adults? Select all that apply. A) Increased risk of complications B) Decreased continuity of care C) Decreased cognition D) Decreased medication adherence E) Decreased costs of care Ans: A, C Feedback: Polypharmacy and the consequent interactions of medications can lead to greater complications and diminished mental status. It does not necessarily reduce the continuity of care or medication adherence. Costs to the patient are likely to be higher, not lower.

Ch. 6

1. A pregnant woman is experiencing nausea and vomiting in her first trimester of pregnancy. Which herbal agent has traditionally been used as an antiemetic? A) Ginger B) Garlic C) Ginkgo biloba D) Green tea Ans: A Feedback: Ginger has been used to relieve nausea and vomiting during pregnancy. Garlic, Ginkgo biloba, and green tea are not recommended to relieve nausea and vomiting in pregnancy.

2. A pregnant woman asks why she needs to take a folic acid supplement. What is the nurse's best explanation for the administration of folic acid? A) “Folic acid prevents the development of contractions.” B) “Folic acid prevents neural tube birth defects.” C) “Folic acid builds strong fetal bones.” D) “Folic acid will decrease nausea and vomiting.” Ans: B Feedback: Folic acid prevents neural tube birth defects. Folic acid does not prevent contractions. Folic acid will not build fetal bones. Folic acid will not prevent nausea and vomiting.

3. A woman is being administered IV magnesium sulfate. What is a desired outcome related to the administration of magnesium sulfate? A) Increased contractions B) Respiratory rate above 18 C) Decreased blood pressure D) Increased uterine tone Ans: C Feedback: The administration of magnesium sulfate can prevent seizure activity and reduce severe hypertension. Magnesium sulfate is administered for preterm labor to prevent contractions and reduce uterine tone, not to increase respiratory rate.

4. A woman who began labor several hours ago is to be administered oxytocin. What is the goal of oxytocin therapy? A) Prevent postpartum bleeding B) Decrease fetal hyperactivity C) Augment weak or irregular contractions D) Diminish periods of relaxation Ans: C

Feedback: Use of this manufactured hormone induces labor or augments weak, irregular uterine contractions during labor. It is not used in the labor phase to prevent bleeding. It is not administered to decrease fetal hyperactivity. The administration of oxytocin should allow for adequate periods of relaxation between contractions.

5. A woman in labor is being treated with magnesium sulfate intravenously and is beginning to show signs and symptoms of hypermagnesemia. The infusion has been discontinued, and the nurse should anticipate administration of what drug? A) Metoprolol (Lopressor) B) Calcium gluconate C) Potassium chloride D) Furosemide (Lasix) Ans: B Feedback: Overdoses of magnesium sulfate may lead to hypotension, muscle paralysis, respiratory depression, and cardiac arrest. Calcium gluconate, the antidote for magnesium sulfate, should be readily available for use if hypermagnesemia occurs.

6. A patient is being administered magnesium sulfate for preterm labor. The patient's serum magnesium level is elevated at 11 mg/dL. With what sign or symptom will the patient likely present? A) Tachypnea B) Muscle rigidity C) Tachycardia D) Depressed deep tendon reflexes Ans: D Feedback: Hypermagnesemia will cause depressed deep tendon reflexes. The serum magnesium level of 11 mg/dL would result in depressed respirations. The serum magnesium level of 11 would result in decreased muscle strength. The serum level of 11 mg/dL would result in bradycardia, not tachycardia.

7. A woman in preterm labor has been administered terbutaline sulfate (Brethine). For what potential adverse effects should the nurse assess the patient? A) Pruritus (itching) and copious diaphoresis B) Joint pain and numbness in her extremities C) Headache and visual disturbances D) Palpitations and shortness of breath Ans: D Feedback: Terbutaline sulfate (Brethine) is a beta-adrenergic agent that inhibits uterine contractions

by reducing intracellular calcium levels. Adverse effects may include hyperkalemia, hyperglycemia, cardiac dysrhythmias, hypotension, and pulmonary edema. Women commonly experience hand tremors, palpitations, and shortness of breath with chest tightness.

8. When administering magnesium sulfate, for what should the nurse assess the patient? A) Dry, pale skin B) Respiratory depression C) Agitation D) Tachycardia Ans: B Feedback: Overdoses of magnesium sulfate may lead to hypotension, muscle paralysis, respiratory depression, and cardiac arrest. The nurse would not anticipate dry, pale skin; agitation; or tachycardia.

9. A pregnant woman states that she has been constipated since becoming pregnant. Which medication is most appropriate for preventing constipation related to pregnancy? A) Metamucil B) Mineral oil C) Saline cathartic D) Stimulant cathartic Ans: A Feedback: A bulk-producing agent, such as Metamucil, is most physiologic for the mother and safe for the fetus. Mineral oil is not recommended because of the lack of absorption of fatsoluble vitamins. Saline cathartics are not recommended because of hypernatremia. Stimulant cathartics are not recommended for the pregnant woman.

10. A woman who is 7 months pregnant is waking up at night with gastroesophageal reflux. Which of the following medications is most highly recommended? A) Terbutaline (Brethine) B) Diphenoxylate (Lomotil) C) Ranitidine (Zantac) D) Chlorothiazide (Diuril) Ans: C Feedback: A histamine2 receptor antagonist, such as ranitidine, is used for gastroesophageal reflux disease. Terbutaline is a tocolytic agent. Diphenoxylate is not administered for GERD. Chlorothiazide is a diuretic agent.

11. A woman who takes highly active antiretroviral therapy (HAART) for HIV/AIDS has become pregnant. What effect will the woman's pregnancy have on her drug regimen? A) She must discontinue HAART due to the risk of teratogenic effects. B) Her dosages of HAART must be increased to reduce the risk of in utero transmission. C) She can continue her HAART unchanged. D) Some components of her HAART must be replaced or discontinued. Ans: C Feedback: Antiretroviral drug therapy for the pregnant woman reduces perinatal transmission by about two thirds. In general, highly active antiretroviral therapy, or HAART, is safe, with recommended dosage the same as for nonpregnant women.

12. A woman is at 42 weeks of gestation. Which of the following medications will be administered to promote cervical ripening? A) Calcium gluconate B) Magnesium sulfate C) Terbutaline (Brethine) D) Dinoprostone (Cervidil) Ans: D Feedback: Cervidil is administered to ripen the cervix in a woman who is at 42 weeks of gestation. Calcium gluconate, magnesium sulfate, and terbutaline are not administered to ripen the cervix.

13. A patient is receiving oxytocin (Pitocin). Which of the following is a maternal adverse effect of Pitocin? A) Acute confusion B) Hypertension C) Edema D) Inverted T wave Ans: B Feedback: Hypertension is a maternal adverse effect of Pitocin. Confusion, edema, and inverted T wave are not adverse effects of Pitocin.

14. A woman was administered misoprostol (Cytotec) in an effort to induce labor, but the care team is unsatisfied with the results. Consequently, oxytocin will be used. Prior to administering oxytocin, what must occur? A) Four hours must elapse after the last dose of misoprostol. B) The woman must have a type and cross-match performed. C) The woman must receive a bolus of 500-mL normal saline.

D) Ans:

The woman must have her electrolytes measured. A Feedback: If the course of treatment changes and oxytocin is to be given after misoprostol, it is essential to wait 4 hours from the last administration of misoprostol before starting oxytocin. Blood work and IV hydration are not necessary.

15. A patient is being treated for preterm labor. Which beta-adrenergic medication is administered orally to decrease uterine contractions? A) Magnesium sulfate B) Oxytocin (Pitocin) C) Nifedipine (Procardia) D) Terbutaline (Brethine) Ans: D Feedback: Terbutaline is a beta-adrenergic agent that inhibits uterine contractions by reducing intracellular calcium levels; oral doses can be given as maintenance therapy. Magnesium sulfate is administered intravenously and not administered at home. Oxytocin induces labor. Nifedipine is a calcium channel blocker that decreases uterine contractions.

16. A couple have been trying unsuccessfully for nearly a year to become pregnant and have now sought fertility counseling. The nurse should be aware of what potential etiological factors related to infertility? Select all that apply. A) Absence of sperm B) Endometriosis C) Vaginitis D) Blocked fallopian tubes E) Fibromyalgia Ans: A, B, D Feedback: In women, the most common causes are ovulation disorders, blocked fallopian tubes, endometriosis, and advanced maternal age, which affects egg quality and quantity. In men, causes include absence of sperm, declining sperm counts, testicular abnormalities, and ejaculatory dysfunction. Vaginitis cannot cause infertility, and fibromyalgia is not noted as a common etiological factor.

17. A woman has been unable to conceive for many months and will soon begin treatment with clomiphene (Clomid). What health education should the nurse provide to this patient? A) Avoid drinking alcohol while taking Clomid. B) Perform daily OTC pregnancy tests beginning the day after taking Clomid. C) Take her basal temperature between 5 to 10 days after taking Clomid.

D) Ans:

Report any numbness or tingling in her hands or lips to her care provider. C Feedback: Ovulation occurs 5 to 10 days after the course of clomiphene treatment has been completed. Prior to beginning the drug regimen, the nurse instructs the woman about taking her basal temperature 5 to 10 days following administration. An incremental rise in temperature is an indication of ovulation. There is no specific contraindication against alcohol, and neurological adverse effects are not expected.

18. A nurse is performing health education with a woman who has just learned that she is pregnant. The nurse has explained the concept of teratogenic drugs and emphasized the need to have her care provider assess any medications she should consider taking. The nurse should teach the woman that drug-induced teratogenicity is most likely to occur at what point in her pregnancy? A) During the second half of her third trimester B) In the 7 to 10 days after conception C) In the first trimester during organogenesis D) During 30 to 34 weeks of gestation Ans: C Feedback: Drug-induced teratogenicity is most likely to occur when drugs are taken during the first three months of pregnancy, during organogenesis.

19. A primiparous woman was vigilant in avoiding medications and herbs during her pregnancy and states that she is similarly committed to protecting her baby's health now that she is breast-feeding. What principle should guide the woman's use of medications while breast-feeding? A) Very few medications are explicitly contraindicated while breast-feeding. B) It is generally safer to use herbs rather than medications while breast-feeding. C) Most women can resume their prepregnancy medication regimen after delivery. D) Most medications are contraindicated while a woman is breast-feeding. Ans: D Feedback: A wide variety of medications are contraindicated during pregnancy, and herbs are not guaranteed to be safe.

20. A woman who is in the first trimester of her pregnancy has told the nurse, “I've stopped taking my blood pressure pill because I know it could harm the baby. Instead, I've started taking natural and herbal remedies.” What nursing diagnosis is suggested by the woman's statement? A) Deficient knowledge related to drug and herbal effects during pregnancy B) Health-seeking behaviors related to protection of fetal health

C) D) Ans:

Acute confusion related to the potential teratogenic effects of herbs Effective therapeutic regimen management related to use of herbs rather than drugs A Feedback: This patient is evidently unaware of the fact that herbs pose risks to her fetus and that such risks are not limited to drugs. The nurse should address this knowledge gap. Acute confusion suggests a deficit in cognitive processes, not a lack of relevant and accurate information.

Question 1

See full question 1h 21m 41s

Which statement indicates that the client understands the follow-up needed after an injection of Depo-Provera? You Selected: •

"I know that I will need to return in 6 months for another injection."

Correct response: •

"I know that this injection lasts for 3 months."

Explanation: Reference: •

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 7: Pharmacology and Women's Health, p. 116. Chapter 7: Pharmacology and Women's Health - Page 116

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Question 2

See full question 10s

A client who is taking an estrogen reports swelling and weight gain. The nurse notes some peripheral edema. Which nursing diagnosis would the nurse identify as the priority? You Selected: •

Fluid volume excess

Correct response: •

Fluid volume excess

Explanation: Reference: •

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 40: Drugs Affecting the Female Reproductive System, p. 113. Chapter 7: Pharmacology and Women's Health - Page 113

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Question 3

See full question 10s

Estradiol (Estraderm) is administered to postmenopausal women to prevent which condition? You Selected: •

Endometriosis

Correct response: •

Osteoporosis

Explanation: Reference: •

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 7: Pharmacology and Women's Health, pp. 110-112. Chapter 7: Pharmacology and Women's Health - Page 110-112

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Question 4

See full question 3m 19s

A school nurse who is teaching a health course at the local high school is presenting information on human development and sexuality. In the class about the role of hormones in sexual development, which hormone does the nurse teach the students is the most important for developing and maintaining the female reproductive organs? You Selected: •

Estrogen

Correct response: •

Estrogen

Explanation: Reference: •

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 7: Pharmacology and Women's Health, p. 107. Chapter 7: Pharmacology and Women's Health - Page 107

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Question 5

See full question 1m 48s

A nurse caring for a 43-year-old client explains to the client that ovarian functions gradually decrease around this age. What is the implication of decreased ovarian function? You Selected: •

Inability to become pregnant

Correct response: •

Inability to become pregnant

Explanation: Reference: •

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 7: Pharmacology and Women's Health, p. 109. Chapter 7: Pharmacology and Women's Health - Page 109

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Question 6

See full question 21s

The pubescent girl exhibits many changes as a result of estrogen production. Her mother asks the nurse what secondary sexual characteristics to look for in her daughter. What is the bestinformation for the nurse to provide to the mother about secondary sexual characteristics? (Select all that apply.) You Selected: • • •

Wider hip structure Pubic and axillary hair Breast development

Correct response: • • •

Wider hip structure Pubic and axillary hair Breast development

Explanation: Reference: •

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 7: Pharmacology and Women's Health, pp. 107-114. Chapter 7: Pharmacology and Women's Health - Page 107-114

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Question 7

See full question 1m 26s

Hormones from various organs regulate the menstrual cycle. Which of the following hormones does not directly influence the cycle? You Selected: •

Testosterone

Correct response: •

Testosterone

Explanation: Reference: •

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 7: Pharmacology and Women's Health, pp. 108-109. Chapter 7: Pharmacology and Women's Health - Page 108-109

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Question 8

See full question 11s

A 37-year-old woman recently underwent a bilateral salpingo-oophorectomy. During the assessment, which of the following situations should the nurse ask about to determine the client's surgical menopausal status? You Selected: •

Hot flashes

Correct response: •

Hot flashes

Explanation: Reference: •

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 7: Pharmacology and Women's Health, p. 109. Chapter 7: Pharmacology and Women's Health - Page 109

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Question 9

See full question 10s

The nurse knows that which symptoms of menopause are considered vasomotor? Select all that apply. You Selected: • • •

Loss of bone density Sweating Flushing

Correct response: • •

Flushing Sweating

Explanation: Reference: •

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 7: Pharmacology and Women's Health, p. p. 109.. Chapter 7: Pharmacology and Women's Health - Page p. 109.

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Question 10

See full question 9s

A client has been prescribed transdermal estradiol. What important information does the nurse share with this client? You Selected: •

Avoid prolonged sun exposure

Correct response: •

Avoid prolonged sun exposure

Explanation: Reference: •

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 7: Pharmacology and Women's Health, p. 114. Chapter 7: Pharmacology and Women's Health - Page 114

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Question 11

See full question 4m 7s

The nurse is caring for a woman who is receiving estrogen for treatment of amenorrhea. What evidence will the nurse use to indicate that the medication is working properly? You Selected: •

Lack of menstruation

Correct response: •

Occurrence of menstruation

Explanation: Reference: •

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 7: Pharmacology and Women's Health, p. 114. Chapter 7: Pharmacology and Women's Health - Page 114

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Question 12

See full question 28s

The nurse is aware that medroxyprogesterone has a black box warning that the use of the medication can lead to what problem? You Selected: •

Bone breakage

Correct response: •

Bone breakage

Explanation: Reference: •

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 7: Pharmacology and Women's Health, p. 117. Chapter 7: Pharmacology and Women's Health - Page 117

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Question 13

See full question 37s

During pregnancy, what becomes a massive endocrine gland? You Selected: •

Placenta

Correct response: •

Placenta

Explanation: Reference: •

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 7: Pharmacology and Women's Health, p. 108. Chapter 7: Pharmacology and Women's Health - Page 108

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Question 14

See full question 25s

The nurse is discussing the use of vaginal estrogen for a woman with vaginal atrophy. The nurse knows that vaginal estrogen has what advantage over other forms of estrogen? You Selected: •

It treats the vaginal tissue with little systemic effects.

Correct response: •

It treats the vaginal tissue with little systemic effects.

Explanation: Reference: •

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 7: Pharmacology and Women's Health, p. 110. Chapter 7: Pharmacology and Women's Health - Page 110

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Question 15

See full question 29s

When considering the hormonal changes that occur, the nurse should encourage which diagnostic screening for a postmenopausal woman? You Selected: •

Bone calcium level

Correct response: •

Bone calcium level

Explanation: Reference: •

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 39: Introduction to the Reproductive System, p. p. 109.. Chapter 7: Pharmacology and Women's Health - Page p. 109.

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Question 16

See full question 31s

A nurse teaching a 57-year-old client about the factors that must be considered around the use of hormone replacement therapy (HRT) should discuss what increased risk associated with the therapy? You Selected: •

venous thromboembolism

Correct response: •

venous thromboembolism

Explanation: Reference: •

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 7: Pharmacology and Women's Health, p. 113. Chapter 7: Pharmacology and Women's Health - Page 113

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Question 17

See full question 2m 58s

A menopausal client prescribed estrogen asks what the implications of taking the medication are. Which response by the nurse best demonstrates an understanding of the associated implications?

You Selected: •

“Estrogen increases the risk of certain cancers, myocardial infarctions, and blood clots.”

Correct response: •

“Estrogen increases the risk of certain cancers, myocardial infarctions, and blood clots.”

Explanation: Reference: •

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 7: Pharmacology and Women's Health, p. 113. Chapter 7: Pharmacology and Women's Health - Page 113

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Question 18

See full question 19s

What statement by the client prescribed a combination contraceptive several months ago indicates a need for health education? You Selected: •

“It’s good to know that the pill protects against some sexually transmitted infections (STIs).”

Correct response: •

“It’s good to know that the pill protects against some sexually transmitted infections (STIs).”

Explanation: Reference: •

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 7: Pharmacology and Women's Health, p. 123. Chapter 7: Pharmacology and Women's Health - Page 123

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Question 19

See full question 8s

A client is receiving a medroxyprogesterone contraceptive injection. The nurse would instruct the client to return for the next dose at which time? You Selected: •

6 months

Correct response: •

3 months

Explanation: Reference: •

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 7: Pharmacology and Women's Health, p. 115. Chapter 7: Pharmacology and Women's Health - Page 115

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Question 20

See full question 19s

A nurse is obtaining a history from an older adult woman. During the interview, the woman states, “When I feel like I have to urinate, the urge is really strong and I go to the bathroom really frequently, often waking up several times during the night to go.” The nurse would most likely identify this as which condition? You Selected: •

overactive bladder syndrome

Correct response: •

overactive bladder syndrome

Question 1

See full question 37m 1s

Oral contraceptive use would be contraindicated by what in a client's medical history? You Selected: •

A 50-year-old client who is taking a cholesterol-lowering medication

Correct response: •

A 40-year-old client who smokes 1 to 1½ packs of cigarettes per day

Explanation: Reference: •

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 7: Pharmacology and Women's Health, p. 113. Chapter 7: Pharmacology and Women's Health - Page 113

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Question 2

See full question 13s

A client is menopausal and has been given a prescription for estrogen. She asks the nurse what some of the risks are in taking this medication. The nurse's best response is: You Selected: •

Estrogen increases the risk of certain cancers, myocardial infarctions, and blood clots.

Correct response: •

Estrogen increases the risk of certain cancers, myocardial infarctions, and blood clots.

Explanation: Reference: •

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Question 3

See full question 22s

A 49-year-old female client is asking the nurse about how her changing hormones relate to menopause. The nurse explains that atrophic vaginitis is a common problem during menopause. The treatment for atrophic vaginitis requires replacing: You Selected: •

estrogen.

Correct response: •

estrogen.

Explanation: Reference: •

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 7: Pharmacology and Women's Health, pp. 111-112. Chapter 7: Pharmacology and Women's Health - Page 111-112

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Question 4

See full question 55s

A nurse is caring for a 25-year-old clinic client who is starting on birth control pills. What statement by the client indicates that she needs further teaching? You Selected: •

“I may gain or lose weight while I am taking these pills.”

Correct response: •

“I will exercise more if I experience chest or leg pain.”

Explanation: Reference: •

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 7: Pharmacology and Women's Health, p. 123. Chapter 7: Pharmacology and Women's Health - Page 123

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Question 5

See full question 11s

Which releasing hormone stimulates the release of the follicle-stimulating hormone (LH) from both male and female glands? You Selected: •

Gonadotropin-releasing hormone (GnRH)

Correct response: •

Gonadotropin-releasing hormone (GnRH)

Explanation: Reference:

•

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 7: Pharmacology and Women's Health, p. 108. Chapter 7: Pharmacology and Women's Health - Page 108

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Question 6

See full question 1m 48s

A 20-year-old woman will soon begin taking oral contraceptives for the first time. What advice should the nurse provide to this client? You Selected: •

“Make sure to seek care quickly if you experience bad headaches, calf pain, or changes in vision.”

Correct response: •

“Make sure to seek care quickly if you experience bad headaches, calf pain, or changes in vision.”

Explanation: Reference: •

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 7: Pharmacology and Women's Health, p. 123. Chapter 7: Pharmacology and Women's Health - Page 123

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Question 7

See full question 18s

Kalie, age 18, is prescribed progesterone for the treatment of primary amenorrhea. Which adverse effect would need to be reported immediately to the health care provider? You Selected: •

Pain in one leg

Correct response: •

Pain in one leg

Explanation: Reference:

•

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 7: Pharmacology and Women's Health, p. 117. Chapter 7: Pharmacology and Women's Health - Page 117

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Question 8

See full question 16s

A 21-year-old woman is prescribed an oral contraceptive pill to prevent pregnancy. The nurse should inform the client of which adverse effects of this medication? You Selected: •

Nausea

Correct response: •

Nausea

Explanation: Reference: •

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 7: Pharmacology and Women's Health, p. 121. Chapter 7: Pharmacology and Women's Health - Page 121

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Question 9

See full question 22s

Why does the presence of estrogen in oral contraceptives increase the risk for developing blood clots? You Selected: •

The estrogen causes peripheral vasoconstriction.

Correct response: •

The estrogen increases production of factors II, VII, IX, and X.

Explanation: Reference:

•

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 7: Pharmacology and Women's Health, p. 113. Chapter 7: Pharmacology and Women's Health - Page 113

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Question 10

See full question 35s

Estropipate is sometimes administered to postmenopausal women to prevent which condition? You Selected: •

Osteoporosis

Correct response: •

Osteoporosis

Explanation: Reference: •

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 40: Drugs Affecting the Female Reproductive System, p. 112. Chapter 7: Pharmacology and Women's Health - Page 112

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Question 11

See full question 36s

After teaching a class on the female reproductive system, the nurse determines that the teaching was successful when the class identifies what as a primary function of the ovaries? You Selected: •

Secretion of estrogen and progesterone

Correct response: •

Secretion of estrogen and progesterone

Explanation: Reference: •

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 7: Pharmacology and Women's Health, p. 107.

Chapter 7: Pharmacology and Women's Health - Page 107 Add a Note

Question 12

See full question 49s

After teaching a group of adolescent girls about female reproductive development, the nurse determines that teaching was successful when the girls state that menarche is defined as a woman's first: You Selected: •

menstrual period.

Correct response: •

menstrual period.

Explanation: Reference: •

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 7: Pharmacology and Women's Health, p. 109. Chapter 7: Pharmacology and Women's Health - Page 109

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Question 13

See full question 42s

A group of students are reviewing material in preparation for a test on the male and female breasts. The students demonstrate understanding of the material when they state: You Selected: •

A primary function of the female breast is to produce milk.

Correct response: •

A primary function of the female breast is to produce milk.

Explanation: Reference: •

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 7: Pharmacology and Women's Health, p. 107. Chapter 7: Pharmacology and Women's Health - Page 107

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Question 14

See full question 20s

A client with a 28-day cycle reports that she ovulated on May 10. The nurse would expect the client's next menses to begin on: You Selected: •

May 24. Correct response:

•

May 24. Explanation: Reference: •

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 7: Pharmacology and Women's Health, pp. 108-109. Chapter 7: Pharmacology and Women's Health - Page 108-109

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Question 15

See full question 26s

Patient education is necessary to ensure proper use of exogenous estrogen and to enable the patient to recognize adverse effects. Which of the following should a nurse teach the patient? You Selected: •

Self-breast examination

Correct response: •

Self-breast examination

Explanation: Reference: •

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 7: Pharmacology and Women's Health, pp. 111-114. Chapter 7: Pharmacology and Women's Health - Page 111-114

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Question 16

See full question 33s

The nurse is aware that estrogen is used without progestin for hormone replacement therapy in what circumstance? You Selected: •

If the client has had her uterus removed

Correct response: •

If the client has had her uterus removed

Explanation: Reference: •

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 40: Drugs Affecting the Female Reproductive System, p. 111. Chapter 7: Pharmacology and Women's Health - Page 111

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Question 17

See full question 1m 59s

A client who is taking estrogen therapy calls the clinic and tells the nurse that she is experiencing sudden, sharp chest pain. The nurse suspects the client is experiencing what adverse reaction related to estrogen therapy? You Selected: •

Pulmonary embolism

Correct response: •

Pulmonary embolism

Explanation: Reference: •

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Question 18

See full question 6s

What would a nurse attribute to estrogen? You Selected: •

Breast growth

Correct response: •

Breast growth

Explanation: Reference: •

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 7: Pharmacology and Women's Health, p. 107. Chapter 7: Pharmacology and Women's Health - Page 107

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Question 19

See full question 25s

A menopausal client, prescribed estrogen and progesterone, asks why she should take two different medications. Which explanation best addresses the client’s question? You Selected: •

When estrogens are used alone, they cause endometrial hyperplasia and may cause endometrial cancer.

Correct response: •

When estrogens are used alone, they cause endometrial hyperplasia and may cause endometrial cancer.

Explanation: Reference: •

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 7: Pharmacology and Women's Health, p. 113. Chapter 7: Pharmacology and Women's Health - Page 113

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Question 20

See full question 21s

A new client telephones the clinic requesting a renewal prescription for contraceptives she has been taking for 4 years. It has been more than a year since her last health care visit, but she is unable to come into the clinic until next month. She insists she is “doing fine” on this medication and must have her prescription now. Considering the circumstances and related safety issues, how should the clinic nurse respond?

You Selected: •

*“Before the drugs are prescribed, a complete medical history, physical examination, Pap test, urinalysis, and weight and blood pressure measurements are recommended.”

Correct response: •

*“Before the drugs are prescribed, a complete medical history, physical examination, Pap test, urinalysis, and weight and blood pressure measurements are recommended.”

Question 1

See full question 41s

After teaching a group of students about the events that occur with fertilization and implantation of an ovum, the instructor determines that the teaching has been effective when the students identify what as an endocrine structure? You Selected: •

Placenta

Correct response: •

Placenta

Explanation: Reference: •

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 7: Pharmacology and Women's Health, p. 108. Chapter 7: Pharmacology and Women's Health - Page 108

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Question 2

See full question 12s

The nursing instructor is discussing the physiology of pregnancy with the clinical group. What hormone, produced during pregnancy, would the instructor tell the students helps to maintain the pregnancy until birth of the fetus? You Selected: •

Low levels of estrogen, high levels of progesterone

Correct response:

•

High levels of estrogen and progesterone

Explanation: Reference: •

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 7: Pharmacology and Women's Health, p. 108. Chapter 7: Pharmacology and Women's Health - Page 108

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Question 3

See full question 8s

Which hormone causes ovulation to occur? You Selected: •

Follicle-stimulating hormone (FSH)

Correct response: •

Luteinizing hormone (LH)

Explanation: Reference: •

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 7: Pharmacology and Women's Health, p. 110. Chapter 7: Pharmacology and Women's Health - Page 110

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Question 4

See full question 5s

Women generally do not eat foods high in calcium, which means that women of all ages generally consume less than the recommended amount of calcium. What supplement may be helpful in reducing bone loss? You Selected: •

Vitamin D

Correct response: •

Vitamin D

Explanation:

Reference: •

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 7: Pharmacology and Women's Health, pp. 107-109. Chapter 7: Pharmacology and Women's Health - Page 107-109

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Question 5

See full question 9s

A 20-year-old woman has been prescribed estrogen. As with all women taking estrogen, the nurse will carefully monitor the client for: You Selected: •

cardiovascular complications.

Correct response: •

cardiovascular complications.

Explanation: Reference: •

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Question 6

See full question 19s

Which would the nurse include in a teaching plan about the signs and symptoms of thrombophlebitis and thromboembolism that should be reported by a client taking estrogen? You Selected: •

Headaches

Correct response: •

Headaches

Explanation: Reference:

•

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 7: Pharmacology and Women's Health, pp. 113-114. Chapter 7: Pharmacology and Women's Health - Page 113-114

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Question 7

See full question 5s

Which of the following mood disorders can result from estrogen therapy? You Selected: •

All the above

Correct response: •

Depression

Explanation: Reference: •

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 7: Pharmacology and Women's Health, p. 113. Chapter 7: Pharmacology and Women's Health - Page 113

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Question 8

See full question 42s

The increase in thickness of the endometrial layer during the first half of the menstrual cycle is controlled by the: You Selected: •

increasing level of estrogen.

Correct response: •

increasing level of estrogen.

Explanation: Reference: •

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 7: Pharmacology and Women's Health, p. 108.

Chapter 7: Pharmacology and Women's Health - Page 108 Add a Note

Question 9

See full question 20s

The U.S. Food and Drug Administration (FDA) has issued a Black Box Warning concerning estrogen's use and associated increased risk of which of the following? You Selected: •

Endometrial carcinoma

Correct response: •

Endometrial carcinoma

Explanation: Reference: •

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 7: Pharmacology and Women's Health, p. 113. Chapter 7: Pharmacology and Women's Health - Page 113

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Question 10

See full question 9s

A 27-year-old woman is concerned that she is pregnant even though she has been using oral contraceptives. During the assessment, the nurse discovers the client has been using various herbs. Which of the following herbs is contraindicated for use with oral contraceptives? You Selected: •

St. John's wort

Correct response: •

St. John's wort

Explanation: Reference: •

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 7: Pharmacology and Women's Health, p. 114.

Chapter 7: Pharmacology and Women's Health - Page 114 Add a Note

Question 11

See full question 6s

Before a patient starts an estrogen regimen, a thorough assessment is necessary to ensure that she is not put at unnecessary risk. The nurse recognizes that this assessment should most include which of the following laboratory studies? You Selected: •

Lipid panel

Correct response: •

Lipid panel

Explanation: Reference: •

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 7: Pharmacology and Women's Health, p. p. 114.. Chapter 7: Pharmacology and Women's Health - Page p. 114.

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Question 12

See full question 25s

The nurse is caring for a client who has cancer and who until recently took estrogen. The nurse knows that estrogen may have increased the risk of development of which types of cancer? (Select all that apply.) You Selected: • •

Endometrial cancer Breast cancer

Correct response: • •

Breast cancer Endometrial cancer

Explanation: Reference:

•

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 7: Pharmacology and Women's Health, p. 113. Chapter 7: Pharmacology and Women's Health - Page 113

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Question 13

See full question 21s

The nurse is instructing a woman with type 2 diabetes mellitus who has been prescribed combined estrogen–progestin therapy. The nurse instructs the client to be alert for what change related to her diabetes? You Selected: •

Increase in blood glucose

Correct response: •

Increase in blood glucose

Explanation: Reference: •

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 7: Pharmacology and Women's Health, pp. 117-118. Chapter 7: Pharmacology and Women's Health - Page 117-118

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Question 14

See full question 29s

A patient is receiving estrogen therapy. What would the nurse instruct the patient to report immediately? You Selected: •

Shortness of breath

Correct response: •

Shortness of breath

Explanation: Reference:

•

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 7: Pharmacology and Women's Health, pp. 113-114. Chapter 7: Pharmacology and Women's Health - Page 113-114

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Question 15

See full question 7s

Which hormone would be initially responsible for hormone secretion from the ovaries and testes? You Selected: •

Follicle-stimulating hormone

Correct response: •

Gonadotropin-releasing hormone

Explanation: Reference: •

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 7: Pharmacology and Women's Health, p. 107. Chapter 7: Pharmacology and Women's Health - Page 107

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Question 16

See full question 18s

After teaching a group of students about female reproductive hormones, the instructor determines that the teaching was successful when the students identify which hormone as being primarily responsible for maintaining pregnancy? You Selected: •

Progesterone

Correct response: •

Progesterone

Explanation: Reference:

•

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 7: Pharmacology and Women's Health, p. 108. Chapter 7: Pharmacology and Women's Health - Page 108

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Question 17

See full question 24s

The nurse is scheduled to administer an oral contraceptive to a client admitted with adult onset diabetes. What is the priority teaching that would be provided regarding this medication? You Selected: •

Call the primary care provider for any sudden onset of chest pain, shortness of breath, or redness, swelling, and pain in a leg.

Correct response: •

Call the primary care provider for any sudden onset of chest pain, shortness of breath, or redness, swelling, and pain in a leg.

Explanation: Reference: •

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 7: Pharmacology and Women's Health, pp. 114-122. Chapter 7: Pharmacology and Women's Health - Page 114-122

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Question 18

See full question 31s

The health care provider has ordered a variety of laboratory assessments on a client who will need estrogen replacement. The follow labs are ordered: blood urea nitrogen (BUN), creatinine, and liver function tests (LFTs). What is the nurse’s best statement explaining to a client the need to draw the labs? You Selected: •

“The labs will identify your body’s ability to filter and excrete medications.”

Correct response: •

“The labs will identify your body’s ability to filter and excrete medications.”

Explanation: Reference: •

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 7: Pharmacology and Women's Health, p. 113. Chapter 7: Pharmacology and Women's Health - Page 113

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Question 19

See full question 39s

A monophasic oral contraceptives composition is described as having which characteristic? You Selected: •

fixed amounts of both estrogen and progestin components

Correct response: •

fixed amounts of both estrogen and progestin components

Explanation: Reference: •

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 7: Pharmacology and Women's Health, p. 118. Chapter 7: Pharmacology and Women's Health - Page 118

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Question 20

See full question 53s

What assessment question is most appropriate when assessing a 58-yearold woman for therapeutic effects of prescribed estrogen therapy? You Selected: •

“Have you stopped having menstrual bleeding since you started taking estrogen?”

Correct response: •

“Have you been having as many hot flashes and night sweats lately?”

Question 1

See full question 29s

A client is going through menopause. She informs you that her health care provider has prescribed estrogen and progesterone. She asks why she should take two medications. The nurse's bestresponse is: You Selected: •

When estrogens are used alone, they cause endometrial hyperplasia and may cause endometrial cancer.

Correct response: •

When estrogens are used alone, they cause endometrial hyperplasia and may cause endometrial cancer.

Explanation: Reference: •

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Question 2

See full question 50s

After teaching a group of students about hormonal secretion of the reproductive system, the instructor determines that the teaching was successful when the students identify what as initiating hormone secretion from the ovaries and testes? You Selected: •

Gonadotropin releasing hormone

Correct response: •

Gonadotropin releasing hormone

Explanation: Reference: •

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 7: Pharmacology and Women's Health, p. 108. Chapter 7: Pharmacology and Women's Health - Page 108

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Question 3

See full question 37s

The release of gonadotropin releasing hormone by the hypothalamus signals the onset of:

You Selected: •

menarche.

Correct response: •

puberty.

Explanation: Reference: •

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 39: Introduction to the Reproductive System, p. 108. Chapter 7: Pharmacology and Women's Health - Page 108

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Question 4

See full question 38s

A client is receiving conjugated estrogens. The nurse would anticipate administering this drug by which route? You Selected: •

Subcutaneous

Correct response: •

Oral

Explanation: Reference: •

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 40: Drugs Affecting the Female Reproductive System, p. 114. Chapter 7: Pharmacology and Women's Health - Page 114

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Question 5

See full question 14s

After teaching a patient who is prescribed estradiol vaginal cream, the nurse determines that the patient has understood the instructions when she states that she will administer the medication at which frequency? You Selected: •

Once a day

Correct response:

•

Once a day

Explanation: Reference: •

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 7: Pharmacology and Women's Health, p. 112. Chapter 7: Pharmacology and Women's Health - Page 112

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Question 6

See full question 20s

Estradiol (Estraderm) is administered to postmenopausal women to prevent which condition? You Selected: •

Osteoporosis

Correct response: •

Osteoporosis

Explanation: Reference: •

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 7: Pharmacology and Women's Health, pp. 110-112. Chapter 7: Pharmacology and Women's Health - Page 110-112

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Question 7

See full question 18s

The nurse has been conducting patient teaching for a 16-year-old who is starting on oral contraception. What statement indicates that she needs additional teaching? You Selected: •

“I know nausea is common, so I will make sure that I take the medication at the same time each day with food.”

Correct response: •

“I will continue to do monthly breast self-examination, even though these pills should decrease my risk for developing breast cancer.”

Explanation: Reference: •

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 7: Pharmacology and Women's Health, p. 113. Chapter 7: Pharmacology and Women's Health - Page 113

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Question 8

See full question 28s

On the advice of her sister, a 52-year-old woman has visited her nurse practitioner to discuss the potential benefits of hormone replacement therapy in controlling the symptoms of menopause. Which response by the nurse is most appropriate? You Selected: •

“It's important to balance the possible benefits of HRT with the fact that it might increase your risk of heart disease and stroke”

Correct response: •

“It's important to balance the possible benefits of HRT with the fact that it might increase your risk of heart disease and stroke”

Explanation: Reference: •

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 40: Drugs Affecting the Female Reproductive System, pp. 113-121. Chapter 7: Pharmacology and Women's Health - Page 113-121

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Question 9

See full question 18s

Often medications are found useful in treating symptoms other than those for which they were designed. For what other condition has the Food and Drug Administration (FDA) approved Estrostep? You Selected: •

Premenstrual dysphoric disorder

Correct response: •

Acne

Explanation:

Reference: •

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 7: Pharmacology and Women's Health, p. 118. Chapter 7: Pharmacology and Women's Health - Page 118

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Question 10

See full question 7s

In an ideal 28-day menstrual cycle, the secretory phase occurs during which days? You Selected: •

12 to 14

Correct response: •

15 to 28

Explanation: Reference: •

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 7: Pharmacology and Women's Health, pp. 108-109. Chapter 7: Pharmacology and Women's Health - Page 108-109

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Question 11

See full question 16s

The nurse performs which assessments when a female client comes to the clinic for a follow up visit while undergoing estrogen therapy? (Select all that apply.) You Selected: •

Peripheral pulse

•

Client weight

•

Peripheral oxygen saturation

•

Blood pressure check

Correct response: •

Blood pressure check

•

Client weight

•

Peripheral pulse

Explanation: Reference: •

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 40: Drugs Affecting the Female Reproductive System, pp. p. 114-123.. Chapter 7: Pharmacology and Women's Health - Page p. 114-123.

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Question 12

See full question 6s

The nurse is caring for a woman who is receiving estrogen for treatment of amenorrhea. What evidence will the nurse use to indicate that the medication is working properly? You Selected: •

Lack of menstruation

Correct response: •

Occurrence of menstruation

Explanation: Reference: •

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 7: Pharmacology and Women's Health, p. 114. Chapter 7: Pharmacology and Women's Health - Page 114

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Question 13

See full question 21s

A female client asks the nurse about the use of progestins. The nurse shares with the client that clients who take this medication are at an increased risk for what serious adverse effect? You Selected: •

Cardiovascular complications

Correct response: •

Cardiovascular complications

Explanation: Reference:

•

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 7: Pharmacology and Women's Health, p. 117. Chapter 7: Pharmacology and Women's Health - Page 117

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Question 14

See full question 24s

A patient who is taking oral contraceptives develops an upper respiratory infection for which a tetracycline is ordered. Which instruction would be most important for the nurse to include? You Selected: •

Using an alternative means of contraception while taking the tetracycline

Correct response: •

Using an alternative means of contraception while taking the tetracycline

Explanation: Reference: •

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 7: Pharmacology and Women's Health, p. 122. Chapter 7: Pharmacology and Women's Health - Page 122

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Question 15

See full question 15s

The nurse is caring for a client who would like to start taking oral contraceptives. What aspect of this client’s health history should the nurse prioritize for follow-up? You Selected: •

The client was treated for deep vein thrombosis following surgery

Correct response: •

The client was treated for deep vein thrombosis following surgery

Explanation: Reference: •

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 7: Pharmacology and Women's Health, p. 113,117,122.

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Question 16

See full question 19s

The nurse is caring for a woman with a new prescription for oral contraceptives. What outcome would be most important for the nurse to evaluate? You Selected: •

The client can verbalize how and when to take medication even if a pill is missed.

Correct response: •

The client can verbalize how and when to take medication even if a pill is missed.

Explanation: Reference: •

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 7: Pharmacology and Women's Health, pp. 123-124. Chapter 7: Pharmacology and Women's Health - Page 123-124

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Question 17

See full question 7s

A client alerts the nurse she has been in menopause for a couple of months. The nurse teaches the client how menopause occurs. Which statement reflects the teaching has been effective? You Selected: •

“Hot flashes and night sweats are prominent.”

Correct response: •

“Estrogen and progesterone diminish.”

Explanation: Reference: •

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 40: Drugs Affecting the Female Reproductive System, p. 109. Chapter 7: Pharmacology and Women's Health - Page 109

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Question 18

See full question 38s

Which statements indicate that a client understands the need for a follow-up after the initial injection of medroxyprogesterone? You Selected: •

“I know that this injection is good for 1 year.”

Correct response: •

“I know that this injection lasts for 3 months.”

Explanation: Reference: •

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 7: Pharmacology and Women's Health, p. 115. Chapter 7: Pharmacology and Women's Health - Page 115

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Question 19

See full question 8s

A 63-year-old woman taking estrogen and progestin for several years has recently changed to estrogen alone. What medical event would prompt such a change in treatment? You Selected: •

development of hypertension

Correct response: •

hysterectomy

Explanation: Reference: •

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 7: Pharmacology and Women's Health, p. 117. Chapter 7: Pharmacology and Women's Health - Page 117

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Question 20

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A client is receiving a medroxyprogesterone contraceptive injection. The nurse would instruct the client to return for the next dose at which time? You Selected:

•

1 year

Correct response: •

3 months

Explanation: Reference: •

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 7: Pharmacology and Women's Health, p. 115. Chapter 7: Pharmacology and Women's Health - Page 115

What is the preferred treatment for the diagnosis of atrophic vaginitis? You Selected: •

Estrogen preparations

Correct response: •

Estrogen preparations

Explanation: Reference: •

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 7: Pharmacology and Women's Health, pp. 111-112. Chapter 7: Pharmacology and Women's Health - Page 111-112

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Question 2

See full question 24s

Which hormone is responsible for ovulation? You Selected: •

Follicle stimulating hormone

Correct response: •

Luteinizing hormone

Explanation:

Reference: •

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 7: Pharmacology and Women's Health, p. 108. Chapter 7: Pharmacology and Women's Health - Page 108

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Question 3

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After describing the events of the menstrual cycle to a group of students, the instructor determines that the students have understood the information when they identify what as the initial event that occurs following fertilization and implantation? You Selected: •

Formation of the corpus luteum

Correct response: •

Production of human chorionic gonadotropin

Explanation: Reference: •

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018. Chapter 7, Pharmacology and Women’s Health, p. 108. Chapter 7: Pharmacology and Women's Health - Page 108

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Question 4

See full question 12s

The nurse is discussing the plan of care another nurse has developed with the client. What is an appropriate outcome that the nurse and the client may decide on? You Selected: •

Provide client teaching for drug therapy.

Correct response: •

The client can verbalize an understanding of preventable adverse drug effects.

Explanation: Reference:

•

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 7: Pharmacology and Women's Health, p. 124. Chapter 7: Pharmacology and Women's Health - Page 124

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Question 5

See full question 17s

The nurse is caring for a 23-year-old female client who is on estrogen therapy. What intervention would be appropriate in a care plan for this client? You Selected: •

Help plan for adequate calcium and vitamin D in the diet.

Correct response: •

Monitor liver function periodically.

Explanation: Reference: •

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 7: Pharmacology and Women's Health, p. 113. Chapter 7: Pharmacology and Women's Health - Page 113

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Question 6

See full question 5s

Estrogen

Correct response: •

Estrogen

Explanation: Reference:

•

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 7: Pharmacology and Women's Health, p. 107. Chapter 7: Pharmacology and Women's Health - Page 107

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Question 7

See full question 18s

As a pregnancy nears the time of delivery, what physiologic event occurs preparing the way for delivery of the fetus? You Selected: •

Levels of progesterone drop

Correct response: •

Levels of progesterone drop

Explanation: Reference: •

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 7: Pharmacology and Women's Health, p. 108. Chapter 7: Pharmacology and Women's Health - Page 108

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Question 8

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When caring for a patient receiving estrogen replacement therapy for postmenopausal symptoms, the nurse documents a diagnosis related to impaired tissue perfusion. Which condition is the nurse referring to in the diagnosis? You Selected: •

Edema of the feet

Correct response: •

Thromboembolism

Explanation: Reference:

•

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 7: Pharmacology and Women's Health, p. 113. Chapter 7: Pharmacology and Women's Health - Page 113

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Question 9

See full question 26s

A 16-year-old is prescribed estrogen therapy for hypogonadism. During therapy, what will the nurse monitor the client closely for? You Selected: •

Normal sexual development and growth

Correct response: •

Normal sexual development and growth

Explanation: Reference: •

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 7: Pharmacology and Women's Health, p. 114. Chapter 7: Pharmacology and Women's Health - Page 114

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Question 10

See full question 24s

The nurse is caring for a patient who is beginning hormone replacement therapy. Which goal is appropriate to include in the patient's plan of care? You Selected: •

The nurse will schedule appointments to monitor drug effects.

Correct response: •

The patient will take drugs accurately and for the length of time prescribed.

Explanation: Reference: •

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 7: Pharmacology and Women's Health, p. 124.

Chapter 7: Pharmacology and Women's Health - Page 124 Add a Note

Question 11

See full question 10s

When caring for a patient receiving estrogen therapy, which action would be an appropriate part of the evaluation process? You Selected: •

Teaching the patient to take estrogens and progestins with food or at bedtime to decrease nausea

Correct response: •

Interviewing the patient and observing for therapeutic and adverse effects

Explanation: Reference: •

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 7: Pharmacology and Women's Health, p. 114. Chapter 7: Pharmacology and Women's Health - Page 114

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Question 12

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A young mother is requesting oral contraceptives at her 6-week postnatal visit. Which of the following would be a contraindication for the use of progestin? You Selected: •

Breastfeeding

Correct response: •

Breastfeeding

Explanation: Reference: •

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 7: Pharmacology and Women's Health, p. 117. Chapter 7: Pharmacology and Women's Health - Page 117

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Question 13

See full question 11s

Which statement by a female client who is using the Estradiol transdermal system indicates a need for further instruction? You Selected: •

"I prefer to apply the patch to my upper thigh only."

Correct response: •

"I prefer to apply the patch to my upper thigh only."

Explanation: Reference: •

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 7: Pharmacology and Women's Health, p. 114. Chapter 7: Pharmacology and Women's Health - Page 114

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Question 14

See full question 10s

The nurse is giving discharge instructions to a client who has begun to take medroxyprogesterone for treatment of irregular vaginal bleeding. The nurse instructs the client to take this medication at what time to reduce gastrointestinal effects? You Selected: •

At bedtime

Correct response: •

At bedtime

Explanation: Reference: •

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 7: Pharmacology and Women's Health, p. 118. Chapter 7: Pharmacology and Women's Health - Page 118

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Question 15

See full question 9s

The nurse is discussing contraception with a client who has been prescribed a triphasic oral contraceptive. The nurse knows that this preparation is used for what reason? You Selected: •

It mimics normal variations of hormone secretions.

Correct response: •

It mimics normal variations of hormone secretions.

Explanation: Reference: •

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 7: Pharmacology and Women's Health, p. 118. Chapter 7: Pharmacology and Women's Health - Page 118

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Question 16

See full question 15s

The production of estrogen during pregnancy would be negatively affected if which structure was not functioning effectively? You Selected: •

placenta

Correct response: •

placenta

Explanation: Reference: •

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 7: Pharmacology and Women's Health, p. 108.. Chapter 7: Pharmacology and Women's Health - Page 108.

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Question 17

See full question 9s

What additional warnings or risks should the nurse include in the teaching plan of a client receiving estrogen? You Selected:

•

cardiac valve dysfunction

Correct response: •

endometrial cancer

Explanation: Reference: •

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 7: Pharmacology and Women's Health, p. 113. Chapter 7: Pharmacology and Women's Health - Page 113

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Question 18

See full question 42s

When considering serious adverse effects, oral contraceptive use would most likely be contraindicated in which client? You Selected: •

a 38-year-old client who smokes 1 to 1½ packs of cigarettes per day

Correct response: •

a 38-year-old client who smokes 1 to 1½ packs of cigarettes per day

Explanation: Reference: •

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 7: Pharmacology and Women's Health, pp. 113-121. Chapter 7: Pharmacology and Women's Health - Page 113-121

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Question 19

See full question 8s

When providing follow-up care for a client prescribed an oral contraceptive several months ago, the nurse must be certain to prioritize what assessment? You Selected: •

heart rate and rhythm

Correct response:

•

blood pressure application

Explanation: Reference: •

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 7: Pharmacology and Women's Health, pp. 122-123. Chapter 7: Pharmacology and Women's Health - Page 122-123

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Question 20

See full question 4s

overactive bladder syndrome

Question 1

See full question 39s

A 20-year-old woman will soon begin taking oral contraceptives for the first time. What advice should the nurse provide to this client? You Selected: •

“Make sure to seek care quickly if you experience bad headaches, calf pain, or changes in vision.”

Correct response: •

“Make sure to seek care quickly if you experience bad headaches, calf pain, or changes in vision.”

Explanation: Reference: •

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 7: Pharmacology and Women's Health, p. 123. Chapter 7: Pharmacology and Women's Health - Page 123

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Question 2

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A 21-year-old woman is prescribed an oral contraceptive pill to prevent pregnancy. The nurse should inform the client of which adverse effects of this medication? You Selected: •

Nausea

Correct response: •

Nausea

Explanation: Reference: •

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 7: Pharmacology and Women's Health, p. 121. Chapter 7: Pharmacology and Women's Health - Page 121

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Question 3

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Why does the presence of estrogen in oral contraceptives increase the risk for developing blood clots? You Selected: •

The estrogen increases production of factors II, VII, IX, and X.

Correct response: •

The estrogen increases production of factors II, VII, IX, and X.

Explanation: Reference: •

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 7: Pharmacology and Women's Health, p. 113. Chapter 7: Pharmacology and Women's Health - Page 113

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Question 4

See full question 11s

Estropipate is sometimes administered to postmenopausal women to prevent which condition?

You Selected: •

Osteoporosis

Correct response: •

Osteoporosis

Explanation: Reference: •

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 40: Drugs Affecting the Female Reproductive System, p. 112. Chapter 7: Pharmacology and Women's Health - Page 112

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Question 5

See full question 10s

Self-breast examination

Correct response: •

Self-breast examination

Explanation: Reference: •

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 7: Pharmacology and Women's Health, pp. 111-114. Chapter 7: Pharmacology and Women's Health - Page 111-114

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Question 6

See full question 11s

A client has been prescribed transdermal estradiol. What important information does the nurse share with this client? You Selected: •

Avoid prolonged sun exposure

Correct response: •

Avoid prolonged sun exposure

Explanation: Reference: •

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 7: Pharmacology and Women's Health, p. 114. Chapter 7: Pharmacology and Women's Health - Page 114

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Question 7

See full question 16s

A nurse is preparing to administer estrogen to a client with menopause. Through which routes can estrogen be administered? Select all that apply. You Selected: •

Transdermally

•

Correct response: •

•

Transdermally

Explanation: Reference: •

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 40: Drugs Affecting the Female Reproductive System, pp. 111-112. Chapter 7: Pharmacology and Women's Health - Page 111-112

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Question 8

See full question 11s

Which statement should the nurse share with a client to best describe the rationale for using a 28-day oral contraceptive pack? You Selected:

•

This cycle allows the medication regimen to mimic normal variations of hormone secretions and allows for a rest of breast function between periods.

Correct response: •

This will assist clients to comply with their medication regimen, making it less likely to forget taking their pill every day.

Explanation: Reference: •

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 7: Pharmacology and Women's Health, p. 118. Chapter 7: Pharmacology and Women's Health - Page 118

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Question 9

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*“Before the drugs are prescribed, a complete medical history, physical examination, Pap test, urinalysis, and weight and blood pressure measurements are recommended.”

Correct response: •

*“Before the drugs are prescribed, a complete medical history, physical examination, Pap test, urinalysis, and weight and blood pressure measurements are recommended.”

Explanation: Reference: •

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 7: Pharmacology and Women's Health, pp. 114-124. Chapter 7: Pharmacology and Women's Health - Page 114-124

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Question 10

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What assessment question is most appropriate when assessing a 58-year-old woman for therapeutic effects of prescribed estrogen therapy? You Selected: •

“Have you been having as many hot flashes and night sweats lately?”

Correct response:

The release of gonadotropin releasing hormone by the hypothalamus signals the onset of: You Selected: •

puberty.

Correct response: •

puberty.

Explanation: Reference: •

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 39: Introduction to the Reproductive System, p. 108. Chapter 7: Pharmacology and Women's Health - Page 108

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Question 2

See full question 13s

The nurse has been conducting patient teaching for a 16-year-old who is starting on oral contraception. What statement indicates that she needs additional teaching? You Selected: •

“I will continue to do monthly breast self-examination, even though these pills should decrease my risk for developing breast cancer.”

Correct response: •

“I will continue to do monthly breast self-examination, even though these pills should decrease my risk for developing breast cancer.”

Explanation: Reference: •

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 7: Pharmacology and Women's Health, p. 113.

Chapter 7: Pharmacology and Women's Health - Page 113 Add a Note

Question 3

See full question 13s

When a woman becomes pregnant, what structure develops that acts as both an endocrine gland and a supportive structure of the developing fetus? You Selected: •

Placenta

Correct response: •

Placenta

Explanation: Reference: •

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 7: Pharmacology and Women's Health, p. 108. Chapter 7: Pharmacology and Women's Health - Page 108

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Question 4

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The U.S. Food and Drug Administration (FDA) has issued a Black Box Warning concerning estrogen's use and associated increased risk of which of the following? You Selected: •

Endometrial carcinoma

Correct response: •

Endometrial carcinoma

Explanation: Reference: •

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 7: Pharmacology and Women's Health, p. 113. Chapter 7: Pharmacology and Women's Health - Page 113

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Question 5

See full question 6s

Breast cancer Endometrial cancer

Correct response: • •

Breast cancer Endometrial cancer

Explanation: Reference: •

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 7: Pharmacology and Women's Health, p. 113. Chapter 7: Pharmacology and Women's Health - Page 113

Question 4

See full question 26s

The nurse is completing a health history on a client experieicing menopause. What assessment findings indicate menopause? Select all that apply. You Selected: • • •

sleep problems hot flashes mood changes

Correct response: • • • •

hot flashes mood changes sleep problems painful intercourse

Question 1

See full question 1m 44s

Anabolic steroid use causes an increase in muscular work capacity, which is what makes these agents popular as performance-enhancing drugs. They are dangerous specifically to teens because they: You Selected: •

can damage the heart, liver, and kidneys.

Correct response: •

can damage the heart, liver, and kidneys.

Explanation: Reference: •

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 8: Pharmacology and Men's Health, p. 132. Chapter 8: Pharmacology and Men's Health - Page 132

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Question 2

See full question 48s

A male clent who uses a transdermal testosterone gel for treatment of his oligospermia applies the medication first thing in the morning and washes it off before bed. What client education is necessary? You Selected: •

Leave the gel on until the next application is due.

Correct response: •

Leave the gel on until the next application is due.

Explanation: Reference: •

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 8: Pharmacology and Men's Health, pp. 131-132. Chapter 8: Pharmacology and Men's Health - Page 131-132

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Question 3

See full question 49s

Which results with the administration of testosterone? You Selected: •

Decreased retention of sodium

Correct response: •

Decreased protein catabolism

Explanation: Reference: •

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 8: Pharmacology and Men's Health, p. 128. Chapter 8: Pharmacology and Men's Health - Page 128

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Question 4

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A 9-year-old boy is taking testosterone injections for treatment of hypogonadism. What should be measured every 6 months on this child? You Selected: •

Hand and wrist epiphyseal growth plates

Correct response: •

Hand and wrist epiphyseal growth plates

Explanation: Reference: •

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 8: Pharmacology and Men's Health, p. 131. Chapter 8: Pharmacology and Men's Health - Page 131

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Question 5

See full question 27s

An adult female has been taking prescribed androgens. What result of taking androgens should be included in the client teaching?

You Selected: •

Suppression of menstruation

Correct response: •

Suppression of menstruation

Explanation: Reference: •

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 8: Pharmacology and Men's Health, p. 130. Chapter 8: Pharmacology and Men's Health - Page 130

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Question 6

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A 52-year-old male with type 2 diabetes is using an anabolic steroid for treatment of hormonal deficiency. He is taking the sulfonylurea glyburide (DiaBeta) to treat his diabetes. The nurse caring for this client would closely monitor his: You Selected: •

blood glucose level.

Correct response: •

blood glucose level.

Explanation: Reference: •

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 8: Pharmacology and Men's Health, p. 131. Chapter 8: Pharmacology and Men's Health - Page 131

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Question 7

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The health care provider for a 63-year-old male prescribes androgens for treatment of impotence. Which statement by the client leads the nurse to believe that he has understood the teaching?

You Selected: •

“If my skin appears yellow or my urine turns dark, I will contact my provider.”

Correct response: •

“If my skin appears yellow or my urine turns dark, I will contact my provider.”

Explanation: Reference: •

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 8: Pharmacology and Men's Health, p. 131. Chapter 8: Pharmacology and Men's Health - Page 131

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Question 8

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What would danazol (Danocrine) be administered to women for? You Selected: •

Decrease symptoms of endometriosis

Correct response: •

Decrease symptoms of endometriosis

Explanation: Reference: •

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Question 9

See full question 1m 38s

A 24-year-old female athlete is using high doses of anabolic steroids to enhance her performance. She may be at risk for which condition? You Selected:

•

Acne

Correct response: •

Acne

Explanation: Reference: •

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 8: Pharmacology and Men's Health, p. 133. Chapter 8: Pharmacology and Men's Health - Page 133

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Question 10

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Androgens may be prescribed to women to treat conditions related to the effects of the female sex hormones. Danazol is prescribed to prevent or treat fibrocystic breast disease and: You Selected: •

endometriosis.

Correct response: •

endometriosis.

Explanation: Reference: •

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Question 11

See full question 24s

A nurse is caring for a 28-year-old patient who is taking exogenous testosterone for treatment of cryptorchidism. What statement by this patient would lead the nurse to believe that patient teaching has been ineffective? You Selected: •

"My sperm count should increase."

Correct response: •

"My sperm count should increase."

Explanation: Reference: •

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 8: Pharmacology and Men's Health, pp. 130-131. Chapter 8: Pharmacology and Men's Health - Page 130-131

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Question 12

See full question 1m 51s

A client has been given a prescription for sildenafil (Viagra) for treatment of erectile dysfunction. The nurse will instruct the client to take this medication at what time prior to the onset of sexual intercourse? You Selected: •

30 minutes

Correct response: •

30 minutes

Explanation: Reference: •

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 41: Drugs Affecting the Male Reproductive System, p. 134. Chapter 8: Pharmacology and Men's Health - Page 134

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Question 13

See full question 48s

The nurse instructs the client who is receiving sildenafil to avoid eating which meal immediately prior to taking the medication? You Selected: •

Fried catfish, baked potato with butter, and sour cream and broccoli

Correct response: •

Fried catfish, baked potato with butter, and sour cream and broccoli

Explanation: Reference: •

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 8: Pharmacology and Men's Health, p. 135. Chapter 8: Pharmacology and Men's Health - Page 135

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Question 14

See full question 46s

A teenage client who is using testosterone to treat a hormone deficiency calls the clinic to report acne-like skin eruptions on the face. How should the nurse counsel this client? You Selected: •

Practice frequent and thorough skin cleansing.

Correct response: •

Practice frequent and thorough skin cleansing.

Explanation: Reference: •

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Question 15

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A group of students are reviewing the drugs available for treating penile erectile dysfunction. The students demonstrate understanding when they identify which drug as a PDE5 inhibitor? You Selected: •

Sildenafil

Correct response: •

Sildenafil

Explanation: Reference:

•

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 41: Drugs Affecting the Male Reproductive System, p. 133. Chapter 8: Pharmacology and Men's Health - Page 133

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Question 16

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A nurse is instructing a client about vardenafil. The nurse would instruct the client to take the drug how many minutes before sexual stimulation? You Selected: •

30 minutes

Correct response: •

60 minutes

Explanation: Reference: •

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 8: Pharmacology and Men's Health, p. 134. Chapter 8: Pharmacology and Men's Health - Page 134

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Question 17

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A client has begun treatment for penile erectile dysfunction. What explanation should the nurse provide regarding the primary effect a prescribed phosphodiesterase type 5 inhibitor will have on this condition? You Selected: •

Blood flow to the penis will be improved

Correct response: •

Blood flow to the penis will be improved

Explanation: Reference: •

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 41: Drugs Affecting the Male Reproductive System, p. 133.

Chapter 8: Pharmacology and Men's Health - Page 133 Add a Note

Question 18

See full question 32s

What aspect of a client’s current health status may contraindicate the use of a PDE5 inhibitor? You Selected: •

The client has a history of unstable angina pectoris.

Correct response: •

The client has a history of unstable angina pectoris.

Explanation: Reference: •

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 8: Pharmacology and Men's Health, p. 134. Chapter 8: Pharmacology and Men's Health - Page 134

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Question 19

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A client, prescribed finasteride, asks the nurse how the medication works. Which statement bestaddresses the client’s question? You Selected: •

“Decreases proliferative prostatic cells.”

Correct response: •

“Decreases proliferative prostatic cells.”

Explanation: Reference: •

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 8: Pharmacology and Men's Health, Table 8.1 Drugs Administered for Maintenance of Male Reproductive Health, p. 136. Chapter 8: Pharmacology and Men's Health - Page 136

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Question 20

See full question 34s

A client is prescribed testosterone gel. Which would the nurse include in the teaching plan? Select all that apply. You Selected: • • •

Allowing the application site to dry before getting dressed. Applying the gel once daily in the morning. Washing hands with soap and water after applying.

Correct response: • • •

Allowing the application site to dry before getting dressed. Applying the gel once daily in the morning. Washing hands with soap and water after applying.

Question 1

See full question 11s

A patient presenting with an androgen deficiency state is prescribed an oral anabolic steroid. A higher dose of steroid is indicated due to its: You Selected: •

Extensive metabolism in the first pass through liver.

Correct response: •

Extensive metabolism in the first pass through liver.

Explanation: Reference: •

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 8: Pharmacology and Men's Health, p. 131. Chapter 8: Pharmacology and Men's Health - Page 131

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Question 2

See full question 2m 7s

In older adult men, anabolic steroids may be prescribed for a deficiency condition. If hypertensive, what might be the cause for an increase in blood pressure? You Selected: •

Increased fluid and sodium retention

Correct response:

•

Increased fluid and sodium retention

Explanation: Reference: •

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 8: Pharmacology and Men's Health, p. 131. Chapter 8: Pharmacology and Men's Health - Page 131

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Question 3

See full question 1m 4s

Which would be most important to assess in a client receiving testosterone for a prolonged period of time? You Selected: •

Liver function studies

Correct response: •

Liver function studies

Explanation: Reference: •

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Question 4

See full question 2m 4s

An older male client will soon begin taking an androgen. The client has difficulty swallowing tablets and pills. Because of the available drug route, a good choice for this client would be: You Selected: •

Testosterone (Testoderm).

Correct response: •

Testosterone (Testoderm).

Explanation:

Reference: •

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 8: Pharmacology and Men's Health, p. 127. Chapter 8: Pharmacology and Men's Health - Page 127

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Question 5

See full question 25s

A student asks the pharmacology instructor what effect the administration of androgens can have on a fetus if administered during pregnancy. What should the instructor respond? You Selected: •

Female child may have masculinized features

Correct response: •

Female child may have masculinized features

Explanation: Reference: •

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 8: Pharmacology and Men's Health, p. 131. Chapter 8: Pharmacology and Men's Health - Page 131

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Question 6

See full question 14s

A female patient receiving fluoxymesterone, an androgenic drug, for metastatic breast cancer is disturbed by the physical changes seen in her body. Which feature of virilization may be seen in the patient receiving this therapy? You Selected: •

Deepening of the voice

Correct response: •

Deepening of the voice

Explanation: Reference:

•

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 8: Pharmacology and Men's Health, p. 131. Chapter 8: Pharmacology and Men's Health - Page 131

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Question 7

See full question 49s

A young male patient, age 14, has been prescribed testosterone for delayed onset of puberty. Follow-up care includes a visit to the clinic at least every 6 months for ongoing assessment. It will be most important for the nurse to monitor: You Selected: •

Bone growth

Correct response: •

Bone growth

Explanation: Reference: •

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 8: Pharmacology and Men's Health, p. 131. Chapter 8: Pharmacology and Men's Health - Page 131

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Question 8

See full question 27s

What effect can administration of androgens have on fetal development? You Selected: •

A female fetus may be spontaneously aborted.

Correct response: •

A female fetus may experience masculinization.

Explanation: Reference: •

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 8: Pharmacology and Men's Health, p. 131.

Chapter 8: Pharmacology and Men's Health - Page 131 Add a Note

Question 9

See full question 2m 41s

When fluoxymesterone is administered to a 14-year-old male, what is the expected result? You Selected: •

Development of sexual organs

Correct response: •

Development of sexual organs

Explanation: Reference: •

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Question 10

See full question 1m 41s

The nurse is instructing the parents of an 11-year-old male who has testosterone deficiency. Which symptom, if found in this child, would cause the discontinuation of this medication? You Selected: •

Enlarged penis

Correct response: •

Enlarged penis

Explanation: Reference: •

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 8: Pharmacology and Men's Health, p. 131. Chapter 8: Pharmacology and Men's Health - Page 131

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Question 11

See full question 42s

The nurse is assessing a 22-year-old male. What symptoms would indicate that this client may be experiencing androgen deficiency? (Select all that apply.) You Selected: • • •

Low sperm count Inability to have an erection Very small testicles

Correct response: • • •

Very small testicles Inability to have an erection Low sperm count

Explanation: Reference: •

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 8: Pharmacology and Men's Health, p. 129. Chapter 8: Pharmacology and Men's Health - Page 129

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Question 12

See full question 43s

The health care provider has prescribed testosterone for a 77-year-old client with a low testosterone level. The nurse will evaluate this client for what condition that may develop in this client in response to this medication? You Selected: •

Benign prostatic hypertrophy

Correct response: •

Benign prostatic hypertrophy

Explanation: Reference: •

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 8: Pharmacology and Men's Health, p. 127.

Chapter 8: Pharmacology and Men's Health - Page 127 Add a Note

Question 13

See full question 27s

The nurse is aware that a client receiving which category of medication will not be prescribed vardenafil? You Selected: •

Antidysrhythmics

Correct response: •

Antidysrhythmics

Explanation: Reference: •

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 8: Pharmacology and Men's Health, p. 136. Chapter 8: Pharmacology and Men's Health - Page 136

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Question 14

See full question 43s

A male adolescent is prescribed testosterone. In order to help the client deal with the added social stress that the medication may cause, the nurse should discuss which possible adverse effect? You Selected: •

Deepening of the voice

Correct response: •

The development of acne

Explanation: Reference: •

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 8: Pharmacology and Men's Health, p. 131. Chapter 8: Pharmacology and Men's Health - Page 131

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Question 15

See full question 1m 5s

A client with a history of benign prostatic hypertrophy (BPH) is seeking androgenic medication treatment for penile erectile dysfunction. What information should the nurse provide the client regarding this therapy? You Selected: •

It increases the risk for prostate cancer

Correct response: •

It increases the risk for prostate cancer

Explanation: Reference: •

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 41: Drugs Affecting the Male Reproductive System, pp. 129-131. Chapter 8: Pharmacology and Men's Health - Page 129-131

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Question 16

See full question 28s

The 22-year-old client tells the nurse he doesn't have trouble obtaining and maintaining an erection but wonders if taking Viagra would improve the sexual experience anyway. What is the nurse's best response? You Selected: •

“The only thing Viagra does is improve blood flow to the penis to make it erect.”

Correct response: •

“The only thing Viagra does is improve blood flow to the penis to make it erect.”

Explanation: Reference: •

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 8: Pharmacology and Men's Health, p. 133. Chapter 8: Pharmacology and Men's Health - Page 133

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Question 17

See full question 31s

An older adult client has developed an androgen deficiency, and treatment options are being considered. The client’s nurse should be aware that the use of exogenous testosterone has the potential to exacerbate what problem? You Selected: •

benign prostatic hypertrophy (BPH)

Correct response: •

benign prostatic hypertrophy (BPH)

Explanation: Reference: •

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 8: Pharmacology and Men's Health, pp. 127-129. Chapter 8: Pharmacology and Men's Health - Page 127-129

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Question 18

See full question 52s

An older adult client’s current medication regimen includes tamsulosin and sildenafil. The combination of these two medications should prompt what action by the nurse? You Selected: •

arranging for the client to have blood clotting diagnostic samples drawn

Correct response: •

assessing the client regularly for signs of orthostatic hypotension

Explanation: Reference: •

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 8: Pharmacology and Men's Health, pp. 134-139. Chapter 8: Pharmacology and Men's Health - Page 134-139

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Question 19

See full question 40s

A female client expresses the desire to suppress her female sex characteristics to facilitate a transition to being male. Which androgen does the nurse anticipate the provider will prescribe? You Selected: •

Testosterone

Correct response: •

Testosterone

Explanation: Reference: •

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 8: Pharmacology and Men's Health, p. 130. Chapter 8: Pharmacology and Men's Health - Page 130

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Question 20

See full question 27s

A client reports impotence and a lack of sexual desire. What medication does the nurse anticipate educating the client about? You Selected: •

Vardenafil

Correct response: •

Testosterone

Question 1

See full question 50s

Which is an example of an androgen that can be used to treat hypogonadism? You Selected: •

fluoxymesterone

Correct response: •

fluoxymesterone

Explanation: Reference: •

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Question 2

See full question 32s

The nurse is providing patient education to a 16-year-old male who has been prescribed androgen therapy for treatment of delayed puberty. The nurse explains that, after drug therapy is stopped, stimulation of skeletal growth continues for approximately You Selected: •

6 months

Correct response: •

6 months

Explanation: Reference: •

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 8: Pharmacology and Men's Health, p. 131. Chapter 8: Pharmacology and Men's Health - Page 131

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Question 3

See full question 31s

The nurse receives a call from a male client who takes finasteride (Proscar) for treatment of BPH, and tells the nurse that his wife may be pregnant. What does the nurse expect the health care provider to do? You Selected: •

Discontinue the medication.

Correct response: •

Discontinue the medication.

Explanation: Reference: •

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 8: Pharmacology and Men's Health, p. 136. Chapter 8: Pharmacology and Men's Health - Page 136

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Question 4

See full question 38s

The nurse is obtaining a history from a 23-year-old man. The nurse suspects that the client may be using DHEA if he displays which symptom? You Selected: •

Hirsutism

Correct response: •

Hirsutism

Explanation: Reference: •

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 8: Pharmacology and Men's Health, p. 133. Chapter 8: Pharmacology and Men's Health - Page 133

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Question 5

See full question 18s

The nurse is reviewing the history of a client who is to receive testosterone. Which of the following would alert the nurse to the need for close monitoring of the client? You Selected: •

Cardiovascular disease

Correct response: •

Cardiovascular disease

Explanation: Reference: •

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 8: Pharmacology and Men's Health, pp. 131-132. Chapter 8: Pharmacology and Men's Health - Page 131-132

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Question 6

See full question 32s

A client has been receiving long-term testosterone therapy. The nurse would expect to monitor: You Selected: •

Liver function studies

Correct response: •

Liver function studies

Explanation: Reference: •

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Question 7

See full question 1m 23s

A client is receiving androgen therapy. Which would cause the nurse the greatest concern? You Selected: •

Elevated liver enzyme levels

Correct response: •

Elevated liver enzyme levels

Explanation: Reference: •

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 8: Pharmacology and Men's Health, p. 131. Chapter 8: Pharmacology and Men's Health - Page 131

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Question 8

See full question 23s

The nurse would instruct a client who is using a transdermal system for testosterone administration to apply a new patch at which frequency?

You Selected: •

Every day

Correct response: •

Every day

Explanation: Reference: •

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 8: Pharmacology and Men's Health, p. 130. Chapter 8: Pharmacology and Men's Health - Page 130

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Question 9

See full question 25s

A child is prescribed testosterone therapy. Which diagnostic lab result should the nurse monitor to determine the effectiveness of the therapy? You Selected: •

Liver function

Correct response: •

Red blood cell count

Explanation: Reference: •

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018. Chapter 8, Pharmacology and Men’s Health, p. 131. Chapter 8: Pharmacology and Men's Health - Page 131

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Question 10

See full question 31s

A 68-year-old male client tells the nurse that he has been unable to maintain an erection for the past 6 months and he guesses his sex life is over. The provider orders diagnostic testing to determine whether sildenafil (Viagra) is appropriate for the client. What is the most appropriate nursing diagnosis for this client?

You Selected: •

Sexual dysfunction

Correct response: •

Sexual dysfunction

Question 1

See full question 38s

Which would the nurse expect to administer as a depot injection? You Selected: •

Testosterone

Correct response: •

Testosterone

Explanation: Reference: •

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 8: Pharmacology and Men's Health, p. 131. Chapter 8: Pharmacology and Men's Health - Page 131

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Question 2

See full question 40s

A post-menopausal client has been diagnosed with breast cancer. The client is being treated with methyltestosterone (Testred). What would indicate that she is developing a complication from the medication? You Selected: •

Jaundice

Correct response: •

Jaundice

Explanation: Reference:

•

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 8: Pharmacology and Men's Health, p. 131. Chapter 8: Pharmacology and Men's Health - Page 131

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Question 3

See full question 20s

A 69-year-old male is diagnosed with hypogonadism, and the health care provider orders testosterone. The client is found to have hypertension. What is this client at increased risk for? You Selected: •

Liver failure

Correct response: •

Aggravated cardiovascular disorders

Explanation: Reference: •

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 8: Pharmacology and Men's Health, p. 131. Chapter 8: Pharmacology and Men's Health - Page 131

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Question 4

See full question 35s

An 80-year-old patient with chronic renal insufficiency is advised to undertake anabolic steroid therapy for the management of anemia associated with renal insufficiency. Which risk increases in elderly patients undergoing anabolic steroid therapy? You Selected: •

Cancer of the prostate

Correct response: •

Cancer of the prostate

Explanation: Reference:

•

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 8: Pharmacology and Men's Health, p. 131. Chapter 8: Pharmacology and Men's Health - Page 131

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Question 5

See full question 37s

A patient with delayed puberty has been advised to take testosterone (Androderm) transdermal therapy. Which instruction should the nurse provide the patient to help promote an optimal response to this therapy? You Selected: •

Apply immediately after removing the cover.

Correct response: •

Apply immediately after removing the cover.

Explanation: Reference: •

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Question 6

See full question 29s

Phil is prescribed testosterone for erectile dysfunction secondary to androgen deficiency. During the assessment, the nurse notes that he also suffers from benign prostatic hypertrophy (BPH). What effect is the drug most likely to have in this case? You Selected: •

Worsening of the BPH with possible urethral obstruction

Correct response: •

Worsening of the BPH with possible urethral obstruction

Explanation: Reference:

•

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 8: Pharmacology and Men's Health, p. 131. Chapter 8: Pharmacology and Men's Health - Page 131

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Question 7

See full question 30s

A nurse is instructing a client about vardenafil. The nurse would instruct the client to take the drug how many minutes before sexual stimulation? You Selected: •

60 minutes

Correct response: •

60 minutes

Explanation: Reference: •

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 8: Pharmacology and Men's Health, p. 134. Chapter 8: Pharmacology and Men's Health - Page 134

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Question 8

See full question 31s

A 9 year old child has been prescribed testosterone. What information should the nurse provide the client's parents regarding the continuation of the therapy? You Selected: •

If signs of early puberty are identified the therapy should be stopped

Correct response: •

If signs of early puberty are identified the therapy should be stopped

Explanation: Reference:

•

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 8: Pharmacology and Men's Health, p. 131. Chapter 8: Pharmacology and Men's Health - Page 131

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Question 9

See full question 42s

A female client is prescribed danazol, an androgen. Which assessment question demonstrates the nurse's understanding of the medication's indications for a female client? Select all that apply You Selected: • • •

"Who else in your family experienced angioedema?" "Have you ever been diagnosed with endometriosis?" "When were you diagnosed with fibrocystic breast disease?"

Correct response: • • •

"Have you ever been diagnosed with endometriosis?" "When were you diagnosed with fibrocystic breast disease?" "Who else in your family experienced angioedema?"

Explanation: Reference: •

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Question 10

See full question 50s

A client with a recent history of benign prostatic hypertrophy (BPH) will soon begin treatment with finasteride. Before beginning this course of therapy, the nurse should caution the client to be aware of what potentially adverse effect? You Selected: •

sexual dysfunction

Correct response: •

sexual dysfunction

Question 1

See full question 33s

A male taking anabolic steroids could expect to experience what physical change? You Selected: •

Reduced sperm count

Correct response: •

Reduced sperm count

Explanation: Reference: •

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 8: Pharmacology and Men's Health, p. 131. Chapter 8: Pharmacology and Men's Health - Page 131

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Question 2

See full question 19s

A male patient with a medical background tells the nurse that he is not satisfied with the oral synthetic testosterone that has been prescribed for him and he would like to try a natural form of oral testosterone. Which of the following would be an appropriate response by the nurse? You Selected: •

“Natural testosterone undergoes a short first-past effect and is less extensively metabolized than what has been prescribed for you.”

Correct response: •

“Natural testosterone undergoes a high first-pass effect and is not used orally.”

Explanation: Reference: •

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 8: Pharmacology and Men's Health, p. 131.

Chapter 8: Pharmacology and Men's Health - Page 131 Add a Note

Question 3

See full question 26s

A 32-year-old male on glyburide drug therapy is prescribed a transdermal testosterone patch. This combination of therapies requires the nurse to closely monitor the patient for what possible adverse reaction? You Selected: •

Hypoglycemia

Correct response: •

Hypoglycemia

Explanation: Reference: •

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 8: Pharmacology and Men's Health, p. 131. Chapter 8: Pharmacology and Men's Health - Page 131

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Question 4

See full question 24s

A nurse is teaching a class at the local high school on the abuse of anabolic steroids. Which potential adverse reaction should the nurse cite regarding the long-term use of these hormones? You Selected: •

liver tumors.

Correct response: •

liver tumors.

Explanation: Reference: •

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 8: Pharmacology and Men's Health, p. 133. Chapter 8: Pharmacology and Men's Health - Page 133

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Question 5

See full question 24s

The nurse is aware that medications for erectile dysfunction are frequently prescribed because what percentage of men between the ages of 40 and 70 years develop this disorder? You Selected: •

75%

Correct response: •

50%

Explanation: Reference: •

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 8: Pharmacology and Men's Health, p. 127. Chapter 8: Pharmacology and Men's Health - Page 127

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Question 6

See full question 45s

The nurse knows that finasteride is used to treat prostatic hypertrophy, and in smaller doses is used to treat what condition? You Selected: •

Erectile dysfunction

Correct response: •

Male pattern baldness

Explanation: Reference: •

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 8: Pharmacology and Men's Health, p. 136. Chapter 8: Pharmacology and Men's Health - Page 136

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Question 7

See full question 3m 18s

A client has been prescribed a PDE5 inhibitor for penile erectile dysfunction. Medication education should strongly discourage the use of what drug classification while on this medication? You Selected: •

Serotonin re-uptake inhibitors

Correct response: •

Alpha-blockers

Explanation: Reference: •

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 41: Drugs Affecting the Male Reproductive System, p. 138. Chapter 8: Pharmacology and Men's Health - Page 138

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Question 8

See full question 28s

The nurse has administered a prescribed dose of danazol to an adult female client for the purpose of preventing ovulation. When providing care related to the client’s underlying diagnosis, what nursing action is most appropriate? You Selected: •

Monitor the client for signs and symptoms of infection

Correct response: •

Assess the client’s pain frequently

Explanation: Reference: •

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018. Chapter 8, Pharmacology and Men’s Health. p. 132. Chapter 8: Pharmacology and Men's Health - Page 132

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Question 9

See full question 1m 25s

The nurse is scheduled to administer testosterone transdermal patch to a client admitted with primary hypogonadism. What is the priority teaching that would be provided regarding this medication? You Selected: •

Report to primary care provider any leg pain, redness, and swelling right away.

Correct response: •

Report to primary care provider any leg pain, redness, and swelling right away.

Explanation: Reference: •

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018. Chapter 8, Pharmacology and Men’s Health, pp. 130-132. Chapter 8: Pharmacology and Men's Health - Page 130-132

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Question 10

See full question 35s

A client reports impotence and a lack of sexual desire. What medication does the nurse anticipate educating the client about? You Selected: •

Sildenafil

Correct response: •

Testosterone

Question 1

See full question 1m 1s

Which would be most important to assess in a client receiving testosterone for a prolonged period of time? You Selected: •

Liver function studies

Correct response: •

Liver function studies

Explanation:

Reference: •

Add a Note

Question 2

See full question 31s

A 9-year-old boy is taking testosterone injections for treatment of hypogonadism. What should be measured every 6 months on this child? You Selected: •

Hand and wrist epiphyseal growth plates

Correct response: •

Hand and wrist epiphyseal growth plates

Explanation: Reference: •

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 8: Pharmacology and Men's Health, p. 131. Chapter 8: Pharmacology and Men's Health - Page 131

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Question 3

See full question 30s

A client is using a transdermal system for androgen administration. Which drug would the client most likely be using? You Selected: •

Testosterone

Correct response: •

Testosterone

Explanation: Reference:

•

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 8: Pharmacology and Men's Health, p. 131. Chapter 8: Pharmacology and Men's Health - Page 131

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Question 4

See full question 28s

It increases the risk for prostate cancer

Correct response: •

It increases the risk for prostate cancer

Explanation: Reference: •

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 41: Drugs Affecting the Male Reproductive System, pp. 129-131. Chapter 8: Pharmacology and Men's Health - Page 129-131

Add a Note

Question 5

See full question 55s

An older adult client’s current medication regimen includes tamsulosin and sildenafil. The combination of these two medications should prompt what action by the nurse? You Selected: •

assessing the client regularly for signs of orthostatic hypotension

Correct response: •

assessing the client regularly for signs of orthostatic hypotension

Question 1

See full question 1m 43s

The nurse is obtaining a history from a 23-year-old man. The nurse suspects that the client may be using DHEA if he displays which symptom? You Selected:

•

Hirsutism

Correct response: •

Hirsutism

Explanation: Reference: •

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 8: Pharmacology and Men's Health, p. 133. Chapter 8: Pharmacology and Men's Health - Page 133

Add a Note

Question 2

See full question 19s

The nurse is aware that a client receiving which category of medication will not be prescribed vardenafil? You Selected: •

Antidysrhythmics

Correct response: •

Antidysrhythmics

Explanation: Reference: •

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 8: Pharmacology and Men's Health, p. 136. Chapter 8: Pharmacology and Men's Health - Page 136

Add a Note

Question 3

See full question 30s

The nurse is reviewing the history of a client who is to receive testosterone. Which of the following would alert the nurse to the need for close monitoring of the client? You Selected: •

Cardiovascular disease

Correct response: •

Cardiovascular disease

Explanation: Reference: •

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 8: Pharmacology and Men's Health, pp. 131-132. Chapter 8: Pharmacology and Men's Health - Page 131-132

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Question 4

See full question 44s

A client is receiving androgen therapy. Which would cause the nurse the greatest concern? You Selected: •

Elevated liver enzyme levels

Correct response: •

Elevated liver enzyme levels

Explanation: Reference: •

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 8: Pharmacology and Men's Health, p. 131. Chapter 8: Pharmacology and Men's Health - Page 131

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Question 5

See full question 44s

Which medical diagnosis is a contraindication for testosterone therapy? Select all that apply. You Selected: • •

liver dysfunction prostate cancer

Correct response:

• • •

pPregnancy prostate cancer breast cancer

Question 1

See full question 14s

Which would the nurse expect to administer as a depot injection? You Selected: •

Testosterone

Correct response: •

Testosterone

Explanation: Reference: •

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 8: Pharmacology and Men's Health, p. 131. Chapter 8: Pharmacology and Men's Health - Page 131

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Question 2

See full question 13s

Jaundice

Correct response: •

Jaundice

Explanation: Reference: •

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 8: Pharmacology and Men's Health, p. 131.

Chapter 8: Pharmacology and Men's Health - Page 131 Add a Note

Question 3

See full question 15s

A 9 year old child has been prescribed testosterone. What information should the nurse provide the client's parents regarding the continuation of the therapy? You Selected: •

If signs of early puberty are identified the therapy should be stopped

Correct response: •

If signs of early puberty are identified the therapy should be stopped

Explanation: Reference: •

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 8: Pharmacology and Men's Health, p. 131. Chapter 8: Pharmacology and Men's Health - Page 131

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Question 4

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urinary retention

Correct response: •

sexual dysfunction

Explanation: Reference: •

Frandsen, Geralyn, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 8: Pharmacology and Men's Health, p. 136.

Chapter 8: Pharmacology and Men's Health - Page 136 Add a Note

Question 5

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A client diagnosed with benign prostatic hypertrophy (BPH) is prescribe tamsulosin. The client communicates with the nurse about a friend that was prescribed sildenafil for his BPH. Which is the nurse’s best response regarding the difference in the use of the two drugs for BPH? You Selected: •

Tamsulosin is recommended for long-term therapy of BPH.

Correct response: •

Tamsulosin relaxes muscles in the prostate and bladder and increases ability to urinate.

Question 4

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9 months

Correct response: •

6 months

1. A patient is taking warfarin (Coumadin) after open heart surgery. The patient tells the home care nurse she has pain in both knees that began this week. The nurse notes bruises on both knees. Based on the effects of her medications and the complaint of pain, what does the nurse suspect is the cause of the pain? A) Joint thrombosis B) Torn medial meniscus C) Degenerative joint disease caused by her medication D) Bleeding Ans: D Feedback: The main adverse effect of warfarin (Coumadin) is bleeding. The sudden onset of pain in the knees alerts the nurse to assess the patient for bleeding. Arthritis, torn medical meniscus, and degenerative joint disease could all be symptoms of knee pain, but the onset and combination of anticoagulant therapy is not an etiology of these types of injuries and disease.

2. A patient who has been treated with warfarin (Coumadin) after cardiac surgery is found to have an INR of 9.0. Which medication will be administered to assist in the development of clotting factors? A) Vitamin K B) Vitamin E C) Protamine sulfate D) Acetylsalicylic acid (Aspirin) Ans: A Feedback: Vitamin K is the antidote for warfarin overdosage. In this case, the patient may be at the therapeutic level to control thrombus formation, but, due to the injury, it is important to control bleeding. Vitamin E is not used as an antidote for warfarin overdosage. Protamine sulfate is used as an antidote to heparin or low molecular-weight heparin. Acetylsalicylic acid (Aspirin) is used to decrease coagulation as a preventive measure for myocardial infarction.

3. A patient has a history of clot formation. She is scheduled for bowel resection due to colorectal cancer. What anticoagulant agent will be administered prophylactically? A) Acetylsalicylic acid (Aspirin) B) Heparin C) Warfarin (Coumadin) D) Streptokinase (Streptase) Ans: B Feedback: Prophylactically, low doses of heparin are given to prevent thrombus formation in patients having major abdominal surgery. Acetylsalicylic acid is not used to prevent thrombus in patients having major abdominal surgery. Warfarin takes several days for

therapeutic effects to occur; thus it is not used prophylactically to prevent thrombus in a patient with abdominal surgery. Streptokinase promotes thrombolysis and is not used to prevent thrombus.

4. A patient has been administered heparin to prevent thromboembolism development status postmyocardial infarction. The patient develops heparin-induced thrombocytopenia. Which of the following medications will be administered? A) Argatroban (Acova) B) Vitamin K C) Calcium gluconate D) Aminocaproic acid (Amicar) Ans: A Feedback: Heparin-induced thrombocytopenia may occur in 1% to 3% of those receiving heparin and is a very serious side effect of heparin. In this patient, all heparin administration must be discontinued and anticoagulation managed with a direct thrombin inhibitor, such as argatroban. The patient is not administered vitamin K, calcium gluconate, or aminocaproic acid.

5. A patient is receiving low molecular weight heparin to prevent thromboembolic complications. The nursing student asks the nursing instructor the reason why this treatment is given instead of heparin. What is the instructor's best explanation of the rationale for LMWH over heparin? A) ìLMWH is associated with less thrombocytopenia than standard heparin.î B) ìLMWH is associated with stronger anticoagulant effects than standard heparin.î C) ìLMWH is given to patients who have a history of blood dyscrasia.î D) ìLMWH is more effective than standard heparin for patients with hypertension.î Ans: A Feedback: Low molecular weight heparins are associated with less thrombocytopenia than standard heparin. Low molecular weight heparin is not stronger than standard heparin. Low molecular weight heparin is administered cautiously in patients with blood dyscrasia and hypertension.

6. A patient who is receiving warfarin (Coumadin) has blood in his urinary catheter drainage bag. What medication will likely be ordered by the physician? A) Aminocaproic acid (Amicar) B) Platelets C) Protamine sulfate D) Vitamin K Ans: D Feedback: Vitamin K is the antidote for warfarin overdose. Aminocaproic acid is used to control

excessive bleeding from systemic hyperfibrinolysis. Platelets are a blood product, not a medication. Protamine sulfate is the antidote for heparin therapy.

7. A patient has experienced the formation of clots and has bruising. It is determined that there is a depletion of the patient's coagulation factors and widespread bleeding. Which of the following medications will be administered? A) Aminocaproic acid (Amicar) B) Heparin C) Warfarin (Coumadin) D) Protamine sulfate Ans: B Feedback: The development of clots and widespread bleeding is indicative of disseminated intravascular coagulation. The patient should be administered heparin to slow the formation of clots. The goal of heparin therapy in DIC is to prevent blood coagulation long enough for clotting factors to replenish and control hemorrhage. Aminocaproic acid is used to control excessive bleeding from systemic hyperfibrinolysis. Warfarin is administered orally to decrease clot formation. Protamine sulfate would not be administered.

8. A patient is admitted with thrombophlebitis and sent home on enoxaparin (Lovenox). Which statement indicates a good understanding of why enoxaparin is being administered? A) Enoxaparin inhibits the formation of additional clots. B) Enoxaparin eliminates certain clotting factors. C) Enoxaparin decreases the viscosity of blood. D) Enoxaparin will dissolve the existing clots. Ans: A Feedback: Low molecular weight heparins prevent the development of additional clots. They do not eliminate clotting factors. LMWHs do not dissolve the clot or decrease the viscosity of blood.

9. A patient is being discharged from the hospital with warfarin (Coumadin) to be taken at home. Which of the following foods should the patient be instructed to avoid in his diet? A) Eggs B) Dairy products C) Apples D) Spinach Ans: D Feedback: Spinach is a green leafy vegetable that is high in vitamin K and will interact to prevent adequate levels of anticoagulant therapy. Eggs, dairy products, and apples are not

contraindicated with warfarin.

10. A patient is discharged from the hospital with a prescription of warfarin (Coumadin). Which of the following statements indicates successful patient teaching? A) ìIf I miss a dose, I will take two doses.î B) ìI will avoid herbal remedies.î C) ìI will eat spinach or broccoli daily.î D) ìI will discontinue my other medications.î Ans: B Feedback: Most commonly used herbs and supplements have a profound effect on drugs for anticoagulation. The patient should never double up on dosing related to a missed dose. The patient should avoid green leafy vegetables due to vitamin K. The patient should not discontinue his or her medications.

11. A patient is being administered heparin IV and has been started on warfarin (Coumadin). The patient asks the nurse why she is taking both medications. What is the nurse's most accurate response? A) ìAfter a certain period of time, you must start warfarin and heparin together.î B) ìYou will need both warfarin and heparin for several days.î C) ìWarfarin takes 3 to 5 days to develop anticoagulant effects, and you still need heparin.î D) ìWarfarin cannot be given without heparin due to the amount of clotting you need.î Ans: C Feedback: Anticoagulant effects do not occur for 3 to 5 days after warfarin is started because clotting factors already in the blood follow their normal pathway of elimination. The statement ìAfter a certain period of time, you must start warfarin and heparin togetherî does not explain clearly the reason for the two medications concurrently. The statement ìYou will need both warfarin and heparin for several daysî does not explain clearly the reason for the two medications. The statement ìWarfarin cannot be given without heparin due to the amount of clotting you needî is not accurate.

12. A patient asks the nurse what dose of acetylsalicylic acid (Aspirin) is needed each day for antiplatelet effects to prevent heart attacks. What dose is most appropriate to reduce platelet aggregation? A) 10 mg B) 30 mg C) 625 mg D) 1000 mg Ans: B Feedback:

A single dose of 300 to 600 mg or multiple doses of 30 mg inhibit cyclooxygenase in circulating platelets almost completely. The dose of 10 mg is too small. The doses of 625 mg and 1000 mg are too large.

13. A patient is prescribed eptifibatide (Integrilin), which inhibits platelet aggregation by preventing activation of GP IIb/IIIa receptors on the platelet surface and the subsequent binding of fibrinogen and von Willebrand factor to platelets. Which of the following syndromes are treated with eptifibatide? A) Blocked carotid arteries B) Intermittent claudication C) Hypertension D) Unstable angina Ans: D Feedback: Eptifibatide (Integrilin) inhibits platelet aggregation by preventing activation of GP IIb/IIIa receptors on the platelet surface and the subsequent binding of fibrinogen and von Willebrand factor to platelets. Eptifibatide is used for acute coronary syndromes, including unstable angina, myocardial infarction, and nonñQ wave MI. Blocked carotid arteries, intermittent claudication, and hypertension are not treated with eptifibatide.

14. A patient is receiving IV heparin every 6 hours. An activated partial thromboplastin time (aPTT) is drawn 1 hour before the 08:00 dose. The PTT is 92 seconds. What is the most appropriate action by the nurse? A) Give the next two doses at the same time. B) Give the dose and chart the patient response. C) Check the patient's vital signs and give the dose. D) Hold the dose and call the aPTT result to the physician's attention. Ans: D Feedback: The normal control value is 25 to 35 seconds; therefore, therapeutic values are 45 to 70 seconds, approximately. A result of 92 seconds is a risk for bleeding, and the dose should be held until approval to administer is provided by the physician. The nurse should not give the next two doses at the same time. The nurse should not give the dose and document the patient's response. The nurse should not check the patient's vital signs and give the dose.

15. A patient is taking warfarin (Coumadin) to prevent clot formation related to atrial fibrillation. How are the effects of the warfarin (Coumadin) monitored? A) RBC B) aPTT C) PT and INR D) Platelet count Ans: C

Feedback: The warfarin dose is regulated according to the INR. The INR is based on the prothrombin time. The red blood cell count is not indicative of warfarin dosage. The aPTT is utilized to determine heparin dose. The platelet count is required to determine warfarin dose.

16. A patient who is recovering in hospital from a bilateral mastectomy has developed minor bleeding at one of her incision sites. During the process of clot formation, plasminogen will become part of a clot by which of the following means? A) By binding with fibrin B) By binding with platelets C) By activating plasmin D) By activating factor VII Ans: A Feedback: When a blood clot is being formed, plasminogen, an inactive protein present in many body tissues and fluids, is bound to fibrin and becomes a component of the clot. Plasminogen does not bind to platelets, activate plasmin, or active factor VII.

17. A 55-year-old man has been diagnosed with coronary artery disease and begun antiplatelet therapy. The man has asked the nurse why he is not taking a ìblood thinner like warfarin.î What is the most likely rationale for the clinician's use of an antiplatelet agent rather than an anticoagulant? A) Antiplatelet agents do not require the man to undergo frequent blood work; anticoagulants require constant blood work to ensure safety. B) Antiplatelet agents are more effective against arterial thrombosis; anticoagulants are more effective against venous thrombosis. C) Antiplatelet agents are most effective in large vessels; anticoagulants are most effective in the small vessels of the peripheral circulation. D) Antiplatelet agents have fewer adverse effects than anticoagulants. Ans: B Feedback: Anticoagulants are more effective in preventing venous thrombosis than arterial thrombosis. Antiplatelet drugs are used to prevent arterial thrombosis. CAD has an arterial rather than venous etiology. The rationale for the use of antiplatelet agents in CAD is not likely related to the need for blood work or the presence of adverse effects.

18. A nurse at a long-term care facility is conducting a medication reconciliation for a man who has just moved into the facility. The man is currently taking clopidogrel (Plavix). The nurse is most justified is suspecting that this man has a history of A) hemorrhagic cerebrovascular accident. B) hemophilia A. C) idiopathic thrombocytopenic purpura (ITP).

D) Ans:

myocardial infarction. D Feedback: Indications for use of Plavix include reduction of myocardial infarction, stroke, and vascular death in patients with atherosclerosis and in those after placement of coronary stents. It is not indicated in the treatment of ITP, CVA, or hemophilia.

19. A 79-year-old woman has been brought to the emergency department by ambulance with signs and symptoms of ischemic stroke. The care team would consider the STAT administration of what drug? A) Low molecular weight heparin B) Vitamin K C) Clopidogrel (Plavix) D) Alteplase (Activase) Ans: D Feedback: Alteplase (Activase) is used as first-line therapy for the treatment of acute ischemic stroke in selected people. Vitamin K would exacerbate the woman's symptoms, and LMWH and Plavix would be ineffective.

20. A 50-year-old man has undergone a bunionectomy and has been admitted to the postsurgical unit. What aspect of the man's medical history would contraindicate the use of heparin for DVT prophylaxis? A) The man is morbidly obese. B) The man has a diagnosis of ulcerative colitis. C) The man had a myocardial infarction 18 months ago. D) The man has a diagnosis of type 2 diabetes mellitus. Ans: B Feedback: GI ulcerations contraindicate the use of heparin. Obesity, diabetes, and previous MI do not rule out the safe use of heparin.

1. An obese patient who has an elevated triglyceride level and reduced high-density

A) B) C) D) Ans:

lipoprotein cholesterol is seen by her primary care physician. What do these data suggest in this patient? The development of arthritic syndrome The development of metabolic syndrome The development of Reye's syndrome The development of Tay-Sachs disease B Feedback: Metabolic syndrome is noted when the patient has elevated waist circumference, elevated triglycerides, reduced high-density lipoprotein cholesterol, elevated blood pressure, and elevated fasting glucose. Elevated triglyceride level and reduced high-density lipoprotein cholesterol are not indicative of arthritic syndrome. Reye's syndrome is marked by acute encephalopathy and seen in children under the age of 15 years after an acute viral infection. Tay-Sachs is a genetic disease characterized by neurological deterioration in the first year of life.

2.A patient has an elevated total serum cholesterol of 260 mg/dL. Which of the following aspects of patient teaching of lifestyle changes is most important for the patient? A) Eat organic foods. B) Stop smoking. C) Increase rest periods. D) Drink whole milk. Ans: B Feedback: Therapeutic lifestyle changes to lower serum cholesterol, including exercise, smoking cessation, change in diet, and drug therapy, are recommended to lower serum cholesterol. The patient with an elevated serum cholesterol should increase exercise and not increase rest periods. The patient should consume low-fat dairy products and avoid whole milk. Organic foods are not specifically recommended.

3.A patient with a diagnosis of cardiovascular disease is taking atorvastatin calcium (Lipitor) to reduce serum cholesterol. What is the goal of therapy for LDL cholesterol for a patient taking atorvastatin calcium (Lipitor)? A) 100 to 115 mg/dL B) 75 to 85 mg/dL C) Less than 60 mg/dL D) Less than 100 mg/dL Ans: D Feedback: In patients with a diagnosis of cardiovascular disease, the goal of therapy is an LDL below 100 mg/dL.

4.A male patient is taking atorvastatin calcium (Lipitor) to reduce serum cholesterol. Which of the following aspects of patient teaching is most important? A) Call his physician if he develops muscle pain. B) It is unacceptable to eat dietary fats. C) Decrease the dose if lethargy occurs. D) Eat two eggs per day to increase protein stores. Ans: A Feedback: Patients should be advised to notify their health care provider if unexplained muscle pain or tenderness occurs. The patient should avoid saturated fats when taking statins but should not entirely eliminate fats from his diet. The patient should not decrease the dose of statins without the physician's knowledge. The patient should not increase the intake of eggs due to the increase in cholesterol.

5.A patient has begun taking cholestyramine. Which of the following are noted as the most common adverse effects? A) Nausea, flatulence, and constipation B) Increased appetite and blood pressure C) Fatigue and mental disorientation D) Hiccups, nasal congestion, and dizziness Ans: A Feedback: Cholestyramine is not absorbed systemically, so the main adverse effects are gastrointestinal (GI) ones (abdominal fullness, flatulence, diarrhea, and constipation). Constipation is especially common, and a bowel program may be necessary to control this problem.

6.A patient who has been taking a statin has seen an improvement in his cholesterol laboratory values; however, the low-density lipoprotein remains elevated. What medication will be added to the medication regimen? A) Digoxin (Lanoxin) B) Vitamin D C) Cholestyramine (Questran) D) Calcium carbonate Ans: C Feedback: Cholestyramine is administered to patients to reduce LDL cholesterol in patients who are already taking a statin drug. Digoxin is not given to lower LDL cholesterol. Vitamin D is not given to lower LDL cholesterol. Calcium carbonate is not given to lower LDL cholesterol.

7.A patient is taking cholestyramine (Questran) to reduce LDL cholesterol. Cholestyramine will cause a decrease in absorption of which of the following medications?

A) B) C) D) Ans:

Digoxin (Lanoxin) Ibuprofen (Motrin) Aspirin Acetaminophen (Tylenol) A Feedback: Bile acid sequestrants may decrease absorption of digoxin (Lanoxin). Cholestyramine will not decrease the ibuprofen, aspirin, or acetaminophen.

8.A patient is prescribed fenofibrate (TriCor). When providing patient teaching, which of the following accurately describes the action of fenofibrate? A) It binds to bile acids in the intestinal lumen. B) It increases oxidation of fatty acids in the liver. C) It inhibits an enzyme required for hepatic synthesis. D) It inhibits mobilization of free fatty acids from peripheral tissues. Ans: B Feedback: Fibrates increase oxidation of fatty acids in the liver. Bile acid sequestrants bind to bile acids in the intestinal lumen. HMG-CoA reductase inhibitors inhibit an enzyme required for hepatic synthesis. Niacin inhibits mobilization of free fatty acids from peripheral tissues.

9.Which single drug class is known to be most effective in reducing the major types of dyslipidemia? A) Statins B) Bile acid sequestrants C) Fibrates D) Niacin Ans: A Feedback: For single-drug therapy, a statin is preferred for the treatment of dyslipidemia. To lower cholesterol and triglycerides, a statin, a cholesterol absorption inhibitor, gemfibrozil, a fibrate, or the vitamin niacin may be used. To lower triglycerides, gemfibrozil, ezetimibe, a cholesterol absorption inhibitor, or niacin may be given.

10.A patient is taking cholestyramine (Questran) and ezetimibe (Zetia). What administration guideline is most important to teach this patient? A) The two medications should be taken together. B) The ezetimibe inhibits cholesterol in the liver. C) The cholestyramine (Questran) is administered 1 hour after ezetimibe. D) The administration of ezetimibe (Zetia) is 2 hours before cholestyramine. Ans: D Feedback:

Ezetimibe (Zetia) should be taken 2 hours before or 4 hours after a bile acid sequestrant. The two medications should not be taken together. Ezetimibe acts in the small intestine to inhibit absorption of cholesterol and decrease the delivery of intestinal cholesterol in the liver. They do not inhibit the absorption of cholesterol. Cholestyramine should not be administered 1 hour after ezetimibe.

11.A patient has been reading about the use of flax seed to lower cholesterol. What should the patient be taught about the use of flax seed and cholestyramine (Questran)? A) Cholestyramine absorption will be increased with flax seed. B) Cholestyramine absorption will be decreased with flax seed. C) Bleeding will be increased with flax seed and cholestyramine. D) Hypoglycemia will result from flax seed and cholestyramine. Ans: B Feedback: Absorption of cholestyramine is decreased with flax seed. Bleeding is not increased with flax seed and cholestyramine. Hypoglycemia will not result from flax seed and cholestyramine.

12.Which herbal and dietary supplement has shown proven success in lowering LDL and total cholesterol in research studies? A) Soy B) Ginkgo biloba C) Green tea D) Garlic Ans: A Feedback: Soy is used as a food source and has been researched extensively to lower cholesterol. Ginkgo biloba, green tea, and garlic do not have extensive scientific research to support the lowering of cholesterol.

13.A patient is scheduled to have her serum triglyceride level assessed. How long should the patient be without food or fluids prior to the serum triglyceride test? A) 6 hours B) 8 to 10 hours C) 12 hours D) 24 hours Ans: C Feedback: For accurate interpretation of a patient's lipid profile, blood samples for laboratory testing of triglycerides should be drawn after the patient has fasted for 12 hours.

14.Mr. Burris is a 66-year-old man who leads a sedentary lifestyle and who has recently

A) B) C) D) Ans:

been diagnosed with dyslipidemia. Mr. Burris is disappointed to learn of this apparent deterioration in his health, stating, “First it was the diabetes and then the arthritis, now this.” The nurse has performed health education with Mr. Burris and has described metabolic syndrome. In addition to his elevated cholesterol levels, what aspect of Mr. Burris' health is congruent with a diagnosis of metabolic syndrome? Sedentary lifestyle Age over 65 coupled with male gender Arthritis Diabetes mellitus D Feedback: Diagnostic criteria for metabolic syndrome include a cluster of several cardiovascular risk factors linked with obesity: increased waist circumference, elevated triglycerides, reduced high-density lipoprotein cholesterol, elevated blood pressure, and elevated fasting glucose. Age, gender, and joint disorders are not among these criteria.

15.A male patient has been diagnosed with moderately increased LDL, and his primary care provider wishes to begin him on a statin. What is a potential disadvantage of statins that the care provider should consider? Select all that apply. A) Statins are nephrotoxic. B) Statins are expensive. C) Statins are contraindicated in patients with a history of myocardial infarction. D) Statins require regularly scheduled blood work. E) Statins have an immunosuppressive effect. Ans: B, D Feedback: Because liver enzymes may be elevated during atorvastatin use, patients need liver function tests and repeat lipid profile testing on a routine basis. These drugs are also expensive. They are not nephrotoxic and do not suppress the immune system. Previous MI is an indication for their use, not a contraindication.

16.A patient will begin taking atorvastatin (Lipitor), and the nurse is conducting relevant health education. The nurse should emphasize the need to report any new onset of A) muscle pain. B) dry mouth. C) pruritus (itching). D) increased thirst. Ans: A Feedback: Myopathy is an important adverse effect of statins. Statins can injure muscle tissue, resulting in muscle ache or weakness; this should be reported promptly. Dry mouth, pruritus, and thirst are not reported adverse effects of statins.

17.A 74-year-old male patient is being treated in the hospital for a stroke and is undergoing an extended stay on a rehabilitation unit. The patient's wife has been participating actively in his care and performs much of his feeding and hygiene. This evening, the patient's wife has brought in a number of healthy snacks to keep at his bedside. Knowing that the patient's medication regimen includes simvastatin, the nurse would remove which of the following items? A) Purple grapes B) Cranberry cocktail C) Grapefruit juice D) Trail mix (salted nuts and seeds) Ans: C Feedback: It is important to avoid taking simvastatin with grapefruit juice. None of the other listed foods is contraindicated.

18.A patient has been largely unsuccessful in achieving adequate control of dyslipidemia through lifestyle changes and the use of a statin. As a result, the patient has been prescribed cholestyramine (Prevalite, Questran). What change in this patient's lipid profile will the nurse identify as the most likely goal of therapy? A) Reduction in triglycerides B) Reduction in total serum cholesterol levels C) Increase in HDL levels D) Reduction in LDL cholesterol levels Ans: D Feedback: Cholestyramine (Prevalite, Questran), the prototype bile acid sequestrant, has the ability to reduce LDL cholesterol. It has little or no effect on HDL cholesterol and either no effect or an increased effect on triglyceride levels.

19.A 66-year-old woman's most recent physical assessment and diagnostic workup reveal the presence of dyslipidemia. The woman is a candidate for monotherapy with a statin, and she will soon begin treatment with atorvastatin (Lipitor). The nurse should anticipate what order? A) “Lipitor 150 mg PO BID” B) “Lipitor 10 mg PO OD” C) “Lipitor 50 mg PO TID with meals” D) “Lipitor 75 mg PO BID” Ans: B Feedback: Lipitor is normally administered PO 10 to 80 mg daily in a single dose.

20.An elderly patient with dyslipidemia has had fenofibrate (TriCor) added to her existing medication regimen. In addition to having her lipid profile drawn on a regular basis, the

A) B) C) D) Ans:

nurse should educate the patient about the need for what ongoing laboratory testing during therapy? Complete blood count (CBC) Liver panel INR and aPTT Reticulocyte count B Feedback: Because of the risk for hepatotoxicity, patients taking fenofibrate (TriCor) require serial testing of liver enzyme levels. There is no specific need for follow-up with CBCs, coagulation tests, or reticulocyte counts.

1.A patient has a low erythrocyte count. How may a colony-stimulating factor affect the patient's erythrocyte count? A) It stimulates growth of red blood cells. B) It suppresses T-cell production. C) It inhibits protein synthesis. D) It stimulates antibody production. Ans: A Feedback: Colony-stimulating factors stimulate the production of red blood cells, platelets, granulocytes, granulocyte–macrophages, and monocyte–macrophages. Colonystimulating factors will not suppress the T-cell production, inhibit protein production, or stimulate antibody production.

2.A patient is exposed to a viral infection. What role will interferon most likely play during this exposure? A) It will stimulate B-lymphocyte activity. B) It will interfere with stem cell multiplication. C) It will stimulate growth of lymphoid cells. D) It will interfere with virus replication. Ans: D Feedback: Interferons interfere with the ability of viruses in infected cells to replicate and spread to uninfected cells. Interferons will not stimulate B-lymphocyte activity, stem cell multiplication, or growth of lymphoid cells.

3.A patient has developed a decubitus ulcer on the coccyx. What defense mechanism is most affected by this homeostatic change? A) The mucous membrane is affected. B) The respiratory tract is affected. C) The skin is affected. D) The gastrointestinal tract is affected. Ans: C Feedback: The body's primary external defense mechanism is intact skin. The development of a decubitus ulcer allows for entry of microbial growth. The mucous membranes, respiratory tract, and gastrointestinal tract are not affected primarily.

A) B) C)

4.A patient is being administered chemotherapeutic agents for the treatment of cancer. Which of the following blood cells will be stimulated by the colony-stimulating factors in response to the effects of the chemotherapy? White blood cells Red blood cells Phagocytes

D) Ans:

Myocardial cells B Feedback: Chemotherapeutic agents have the potential to decrease red blood cells and will result in the colony-stimulating factors stimulating the production of red blood cells. The colonystimulating factors do not affect the white blood cell production, phagocytes, or cardiac cells.

5.A patient with chronic renal failure is prescribed filgrastim (Neupogen). What is the major effect of filgrastim (Neupogen)? A) Decreases neutropenia related to chemotherapy B) Decreases white blood cells related to infection C) Decreases growth of blood vessels due to ischemia D) Decreases platelet count related to bleeding Ans: A Feedback: Filgrastim (Neupogen) is used to stimulate blood cell production by the bone marrow in places with bone marrow transplantation or chemotherapy-induced neutropenia. Filgrastim does not decrease white blood cells in response to infection. Filgrastim increases growth of blood vessels related to ischemic heart disease. Filgrastim does not decrease platelet count related to bleeding.

6.A patient has been diagnosed with chronic renal failure. Which of the following agents will assist in raising the patient's hemoglobin levels? A) Epoetin alfa (Epogen, Procrit) B) Pentoxifylline (Pentoxil) C) Estazolam (ProSom) D) Dextromethorphan hydrobromide Ans: A Feedback: Uses of epoetin include the prevention and treatment of anemia associated with chronic renal failure, hepatic impairment, or anticancer chemotherapy. Pentoxifylline is used for intermittent claudication to maintain the flexibility of red blood cells. Estazolam is a benzodiazepine agent used short term for insomnia. Dextromethorphan hydrobromide is used to relieve cough.

7.A patient is undergoing a bone marrow transplant. Which of the following medications is most effective in stimulating the production of granulocytes and macrophages? A) Bacillus Calmette-Guérin (BCG) B) Epoetin alfa (Epogen) C) Aldesleukin (Proleukin) D) Sargramostim (Leukine) Ans: D

Feedback: Sargramostim (Leukine) is a formulation of granulocyte colony-stimulating factor (GCSF) and granulocyte macrophage colony-stimulating factor (GM-CSF). Bacillus Calmette-Guérin is a vaccine used to treat bladder cancer. Epoetin alfa stimulates bone marrow production of red blood cells. Aldesleukin (Proleukin) is a recombinant DNA version of interleukin-2. It activates cellular immunity.

8.A hospital patient's complex medical history includes a recent diagnosis of kidney cancer. Which of the following medications is used to treat metastatic kidney cancer? A) Filgrastim (Neupogen) B) Aldesleukin (Proleukin) C) Interferon alfa-2b (Intron A) D) Darbepoetin alfa (Aranesp) Ans: B Feedback: Aldesleukin (Proleukin) is used to treat metastatic kidney cancer but is contraindicated in patients with serious pulmonary impairment. Filgrastim is a colony-stimulating factor that is not used for the treatment of kidney cancer. Darbepoetin alfa is a hormone that stimulates the production of red blood cells by the bone marrow. Interferon alfa-2b (Intron A) is normally used to treat leukemia.

9.A patient is diagnosed with ischemic heart disease. She is prescribed filgrastim (Neupogen). What effect will this medication provide in the treatment of ischemic heart disease? A) Increase platelets B) Decrease platelets C) Promote angiogenesis D) Prevent thrombus formation Ans: C Feedback: Experts believe that filgrastim promotes the growth of arterioles around blocked areas in coronary arteries. Filgrastim does not increase or decrease platelets. Filgrastim does not prevent thrombus formation.

10.A patient with a diagnosis of renal failure is being treated with epoetin alfa (Epogen). Frequent assessment of which of the following laboratory values should be prioritized before and during treatment? A) AST B) C-reactive protein C) CBC D) ALT Ans: C Feedback:

With the use of hematopoietic and immunostimulant drugs, a CBC with WBC differential and platelet count should be done before and during treatment to monitor response and prevent avoidable adverse reactions. It is less imperative to monitor liver enzymes or CRP levels.

11.A patient is receiving epoetin alfa (Epogen) for anemia. Which of the following adjunctive therapies is imperative with epoetin alfa? A) Potassium supplements B) Sodium restriction C) Iron supplement D) Renal dialysis Ans: C Feedback: When administering darbepoetin and epoetin, an adequate intake of iron is required for drug effectiveness and an iron supplement is usually necessary. It is not necessary to provide the patient with potassium supplements, restrict sodium, or place the patient on renal dialysis.

12.A patient is administered a granulocyte colony-stimulating factor (G-CSF). What is the expected outcome of a G-CSF? A) Red blood cell count of 3000 mm3 B) Decreased number of infections C) Decreased fatigue and increased energy D) White blood cell count of 20,000 mm3 Ans: B Feedback: G-CSFs help to prevent infection by reducing the incidence, severity, and duration of neutropenia associated with several chemotherapy regimens. The administration of a GCSF should not lower red blood cell count or raise white blood cell count. They assist in the prevention of infection but do not necessarily resolve fatigue.

13.An oncology nurse is providing for an adult patient who is currently immunocompromised. The nurse is aware of the physiology involved in hematopoiesis and immune function, including the salient role of cytokines. What is the primary role of cytokines in maintaining homeostasis? A) Cytokines perform phagocytosis in response to bacterial and protozoal infection. B) Cytokines perform a regulatory role in the development of diverse blood cells. C) Cytokines can be considered to be the basic “building blocks” of all blood cells. D) Cytokines are formed in response to the presence of antibodies. Ans: B Feedback: Hematopoietic cytokines are diverse substances produced mainly by bone marrow and white blood cells (WBCs). They regulate many cellular activities by acting as chemical

messengers among cells and as growth factors for blood cells. Blood cells are not made up of cytokines, and they do not perform phagocytosis. The presence of antigens, not antibodies, can prompt the expression of certain cytokines.

14.A patient's current medical condition is suggestive of impaired erythropoiesis. Which of the following laboratory studies would be most clinically relevant in diagnosing this health problem? A) White blood cell count with differential B) RBC, hemoglobin, and hematocrit C) INR and aPTT D) d-dimer and C-reactive protein Ans: B Feedback: Parameters used to measure erythropoiesis include RBC count, hemoglobin concentration and hematocrit, and mean corpuscular volume. Tests related to immune function, hemostasis, and inflammation are not used to diagnose erythropoiesis.

15.An adult patient has developed renal failure secondary to an overdose of a nephrotoxic drug. Which of the following assessment findings would the nurse recognize as being most suggestive of impaired erythropoiesis? A) Frequent infections and low neutrophil levels B) Fatigue and increased heart rate C) Agitation and changes in cognition D) Increased blood pressure and peripheral edema Ans: B Feedback: As RBCs decrease, conditions related to inadequate hematopoiesis develop. Clinical manifestations of inadequate erythropoiesis include anemia. This results in a decrease in the oxygen-carrying capacity of blood and consequently a decreased oxygen availability to the tissues. A compensatory increase in heart rate and cardiac output initially increases cardiac output, offsetting the lower oxygen-carrying capacity of the blood.

16.A patient with a diagnosis of chronic renal failure will soon begin a regimen of epoetin that will administered by the patient at home. Which of the following statements indicates that the nurse's initial health education has been successful? A) “I'll make sure to take my Epogen pill on a strict schedule and make sure I never miss a dose.” B) “I'm glad that Epogen can help to protect me from getting an infection.” C) “I'm excited that there's a medication that can help my kidneys work better.” D) “I'm not all that comfortable with giving myself an injection, but I'm sure I'll be able to learn.” Ans: D Feedback:

Epogen is administered parenterally, not orally. It acts by stimulating erythroid progenitor cells to produce RBCs but does not enhance overall renal function. Epogen does not enhance immune function.

17.Which of the following patients would likely be the most appropriate candidate for treatment with filgrastim (Neupogen)? A) A patient who has undergone a mastectomy for the treatment of breast cancer B) A patient with acquired immune deficiency syndrome (AIDS) who has been diagnosed with Kaposi's sarcoma C) A patient who developed acute renal failure secondary to rhabdomyolysis D) A patient whose acute myelogenous leukemia necessitated a bone marrow transplant Ans: D Feedback: Indications for filgrastim include preventing infection in patients with neutropenia induced by cancer chemotherapy or bone marrow transplantation. Surgical patients, patients with AIDS, and patients with renal failure are not typically treated with G-CSFs.

18.A 69-year-old female patient has been diagnosed with malignant melanoma. The care team has collaborated with the patient and her family and agreed on a plan of care that includes administration of interferon alfa-2b. After administering interferon alfa-2b, the oncology nurse should anticipate that the patient may develop which of the following adverse effects? A) Profound diaphoresis B) Decreased level of consciousness C) Flu-like symptoms D) Cyanosis and pallor Ans: C Feedback: In the majority of patients, flu-like symptoms (e.g., fever, chills, fatigue, muscle aches, headache, tachycardia) develop within 2 hours of administration of interferon alfa-2b and last up to 24 hours. Diaphoresis, changes in LOC, and changes in oxygenation are not associated with the use of interferon alfa-2b.

19.Which of the following nursing diagnoses would provide the most plausible indication for the use of epoetin alfa (Epogen) in a patient with renal failure? A) Risk for infection related to decreased erythropoiesis B) Activity intolerance related to decreased oxygen-carrying capacity C) Powerlessness-related sequelae of renal failure D) Ineffective breathing pattern related to inadequate erythropoietin synthesis Ans: B Feedback: The impaired erythropoiesis that accompanies renal failure results in fatigue and

decreased stamina, symptoms that can be addressed with the administration of epoetin alfa. Decreased erythropoiesis does not constitute a risk for infection, and the patient may or may not experience feelings of powerlessness. Inadequate erythropoietin synthesis causes impaired oxygenation, but this does not normally manifest as breathing problems.

20.A patient who is undergoing chemotherapy for the treatment of non-Hodgkin's lymphoma will soon begin treatment with epoetin alfa (Epogen). The nurse should be aware that this drug may be administered by which of the following routes? Select all that apply. A) Subcutaneous B) Intramuscular C) Oral D) Buccal E) Intravenous Ans: A, E Feedback: Epogen is administered by either IV or sub-Q routes.

Chapter 12: Drug Therapy- Immunizations A nurse is explaining to a parent how vaccines work. Vaccines provide which of the following? A. active immunity B. passive immunity C. innate immunity D. nonspecific immunity The nurse is caring for a patient with severe immunosuppression. This condition is a contraindication to which of the following? A. all injectable immunizations B. the use of live bacterial or viral vaccines C. the use of immune globulins for passive immunity D. annual influenza vaccine A child is receiving an immunization. The nurse should inform the parents that common aftereffects may include which of the following? A. skin rash and itching B. redness and soreness at the injection site C. muscle weakness and difficulty in walking D. cause, vomiting, and diarrhea A nurse is caring for a 74-year-old man. The nurse recognizes that he would most likely have deceased immune response to the influenza vaccine if he is taking which of the following medications? A. levothyroxine B. prednisone C. metoprolol D. lovastatin A nurse is preparing to administer an unfamiliar vaccine. To obtain current information and provide patient teaching about vaccine recommendations and contraindications, it is best to do which of the following? A. Ask a coworker about the vaccine (when and how it should be administered B. Use a drug guide to look up the vaccine information C. Access an Internet search engine to find vaccine information D. Obtain vaccine information and a Vaccine Information Statement (VIS) from the Centers for Disease Control and Prevention (CDC) Website

An elderly client has been given a tetanus-diphtheria (Td) booster after stepping on a rusty nail. Which statements indicate an understanding of vaccine schedules? A. I know that I will need to return in 6 months for another injection. B. I know that this injection is good for 1 year.

C. I know that this booster is good for 10 years. D. I know that I do not need to worry about infection after getting this injection. A nurse is receiving post-exposure prophylaxis for hepatitis B. What would the nurse most likely receive? A. Immune globulin B. Antivenin crotalidae C. Zoster vaccine D. BCG vaccine A nursing instructor is discussing the intended populations for various vaccines. Which groups might the instructor mention when discussing the hepatitis B vaccine? A. Ventilator-dependent patients B. Day care workers C. People over the age of 65 D. Paramedics and emergency medical technicians The nurse understands that administration of the routine and booster vaccines are indicated for immunization against polio in which of the following age groups? Select all that apply. A. 7 years B. 2 months C. 6 months D. 8 years E. 4 months A 65-year-old client is being seen in the emergency department for exposure to rabies. The nurse checks the electronic health record and discovers the client has had no history of allergic reactions to immunization agents. The client's history guides the nurse to take which action? A. Teach the client that the administration of immune globulin is contraindicated for senior citizens regardless of previous reactions. B. Teach the client that the there is no known treatment for rabies. C. Teach the client that the best treatment is to take over-the-counter herbal remedies. D. Teach the client that the agent of choice is rabies immune globulin

A female client is receiving chemotherapy for breast cancer. She requires a vaccine booster. For when would the health care provider order the administration of the vaccine? A. 30 days after chemotherapy is completed B. 6 months after chemotherapy is completed C. 3 months after chemotherapy is completed D. 1 year after chemotherapy is completed

What is the best source of information for current recommendations regarding immunizations and immunization schedules? A. Local health care provider's office B. Department of Epidemiology C. Centers for Disease Control and Prevention D. Department of Public Health A client has come to the clinic requesting a hepatitis A and B vaccination before leaving on a tropical vacation. After assessing the client, the nurse should prioritize what finding to communicate to the provider? The client takes corticosteroids to treat rheumatoid arthritis The client uses marijuana two to three times per month The client received the annual influenza vaccine seven days ago The client has type two diabetes that is controlled by diet

The nurse is educating an older adult client on routine vaccines. Which statement best describes the recommended vaccination schedule for an older adult client? A. an influenza vaccine booster every 10 years, annual tetanus-diphtheria vaccine, and a one-time administration of pneumococcal vaccine at 65 years of age B. a tetanus-diphtheria booster and influenza vaccination every fall or winter C. a tetanus-diphtheria booster every 2 years, annual influenza vaccine, and a yearly administration of pneumococcal vaccine D. a tetanus-diphtheria booster every 10 years, annual influenza vaccine, and a onetime administration of pneumococcal vaccine at 65 years of age

Which statements best indicates the client understands recommended vaccines following the 65th birthday? A. A tetanus-diphtheria booster every 2 years, annual influenza vaccine, and a yearly administration of pneumococcal vaccine B. An influenza vaccine booster every 10 years, annual tetanus-diphtheria vaccine, and a one-time administration of pneumococcal vaccine at 65 years of age C. A tetanus-diphtheria booster every 10 years, annual influenza vaccine, and a onetime administration of pneumococcal vaccine at 65 years of age D. A tetanus-diphtheria booster every 2 years When educating a group of nursing students on immunologic agents, the nurse refers to a substance that is attenuated (or weakened) but still capable of stimulating the formation of antitoxins. The nurse is referring to: A. vaccines. B. antivenins. C. immune globulins. D. toxoids.

Administration of the tetanus toxoid in adults involves two initial injections given four weeks apart, a booster injection given six months to a year later, and periodic injections thereafter. What is the recommended interval for the periodic injections for a 66-year-old client? Every 5 years Every 2 years Every 10 years Annually

Chapter 13 Drug Therapy to Decrease Immunity After organ transplantation, immunosuppressants are given to prevent which of the following? A. nephrotoxicity B. hepatotoxicity C. rejection reaction D. bleeding disorders

The most common cancers that develop with long-term immunosuppression after organ transplant are A. skin cancers and lymphomas B. cancers of the gastrointestinal tract C. renal and liver cancers D. brain and spinal cord cancers

The nurse should instruct the patient taking cyclosporine or tacrolimus that toxic levels of the drug may be reached if taken with which of the following beverages that inhibit metabolism of the drugs? A. orange juice B. coffee C. grapefruit juice D. milk

A nurse is caring for a patient who is taking immunosuppressant drugs. The most critical information to teach the patient is ways A. to decrease infection B. to avoid weight gain C. to maintain a good fluid intake D. to increase rest and decrease exercise

A patient in an outpatient clinic is taking mycophenolate after a kidney transplant. Which of the following over-the-counter products is likely to interfere with the activity of this immunosuppressant? A. diphenhydramine, used for itchy mosquito bites B. acetaminophen, used for a tension headache

C. magnesium/aluminum hydroxide, used for heartburn D. benzocaine/dextromethorphan throat lozenges, used for throat irritation A woman is taking leflunomide for rheumatoid arthritis, and her provider monitors her laboratory results on a regular basis. Which of the following laboratory findings indicates that the patient is experiencing an adverse effect? A. increased red blood cell count B. decreased creatinine C. increased white blood cell count D. decreased liver enzymes

Monoclonal antibodies are engineered to specifically target a certain antigen, such as one found on cancer cells. Which of the following actions by monoclonal antibodies have demonstrated effectiveness in cancer therapy? (Check all that apply.) A. make the cancer cell more visible to the immune system B. block growth signals C. increase growth of new blood vessels D. deliver radiation or chemotherapy to cancer cells A client has developed a wound infection and leukocytes are leaving the bloodstream to perform phagocytosis on pathogens. What white cells are most likely performing this function? A. Basophils B. Neutrophils C. Monocytes D. Eosinophils

A client is experiencing an allergy to a penicillin antibiotic. What immunoglobulin (Ig) will most directly relate to this immune response? A. IgA B. IgM C. IgE D. IgG

A 23-year-old man has received a recent diagnosis of appendicitis following 24 hours of acute abdominal pain. The nurse providing care for the man is explaining that while unpleasant, the inflammation of his appendix is playing a role in his body's fight against the underlying infectious process. Which teaching point should the nurse not teach to the patient? A. "Inflammation ultimately aids in eliminating the initial cause of the cell injury in your appendix." B. "Inflammation will start your body on the path to growing new, healthy tissue at the

site of infection." C. "Inflammation helps your body to produce the right antibodies to fight the infection." D. "Inflammation can help to remove the body tissue cells that have been damaged by infection."

The health care provider changes a female client's immunosuppressant to a newer drug. The client asks why this is necessary. What is true about the newer immunosuppressants? A. They are less expensive. B. They have fewer severe adverse effects. C. They will enhance her health and well-being. D. They will prolong her life.

A client who is receiving an immune suppressant has been admitted to the hospital unit. What action should the nurse prioritize? A. Monitor the client's nutritional status. B. Place the client on protective isolation. C. Provide client teaching regarding pharmacokinetics. D. Provide support and comfort measures related to adverse effects.

A nurse is providing patient education to a 45-year-old man who is taking cyclosporine (Sandimmune). The nurse will provide the patient with education related to one of the most common and severe adverse effects of cyclosporine, which is: A. gastritis. B. cardiac effects. C. hyperthyroidism. D. nephrotoxicity.

A 53-year-old man is receiving cyclosporine in order to prevent rejection of a transplanted kidney. The nurse should prioritize assessments related to: A. infection. B. respiratory depression. C. nausea. D. dizziness.

Which of the T cells is responsible for destroying pathogens by punching holes in their cell membrane and by secreting cytokines/lymphokines? A. Memory T cells B. Cytotoxic T cells

C. Regulatory T cells D. Helper T cells

Six months after undergoing transplantation, a female client asks her health care provider if it would be all right for her to volunteer at the local children's health clinic. She has limited adverse effects from her immunosuppressant drugs and is beginning to feel healthy again. The provider suggests alternate volunteer options because: A. It will increase the risk of rejection. B. She may develop an infectious process at the clinic. C. She may not have the stamina to work at the clinic. D. It is too soon to volunteer in a clinic setting.

A client with colorectal cancer has been prescribed bevacizumab. The client is relieved that he will only have to receive a dose of the medication every two weeks but is skeptical that it will be effective if given so infrequently. What characteristics of the medication should the nurse explain? Select all that apply. A. The severe adverse effects B. The rapid onset C. The long duration of action D. The delayed peak E. The long half life

A client who has recently been diagnosed with HIV is waiting for the results of lab work to determine their T-cell count. How should the nurse best explain a T cell to the client? A. "T cells are neutrophils, which are a type of white blood cell that helps to fight off infections and other foreign bodies that enter the body." B. "T cells are monocytes, which are a type of white blood cell that helps to fight off infections and other foreign bodies that enter the body." C. "T cells are lymphocytes, which are a type of white blood cell that helps to fight off infections and other foreign bodies that enter the body." D. "T cells are basophils, which are a type of white blood cell that helps to fight off infections and other foreign bodies that enter the body."

When explaining the risks of pretransplant immunosuppression, the nurse demonstrates understanding of the process when making which statement? A. "Once the transplant is completed, complications associated with immunosuppression are no longer a concern." B. "Serious complications can occur if you are not monitored carefully while you are immunosuppressed." C. "Inadequate immunosuppression increases your risk of developing an infection."

D. "Excessive immunosuppression can be corrected fairly easily with other medications."

A client admitted to the ICU with gunshot wounds in the chest and thigh is noted to have extensive edema present. Anticipating a generalized reaction to tissue damage, the nurse concludes that the client's edema is the result of what development? A. vasoconstriction. B. hypoxia. C. internal pathogenic control. D. inflammatory process.

Which are the LEAST serious adverse effects associated with the use of monoclonal antibodies? Select all that apply. A. acute pulmonary edema B. diarrhea C. cytokine release syndrome D. fever E. malaise

Which would the nurse expect to administer orally? A. Abatacept B. Alefacept C. Glatiramer acetate D. Cyclosporine

The nurse is caring for an older adult receiving immune modulators. What are appropriate actions by the nurse? Select all that apply. A. Obtain baseline liver function studies and monitor follow-up studies. B. Determine dosage based on renal and liver function. C. Assess carefully for infection. D. Encourage the family to visit often, especially young children. E. Minimize teaching to avoid causing confusion.

While studying the T- and B-cell immune suppressors, the nursing students learn that the most commonly used immune suppressant is: A. Azathioprine (Imuran). B. Pimecrolimus . C. Cyclosporine . D. Glatiramer (Copaxone).

Chapter 14: Drug Therapy for the Treatment of Cancer A male patient is being treated for Hodgkin's lymphoma with vincristine. He also takes phenytoin daily in the morning for a seizure disorder. How will these two medications interact? A. Vincristine, when combined with phenytoin, will increase sedation. B. Phenytoin and vincristine are metabolized by CYP3A4, increasing vincristine toxicity. C. Phenytoin administered with vincristine will decrease cytotoxic drug effects. D. Vincristine will increase the patient's risk of having a seizure.

For a patient receiving a cytotoxic drug that will likely result in bone marrow depression, which of the following teaching considerations should be the priority for the nurse with the patient and family members or caregivers? A. Wash hands often and avoid people with colds, flu, or other infections. B. Do not expect fatigue and weakness, which are uncommon. C. Expect gastrointestinal upset. More nausea and vomiting may occur when the blood cell counts are low. D. Take acetaminophen for fever.

In explaining antineoplastic therapy to a family member of a patient who is to receive treatment with a cytotoxic drug, which of the following explanations is most accurate? A. Antineoplastic therapy damages both malignant and nonmalignant cells. B. It causes few adverse effects. C. It stimulates growth of cancer cells. D. It must be given daily.

A female patient with chronic lymphocytic leukemia is beginning to receive an oral cyclophosphamide. Which of the following instructions is most accurate? A. Administer the drug with food. B. Take the drug on an empty stomach. C. Take the drug at bedtime. D. Administer the drug 1 hour after a meal.

A patient is prescribed fulvestrant. What is the action of this drug? A. Fulvestrant is highly cytotoxic to both cancer cells and normal cells. B. It blocks estrogen receptors and decreases estrogen-mediated growth stimulation. C. It boosts the immune response to increase the effectiveness of other chemotherapy agents. D. It stops cancer cell maturation in the G1 phase of the cell cycle.

Hormone inhibitor drugs are most effective in which of the following? A. treating breast or prostate cancer B. preventing hematologic malignancies C. treating thyroid and pituitary tumors D. protecting normal cells from cytotoxic drugs

A vesicant antineoplastic drug does which of the following? A. It causes minor skin irritation. B. It causes extensive tissue damage. C. It requires administration with a corticosteroid. D. It requires deep intramuscular injection if diluted with normal saline. A patient who is receiving methotrexate is also receiving leucovorin. The nurse understands that this drug is being given for which reason? A. Counteract effects of methotrexate B. Synergistic effect on the cancer cells C. Relief of nausea and vomiting D. Reduction of renal toxicity risk

When describing the various effects of antineoplastic agents, the nurse explains that antineoplastic drugs primarily affect human cells that are rapidly multiplying, going through the cell cycle quickly. The nurse would identify which cells as an example? A. Skin B. Breast C. Testicles D. Ovaries The nurse may be asked to administer which medications to a client to counteract the increase in uric acid and subsequent hyperuricemia resulting from the metabolic waste buildup from rapid tumor lysis? A. allopurinol B. amifostine

C. mesna D. leucovorin A client with a diagnosis of bladder cancer is started on a chemotherapeutic regimen that includes three agents. What is the rationale for using multiple antineoplastic agents? A. The use of three agents decreases the development of cell resistance. B. The use of three agents increases the length of treatment. C. The use of three agents increases the quantity of one of the agents. D. The use of three agents decreases the adverse effects.

A patient having chemotherapy is losing her hair. She asks the nurse if her hair will come back as it originally was. What is the best response by the nurse? A. "I think you have more to worry about than if you have hair. You can buy a wig." B. "Your hair will grow back, but the new hair may be a different color or texture." C. "Your hair will grow back, but it will be very thin and straight." D. "Your hair may not grow back, but we can refer you to a wig specialist."

A 25-year-old female client is prescribed methotrexate to treat rheumatoid arthritis (RA). The nurse should teach the client to: A. use an effective contraceptive. B. drink milk with the medication. C. expect a mild rash and itching. D. take a pain reliever for sore throat.

A client on the oncology unit has begun chemotherapy with a regimen that includes bendamustine. The client has begun to experience alopecia. The nurse should prioritize assessments related to what potential nursing diagnosis? A. Disturbed body image B.Ineffective thermoregulation C. Impaired tissue integrity D. Hypothermia A 49-year-old client is diagnosed with ovarian cancer. What is a characteristic of malignant cells that differentiates them from normal body cells? A .Cancerous cells do not require an energy source in order to proliferate. B. Cancerous cells grow in an uncontrollable fashion. C. Cancerous cells have a theoretically infinite life span. D. Cancerous cells are not responsive to the presence of drugs.

A patient is diagnosed with a brain tumor. The patient is told that the cancer cells proliferate. The patient asks the nurse what this means. What is the nurse's best response? A. "The proliferation of the cancer cells is the treatment with chemotherapy." B. "The proliferation is the growth of cancer cells and the rate of growth." C. "The proliferation of the cancer cells is the suppression of growth." D. "The proliferation of cancer cells is the metastasis of the tumor."

A patient has just received the first dose of imatinib and the nurse on the oncology unit is amending the patient's care plan accordingly. What nursing diagnosis is most appropriate in light of this addition to the patient's drug regimen? A. Risk for Deficient Fluid Volume related to changes in osmotic pressure B. Risk for Infection related to bone marrow suppression C. Risk for Impaired Skin Integrity related to exaggerated inflammatory response D. Risk for Acute Confusion related to adverse neurological effects of imatinib

An elderly man has been admitted to a residential care facility and the nurse has conducted a medication reconciliation. The man has taken numerous drugs in the past, including a course of bicalutamide (Casodex) several years earlier. The nurse recognizes this drug as being an antiandrogen and is consequently justified in presuming that the man has a history of what disease? A. Lymphoma B. Skin cancer C. Prostate cancer D. Lung cancer A patient with non-Hodgkin's lymphoma (NHL) will be starting a course of doxorubicin shortly. When planning this patient's care, what nursing diagnosis should the nurse prioritize? A. Risk for Ineffective Airway Clearance related to decreased neurological function B. Risk for Infection related to suppressed bone marrow function C. Risk for Imbalanced Nutrition: More Than Body Requirements related to metabolic effects of doxorubicin D. Risk for Impaired Skin integrity related to cytotoxic effects of doxorubicin

The oncology nurse understands that chemotherapeutic agents are most effective during a particular phase of the cell cycle. This means the agents are: A. cell targeting. B. cell cycle-specific. C. growth fraction. D. cell cycle-nonspecific.

A postmenopausal woman with breast cancer will most likely be treated with which anti-estrogen drug? A. Bleomycin B. Cisplatin C. Cyclophosphamide D. Tamoxifen A parent hears the health care provider using the word extravasation. The parent asks the nurse what extravasation means. What would be a correct answer? A. "Extravasation is when blood vessels are severed." B. "Extravasation is when fluid is pooled in one part of the body." C. "Extravasation is a disease that causes shock." D. "Extravasation is when fluid escapes from a blood vessel into the surrounding tissue."

A client's chemotherapy regimen has been deemed successful, but the client is experiencing debilitating nausea and vomiting. These adverse effects should signal the nurse to the possibility of what nursing diagnosis? A. Ineffective therapeutic regimen management B. Imbalanced nutrition: less than body requirements C. Adult failure to thrive D. Acute pain When describing alkylating agents, the nurse would explain that this medication is seen as the prototype: A. Chlorambucil B. Fluorouracil C. Methotrexate D. Vincristine A patient is receiving carboplatin. The nurse would expect to administer this drug by which route? A. Intramuscular B. Intravenous C. Subcutaneous D. Oral

Chapter 15- Inflammation, Infection, and the Use of Antimicrobial Agents 1. A female patient has been treated for strep throat with ampicillin by mouth. She visits the occupational health nurse and states she has vaginal itching. What organism is the cause of the vaginal itching? A) Klebsiella B) Enterobacter C) Candida albicans D) Proteus 2. An elderly patient is treated for pneumonia with clindamycin (Cleocin). One week after the completion of the medication, she develops diarrhea. What is the most probable cause of the diarrhea? A) Change in normal flora B) Food-borne illness C) Crohn's disease D) Incontinence 3. A patient with burns has developed a wound infection. This patient is experiencing what type of wound infection? A) Fungal infection B) Opportunistic infection C) Nosocomial infection D) Food-borne infection 4.

An elderly man who is a resident of a skilled nursing facility develops methicillinresistant Staphylococcus aureus. What type of infection has this man developed? A) Community acquired B) Postoperative C) Sustained infection D) Nosocomial infection

A) B) C)

5. A nurse is instructing a patient on the antibiotic regimen for the treatment of pneumonia. Which of the following is most important to teach the patient? Take the medication with orange juice. Supplement the medication with multivitamins. Complete the entire prescription of medication. D) Administer the medication with dairy products.

6. A patient is to be started on an antibiotic. Which of the following is most important to take into consideration before beginning the antibiotic regimen? A) Duration of symptoms B) Culture and sensitivity C) The patient's hydration status D) The patient's age and weight

7. A patient has presented to the emergency department after suffering a severe laceration to his hand in a workplace accident. During the subsequent process of acute inflammation, what physiological event took place first? A) The patient's B cells produced antibodies. B) The patient's blood vessels constricted. C) Neutrophils migrated to the injury site. D) Opsonization occurred. 8. A 12-year-old boy was bitten by a dog, and inflammation took place at the site of the injury. During the process of opsonization, what physiological event occurred? A) The boy's blood vessels dilated, allowing rapid peripheral blood flow. B) Viscosity of the boy's blood decreased, facilitating the migration of neutrophils. C) Antigens were coated, marking them for phagocytosis. D) T cells were released from the boy's thymus gland. 9. An adult patient with an autoimmune disorder regularly takes oral corticosteroids. The nurse knows that corticosteroids can be used in the successful treatment of inflammation but that they also create a risk for A) bleeding. B) leukocytosis. C) infection. D) electrolyte imbalances. 10. The family members of a geriatric patient are angered that she has been colonized with methicillin-resistant Staphylococcus aureus during her stay in the hospital. The nurse should explain what characteristic of colonization to the members of the family? A) The bacteria are present but are not causing infection. B) The bacteria are causing an infection, but the infection is not spreading. C) The bacteria are causing tissue injury at the site of colonization. D) The bacteria are spreading within a clearly defined body region. 11. An adult female patient has been living with human immunodeficiency virus (HIV) for several years but has recently been admitted to the hospital after being diagnosed with herpes simplex. How would this patient's herpes infection most likely be characterized? A) Community-acquired infection B) Opportunistic infection C) Secondary infection D) Nosocomial infection

12. A group of nursing students are learning about the factors that underlie recent increases in the incidence and prevalence of antibiotic-resistant microorganisms. What factor is known to contribute to antibiotic resistance? A) Increased survival rates from acute infections B) Increased population density C) Use of antibiotics that are ineffective against the infectious microorganism D) Overuse of antibiotics 13. A 4-month-old baby has been brought to the emergency department by her parents, and initial assessment is highly suggestive of bacterial meningitis. Consequently, the baby has been admitted, and empiric antibiotic therapy has been ordered. The nurse should understand what characteristic of this infant's current treatment plan? A) Success or failure of treatment will not be apparent for several weeks. B) The infant will receive aggressive treatment with a narrow-spectrum antibiotic. C) Culture and sensitivity results of the infant's cerebrospinal fluid are still pending. D) The infant is suspected of having an antibiotic-resistant infection. 14. A patient with an infection has not responded appreciably to antibiotic therapy, and the nurse suspects antibiotic resistance. What phenomenon is known to contribute to acquired antibiotic resistance? A) Bacteria take on genetic material from healthy body cells, reducing antigen recognition. B) Microorganisms remain in resting (G0) phase during antibiotic treatment. C) Distribution of an antibiotic is insufficient to cause resolution of the infection. D) The strongest microorganisms survive antibiotic treatment while the weakest are eradicated. 15. When participating in the care of a patient who is being treated with antimicrobials, the nurse can promote the appropriate use of these medications in which of the following ways? A) Encouraging the use of narrow-spectrum, rather than broad-spectrum, antibiotics B) Promoting the use of prophylactic antibiotics for patients possessing risk factors for infection C) Initiating empiric therapy for all older adult patients admitted to a health care facility D) Promoting the use of herbal treatment for infection rather than antimicrobial drugs 16. A critically ill patient has developed a fever of 38.9°C, and blood cultures have been drawn and sent to the laboratory for culture and sensitivity testing. Determination of the culture will tell the care team A) whether the infection is antibiotic resistant. B) the exact identity of the infectious microorganism. C) the most likely location of the infection. D) the most likely origin of the infection.

17. A medical nurse on a night shift is reviewing a patient's medication administration record for the following day. The nurse notes that a combination antimicrobial drug is ordered. What is implied by the fact that the patient has been ordered a combination drug? A) The patient's infection likely has a fungal or protozoal etiology. B) The patient likely has a history of recurrent, multisystemic infections. C) The patient may be unable to tolerate treatment with a single antimicrobial. D) The patient may have an infection caused by multiple microorganisms. 18. A hospital nurse is aware that nosocomial infections pose a significant threat to many patients' health status. In order to reduce the spread of nosocomial infections, the nurse should prioritize which of the following actions? A) Increased use of empiric antibiotic therapy B) Use of disinfectants when providing patient hygiene C) Vigilant and thorough hand hygiene D) Patient education on the causes of infection 19. An 81-year-old female patient has been admitted to the hospital after a urinary tract infection developed into urosepsis. What assessments should the nurse prioritize when monitoring the course of this patient's infection? Select all that apply. A) Blood urea nitrogen and creatinine B) White blood cell count C) Heart rhythm D) Temperature E) Liver panel 20. Mr. Garcia has been taking antibiotics at home for the treatment of a respiratory infection for the past 6 days, and there is no evident improvement in his infection. Which of the following nursing assessments is most appropriate? A) Assess Mr. Garcia's adherence to his medication regimen. B) Assess Mr. Garcia's home hygiene. C) Assess Mr. Garcia's understanding of his illness. D) Assess Mr. Garcia's use of herbal or alternative remedies.

1. Ans: C Feedback: The yeast Candida albicans is a normal resident of the vagina and the intestinal tract. An antibacterial drug may destroy the normal bacterial flora without affecting the fungal organism. Klebsiella, Enterobacter, and Proteus will not contribute to the development of a yeast infection.

2. Ans: A Feedback: Much of the normal flora can cause disease under certain conditions, especially in the elderly, debilitated, or immunosuppressed people. The development of infectious diarrhea is related to the change in the normal flora of the bowel. Food-borne illness, Crohn's disease, and incontinence do not contribute to this particular development of diarrhea.

3. Ans: B Feedback: Opportunistic infections are likely to occur in people with severe burns, cancer, human immunodeficiency virus, and indwelling catheters and are often caused by drugresistant microorganisms, are usually serious, and may be life threatening. The patient may be at risk for a fungal, nosocomial, or food-borne infection, but the risk for all infections is high due to the patient's opportunistic nature of the burn. 4. Ans: D Feedback: Nosocomial infections are infections acquired from microorganisms in hospitals and other health care facilities. The patient's infection is not community acquired, postoperative, or sustained.

5. Ans: C Feedback: Interruption or inadequate antimicrobial treatment of infections may also contribute to the emergences of antibiotic-resistant organisms. The administration of an antibiotic with orange juice is not recommended in all instances. The medication does not need to be supplemented with vitamins. Antibiotics need not be administered with dairy products.

6. Ans: B Feedback: Culture identifies the causative organism, and susceptibility tests determine which drugs are likely to be effective against the organism. The duration of symptoms and the

patient's hydration status, age, and weight are important, but not imperative, in determining the antibiotic of choice.

7. Ans: B Feedback: The process of acute inflammation occurs in three stages. The first stage is the vascular stage; notable changes occur in the small blood vessels at the site of the cellular and tissue injury. At the time of the injury, vasoconstriction results, followed by vasodilation of the capillaries and venules to increase capillary blood flow, increasing temperature and redness at the site. Opsonization, neutrophil migration, and antibody production take place in later stages of inflammation.

8. Ans: C Feedback: The third stage of inflammation involves opsonization, which facilitates phagocytosis. During opsonization, a substance coats the foreign antigens, producing inflammation. This inflammation makes the antigens more susceptible to the macrophages and leukocytes, thus increasing phagocytic activity. Opsonization is not characterized by Tcell activity or changes in blood flow and viscosity.

9. Ans: C Feedback: Corticosteroids impair phagocytosis by preventing phagocytic cells from leaving the bloodstream. They decrease the amount of lymphocytes, fibroblasts, and collagen needed for tissue repair. This causes a reduction in inflammation but a commensurate increase in the patient's risk for infection.

10. Ans: A Feedback: Colonization is the presence and growth of microorganisms. The microorganisms do not necessarily cause tissue injury or elicit an immune response in the human body.

11. Ans: B Feedback: Microorganisms may become pathogens in hosts whose defense mechanisms are impaired. Opportunistic infections are likely to occur in people whose defenses are compromised due to human immunodeficiency virus (HIV) infection. This is not characterized as a nosocomial infection (hospital-acquired infection) or a secondary infection. The infection was likely to have been acquired in the community, but the

patient's HIV diagnosis means that it would be considered to be an opportunistic infection.

12. Ans: D Feedback: Antibiotic overuse can contribute to antibiotic resistance. Resistance is not typically attributable to increased age of patients, increased population density, or the use of ineffective antibiotics.

13. Ans: C Feedback: Empiric therapy is based on an informed estimate of the most likely pathogen(s) given the patient's signs and symptoms and the site of infection, as well as knowledge of communicable diseases currently infecting other people in the community. Because laboratory tests used to definitively identify causative organisms and to determine susceptibility to antibiotics usually require 48 to 72 hours, the prescriber usually initiates treatment with an antimicrobial drug that is likely to be effective. The other listed statements are not true of empiric therapy.

14. Ans: D Feedback: Selective pressure, or natural selection, refers to the survival of the fittest bacteria. When antibiotic therapy is initially begun, the weakest bacteria are killed first while the strongest bacteria, which are best able to withstand the effects of antibiotic therapy, remain. This contributes to antibiotic resistance. Resistance is not the result of an extended G0 phase, impaired distribution, or bacterial appropriation of human genetic material.

15. Ans: A Feedback: Guidelines to promote more appropriate use of antimicrobial drugs include using a narrow-spectrum antibacterial drug instead of a broad-spectrum drug, whenever possible, in order to decrease the risk of a superinfection. Herbal alternatives are frequently not available. Antibiotics should not normally be administered in the absence of a diagnosed infection.

16. Ans: B Feedback:

Culture identifies the causative microorganism. It does not necessarily indicate the presence of antibiotic resistance. The origin or location of the infection may often been indirectly determined by the culture, but this is not always the case.

17. Ans: D Feedback: Indications for combination therapy may include infections caused by multiple microorganisms. A fungal or protozoal infection is not implied, and the patient may or may not have a history of recurrent infections. Intolerance of single antibiotics is not normally an indication for combination therapy.

18. Ans: C Feedback: Good hand hygiene is probably the most effective method of preventing infections. This supersedes the importance of education regarding the causes of infection or the use of disinfectants. Antibiotic therapy should only be used on patients who clearly need this treatment. 19. Ans: B, D Feedback: For patients with an infection, the nurse should prioritize assessment of WBCs and temperature. Cardiac, renal, and liver function are important measures of health, but these are less directly affected by the presence of infection.

20. Ans: A Feedback: Nonadherence to antibiotic therapy can result in a continuation or exacerbation of the infection. Poor hygiene is a risk factor for the development of infection but is less likely to perpetuate an existing infection that is being treated appropriately with antibiotics. Herbs may be contraindicated but are unlikely to negate the therapeutic effects of an antibiotic. The nurse should gauge the patient's understanding of his illness, but this does not have a bearing on his lack of improvement.

Chapter 16 drug therapy to decrease pain, fever, and inflammation Which instruction would be most important to include when teaching parents about overthe-counter (OTC) anti-inflammatory agents? a. “Be sure to read the label for the ingredients and dosage.” b. “Aspirin is best for treating your child’s flulike symptoms.” c. “Make sure to give the drug on an empty stomach or before meals.” d. “Refrain from using acetaminophen for the child’s symptoms.”

A 16-year-old female client asks the nurse if she can take two Tylenol every 2 hours during exams because it helps relieve her tension headaches. What is the nurse's most appropriate response? a. "Why do you feel so tense regarding exams?" b. "Do not exceed recommended doses of acetaminophen due to the risk of life-threatening liver damage." c. "Consult your health care provider." d. "Acetaminophen is a benign drug and will relieve your pain."

A patient with arthritis is on nonsteroidal anti-inflammatory drug (NSAID) therapy. What should be evaluated by the nurse to determine the effectiveness of NSAID therapy? a. Blood sugar b. Respiratory rate c. Body temperature d. Better mobility

A 70-year-old woman on long-term ibuprofen therapy for osteoarthritis has returned to the clinic for her regular 6-month visit. The client states that in the last couple of months, she has been having increasing periods of abdominal pain. The nurse suspects that this pain may be related to which? a. anemia. b. peptic ulcer disease or gastritis. c. interstitial nephritis. d. constipation.

A salicylate is contraindicated in clients who have had surgery within the past week for which reason? a. Increased risk for allergic reaction b. Increased risk for toxicity c. Increased risk for bleeding d. Increased risk for fluid imbalance

While providing client teaching relative to inflammatory disorders, the nurse would explain the presence of inflammation as: a. the initial stage of infection, requiring antibiotic medication for resolution. b. a normal response to infection or trauma, which results in necrotic tissue formation. c. a typical response to bacterial infection. d. an attempt by the body to remove the damaging agent and repair the damaged tissue.

A client diagnosed with gout reports having no symptoms of the disease and asks why allopurinol was prescribed. How will the nurse best respond? a. “It is used to prevent or treat hyperuricemia, which occurs with gout.” b. “It is used to cure hyperuricemia, which occurs with gout.” c. “It is used in combination with another drug to prevent reoccurrences.” d. “It is not a first-line drug but can be used for gout.”

Which of the following is a serious risk involved in the use of NSAIDs? a. Increased granulocyte count b. Cardiovascular thrombosis c. Increased WBC count d. Sickle cell anemia

A 60-year-old man has told the nurse that he has been treating his joint pain with regular doses of ibuprofen. In order to ascertain the man's risks of experiencing adverse effects, the nurse should assess the patient's a. alcohol intake. b. calcium intake. c. body mass index. d. skin integrity.

A patient comes to the clinic reporting throbbing pain that started at night and intolerance to covers on the foot. The nurse observes swelling at the site of the first metatarsophalangeal (MTP) joint. For what disorder does the nurse anticipate the patient will be treated? a. Osteoarthritis b. Chronic gouty arthritis c. Rheumatoid arthritis d. Acute gouty arthritis

What drug is useful in the management of gout because of its ability to inhibit the formation of uric acid crystals? a. Allopurinol b. Probenecid

c. Colchicine d. Salicylic acid

A 78-year-old male client calls the clinic and reports severe pain and swelling in his right great toe. The client states that the pain is worse at night and has been present for at least 2 weeks. The nurse understands that this client has what type of inflammatory disorder? a. Osteoarthritis of the toe b. Probable fracture of the toe c. Gout d. Spondylarthritis An 80-year-old male client presents to the health care provider's office with reports of fatigue and a change in the color of stools. He self-administers ibuprofen 400 mg each night for general discomfort. The provider orders a stool test for guaiac (occult blood), which yields positive results. The provider discontinues the ibuprofen. The nurse is responsible for a client education plan. The client should be educated regarding what as a risk with chronic use of NSAIDs? a. GI discomfort b. GI distress c. GI bleed d. GI upset

Which of the following patients would the nurse determine has the highest risk of cumulative toxicity if prescribed colchicine? a. A pregnant patient b. A patient with hepatic disease c. A patient undergoing radiation therapy d. A patient with myelosuppression

A nurse will instruct a patient taking allopurinol to take each dose a. at night. b. first thing in the morning. c. after a meal. d. before a meal.

A 65-year-old man who just had a heart attack is placed on aspirin, 81 mg daily. The nurse is explaining the purpose of this medication to the client and his wife. What would be the nurse’s best explanation? a. The aspirin is being prescribed because it reduces the prostaglandins in your body. b. The aspirin is being prescribed because it will protect your heart. c. The aspirin is being prescribed because it reduces your risk of a second heart attack. d. The aspirin is being prescribed to relieve the pain from the heart attack.

Patients are often given a daily dose of aspirin for prophylaxis of myocardial infarction (MI), transient ischemic attacks (TIA), and cerebrovascular accident (CVA). What is the recommended daily dose for this purpose? a. 81-325 mg b. 180-240 mg c. 360-460 mg d. 600-650 mg

The 56-year-old client is diagnosed with osteoarthritis and reports joint pain and stiffness. Which medication would be identified as appropriate for the client to take? a. Eletriptan b. Ergotamine c. Sumatriptan d. Celecoxib

The nurse would question the health care provider who prescribed nonsteroidal antiinflammatory drugs (NSAIDs) for which client? a. The client diagnosed with peptic ulcers b. The client diagnosed with diabetes c. The client diagnosed with psoriasis d. The postpartum woman who had a vaginal birth

A nurse is preparing to teach a client about the adverse effects of prescribed nonsteroidal anti-inflammatory drug (NSAID) therapy. The nurse plans to focus on the most common adverse reactions caused by this group of drugs. Which effects would the nurse include as being involved? a. stomach b. lungs c. liver d. peripheral nerves

Acetaminophen is frequently used as a substitute for aspirin. What effects of aspirin are absent in acetaminophen? a. Antiplatelet and antipyretic effects b. Analgesic and antipyretic effects c. Anti-inflammatory and antiplatelet effects d. Anti-inflammatory and analgesic effects

A client is alarmed to be prescribed celecoxib (Celebrex), stating, "I heard on TV that Celebrex causes heart attacks." How should the nurse best respond?

a. "This drug hasn't been definitively proven to be unsafe, so it's still available." b. "A final decision from the FDA on whether Celebrex is safe will be released in 2018." c. "As long as you take your heart medications, you'll be fine." d. "That was a scare that was entirely created by the media."

An adult client has been admitted to the emergency department after deliberately overdosing on approximately 50 grams of acetaminophen. The nurse should prepare for what intervention? a. Administration of acetylcysteine as prescribed b. Watchful waiting c. Administration of naloxone as prescribed d. Intravenous administration of Lactated Ringer's

A nurse is teaching a patient about his newly prescribed drug, colchicine, for gout. The nurse will instruct the patient to avoid which of the following foods? a. Green beans b. Shrimp c. Eggs d. Milk

The nurse is conducting a medication reconciliation of a new resident of a long-term care facility. The nurse notes that the resident takes allopurinol on a daily basis for the treatment of gout. What is the primary purpose of this drug? a. To balance urate concentration and prevent gout attacks b. To promote the remodeling of damaged synovium c. To potentiate the metabolism of dietary purines d. To achieve pain relief in joints affected by gout

Chapter 17 Drug Therapy with Corticosteroids You are providing client education relative to an inhaled glucocorticoid. You would include which of the following instructions? a) While using the inhaler, hold your breath for 10 seconds to assist in the absorption of the medication. b) Rinse your mouth completely after using the inhaler. c) Do not eat or drink anything for 20 minutes after using the inhaler. d) Forcefully exhale after using the inhaler. A nurse tells a patient to take a prescribed glucocorticoid in the morning based on the understanding that: a) This time ensures that the patient will take the drug. b) This time mimics the normal peak diurnal concentration levels. c) The drug needs to suppress the hypothalamic pituitary axis. d) The drug is absorbed better in the morning.

A nurse is caring for a 78-year-old client with rheumatoid arthritis. The health care provider has prescribed cortisone, a corticosteroid, to the client. The nurse would administer the drug cautiously to a client with which condition? Select all that apply. -decreased muscle mass -osteoporosis -migraine headaches -liver disease -heart failure

A female client has been taking prednisone for her asthma for 1 month. The nurse will teach her to gradually decrease her dose of prednisone to avoid: a) menstrual irregularities. b) adrenal insufficiency. c) hypokalemia. d) gastrointestinal problems.

A nurse is overseeing the care of a young man whose ulcerative colitis is being treated with oral prednisone. Which action should the nurse take in order to minimize the potential for risks associated with prednisone treatment? a) Advocate for intravenous, rather than oral, administration. b) Avoid OTC antacids for the duration of treatment. c) Teach the client strategies for dealing with headaches. d) Carefully assess the client for infections.

Based on the metabolic action of glucocorticoids, a client who is on long-term glucocorticoid therapy is at risk of developing what disease? a) Osteoporosis b) Bronchoconstriction c) Cryptorchism d) Swelling in the brain and spinal cord

The nurse is caring for an 84-year-old client with diabetes who is receiving hydrocortisone 40 mg daily PO for treatment of an arthritic flare-up. When writing a plan of care for this client, which nursing intervention would be most appropriate? a) Restricting dietary protein b) Increasing fluids to 2000 mL per day c) Increasing dietary sodium d) Monitoring blood glucose levels frequently

A male client is diagnosed with Addison disease. What daily medication would the nurse expect to be administered? a) Warfarin b) Prednisone c) Hydrochlorothiazide d) Apresoline A 65-year-old client who has been on long-term corticosteroid therapy is admitted to the hospital and will need an IV inserted. What adverse effect of corticosteroid may negatively affect this procedure? a) Moon face b) Truncal obesity c) Insomnia d) Thinning of the skin

The nurse is working in a home care setting. A female client is prescribed oral corticosteroids by her health care provider secondary to a diagnosis of Addison disease. What is the nurse's responsibility in this situation? a) Supervising and monitoring the administration of the drug b) Administering all doses of the oral medication for the first month of use c) Administering all doses of the oral medication d) Teaching all family members to administer the medication

A male client who is being treated for chronic obstructive pulmonary disease (COPD) is diagnosed with adult respiratory distress syndrome. His family asks

whether corticosteroids may help him to breathe easier. Which statement about corticosteroids is accurate? a) They are successfully used for the long-term treatment of ARDS. b) They are not used when the client are diagnosed with a chronic respiratory disorder. c) They are not a beneficial treatment for ARDS. d) They are successful for the short-term treatment of ARDS.

A 45-year-old woman has been taking a corticosteroid and calls the clinic reporting the development of acne-like lesion on her face as well as facial hair. What is the nurse's best response? a) "Sadly, this is an adverse effect seen in women. It should improve when you finish the medication." b) "If you shave it regularly, no one will notice." c) "Stop taking the drug immediately." d) "This is a permanent problem. You will need to schedule electrolysis treatments."

A female client asks the nurse why her 4-year old son is not receiving corticosteroids. The client read in an article that they are more effective to prevent transplant rejection than the medication that is currently prescribed. What is the appropriate response by the nurse? a) Corticosteroids increase the risk for childhood illness. b) Corticosteroids impair the child's mental status. c) Corticosteroids increase the risk for rejection in children younger than 6 years of age. d) Corticosteroids impair growth in children.

The nurse is teaching a client who will require long-term corticosteroid therapy how to reduce the risk of infection. What suggestions will the nurse include? a) "Avoid working in areas with other people." b) "Avoid large crowds of people in confined spaces." c) "Avoid touching other people who may carry germs." d) "Avoid exercising to reduce risk of injury."

Which finding should alert the nurse to a potential Cushing's syndrome manifestation presented by a client prescribed long-term corticosteroid therapy? a) weight loss b) hair loss c) buffalo hump d) insomnia

To minimize adrenal suppression, when should the nurse encourage a client to take his or her daily dose of prescribed prednisone?

a) "Take your medications in the morning." b) "Take your medication just before bedtime." c) "Take your medications on an empty stomach." d) "Take your medications with the evening meal."

The nurse just completed client education relative to chronic adrenocortical insufficiency and corticosteroid medication treatment. Which statement indicates the client requires further instruction? a) "I will start this medication as soon as I am feeling ill or tired." b) "I will call my health care provider if I develop a fever." c) "I will report any weight gain above 5 pounds in 1 week to my health care provider." d) "I need to minimize my exposure to anyone who may be ill."

A client with a diagnosis of asthma has responded well to treatment with oral corticosteroids, and a switch to inhaled corticosteroids is planned. What strategy for managing this change in treatment should be implemented? a) The oral drug should be stopped approximately 1 week prior to starting the inhaled drug. b) The inhaled drug should be started during tapering of the oral drug. c) The two drugs should be taken simultaneously for 10 to 12 weeks. d) The inhaled drug should begin 3 to 4 weeks before starting to taper the oral drug.

A client is on daily doses of prednisone. To minimize adrenal suppression, the nurse's instructions for administration should include to take the medication: a) on an empty stomach. b) with the evening meal. c) in the morning. d) just before bedtime.

The nursing instructor is discussing short-term versus long-term corticoid steroid therapy with the nursing students. What would be the most appropriate teaching for a client on long-term corticosteroid therapy? a) Long-term therapy is anything 10 days or longer b) Taper doses when discontinuing drug c) Give with meals d) Short-term therapy is 1 week or less

When monitoring a client who is receiving mineralocorticoid therapy, which assessment finding would be most important for the nurse to report? a) Slight pedal edema b) Weakness

c) Shortness of breath d) Headache

The nurse anticipates an order for a glucocorticoid when caring for a client with what condition? a) septicemia b) hypoglycemia c) arthritis d) appendicitis

A 2-year-old client is placed on a course of prednisone following a series of hypersensitivity responses. What instruction the nurse provide the client's family about this drug? a) "Don't stop this medication suddenly; you will have to taper dosage gradually." b) "The child may receive immunizations while on this drug, but keep them to a minimum." c) "Monitor your child closely for any difficulty swallowing or signs of gastric reflux." d) "You might find that your child is sleepier than usual, especially near the beginning of treatment."

When caring for a client receiving long-term therapy with corticosteroids, the nurse would plan care incorporating interventions aimed at preventing what? a) anemia b) infection c) cognitive changes d) allergies

The home health nurse provides client teaching to a client who is taking oral prednisolone. The nurse provides what instruction to the client? a) "Take before bedtime." b) "Take 1 hour before meals." c) "Split the dose into two equal doses." d) "Take it first thing in the morning."

A nurse taking a medical history on a client prescribed a corticosteroid medication should focus on which condition? a) infections b) depression

c) cognitive impairment d) urinary incontinence

A client with a diagnosis of asthma has responded well to treatment with oral corticosteroids, and a switch to inhaled corticosteroids is planned. What strategy for managing this change in treatment should be implemented? a) The oral drug should be stopped approximately 1 week prior to starting the inhaled drug. b) The two drugs should be taken simultaneously for 10 to 12 weeks. c) The inhaled drug should be started during tapering of the oral drug. d) The inhaled drug should begin 3 to 4 weeks before starting to taper the oral drug.

Chapter 18 Drug Therapy With Beta-Lactam Antibacterial Agents Your client receives IV vancomycin every 12 hours. You know that this infusion should run over: A. 1 to 2 hours. B. 3 to 4 hours. C. 2 to 4 hours. D. 30 minutes. Rationale: For systemic infections, vancomycin is given IV and reaches therapeutic plasma levels within 1 hour after infusion. It is very important to give IV infusions slowly, over 1 to 2 hours, to avoid an adverse reaction characterized by hypotension, flushing, and skin rash. This reaction, sometimes called "red man syndrome," is attributed to histamine release.

A male client who has undergone surgery of the urinary tract is administered cephalosporins to prevent infections. When assessing the client on the day after the surgery, the nurse notices that he has an elevated temperature. Which nursing intervention would be most appropriate in this case? A. Administer a higher dosage of the drug. B. Discontinue use of the drug. Inform the primary health care provider. C. Record the client's fluid intake. D. Inform the primary health care provider. Rationale: The nurse should immediately report an increase in the client's body temperature to the primary health care provider. The nurse should consult the provider before increasing, decreasing, or discontinuing the dosage. The nurse should measure and record the fluid intake if there is a decrease in the urine output.

A health care center is conducting a seminar on cephalosporins drugs. During the question-and-answer period, the audience wants examples of conditions that can be treated by cephalosporins. Which of the following infections should the nurse state as examples? A. Hemolysis B. Nausea and diarrhea C. Jaundice D. Urinary tract infections Rationale: Cephalosporins are used to treat urinary tract infections, skin infections, and hospital-acquired pneumonias. Cephalosporins are not used to treat hemolysis or jaundice. Nausea and diarrhea are some of the adverse reactions that can occur when a patient is on cephalosporins therapy.

The nurse administers cefuroxime to a client at least one hour before meals, as prescribed. However, the client experiences a GI upset. Which is an appropriate nursing intervention in this case? A. Administer the drug with food. B. Administer an antacid. C. Discontinue the drug. D. Lower the dosage. Rationale: If the client experiences GI upset, the nurse can administer cefuroxime with food. A decrease in the dosage is suggested in a client with renal impairment. A change in dosage, discontinuation of the drug, or use of an antacid is recommended only if prescribed.

A 34-year-old female client is taking oral cephradine, a first-generation cephalosporin, at regular intervals with a 2-hour gap before meals. The client reports gastrointestinal distress. The nurse will encourage the client to do which? A. Change the drug dosage. B. Drink plenty of fluids. C. Take the drug with food. D. Avoid dairy products Rationale: Oral forms of cephradine are best taken with food to reduce GI distress. Drinking plenty of fluids will help maintain the fluid balance but will not deter cephradine absorption in the body. Altering the drug dosage would not have any effect if the client takes the medication on an empty stomach. The IV route is recommended only if the client cannot retain the oral form of the drug and could not be self-administered.

An older adult is to receive a low dose of a cephalosporin for an infection. When realizing that this client has age-related diminished renal function, what intervention should the nurse implement? A. Notify the prescribing provider. B. Monitor blood creatinine levels. C. Initiate monitoring of intake and output. D. Hold the drug for lab work. Rationale: The older adult is more susceptible to the nephrotoxic effects of the cephalosporins, particularly if renal function is already diminished because of the aging process or a disease. With renal impairment, a lower dose can be given and monitoring creatinine levels is indicated. Refusing to give the drug is not necessary nor is immediately notifying the prescriber. Monitoring intake and output will not effectively monitor of nephrotoxicity.

The nurse is caring for a 23-year-old female client who uses oral contraceptives and has been prescribed ampicillin for treatment of a respiratory infection. What information is most important for the nurse to share with this client? A. Do not take your oral contraceptives while you are taking this medication. B. Your menstrual cycle will have a heavier flow while on this medication. C. Taking this antibiotic with your oral contraceptives will cause an increased chance of bleeding. D. Use a type of barrier birth control while you are taking this antibiotic. Rationale: Clients taking oral contraceptives should be encouraged to use a barrier type of birth control during penicillin therapy; the penicillin will cause a decreased effectiveness of the contraceptive agent. The client should not be told to stop taking the oral contraceptive. This will not cause a heavier mensus. The interaction between oral contraceptives and ampicillin will not cause an increased chance of bleeding, as that interaction is between large doses of penicillins and anticoagulants.

A male client is admitted to the unit with Pseudomonas aeruginosa sepsis. The health care provider orders aminoglycoside to be given concomitantly with penicillin intravenously. How would the nurse administer these drugs? A. By mixing both drugs in normal saline solution B. By administering the drugs dextrose 5% and 0.9% normal saline C. By administering the drug in separate IV bags D. By administering the drugs every other day Rationale: Aminoglycosides are often given concomitantly with penicillins for serious infections, such as those caused by Pseudomonas aeruginosa. The drugs should not be admixed in a syringe or in an IV solution, because the penicillin inactivates the aminoglycoside.

The nurse is admitting a 12-year-old girl to the acute care facility and notices discolored secondary teeth. The mother says she doesn't know why the teeth are discolored because the child is very good about brushing and flossing and sees the dentist regularly. What question should the nurse ask? A. "Has she ever received tetracycline?" B. "Has she ever received cephalexin?" C. "Has she ever received gentamicin?" D. "Has she ever received ampicillin?" Rationale: The nurse would question whether the child was ever given tetracycline because this drug is commonly associated with discoloration of secondary teeth when it is administered to children who still have their primary teeth. Gentamicin, ampicillin, and cephalexin are not associated with discoloration of the teeth.

The nurse is reviewing the medication history of a client who is prescribed penicillin therapy. Use of which medication would alert the nurse to the possibility of the client's increased risk for an anaphylactic reaction? A. losartan B. propranolol C. verapamil D. benazepril Rationale: The concomitant use of penicillins with beta-adrenergic blocking drugs, such as propranolol, may increase the risk for an anaphylactic reaction. Losartan and benazepril are also antihypertensives but work on different mechanisms than the beta-blocker propranolol by blocking adrenaline; they are ACE inhibitors or angiotensin receptor blockers/receptor antagonists. Verapamil is a calcium channel blocker, used to treat blood pressure as well as some arrythmias by keeping the blood pressure down through dilation of the vessels to lower blood pressure.

Your client is scheduled for surgery and has prophylaxis antibiotics ordered to be given IVPB. You know that to reach therapeutic serum levels, the drug should be given: A. Immediately after the first incision. B. Within 2 hours of surgery being completed. C. The night before surgery. D. Within 2 hours of the first skin incision being made. Rationale: When used perioperatively, cephalosporins should be given within 2 hours before the first skin incision is made so the drug has time to reach therapeutic serum and tissue concentrations. A single dose is usually sufficient, although repeat doses are necessary in clients undergoing a surgical procedure exceeding 4 hours or procedures involving major blood loss. Postoperative doses are rarely necessary, but, if used, should generally not be given beyond 24 hours.

A 75-year-old patient with a history of renal impairment is admitted to the primary health care center with a UTI and has been prescribed a cephalosporin. Which of the following interventions is most important for the nurse to perform when caring for this patient? A. Testing for increased glucose levels. B. Monitoring blood creatinine levels. C. Testing for occult blood. D. Monitoring fluid intake. Rationale: An elderly patient is more susceptible to the nephrotoxic effects of the cephalosporins. Since renal impairment is present, it is important for the nurse to closely monitor the patient's blood creatinine levels. The nurse should conduct a test for occult blood if blood and mucus occur in the stool and monitor the fluid

intake if there is a decrease in urine output. The nurse does not need to monitor for increased glucose levels unless the patient has a history of diabetes.

The nurse knows that superinfections are a concern for clients who have been taking oral penicillins. Which is one of the more common superinfections? A. meningococcal meningitis B. pseudomembranous colitis C. septicemia D. syphillis Rationale: A superinfection can develop rapidly and is potentially life-threatening. Pseudomembrananous colitis is a common bacterial superinfection. The others are infections typically treated with penicillin.

A young adult has been receiving Keflex P.O. for the last 5 days to treat a respiratory infection. The nurse is concerned when the client reports urinating only once in the last 16 hours. What should the nurse consider as the cause? A. Superinfection B. Systemic dehydration C. Nephrotoxicity D. Steven-Johnson syndrome Rationale: Nephrotoxicity may develop from administration of cephalosporins. An early sign of this adverse reaction is decreased urine output. The nurse should measure and record fluid intake and output and notify the primary healthcare provider if output is less than 500 ml/day. Decreased urine output is not a sign of Steven-Johnson syndrome. It also is not indicative of a superinfection. There is no indication of dehydration existing.

What event triggers the development of a superinfection? A. unforeseen interactions between the antibiotic and other prescribed medications B. the infection is well established before antibiotic treatment begins C. bone marrow suppression triggered by antibiotic treatment D. proliferation of antibiotic-resistant microorganisms Rationale: Superinfection is an infection after the occurrence of a previous infection, typically caused by microorganisms that are resistant to the antibiotics used earlier. None of the other options accurately describe this condition as it is associated with antibiotic-resistant microorganisms.

Chapter 18 Drug Therapy With Beta-Lactam Antibacterial Agents You know that penicillins are more effective when used on what type of bacteria? A. Gram-negative viruses B. Gram-positive bacteria C. Gram-negative bacteria D. Fungal infections Rationale: Clinical indications for use of penicillins include bacterial infections caused by susceptible microorganisms. As a class, penicillins usually are more effective in infections caused by gram-positive bacteria than those caused by gram-negative bacteria. However, their clinical uses vary significantly according to the subgroup or individual drug and microbial patterns of resistance.

A client is receiving a cephalosporin and an aminoglycoside as combination therapy. What assessment should the nurse prioritize? A. Serum BUN and creatinine levels B. Complete blood count C. Coagulation studies D. Signs of disulfiram-like reaction Rationale: The nurse would need to assess renal function indicated by serum BUN and creatinine levels because combining cephalosporins with aminoglycosides increases the client's risk for renal toxicity. Coagulation studies would be important if the client was receiving a cephalosporin with an oral anticoagulant because there is an increased risk for bleeding. Combining cephalosporins with alcohol could result in a disulfiram-like reaction. Assessing the client's complete blood count would not be directly indicated by the combination of cephalosporins and aminoglycosides.

A client has been prescribed 200 mg of cefpodoxime every 12 hours. On hand are 25-milligram tablets. To meet the prescribed dose, the nurse administers tablets at each dosage. A. 8 B. 6 C. 4 D. 10 Rationale: The required dosage is 200 mg, while the available tablet contains 25 mg of the drug. Therefore, 8 tablets (200 mg/25 mg) need to be administered at each dosage.

Which of the following should a nurse carefully monitor in a patient who has been administered cephalosporin as well as aminoglycosides for a wound infection? A. Increased bleeding B. Respiratory difficulty C. Nephrotoxicity D. Nausea Rationale: When cephalosporin is administered with aminoglycosides, it increases the risk for nephrotoxicity and should be closely monitored. Nausea is an adverse reaction of cephalosporins in patients with gastrointestinal tract infection. The risk of bleeding increases when cephalosporin is administered with oral anticoagulants. Risk for respiratory difficulty increases if alcohol is consumed within 72 hours after certain cephalosporin administration.

A patient who was administered cephalosporins has developed a skin rash. The nursing assistant is scared and thinks that this is a serious reaction. The nurse tells him that this is a mild reaction. Which of the following should the nurse mention as the symptoms of serious hypersensitivity reaction? A. Renal dysfunction B. Pruritis C. Urticaria D. Skin rashes Rationale: Renal dysfunction is one of the life-threatening hypersensitivity reactions that can occur with administration of the cephalosporins. Mild hypersensitivity reactions include pruritus, urticaria, and skin rashes; these can be controlled with appropriate nursing interventions.

A client on cephalosporin therapy is prescribed cefazolin for a sinus infection. After administration of the first dose of the cefazolin, the client reports itching. The nursing assessment reveals a rash over the client's torso. What is the most likely cause of the itching? A. A side effect from the cefazolin. B. A cross-sensitivity reaction. C. A need for a dosage reduction D. A tolerance reaction to the cephalosporin Rationale: Cefazolin is contraindicated in anyone with a known allergy to cephalosporins. Caution must be used in clients with renal failure and in pregnant or lactating women. Because of the structural similarities between cephalosporins and penicillins, clients who are allergic to one type of drug may experience cross-sensitivity to the other. Cephalosporin hypersensitivity occurs in 5% to 10% of clients with penicillin allergy. Clients with a history of severe allergic reactions to penicillins should not receive cephalosporins because of their increased risk for cross-sensitivity reactions.

Penicillins may trigger an anaphylactic reaction in some clients. Within what period following injection of a penicillin is anaphylaxis most likely to occur? A. 30 minutes B. 15 minutes C. 10 minutes D. 45 minutes Rationale: Anaphylaxis induced by injectable penicillins typically occurs within 30 minutes of administration

Unless hemodialysis is started within 48 hours, imipenem is contraindicated for clients with severe renal impairment. What laboratory measurement would indicate renal impairment? A. Creatinine clearance B. Hematocrit C. Serum albumin D. White blood count Rationale: Dosage of imipenem should be reduced in most clients with renal impairment, and the drug is contraindicated in clients with severe renal impairment (CrCl of 5 mL/min or less) unless hemodialysis is started within 48 hours. For clients already on hemodialysis, the drug may cause seizures and should be used very cautiously, if at all.

A female client is admitted to the critical care unit with sepsis related to a contaminated central line. The health care provider orders intravenous betalactam antimicrobials. The client's current laboratory report reflects renal impairment. What would the nurse expect the provider to do? A. Maintain the drug dose. B. Decrease the drug dose. C. Increase the drug dose. D. Administer the drug via an intramuscular route. Rationale: Beta-lactam antimicrobials are commonly used in critical care units to treat pneumonia, bloodstream infections, wound infections, and other infections. Renal, hepatic, and other organ functions should be monitored in critically ill clients, and drug dosages should be reduced when indicated.

A client being treated with an oral penicillin should be encouraged to administer the medication on which schedule to best achieve a therapeutic effect? Select all that apply. A. at bedtime B. around the clock C. with meals D. at regular intervals E. upon rising in the am Rationale: Clients should aim to take penicillins at even intervals, preferably around the clock. These drugs are not normally taken with food.

Penicillin would NOT be indicated for which of the following clients? A. A client with gram-negative bacterial infection allergic to sulfa B. A client with a mixture of gram-positive and gram-negative bacteria C. A client with gram-negative bacteria allergic to penicillin D. A client with gram-negative bacteria allergic to tetracycline Rationale: Contraindications include hypersensitivity or allergic reactions to any penicillin preparation. An allergic reaction to one penicillin means the client is allergic to all members of the penicillin class. The potential for cross-allergenicity with cephalosporins exists, although recent data suggest that the incidence is less than 1%, lower than previously thought. Administration of cephalosporins should be avoided in individuals with life-threatening allergic reactions to penicillin (anaphylaxis, laryngeal swelling angioedema, or hives).

A health care provider prescribes a client 3.375 g piperacillin sodium and tazobactam (Zosyn) every six hours. After reconstitution, the concentration of the drug is 2.25 g/50 mL. Which quantity of the reconstituted solution should the nurse administer to the client? A. 60 mL B. 75 mL C. 70 mL D. 65 mL Rationale: After reconstitution, the concentration of the drug is 2.25 g/50 mL. Concentration of drug per mL is 0.045 g (2.25/50). Therefore, to administer 3.375 mg piperacillin, 75 (3.375/0.045) mL of the reconstituted solution is required.

A 7-year-old child has tonsillitis and is prescribed penicillin V, which is to be administered at home. The nurse will instruct the parents to administer the drug A. intravenously with the assistance of a home health nurse. B. immediately before or with a meal.

C. with a glass of water 1 hour before or 2 hours after a meal. D. with a sip of water 1 hour before mealtime. Rationale: The nurse should instruct the parents to administer penicillin V exactly as prescribed at regular intervals. Penicillin V should be taken on an empty stomach 1 hour before or 2 hours after a meal with a glass of water. Penicillin V should not be taken with meals because food may affect the absorption of the drug. Penicillin V is easy to administer in the home setting; it does not need to be given IV under the supervision of a home health nurse.

When learning about the different classes of cephalosporins, the nurse correctly identifies which of the following statements? A. Cephalosporins are divided into three different groups. B. Cephalosporins are completely different chemically from penicillin. C. A first-generation cephalosporin is more useful than a third-generation cephalosporin against gram-positive microorganisms. D. Cephalosporins are limited in treating many types of bacteria. Rationale: Cephalosporins are valuable and effective in treating infections with almost all strains of bacteria also affected by penicillins, as well as some strains that have become resistant to penicillin. Cephalosporins are structurally and chemically related to penicillin. They are divided into four groups: first, second-, third-, and fourth-generation drugs. It is true that progression from first to fourth generation shows an increase in the sensitivity of gram-negative microorganisms and a decrease in the sensitivity of gram-positive microorganisms. For instance, a first-generation cephalosporin would be more useful against gram-positive microorganisms than would a third-generation cephalosporin.

A group of students are reviewing material for a test on antibiotics. They demonstrate an understanding of the material when they identify what as the first antibiotic introduced for clinical use? A. Cephalexin B. Penicillin C. Ampicillin D. Erythromycin Rationale: Penicillin was the first antibiotic introduced for clinical use. Sir Alexander Fleming produced the original penicillin in the 1920s.

Chapter 19- Drug Therapy With Aminoglycosides and Fluoroquinolones 1. A patient is diagnosed with an infection attributable to the gram-negative microorganism Pseudomonas. Which of the following anti-infective agents is most reliable in treating this microorganism? A) Aminoglycoside B) Antifungal C) Aminopenicillin D) GABA analog Ans: A Feedback: Aminoglycosides are used to treat infections caused by gram-negative microorganisms, such as Pseudomonas. Antifungal and aminopenicillin agents are not used to treat Pseudomonas. A GABA analog is used to treat pain related to neuropathy.

2. A patient is diagnosed with a gram-negative infection and is prescribed an aminoglycoside. What is the action of an aminoglycoside? A) It blocks protein synthesis of the cell wall. B) It blocks DNA replication. C) It destroys the integrity of the cell wall structure. D) It increases white blood cell viability. Ans: A Feedback: Aminoglycosides penetrate the cell walls of susceptible bacteria and bind irreversibly to 30S and 50S ribosomes, intracellular structures that synthesize proteins. Aminoglycosides do not block DNA replication, destroy cell wall structure, or increase white blood cells.

3. The nurse is preparing to administer gentamicin (Garamycin) to a patient when he mentions that he has recently been experiencing diminished hearing. What action should the nurse take based on this statement? A) Administer the dosage and notify the physician of the alteration in hearing. B) Hold the dosage and notify the physician of the alteration in hearing. C) Administer the dosage and report the alteration in hearing to the audiologist. D) Hold the dosage and document the finding in the nurses' notes. Ans: B Feedback: Aminoglycosides accumulate in high concentrations in the inner ear, damaging sensory cells in the cochlea and vestibular apparatus. The medication should be held and alteration in hearing reported to the physician. The administration of the medication will only cause more damage to the cochlea and vestibular apparatus. Holding the medication and documenting the information in the nurses' notes will not allow for a new anti-infective to be administered and for the hearing to be assessed.

4. A patient is diagnosed with multidrug-resistant tuberculosis. Which of the following

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aminoglycoside medications is used in a 4- to 6-drug regimen? A) Tetracycline hydrochloride (Achromycin) B) Amoxicillin (Amoxil) C) Sulfadiazine (Sulfisoxazole) D) Streptomycin (Sulfate) Ans: D Feedback: Streptomycin may be used as part of a 4- to 6-drug regimen for treatment of multidrugresistant tuberculosis. Tetracycline, amoxicillin, and sulfadiazine are not aminoglycosides or drugs of choice for multidrug-resistant tuberculosis.

5. A patient is scheduled for a bowel resection. He is to receive neomycin sulfate (NeoFradin) by mouth. The patient asks the nurse the purpose of this medication. What is the most appropriate response the nurse can provide to the patient? A) “The administration by mouth will prevent renal damage.” B) “The administration by mouth will prevent ototoxicity.” C) “The administration will decrease the risk of contamination.” D) “The administration decreases the risk of airborne contamination.” Ans: C Feedback: Neomycin can be given before bowel surgery to suppress intestinal bacterial growth. The administration of neomycin will not prevent renal damage or ototoxicity. It will also not affect the risk of airborne contamination.

6. A patient has been administered an aminoglycoside. It is time for his next dose, and the nurse learns his creatinine level is elevated at 3.9 mg/dL. What action should the nurse take regarding this assessment? A) Administer the medication and report the creatinine level. B) Hold the dose until another creatinine level is assessed. C) Administer the medication with 100 mL of fluids. D) Hold the medication and assess the urine output. Ans: D Feedback: Aminoglycosides are nephrotoxic and should not be administered in the presence of renal impairment. It is important to hold the medication, assess the urine output, and notify the physician. The medication should not be administered. The medication should be held, but the creatinine level cannot be reassessed without a doctor's order. The administration with fluids will not protect the patient from renal impairment.

7. A patient has a genitourinary infection and is being treated with a fluoroquinolone. What is the advantage of a fluoroquinolone over an aminoglycoside? A) The fluoroquinolone does not have adverse effects. B) The fluoroquinolone can be given orally.

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C) The fluoroquinolone has a nearly immediate peak. D) The fluoroquinolone has a broader spectrum. Ans: B Feedback: Fluoroquinolones are often given orally. Like all drugs, they have adverse effects. Peak levels are not immediately achieved, and they do not have a broader spectrum than an aminoglycoside.

8. A patient is receiving gentamicin (Garamycin) to treat meningitis. The physician has ordered a peak serum level be drawn in association with the 07:00 dose, which will finish infusing at 07:30. When should the peak serum level be drawn? A) 08:00 B) 09:00 C) 10:00 D) 12:00 Ans: A Feedback: With conventional dosing, it is necessary to take gentamicin peak levels 30 minutes after the end of a 30-minute IV infusion. Thus, 8:00 AM is the optimal peak time to assess the serum level of gentamicin.

9. A patient has been prescribed a once-daily aminoglycoside. What is the advantage of this method of administration? A) It is associated with less hepatotoxicity. B) It is significantly more cost-effective. C) It reduces the risk of nephrotoxicity. D) It increases adherence to treatment. Ans: C Feedback: The use of once-daily aminoglycoside dosing has replaced the common multiple daily dosing. The rationale for this dosing approach is a potential increase in efficacy with a reduced incidence of nephrotoxicity.

10. A patient is prescribed ciprofloxacin (Cipro). Which of the following nursing interventions will best prevent crystalluria? A) The nurse should limit oral fluids to 500 mL/day. B) The nurse should administer 2000 mL of oral fluids per day. C) The nurse should insert a urinary catheter. D) The nurse should administer phenazopyridine (Pyridium). Ans: B Feedback: Guidelines to decrease the incidence and severity of adverse effects include keeping patients well hydrated to decrease drug concentrations in serum body tissues. The

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administration of 500 mL is not a sufficient amount to prevent crystalluria. The administration of Pyridium will not prevent crystalluria. A urinary catheter is not indicated.

11. A nurse has informed the laboratory technician that a patient's gentamicin has finished infusing and the technician will soon draw a blood sample to determine the patient's serum drug concentration. Why is assessment of gentamicin levels necessary? A) To identify possible changes in the patient's serum osmolality B) To identify whether the drug is at a therapeutic level C) To identify whether the drug is causing hepatotoxicity D) To identify possible hemolysis following administration Ans: B Feedback: Measurement of both peak and trough levels of gentamicin helps maintain therapeutic serum levels without excessive toxicity. Gentamicin is nephrotoxic, not hepatotoxic. Hematological changes are not assessed by measuring serum drug levels.

12. An adult male patient with a diagnosis of osteomyelitis will soon begin treatment with gentamicin. Which of the following schedules is most likely to maximize efficacy and minimize nephrotoxicity? A) Gentamicin 500 mg IV OD at 1200 B) Gentamicin 250 mg PO BID at 07:30 and 19:30 C) Gentamicin 500 mg PO TID at 08:00, 12:00, and 17:00 D) Gentamicin 125 mg IV QID at 06:00, 1200, 18:00, and 24:00 Ans: A Feedback: The ODA method uses higher doses (e.g., 4 to 7 mg/kg) to produce high initial drug concentrations, with no repeat dosing until the serum concentration is quite low (typically 24 hours later). The rationale for this dosing approach is a potential increase in efficacy with a reduced incidence of nephrotoxicity. Gentamicin is not administered orally.

13. A medical nurse is aware of the need to assess for potential ototoxicity in patients who are being treated with gentamicin. Which of the following patients is likely most susceptible to developing ototoxicity secondary to gentamicin? A) A man who received his first dose of IV gentamicin 12 hours ago B) A man who has required repeated courses of gentamicin over the past several months C) A woman who has a Pseudomonas infection but who has a hypersensitivity to penicillins D) A woman who is immunocompromised and who is being treated with gentamicin Ans: B Feedback: Ototoxicity (auditory or vestibular) may develop after extended use of gentamicin and may not be reversible. Penicillin allergies and immunocompromised status are not risk

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factors for ototoxicity.

14. A patient with sepsis is being treated with gentamicin, and her medication regimen takes into account the phenomenon of postantibiotic effects. What are postantibiotic effects? A) The tendency for patients to exhibit symptoms mimicking hypersensitivity after drug administration B) The tendency for adverse effects of a drug to be masked during administration C) The ability of microorganisms to proliferate between doses of antibiotics D) The ability of an antibiotic to kill bacteria even when serum concentrations are low Ans: D Feedback: Postantibiotic effects mean that aminoglycosides continue killing microorganisms even at low serum concentrations.

15. Extreme caution would be necessary with the use of gentamicin in which of the following patients? A) A patient who is morbidly obese and who has primary hypertension B) A patient who has chronic renal failure secondary to diabetes mellitus C) A patient who has bipolar disorder and who is on long-term lithium therapy D) A patient who has an atrioventricular block Ans: B Feedback: Gentamicin is nephrotoxic, and with impaired renal function, a reduction in dosage is essential. Heart blocks, obesity, and lithium therapy do not severely complicate, or contraindicate, the use of an aminoglycoside.

16. A patient has been prescribed ciprofloxacin after being diagnosed with a sinus infection. Which of the following should the patient avoid taking concurrently with ciprofloxacin? A) Antacids B) Calcium channel blockers C) Beta-adrenergic blockers D) Diuretics Ans: A Feedback: Patients should space out ciprofloxacin administration 4 to 6 hours with any of the following: antacids, multivitamins, sucralfate, or other products containing calcium, iron, or zinc. Absorption of ciprofloxacin may be impaired when these substances are administered together with ciprofloxacin, resulting in a decreased antibiotic effect.

17. An older adult patient is recovering in hospital from an ischemic stroke and has a feeding tube in place due to dysphagia. The patient has developed an infected pressure ulcer, and ciprofloxacin suspension has been ordered as empiric therapy. How should

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the nurse follow up this order? A) The nurse should flush the patient's feeding tube with free water before and after administration of the ciprofloxacin suspension. B) The nurse should dilute the suspension thoroughly before administration. C) The nurse should liaise with the care provider to provide an alternative route of administration. D) The nurse should administer small, frequent doses of the drug to minimize GI upset. Ans: C Feedback: Administration of the oral suspension of ciprofloxacin via feeding tubes should not occur, because the oil-based formulation tends to adhere to the feeding tube. An alternative route is consequently necessary.

18. A hospital patient has been prescribed ciprofloxacin IV for the treatment of cellulitis. After initiating the infusion of the patient's first scheduled dose, the patient develops a pronounced rash to her chest and arms. How should the nurse respond to this event? A) Discontinue the infusion and inform the care provider promptly B) Slow down the rate so that the infusion takes place over 2 hours C) Administer oral diphenhydramine to the patient during the infusion D) Administer a STAT dose of acetylcysteine Ans: A Feedback: Severe hypersensitivity reactions have occurred with the administration of fluoroquinolones. The nurse discontinues the antibiotic immediately if skin rash or other signs or symptoms occur. Administration of acetylcysteine or diphenhydramine is not indicated.

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Chapter 20- Drug Therapy With Tetracyclines, Sulfonamides, and Urinary Antiseptics 1. A patient has been prescribed phenazopyridine (Pyridium) for urinary tract symptoms related to the infection. The patient asks why she is taking this medication. What is the most appropriate response by the nurse? A) “This medicine is used to treat urinary retention.” B) “This medicine will stop the blood in your urine.” C) “This medicine will decrease the pain of your infection.” D) “This medicine will prevent hesitancy when you're passing urine.” 2. A patient is given tetracycline (Sumycin) to treat acne-related skin eruptions. How does tetracycline work? A) It binds to the 30S ribosome to inhibit protein synthesis. B) It reduces central nervous system stimulation. C) It is a beta-lactam antibiotic inhibiting cell wall synthesis. D) It works on the final stage of cell wall synthesis. 3. A patient is seen in the clinic after a bite from a tick. She has a rash over her arms and legs and arthritic pain in the joints. What is the drug of choice for Lyme's disease? A) Ibuprofen (Motrin) B) Tetracycline (Sumycin) C) Phenazopyridine (Pyridium) D) Nitrofurantoin (Macrodantin) 4. A teenager asks the nurse how tetracycline (Sumycin) will improve her acne. Which of the following is the best statement the nurse can provide to the patient regarding the action of tetracycline? A) “Tetracycline decreases redness and swelling of the pustules.” B) “Tetracycline treats the Chlamydia organism that causes acne.” C) “Tetracycline is used in combination with doxycycline to treat acne.” D) “Tetracycline interferes with the production of free fatty acids.” 5. A patient has sustained a burn from a gas grill. She has been prescribed a sulfonamide to prevent a burn infection. What route is preferred in the prevention of a burn infection? A) Intrathecal B) Topical C) Parenteral D) Oral

6. A 70-year-old woman is assessed in the clinic for signs and symptoms of chronic bronchitis related to pneumococci. Which of the following is a sulfonamide that will most likely be prescribed?

A) B) C) D)

Trimethoprim–sulfamethoxazole (Bactrim) Tetracycline (Sumycin) Doxycycline (Vibramycin) Demeclocycline (Declomycin)

7. A patient is being treated for a urinary tract infection with trimethoprim– sulfamethoxazole (Bactrim). What assessment should the nurse make prior to the administration of the medication? A) Assessing for the presence of asthma B) Assessing for hypertension C) Assessing for diabetes mellitus D) Assessing for renal insufficiency 8. A patient has been prescribed doxycycline (Vibramycin). Which of the following teaching instructions is a priority with this medication? A) Avoid sun exposure. B) Avoid unprotected sexual activity. C) Administer with an antacid. D) Chew the tablets. 9. A patient is started on sulfamethoxazole–trimethoprim (Bactrim) for a urinary infection. What would contraindicate the use of Bactrim with this patient? A) Liver failure B) Rheumatoid arthritis C) Bone marrow depression D) Congestive heart failure 10. A patient is administered a sulfonamide for a urinary tract infection. Which of the following nursing interventions is most appropriate to increase the alkalinity of the patient's urine? A) Provide at least 2000 mL of water daily. B) Administer sodium bicarbonate. C) Recommend a tub bath every evening. D) Provide orange juice daily. 11. What is the rationale for not administering tetracycline (Sumycin) to children under the age of 8 years? A) It will not treat the infection. B) It will increase the risk of heart failure. C) It will interfere with enamel development. D) It will increase the risk for future infections. 12. A 64-year-old female patient sought care for the treatment of a urinary tract infection, and her primary care provider prescribed nitrofurantoin. What change in the patient's health

status would prompt the use of an alternative medication? A) fluid volume deficit. B) Urinalysis reveals the presence of ketones. C) The patient develops leukocytosis. D) The patient's UTI progresses to urosepsis.

The patient develops a

13. A public health nurse interacts with many members of the community who are at risk for sexually transmitted infections (STIs). The nurse should anticipate the use of tetracycline in a patient who is diagnosed with what STI? A) Vaginitis B) Chlamydia C) Human papillomavirus D) Trichomoniasis 14. A nurse is preparing to administer a patient's first scheduled dose of tetracycline. The nurse should first ensure that the patient has not recently eaten A) dairy products. B) leafy green vegetables. C) any high-fat foods. D) acidic foods. 15. A young adult patient's acne has responded well to treatment with tetracycline. However, the patient has now returned to the clinical with signs and symptoms of oral candidiasis. The nurse should recognize that this patient's current health problem is likely attributable to which of the following? A) A delayed (type IV) hypersensitivity reaction B) The fact that the patient may have chewed the capsules prior to swallowing them C) Superinfection following the eradication of normal oral flora D) A type I hypersensitivity reaction 16. A 9-year-old boy has been admitted to the pediatric unit after being diagnosed with pertussis. The pediatric nurse is processing the boy's admission orders and notes that IV demeclocycline (Declomycin) has been ordered. After beginning this treatment, the nurse should confirm the results of what laboratory test? A) Mean corpuscular volume (MCV) B) D-dimer C) Bilirubin D) Blood urea nitrogen (BUN)

1. Ans: C Feedback: Phenazopyridine (Pyridium) is given to relieve pain associated with urinary tract infection. It is not administered for urinary retention, hematuria, or hesitancy.

2. Ans: A Feedback: Tetracycline binds with the 30S ribosome to inhibit protein synthesis. It has no effect on the central nervous system. The penicillin agents are beta-lactam antibiotics. Ampicillin works in the final stage of cell wall synthesis.

3. Ans: B Feedback: Tetracyclines are useful in treating some animal bites and Lyme's disease. Ibuprofen is administered for the inflammation associated with the arthritic pain, but not to treat the infection. Phenazopyridine is not administered for Lyme's disease. Nitrofurantoin is administered for urinary tract infections.

4. Ans: D Feedback: Tetracyclines interfere with the production of free fatty acids and decrease Corynebacterium in sebum. Tetracycline will decrease redness and swelling, but this response is not the direct action of the medication. Tetracycline treats Chlamydia but is not the cause of acne. Tetracycline is not combined with doxycycline.

5. Ans: B Feedback: Topical sulfonamides are used in prevention of burn wound infections. Sulfonamides are not administered intrathecally. Parenteral and oral administrations are not recommended for the prevention of a burn infection.

6. Ans: A Feedback: Trimethoprim–sulfamethoxazole is used to treat chronic bronchitis due to pneumococci. Tetracycline, doxycycline, and demeclocycline are not sulfonamides.

7. Ans: D Feedback: Both tetracyclines and sulfonamides are contraindicated in patients with renal failure.

These medications are not contraindicated in patients with asthma, hypertension, or diabetes mellitus.

8. Ans: A Feedback: The administration of doxycycline increases photosensitivity, which is a common side effect. Avoidance of sexual activity is not taught. The medication should not be administered with an antacid; the administration of an antacid will result in diminished absorption of the medication. The doxycycline tablets should not be chewed.

9. Ans: A Feedback: Hepatic disease contraindicates the use of Bactrim. The other listed health problems do not necessarily preclude the safe use of Bactrim.

10. Ans: B Feedback: The urine can be alkalinized by giving sodium bicarbonate. The administration of water is important but will not increase alkalinity. The taking of tub baths is not recommended due to the fact that doing so increases the risk of urinary tract infection. The administration of orange juice increases acid, not alkalinity.

11. Ans: C Feedback: Tetracyclines should not be used in children younger than 8 years because of their effects on teeth and bones. In teeth, the drugs interfere with enamel development. The medication can treat the infection. Tetracycline does not increase the risk of heart failure. The administration of tetracycline will not increase the risk of future infections.

12. Ans: D Feedback: Urinary antiseptics may be bactericidal for sensitive organisms in the urinary tract because these drugs are concentrated in renal tubules and reach high levels in urine. They are not used in systemic infections because they do not attain therapeutic plasma levels. Consequently, the development of urosepsis would necessitate a systemic antibiotic. Fluid deficit, ketones in the urine, and elevated white cells would not necessarily contraindicate the use of nitrofurantoin.

13. Ans: B

Feedback: Tetracycline is effective for treating Mycoplasma, Chlamydia, and Rickettsia. It is not efficacious in the treatment of trichomoniasis, HPV, or vaginitis.

14. Ans: A Feedback: It is important not to take tetracycline with dairy products, antacids, or iron supplements.

15. Ans: C Feedback: Candidal superinfections may result from the use of tetracycline. The superinfection results from the elimination of normal flora and is not a hypersensitivity reaction. This is not the result of physical contact between the drug and the oral mucosa.

16. Ans: D Feedback: When administering demeclocycline, it is important to monitor the patient's BUN. Increases in the BUN are secondary to antianabolic effects. D-dimer and MCV values are not relevant. Bilirubin levels would only be important in the presence of liver toxicity.

Chapter 21- Drug Therapy With Macrolides and Miscellaneous Anti-infective Agents 1. A patient is admitted to the emergency room with a diagnosis of Legionnaires' disease and is placed on isolation. Which of the following medications is the drug of choice for Legionnaires' disease? A) Erythromycin (Ery-Tab) B) Loxapine hydrochloride (Loxitane) C) Meclizine (Antivert) D) Pravastatin (Pravachol) 2. The nurse is administering telithromycin (Ketek) to a child with Streptococcus pneumoniae infection. What nursing intervention is implemented when administering this medication? A) Administer the medication with or without food. B) Administer the medication with grapefruit juice. C) Increase the dose in the event of QT elongation. D) Administer the medication with lovastatin. 3. A patient is allergic to penicillin and has been diagnosed with a genitourinary infection caused by Chlamydia trachomatis. Which of the following medications will most likely be administered? A) Acamprosate calcium (Campral) B) Atazanavir (Reyataz) C) Erythromycin (Ery-Tab) D) Flumazenil (Mazicon) 4. A patient is diagnosed with peptic ulcer disease. He has been prescribed clarithromycin (Biaxin). Which of the following organisms is this medication used to treat? A) Streptococcus pneumoniae B) Haemophilus influenzae C) Mycobacterium avium complex D) Helicobacter pylori 5. A patient is administered telithromycin (Ketek) to treat a community-acquired pneumonia. A change in what blood level may necessitate a reduction in the dosage? A) Creatinine B) AST and ALT C) CPK D) Differential

6. A patient has been prescribed chloramphenicol (Chloromycetin) for vancomycinresistant enterococci. How is this medication eliminated from the body? A) Through the liver B) Exhaled through the lungs C) Excreted in the urine D) Excreted in the bile 7. Which of the following miscellaneous antibacterial drugs is administered topically in the treatment of acne? A) Chloramphenicol (Chloromycetin) B) Clindamycin (Cleocin) C) Daptomycin (Cubicin) D) Tigecycline (Tygacil) 8. A patient is administered daptomycin (Cubicin) to treat a gram-negative infection caused by Staphylococcus aureus. Which of the following symptoms should be reported immediately to the physician based on the known adverse effects of daptomycin? A) Weakness of the legs and arms B) Decreased wound drainage C) Hematuria D) Shortness of breath 9. A patient has been diagnosed with a community-acquired skin infection and has been prescribed linezolid (Zyvox). Which of the following foods should not be eaten during the administration of this medication? A) Pasta B) Garlic C) Green leafy vegetables D) Cheddar cheese 10. A patient has developed Clostridium difficile associated with pseudomembranous colitis. Which of the following medications is effective in the treatment of Clostridium difficile? A) Linezolid (Zyvox) B) Cladribine (Leustatin) C) Clarithromycin (Biaxin) D) Metronidazole (Flagyl) 11. A patient returns from a trip to the Caribbean and is suffering from severe diarrhea related to E. coli. Which of the following medications is the drug of choice for traveler's diarrhea? A) Rifaximin (Xifaxan) B) Spectinomycin (Trobicin) C) Chloramphenicol (Chloromycetin) D) Erythromycin (Ery-Tab)

12. A patient who is being administered metronidazole (Flagyl) to treat Clostridium difficile will also be administered which medication orally to assist in restructuring the flora of the intestinal tract? A) Spectinomycin (Trobicin) B) Rifaximin (Xifaxan) C) Vancomycin (Vancocin) D) Quinupristin–dalfopristin 13. A patient who is being treated in the intensive care unit has been diagnosed with ventilator-associated pneumonia. Culture and sensitivity testing of the patient's sputum indicates that erythromycin is a treatment option. The nurse knows that this drug is likely contraindicated for what reason? A) Erythromycin inhibits normal liver function. B) Erythromycin is associated with gastrointestinal upset. C) Erythromycin is nephrotoxic. D) Erythromycin cannot be administered orally. 14. An adult patient has been diagnosed with bacterial sinusitis, and her care provider has prescribed oral erythromycin. The nurse has cautioned the patient against taking the drug together with antacids because this practice A) delays metabolism of the drug. B) can exacerbate nausea and reflux. C) causes a dangerous rise in gastric pH. D) decreases the absorption of the drug. 15. A 22-year-old college student is allergic to penicillin. Consequently, her current chlamydial infection is being treated with oral erythromycin. What assessment should the nurse prioritize during this patient's course of treatment? A) Assessment of the patient's apical heart rate B) Assessment of the patient's hearing C) Assessment of the patient's peripheral pulses D) Assessment of the patient's renal function 16. An older adult patient has been prescribed telithromycin for community-acquired pneumonia. The nurse has contacted the patient's primary care provider because the patient is on replacement corticosteroid therapy. Why is concomitant use of telithromycin and corticosteroids contraindicated? A) The woman may be unable to adequately metabolize her corticosteroid. B) The effect of the corticosteroid may be greatly increased. C) The woman may have an increased risk of thromboembolism. D) The corticosteroid may negate the efficacy of the telithromycin.

17. A patient states that he has been taking his prescribed clindamycin as ordered, but that it has been causing him to have frequent diarrhea. How should the nurse best respond to this patient's statement? A) Reemphasize the importance of taking clindamycin with food. B) Encourage the patient to temporarily use an over-the-counter antidiarrheal. C) Encourage the patient to increase his fluid intake until the course of treatment is complete. D) Liaise with the patient's care provider to have the drug discontinued. 18. Numerous residents of a long-term care facility have developed Clostridium difficile– associated diarrhea over the past week. The nurses at this facility would anticipate that many residents would require which of the following drugs? A) Linezolid (Zyvox) B) Daptomycin (Cubicin) C) Metronidazole (Flagyl) D) Chloramphenicol (Chloromycetin) 19. A nurse has returned to a patient's hospital room for a follow-up assessment during the intravenous infusion of vancomycin. What assessment finding would signal the nurse to the possibility that the patient's infusion is running too quickly? A) The patient is flushed and has a visible skin rash. B) The patient's apical heart rate is irregular. C) The patient is difficult to rouse and has dilated pupils. D) The patient complains of pain at the intravenous access site. 20. A nurse is preparing a patient's scheduled dose of oral vancomycin. This patient's current illness was most likely manifested by what sign or symptom? A) Vomiting B) Inflamed, swollen skin C) Shortness of breath D) Diarrhea

1. Ans: A Feedback: Erythromycin is the prototype macrolide used to treat Legionnaires' disease. Loxapine hydrochloride is an antipsychotic agent. Meclizine (Antivert) is used to treat nausea and dizziness. Pravastatin is used to treat hypercholesterolemia.

2. Ans: A Feedback: When administering telithromycin, food does not affect the absorption of the medication. The administration of the medication with grapefruit juice may increase the plasma concentration and cause adverse effects. Telithromycin can cause an elongation of the QT interval; thus, the dose should not be increased. The administration of telithromycin and lovastatin can cause an increase in the QT interval.

3. Ans: C Feedback: A patient who is diagnosed with a genitourinary infection that is caused by trachomatis and who is allergic to penicillin should be administered erythromycin (Ery-Tab). Acamprosate calcium is administered as a substance abuse deterrent, not in place of penicillin. Atazanavir (Reyataz) is an antiviral agent that is used to treat HIV infection, not Chlamydia trachomatis. Flumazenil is a benzodiazepine antagonist and not used for Chlamydia trachomatis. 4. Ans: D Feedback: Clarithromycin is approved to treat H. pylori infections associated with peptic ulcer disease. Clarithromycin is also approved to treat Streptococcus pneumoniae, Haemophilus influenza, and Mycobacterium avium complex, but these organisms do not cause peptic ulcer disease.

5. Ans: A Feedback: For patients who have renal impairment, together with hepatic impairment, it is essential to reduce the dosage to 400 mg once daily. Alterations in CPK, white cell differential, and liver enzymes may not require a change in the dosage.

6. Ans: C Feedback: Chloramphenicol is metabolized in the liver and excreted in the urine. It is not eliminated in the liver, exhaled through the lungs, or excreted in the bile.

7. Ans: B Feedback: Clindamycin is administered topically for the treatment of acne. Chloramphenicol, daptomycin, and tigecycline are not administered topically for the treatment of acne.

8. Ans: A Feedback: The nurse should report weakness of legs and arms due to increased serum creatine kinase levels. Decrease in wound drainage, hematuria, and shortness of breath are not adverse effects of daptomycin.

9. Ans: D Feedback: Because linezolid is a weak monoamine oxidase inhibitor, patients should avoid food high in tyramine content, such as aged cheeses. Pasta, garlic, and green leafy vegetables are not contraindicated with linezolid.

10. Ans: D Feedback: Metronidazole (Flagyl) is indicated for use in the treatment of Clostridium difficile. Linezolid (Zyvox) is not used to treat C. difficile. Cladribine (Leustatin) is an antineoplastic agent that is not used for C. difficile. Clarithromycin (Biaxin) is not used to treat C. difficile. 11. Ans: A Feedback: Rifaximin (Xifaxan) is administered for the treatment of traveler's diarrhea related to E. coli. Spectinomycin is used to treat gonococcal infections. Chloramphenicol is not administered to treat traveler's diarrhea related to E. coli. Erythromycin is not used to treat traveler's diarrhea related to E. coli.

12. Ans: C Feedback: Oral vancomycin is used to treat pseudomembranous colitis caused by C. difficile. Spectinomycin (Trobicin), rifaximin (Xifaxan), and quinupristin–dalfopristin are not administered to treat pseudomembranous colitis caused by C. difficile.

13. Ans: A Feedback:

Erythromycin is seldom used in critical care settings, partly because broader spectrum bactericidal drugs are usually needed in critically ill patients and partly because it inhibits liver metabolism and slows elimination of several other drugs. Erythromycin is not nephrotoxic. The drug is administered orally, and GI upset does not contraindicate use. 14. Ans: D Feedback: People should not take erythromycin after taking antacids. Antacids decrease the absorption of both the tablet and suspension form of erythromycin. Antacids do not cause a dangerous rise in pH, exacerbate GI upset, or delay the metabolism of the drug.

15. Ans: B Feedback: With erythromycin, it is important to assess the patient's hearing. The loss of hearing is reversible with the discontinuation of the medication. Erythromycin does not typically affect renal function or circulation. The IV form has been associated with dysrhythmias, but this is not the case with the oral form.

16. Ans: A Feedback: Telithromycin is a potent CYP3A4 inhibitor. Combination of this drug with several medications, including corticosteroids, results in an increased serum concentration of these other drugs. 17. Ans: D Feedback: The FDA has issued a black box warning for clindamycin regarding the potential of severe and possible fatal colitis. If diarrhea develops in a patient receiving clindamycin, discontinuation of the drug is essential.

18. Ans: C Feedback: Clinical indications for metronidazole include prevention or treatment of anaerobic bacterial infections (e.g., in colorectal surgery, intra-abdominal infections) and treatment of C. difficile infections associated with pseudomembranous colitis. The other listed antibiotics are not used for the treatment of Clostridium difficile–associated diarrhea.

19. Ans: A Feedback:

It is very important to give IV infusions slowly, over 1 to 2 hours, to avoid an adverse reaction characterized by hypotension, flushing, and skin rash. This reaction, sometimes called red man syndrome, is attributed to histamine release.

20. Ans: D Feedback: Oral vancomycin is useful only to treat staphylococcal enterocolitis and pseudomembranous colitis caused by C. difficile. These illnesses are always characterized by diarrhea, not vomiting, skin inflammation, or shortness of breath.

Chapter 22- Drug Therapy for Tuberculosis and Mycobacterium avium Complex Disease 1. A patient seen in the clinic has symptoms of persistent cough, fever, and night sweats. He recently entered the United States from the Philippines. Which of the following is the most plausible explanation for the patient's condition? A) Latent tuberculosis B) Bacterial pneumonia C) Active tuberculosis D) Emphysema Ans: C Feedback: Emigration from countries where the disease occurs, such as the Philippines, places patients at risk for tuberculosis. Active tuberculosis is characterized by symptoms of cough, fever, and night sweats. Patients with latent tuberculosis exhibit no symptoms and do not feel sick. Bacterial pneumonia is not commonly noted with night sweats. Emphysema is not noted with fever.

2. A college student has a TB test prior to starting the semester. The tuberculin test site is noted with a reddened, raised area. What condition will the student be diagnosed with if the chest radiograph is negative? A) Transmission B) Primary infection C) Latent tuberculosis D) Active tuberculosis Ans: C Feedback: People with inactive or latent TB have no symptoms and do not feel sick. The transmission of the infection occurs when an uninfected person inhales infected airborne particles that are exhaled by an infected person. Primary infection occurs 6 to 8 weeks after exposure. The patient has a mild, pneumonia-like illness that often is undiagnosed. Active tuberculosis is a result from reactivation of a latent infection.

3. A patient is hospitalized with active tuberculosis. The patient is receiving antitubercular drug therapy and is not responding to the medications. What do you suspect the patient is suffering from? A) Human immunodeficiency virus B) Drug-resistant tuberculosis C) Methicillin-resistant Staphylococcus aureus D) Vancomycin-resistant Staphylococcus aureus Ans: B Feedback: A patient who is being treated with antitubercular drug therapy and is not responding to the medication regime is most likely experiencing drug-resistant tuberculosis. Human immunodeficiency virus causes tuberculosis to move more rapidly. This scenario does not provide any indication that the tuberculosis is related to the diminished patient response. The scenario does not identify methicillin- or vancomycin-resistant

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Staphylococcus aureus.

4. A patient being treated for tuberculosis is determined to be drug resistant. Which of the following medications will the patient be resistant to in the treatment of the tuberculosis? A) Isoniazid (INH) and rifampin B) Carbamazepine (Tegretol) and phenytoin (Dilantin) C) Dextroamphetamine (Dexedrine) and doxapram (Dopram) D) Propranolol (Inderal) and sotalol (Betapace) Ans: A Feedback: Isoniazid (INH) and rifampin are used to treat tuberculosis. In multidrug resistance, the most effective drugs the patient is resistant to are isoniazid and rifampin. Carbamazepine and phenytoin are used to control seizures. Dextroamphetamine and doxapram are central nervous system stimulants. Propranolol and sotalol are betaadrenergic blocking agents.

5. A patient who was frequently homeless over the past several years has begun a drug regimen consisting solely of isoniazid (INH). What is this patient's most likely diagnosis? A) Active tuberculosis B) Latent tuberculosis C) Mycobacterium avium complex D) Human immunodeficiency virus Ans: B Feedback: Although use of INH by itself for treatment of latent TB is appropriate, use with other anti-TB drugs is essential for treatment of active TB. INH would not be used exclusively in the treatment of HIV or MAC.

6. A patient is administered isoniazid (INH) for tuberculosis. Which of the following adverse effects will result in discontinuation of the medication? A) Weight gain B) Jaundice C) Fever D) Arthralgia Ans: B Feedback: Potentially serious adverse effects of INH include hepatotoxicity and peripheral neuropathy. Hepatotoxicity may be manifested by symptoms of hepatitis (e.g., anorexia, nausea, fatigue, malaise, jaundice) or elevated liver enzymes. Weight gain, fever, and arthralgia are not the most known adverse effects of isoniazid (INH).

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7. A patient receiving isoniazid (INH) and rifampin (Rifadin) has a decreased urinary output and decreased sensation in his great toes. Which laboratory values should be assessed? A) Hematocrit and hemoglobin B) ALT and AST C) Urine culture and sensitivity D) Erythrocyte count and differential Ans: B Feedback: Hepatotoxicity and peripheral neuropathy are important adverse effects of isoniazid and rifampin. The ALT/AST will assess liver function. The hematocrit and hemoglobin are not indicated with the described symptoms. Erythrocyte count and differential are not indicated with these symptoms.

8. A nursing student is learning about the effects of bactericidal agents. How does rifampin (Rifadin) achieve a therapeutic action against both intracellular and extracellular tuberculosis organisms? A) It is metabolized in the liver. B) It binds to acetylcholine. C) It inhibits synthesis of RNA. D) It causes phagocytosis. Ans: C Feedback: Rifampin kills Mycobacterium by inhibiting synthesis of RNA. It is metabolized in the liver, but this characteristic does not represent its action. It does not bind to acetylcholine. It does not cause phagocytosis.

9. A patient is administered rifampin (Rifadin). Which of the following facts should the patient be taught? A) When taking it with warfarin (Coumadin), an increased anticoagulant effect occurs. B) It decreases hepatic enzymes and decreases metabolism of drugs. C) It has an increased serum half-life, so it is more effective than rifabutin (Mycobutin). D) The urine, tears, sweat, and other body fluids will be a discolored red-orange. Ans: D Feedback: The patient's urine, tears, sweat, and other body fluids will be a discolored red-orange. This adverse effect is harmless, but the patient should be instructed on this adverse effect. The administration of this medication with warfarin will decrease the anticoagulant effect. The medication increases hepatic cytochrome P450 3A4 enzyme and decreases serum concentrations. The serum half-life of rifampin is shorter than that of the medication rifabutin.

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10. A patient who is being administered isoniazid (INH) for tuberculosis has a yellow color in the sclera of her eye. What other finding would lead you to believe that hepatotoxicity has developed? A) Diarrhea B) Numbness C) Diminished vision D) Light-colored stools Ans: D Feedback: The presence of light-colored stools is suggestive of hepatotoxicity. Diarrhea, numbness, and diminished vision are not related to hepatotoxicity of isoniazid (INH).

11. A patient is being treated for active tuberculosis with ethambutol (Myambutol). The patient states to the nurse that he cannot identify the red and green on the traffic lights when he is driving. Based on this finding, what medical intervention is most appropriate? A) Assess for photosensitivity. B) Discontinue ethambutol (Myambutol). C) Decrease the ethambutol (Myambutol) dose. D) Administer vitamin B12. Ans: B Feedback: The administration of ethambutol should be discontinued if optic neuritis develops. Optic neuritis is an inflammatory, demyelinating disorder of the optic nerve that decreases visual acuity and ability to differentiate red and green. The inability to distinguish red and green is not indicative of photosensitivity. The ethambutol should not be decreased. There is no indication for the administration of vitamin B12.

12. A patient is hospitalized due to nonadherence to an antitubercular drug treatment. Which of the following is most important for the nurse to do? A) Observe the patient taking the medications. B) Administer the medications parenterally. C) Instruct the family on the medication regime. D) Count the number of tablets in the bottle daily. Ans: A Feedback: Directly observed therapy in which a health care provider observes the patient taking each dose of anti-TB drugs is recommended for all drug regimens and is considered mandatory in this case. The medications are not administered parenterally. The family should be instructed on the medication regime, but this action is not imperative in maintaining compliance. Tablets missing from the bottle may not necessarily have been taken correctly by the patient.

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13. A patient with HIV has been infected with Mycobacterium avium complex from an indoor pool. Which of the following medications is the recommended treatment for MAC? A) Clarithromycin B) Isoniazid (INH) C) Rifabutin D) Azithromycin Ans: A Feedback: The main drugs used in prevention of MAC disease in patients with HIV are the macrolides azithromycin and clarithromycin.

14. A homeless man was screened for tuberculosis (TB) during a health consultation at a shelter, and the results indicate latent TB. The community health nurse who is liaising with the providers of the shelter would anticipate what component of this man's plan of care? A) The man will undergo conservative treatment for TB using adjuvant medications. B) The man will be treated for TB using first-line antitubercular drugs. C) The man will be monitored closely to determine if treatment is necessary. D) The man will be screened again in 10 to 12 weeks to determine whether he has developed active TB. Ans: B Feedback: Patients with latent TB cannot spread the disease to others, but treatment of the latent disease prevents progression of the disease to an active state. It is particularly important to treat latent TB in those patients who are at high risk for progression to active TB. Homelessness is a major risk factor for active TB.

15. A female patient has been diagnosed with tuberculosis and begun multiple-drug therapy. The woman has asked the nurse why it is necessary for her to take several different drugs instead of one single drug. How should the nurse best respond to the patient's question? A) “Multiple drugs are used because doctors aren't sure which drug will kill a particular TB strain.” B) “The use of multiple drugs prevents the development of drug-resistant TB.” C) “Multiple drugs are prescribed because the final testing results for TB can take up to 3 months.” D) “Multiple drugs are used in order to speed up the course of treatment.” Ans: B Feedback: Use of multiple drugs to treat TB is necessary to prevent the development of drugresistant TB. This approach to treatment is not necessitated by delays in testing, questionable diagnostic results, or the need to hasten the course of treatment.

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16. A patient is being treated for latent tuberculosis on an outpatient basis and tells the nurse during a scheduled follow-up visit, “I've been feeling pretty good lately, so I haven't actually been all that consistent with taking my drugs.” Subsequent health education should focus on what subject? A) The fact that nonadherence to treatment exacerbates the risks of adverse effects B) The need to consistently take the prescribed drugs in order to cure TB C) The need to match drug dosages carefully to signs and symptoms D) The fact that nonadherence will necessitate the use of antiretrovirals Ans: B Feedback: Consistent adherence to treatment is imperative to ensure successful treatment of TB. Nonadherence leads to resistance and unsuccessful treatment, not increased adverse effects. Antivirals are ineffective against TB.

17. A patient has been diagnosed with tuberculosis and will soon begin first-line drug treatment. How will rifampin most likely be administered to this patient by the nurse? A) Orally, with food B) Orally, on an empty stomach C) Intramuscularly D) Intravenously, as bolus Ans: B Feedback: Rifampin should be taken on an empty stomach, either 1 hour before or 2 hours after a meal. IV administration is possible, but this takes place as a three-hour infusion, not as a bolus. Rifampin is not administered IM.

18. The nurse is providing care for a patient who is taking isoniazid and rifampin (Rifadin) for the treatment of active tuberculosis. The patient should be taught that an improvement in symptoms will likely be noticed within A) 48 hours. B) a week to 10 days. C) 2 to 3 weeks. D) 4 to 6 weeks. Ans: C Feedback: Therapeutic effects are usually apparent with the first 2 to 3 weeks of drug therapy for active TB.

19. A patient with a diagnosis of active TB has begun second-line therapy that includes the use of pyrazinamide. When monitoring this patient, the nurse should suspect that adverse effects of this drug may account for which of the following laboratory values? A) Low hematocrit and mean corpuscular volume (MCV)

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B) Increased INR and aPTT C) Increased blood urea nitrogen and creatinine D) Increased AST, ALT, and GGT Ans: D Feedback: The most severe adverse effect of pyrazinamide is hepatotoxicity. Consequently, liver enzymes such as GGT, ALT, and AST should be monitored. Changes in erythrocytes, coagulation, and renal function are less likely to result from pyrazinamide therapy.

20. A 40-year-old man has been living with HIV for several years but experienced a significant decrease in his CD4+ levels a few months ago. The patient has just been diagnosed with Mycobacterium avium complex disease. The nurse should anticipate administering which of the following medications? Select all that apply. A) Clarithromycin B) Pyrazinamide C) Rifapentine (Priftin) D) Azithromycin E) Bactrim Ans: A, D Feedback: The main drugs used in prevention of MAC disease in patients with HIV are the macrolides azithromycin and clarithromycin. Pyrazinamide, Bactrim, and Priftin are not used to treat MAC.

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Chapter 23 Drug Therapy for Viral Infections For which clients would treatment with acyclovir be most clearly indicated? A 2-month-old infant brought to the emergency department with signs of respiratory syncytial virus (RSV) A man who contracted hepatitis A virus (HAV) while on a tropical vacation A 44-year-old intravenous drug user who has been diagnosed with hepatitis C virus (HCV) A 77-year-old whose recent debilitating pain has been attributed to a herpes zoster infection

A patient began combination antiretroviral therapy 7 months ago and is being followed closely by a care team that includes members of several disciplines. When attempting to determine the efficacy of the patient's current drug regimen, the nurse should prioritize which of the following laboratory data? Viral load CD4 cell count Total leukocyte level Neutrophil level

A nurse is preparing to administer famciclovir to a client with a herpes virus infection. The nurse should expect to administer this drug by which route? Oral Subcutaneous Intramuscular Intravenous

A primary health care provider has prescribed 6000 mg of foscarnet per day to be administered intravenously. In the pharmacy, foscarnet is available in a 500 mL IV piggyback. The strength of the drug in the solution is 24 mg/mL. How many mL of the solution should the nurse administer to the client in a day? 1000 mL 500 mL 750 mL 250 mL

A hospitalized client with complex health needs is receiving amantadine. What is the nurse's priority action after administering this medication? Encourage the client to ambulate 10 minutes after each dose.

Monitor vital signs every 30 minutes. Keep side rails up and ensure the client's call light is at hand. Decrease fluid intake to prevent drug dilution.

A 45-year-old client is prescribed acyclovir for the treatment of genital herpes. Which is an expected outcome for this client? The client will be cured of the viral infection. The client will experience fewer recurrences. The client will no longer be able to transmit the infection to others. The client will experience recurrences but milder symptoms.

A nurse is explaining the rationale for the use of combination therapy in the treatment of HIV infections. Which would the nurse include as the primary reason? More than one drug is needed to ensure sensitivity to the different forms of the virus. One drug helps to control the virus, while the other drugs help to alleviate the adverse effects. Using several drugs at once helps to improve the client's immune response. The use of multiple drugs allows attack on the virus at different points in its life cycle.

A nursing student is reading a journal article about highly active antiretroviral therapy (HAART). The nurse would expect to find which condition as being treated with this therapy? herpes simplex virus (HSV) rotavirus human immunodeficiency virus (HIV) cytomegalovirus (CMV)

A client who is hospitalized and receiving antiretroviral therapy has a nursing diagnosis of Risk for Injury related to weakness and dizziness. Which would be most appropriate for the nurse to do? Provide for frequent rest periods. Place the client's call light behind the client's bed on a table. Encourage independent ambulation at least every 2 hours. Have the client quickly change positions.

A child is prescribed ribavirin for a diagnosis of respiratory syncytial virus (RSV). The nurse should assess the client often for which possible adverse reaction(s)? Select all that apply. headache pulmonary embolism

rhinitis bronchospasm conjunctivitis

A client with a diagnosis of AIDS has been prescribed valganciclovir. The nurse should expect that this client has developed what AIDS-related complication? CMV retinitis Kaposi's sarcoma Diarrhea Pneumocystis pneumonia The nurse is caring for a child with respiratory syncytial virus (RSV). Which drug should the nurse expect the pediatrician to order? Rimantadine Zanamivir Oseltamivir Ribavirin

What stage in the replication cycle of a virus represents viral DNA being injected into a host cell? Synthesis Replication Penetration Attachment

The nurse admits a client for treatment of cytomegalovirus (CMV). The client has been ordered foscarnet, 40 mg/kg q12h given over 2 hours. By what route should the nurse expect to administer this drug? Sub q IM PO IV

An immunocompromised 3-year-old has been exposed to avian flu. The client is brought to the clinic, and the mother reports that the client has had flu-like symptoms for the past 12 hours. What medication should the nurse expect to administer? ribavirin zanamivir amantadine oseltamivir

A HIV-positive patient is being treated with didanosine as part of the antiretroviral therapy. Which of the following symptoms should the nurse monitor for and immediately report to the care provider? Taste alteration Excoriation Headache Peripheral neuropathy

A nurse is assessing a 66-year-old man who is HIV-positive. The patient has been prescribed didanosine (Videx). It would be most important to question the patient about which of the following? Alcohol use Activity level High-calorie diet Fluid intake

A 70-year-old man is being treated for herpes zoster virus. He has been prescribed acyclovir (Zovirax). The clinic nurse should prioritize assessments of which of the following? Renal function Neurologic function Respiratory function Cardiac function

For which clients would treatment with acyclovir be most clearly indicated? A 44-year-old intravenous drug user who has been diagnosed with hepatitis C virus (HCV) A 77-year-old whose recent debilitating pain has been attributed to a herpes zoster infection A 2-month-old infant brought to the emergency department with signs of respiratory syncytial virus (RSV) A man who contracted hepatitis A virus (HAV) while on a tropical vacation

Jeff's mother tells you that she finds it difficult to give ritonavir solution to him. Jeff is an 8-year-old boy suffering from HIV infection. Your advice is to combine the drug with chocolate milk, which will mask its bitter taste. Which of the following actions is important for Jeff's mother to learn? Keep the milk with the drug at room temperature. Drink the milk with the drug before bedtime. Refrigerate the milk and the drug. Have Jeff drink the milk with the drug within 1 hour of mixing.

A male patient is taking indinavir (Crixivan) for HIV. To decrease the risk of kidney stones, the nurse's teaching plan will include which of the following? Increase physical activity Drink 1 to 2 L of water a day Decrease fatty foods in his diet Avoid taking acetaminophen

A 24-year-old client is treated with acyclovir for herpes. The client has a history of epilepsy. What indication would the nurse see that would indicate a serious reaction? The client is having tremors more pronounced at rest. The client reports nausea after taking the medication. The client has a change in bowel elimination pattern. The client has an increase in urinary output since the medication.

An elderly female client is admitted to the medical floor with pustules on her body that travel along the nerve route in her legs and arms. The health care provider prescribes the drug acyclovir (Zovirax). What disease is this client demonstrating? Herpes simplex Shingles Influenza CMV The nurse is caring for a 3-year-old with HIV. The nurse knows that, when administering antiviral drug therapy in young children with HIV, dosage calculations are typically based on: dosage recommendations for adults. the severity of the client's condition. the client's weight. the client's body surface area.

A nurse is giving discharge instructions to a client taking entecavir. What is an important teaching point the nurse should provide about taking entecavir? It should be taken before bed each night. It should be taken immediately after eating a large meal. It should be taken with a small snack before bed. It should be taken on an empty stomach.

Chapter 24- Drug Therapy for Fungal Infections 1. A patient develops itching and burning of the vaginal vault while taking an antiinfective to treat strep throat. What fungal agent has most likely caused the burning and itching? A) Cryptococcus neoformans B) Candida albicans C) Aspergillus D) Dermatophytes Ans: B Feedback: Growth of Candida organisms is normally restrained by intact immune mechanisms and bacterial competition of nutrients. When these restraining forces are altered (antibacterial drug therapy), fungal overgrowth and opportunistic infection can occur. Cryptococcus neoformans organisms evade normal immune defense of phagocytosis. Aspergillus organisms produce protease. Dermatophytes grow on cool body surfaces.

2. A patient is being treated with amphotericin B for a fungal infection of the urinary tract. What is the action of amphotericin B? A) It binds to ergosterol and forms holes in the membrane. B) It binds to an enzyme required for synthesis of ergosterol. C) It disrupts the fungal cell walls rather than the cell membrane. D) It inhibits glucan synthetase required for glucan synthesis. Ans: A Feedback: Amphotericin B binds to ergosterol and forms holes in the membrane, causing leakage of fungal cell contents and lysis of the cell. The azole drugs bind to an enzyme that is required for synthesis of ergosterol. This action causes production of a defective cell membrane, which allows leakage of intracellular contents and destruction of the cell. Echinocandins disrupt fungal cell walls rather than fungal cell membranes. They inhibit glycan synthetase, an enzyme required for synthesis of glucan.

3. A patient is being treated for a severe fungal infection with amphotericin B. What is the expected length of treatment for this patient? A) 1 to 2 weeks B) 3 to 6 weeks C) 4 to 12 weeks D) 15 to 18 weeks Ans: C Feedback: Because of the toxicity of amphotericin B, the drug is used only for serious infections. It is usually given for 4 to 12 weeks. Amphotericin B is not given for 1 to 2 weeks, 3 to 6 weeks, or 15 to 18 weeks.

4. A patient is given Abelcet instead of amphotericin B. What is the advantage of Abelcet

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over amphotericin B? A) It is a newer medication with a lower cost. B) It is the same as amphotericin B in hepatotoxicity. C) It reaches higher concentration in diseased tissue. D) It constricts afferent renal arterioles to reduce blood flow. Ans: C Feedback: Lipid formulations, such as Abelcet, reach higher concentrations in diseased tissues than in normal tissues, so larger doses can be given to increase therapeutic effects. Abelcet does not cost less than amphotericin B. Abelcet has fewer side effects than amphotericin B. Amphotericin B constricts afferent renal arterioles to reduce blood flow.

5. A child with a serious fungal infection is receiving amphotericin B parenterally. Which of the following minerals will the patient most likely be required to receive? A) Chloride B) Magnesium C) Glucose D) Sodium Ans: B Feedback: Hypomagnesemia may occur, which will require the administration of magnesium. The patient is less at risk for changes in chloride, glucose, or sodium.

6. A patient is receiving oral nystatin suspension for a fungal infection of the mouth. Which of the following adverse effects is most likely to be experienced with this form of nystatin? A) Local irritation B) Burning C) Nausea D) Urinary urgency Ans: C Feedback: Oral use of nystatin produces the following adverse effects: nausea, vomiting, and diarrhea. The vaginal application of nystatin produces the following adverse effects: local irritation and burning. Urinary urgency is not an adverse effect associated with nystatin.

7. A woman is seen in the clinic for vaginal itching and discharge. Which of the following medications can be administered in a single dose to treat her discomfort and vaginal discharge? A) Caspofungin (Cancidas) B) Terbinafine (Lamisil) C) Ketoconazole (Nizoral)

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D) Fluconazole (Diflucan) Ans: D Feedback: Fluconazole (Diflucan) is used for vaginal candidiasis in a single oral dose of 150 mg. Caspofungin is not used for vaginal candidiasis, but for invasive aspergillosis. Terbinafine is used for interdigital tinea pedis. Ketoconazole is used for patients with organ transplants.

8. A patient has been diagnosed with a fungal infection and is to be treated with itraconazole (Sporanox). Prior to administration, the nurse notes that the patient is taking carbamazepine (Tegretol) for a seizure disorder. Based on this medication regime, which of the following will be true regarding the medications? A) The serum level of carbamazepine will be increased. B) The patient's carbamazepine should be discontinued. C) The patient's antiseizure medication should be changed. D) The patient will require a higher dosage of itraconazole (Sporanox). Ans: D Feedback: Drugs that induce drug-metabolizing enzymes (e.g., carbamazepine, phenytoin, rifampin) decrease serum concentrations of itraconazole. The serum level of carbamazepine will not need to be increased. The carbamazepine should not be discontinued or changed.

9. A patient is being treated with caspofungin for a systemic fungal infection related to Aspergillus. Prior to the administration of the first parenteral dose, the nurse notes that the patient's AST and ALT levels are elevated. How will these serum hepatic enzymes affect the administration of caspofungin? A) The dose will need to be increased. B) The dose will need to be decreased. C) The dose will require a serum trough. D) The medication should not be given. Ans: B Feedback: The dose of caspofungin will need to be reduced due to the risk of hepatotoxicity. The dose of caspofungin should not be increased. The peak and trough are not as vital as the reduction of the dose. The medication should be administered at a lower dose.

10. A patient is being treated for a fungal infection with IV amphotericin B. In order to prevent drug discomfort, the nurse should consistently monitor the patient's levels of A) sodium. B) hemoglobin. C) calcium. D) leukocytes.

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Ans: A Feedback: It is essential to assess the sodium balance throughout the administration of amphotericin. By maintaining the serum sodium level within normal range, the patient has decreased symptoms of drug discomfort.

11. A patient is receiving intravenous amphotericin. Which of the following assessments warrants the discontinuation of the antifungal agent? A) Sodium of 138 mEq/L B) Hematocrit of 39% C) Blood urea nitrogen of 60 mg/dL D) AST 10 Unit/L Ans: C Feedback: If the patient's BUN exceeds 40 mg/dL or serum creatinine exceeds 3 mg/dL, the drug should be stopped or dosage should be reduced until renal function recovers. The hematocrit is in normal range and will not affect the medication administration. The AST and sodium levels are within normal range and will not affect the administration.

12. A patient is being treated with amphotericin B. Which of the following statements indicates that the patient has understood the patient teaching? A) “The medication may cause diabetes.” B) “The medication will cause liver necrosis.” C) “The medication may cause kidney damage.” D) “The medication will cause pancreatitis.” Ans: C Feedback: The main concern with the administration of amphotericin B is the risk of nephrotoxicity. Thus, the statement that the medication may cause kidney damage is the most appropriate. The medication will not cause diabetes, liver necrosis, or pancreatitis.

13. Amphotericin B is being used in the treatment of cryptococcosis in a patient who has HIV. When assessing for potential signs and symptoms of cryptococcosis, the nurse should prioritize what assessment? A) Neurological assessment B) Functional assessment C) Nutritional assessment D) Cardiac assessment Ans: A Feedback: Cryptococcosis may involve the lungs, skin, and other body organs. In patients with AIDS or other immunosuppressant disorders, it often involves the CNS and produces mental status changes, headache, dizziness, and neck stiffness. Neurological assessment

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is consequently a priority.

14. An adult patient was recently diagnosed with a tinea infection, and her primary care provider promptly began treatment with griseofulvin. During a scheduled clinic visit, the patient states to the nurse, “I'm pretty good at reading my body's signals, so I make sure to take a bit extra when I think my infection is getting worse.” This patient's statement is suggestive of what nursing diagnosis? A) Deficient knowledge related to correct use of griseofulvin B) Effective therapeutic regimen management related to symptom identification C) Disturbed thought processes related to appropriate use of griseofulvin D) Ineffective coping related to self-medication Ans: A Feedback: In order to achieve maximum therapeutic benefit, it is important for the patient to take the drug exactly as ordered. The patient's statement suggests that she does not appreciate or understand this fact. There is no evidence of pathological thought patterns or ineffective coping.

15. A patient with systemic candidiasis has been prescribed flucytosine. The nurse should be aware of the need to administer this drug with which of the following? A) Vitamin D and calcium supplements B) Fluconazole (Diflucan) C) Amphotericin B D) Penicillin G Ans: C Feedback: Flucytosine is used as an adjunctive agent with amphotericin B for the treatment of systemic fungal infections caused by Candida and Cryptococcus.

16. An adult patient has begun treatment with fluconazole. The nurse should recognize the need to likely discontinue the drug if the patient develops which of the following signs or symptoms? A) Jaundice B) Weight gain C) Iron deficiency anemia D) Hematuria Ans: A Feedback: The azoles may cause hepatotoxicity, and the development of jaundice usually accompanies liver damage, which may necessitate discontinuing the drug. Fluconazole is not associated with weight gain, anemia, or hematuria.

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17. An older adult patient has asked her primary care provider for a prescription that will help to resolve her “warped toenails.” The care provider has diagnosed the woman with onychomycosis. The nurse should anticipate that this patient will be treated with what drug? A) Micafungin (Mycamine) B) Terbinafine (Lamisil) C) Voriconazole (Vfend) D) Fluconazole (Diflucan) Ans: B Feedback: Terbinafine (Lamisil) is used for the treatment of onychomycosis of the fingernails or toenails.

18. A 43-year-old man has tested positive for systemic candidiasis, and the care team has decided on IV fluconazole as a first-line treatment. When administering this medication, the nurse should A) administer the drug with lactated Ringer's. B) infuse the drug no faster than 200 mg/h. C) avoid administering the drug through a peripheral IV. D) administer prophylactic heparin prior to the fluconazole. Ans: B Feedback: Continuous infusion of fluconazole occurs at a maximum rate of 200 mg/h. The drug is not administered with lactated Ringer's or heparin. A peripheral IV may be used.

19. When administering the azoles in the home setting, the home health nurse should prioritize educational interventions that address what nursing diagnosis? A) Risk for injury related to antifungal therapy B) Risk for acute confusion related to antifungal therapy C) Risk for infection related to antifungal therapy D) Risk for falls related to antifungal therapy Ans: C Feedback: When administering the azoles in the home setting, it is important that the home care nurse instruct the patient and family on the management of the environment with the implementation of good hand hygiene, household cleanliness, removal of potted plants and fresh flowers, and the use of air conditioning and air filtration systems. The nurse should also tell the patient and family about measures to prevent the reinfection and spread of the fungal infection. Falls, confusion, and injury are less likely consequences of using the azoles in the home setting.

20. Caspofungin has been ordered in the treatment of a patient who is being treated in the acute medicine unit for invasive aspergillosis. The nurse should teach the patient to

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promptly report what symptoms? A) Cardiac symptoms B) Diaphoresis C) Dry mouth D) Muscle pain Ans: A Feedback: Caspofungin is administered in the acute care setting. The patient should receive instruction about the histamine reaction to the medication and the necessity of reporting any cardiac symptoms. Diaphoresis, dry mouth, and muscle pain are not normally associated with the administration of caspofungin.

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Chapter 25 Drug therapy for Parasitic Infections A client's signs, symptoms, and recent travel history suggest a helminthic infection. What should the nurse do in order to most accurately determine what type of helminth is infecting the client? Collect a stool sample for culture and sensitivity. Collect a stool sample for ova and parasite. Collect blood cultures. Review the results of the client's liver function studies.

Several children in an elementary school have been diagnosed with pinworm infections and the school nurse is providing health promotion education. What information should the nurse prioritize when providing education? The importance of vigilant and thorough hand hygiene The importance of ensuring that families adhere to recommended immunization schedules The appropriate use of anthelmintic prophylaxis Prevention of opportunistic infections

A client is prescribed metronidazole for the treatment of trichomoniasis. What is the most important information for the nurse to teach the client about proper administration of this medication? "Increase your fluid intake while taking this medication." "Do not drink alcohol while taking this medication." "Take the medication with meals if you have GI irritation." "Suck on sugar-free hard candy if you have a dry mouth."

A nurse is preparing to administer primaquine therapy to a client. The nurse should anticipate administering the drug by which route? Oral Subcutaneous Inhalation Intramuscular

A man with intestinal amebiasis has received a prescription for metronidazole. He later develops a cough and takes a prescription cough syrup. What adverse effect will he experience? edema bronchospasm flushing bradycardia

What assessment should the nurse implement when caring for a patient who is receiving metronidazole for intestinal amebiasis? diminished diarrhea hypomagnesemia increased temperature hyperkalemia A nurse who is scheduled to work at a hospital in Haiti in 2 weeks comes to the clinic for antimalarial medication. A health care provider should prescribe which of the following drugs prior to the nurse's trip? primaquine metronidazole amitriptyline clindamycin

Which of the following aspects of teaching is most important to provide to a patient who is taking chloroquine phosphate? -Take chloroquine with vitamin C -Have frequent ophthalmologic examinations -Administer antacids to reduce gastric distress -Take chloroquine on an empty stomach

A 4-year-old child receives a diagnosis of enterobiasis, an infection with Enterobius vermicularis. What is E. vermicularis? pinworm hookworm whipworm roundworm pinworm

A patient who has enterobiasis, which is caused by Enterobius vermicularis, is receiving treatment with mebendazole. Which of the following agents decreases the serum concentration of mebendazole? alcohol phenytoin ampicillin metronidazole mebendazole

A prescriber has ordered permethrin for an elderly patient who has received a diagnosis of scabies. What is the action of permethrin? -It inhibits the influx of sodium through the nerve cell membranes to paralyze the

parasite -It inhibits the influx of calcium through the nerve cell membranes to paralyze the parasite -It inhibits the influx of potassium through the nerve cell membranes to paralyze the parasite -It inhibits the influx of chloride through the nerve cell membranes to paralyze the parasite

When applying spinosad to a dry scalp for treatment of head lice, how long should it be left on? 5 minutes 10 minutes 20 minutes 30 minutes

Pharmacology Drugs for Hypertension A client receiving HCTZ 25 mg q.d. and digoxin 0.125 mg q.d. complains of nausea and vomiting, and of seeing halos around lights. The client's serum digoxin level is 2.5 ng. The appropriate nursing intervention is to: A. Administer both drugs as ordered. B. Hold the digoxin and HCTZ. C. Document the findings; the lab results are within normal limits. D. Hold the digoxin, and give HCTZ as ordered.

The client presents to the medical office with a history of blood pressure 140/90154/92 for the past month. There is no history of other medical conditions. The nurse recognizes the most likely initial treatment to include is: A. Lasix 40 mg, amlodipine (Norvasc) 5 mg q.d. B. Diuril 25 mg, nifedipine 30 mg q.d. C. Diuril 25 mg b.i.d. D. Lasix 40 mg q.d.

A diuretic is added to the treatment regimen for a client with hypertension. The nurse explains that diuretics help reduce blood pressure by: A. Constricting blood vessels. B. Removing serum potassium. C. Reducing sympathetic outflow. D. Dilating peripheral blood vessels. The client has been given a prescription of furosemide (Lasix) as an adjunct to treatment of hypertension and returns for a follow-up check. Which of the following is the most objective data for determining the therapeutic effectiveness of the furosemide? A. Absence of edema in lower extremities B. Weight loss of 6 lbs C. Blood pressure log notes blood pressure 120/70 mmHg to 134/88 mmHg since discharge D. Frequency of voiding of at least 6 times per day

What health teaching should the nurse provide for the client receiving nadolol (Corgard)? A. Increase fluids and fiber to prevent constipation. B. Report a weight gain of 1 kg per month or more. C. Immediately stop taking the medication if sexual dysfunction occurs. D. Rise slowly after prolonged periods of sitting or lying down.

After receiving the results of an echocardiogram, a client has many questions regarding the results and their impact on the client's lifestyle. The client is a 57year-old Hispanic man with a 10-year history of hypertension. The client would like to know what effect hypertension has on the heart. What is the nurse's best reply? A. Decreased risk of thrombosis B. Arterial lumen dilation C. Myocardium hypertrophy D. Increased risk for hepatic damage

A patient who is prescribed losartan for hypertension has stopped taking the drug immediately after experiencing adverse effects. Which of the following may result when antihypertensives are abruptly discontinued? A. Rebound hypertension B. Anginal attacks C. Breathing difficulty D. Orthostatic hypotension

The goal of therapy for a client taking antihypertensive medication is to maintain: A. a fluid volume balance. B. compliance. C. homeostasis. D. the blood pressure within normal limits.

A client with a long history of hypertension has just been prescribed an alpha1adrenergic receptor blocker. To reduce this client's risk of orthostatic hypotension and falls, the nurse should encourage the client to implement what intervention? A. Increase fluid intake for 48 hours before taking the first dose. B. Take the medication at bedtime. C. Start with a low dose and increase gradually over 2 to 3 weeks. D. Take the medication with a high-fat meal.

The client is diagnosed with primary hypertension. The nurse is educating a client about dietary changes that help decrease blood pressure. Which menu selection indicates the need for further client education? A. Baked fish, broccoli, and oranges B. Ham sandwich with mustard, carrots and cheesy dip C. Salad with a grilled chicken; unsweetened tea D. Turkey sandwich on whole wheat with lettuce and tomato; sweetened tea

A staff nurse on a renal unit knows that most patients require treatment for hypertensive disease. What would the nurse expect to assess prior to the beginning of antihypertensive treatment? A. Baseline renal function B. A temporary increase in renal function C. A sustained increase in renal dysfunction D. A sustained decrease in renal function

A 71-year-old male client has recently been diagnosed with hypertension. Which measurement is a partial indication of effective treatment and management? A. Systolic blood pressure below 160 mm Hg B. Diastolic blood pressure below 90 mm Hg C. Systolic blood pressure above 140 mm Hg D. Diastolic blood pressure below 100 mm Hg

The nurse is providing drug teaching for a client who is prescribed enalapril. What drug-specific adverse effect will the nurse include in the drug teaching? A. Hypersensitivity reaction B. Sedation C. Hepatic dysfunction D. Persistent cough

A client has been diagnosed with primary hypertension. Which medications are used to treat primary hypertension? A. Loop diuretics B. C. Beta adrenergic antagonists D. Thiazide diuretics E. Angiotensin receptor blockers (ARBs) F. Angiotensin converting enzymes (ACEs)

A 48-year-old client with a blood pressure of 198/112 mm Hg reports severe headache and drowsiness. The nurse notes that the client is disoriented and has begun to vomit. What is the primary nursing goal for this client experiencing a hypertensive emergency? A. Assess the level of head pain. B. Implement interventions to lower blood pressure. C. Administer antiemetic medication. D. Monitor the client's level of consciousness.

Chapter 26 Drugs for Hypertension part 2 Nitroprusside (Nitropress) is prescribed for a client admitted with a blood pressure of 220/110. What action by a new nurse would require intervention by the charge nurse? A. The nurse documents the IV rate and status of site every 15 minutes. B. The nurse cautions the client to call for assistance before getting out of bed. C. The nurse uses electronic monitoring of blood pressure every hour. D. The nurse inserts a Foley catheter.

The nurse preparing to administer HCTZ (Hydrodiuril) 25 mg to a client with hypertension checks laboratory values and finds that the potassium level is 2.8 mEq. The appropriate action is to: A. Administer the drug with orange juice. B. Give the client a banana, and recheck the potassium level. C. Hold the medication, and notify the health care provider. D. Administer the drug as ordered, and continue to monitor the potassium level. Atenolol (Tenormin) is prescribed for a client with hypertension. The nurse recognizes that a safe dose for this drug is: A. Atenolol (Tenormin) 100 mg b.i.d. B. Atenolol (Tenormin) 150 mg q.d. C. Atenolol (Tenormin) 50 mg b.i.d. D. Atenolol (Tenormin) 75 mg b.i.d.

Nifedipine (Procardia) has been ordered for a client with hypertension. In the care plan, the nurse includes the need to monitor for which adverse effect? A. Rash and chills. B. Reflex tachycardia. C. Increased urinary output. D. Weight loss.

The nurse is preparing to administer the first dose of enalapril (Vasotec). Identify the potential adverse effects of this medication (select all that apply.) A. Reflex hypertension B. Hyperkalemia C. Persistent cough D. Angioedema E. Hypotension

A client is receiving fosinopril. Which adverse effect would the nurse caution the client about to help to promote compliance? A. Photosensitivity B. Cough C. GI irritation D. Constipation

A male client who is an Asian executive visiting the United States presents to the emergency department with a severe headache and an elevated blood pressure. He is admitted to the hospital for treatment and regulation of his medication regimen. The client is concerned because the dosage prescribed for his antihypertensive medication is lower than what he researched on the Internet. What is an accurate response for the nurse to make? A. "I will contact the provider immediately." B. "People of Asian descent excrete the drugs more slowly, so the doses prescribed are smaller." C. "There is an error on the prescription." D. "People of Asian descent excrete the drugs more rapidly, so the doses prescribed are smaller."

A nurse is educating a patient with hypertension who is prescribed losartan on the mechanism of action of the drug. Which mode of action helps losartan to bring about its antihypertensive effect? A. By preventing the conversion of angiotensin I B. By blocking the aldosterone receptors C. By preventing renin secretion D. By blocking the angiotensin II receptors

A client, newly diagnosed with hypertension is started on captopril, an ACE inhibitor. The client should be informed of the possibility of what adverse effect? A. Sweating B. Persistent cough C. Hypokalemia D. Sedation

The nurse should inform the client of the possibility of developing what common adverse effect of captopril therapy? A. photosensitivity B. rhinitis C. rash to the trunk and extremities D. dry cough

The patient has been placed on a nitroprusside drip for the treatment of a hypertensive crisis. Which mechanism of action does the nurse know is true for nitroprusside? A. It inhibits the movement of calcium ions across cell membranes. B. It directly relaxes vascular smooth muscle, allowing dilation of peripheral arteries and veins. C. It blocks the action of angiotensin II from all the different pathways where it is formed, not just the single substrate altered by ACE inhibitors. D. It binds selectively to the mineralocorticoid receptors.

When the cardiac workload is increased from secondary hypertension, the client is at risk for developing what associated condition? A. increased venous tone B. myocardial hypertrophy C. arterial lumen dilation D. hepatic damage

A 26-year-old white male client has been prescribed captopril for hypertension. A nurse has been assigned to the client to provide education regarding the use of this drug. The nurse will advise the client that: A. the first dose of the medication should be taken at breakfast. B. a persistent, dry cough may occur; however, it is not serious. C. if sore throat, fever, and swollen hands or feet occur, do not be alarmed. These manifestations will subside. D. he should use a salt substitute containing potassium to avoid hypokalemia.

Which question would be most important for a nurse to ask a female client who is starting on an angiotensin II receptor blocker for hypertension? A. "When was your last menstrual period?" B. "Do you eat something when you take your medications?" C. "Have you always weighed 150 pounds?" D. "How much physical exercise do you get?"

chapter 27 drug therapy for dysrhythmia The electrical impulses flow in the following manner: Sinoatrial node, the atrioventricular node, bundle of His, right and left bundle branches, and Purkinje fibers.

After teaching a group of students about the conduction system of the heart, the instructor determines that the teaching was successful when the students identify what as the origination of the impulse? SA node

When educating a group of nursing students on the mechanism of the action of various anti-arrhythmic drugs, the nurse identifies which drugs as inhibiting the beta-adrenergic receptors of the heart and the kidney? acebutolol

A nurse is the cardiac care unit is preparing to hang an intravenous dose of dofetilide (Tikosyn) for a client who has just been admitted. What is the most likely goal of this intervention? To convert the client's atrial fibrillation to normal sinus rhythm

A client, diagnosed with a cardiac dysrhythmia, will not require medication therapy. The client expresses concern about the lack of proposed treatment. What response should the nurse provide to best address the client's concern? "The dysrhythmia you have isn't interfering with getting oxygen to your body tissues so there is no need to treat it."

A client with impaired renal function is to receive dofetilide (Tikosyn) for conversion of atrial fibrillation. Which should the nurse do before administering the drug? Check the client's creatinine level.

Amidorone and dofetilide given together can cause? Life threatening arrhythmia's

A patient presents at the clinic with shortness of breath, fatigue, and difficulty performing ADLs. The nurse notes bluish color around the patient's mouth and in the patient's nail beds. The nurse expects that the patient has: heart failure.

Arrhythmia may be triggered by which of the following? heart disease, a disorder that affects cardiovascular function, emotional stress, hypoxia, and electrolyte imbalances.

A patient on anti-arrhythmic drug therapy reports nausea, vomiting, abdominal pain, diarrhea, and a ringing sensation in the ears. Which drug should the nurse consider as the cause for these adverse effects? Quinidine

A patient, admitted to a health care facility with cardiac arrhythmia, is prescribed propranolol. Which factor should the nurse closely monitor as a part of the ongoing assessment during the therapy? Pulse rate The nurse is caring for a patient receiving intravenous lidocaine for treatment of dysrhythmia. Which of the following dysrhythmias is this patient most likely to have? a class 1B antidysrhythmic drug, is used in the treatment of symptomatic PVC and ventricular tachycardia. It is used to prevent ventricular fibrillation. Drug treatment of asymptomatic PVC and non-sustained ventricular tachycardia is not recommended.

The nurse is administering quinidine to a client who is also taking digoxin. The nurse will assess this client for which important adverse effect? Increased digoxin level

While lecturing on blood pressure, the nurse will emphasize that the body maintains its blood pressure by adjusting the cardiac output to compensate for changes in which physiologic process? Peripheral Vascular Resistance

The nurse is assessing a client and suspects that the client is experiencing a dysrhythmia. What client assessments would support this condition? oliguria, hypotension, mental confusion or syncope, or shortness of breath

A client is to receive esmolol. The nurse would expect to administer this agent by which route? IV

Initiation of the heart's electrical impulses depends predominantly on what electrolyte movement? predominately on the movement of sodium and calcium ions into a myocardial cell and movement of potassium ions out of the cell

A client receiving warfarin is prescribed disopyramide. The nurse would monitor for signs and symptoms of what as most important? bleeding

There are four primary classes of antidysrhythmic drugs. What class consists primarily of potassium channel blockers? Class III How long does it take for amiodorone to work? Immediately It is determined that a client's cardiac rhythm is being originated in the sinoatrial (SA) node. What mechanism is responsible for the triggering of this node? Specialized cells within the node itself

What is the primary goal of antidysrhythmic drug therapy for a client who has been successfully cardioverted? Normal sinus rythm

The nurse notes that a client's current medications include both diltiazem for a dysrhythmia and nitroglycerin. The nurse should recognize the need to closely monitor the which client assessment datum? Blood pressure

Verapamil (Calan) can produce which of the following effects on the cardiovascular system? Select all that apply: Dilate coronary arteries. Dilate peripheral arteries. Slow conduction through the SA and AV nodes

Before the administration of any anti-arrhythmic, what should the nurse's preassessment of the client's general condition include? Skin color Orientation Level of consciousness

Chapter 28- Drug Therapy for Coronary Heart Disease 1. A patient is experiencing anaphylaxis. Which of the following medications will most likely be administered? A) Epinephrine B) Norepinephrine C) Acetylcysteine (Mucomyst) D) Dantrolene sodium (Dantrium) 2. A patient is suffering from hypovolemic shock. Which agents are administered if fluid volume replacement does not restore sufficient blood pressure? A) First-line agents B) Second-line agents C) Beta-blockers D) Antianginal drugs 3. A patient has been diagnosed with narrow-angle glaucoma. What ocular effect will be produced if the patient is prescribed an adrenergic agent? A) Hypothyroidism B) Decreased heart rate C) Mydriasis D) Hypertension 4. A patient is administered epinephrine in conjunction with a local anesthetic. What effect will epinephrine produce? A) Decreased cerebral circulation B) Decreased coronary circulation C) Increased vasoconstrictive effects D) Increased bronchoconstriction 5. An emergency department nurse enters a patient's room with an order to administer epinephrine subcutaneously to treat his asthma attack. The patient's wife asks the nurse why it could not be given by mouth. Which of the following is the best response by the nurse? A) “The medication he is to receive is only given by an injection in the arm.” B) “The medication is administered this way because it works faster than by mouth.” C) “The medication is given many ways, but this is the way it was ordered.” D) “The medication will not absorb in the GI tract if given by mouth.” 6. A patient suffers from bronchial asthma. Which of the following medications is a mixedacting adrenergic drug that may be administered? A) Epinephrine B) Ephedrine C) Pseudoephedrine D) Isoproterenol

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A) B) C) D)

7. A home care nurse is visiting a patient, and the assessment will include blood pressure and heart rate. The patient's grandson has a large amount of pseudoephedrine (Sudafed) in the kitchen. For what might the nurse suspect the patient's grandson is using the pseudoephedrine? Methamphetamine production Treatment of bronchial asthma Treatment of sinusitis To increase appetite

8. A patient suffers from bradycardia. Which of the following medications is a synthetic catecholamine for the treatment of bradycardia? A) Isoproterenol (Isuprel) B) Pseudoephedrine (Sudafed) C) Ephedrine D) Epinephrine 9. A patient has been using phenylephrine (Neo-Synephrine) for nasal congestion. He states to the nurse that he is using more every day because his nose is so congested. What effect is the medication producing? A) Reflex bradycardia B) Mucosal hemorrhage C) Tachycardia D) Rebound congestion 10. A pediatric patient is administered epinephrine to treat bronchospasm as a result of acute asthma. What effect should the patient be monitored for? A) Edema B) Syncope C) Bradycardia D) Hemorrhage 11. A nurse is participating in a “code blue” response to a patient who lost consciousness after a short period of distress. The physician leading the code has ordered the administration of IV epinephrine. When preparing this drug for administration, the nurse should recognize what goal of this treatment? A) Increased cardiac contractility B) Increased blood flow to the heart and brain C) Increased peripheral blood circulation D) Increased release of dopamine

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12. Epinephrine is indicated in the treatment of a 79-year-old patient whose blood pressure has plummeted in the postanesthesia recovery room following prostate surgery. Epinephrine should be used with caution in a patient of this age because of the risk of A) exacerbating chronic cardiac conditions. B) causing cerebral ischemia. C) increasing intracranial pressure. D) causing Stevens-Johnson's syndrome 13. A teenage boy has been brought to the emergency department (ED) by his football coach, who states that the boy has not responded to his normal rescue inhaler. The care team has opted for the administration of subcutaneous epinephrine. The ED nurse should anticipate what assessment finding subsequent to the administration of this drug? A) Increased level of consciousness within 2 to 5 minutes B) Immediate bronchodilation C) An immediate decrease in respiratory rate D) Bronchodilation within 5 to 10 minutes 14. A clinic nurse is teaching the parents of toddler about the safe and effective use of an EpiPen after the child was diagnosed with severe nut allergies. What instruction should the nurse convey to the parents? A) “It's prudent to administer a small dose of epinephrine if you want to prevent a future reaction.” B) “Only use your EpiPen if you've tried oral medications and they've been ineffective.” C) “The thigh is usually the ideal place to inject the EpiPen.” D) “Keep administering repeated doses of epinephrine until your child's symptoms abate.” 15. Epinephrine is being considered in the treatment of an adult hospital patient. In anticipation, the nurse has reviewed the patient's current medication regimen. The presence of a drug from which of the following drug categories would contraindicate the safe use of epinephrine? A) Potassium-wasting diuretics B) Sulfonamide antibiotics C) Selective serotonin reuptake inhibitors (SSRIs) D) Monoamine oxidase (MAO) inhibitors 16. A 19-year-old has been brought to the emergency department (ED) by ambulance after a suspected overdose of a herbal preparation that contained ephedra. Due to the risk of seizures and intracranial hemorrhage, the nurse should prioritize what assessment? A) Continuous oxygen saturation monitoring B) Blood pressure monitoring C) Respiratory auscultation D) Assessing extremities for color, warmth, movement, and sensation

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17. An adult patient with diagnoses of liver cirrhosis and hepatitis C is exhibiting signs and symptoms of hypovolemic shock. How will the patient's compromised hepatic function affect the possible use of epinephrine? A) The patient will require a higher-than-normal dose. B) The patient's hepatic function is not a priority consideration. C) The patient should not receive epinephrine by a parenteral route. D) The patient should receive a small fraction of the normal dose. 18. A patient has been resuscitated using epinephrine following an episode of asystole and is now being monitored in the intensive care unit (ICU). When monitoring the patient's status, the nurse should anticipate which of the following effects of epinephrine administration? Select all that apply. A) Decreased urine output B) Hyperglycemia C) Increased serum potassium levels D) Hypercapnia E) Increased blood pressure

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1. Ans: A Feedback: Epinephrine is the adrenergic drug of choice for relief of anaphylactic shock, the most serious allergic reaction, as well as in treatment of cardiac arrest. Norepinephrine is not administered. Acetylcysteine (Mucomyst) is used for acetaminophen overdose. Dantrolene sodium is used to treat malignant hyperthermia.

2. Ans: B Feedback: In hemorrhagic or hypovolemic shock, the drugs are second-line agents that may be used if adequate fluid volume replacement does not restore sufficient blood pressure and circulation to maintain organ perfusion. First-line agents are not used; the first-line therapy is fluid replacement. Beta-blockers decrease heart rate and are not administered with hypovolemic shock. Antianginals are not administered in hypovolemia.

3. Ans: C Feedback: Narrow-angle glaucoma is a contraindication to adrenergic agents because the drugs result in mydriasis, closure of the filtration angle of the eye, and increased intraocular pressure. Hypothyroidism will not occur with the administration of adrenergic agents. Decreased heart rate will not occur with the administration of adrenergic agents and is not an ocular effect. Hypertension is not an ocular effect.

4. Ans: C Feedback: Epinephrine is added to local anesthetics for vasoconstrictive effects, which include prolonging the action of the local anesthetic drug, preventing systemic absorption, and minimizing bleeding. Epinephrine will not decrease cerebral circulation or coronary circulation. Epinephrine will not increase bronchoconstriction.

5. Ans: D Feedback: Epinephrine is not given orally because enzymes in the GI tract and liver destroy it. The medication can be given through inhalation, intravenously, and subcutaneously. The medication will work more quickly in a parenteral form but is not given orally. Stating to the patient that this method is the way the physician ordered it to be given will belittle the patient and not provide adequate patient teaching.

6. Ans: B

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Feedback: Ephedrine is a mixed-acting adrenergic drug that acts by stimulating alpha1 and beta receptors and causing release of norepinephrine from presynaptic terminals. It is used in the treatment of bronchial asthma. Epinephrine is not a mixed-acting adrenergic drug. Pseudoephedrine is a related drug, stimulating alpha1 and beta receptors. It is used as a nasal decongestant. Isoproterenol is a synthetic catecholamine that acts on beta1- and beta2-adrenergic receptors.

7. Ans: A Feedback: Pseudoephedrine and ephedrine are ingredients used in making methamphetamine, a highly addictive and illegal drug of abuse. Pseudoephedrine is used in the treatment of bronchospasm but is not the drug of choice. Pseudoephedrine is used in the treatment of sinusitis, but, in large quantities, the nurse should suspect methamphetamine production. Pseudoephedrine will increase basal metabolic rate but is not the drug of choice to increase appetite.

8. Ans: A Feedback: Isoproterenol (Isuprel) is a synthetic catecholamine that acts on beta1- and beta2adrenergic receptors to stimulate heart rate. Pseudoephedrine (Sudafed) is not a synthetic catecholamine. Ephedrine and epinephrine are not synthetic catecholamines.

9. Ans: D Feedback: Overuse of nasal decongestants leads to decreased effectiveness (tolerance), irritation and ischemic changes in the nasal mucosa, and rebound congestion. These effects can be minimized by using small doses only when necessary and for no longer than 3 to 5 days. Phenylephrine will not produce reflex bradycardia, mucosal irritation, or tachycardia.

10. Ans: B Feedback: Epinephrine is mainly used in children for treatment of bronchospasm due to asthma or allergic reactions. Parenteral epinephrine may cause syncope when given to asthmatic children. Epinephrine will not increase edema or cause bradycardia or hemorrhage.

11. Ans: B Feedback:

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Epinephrine is often administered during cardiopulmonary resuscitation (CPR). The most important action of epinephrine during cardiac arrest is constriction of peripheral blood vessels, which shunts blood to the central circulation and increases blood flow to the heart and brain. The goal of epinephrine administration is not increased contractility or dopamine release.

12. Ans: A Feedback: Clinicians use adrenergic agents to treat asthma, hypotension, shock, cardiac arrest, and anaphylaxis in older adults. These drugs stimulate the heart to increase rate and force of contraction and blood pressure. Because older adults often have chronic cardiovascular conditions (e.g., angina, dysrhythmias, heart failure, coronary artery disease, hypertension, peripheral vascular disease) that are aggravated by adrenergic drugs, careful monitoring by the nurse is required. 13. Ans: D Feedback: For acute asthma attacks, subcutaneous (Sub-Q) administration of epinephrine usually produces bronchodilation within 5 to 10 minutes; maximal effects may occur within 20 minutes. An increase in LOC is not a priority, and respiratory rate would not likely decrease.

14. Ans: C Feedback: The thigh is the preferred site for autoinjection, providing more rapid absorption and higher blood levels of epinephrine than the arm in children and adults for either intramuscular or subcutaneous administration. Epinephrine is not administered as a prophylactic treatment. Emergencies preclude the use of oral medications, and repeated injections may result in toxicity.

15. Ans: D Feedback: It is essential not to give MAO inhibitors with adrenergic drugs because the combination may cause death. Use of adrenergics with diuretics, SSRIs, or sulfa antibiotics is not necessarily contraindicated. 16. Ans: B Feedback: Ephedrine and ephedra-containing herbal preparations (e.g., ma huang, herbal ecstasy) are often abused as an alternative to amphetamines. The primary clinical manifestation of this adrenergic drug toxicity is severe hypertension, which may lead to headache, confusion, seizures, and intracranial hemorrhage. Vigilant blood pressure monitoring is thus a high priority.

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17. Ans: B Feedback: Liver disease is not usually considered a contraindication to administering adrenergic drugs. Dosages do not normally need to be adjusted.

18. Ans: A, B, E Feedback: Administration of epinephrine is associated with decreased urine output, increased blood glucose, hyperkalemia, and increased blood pressure. Excess CO2 levels are not anticipated

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Chapter 29- Drug Therapy for Shock and Hypotension 1. A community health nurse is facilitating a health promotion session to a group of seniors. Which of the following is most important to instruct regarding hypertension? A) Hypertension will increase the risk of cancer. B) An increase in sodium is recommended with hypertension. C) Vigorous exercise will increase the risk of hypertension. D) Hypertension will increase the risk of heart disease. Ans: D Feedback: Hypertension increases risks of myocardial infarction, heart failure, cerebral infarction and hemorrhage, and renal disease. Hypertension does not increase the risk of cancer. An increase in sodium in a patient's diet is not recommended with hypertension. Exercise will decrease the risk of hypertension. 2. A patient is diagnosed with high blood pressure. Which of the following events occurs in a patient with hypertension? A) The kidneys excrete more fluid in response to increased blood pressure. B) Fluid loss increases blood volume in the patient with hypertension. C) Decreased blood volume increases blood pressure. D) Cardiac output increases and in turn causes an increase in blood pressure. Ans: A Feedback: When arterial blood pressure is elevated, the kidneys excrete more fluid. The loss of fluid will reduce, not increase, blood volume. The decreased blood volume will decrease cardiac output. The decreased cardiac output decreases blood pressure.

3. A patient has had multiple blood pressure readings that indicate he has hypertension. How is hypertension defined? A) Systolic pressure above 140 mm Hg or diastolic pressure above 90 mm Hg B) Systolic pressure above 160 mm Hg or diastolic pressure above 110 mm Hg C) Systolic pressure above 130 mm Hg or diastolic pressure above 95 mm Hg D) Systolic pressure above 150 mm Hg or diastolic pressure above 100 mm Hg Ans: A Feedback: Hypertension is defined as a systolic pressure above 140 mm Hg or a diastolic pressure above 90 mm Hg on multiple blood pressure measurements. The blood pressure of 160/110 mm Hg is considered hypertensive but does not define hypertension. The blood pressure of 130/95 mm Hg is hypertensive but does not define hypertension. The blood pressure of 150/100 mm Hg is hypertensive but does not define hypertension. 4. A patient has recently been diagnosed with hypertension. Which of the following outcomes is most important in this patient?

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A) Verbalization of an understanding of medical regimen B) Compliance with antihypertensive medications C) Multiple diastolic blood pressure readings <90 mm Hg D) Compliance with a low-sodium diet Ans: C Feedback: The diastolic blood pressure below 90 mm Hg is the most important outcome in this patient. Verbalization of understanding of the medical regime is a patient-related outcome that is important but not the most important outcome. Compliance with antihypertensive medications is important but does not confirm a decreased blood pressure. Compliance with a low-sodium diet will assist in decreasing blood pressure but will not confirm that the blood pressure is decreased. 5. A patient is diagnosed with hypertension and is being treated with captopril (Capoten). Which of the following patients should be administered captopril as the first-line treatment? A) A patient with diabetes mellitus B) A patient with asthma C) A patient with glaucoma D) A patient with angina pectoris Ans: A Feedback: Captopril (Capoten) is the first-line agent for treating hypertension in diabetic patients, particularly those with type 1 diabetes. Captopril can be used for hypertension in patients with asthma, glaucoma, and angina pectoris but is not the first-line agent, as noted in diabetes mellitus.

6. A patient with diabetes mellitus is prescribed captopril (Capoten) to treat hypertension. What electrolyte imbalance might the patient be prone to develop? A) Hyperkalemia B) Hypokalemia C) Hypernatremia D) Hypermagnesemia Ans: A Feedback: Hyperkalemia may develop in patients who have diabetes mellitus or renal impairment. Hypokalemia is not a risk in patients with diabetes mellitus. Hypernatremia is not a major risk in patients with diabetes who are taking captopril. Hypermagnesemia is not a risk in patients with diabetes who are taking captopril.

7. A patient is prescribed losartan (Cozaar). The medication alone is not

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effective in controlling blood pressure. What medication will best increase the effectiveness of blood pressure control in this patient? A) Atorvastatin calcium (Lipitor) B) Hydrochlorothiazide (HCTZ) C) Hydralazine hydrochloride D) Digoxin (Lanoxin) Ans: B Feedback: If losartan alone does not control blood pressure, a low dose of diuretic may be added. Hydrochlorothiazide is a diuretic agent. Atorvastatin calcium is not a diuretic agent. Hydralazine is not a diuretic agent. Digoxin is not a diuretic agent.

8. A patient who is malnourished and has hypertension is being treated with losartan (Cozaar). How should the dose of the medication be adjusted in this patient? A) The dose should be higher than normal. B) The dose should be lower than normal. C) The dose should remain the same as normal. D) The medication should be combined with a diuretic. Ans: B Feedback: Both losartan and the metabolite are highly bound to plasma albumin, and losartan has a shorter duration of action. Due to malnutrition, a low dose of losartan should be prescribed. The dose should not be higher than normal due to possible toxicity. The dose should not be the same as normal due to possible toxicity. The medication will not be combined with a diuretic unless the blood pressure is not controlled. 9. A patient is prescribed trandolapril (Mavik). What adverse effect should the patient be instructed on that can occur with angiotensin-converting enzyme (ACE) inhibitors? A) Sedation B) Persistent cough C) Tachycardia D) Rash Ans: B Feedback: A persistent cough can develop with the use of ACE inhibitors. Sedation, tachycardia, and rash are not noted with ACE Inhibitors.

10. A patient is being administered enalapril maleate (Vasotec). Which of

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the following diuretics can be combined with ACE inhibitors to increase effectiveness in decreasing blood pressure? A) Loop diuretics B) Osmotic diuretics C) Potassium-sparing diuretics D) Thiazide diuretics Ans: D Feedback: ACE inhibitors may be used alone or in combination with other antihypertensive agents, such as thiazide diuretics. ACE inhibitors are not routinely combined with loop, osmotic, or potassium-sparing diuretics.

11. A patient is diagnosed with hypertension, and the care team is establishing the best medication regimen to match the patient's decreased level of function. Which of the following medications can be administered by transdermal patch? A) Amlodipine (Norvasc) B) Candesartan (Atacand) C) Enalapril (Vasotec) D) Clonidine (Catapres) Ans: D Feedback: Clonidine is available as a transdermal patch. Enalapril, candesartan, and amlodipine are not available by this route.

12. An African American patient is being treated for a new diagnosis of hypertension. What antihypertensive agent is the most likely drug of choice for this patient? A) Diuretic B) Vasodilator C) Calcium channel blocker D) Beta-adrenergic blocker Ans: A Feedback: In African Americans, diuretics are effective and recommended as initial drug therapy.

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13. A patient is prescribed a potassium-sparing diuretic. What electrolyte imbalance would the patient be prone to develop?

A) Hypernatremia B) Hyponatremia C) Hypokalemia D) BHyperkalemia Ans: D Feedback: Potassium-sparing diuretics may precipitate hyperkalemia. Potassium-sparing diuretics would not precipitate hypernatremia, hyponatremia, or hypokalemia.

14. When providing dietary instruction on a low-sodium diet, which dietary choice is most appropriate for a patient with hypertension? A) Hot dog, baked beans, and coleslaw B) Grilled hamburger, french fries, and cola C) Grilled chicken, green salad, and apple D) Ham sandwich, potato chips, and cookie Ans: C Feedback: Therapeutic regimes include sodium restriction. The grilled chicken, green salad, and apple represent low-sodium dietary choices. Hot dog, baked beans, and coleslaw are high in sodium. Grilled hamburger, french fries, and cola are high in sodium. Ham sandwich, potato chips, and cookie are high in sodium.

15. A patient of Asian descent has been diagnosed with hypertension. He is placed on a beta-blocker. Why is the dose lower than in most other patients?

A) Asians metabolize and excrete beta-blockers slower. B) Asians metabolize beta-blockers in the small intestine. C) Asians have a diminished renal excretion of beta-blockers. D) Asians are more likely to have a lower albumin level. Ans: A Feedback: Asians in general need much smaller doses of beta-blockers because they metabolize and excrete beta-blockers slowly. They do not metabolize beta-blockers in the small intestine. They do not have diminished renal excretion of beta-blockers. They do not have a lower albumin level. Page 5

16. After obtaining several elevated blood pressure readings from the automated sphygmomanometer in his local drugstore, a 51-year-old man sought care from his primary care provider. The patient has been diagnosed with hypertension following several elevated blood pressure readings. The nurse at the clinic should recognize which of the following drug regimens as being most likely? A) Monotherapy with a loop diuretic B) Monotherapy with an ACE inhibitor C) A beta-blocker combined with a calcium channel blocker D) A thiazide diuretic combined with a beta-blocker Ans: D Feedback: The JNC 7 guidelines suggest thiazide diuretics be used as first-line therapy, either alone (monotherapy) or with a beta-blocker, ACE inhibitor, ARB, or calcium channel blocker. Consequently, the other listed drug regimens are less likely to be implemented. 17. An elderly man who resides in a care facility has been prescribed antihypertensives for the first time following many years of generally good health. When administering the first dose of the prescribed medications, the nurse should recognize what nursing diagnosis? A) Risk for falls related to antihypertensive medications B) Risk for infection related to antihypertensive medications C) Risk for acute confusion related to antihypertensive medications D) Risk for impaired oxygenation related to antihypertensive medications Ans: A Feedback: Initiation of antihypertensive therapy creates a risk of acute hypotension and consequent falls. Infection, confusion, or impaired oxygenation is much less likely. 18. A patient is being treated in the hospital for a femoral fracture and is scheduled to receive his daily dose of metoprolol (Lopressor) that he has been taking for the treatment of hypertension for several years. Prior to administering this drug, the nurse should assess and document which of the following? Select all that apply. A) Oxygen saturation level B) Heart rate C) Potassium level D) Blood pressure E) Capillary refill Ans: B, D Feedback: Beta-blockers reduce heart rate and blood pressure; both parameters should be assessed prior to administration. Beta-blockers do not significantly affect potassium levels, oxygen levels, or peripheral circulation.

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Chapter 30: Drug Therapy for Heart Failure MULTIPLE CHOICE BASIC CONCEPTS 1. What does the term “afterload” mean? a. The amount of blood entering the left ventricle that must be pumped out of the

heart b. The peripheral resistance of the arterial system, including mean arterial pressure c. The ability of the living muscle fibers of the heart to contract and pump blood d. The percentage of blood pumped out of the heart with each heartbeat ANS: B

Afterload is the pressure in the aorta that the left ventricle must overcome before blood can move from it into the aorta. Mean arterial pressure (MAP) is also the pressure that the left ventricle must overcome to move blood from the left ventricle into the aorta during contraction (afterload). Afterload increases because of increased peripheral resistance usually as a result of high blood pressure. DIF: Cognitive Level: Remembering

REF: p. 274

2. What is the most common cause of heart failure? a. High blood pressure NURSINGKING.COM b. Low blood pressure c. Defective heart valves d. Defective coronary arteries ANS: A

Most heart failure is caused by hypertension. Other causes of heart failure include myocardial infarction, coronary artery disease, cardiomyopathy, substance abuse (alcohol and illicit or prescribed drugs), heart valve disease, congenital defects, cardiac infections and inflammations, and conditions that increase cardiac output and energy demands such as sepsis. DIF: Cognitive Level: Remembering

REF: p. 278

3. What is the main physiological problem in most types of heart failure? a. Overstretching of the right ventricle so that too much blood leaves the heart b. Overstretching of the right ventricle so that too little blood leaves the heart c. Overstretching of the left ventricle so that too much blood leaves the heart d. Overstretching of the left ventricle so that too little blood leaves the heart ANS: D

The muscle of the left ventricle becomes overstretched. When any muscle is overstretched, its contraction is weaker. When the muscles of the left ventricle are overstretched or flabby and the contraction is weak, too much blood remains in the left ventricle, and more blood arriving from the left atrium is added to it. This overstretches the muscle more and continues to weaken contractions, leading to heart failure. DIF: Cognitive Level: Remembering

REF: p. 274

4. Which symptom occurs with only pure right-sided heart failure and does not occur with pure

left-sided heart failure? a. Confusion b. Shortness of breath c. Decreased afterload d. Swelling in the ankles and legs ANS: D

When the right ventricle contracts poorly, signs and symptoms of peripheral congestion occur (Box 17-2 in text) such as weight gain, swelling in the legs, jugular vein distention (Figure 17-4 in text), and increased blood pressure. DIF: Cognitive Level: Remembering

REF: p. 276, Box 17-2

5. Which statement about drug therapy for heart failure is true? a. The drugs work only directly on the heart muscle. b. Drug therapy improves heart function but does not cure heart failure. c. When heart function returns to normal, the drug therapy can be stopped. d. Drug therapy for heart failure does not work when the patient continues to smoke.

NURSINGKING.COM

ANS: B

Drug therapy only improves heart function; drugs do not cure heart failure. Because the damage to the heart muscle is not reversible, the only real cure for heart failure is a heart transplant. DIF: Cognitive Level: Remembering

REF: p. 277

6. What is a common side effect of hydralazine (Apresoline) therapy for heart failure? a. Tachycardia b. High blood pressure c. Constipation d. Difficulty sleeping ANS: A

Common side effects of hydralazine include tachycardia and salt retention. DIF: Cognitive Level: Remembering

REF: p. 280

7. How should sublingual nitroglycerin tablets for heart failure be taken? a. On a full stomach b. On an empty stomach c. Dissolved under the tongue d. Placed under a patch on the chest

ANS: C

Sublingual means to place the drug under the tongue. Remind patients that sublingual nitroglycerin should be kept in place until dissolved. DIF: Cognitive Level: Remembering

REF: p. 281

8. What is the mechanism of action for cardiac glycosides? a. Slowing the heart rate and increasing the force of the heart muscle contraction b. Increasing the heart rate and decreasing the force of the heart muscle contraction c. Directly relaxing blood vessel muscles and decreasing afterload d. Directly constricting blood vessel muscles and increasing afterload ANS: A

Cardiac glycosides are a class of drugs that improve heart failure by slowing down a heart rate that is too fast, allowing more time for the left ventricle to fill. They also work on the muscle fibers in the heart and increase the force of each heartbeat (contractility). DIF: Cognitive Level: Remembering

REF: pp. 281-282

9. What is the most common side effect of cardiac glycoside drugs for heart failure therapy? a. Abdominal cramping and constipation b. Heart rhythm disturbances c. High blood pressure d. Skin rashes ANS: B

The most common side effects of digoxin (Lanoxin), a cardiac glycoside, are heart rhythm disturbances that are related tN oU diRgS oxIinNtGoK xiI ciN tyG .. OC thO erMcommon side effects to watch for include fatigue, bradycardia (slow heart rate less than 60 beats/min), anorexia (loss of appetite), nausea, and vomiting. DIF: Cognitive Level: Remembering

REF: p. 282

10. Which drug for heart failure is a common positive inotrope? a. Amiloride (Midamor) b. Nesiritide (Natrecor) c. Captopril (Capoten) d. Dobutamine (Dobutrex) ANS: D

Dobutamine (Dobutrex) is a positive inotrope. This drug is a heart pump drug that makes the heart muscle contract more forcefully. It also relaxes blood vessels so blood can flow better. DIF: Cognitive Level: Remembering

REF: p. 285

11. When are vasodilator drugs usually prescribed for heart failure? a. When angiotensin-converting enzyme (ACE) inhibitors cannot be taken b. When venous dilation is also needed c. When beta blockers are also being taken d. When heart failure is improving ANS: A

Vasodilators act directly on the peripheral arteries, causing them to dilate, which leads to decreased blood pressure and workload on the heart. When patients cannot take ACE inhibitors or angiotensin II receptor blockers, vasodilators are often prescribed. DIF: Cognitive Level: Remembering

REF: p. 279

ADVANCED CONCEPTS 12. Why must the muscles of the left ventricle be the strongest ones in the heart? a. The mitral (bicuspid) valve is larger than the aortic valve. b. The left ventricle receives blood under high pressure from the pulmonary system. c. The pressure in the aorta is higher than the pressures elsewhere in the circulatory

system. d. Blood in the left ventricle is oxygenated, making it thicker and harder to move than

deoxygenated blood. ANS: C

Movement of blood through the other chambers of the heart is against low pressure, and the distance is short. Blood leaving the left ventricle must move with enough force to first overcome pressure in the aorta, which is the highest in the entire circulatory system, and then move long distances throughout the entire body. Contraction of the muscles in the walls of the left ventricle is what provides the pressure to move blood forward into general circulation. DIF: Cognitive Level: Understanding

REF: p. 273

13. Which two factors are most likely to result in improved cardiac output? a. Greater preload; greater afterload b. Greater preload; reduced N afU teR rlS oaIdNGKING.COM c. Reduced preload; greater afterload d. Reduced preload; reduced afterload ANS: B

Cardiac output is the movement of blood out of the heart and into general circulation. Preload is the amount of blood in the left ventricle before contraction. This volume stretches the muscle of the left ventricle to result in a better force of contraction. So, to a point, greater preload helps improve cardiac output. Afterload is the pressure in the aorta that must be overcome for blood to leave the left ventricle. When this pressure is lower, the heart does not have to work as hard to move blood out of the left ventricle into the aorta. So, greater preload and reduced afterload tend to improve cardiac output. DIF: Cognitive Level: Understanding

REF: p. 275

14. Which symptom is commonly assessed when a patient has left ventricular heart failure? a. Weight gain b. Swelling in the legs c. Jugular vein distention d. Crackles in the lungs ANS: D

When the left ventricle fails, less blood is pumped out to the body and blood backs up into the pulmonary system causing signs of pulmonary congestion such as crackles and wheezes. Weight gain, peripheral swelling, and jugular vein distention are all signs of right ventricular failure. DIF: Cognitive Level: Understanding

REF: p. 275

15. How does hydralazine (Apresoline) help improve heart failure? a. By directly stimulating the right heart muscle to increase the strength of heart

muscle contraction b. By directly stimulating the left heart muscle to increase the strength of heart muscle contraction c. By directly relaxing blood vessel muscles and decreasing afterload d. By directly constricting blood vessel muscles and increasing afterload ANS: C

Hydralazine is a vasodilator. Vasodilators are a class of drugs that act directly on the peripheral arteries to cause them to dilate (widen). This leads to lowering of blood pressure and decreases the workload of the heart. DIF: Cognitive Level: Remembering

REF: p. 280

16. How do natriuretic peptides work to help improve heart failure? a. Increasing preload b. Decreasing preload c. Decreasing water loss and raising blood pressure d. Increasing water loss and lowering blood pressure

NURSINGKING.COM

ANS: D

Nesiritide (Natrecor) is human B-type natriuretic peptide, which is a hormone that is produced by the heart ventricles and a synthetic drug. The actions of this drug include increased water elimination and blood vessel dilation. Both are helpful when treating a patient with heart failure. This drug is given by the IV route and helps the body get rid of extra salt and water, thus lowering blood pressure. DIF: Cognitive Level: Remembering

REF: p. 284

17. Which condition alerts you to assess a patient for worsening heart failure? a. Blood pressure of 106/40 mm Hg b. Pounding headache c. Foul urine odor d. Ankle swelling ANS: D

Ankle swelling is associated with heart failure, although other conditions also can cause it. If this is a new symptom or is occurring even when the patient is not spending a lot of time sitting or standing, the nurse should assess the patient for other symptoms of heart failure. Although the blood pressure is not high, the pulse pressure is wide which does not indicate failure. A pounding headache is most associated with elevated blood pressure. Foul-smelling urine is associated with urinary tract infection.

DIF: Cognitive Level: Applying or Higher

REF: p. 281

18. You prepare to administer a drug for heart failure to a patient. Which assessment finding do

you report to the prescriber before administering the drug? a. Systolic blood pressure increase from 128 to 136 b. Urine output of 2100 mL in 24 hours c. Weight gain of 1 lb in 3 days d. Heart rate of 54 beats/min ANS: D

Some drugs for heart failure also slow the heart rate. If the heart rate is slow before taking the drug, the drug can slow the heart rate so much that the patient cannot adequately perfuse and oxygenate his or her vital organs. Usually, if the heart rate is less than 60 beats/min, the prescriber is notified. The next dose may be held until the pulse rate returns to normal. DIF: Cognitive Level: Applying or Higher

REF: p. 283

19. Which statement made by a patient with heart failure indicates that more teaching is needed

about the prescribed drug therapy? a. “I always try to take my heart failure drugs at the same time each day.” b. “Now I am using a weekly pill dispenser to keep my drugs straight.” c. “Now that my heart failure is cured I can cut back the drugs I take.” d. “If I gain more than 3 lb in a week I will call my doctor.” ANS: C

Heart failure can be improved with drug therapy but the underlying condition remains. When heart failure is a result of damage, it is not cured. Drug dosage needs may change to control heart failure, but usually the dNoU saRgS esIoNnG lyKinIcNreGa. seCaO sM time goes on. DIF: Cognitive Level: Applying or Higher

REF: p. 277

20. A patient asks you how a prescribed diuretic can help heart failure. What is your best

response? a. “Urinating more prevents heart failure from damaging your kidneys.” b. “Diuretics reduce blood pressure so your heart won’t have to work as hard.” c. “Taking a diuretic reduces salt levels so you don’t have to limit your intake of salty foods.” d. “The diuretic counteracts the side effects of the other drugs prescribed for your heart failure.” ANS: B

The actions of diuretic drugs help heart failure in several ways. They can relax blood vessels and lower blood pressure so that less effort is needed for the heart contraction to move blood into the general circulation. Removing extra fluid from the circulation also can reduce blood pressure. In addition, some diuretics work on the heart muscle itself. DIF: Cognitive Level: Applying or Higher

REF: p. 278

21. A patient with heart failure asks you why the antihypertensive drug enalapril (Vasotec) has

been prescribed. What is your best response? a. “Hypertension is the most common cause of heart failure.”

b. “Lowering your blood pressure will allow your heart to pump more easily.” c. “This drug will decrease the amount of blood your heart has to pump, leading to

less work for your heart.” d. “Enalapril will cause your heart to reestablish its normal electrical functions so that

it works more effectively as a pump.” ANS: B

Decreasing blood pressure helps improve the heart’s action as a pump and decreases the heart’s workload. Diuretics are used to decrease blood volume. Enalopril is an angiotensin-converting enzyme (ACE) inhibitor that interferes with the transition of angiotensin I to angiotensin II. Angiotensin II is a potent vasoconstrictor that causes increased blood pressure and increased workload for the heart. DIF: Cognitive Level: Applying or Higher

REF: p. 279

22. A patient taking lisinopril (Zestril) for heart failure reports a nagging, nonproductive cough.

What is your best first action? a. Ask the patient whether he or she has received the annual influenza vaccination. b. Ask the patient how much the cough is interfering with sleep or other activities. c. Document the report as the only action. d. Notify the prescriber immediately. ANS: B

Many conditions can cause a cough, but a dry, nonproductive cough is the most common side effect of lisinopril and all other ACE inhibitors. Coughs associated with pulmonary infections or worsening of heart failure are usually productive. After assessing the patient’s issues with the cough, if the patient is uncomfortable or if the cough interferes with sleeping and other NU activities, report these problem sR toSthIeNpG reKscIrN ibG er. . COM DIF: Cognitive Level: Applying or Higher

REF: p. 278

23. After giving the first dose of any antihypertensive drug for heart failure, what action must be

taken for a hospitalized patient’s safety? a. Recheck the drug order for accuracy. b. Ensure that the call light is within reach. c. Place a wheelchair in the patient’s room. d. Raise all four side rails on the patient’s bed. ANS: B

Antihypertensive drugs decrease blood pressure and increase a patient’s risk for dizziness, light-headedness, and hypotension. After giving the first dose of any antihypertensive drug, you should be sure that the call light is within easy reach and instruct the patient to call for assistance when getting out of bed. A wheelchair is not necessary and standards of practice state that all four side rails should not be raised because there is a risk for falls if the patient tries to get out of bed alone. DIF: Cognitive Level: Applying or Higher

REF: p. 278

24. Which safety precaution should be taught to a patient going home on any antihypertensive

drug for heart failure? a. Always change positions slowly.

b. Never get up without assistance. c. Take the drug in the evening before bedtime. d. Avoid all over-the-counter drugs while taking this drug. ANS: A

Antihypertensive drugs lower blood pressure, placing the patient at increased risk for dizziness and hypotension. Changing positions slowly gives the body time to adjust, preventing dizziness and falls. The patient can get up at home without assistance if he or she changes positions slowly. Some, but not all, over-the-counter drugs may not be safe with these drugs. You should teach the patient to always consult with the prescriber before taking an over-the-counter drug. DIF: Cognitive Level: Applying or Higher

REF: p. 278

25. A patient with heart failure reports a 5 lb weight gain during the past week and episodes of

feeling more short of breath. What is your best response? a. “These changes are to be expected because you have heart failure.” b. “You will probably need a decreased dose of your diuretic drug.” c. “I will ask the dietitian to discuss a weight loss diet with you.” d. “Your prescriber must be notified because your heart failure is getting worse.” ANS: D

Patient weight gain and increased shortness of breath are signs of worsening heart failure. The prescriber should be notified because the plan of care may need to be modified. If the patient is taking a diuretic, it is likely that the dose may be increased. DIF: Cognitive Level: Applying or Higher

NURSINGKING.COM

REF: p. 277

26. A patient with heart failure is prescribed oral captopril (Capoten) and carvedilol (Coreg). The

heart rate after giving these drugs is decreased from 84 per minute to 68 per minute. What is your best action? a. Hold the next dose. b. Immediately notify the prescriber. c. Document the finding as the only action. d. Schedule the captopril and carvedilol to be given at different times. ANS: C

Beta blockers and ACE inhibitors are often used together to treat heart failure. Beta blockers block the effects of epinephrine on the heart resulting in deceased heart rate and force of contraction, thus decreased blood pressure. You should notify the prescriber if the heart rate is less than 60 per minute. DIF: Cognitive Level: Applying or Higher

REF: p. 279

27. A patient with heart failure is prescribed metoprolol (Toprol XL) 25 mg daily. The pharmacy

sends metoprolol (Lopressor) 25 mg. What is your best action? a. Give the dose as provided because the drugs are the same. b. Ask the pharmacy to send the drug as ordered. c. Contact the prescriber for clarification. d. Check the patient’s heart rate before giving the dose. ANS: B

When prescribed to treat heart failure, only the sustained-release form of metoprolol is used. Metoprolol (Toprol XL) is the sustained-release form of the drug, whereas metoprolol (Lopressor) is not. DIF: Cognitive Level: Applying or Higher

REF: p. 279

28. Which precaution should you stress when teaching a patient about a prescribed nitroglycerin

transdermal patch? a. “If a patch comes loose, tape it tightly to the skin with several layers of tape.” b. “Do not remove old patches, just let them fall off over time.” c. “Take care to apply the patches directly over your heart.” d. “Remove the old patch before applying the new patch.” ANS: D

The previous patch must be removed (and the area wiped clean of drug) before applying a new patch (to a different site) to prevent leftover drug from contributing to a drug overdose. Applying the patch directly over the heart does not increase the speed of drug action on the heart. DIF: Cognitive Level: Applying or Higher

REF: p. 280

29. A patient with severe heart failure is discharged with a prescription for nitroglycerin ointment.

What technique do you teach the patient’s spouse to use to avoid experiencing side effects when applying this drug? a. Squeeze the ointment onto the special paper. b. Cleanse the skin before applying the drug. c. Rotate the drug application skin sites. d. Wear a pair of disposableNURSINGKING.COM gloves. ANS: D

Common side effects of nitroglycerin ointment include hypotension and headaches. When this drug is administered, if a person’s skin comes into contact with the drug as it is squeezed onto the special lined paper, these side effects may develop. Wearing gloves prevents skin contact with the drug and decreases the risk for side effects. DIF: Cognitive Level: Applying or Higher

REF: p. 280

30. Which statement by a patient receiving nitroglycerin ointment indicates the need for

additional teaching? a. “I will remove the previous dose before I put on the new dose.” b. “I will reapply the dose every 4 hours around the clock.” c. “I must avoid rubbing my skin when I put on a new dose.” d. “I will put tape over the paper so that the dose stays in place.” ANS: B

Nitroglycerin ointment or patches lose their effectiveness when used continuously. The drug works much better when there is a “drug free” time during a 24-hour period. Usually the drug is removed at night when the patient has his or her longest sleeping period because the heart is less stressed during that time. DIF: Cognitive Level: Applying or Higher

REF: p. 280

31. For which drug order would you contact the prescriber to verify it is correct? a. Furosemide (Lasix) 40 mg orally each day b. Fosinopril (Monopril) 20 mg orally each day c. Digoxin (Lanoxin) 2.5 mg orally each day d. Amiloride (Midamor) 5 mg orally each day ANS: C

The usual dosage of digoxin is 0.125 to 0.25 mg/day. The order is for 10 to 20 times the normal dose. If this dose is given the results would be adverse effects of even death. The other drug dosages are within the correct ranges. DIF: Cognitive Level: Applying or Higher

REF: p. 282

32. A patient is prescribed isosorbide (Isordil). Which condition will you teach the patient is an

expected side effect of this drug? a. Frequent headaches b. Cold hands and feet c. Change in urine color d. Distaste for sweet foods or drinks ANS: A

Isosorbide dilates blood vessels to allow better blood flow to the heart muscle. However, blood vessels are dilated in many body areas. When blood vessels in the brain or head are dilated, headaches can occur. DIF: Cognitive Level: Applying (Application) or Higher

REF: p. 280

e UsaRfeSlI yN prG esKcI ribNeGd.foCrOaMpatient with heart failure during 33. Which vasodilator drug can bN pregnancy? a. Hydralazine (Apresoline) b. Isosorbide (Isordil) c. Minoxidil (Lonitin) d. Nitroglycerin (Nitrostat) ANS: A

Hydralazine can be safely used for blood pressure control during pregnancy, but isosorbide and nitroglycerin may affect fetal circulation and should be used with caution during pregnancy. Minoxidil is a vasodilator that is not generally used in the treatment of heart failure. DIF: Cognitive Level: Understanding

REF: p. 281

34. A patient asks you how prescribed digoxin (Lanoxin) will help improve heart failure. What is

your best response? a. “It dilates your arteries and decreases your blood pressure.” b. “It directly perfuses your kidneys which decreases your fluid volume and blood pressure.” c. “It increases your heart rate which will result in improved cardiac output.” d. “It increases the force of heart contractions and slows down the heart rate to improve cardiac output.” ANS: D

Digoxin is a cardiac glycoside drug that works on the muscle fiber of the heart to crease the force of each contraction. It also slows down the heart rate. These actions help to improve cardiac output. DIF: Cognitive Level: Applying (Application) or Higher

REF: p. 281

35. A patient with heart failure is prescribed digoxin (Lanoxin). The patient reports nausea, blurry

vision, and feeling like the heart is skipping beats. What is your best action? a. Administer the scheduled dose because it will correct these heart failure symptoms. b. Assess the patient’s heart rate and then administer the scheduled dose. c. Hold the dose and notify the prescriber immediately. d. Place the patient on complete bed rest. ANS: C

Nausea, blurry vision, and heart rate or rhythm changes are signs of digoxin overdose. The dose should be held and the prescriber notified. Most likely you will also be asked to obtain a blood sample to measure the digoxin level. Digoxin has a very narrow therapeutic range (0.8 to 2 ng/mL) and this level should be checked whenever a patient shows any signs of toxicity. Symptoms usually resolve when the drug is held and the body eliminates it. DIF: Cognitive Level: Applying (Application) or Higher

REF: p. 283

36. A patient taking digoxin (Lanoxin) has all of the following laboratory blood values. Which

value do you report to the prescriber before administering the next dose of digoxin? a. Sodium 133 mEq/L b. Potassium 2.8 mEq/L NURSINGKING.COM c. Blood urea nitrogen 9 mg/dL d. White blood cell count 11,000 cells/mm3 ANS: B

Serum potassium level affects the activity of digoxin. A value of 2.8 is low (hypokalemia). Any abnormal potassium value (high or low) requires the prescriber to change the digoxin dosage. In addition, action is needed to bring this critical electrolyte value back to its normal range. Although the other laboratory values are slightly abnormal, none are critically abnormal or likely to have an effect on digoxin activity. DIF: Cognitive Level: Applying (Application) or Higher

REF: p. 283

37. What is the most important action for you to teach a patient to perform before taking his or

her daily dose of digoxin (Lanoxin)? a. Check the pulse for a full 60 seconds. b. Look for edema in your ankles. c. Notify the prescriber for any heart palpitations. d. Take the drug at exactly the same time every day. ANS: A

Although all the actions are important, the most important is to ensure that the pulse rate is between 60 and 100 beats/min and is regular before administering digoxin or any other cardiac glycoside. For an irregular heart rate or one that is outside of this range, the dose must be held and the prescriber notified immediately.

DIF: Cognitive Level: Applying (Application) or Higher

REF: p. 283

38. A patient with heart failure asks why two diuretic drugs, furosemide (Lasix) and

spironolactone (Aldactone), have been prescribed. What is your best response? a. “Your prescriber wants you to lose fluids and that’s why you are taking two diuretics.” b. “Each of these diuretics works in a different way to decrease workload on your heart.” c. “Using two diuretics will double the amount of fluid you lose to decrease the work your heart must do.” d. “Let me contact your prescriber because patients usually do not take two diuretics at the same time.” ANS: B

Spironolactone, when used in low doses, blocks the action of aldosterone, which causes the body to lose salt and water. Furosemide works in the loop of Henle to decrease reabsorption of salt and water. Spironolactone is usually prescribed with another diuretic to decrease the volume of fluid in the blood vessels, which reduces the workload of the heart. Additionally when used together, these drugs help the body maintain a more normal blood potassium level. DIF: Cognitive Level: Applying (Application) or Higher

REF: pp. 283-284

39. A patient with heart failure is prescribed a one-time dose of furosemide (Lasix) 400 mg by

intravenous (IV) push immediately. What is the best action? a. Contact the prescriber and request that the dose be changed from IV push to IV piggyback. NURSINGKING.COM b. Give the dose by IV push over a 10-minute period of time. c. Hold the dose and notify the prescriber immediately. d. Start an IV and administer the drug as prescribed. ANS: C

The usual IV dose of furosemide ranges between 10 and 80 mg. A dose of 400 mg is very large. You must verify the correct drug dose before administering it. DIF: Cognitive Level: Applying (Application) or Higher

REF: p. 272

40. A patient receiving dobutamine (Dobutrex) at 180 mcg/min is having all of the following

physiologic responses. Which response indicates that the drip rate may be too high? a. Systolic blood pressure increase from 106 to 122 mm Hg b. Hourly urine output of 100 mL c. Facial flushing d. Chest pain ANS: D

Dobutamine is a positive inotropic drug. Side effects include improved urine output and increased blood pressure. Facial flushing is common but not serious. Chest pain indicates the heart is working too hard, which may be related to the dosage level. You should slow the drip rate and immediately notify the prescriber. DIF: Cognitive Level: Applying (Application) or Higher

REF: p. 286

41. A patient with heart failure is receiving dobutamine (Dobutrex) intravenously at home. Which

sign or symptom should the patient and family be instructed to report to the prescriber immediately? a. Burning or pain at the intravenous (IV) site b. Heart rate between 60 and 70 beats/min c. Urine output of 1600 mL over 24 hours d. Brief episode of shortness of breath ANS: A

Patients receiving dobutamine at home should be taught the signs and symptoms of IV lines that are no longer patent or have developed infection (e.g., burning, pain, redness, swelling, warmth at the site). Patients should be instructed to report these signs immediately to the prescriber or home health nurse. DIF: Cognitive Level: Applying (Application) or Higher

REF: p. 286

42. What should you teach a patient who has been prescribed potassium (K-Dur) tablets? a. “If you miss a dose, double your next dose to keep your blood level of potassium

normal.” b. “Take your potassium with food or a full glass or water to avoid nausea/vomiting.” c. “Be sure to use salt substitutes instead of salt so that your body will not retain

water.” d. “Eat lots of foods that are high in potassium such as bananas, spinach, broccoli,

and sweet potatoes.” ANS: B

Common side effects of potassium include nausea, vomiting, diarrhea, gas, and abdominal NiUthRfSooIdNoGr KriI discomfort. Taking the drug w ghNt G af.teCr O mMeals with a full glass of water or fruit juice will decrease or prevent these side effects. A patient should never take a double dose of a prescribed drug. Most salt substitutes are made by replacing sodium with potassium. Use of salt substitutes or eating excessive amounts of foods that are high in potassium while taking a potassium supplement increases the risk of hyperkalemia (high blood potassium). DIF: Cognitive Level: Applying (Application) or Higher

REF: p. 288

43. A patient is receiving magnesium by intravenous infusion. Which finding indicates that the

patient’s blood magnesium level may be too high? a. Respirations are 10 per minute and shallow. b. Heart rate is 66 beats/min and regular. c. The patient reports difficulty staying asleep. d. Episodes of diarrhea. ANS: A

High blood levels of magnesium interfere with muscle contraction, causing muscle weakness. Breathing is dependent on good contraction of respiratory muscles. Shallow and slow respirations are a serious manifestation of excess blood magnesium levels. DIF: Cognitive Level: Applying (Application) or Higher

REF: p. 288

44. A patient is prescribed inamrinone (Inocor) by continuous intravenous infusion. When you

make rounds and assess the patient, the intravenous bag infusing is labeled (Primacor). What should you do? a. Stop the infusion and notify the prescriber. b. Assess the infusion site for a blood return. c. Document the infusion and site conditions as the only action. d. Slow the infusion rate because Primacor is more potent than Inocor. ANS: A

The two drugs, Inocor and Primacor, are not the same, although both are positive inotropes. Their dosages and infusion rates are very different. The pharmacy has sent up the wrong drug or has labeled the infusion bag incorrectly. Either way, you must stop the existing infusion and clarify all of this with the prescriber first and then the pharmacy. DIF: Cognitive Level: Applying or Higher

REF: p. 285

45. What is the most important reason intravenous potassium is considered a high alert drug? a. When intravenous potassium is administered at too low a dose its mechanism of

action is greatly reduced. b. Intravenous potassium is a highly irritating solution and can cause significant pain

or burning at the infusion site. c. Administering too much intravenous potassium or administering it too quickly

may cause life-threatening problems. d. Excessive blood potassium levels can lead to nausea, vomiting, severe diarrhea,

abdominal cramping, and other intestinal problems. ANS: C

Blood potassium levels have N aU veRrySI naNrrGoK wIraNnG ge.oCfOnM ormal. When intravenous potassium is administered at too high a dose or too rapidly, life-threatening cardiac rhythm problems develop and death is possible. Always check an intravenous potassium dose with another health care professional and never administer it either by intravenous push or as a bolus. DIF: Cognitive Level: Applying or Higher

REF: p. 287

MULTIPLE RESPONSE ADVANCED CONCEPTS 1. Which are sympathetic nervous system compensatory mechanisms of the body for heart

failure? (select all that apply) a. Increased heart rate b. Decreased respiratory rate c. Increased contractility d. Decreased body temperature e. Increased cardiac output f. Decreased cardiac output ANS: A, C, E

The sympathetic nervous system releases the catecholamine hormones epinephrine and norepinephrine, which act on the heart in two ways. First they increase the heart rate, and second they increase the power of the heart muscle fibers to contract so that the heart pumps more forcefully. These actions increase cardiac output. DIF: Cognitive Level: Understanding

REF: p. 277

2. Which lifestyle changes should you suggest to a patient with heart failure? (select all that

apply) a. Fluid restriction of 1000 mL/day b. Weight loss program c. Smoking cessation program d. Aerobic exercise program e. Low-salt, low-fat diet ANS: B, C, E

Lifestyle changes that are important in treating heart failure include weight loss, smoking cessation, and a low-salt and low-fat diet. A fluid restriction of 1000 mL can result in decreased perfusion of the kidneys. Patients with heart failure may not be able to tolerate an aerobic exercise program. DIF: Cognitive Level: Applying or Higher

REF: p. 277

3. A patient has been prescribed sublingual nitroglycerin. Which key points will you teach the

patient about this drug? (select all that apply) a. Keep the tablet in place until it is dissolved. b. Swallow the tablet with a full glass of water. NURSINGKING.COM c. A tingling sensation means that the drug is potent. d. Do not eat anything until after the tablet is dissolved. e. Call your prescriber if chest pain persists after one tablet. ANS: A, C, D, E

Sublingual or buccal nitroglycerin should not be swallowed because the liver destroys most of the drug and makes it ineffective. The drug should be kept in place until it dissolved. Patients should not drink or eat until the tablet is dissolved. A tingling sensation as the tablet dissolves indicates that the drug is potent and any time a patient’s chest pain persists after using one tablet, the prescriber should be notified. DIF: Cognitive Level: Applying or Higher

REF: p. 281

4. A patient is to receive nesiritide (Natrecor). Which patient assessments must be checked

before giving this drug? (select all that apply) a. Heart rate b. Swallowing reflex c. IV line for patency d. Oral intake e. Respiratory rate factors ANS: A, C, E

Nesiritide is given by the IV route, so you should always ensure that the IV line is patent. Heart and respiratory rate should always be assessed before giving this drug. The heart rate should be between 60 and 100 beats/min and the respiratory rate should be between 12 and 20 breaths/min. DIF: Cognitive Level: Applying or Higher

REF: p. 284

COMPLETION ADVANCED CONCEPTS 1. A patient is prescribed digoxin (Lanoxin) 0.03 mg as a liquid dose. The drug on hand is

digoxin 0.05 mg/mL. How many milliliters do you give? ANS:

0.6 Want 0.03 mg, Have 0.05 mg/1 mL. Cancel mg; 0.05X = 0.03; X = 0.6. 0.6  1 mL = 0.6 mL. DIF: Cognitive Level: Applying or Higher

REF: p. 282

2. The patient is prescribed potassium (K-Dur) tablets 30 mg orally each morning. You have

potassium (K-Dur) in 10 mg tablets. How many tablets will you give for each dose? ANS:

NURSINGKING.COM

3 Want 30 mg, Have 10 mg/tablet. 30 mg/X tablets : 10 mg/1 tablet. Cancel mg; 30/10 = 3 tablets. DIF: Cognitive Level: Applying or Higher

REF: p. 287

3. A patient who weighs 259 lb is prescribed to receive nesiritide (Natrecor) 2 mcg/kg as an

intravenous bolus. The drug available is 1.5 mg/5 mL. How many milliliters of the drug will you prepare to make the correct dose? ANS:

0.8 1 kg = 2.2 lb. The patient’s weight in kilogram is 117.72 kg (259/2.2). The correct dose is 2 mcg  117.72 kg, 235.4 mcg. 1 mL of the drug = 0.3 mg (divide 1.5 mg by 5 to get the concentration per mL) or 300 mcg/mL (1 mg = 1000 mcg). Divide 235.4 mcg by 300 mcg for the correct volume to prepare, which is 0.78 mL, round up to 0.8 mL. DIF: Cognitive Level: Applying or Higher

REF: p. 284

Chapter 31- Drug Therapy for Nasal Congestion and Cough 1. A patient presents at the clinic with sneezing and coughing. He is diagnosed with the common cold. Which type of microorganism causes the common cold? A) Gram-positive bacteria B) Gram-negative bacteria C) Virus D) Fungus 2. You are the school nurse educating a group of parents on the prevention of the common cold among their children. Which of the following preventive measures is most important to teach the parents? A) Frequent handwashing B) Maintaining vaccinations C) Taking 1200 mg of vitamin C D) Taking Echinacea daily 3. A 3-year-old child is seen in the pediatric office for a dry, hacking cough. The mother is requesting a prescription for dextromethorphan. In providing patient education, which of the following provides the most effective teaching regarding the use of dextromethorphan in children? A) Dextromethorphan suppresses cough in children. B) Dextromethorphan is ineffective in children. C) Dextromethorphan must be combined with codeine. D) Dextromethorphan raises blood pressure in children. 4. A patient is using oxymetazoline (Afrin) to relieve nasal congestion. Which of the following conditions would contraindicate the use of this drug? A) Nasal congestion B) Cough C) Hypertension D) Skin rash 5. A patient is admitted to the emergency room after consuming 50 acetaminophen tablets in a suicide attempt. What medication will be administered to counteract the effect of the acetaminophen? A) Oxymetazoline hydrochloride (Afrin) B) Acetylcysteine (Mucomyst) C) Daptomycin (Cubicin) D) Darbepoetin alfa (Aranesp)

6. A patient is taking a nasal decongestant. Which of the following medications may dangerously increase the effects of nasal decongestants?

A) B) C) D)

Anti-infective agents Anti-inflammatory agents Proton pump inhibitors Thyroid preparations

7. A patient is prescribed an antitussive agent with codeine. Which of the following statements by the patient indicates that the nurse's teaching has been effective? A) “I will take this medication whenever I am coughing.” B) “This medication may make me anxious and nervous.” C) “I will call my physician if I develop diarrhea when I take it.” D) “This medication will cause drowsiness, and I will not drive.” 8. A patient has hypertension and wants to take a nasal decongestant for cold symptoms. Which of the following statements by the nurse best describes the effect of decongestants on blood pressure? A) “The administration of a nasal decongestant will increase blood pressure due to vasoconstriction of blood vessels.” B) “The administration of a nasal decongestant will cause bradycardia and increase peripheral blood pressure.” C) “The administration of a nasal decongestant will decrease the thyroid production and increase blood pressure.” D) “The administration of nasal decongestant will act on the central nervous system to cause vasodilation of blood vessels.” 9. A patient has expressed frustration at the fact that he has been taking Sudafed for several days and “it still hasn't really cured my cold.” What teaching point should the nurse convey to the patient? A) “Drugs like this can often relieve some of the symptoms of a cold, but they won't cure it.” B) “Most people find that cold medications are essentially ineffective.” C) “It usually takes between 6 and 8 days for Sudafed to cure your cold.” D) “Sudafed can sometimes mask the effects of your cold, essentially prolonging it.” 10. An elderly patient has presented to the clinic for a scheduled visit and states that he has been taking a combination antitussive/decongestant/expectorant for several weeks in order to prevent the common cold. The nurse should cite which of the following effects of long-term use of OTC cold remedies? Select all that apply. A) Chronic epistaxis B) Anticholinergic effects C) Chronic congestion D) Damage to the nasal mucosa E) Hepatotoxicity

11. An adult patient has asked the nurse to recommend an OTC cold remedy because she is unsure which of the many options available is most appropriate. Before making a recommendation, the nurse should do which of the following? A) Consult with a pharmacist or pharmacy technician. B) Assess the patient's understanding of the epidemiology of the common cold and upper respiratory infections. C) Assess the patient for health problems that may contraindicate the use of a particular remedy. D) Ensure that the patient has tried some of the more common herbal and natural remedies. 12. A community health nurse is cautious when recommending the use of OTC cold remedies to patients. The use of pseudoephedrine would most likely be contraindicated in which of the following patients? A) A woman who is breast-feeding B) A man with a history of angina and hypertension C) A man who has diagnoses of chronic obstructive pulmonary disease and diabetes D) A woman who has myasthenia gravis 13. A 30-year-old woman with two preschoolers has sought the nurse's advice because she has heard conflicting reports about the safety and efficacy of cough and cold products in young children. The nurse should inform the woman that A) cough and cold remedies are generally safe and effective for children over the age of 2. B) there are concerns among health professionals about how safe and effective these medications are. C) media reports about the risks of cough and cold medications in children have greatly exaggerated the risks. D) it is imperative to use age-specific preparations of cough and cold remedies. 14. A 55-year-old male patient has been living with type 1 diabetes for many years and has begun to experience diabetic nephropathy over the past year. How will this patient's current health status influence the possible use of pseudoephedrine in the treatment of cold symptoms? A) The patient should monitor his blood glucose levels more frequently when taking pseudoephedrine. B) The use of pseudoephedrine is absolutely contraindicated by the fact that the patient has diabetes and takes insulin. C) The patient may require a higher-than-average dose of pseudoephedrine because of excess fluid volume secondary to renal failure. D) The patient should use caution and will likely require a lower dose of pseudoephedrine because of his impaired renal function.

15. A patient has asked the nurse if it would be appropriate to use dextromethorphan to treat her cough. What type of cough is best suited to treatment with dextromethorphan? A) An occasional, productive cough B) A cough that is nearly continuous and that is accompanied by copious secretions C) A cough that occurs when the patient is exposed to airborne irritants D) A dry, nonproductive cough 16. A 17-year-old boy has been brought to the emergency department by his mother who is distraught by the fact that she caught him and his friend “guzzling cough syrup.” What assessment finding is suggestive of an overdose of dextromethorphan? A) Hallucinations B) Dysrhythmias C) Kussmaul's respirations D) Profound diaphoresis 17. A patient with a persistent and debilitating cough is confused that his physician has prescribed codeine. He tells the nurse, “I was sure that codeine was a narcotic that people take for pain.” The nurse should cite what mechanism of action when describing this use of codeine? A) Depression of the cough center in the medulla oblongata B) Vasodilation of the alveolar capillaries C) Stimulation of the reticular activating system (RAS) D) Desensitization of the cough receptors in the sinuses and trachea 18. A nurse has taught an adult patient about the fact that guaifenesin is not necessarily an effective way of liquefying secretions. To help liquefy the patient's secretions, the nurse should encourage which of the following measures? A) Reducing salt intake B) Deep breathing and exercises C) Gargling with normal saline D) Increasing fluid intake 19. A critically ill patient with a diagnosis of ventilator-associated pneumonia has been administered acetylcysteine by inhalation. The critical care nurse knows that this medication helps to liquefy secretions in the respiratory tract by A) increasing the osmolality of mucus. B) decreasing the osmolality of mucus C) breaking the protein bonds that exist in mucus. D) drawing increased amounts of water from interstitial spaces into mucus.

20. A patient has purchased an OTC cold remedy that advertises a “nondrowsy” formulation. The nurse should recognize that this produce likely contains which of the following?

A) B) C) D)

A nasal decongestant but not an antihistamine An expectorant, a mucolytic, and a benzodiazepine An expectorant but not a decongestant A narcotic analgesic and a decongestant

1. Ans: C Feedback: The common cold, a viral infection of the upper respiratory tract, is the most common respiratory tract infection. The common cold is not caused by gram-negative or grampositive bacteria. Fungal infections are not the cause of the common cold.

2. Ans: A Feedback: Because of the way cold viruses are spread, frequent and thorough hand hygiene is the most important protective and preventive measure. There is vaccine against the common cold. The ingestion of vitamin C and Echinacea is not the most effective preventive measure for the common cold.

3. Ans: B Feedback: Although antitussives continue to be used and adults report beneficial effect in reducing cough, antitussives, particularly dextromethorphan, have not been demonstrated to be effective in children and adolescents. Adverse effects of dextromethorphan in children include behavioral disturbances and respiratory depression, not high blood pressure.

4. Ans: C Feedback: Oxymetazoline is contraindicated in patients with severe hypertension or coronary artery disease because of its cardiac stimulating and vasoconstricting effects. Oxymetazoline is prescribed for nasal congestion. Oxymetazoline is not contraindicated in cough or skin rash.

5. Ans: B Feedback: Acetylcysteine is effective in the treatment of acetaminophen overdose. Oxymetazoline hydrochloride is used for nasal congestion, not acetaminophen overdose. Daptomycin and darbepoetin alfa are not used for acetaminophen overdose.

6. Ans: D Feedback: The administration of thyroid preparations should be done cautiously with nasal decongestants due to their increased effects. PPIs, anti-infectives, and antiinflammatories do not have this effect.

7. Ans: D Feedback: Antitussive agents suppress cough by depressing the cough center in the medulla oblongata or the cough receptors in the throat, trachea, or lungs. Since they are combined with codeine, they will also depress the CNS and induce drowsiness. The medication should not be given every time the patient coughs. The medication will not cause anxiety and nervousness. The medication will cause constipation, not diarrhea.

8. Ans: A Feedback: “The administration of nasal decongestants will increase blood pressure due to vasoconstriction of blood vessels” is indicative of good patient teaching. Nasal decongestants do not cause bradycardia to increase blood pressure. The administration of nasal decongestants will not decrease thyroid production and increase blood pressure. The administration of a nasal decongestant does not act on the central nervous system.

9. Ans: A Feedback: Patients should be made aware that cold medications do not cure the common cold; they only relieve some symptoms. Such medications do not inhibit healing by masking symptoms.

10. Ans: C, D Feedback: Over-the-counter (OTC) cold remedies should not be used longer than 1 week. Do not use nose drops or sprays more often or longer than recommended. Excessive or prolonged use may damage nasal mucosa and produce chronic nasal congestion. These drugs are not associated with chronic epistaxis, anticholinergic effects, or hepatotoxicity.

11. Ans: C Feedback: Before recommending a particular product, the nurse needs to assess the intended recipient for conditions or other medications that contraindicate the product's use. Herbal options do not need to precede pharmaceuticals, and the nurse does not necessarily need to consult with a pharmacist or pharmacy technician. The patient's understanding of the epidemiology of the common cold is not a high priority.

12. Ans: B Feedback: Contraindications to pseudoephedrine use include severe hypertension or coronary artery disease because of the drug's cardiac stimulating and vasoconstricting effects. Breast-feeding does not necessarily contraindicate the use of pseudoephedrine, though caution would be warranted. The other listed medical diagnoses do not contraindicate the use of pseudoephedrine. 13. Ans: B Feedback: Certain organizations have expressed caution about the use of pseudoephedrine in young children. The use of age-specific preparations does not guarantee safety or effectiveness.

14. Ans: D Feedback: Because pseudoephedrine is excreted primarily via the kidneys, caution in patients with renal impairment is important. It may be necessary to reduce the dosage to avoid potential drug accumulation and drug toxicity. The presence of diabetes warrants caution, but it is not an absolute contraindication.

15. Ans: D Feedback: The major clinical indication for use of dextromethorphan is a dry, hacking, nonproductive cough that interferes with rest and sleep. It is not desirable to suppress a productive cough because the secretions need to be removed.

16. Ans: A Feedback: The nurse observes for excessive suppression of the cough reflex (inability to cough effectively when secretions are present) or hallucinations with dosages that exceed recommendations of dextromethorphan. Kussmaul's respirations, dysrhythmias, and diaphoresis are not characteristic adverse effects.

17. Ans: A Feedback: Antitussives such as codeine suppress cough by depressing the cough center in the medulla oblongata. They do not influence blood flow or desensitize peripheral cough receptors. The RAS is not involved in the cough reflex.

18. Ans: D Feedback: Drinking plenty of water while taking guaifenesin may help loosen mucus in the lungs. Deep breathing, gargling with normal saline, and reducing salt intake do not necessarily help liquefy and mobilize secretions. 19. Ans: C Feedback: Mucolytics such as acetylcysteine are drugs that liquefy mucus in the respiratory tract by attacking the protein bonds of the mucus.

20. Ans: A Feedback: “Nondrowsy” or “daytime” cold formulas typically contain a nasal decongestant but not an antihistamine. Such medications would not contain an opioid or a benzodiazepine.

Chapter 32- Drug Therapy to Decrease Histamine Effects and Allergic Response 1. A patient is stung by a bee. What is the chemical mediator released in immune and inflammatory response to the bee sting? A) Norepinephrine B) Mast cells C) Epinephrine D) Histamine 2. A patient is experiencing allergy symptoms after being exposed to environmental dust. This reaction involves the action of histamine, which is released by what cells? A) Lymphocytes B) CD4 T cells C) Basophils D) Platelets 3. A patient is being administered epinephrine for the treatment of anaphylaxis. This patient is experiencing what type of hypersensitivity reaction? A) Type I B) Type II C) Type III D) Type IV 4. An elderly patient is given diphenhydramine (Benadryl) for allergic response to mold. The nurse should consequently assess the patient for A) anticholinergic effects. B) dysrhythmias. C) increased muscle tone. D) respiratory depression. 5. A second-generation H1 receptor antagonist antihistamine formulated as a nasal spray for topical use is A) chlorpheniramine (Chlor-Trimeton). B) clemastine (Tavist). C) cyproheptadine (Periactin). D) azelastine (Astelin). 6. A patient is instructed to take diphenhydramine (Benadryl) after an allergic reaction. Which of the following statements by the patient indicates successful teaching concerning the safe and effective use of diphenhydramine? A) “I will still be able to have my after-dinner drink with this medication.” B) “I will eat a diet low in sodium while taking this medication.” C) “I should not drive my car after taking this medication.” D) “I can take this medication every 2 hours until I feel better.”

7. A patient is having an allergic reaction to mold. The patient describes chest tightness and difficulty breathing. Which of the following body effects is occurring? A) Contraction of smooth muscle in the bronchi B) Suppression of the vagus nerve endings producing tachycardia C) Decreased permeability of the veins and capillaries D) Decreased secretion of the mucous glands 8. A patient is diagnosed with allergic rhinitis. What type of hypersensitivity reaction is causing allergic rhinitis? A) Type I B) Type II C) Type III D) Type IV 9. A patient has been suffering from repeated sinus infections and is diagnosed with allergic rhinitis. The patient is prescribed a first-generation H1 receptor antagonist. What is one of the effects of this medication? A) It depletes norepinephrine and serotonin. B) It decreases capillary permeability. C) It catalyzes the enzymatic oxidation of uric acid. D) It raises the seizure threshold by impairing vitamin D. 10. A patient has been taking cephalexin (Keflex) for an upper respiratory infection. On the seventh day of treatment, the patient develops myalgia and fever. What reaction is the patient likely having? A) The patient has developed a new infection. B) The patient has developed an autoimmune disease. C) The patient has become septic. D) The patient has serum sickness. 11. A patient is scheduled to receive one unit of packed red blood cells. The patient states that she has had an allergic reaction to a transfusion in the past. What class of medication will assist in preventing a reaction to the packed red blood cell transfusion? A) Antipyretics B) Antimicrobials C) Antianginals D) Antihistamines 12. A hospital patient is complaining of nausea and vomiting that has failed to respond to first-line antiemetics. Which of the following medications may be administered for the treatment of nausea and vomiting? A) First-generation antihistamine agent: chlorpheniramine (Chlor-Trimeton) B) First-generation antihistamine agent: hydroxyzine (Vistaril) C) Second-generation antihistamine agent: loratadine (Claritin)

Second-generation antihistamine agent: cetirizine (Zyrtec)

13. A patient who suffers from allergies to grass and mold is getting ready to cut grass. Prior to cutting grass, he takes cetirizine (Zyrtec). When will the patient expect the medication to reach maximum effects? A) 1 hour B) 2 to 3 hours C) 8 to 12 hours D) 12 to 24 hours 14. A child is experiencing severe flu-like symptoms with nausea and vomiting and is admitted to the hospital. Which disorder in children will contraindicate the administration of promethazine? A) Chickenpox B) Endocarditis C) Reye's syndrome D) Hypertensive crisis 15. Antihistamines are used to treat nasal congestion. Which of the following patients should not be administered an antihistamine? A) A male patient with Parkinson's disease B) A female patient with asthma C) A male patient with diabetes mellitus D) A male patient with prostatic hypertrophy 16. An unlicensed care provider administered Benadryl to an elderly resident who has been suffering from seasonal pollen allergies. Which of the following assessment findings should prompt the nurse at the facility to suspect that the resident is experiencing anticholinergic effects of this drug? A) Blurry vision B) Tinnitus C) Wheezing on expiration D) Urticaria 17. An adult patient has questioned whether fexofenadine (Allegra) would be preferable to the first-generation H1 receptor antagonists that he has long taken in the treatment of his environmental allergies. When describing the benefits of second-generation drugs such as Allegra, the nurse should cite what advantage? A) Lower cost B) Decreased sedation C) Absence of adverse effects D) Once-weekly dosing

18. A gerontological nurse has encouraged a group of caregivers who work with older adults to avoid administering first-generation H1 receptor antagonists to these patients. The nurse's cautionary message is an acknowledgment of what possible nursing diagnosis? A) Risk for infection related to adverse effects of antihistamines B) Risk for falls related to sedation C) Risk for deficient fluid volume related to diuresis D) Risk for impaired skin integrity related to urticaria 19. An adult patient has complained to the nurse that she has been experiencing a dry mouth and urinary retention after several nights of taking an OTC sleep aid. The nurse should suspect that this medication contains what antihistamine? A) Loratadine (Claritin) B) Promethazine (Phenergan) C) Diphenhydramine (Benadryl) D) Olopatadine (Patanol) 20. A patient with a long-standing history of seasonal allergies has sought care during the spring and been advised to take a second-generation antihistamine. Which of the patient's following statements suggests a need for the nurse to perform health education? A) “I know these can be a bit expensive, but hopefully it will be worth it for me.” B) “I'm really hoping that these pills will cure my allergies before summer starts.” C) “I'll check with my doctor to make sure that the diet supplements I'm taking are okay to take at the same time as these pills.” D) “It's handy that I don't necessarily have to take these pills at bedtime.”

1. Ans: D Feedback: Histamine is the chemical mediator released in immune and inflammatory response to the bee sting.

2. Ans: C Feedback: Histamine is discharged from mast cells and basophils in response to certain stimuli, such as allergic reactions, cellular injury, and extreme cold. Lymphocytes and platelets do not release histamine.

3. Ans: A Feedback: Anaphylaxis is a type I response, which can be mild or life threatening.

4. Ans: A Feedback: Diphenhydramine (Benadryl) is the prototype of first-generation antihistamines and causes a high incidence of drowsiness and anticholinergic effects. It is not associated with dysrhythmias, increased muscle tone, or respiratory depression. 5. Ans: D Feedback: Azelastine (Astelin) and olopatadine (Patanol) are second-generation H1 receptor antagonists that have been formulated as nasal sprays for topical use. Each of the other listed drugs is a first-generation H1 receptor antagonist. 6. Ans: C Feedback: The administration of diphenhydramine (Benadryl) causes drowsiness, and the patient should not operate machinery, such as driving. The patient should not combine diphenhydramine with alcohol due to central nervous system depression. The patient will not need to limit sodium with this medication. The patient should adhere to the dosing schedule and not take the medication every 2 hours.

7. Ans: A Feedback: An allergic reaction produces contraction of the smooth muscle in the bronchi and bronchioles. The patient will have stimulation, not suppression, of the vagus nerve

endings. The patient will have increased, not decreased, permeability of the veins and capillaries. The patient will have increased secretion from the mucous glands, producing nasal congestion. 8. Ans: A Feedback: A type I response to cell-mediated invasion is mild and characterized by allergic rhinitis. Type II response is mediated by IgG or IgM generating direct damage to the cell surface. The patient with hemolytic anemia is having a type II response. Type III is an IgG- or IgM-mediated reaction characterized by formation of antigen–antibody complexes that induce an acute inflammatory reaction in tissues. Type IV hypersensitivity is a delayed hypersensitivity.

9. Ans: B Feedback: Decreased capillary permeability is among the effects of first-generation drugs. H1 receptor antagonists do not affect vitamin D, uric acid, or neurotransmitters.

10. Ans: D Feedback: Serum sickness is a delayed hypersensitivity reaction most often caused by drugs, such as antimicrobials. Within initial exposure to the antigen, symptoms usually develop within 7 to 10 days and include urticaria, lymphadenopathy, myalgia, arthralgia, and fever. Although the patient has a fever, the patient does not present with all the symptoms of a new infection or sepsis. An autoimmune disease is not likely. 11. Ans: D Feedback: Premedication with an antihistamine may be used to prevent allergic reactions with the administration of a transfusion of packed red blood cells. The administration of antimicrobial or antianginal is not recommended for a transfusion reaction.

12. Ans: B Feedback: Hydroxyzine is a first-generation H1 receptor antagonist that can be administered as an antiemetic agent. Chlorpheniramine is not administered as an antiemetic agent. Loratadine and cetirizine are not administered as antiemetic agents.

13. Ans: A Feedback: Cetirizine (Zyrtec) reaches maximal serum concentration in 1 hour.

14. Ans: C Feedback: Promethazine should not be used in children with hepatic disease or Reye's syndrome. The use of promethazine is not contraindicated with chickenpox, endocarditis, or hypertensive crisis. Promethazine would not be treated with chickenpox unless nausea or vomiting was noted. Endocarditis would not be treated with promethazine. This drug would not be administered with hypertensive crisis.

15. Ans: D Feedback: Antihistamines are contraindicated in patients with prostatic hypertrophy. Antihistamine agents can be administered to patients with Parkinson's disease, asthma, and diabetes mellitus.

16. Ans: A Feedback: First-generation H1 receptor antagonists are associated with anticholinergic effects such as dry mouth, urinary retention, constipation, and blurred vision. Wheezing, urticaria, and tinnitus are not anticholinergic effects.

17. Ans: B Feedback: Unlike the first-generation H1 receptor antagonists, the second-generation H1 receptor antagonists do not readily enter the brain from the blood. This selectivity significantly reduces the occurrence of adverse drug reactions, such as drowsiness and sedation, while still providing effective relief of allergic conditions. Adverse effects are not wholly absent, however. Duration of action is 12 to 24 hours, and these drugs are more expensive than first-generation drugs.

18. Ans: B Feedback: First-generation antihistamines cause drowsiness and impaired cognition that can result in falls. These drugs do not cause diuresis, impaired skin integrity, or infection.

19. Ans: C Feedback: The active ingredient in OTC sleep aids is a sedating antihistamine, usually diphenhydramine (Benadryl).

20. Ans: B Feedback: Antihistamines mitigate the signs and symptoms of allergies, but they do not cure the problem. Second-generation antihistamines are more expensive than earlier drugs. It is prudent to screen for potential interactions with herbal remedies. Because secondgeneration drugs do not cause sedation, they may generally be taken at any time.

Chapter 31- Drug Therapy for Asthma and Bronchoconstriction 1. A patient has been diagnosed with asthma. Which of the following health education topics is most important? A) ìDo not become fatigued. It will trigger asthma attacks.î B) ìExposure to cold temperatures can trigger asthma.î C) ìDo not consume foods high in sodium.î D) ìProlonged exposure to direct sunlight will trigger asthma.î Ans: B Feedback: Exposure to cold air can exacerbate asthma symptoms due to the bronchoconstriction of airways. Fatigue is not a direct trigger of asthma. The consumption of high quantities of sodium will not trigger asthma. The exposure to direct sunlight will not trigger asthma.

2. A patient with asthma has been taking ibuprofen (Advil) twice daily for 2 weeks after an ankle injury. The patient calls her health care provider and states she is bothered by shortness of breath and rapid breathing. What will the patient's health care provider suspect? A) The patient is having an anxiety attack. B) The patient has a sensitivity to the drug. C) The patient is experiencing hypoglycemia. D) The patient is suffering from a myocardial infarction. Ans: B Feedback: In about 25% of patients with asthma, aspirin and other nonsteroidal anti-inflammatory drugs can precipitate an asthma attack. The patient is experiencing a hypersensitivity reaction. The patient is not experiencing hypoglycemia or a myocardial infarction.

3. A patient is using an albuterol (Proventil) inhaler, which is a bronchodilator. Which of the following patient teaching interventions is a priority for the patient who experiences shortness of breath related to constriction of airways? A) Administer insulin to decrease hand shaking. B) Administer ibuprofen (Advil) to decrease inflammation. C) Exercise should be limited to one time per week. D) Stop smoking due to the bronchoconstriction. Ans: D Feedback: Cigarette smoking will increase bronchoconstriction, so the patient should be encouraged to stop. The albuterol causes hand shaking. Insulin will not decrease hand shaking. The patient will not require ibuprofen (Advil). The patient should be encouraged to exercise, and it should not be limited to one time per week.

4. A patient is started on albuterol (Proventil). Of what adverse reaction should the patient be warned?

A) B) C) D) Ans:

Polydipsia Tachycardia Hypotension Diarrhea B Feedback: The symptoms of cardiac stimulation, including tachycardia, are noted with the administration of albuterol. The patient will not experience polydipsia, hypotension, or diarrhea.

5. A patient is admitted to the emergency room with inspiratory stridor and air hunger after a bee sting. Which of the following medications will the nurse prepare for administration? A) Ipratropium bromide (Atrovent) B) Epinephrine (Adrenalin) C) Cromolyn (Intal) D) Pseudoephedrine Ans: B Feedback: Epinephrine may be injected subcutaneously in an acute attack of bronchoconstriction. Ipratropium is administered by inhalation for maintenance therapy of bronchoconstriction related to chronic bronchitis and inflammation. It is not administered for an acute attack of bronchoconstriction. Cromolyn stabilizes mast cells and prevents the release of bronchoconstrictive and inflammatory substances when mast cells are confronted with allergens and other stimuli. It is not used for acute attacks. Pseudoephedrine is not administered for acute bronchoconstriction.

6. A patient is instructed on the administration of inhaled corticosteroid agents to treat asthma. How do inhaled corticosteroid agents assist in the treatment of asthma? A) Inhaled corticosteroid agents will depress the central nervous system. B) Inhaled corticosteroid agents will reduce respiratory rate. C) Inhaled corticosteroid agents will reduce bronchodilation. D) Inhaled corticosteroid agents will reduce airway inflammation. Ans: D Feedback: Inhaled corticosteroid agents suppress the release of inflammatory mediators, block the generations of cytokines, and decrease the recruitment of airway eosinophils. Inhaled corticosteroid agents do not depress the central nervous system. Inhaled corticosteroid agents do not affect bronchodilation or constriction.

7. A patient is prescribed an adrenergic bronchodilator for airway constriction. Which of the following conditions will require it to be administered cautiously? A) Liver failure

B) C) D) Ans:

Renal failure Respiratory constriction Seizure disorder D Feedback: The administration of adrenergic bronchodilators should be used cautiously in patients with hypertension, hyperthyroidism, diabetes mellitus, and seizure disorders. The patient with liver failure and renal failure can be administered adrenergic bronchodilators. The patient with respiratory constriction should receive adrenergic bronchodilators.

8. A patient is experiencing an acute asthma attack. Which of the following medications is contraindicated for the treatment of acute bronchospasm? A) Aminophylline B) Cromolyn (Intal) C) Albuterol (Proventil) D) Formoterol (Foradil) Ans: B Feedback: Cromolyn stabilizes mast cells and is not used in acute bronchospasm. Aminophylline is used in limited cases but is administered for acute asthma attack. Albuterol and formoterol are used for acute asthma attack.

9. A child is prescribed an inhaled corticosteroid agent to decrease respiratory inflammation. The child's parent administers high doses of the drug after 2 days of administration. What is the patient at risk for? A) Adrenal insufficiency B) Tachycardia C) Edema D) Hypoglycemia Ans: A Feedback: Adrenal insufficiency is most likely to occur with systemic or high doses of inhaled corticosteroids. The patient is not at risk for tachycardia, edema, or hypoglycemia unless related to adrenal insufficiency.

10. A patient is experiencing an acute asthma attack. What is the most common first-line therapy for relief of an acute asthma attack? A) Inhaled steroid B) Leukotriene modifier C) Beta2-adrenergic agonist D) Xanthine Ans: C Feedback:

A patient experiencing an acute asthma attack should be administered a beta2-adrenergic agonist. The patient can receive an inhaled steroid, but it is not the first-line therapy. Leukotriene modifiers are used for maintenance in asthma, not during acute exacerbation. Xanthines are not the drug of choice in acute asthma attack.

11. Albuterol (Proventil) is administered to a patient to promote bronchodilation. Administration of this beta2-adrenergic agonist results in increased production of A) leukotrienes. B) cortisol. C) cyclic AMP. D) glucagon. Ans: C Feedback: Beta-adrenergic drugs increase the production of cyclic AMP to produce bronchodilation. They do not increase the release of leukotrienes, cortisol, or glucagon.

12. A patient is being assessed by the home care nurse on the appropriate use of her metered-dose inhalers. Which of the following will assist in proper administration of the inhaler? A) Use of a spacer B) Administration of a corticosteroid first C) Pushing fluids D) Exhaling immediately after administration Ans: A Feedback: The patient should be instructed to use a spacer to increase compliance and accuracy of administration. The corticosteroid should be administered after the bronchodilator. The increase in fluids will not affect the administration of the inhaler. The patient should hold her breath for several seconds after administration of the inhaler.

13. A patient is admitted to the intensive care unit with status asthmaticus. The patient is administered high doses of nebulized albuterol (Proventil). What electrolyte imbalance should the nurse assess for this patient? A) Hyperkalemia B) Hypermagnesemia C) Hypocalcemia D) Hypokalemia Ans: D Feedback: High doses of nebulized albuterol have been associated with tachycardia, hypokalemia, and hyperglycemia. The patient will not have alterations of magnesium or calcium levels.

14. A patient is bothered with nighttime episodes of bronchoconstriction related to asthma. Which of the following medications can be administered to decrease the nighttime episodes and prevent asthma attacks? A) Xanthines B) Beta2-adrenergic agonists C) Anticholinergics D) Leukotriene modifiers Ans: D Feedback: The leukotriene modifiers improve symptoms and pulmonary function tests, decrease nighttime symptoms, and decrease the use of beta2-adrenergic drugs. Xanthines treat acute attacks but do not prevent asthma from occurring. Beta2-adrenergic agonists treat acute attacks but do not prevent asthma from occurring. Anticholinergics block the action of acetylcholine in bronchial smooth muscle when given by inhalation.

15. A patient has begun taking antiasthmatic drugs. The patient should avoid excessive intake of what beverage? A) Coffee B) Grapefruit C) Green tea D) Acai juice Ans: A Feedback: Patients taking antiasthmatic drugs should generally avoid excessive intake of caffeinecontaining fluids such as coffee, tea, and cola drinks. These beverages may increase bronchodilation but also may increase heart rate and cause palpitations, nervousness, and insomnia with bronchodilating drugs.

16. A patient with a recent diagnosis of asthma is anxious because she experienced an asthma attack and was unable to relieve the symptoms despite taking several puffs of her prescribed salmeterol (Serevent). How should the nurse respond to the patient's concerns? A) “Remember that your Serevent isn't effective when you take it at the time of an asthma attack.” B) ìIt's important to take your Serevent as soon as you feel the first sensation of an asthma attack.î C) ìUnfortunately, Serevent can take up to 15 minutes to relieve your difficulty breathing.î D) ìIt's best to take repeated doses of Serevent, every 5 minutes, until your symptoms subside.î Ans: A Feedback: Formoterol (Foradil) and salmeterol (Serevent) are long-acting beta2-adrenergic agonists

used only for prophylaxis of acute bronchoconstriction. They are not effective in acute attacks because they have a slower onset of action than the short-acting drugs.

17. A patient with asthma has been prescribed ipratropium (Atrovent) 2 puffs QID. The nurse should recognize which of the following as the most likely goal of this treatment? A) Promoting short-term relief of acute asthma symptoms B) Relieving acute bronchoconstriction C) Promoting long-term management of asthma symptoms D) Promoting blood flow in the alveolar capillaries Ans: C Feedback: The anticholinergic bronchodilators are most useful in the long-term management of asthma and other conditions producing bronchoconstriction. These drugs are not used in the management of acute exacerbations of asthma. They do not promote alveolar blood flow.

18. A hospital patient's medication administration record specifies concurrent doses of nebulized ipratropium and albuterol at 08:00 and 20:00. When administering these drugs, which of the following statements is true? A) The two drugs should be administered at least 30 minutes apart, with ipratropium administered first. B) The two drugs can be mixed in the nebulizer immediately before administration. C) The two drugs should be administered at least 30 minutes apart, with albuterol administered first. D) The nurse should contact the prescriber due to the increased risk of adverse effects when these drugs are administered concurrently. Ans: B Feedback: It is appropriate to mix ipratropium bromide inhalation solution in the nebulizer with albuterol or metaproterenol if the mixture is used within 1 hour. These drugs have a synergistic effect.

19. A patient with a long-standing history of asthma has failed to achieve adequate symptom control with first-line drugs. As a result, her care provider has prescribed theophylline. The nurse is aware of the narrow therapeutic range of this drug and has taught the patient to recognize the signs and symptoms of toxicity. These include which of the following? A) Polyuria and polyphagia B) Confusion and decreased level of consciousness C) Agitation and dysrhythmias D) Chest pain and shortness of breath Ans: C

Feedback: Signs and symptoms of theophylline overdose include anorexia, nausea, vomiting, agitation, nervousness, insomnia, tachycardia and other dysrhythmias, and tonicñclonic convulsions. Ventricular dysrhythmias or convulsions may be the first sign of toxicity. Chest pain, shortness of breath, polyuria, polyphagia, and decreased level of consciousness do not accompany theophylline overdose.

20. An adult patient with a diagnosis of asthma has been prescribed montelukast (Singulair). The nurse should teach the patient that this drug will help relieve symptoms by A) reducing the muscle tone in the alveoli and facilitating gas exchange. B) relaxing smooth muscle in the bronchi and bronchioles. C) preventing the bronchoconstriction and inflammation that is caused by leukotrienes. D) preventing mast cells from releasing histamine. Ans: C Feedback: Montelukast prevents leukotrienes from binding to its receptors reducing the bronchoconstriction and ultimate inflammation caused by leukotrienes.

1. The physician has ordered the patient hydrochlorothiazide. What assessment should the

A) B) C) D) Ans:

nurse make before administering the first dose of hydrochlorothiazide? Pulse rate Hemoglobin level Sulfonamide allergy Neutrophil level C Feedback: Thiazide diuretics must be used cautiously in patients allergic to sulfonamide drugs because there is a known cross-sensitivity of some sulfonamide-allergic patients to sulfonamide nonantibiotic. It is not imperative to assess pulse, hemoglobin, or neutrophil levels.

2.A patient has edema of the lower extremities and abdomen. What is the reason for administering a stronger diuretic than a thiazide diuretic to this patient? A) A thiazide diuretic will reabsorb potassium in the distal tubule. B) A thiazide diuretic will be ineffective for immediate diuresis. C) A thiazide diuretic will provide peak effects in 2 hours. D) A thiazide diuretic will be excreted in more than 72 hours. Ans: B Feedback: Thiazide diuretics are ineffective when immediate diuresis is required. A thiazide diuretic acts to reabsorb sodium, not potassium, in the distal convoluted tubule. A thiazide diuretic reaches its peak in 4 to 6 hours. A thiazide diuretic is excreted in 72 hours maximum.

3.A patient is admitted to the hospital with a diagnosis of heart failure. The patient is ordered to receive furosemide (Lasix) 40 mg IV. How soon after administration should the nurse expect to see evidence of diuretic effects? A) 1 minute B) 5 minutes C) 30 minutes D) 2 hours Ans: B Feedback: After IV administration, diuretic effects occur within 5 minutes. The diuretic effect is not seen in 1 minute. The peak of the action occurs in 30 minutes, not the onset of action. The duration of action is 2 hours, not the onset of action.

A) B) C)

4.A patient is administered furosemide (Lasix) 20 mg PO every morning. What effect will a diet high in sodium have on the patient? Decreased blood pressure Decreased diuresis Hyperkalemia

D) Ans:

Hyperglycemia B Feedback: A high dietary intake of sodium can cause sodium retention and reduce or cancel the diuretic-induced sodium loss. A high dietary intake of sodium will not increase diuresis. A high dietary intake of sodium will not cause hyperkalemia. A high dietary intake of sodium will not cause hyperglycemia.

5.A patient is switched from furosemide (Lasix) to spironolactone (Aldactone). The patient asks the nurse why she has been switched to a new medicine. What is the nurse's best response? A) “You will lose less potassium with spironolactone than with furosemide.” B) “You will have greater potassium losses with spironolactone than with furosemide.” C) “You will have greater water losses with spironolactone than with furosemide.” D) “You will have greater sodium losses with spironolactone than with furosemide.” Ans: A Feedback: Spironolactone promotes retention of sodium and water and excretion of potassium by stimulating the sodium–potassium exchange mechanism in the distal tubule. The patient will not have greater potassium losses, water losses, or sodium losses with spironolactone rather than furosemide.

6.A patient is taking spironolactone (Aldactone). When providing patient teaching about this medication, what foods should the patient be instructed to avoid? A) Fish B) Apples C) Crackers D) Bananas Ans: D Feedback: Bananas are high in potassium and should be avoided with potassium-sparing diuretics. It is acceptable for the patient to eat fish, apples, and crackers.

7.A patient is admitted to the emergency department and is unconscious as a result of a head injury. The patient's intracranial pressure is increased. What type of diuretic will the nurse most likely administer to the patient? A) Loop diuretic B) Potassium-sparing diuretic C) Thiazide diuretic D) Osmotic diuretic Ans: D Feedback:

An osmotic diuretic is used to reduce intracranial pressure related to a head injury. Loop diuretics, potassium-sparing diuretics, and thiazide diuretics do not reduce intracranial pressure.

8.A patient with hypertension has been prescribed a combination diuretic. What is the major purpose in administering a combination diuretic agent? A) It prevents sodium imbalance. B) It is less expensive than two medications. C) It prevents potassium imbalance. D) It prevents allergic reactions. Ans: C Feedback: The major purpose of the diuretic combinations is to prevent potassium imbalances. The combination products do not prevent sodium imbalance. The combination products are not less expensive than taking two medications. The combination products do not prevent allergic reactions.

9.A patient asks the nurse why she has to take two diuretics when her friend only takes one with a combination medication. The patient takes hydrochlorothiazide 75 mg every day with a potassium-sparing diuretic. What is the nurse's best response? A) “Maybe you should speak with your doctor about the combination.” B) “I do not know why your doctor prefers that you take two medications.” C) “It could be that you need a larger dose than is available in the combination medications.” D) “The combination medications are not as effective as two medications.” Ans: C Feedback: The fixed-dose combination of hydrochlorothiazide and a potassium-sparing diuretic contains 50 mg of hydrochlorothiazide, and this patient requires 75 mg of hydrochlorothiazide. The statement “It could be that you need a larger dose than is available in the combination medications” is the best answer. The statement “Maybe you should speak with your doctor about the combination” does not provide adequate teaching. The statement “I do not know why your doctor prefers that you take two medications” does not provide adequate patient education. The combination medications are very effective, and the statement that they are not as effective is inaccurate.

10.A patient has edema of the lower extremities with crackles in the lung bases. What diuretic is the nurse most likely to administer? A) Hydrochlorothiazide B) Furosemide C) Spironolactone D) Mannitol Ans: B

Feedback: Acute pulmonary edema is an indication for the use of Lasix. HCTZ, spironolactone, and mannitol are not used for this purpose, largely due to their slower onset of action.

11.A patient has been prescribed digoxin (Lanoxin) and furosemide (Lasix) for treatment of congestive heart failure. What is the patient at risk for developing with this combination of medications? A) Hyperkalemia B) Hyperglycemia C) Tachycardia D) Digoxin toxicity Ans: D Feedback: When digoxin and diuretics are used concomitantly, the risk of digoxin toxicity is increased. The patient is at risk for hypokalemia, not hyperkalemia. The patient is not at a particular risk for hyperglycemia or tachycardia.

12.A patient is receiving furosemide (Lasix) and a potassium supplement. When monitoring daily laboratory values, what should the potassium level be for this patient? A) 1.5 to 3.0 mEq/L B) 3.5 to 5.0 mEq/L C) 5.0 to 7.5 mEq/L D) 6.0 to 6.5 mEq/L Ans: B Feedback: The normal serum potassium level is 3.5 to 5.0 mEq/L. A serum potassium level of 1.5 to 3.0 mEq/L is too low. A serum potassium level of 5.0 to 7.5 mEq/L is indicative of hyperkalemia. A serum potassium level of 6.0 to 6.5 mEq/L is indicative of hyperkalemia.

13.An elderly patient with a history of heart failure has presented to the emergency department in respiratory distress. Assessment reveals the presence of pulmonary edema, and an infusion of IV furosemide (Lasix) has been ordered. For the duration of treatment, the nurse should prioritize assessments related to what nursing diagnosis? A) Risk for deficient fluid volume related to diuretic administration B) Risk for decreased cardiac output related to adverse effects of furosemide C) Ineffective health maintenance related to pulmonary edema D) Functional urinary incontinence related to diuretic administration Ans: A Feedback: Increased diuresis creates a risk of deficient fluid volume. Impaired health maintenance and urinary incontinence are not priorities at this time. Lasix will not reduce cardiac output.

14.A hospital patient with a diagnosis of liver failure has been prescribed a low dose of spironolactone in order to treat ascites. The nurse who is providing this patient's care should prioritize assessments for the signs and symptoms of what health problem? A) Peritonitis B) Liver cancer C) Cirrhosis D) Hepatic encephalopathy Ans: D Feedback: Spironolactone is used in the treatment of ascites. However, it should be used cautiously and carefully monitored in patients with significant hepatic impairment because a rapid change in fluid and electrolyte balance may lead to hepatic coma. It is important to monitor susceptible patients carefully for signs and symptoms of hepatic encephalopathy. There is no risk for liver cancer, cirrhosis, or peritonitis that results directly from the use of spironolactone.

15.A clinical nurse educator on a nephrology and dialysis unit is reviewing renal physiology with a nursing student who is completing a preceptorship on the unit. The student should be aware that a majority of reabsorption takes place in what anatomical location? A) Ureters B) Proximal tubule C) Efferent arteriole D) Afferent arteriole Ans: B Feedback: Most reabsorption occurs in the proximal tubule. Almost all glucose and amino acids are reabsorbed; about 80% of water, sodium, potassium, chloride, and most other substances is reabsorbed. Arterial blood enters the glomerulus by the afferent arteriole, and blood that does not become part of the glomerular filtrate leaves the glomerulus through the efferent arteriole. The ureters connect the kidneys to the bladder.

16.A hospital patient with peripheral edema has been prescribed furosemide (Lasix). How should the nurse best determine the extent of the patient's desired fluid loss? A) Assess the patient's skin turgor on a daily basis. B) Test the osmolarity of the patient's urine regularly. C) Weigh the patient daily. D) Auscultate the patient's chest each morning. Ans: C Feedback: The nurse should measure and record weights to assist in determining the amount of mobilization of excess fluid. This is a more accurate gauge of changes in fluid status than skin turgor, urine osmolarity, or chest auscultation.

17. An adult patient with a diagnosis of hypertension has had oral Lasix added to his

A) B) C) D) Ans:

medication regimen by his primary care provider. The nurse is planning a brief health education session with the patient in light of this change in his treatment plan. What goal should the nurse specify when planning this teaching session? The patient will identify strategies for limiting his sodium intake. The patient will describe the rationale for increasing his fluid intake. The patient will be able to demonstrate correct technique for blood glucose monitoring. The patient will accurately describe the basic structure and functions of the kidneys. A Feedback: The reason for furosemide use should guide patient teaching. In most instances, it is necessary to initiate measures to limit sodium intake. Key considerations should include not adding salt to food during preparation or at the dinner table, reading food labels carefully to be aware of hidden sources of sodium, and avoiding processed or highsodium foods. Blood glucose monitoring is not indicated, and there is no need for increased fluid intake. Renal anatomy and physiology are not priority teaching points.

18. An older adult patient has a complex medical history that includes heart failure, type 1

A) B) C) D) Ans:

diabetes, and diabetic nephropathy. The nurse has questioned a care provider's order for oral spironolactone because the patient's health problems would contribute to a high risk of metabolic acidosis. hypocalcemia. hemolytic anemia. hyperkalemia. D Feedback: The presence of renal insufficiency is also a contraindication to the use of spironolactone because use of spironolactone may cause hyperkalemia through the inhibition of aldosterone and the subsequent retention of potassium. This patient does not face a greatly increased risk of anemia, hypocalcemia, or acidosis.

19.A nurse is reviewing a newly admitted patient's medication administration record and notes that the patient takes a loop diuretic as well as a thiazide diuretic. The nurse understands what primary rationale for the concurrent use of these two drugs? A) Increased diuretic effect B) Reduced risk of potassium imbalances C) Decreased blood pressure without a risk of bradycardia D) Increased adherence to treatment Ans: A Feedback:

When an inadequate diuretic response occurs with one drug, people sometimes take two potassium-losing diuretics concurrently. The combination of a loop and a thiazide diuretic has synergistic effects because the drugs act in different segments of the renal tubule. Thus, the rationale for this particular combination is not rooted in prevention of potassium imbalances, increased adherence, or maintenance of a normal heart rate.

20.A patient has been taking an ACE inhibitor and a beta-blocker for the treatment of hypertension but has been consistently obtaining blood pressure readings in the vicinity of 145/90 mm Hg. As a result, the patient's primary care provider has prescribed furosemide (Lasix). What order would be most consistent with this patient's health needs? A) Lasix 125 mg PO OD B) Lasix 40 mg IV TID C) Lasix 20 mg IV OD D) Lasix 40 mg PO BID Ans: D Feedback: For hypertension, Lasix is commonly given as 40 mg PO twice daily and gradually increased if necessary.

Import Settings: Base Settings: Brownstone Default Information Field: Chapter Information Field: Client Needs Information Field: Cognitive Level Information Field: Difficulty Information Field: Integrated Process Information Field: Objective Information Field: Page and Header Highest Answer Letter: D Multiple Keywords in Same Paragraph: No

Chapter: Chapter 33: Nutritional Support Products, Vitamins, and Mineral Supplements

Multiple Choice

1. A patient has suffered from several infections in the last 6 months and unexplained impaired wound healing. What assessment should the nurse prioritize? A) Assess for pain. B) Assess for nutritional deficiencies. C) Assess genetic tendency for infection. D) Assess for edema and decreased hemoglobin. Ans: B Chapter: 33 Client Needs: A-1 Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing Process Objective: 8 Page and Header: 636, Assessment Feedback: Nutritional deficiencies may impair the function of essentially every body function. Signs and symptoms include unintended weight loss, increased susceptibility to infection, and impaired wound healing. The development of infection and impaired wound healing would require assessment for pain but would not provide evidence of cause. The nurse would not be able to assess genetic tendency. Edema and decreased hemoglobin would not explain the etiology

of suffering infections and impaired wound healing.

2. An adult patient is experiencing deficiencies in folic acid and vitamin B12. This patient's compromised health status creates a risk for which of the following? A) Hyperuricemia B) Hepatitis C) Non-Hodgkin's lymphoma D) Megaloblastic anemia Ans: D Chapter: 33 Client Needs: D-4 Cognitive Level: Comprehension Difficulty: Moderate Integrated Process: Nursing Process Objective: 1 Page and Header: 625, Use Feedback: Deficiency states of both vitamin B12 and folic acid present similarly as megaloblastic anemia (characterized by abnormally large, immature red blood cells). These deficiencies do not contribute to hyperuricemia, hepatitis, or lymphoma.

3. An elderly patient's compromised nutritional status has necessitated the use of a nutritional formula. When reviewing this patient's laboratory findings, the nurse should prioritize which of the following values? A) Erythrocyte sedimentation rate (ESR) B) Serum albumin C) GGT, AST, and ALT D) Blood urea nitrogen Ans: B Chapter: 33 Client Needs: D-2 Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing Process Objective: 7 Page and Header: 635, Assessing for Therapeutic Effects Feedback: For patients receiving nutritional formulas, the nurse observes for weight gain and increased serum albumin. In a patient with compromised nutrition, there is less emphasis placed on BUN, liver enzymes, and ESR.

4. A patient with a history of atrial fibrillation has been brought to the emergency department (ED) by his wife after inadvertently taking 22 mg of warfarin rather than 2 mg, which is the patient's prescribed daily dose. The ED nurse should anticipate the administration of A) vitamin K. B) vitamin B12. C) vitamin A. D) vitamin B1. Ans: A Chapter: 33 Client Needs: D-2 Cognitive Level: Comprehension Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Page and Header: 624, Pharmacokinetics and Use Feedback: Vitamin K is used to reverse the effects of warfarin (Coumadin).

5. When providing nutritional teaching to adolescent girls, which aspect of teaching is most important? A) Limit the amount of foods high in fiber. B) Increase potassium chloride in the diet. C) Calcium intake should be 1300 mg daily. D) Increase sodium in the diet. Ans: C Chapter: 33 Client Needs: D-2 Cognitive Level: Application Difficulty: Easy Integrated Process: Teaching/Learning Objective: 8 Page and Header: 615, Minerals Feedback: Adolescent females should consume 1000 to 1300 mg of calcium per day. Adolescent females should not limit fiber or increase potassium chloride or sodium in the diet.

6. A patient is admitted to the hospital with hyperkalemia. The patient is prescribed sodium polystyrene sulfonate (Kayexalate). How does this medication lower the patient's potassium level? A) It decreases the absorption of exogenous potassium. B) It increases urinary excretion of potassium. C) It combines with potassium ions for elimination. D) It releases sodium to acidify urine with potassium. Ans: C Chapter: 33 Client Needs: D-2 Cognitive Level: Comprehension Difficulty: Moderate Integrated Process: Nursing Process Objective: 8 Page and Header: 634, Cation Exchange: Sodium Polystyrene Sulfonate Feedback: Sodium polystyrene sulfonate (Kayexalate), a cation exchange resin, administered orally, removes potassium from the body in the stool. Kayexalate does not decrease the absorption of potassium. Kayexalate does not increase urinary excretion of potassium. Kayexalate does not release sodium to acidify urine with potassium.

7. A patient has an increased serum potassium level and has developed a cardiac arrhythmia. How do insulin and glucose assist in decreasing the serum potassium level? A) Insulin and glucose drive potassium into the cells. B) Insulin and glucose bind potassium to sodium. C) Insulin and glucose increase urinary excretion of potassium. D) Insulin and glucose increase fecal excretion of potassium. Ans: A Chapter: 33 Client Needs: D-2 Cognitive Level: Comprehension Difficulty: Moderate Integrated Process: Nursing Process Objective: 8 Page and Header: 634, Glucose and Insulin Feedback: Insulin and glucose lower serum potassium levels by driving potassium into the cells. Insulin and glucose do not bind potassium to sodium or increase urinary excretion of potassium or fecal excretion of potassium.

8. A 4-year-old child has eaten many of his mother's prenatal vitamins. Which medication is indicated for iron toxicity? A) Deferoxamine (Desferal) B) Penicillamine (Cuprimine) C) Sucralfate (Carafate) D) Magnesium sulfate Ans: A Chapter: 33 Client Needs: D-2 Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing Process Objective: 6 Page and Header: 634, Deferoxamine and Deferasirox Feedback: Deferoxamine is a parenteral drug used to remove excess iron from storage sites in the body. Penicillamine, sucralfate, and magnesium sulfate are not administered for iron toxicity.

9. A patient with thalassemia requires frequent blood transfusions. The patient develops iron overload. Which of the following medications will be administered? A) Calcium gluconate B) Deferoxamine (Desferal) C) Sodium polystyrene sulfonate (Kayexalate) D) Deferasirox (Exjade) Ans: D Chapter: 33 Client Needs: D-2 Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing Process Objective: 6 Page and Header: 634, Deferoxamine and Deferasirox Feedback: Deferasirox (Exjade) is an oral iron chelating agent that is used to treat chronic iron overload in patients who require frequent blood transfusions for severe chronic anemia. Calcium gluconate, deferoxamine (Desferal), and sodium polystyrene sulfonate (Kayexalate) are not used to treat chronic iron overload.

10. A toddler lives in a home that was built in the 1960s. The child has been diagnosed with lead poisoning after eating chips of flaking paint. Which medication will be administered to decrease

lead levels? A) Succimer (Chemet) B) Folic acid C) Deferoxamine (Desferal) D) Deferasirox (Exjade) Ans: A Chapter: 33 Client Needs: D-2 Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing Process Objective: 6 Page and Header: 634, Succimer (Chemet) Feedback: Succimer (Chemet) chelates lead to form water-soluble complexes that are excreted in the urine. Succimer is used to treat lead poisoning in children. Folic acid is not used to treat lead poisoning. Deferoxamine is not used to treat lead poisoning. Deferasirox is not used to treat lead poisoning.

11. A new mother asks why her baby receives vitamin K IM at birth. What is the best statement to explain the need for vitamin K in a newborn? A) “The administration of vitamin K prevents her from bleeding.” B) “Your infant will need multiple injections of vitamin K to prevent health problems.” C) “Your infant will need the conjugated iron in vitamin K to protect her from infection.” D) “Vitamin K helps boost her nutrition until she's able to feed more efficiently.” Ans: A Chapter: 33 Client Needs: D-3 Cognitive Level: Application Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 3, 8 Page and Header: 621, Table 33.3 Feedback: A single IM dose of vitamin K is given to newborn infants to prevent hemorrhagic disease of newborns. The infant does not need multiple injections of vitamin K to prevent hemorrhage. The administration of vitamin K will not protect from infection. Vitamin K is not used to enhance nutrition.

12. A woman in her last trimester of pregnancy is diagnosed with toxemia. The patient is

admitted to labor and delivery and suffers a seizure. What medication will be administered parenterally? A) Magnesium oxide B) Magnesium sulfate C) Potassium chloride D) Calcium gluconate Ans: B Chapter: 33 Client Needs: D-2 Cognitive Level: Application Difficulty: Diffcult Integrated Process: Nursing Process Objective: 5 Page and Header: 633, Magnesium Feedback: Magnesium sulfate is given parenterally for convulsions related to pregnancy. Magnesium oxide is given orally for mild hypomagnesemia. Potassium chloride is not given for convulsions related to pregnancy. Calcium gluconate is not given for convulsion related to pregnancy.

13. A patient's fluid overload has required several doses of furosemide (Lasix). Which medication will be administered if the patient's serum potassium level is 2.8 mEq/L? A) Potassium chloride B) Calcium gluconate C) Potassium carbonate D) Sodium polystyrene sulfonate (Kayexalate) Ans: A Chapter: 33 Client Needs: D-2 Cognitive Level: Application Difficulty: Easy Integrated Process: Nursing Process Objective: 5 Page and Header: 632, Pharmacokinetics and Use Feedback: Furosemide is a potassium-depleting diuretic in which potassium chloride will be administered to prevent hypokalemia. Calcium gluconate and zinc gluconate will not be administered to the patient. Sodium polystyrene sulfonate would be administered with hyperkalemia not hypokalemia.

14. A patient with alcoholism has been admitted to the hospital following an injury. Assessment of the patient's overall health reveals significant nutritional deficits. The patient is likely to require which of the following due to inadequate dietary intake? A) Sodium B) Vitamin A C) Vitamin K D) Thiamine Ans: D Chapter: 33 Client Needs: D-2 Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 621, Table 33.3 Feedback: Thiamine deficiency is common in patients with alcoholism because of inadequate dietary intake and use of large amounts of thiamine to metabolize ethanol. Sodium, vitamin A, and vitamin K are important but not as crucial to this particular patient as thiamine.

15. A patient diagnosed with pernicious anemia asks why vitamin B12 is administered by injection. What is the best response to the patient? A) “Oral forms of vitamin B12 will not be absorbed.” B) “Oral ingestion of vitamin B12 causes irritation and bleeding.” C) “Pernicious anemia causes changes in the mucous membrane.” D) “In severe pernicious anemia, vitamin B12 is not effective.” Ans: A Chapter: 33 Client Needs: D-2 Cognitive Level: Application Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 4, 8 Page and Header: 625, Use Feedback: In pernicious anemia, vitamin B12 must be given by injection because oral forms are not absorbed from the GI tract. Vitamin B12 is not administered orally and thus will not cause irritation and bleeding. Pernicious anemia causes changes in the mucous membrane, but these changes do not explain why vitamin B12 is administered by injection.

16. A 3-year-old child has been diagnosed with an acute gastrointestinal infection that has caused her severe diarrhea for the past 36 hours. The pediatric nurse should anticipate the use of A) magnesium gluconate. B) Pedialyte. C) sodium bicarbonate. D) 50% dextrose. Ans: B Chapter: 33 Client Needs: D-2 Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing Process Objective: 7 Page and Header: 633, Multiple Mineral-Electrolyte Preparations Feedback: Oral electrolyte solutions (e.g., Pedialyte) contain several electrolytes and a small amount of dextrose. They are especially useful in children for treatment of diarrhea and may prevent severe fluid and electrolyte depletion. Magnesium gluconate, 50% dextrose, and sodium bicarbonate are not typically used for this purpose.

17. A middle-aged woman with a family history of breast cancer has told the nurse that she has begun taking 250 mg of vitamin E each day in an effort to prevent cancer. How should the nurse best respond to this woman's statement? A) “Good for you. You're to be commended for being so proactive with your health.” B) “If you do this, it's best to take several smaller doses during the day rather than one big dose.” C) “Unfortunately, high doses of vitamins haven't been shown to protect against disease.” D) “This is actually quite a dangerous practice, and might increase, rather than decrease, your cancer risk.” Ans: C Chapter: 33 Client Needs: B Cognitive Level: Application Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 3, 8 Page and Header: 609, Vitamins Feedback: People should never self-prescribe megavitamins, large doses of vitamins in excess of the recommended dietary allowance (RDA). This practice does not, however, increase an individual's risk of cancer.

18. A patient with a history of homelessness has been diagnosed with nutritional deficits that include a vitamin E deficiency. What aspect of the patient's current health status would contraindicate the safe and effective use of vitamin E supplements? A) Cirrhosis B) Thrombocytopenia C) Low serum albumin D) IV opioid abuse Ans: B Chapter: 33 Client Needs: D-3 Cognitive Level: Analysis Difficulty: Diffcult Integrated Process: Nursing Process Objective: 8 Page and Header: 620, Adverse Effects and Contraindications Feedback: Patients with a history of bleeding disorders or thrombocytopenia should not take vitamin E. Opioid use and liver disease do not necessarily contraindicate the use of vitamin E supplements.

19. A patient with iron deficiency anemia has begun taking daily supplements of oral ferrous sulfate. The nurse who is planning this patient's care should add what nursing diagnosis to the nursing care plan? A) Risk for excess fluid volume related to use of iron supplements B) Risk for unstable blood glucose related to use of iron supplements C) Risk for constipation related to use of iron supplements D) Risk for peripheral neurovascular dysfunction related to use of iron supplements Ans: C Chapter: 33 Client Needs: D-2 Cognitive Level: Application Difficulty: Diffcult Integrated Process: Nursing Process Objective: 8 Page and Header: 628, Adverse Effects and Contraindications Feedback: Constipation is a common adverse effect of iron supplements. Neurovascular dysfunction, fluid volume excess, and unstable blood glucose are unlikely to result from iron supplements.

20. An older adult has been admitted to the hospital with failure to thrive. Assessment suggests that the patient is in a severely malnourished state. Which of the following assessment findings is most suggestive of a vitamin A deficiency? A) Night blindness B) Manic episodes C) Nonblanching erythema D) Petechiae Ans: A Chapter: 33 Client Needs: D-2 Cognitive Level: Analysis Difficulty: Diffcult Integrated Process: Nursing Process Objective: 8 Page and Header: 610, Table 33.1 Feedback: Night blindness is characteristic of vitamin A deficiency. Mania and integumentary changes are not normally associated with this vitamin deficiency.

1.A patient has a body mass index of 27 and weighs 160 pounds. What is this patient considered to be? A) Underweight B) Overweight C) Obese D) Desired weight Ans: B Feedback: Overweight is defined as a body mass index of 25 to 29.9 kg/m2. The patient is not underweight, obese, or at the desired weight. Obesity cannot be determined solely on the basis of body weight.

2.When the nurse is educating a women's group on obesity and healthy eating, which of the following statements is most accurate? A) Consuming 3500 extra calories in a week will result in 1 pound of fat. B) Extra calories are converted to amino acids or protein. C) Food that contains large amounts of fat stimulates energy. D) Women will typically expend more energy than men because of muscle tissue. Ans: A Feedback: Consuming an extra 500 calories each day for a week results in 3500 excess calories, or 1 pound of fat. Excess calories are converted to triglycerides, not amino acids. Foods that contain carbohydrates and protein stimulate energy expenditure. Men expend more energy than women.

3.A school nurse is in the planning stages of a health promotion campaign that will address childhood obesity. Of the following, which is an environmental factor believed to have contributed most to increased weight in children? A) Playing video games B) Genetic changes C) Increased social acceptance of obesity D) Increased incidence of depression Ans: A Feedback: For both adults and children, increased time watching television, playing video and computer games, and working on computers contributes to less physical activity and promotes weight gain. Depression, social factors, and genetic factors are not environmental influences.

4.A nurse is instructing parents about health and nutrition. The nurse should state that overweight children are more likely than normal-weight children to develop which disease process? Glaucoma

B) C) D) Ans:

Migraine headache Scoliosis Diabetes mellitus D Feedback: Overweight and obese children are at risk for developing type 2 diabetes. Overweight children are not particularly prone to developing glaucoma, migraine headache, or scoliosis.

5.A patient is prescribed phentermine (Ionamin) in an effort to promote weight loss. What is the most common adverse effect of phentermine? A) Dry mouth B) Hypernatremia C) Fatigue D) Hypoglycemia Ans: A Feedback: The most commonly reported adverse effects of phentermine are nervousness, dry mouth, constipation, and hypertension. Hypernatremia, fatigue, and hypoglycemia are not adverse effects of phentermine.

6. An obese patient has asked her nurse practitioner to prescribe sibutramine. What variable

A) B) C) D) Ans:

will most affect the nurse's decision? Sibutramine has been taken off the market due to adverse cardiovascular effects. Sibutramine is prohibitively expensive and is not covered by most insurers. The use of sibutramine requires weekly blood work. Sibutramine must be combined with an anticholinergic drug in order to potentiate its effects. A Feedback: Until recently, health care providers used sibutramine, a drug that suppresses appetite by inhibiting the reuptake of the neurotransmitters norepinephrine and serotonin, in the management of obesity. The drug is no longer available in the United States because a clinical study demonstrated an increased risk of cardiovascular events such as heart attack and stroke with its use.

7. Which of the following patients would be the most appropriate candidate for treatment

A) B) C) D)

with orlistat? A 31-year-old woman who has been unable to lose her “baby fat” in the months following the birth of her child A patient with a body mass index of 25.5 A man who is morbidly obese and who has osteoarthritis in his knees A 66-year-old man who was previously healthy but who has been gradually gaining

Ans:

weight since retirement C Feedback: Orlistat is intended for people who are clinically obese, not for those who want to lose a few pounds. A patient with a BMI of 25.5 is nominally overweight.

8.A patient is prescribed orlistat (Xenical) to promote weight loss. What is the action of orlistat? A) It increases central nervous system stimulation. B) It inhibits the reuptake of serotonin and norepinephrine. C) It decreases fat absorption, which leads to decreased caloric intake. D) It decreases appetite because of the caffeine contained in the medication. Ans: C Feedback: Orlistat decreases fat absorption, which leads to decreased caloric intake. Orlistat does not increase central nervous system stimulation. Orlistat does not inhibit reuptake of serotonin and norepinephrine. Orlistat does not decrease appetite because of the caffeine contained in the medication.

9.A 40-year-old patient has a body mass index that classifies him as being severely obese. For several months, the patient has been working with an interdisciplinary team in an effort to lose weight, but he has experienced nominal success. His physician has proposed the use of orlistat, and the nurse has conducted appropriate health education. What statement by the patient indicates a need for further teaching? A) “They explained to me that I have to take the medicine with my meals.” B) “I'm excited that I won't have to cut down on my favorite fried foods anymore.” C) “It still amazes me that you can take a pill that will actually help you lose weight.” D) “If I understand correctly, these pills will help me lower my cholesterol as well as lose weight.” Ans: B Feedback: It is necessary to decrease consumption of high-fat foods when taking orlistat because total caloric intake is a major determinant of weight, and adverse effects (e.g., diarrhea; fatty, malodorous stools) worsen with consumption of a large amount of fat. The patient's other listed statements are accurate.

10.A mother is distraught that her 13-year-old son weighs 260 pounds and continues to gain weight. She has asked her family's primary care provider if her child would be a candidate for treatment with orlistat, which she read about on the Internet. What fact should primarily guide the care provider's decision? A) Orlistat is not approved for use in children under the age of 18. B) Orlistat can only be administered to children in an inpatient setting. C) Alternatives such as increased activity and decreased caloric intake should first be

D) Ans:

exhausted. The drug is not likely to be effective until the boy completes puberty. C Feedback: Although experts do not generally recommend drug therapy for treatment of childhood obesity, the FDA has approved orlistat for use in children aged 12 and older and considers the drug to be safe and effective for weight reduction in overweight adolescents. Orlistat is not limited to inpatient use, and puberty does not negate efficacy.

11.A team of community health nurses have been commissioned to plan and implement a community-based health promotion initiative aimed at addressing obesity. During the planning stages, the nurses should be aware that the prevalence of obesity is highest in which of the following groups? A) Caucasian women B) Caucasian men C) African American women D) African American men Ans: C Feedback: African American women and Mexican American men and women have the highest rates of overweight and obesity in the United States.

12.An obese patient has been receiving extensive health education prior to beginning treatment with phentermine. The nurse has taught the patient about the varied factors that contribute to obesity. Which of these factors is addressed by the use of phentermine? A) Psychosocial factors B) Environmental factors C) Genetic factors D) Physiologic factors Ans: D Feedback: Because phentermine inhibits the reuptake of both serotonin and norepinephrine, it directly affects physiologic factors related to obesity.

13.A nurse who works with patients in a bariatric clinic is teaching a man about the potentially beneficial effects of phentermine. How should the nurse best explain this drug's mechanism of action? A) “This drug will cause you to have less of an appetite.” B) “This drug will cause you to absorb less of the fat that you eat.” C) “This drug will cause you to burn more calories than you normally do.” D) “This drug prevents fat from being deposited in your tissues.” Ans: A Feedback:

Phentermine inhibits the reuptake of both serotonin and norepinephrine. It is an anorexiant, causing appetite suppression, which is thought to result from direct stimulation of the satiety center in the hypothalamic and limbic region. It does not increase calorie metabolism or fat deposition.

14.A patient has been taking phentermine for the past month and a half. During the patient's most recent follow-up visit to the clinic, she tells the nurse, “The pills seemed to work wonders for me for the first few weeks, but now I feel like they don't really make much of a difference.” The nurse should anticipate that the prescriber will take what action? A) Increasing the daily dosage of the drug by approximately 50% B) Ordering blood work to ascertain the serum level of phentermine C) Discontinuing the drug D) Changing the route and schedule of administration Ans: C Feedback: Tolerance to phentermine usually occurs within 4 to 6 weeks and is an indication for discontinuing drug administration. Continued administration or use of large doses does not maintain appetite-suppressant effects. Instead, it increases the incidence of adverse effects. Blood work is unnecessary, and changing the route is not an option.

15.An adult patient with long-standing obesity has been deemed an appropriate candidate for treatment with phentermine. When teaching the patient to safely and effectively administer the drug, the nurse should convey what message to the patient? A) Take phentermine with food, preferably at mealtimes. B) Take the medication on an empty stomach. C) Take the medication 15 minutes after meals to reduce fat absorption. D) Take an increased dose of phentermine if a large meal is anticipated. Ans: B Feedback: It is necessary to take phentermine on an empty stomach. Recipients should take singledose drugs in the early morning; they should take multiple-dose preparations 30 minutes before meals, with the last dose of the day about 6 hours before going to bed. Doses are not increased when large meals are anticipated. Phentermine does not affect fat absorption.

16.A female patient with obesity will soon begin treatment with orlistat. The nurse should teach the patient that A) there will be fat present in her stools. B) her appetite will decline over the next 48 hours. C) she will have to increase her fiber intake. D) she will need to temporarily eliminate fats from her diet. Ans: A Feedback:

Fatty stools are a notable adverse effect of orlistat. This drug does not reduce appetite. A reduced-fat diet may be of benefit, but it is not necessary to wholly eliminate fats from the diet.

17.A nurse educator is working with a patient of a bariatric clinic who has just begun taking orlistat. The nurse should encourage the patient to supplement her diet with which of the following? A) An iron supplement B) A multivitamin C) An omega-3 fatty acid supplement D) A potassium supplement Ans: B Feedback: Because orlistat prevents absorption of the fat-soluble vitamins A, D, E, and K, people who take it should also take a multivitamin daily 2 hours before or after orlistat. Iron supplements, potassium supplements, and omega-3 fatty acid supplements are not necessarily required.

18.A 34-year-old woman with a body mass index of 56 has recently started to take orlistat. The nurse has educated the patient about the common adverse effects of this medication, including the potential for diarrhea and flatulence. Which of the following meals would be most likely to exacerbate the adverse effects of orlistat? A) A Cobb salad with romaine lettuce, boiled egg, chicken breast, tomato, and cheese B) A tomato, green pepper, and ham omelet C) A salami, sausage, and pepperoni pizza topped with mozzarella and parmesan D) A bowl of beef chili con carne topped with diced onions Ans: C Feedback: To minimize GI effects, the nurse encourages patients to distribute fat calories over the three main meals and to avoid high-fat meals. The fat content of a meat-laden pizza exceeds that of a Cobb salad, omelet, or bowl of chili.

19.A young adult man is despondent that he has been unable to lose weight and keep it off. Now that his weight has crested 350 pounds, he has sought advice from the nurse. He states that obesity runs in his family but that his mother had great success in losing weight with the use of amphetamines in the late 1970s. The nurse should explain to the man that this is not a treatment option because A) amphetamines have been shown to be largely ineffective in clinical studies. B) amphetamines have been superseded by more modern lipase inhibitors. C) amphetamines carry a high risk of dependence and abuse. D) amphetamines are prohibitively expense and are not covered by most health insurers. Ans: C

Feedback: Experts do not recommend using amphetamines because they are controlled substances (Schedule II) with a high potential for abuse and dependence. Amphetamines do not inhibit lipase.

20.A nurse has begun the assessment process with an obese patient who states that he is highly motivated to lose weight. How can the nurse most accurately gauge the patient's normal eating and drinking patterns? A) Have the patient keep a detailed food diary for 2 or 3 days. B) Ask the patient to describe a typical meal and snack. C) Check laboratory reports of total and LDL cholesterol, triglycerides, and blood sugar. D) Have the patient describe the differences between a healthy meal and an unhealthy meal. Ans: A Feedback: The best way to assess dietary habits is to ask the patient to keep a food diary for 2 or 3 days. If food intake is not written down, people tend to underestimate the amount and caloric content. Blood work is a relevant assessment datum but does not necessarily indicate the patient's eating and drinking habits. Having the patient describe a healthy or unhealthy meal does not allow the nurse to assess eating habits.

Chapter 37- Drug Therapy for Peptic Ulcer Disease and Hyperacidity 1. A patient is taking nonsteroidal anti-inflammatory agents for arthritis of the knees and hips. Which of the following diseases is a result of cellular destruction of the gastrointestinal tract from this medication? A) Esophageal cancer B) Bowel obstruction C) Liver cancer D) Peptic ulcer disease 2. A patient has Maalox ordered for administration as needed. Which of the following conditions contraindicates the administration of Maalox? A) Hypertension B) Heart rate of 68 C) Renal dysfunction D) Stress ulcer 3. A patient is diagnosed with peptic ulcer disease complicated by H. pylori. What is the rationale for adding bismuth to the patient's medication regimen? A) Increases pepsin activity B) Decreases gastrin secretion C) Prevents metabolic alkalosis D) Protects gastric mucosa from stomach acid 4. A patient is in the intensive care unit and being administered ranitidine (Zantac) parenterally. How long will it take for ranitidine (Zantac) to reach peak blood levels? A) 15 minutes B) 30 minutes C) 1 hour D) 2 hours 5. The nurse practitioner instructs the patient to use over-the-counter ranitidine (Zantac) instead of cimetidine (Tagamet). What risk is decreased when using ranitidine rather than cimetidine? A) Headache B) Drug-to-drug interaction C) Diarrhea D) Bradycardia 6. A patient is taking cimetidine (Tagamet) for increased gastric pain and hypersecretion. Nurses should use extreme caution when administering cimetidine to patients with which of the following conditions? A) Hepatic disease B) Cancer

C) D)

Hypertension Diabetes mellitus

7. A male patient is taking cimetidine (Tagamet). Which adverse effect is more likely to occur with cimetidine than with other histamine2 receptor antagonists? A) Hypoxia B) Hypertension C) Gynecomastia D) Seizures 8. A patient is prescribed a proton pump inhibitor to treat erosive gastritis. How soon will the patient's symptoms most likely be abolished? A) 1 to 2 weeks B) 4 weeks C) 1 month D) 6 weeks 9. A 23-year-old female patient is prescribed misoprostol (Cytotec). Which of the following patient teaching interventions is most important? A) Supplement therapy with magnesium antacids. B) Report postmenopausal bleeding. C) Use effective contraceptive measures. D) Administer the drug one time per day. 10. A 62-year-old man is surprised to learn that his recurrent indigestion has been attributed to a new diagnosis of peptic ulcer disease. The patient states, “I've never been a really anxious type of person, so I never thought I'd develop ulcers.” The nurse has responded with health education addressing the etiology of peptic ulcer disease. What causative factors should the nurse cite? Select all that apply. A) Physiologic or psychological stress B) Diabetes mellitus C) Cigarette smoking D) Infections E) Nonsteroidal anti-inflammatory drugs 11. A critically ill patient is being treated in a burn unit following a workplace accident. The patient's current treatment includes an intragastric drip of an antacid through a nasogastric tube. How should the critical care nurse most accurately titrate the dose and frequency of administration? A) By assessing the pH of a 24-hour urine sample B) By aspirating stomach contents and measuring the pH C) By measuring the pH of urine after each void D) By swabbing the patient's buccal mucosa and testing for pH daily

12. An adult patient has been taking Titralac (Tums) on an increasingly frequent basis. When teaching this patient, the nurse should include suggestions for the prevention of which of the following adverse effects? A) Constipation B) Urinary frequency C) Fatty stools D) Nausea 13. A patient who has been experiencing heartburn has begun taking OTC ranitidine (Zantac). The nurse who is working with this patient should be aware that this drug achieves a therapeutic effect by which of the following means? A) Raising the pH of gastric secretions B) Inhibiting the secretion of gastric acid C) Binding to proton pumps D) Decreasing gastric motility 14. A patient has sought care for follow-up to his recent diagnosis of peptic ulcer disease. The patient states that he has achieved adequate symptom relief with the use of OTC antacids but has asked the nurse about the optimal schedule for taking these drugs. What should the nurse recommend? A) Taking the drugs at the earliest appearance of symptoms B) Immediately prior to each meal and at bedtime C) Every 4 hours during all waking hours D) One hour and three hours after each meal and at bedtime 15. A patient has been prescribed omeprazole by her primary care provider. When questioned by the nurse about her perceived effectiveness of the drug, the patient states, “I think it's working quite well, and I've gotten in the routine of taking it every morning before breakfast.” How should the nurse respond? A) “That's good, but remember that you shouldn't take it on days when you're not having any symptoms.” B) “I'm glad it's working for you, but you'll probably find it works even better if you take it after eating.” C) “That's great. If you find later that it's not working as well, you might want to try taking it at bedtime.” D) “I'm glad to hear that. It sounds like you're taking it exactly like it should be taken.” 16. A patient with a complex medical history states that his primary care provider has changed his proton pump inhibitor from omeprazole (Prilosec) to esomeprazole (Nexium). The patient is unsure of the rationale for this change in medication and has raised this question with the nurse. What rationale is most plausible? A) Nexium has fewer adverse effects. B) Nexium can be used long term. C) Nexium has fewer drug interactions.

Nexium can be taken on an outpatient basis.

17. A patient who has a diagnosis of peptic ulcer disease has begun taking sucralfate (Carafate). The nurse should caution the patient against the concurrent use of A) antacids. B) NSAIDs. C) acetaminophen. D) probiotics. 18. A patient with ulcers has asked the nurse if it would be acceptable for him to take bismuth subsalicylate. Before recommending an OTC formulation of this drug, the nurse should assess the patient's A) immunization history. B) allergy status. C) cognition. D) normal bowel pattern.

1. Ans: D Feedback: Cell destruction will occur from the ingestion of NSAIDs, which can lead to the development of peptic ulcer disease. Nonsteroidal anti-inflammatory agents do not cause esophageal cancer, bowel obstruction, or liver cancer.

2. Ans: C Feedback: Magnesium-based antacids are contraindicated in patients with renal failure. Magnesium-based antacids are not contraindicated with hypertension, regular heart rate, or stress ulcer.

3. Ans: D Feedback: Health care providers use bismuth subsalicylate to coat ulcers, protecting them from stomach acid to treat H. pylori. Bismuth does not increase pepsin activity, decrease gastrin secretion, or prevent metabolic alkalosis.

4. Ans: A Feedback: Parenteral ranitidine reaches peak blood level in 15 minutes. Parenteral ranitidine reaches its peak prior to 30 minutes, 1 hour, and 2 hours.

5. Ans: B Feedback: Unlike cimetidine, ranitidine (Zantac), famotidine (Pepcid, Pepcid RPD), and nizatidine (Axid) do not affect the cytochrome P450 drug-metabolizing system in the liver and therefore do not interfere with the metabolism of other drugs. Use of these other drugs may be preferable in patients who are critically ill because they often require numerous other drugs with which cimetidine may interact.

6. Ans: A Feedback: No absolute contraindications exist, but cimetidine should be used cautiously in patients with impaired hepatic and renal function. The patient with cancer, hypertension, and diabetes mellitus can take cimetidine safely.

7. Ans: C

Feedback: Gynecomastia is an adverse effect that is more likely to occur with cimetidine than with other histamine2 antagonists. Hypoxia, hypertension, and seizures are not adverse effects of cimetidine. 8. Ans: A Feedback: The symptoms of gastroesophageal reflux disease will be abolished in 1 to 2 weeks after the start of the proton pump inhibitor medication regime. It will not take 4 weeks, 1 month, or 6 weeks to see a change with the proton pump inhibitor.

9. Ans: C Feedback: Misoprostol (Cytotec) is used to prevent NSAID gastric ulcer development. The medication can cause spontaneous abortion; thus, the medication should be administered with a good form of birth control. It should not be administered with magnesium antacids. It is not necessary for a patient aged 23 years to report postmenopausal bleeding. The medication should be administered two to four times per day.

10. Ans: A, C, D, E Feedback: There are multiple etiologic factors implicated in PUD. These include smoking, H. pylori infection, NSAID use, and stress. Diabetes is not an identified cause. 11. Ans: B Feedback: For patients with a nasogastric tube in place, antacid dosage may be titrated by aspirating stomach contents, determining pH, and then basing the dose on the pH. Accurate measurement of gastric pH cannot be determined from the buccal mucosa or urine.

12. Ans: A Feedback: With the antacid Titralac (Tums), which contains calcium, it is important to observe for constipation. Combining this antacid with other antacids containing magnesium may prevent this effect. Frequency, fatty stools, and nausea are not noted adverse effects.

13. Ans: B Feedback:

The histamine2 receptor antagonists (H2RAs) inhibit both basal secretion of gastric acid and the secretion stimulated by histamine, acetylcholine, and gastrin. These drugs, such as ranitidine, do not change the pH of secretions, bind to the proton pumps, or decrease gastric motility. 14. Ans: D Feedback: For treatment of peptic ulcer disease, patients should take antacids 1 and 3 hours after meals and at bedtime (four to seven doses daily), 1 to 2 hours before or after other medications.

15. Ans: D Feedback: It is important that omeprazole be administered before food intake. Once-daily dosing is typical. The drug is not taken solely as a response to acute symptoms.

16. Ans: C Feedback: The actions and pharmacokinetics of the other PPIs—esomeprazole (Nexium), lansoprazole (Prevacid), pantoprazole (Protonix), and rabeprazole (AcipHex)—are similar to those of omeprazole. However, the drug interactions associated with omeprazole reportedly do not occur with these other PPIs. 17. Ans: A Feedback: Antacids decrease the effects of sucralfate, and people should not take them within 30 minutes before or after administration of sucralfate.

18. Ans: B Feedback: Because it is a salicylate, this drug can cause serious bleeding problems when used alone in patients with ulcers. People with an allergy to aspirin or other salicylates should not take bismuth subsalicylate. The patient's bowel pattern, immunization history, and cognition are not central considerations.

1.A patient is experiencing nausea and vomiting as a response to radiation therapy. Which of the following antiemetic agents is a phenothiazine administered to control nausea and vomiting? A) Prochlorperazine (Compazine) B) Metoclopramide (Reglan) C) Mesna (Mesnex) D) Dexamethasone Ans: A Feedback: Prochlorperazine (Compazine) is a commonly used phenothiazine administered for nausea and vomiting related to radiation therapy. Metoclopramide is a prokinetic agent that increases GI motility and the rate of gastric emptying by increasing the release of acetylcholine from nerve endings in the GI tract. Mesna is used for thrombocytopenia. Dexamethasone is a corticosteroid.

2.A pregnant woman suffers from morning sickness. Which of the following should be considered a first-line treatment? A) Vitamin B6 B) Promethazine (Phenergan) C) Vitamin E D) Diphenhydramine (Benadryl) Ans: A Feedback: For pregnant women, taking pyridoxine (vitamin B6) 30 to 75 mg daily in three divided doses with or without the antihistamine doxylamine 12.5 mg every 8 hours as needed is considered a first-line treatment option that is safe and effective. Phenergan is not a firstline treatment for morning sickness. Benadryl and vitamin E are not used to treat nausea.

3.A patient with Parkinson's disease develops nausea and vomiting. Promethazine may be contraindicated because it depletes levels of what neurotransmitter? A) Acetylcholine B) Serotonin C) Dopamine D) Adenosine Ans: C Feedback: Promethazine and other phenothiazines have widespread effects on the body. The therapeutic effects in nausea and vomiting are attributed to their ability to block dopamine from receptor sites in the brain and CTZ. This blockage of dopamine has the potential to exacerbate parkinsonian effects.

4.What is a nonpharmacological measure that is effective in treating nausea and vomiting in pregnant women?

A) B) C) D) Ans:

Ginkgo biloba Ginger Garlic Ginseng B Feedback: Clinical trials indicate that ginger can effectively reduce nausea and vomiting associated with motion sickness, pregnancy, and surgery.

5.A patient is administered promethazine (Phenergan) for nausea and vomiting. Which of the following is an adverse effect of promethazine (Phenergan)? A) Urinary incontinence B) Tachycardia C) Taste alteration D) Extrapyramidal symptoms Ans: D Feedback: Extrapyramidal symptoms are adverse effects of promethazine. Urinary retention is an adverse effect, not urinary incontinence. Tachycardia is not an adverse effect of promethazine. Taste alteration is not an adverse effect of promethazine.

6.A patient is administered an antihistamine for nausea. Which of the following is an adverse effect of this classification of medication? A) Diarrhea B) Prolonged QRS complex C) Urinary retention D) Inverted T wave Ans: C Feedback: Adverse anticholinergic effects of antihistamines are dizziness, confusion, dry mouth, and urinary retention. Diarrhea, prolonged QRS complex, and inverted T wave are not adverse effects of antihistamines.

7.A patient is administered a phenothiazine for nausea and vomiting. What is the action of phenothiazine? A) Increases gastric motility B) Antagonizes dopamine receptors C) Blocks histamine receptors D) Antagonizes serotonin receptors Ans: B Feedback: Phenothiazines act on the CTZ and vomiting center by blocking dopamine. They do not increase gastric motility. Phenothiazines do not block histamine receptors. Phenothiazines

do not antagonize serotonin receptors.

8.A patient has been administered hydroxyzine for the treatment of nausea. Which of the following statements indicates that she has understood the teaching provided by the nurse? A) “I will take repeated doses of this medication until my nausea resolves.” B) “I may experience drowsiness with this medication.” C) “I should eat before I take this medication.” D) “I will need to take potassium with this medication.” Ans: B Feedback: Hydroxyzine will produce drowsiness in the patient. Repeated doses are unsafe. The patient should not eat with nausea. The patient does not need to take potassium with hydroxyzine.

9.A pediatric patient is receiving chemotherapy. What is the recommended treatment of nausea and vomiting with pediatric chemotherapy agents? A) Corticosteroids and 5-HT3 receptor antagonists B) Phenothiazines and benzodiazepines C) Proton pump inhibitors and antacids D) Prokinetic agents and antihistamines Ans: A Feedback: 5-HT3 receptor antagonists and corticosteroids are used to treat nausea and vomiting in pediatric oncology patients.

10.A 1-year-old postoperative patient has been experiencing repeated vomiting. What antiemetic drug has a black box warning against use in a patient of this age? A) Promethazine (Phenergan) B) Benzquinamide (Emete-Con) C) Buclizine (Bucladin-S) D) Cyclizine (Marezine) Ans: A Feedback: A black box warning alerts nurses that promethazine is contraindicated in children younger than 2 years of age because of the risk of potentially fatal respiratory depression. Benzquinamide, buclizine, and cyclizine do not have such warnings.

11. An adult patient is administered hydroxyzine for nausea. What adverse effect is most

A) B)

likely with this medication? Thrombocytopenia Palpitations

C) D) Ans:

Hypertonic muscle tone Dry mouth D Feedback: Anticholinergic effects, including dry mouth, can result from the use of hydroxyzine. This drug is not associated with thrombocytopenia, palpitations, or hypertonicity.

12. An 85-year-old patient is administered dimenhydrinate (Dramamine). Which of the

A) B) C) D) Ans:

following is the priority nursing intervention? Encourage fluids with this patient. Have the patient void after administration. Maintain IV access. Protect from injury. D Feedback: Dimenhydrinate (Dramamine) causes drowsiness, especially in older adults, and therefore should be used cautiously. The nurse should protect the patient from injury. The nurse should not force fluids. The patient will not require IV access unless fluid replacement is ordered.

13.A patient is administered promethazine. The patient has an elevated creatinine level. Which of the following is important when administering promethazine to this patient? A) Administer the routine dose. B) Administer a lower dose. C) Administer a higher dose. D) Hold the medication. Ans: B Feedback: A dose reduction may be necessary in patients with renal impairment to avoid the possibility of adverse effects, toxicity, or increased sensitivity to phenothiazines.

14.A patient who is scheduled to begin chemotherapy for the treatment of breast cancer is anxious about the possibility of experiencing nausea and has asked the nurse multiple questions about the physiology of the phenomenon. When explaining the physiology of nausea and vomiting, the nurse should include which of the following statements? A) The vomiting center is a cluster of cells in the cerebellum. B) The vomiting center sends afferent signals to the chemoreceptor trigger zone (CTZ). C) The chemoreceptor trigger zone CTZ is composed of neurons in the fourth ventricle. D) The CTZ is located partly within the central nervous system and partly in the peripheral nervous system. Ans: C

Feedback: The CTZ is composed of neurons in the fourth ventricle. The vomiting center is a nucleus of cells in the medulla oblongata. Stimuli are relayed to the vomiting center by afferent signals from the chemoreceptor trigger zone (CTZ).

15. An adult hospital patient has been experiencing intractable nausea and vomiting for

A) B) C) D) Ans:

several hours, so the nurse has obtained an order for an antiemetic from the primary care provider. The order reads: “Promethazine 25 mg sub-Q every 6 hours PRN.” The nurse should contact the care provider to question what aspect of this order? The drug The dose The route The frequency C Feedback: A black box warning alerts nurses that promethazine is contraindicated for subcutaneous administration. The other parameters of the order are within recommendations.

16. An older adult's physician has recommended the occasional use of hydroxyzine for relief

A) B) C) D) Ans:

of nausea. Following administration, the nurse should assess the patient for pruritus. drowsiness. urinary frequency. bradycardia. B Feedback: The use of hydroxyzine is associated with drowsiness. Antihistamines do not typically cause pruritus, frequency, or bradycardia.

17.A patient has been admitted to the postsurgical unit from postanesthetic recovery following a transurethral prostatic resection. The patient is experiencing nausea subsequent to anesthesia. What antiemetic is the most common first-line drug for the treatment of postoperative nausea and vomiting? A) Ondansetron (Zofran) B) Dronabinol (Marinol) C) Dimenhydrinate (Dramamine) D) Hydroxyzine (Vistaril, Atarax) Ans: A Feedback: The 5-HT3 receptor antagonists are usually considered drugs of first choice for postoperative nausea and vomiting. Ondansetron (Zofran) is the prototype of the 5-HT3 receptor antagonists.

18.A patient is undergoing a course of radiotherapy for the treatment of leukemia. Treatments in the past have caused the patient severe nausea and vomiting. The oncology nurse should normally administer antiemetics on what schedule? A) Simultaneous with radiation treatment B) The night before a scheduled radiation treatment C) 30 to 60 minutes before the treatment D) 10 to 15 minutes before the treatment Ans: C Feedback: The nurse should normally administer antiemetic drugs 30 to 60 minutes before a nauseaproducing event, when possible.

19.When reviewing a newly admitted patient's previous medication record, the nurse notes that the patient has previously been treated with aprepitant (Emend). The nurse is justified is suspecting that this patient's medical history includes which of the following? A) Placement of a nasogastric tube B) Chemotherapy C) Endoscopy D) Radiation therapy Ans: B Feedback: Prescribers often order aprepitant as part of combination therapy along with a 5-HT3 receptor antagonist and corticosteroids to treat both acute and delayed nausea and vomiting associated with chemotherapy. NG tube insertion, radiation therapy, and endoscopy are not typical indications for the use of aprepitant.

20.A hospital patient has a standing order for aprepitant on an as-needed basis. The patient should be encouraged to request a dose of the drug A) when she anticipates that she will become nauseous. B) at the same time each day. C) as soon as she senses the onset of nausea. D) when her nausea results in vomiting. Ans: A Feedback: The nurse instructs patients to take aprepitant as prescribed before the onset of nausea and vomiting. It does not need to be taken on a regular schedule and should not be withheld until the onset or peak of symptoms.

Chapter 39- Drug Therapy for Constipation and Elimination Problems 1. Defecation is normally stimulated by what physiologic trigger? A) Movements and reflexes in the gastrointestinal tract B) Stimulation from the medulla oblongata C) Synthesis and release of digestive enzymes D) Changes in the osmolarity of bowel contents Ans: A Feedback: Defecation is normally stimulated by movements and reflexes in the gastrointestinal tract. It does not result from changes in osmolarity, CNS stimulation, or the release of enzymes.

2. Constipation is defined as A) the passage of fewer than three stools in any 7-day period. B) the passage of fewer than five stools in any 7-day period. C) the infrequent and painful expulsion of hard, dry stools. D) a subjective sensation of bowel fullness. Ans: C Feedback: Constipation is the infrequent and painful expulsion of hard, dry stools. It is not defined by a particular number of stools or in terms of an individual's subjective sensation.

3. A patient is using psyllium hydrophilic mucilloid (Metamucil) to promote evacuation of stool. What is the action of this medication? A) It reduces the surface tension of bowel contents. B) It irritates the intestinal mucosa, thus increasing intestinal motility. C) It increases mass and water content of stool, promoting evacuation. D) It creates a barrier between the colon wall and feces. Ans: C Feedback: Bulk-forming laxatives increase mass and water content of the stool, promoting evacuation. Bulk-forming laxatives do not reduce surface tension of bowel contents. Bulk-forming laxatives do not irritate the intestinal mucosa to increase intestinal motility. Bulk-forming laxatives do not create a barrier between the colon wall and feces.

4. Which of the following statements by your patient leads you to believe that he has understood how to safely and effectively use bulk-forming laxatives? A) “I will mix the medication with around a cup of fluid and then drink the mixture.” B) “I will mix the dry medication with applesauce and then eat prunes before bedtime.” C) “I will use milk of magnesia in conjunction with Metamucil until I have a bowel movement.” D) “I will decrease the roughage in my diet while I am taking the bulk-forming laxative and eat rice.”

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Ans: A Feedback: Bulk-forming laxatives increase mass and water content of the stool, promoting evacuation. Mixing the bulk-forming laxative with applesauce will not provide the needed fluid, and the applesauce can have a binding effect. It is not necessary to mix milk of magnesia with Metamucil. The patient should not decrease roughage in the diet or eat rice, which is binding.

5. Your patient is taking psyllium hydrophilic mucilloid (Metamucil) daily. What information should be included in the discharge plan? A) Drink at least 8 ounces of fluid with the medication. B) Mix the medication with your food at the evening meal. C) Combine all of your medications with the mucilloid. D) Discontinue the mucilloid if you do not have a bowel movement daily. Ans: A Feedback: Bulk-forming laxatives increase mass and water content of the stool, promoting evacuation. The patient should drink at least 8 ounces of fluid with the medication. The patient should not mix the medication with food or other medications. The mucilloid should not be discontinued if the patient does not have a bowel movement.

6. When assessing a patient's bowel habits, which of the following descriptions is the best indication of normal bowel elimination? A) One bowel movement daily in the AM B) One bowel movement daily in the PM C) Soft, formed stool D) Liquid stool Ans: C Feedback: Normal bowel elimination should produce soft, formed stool. One bowel movement in the AM or PM may not be a regular bowel pattern for all patients. Liquid stool is not an indication of normal bowel elimination.

7. A patient is suffering from constipation. He is a truck driver and does not always have access to a toilet. When providing patient teaching, what will result when the patient fails to respond to the defecation reflex? A) Involuntary evacuation B) Increased defecation reflex C) Decreased defecation reflex D) Diarrhea Ans: C Feedback: In people who often inhibit the defecation reflex or fail to respond to the urge to

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defecate, constipation develops as the reflex weakens. The patient will not have involuntary evacuation. The patient will not have increased sensory stimulation. The patient will not have diarrhea.

8. The nurse has an order to administer a saline cathartic to a patient who has a history of congestive heart failure. Why is this type of cathartic contraindicated with this patient? A) The patient is at risk for hypomagnesemia. B) The patient is at risk for excess fluid volume. C) The patient is at risk for third spacing. D) The patient is at risk for hyperphosphatemia. Ans: B Feedback: Patients with congestive heart failure are at risk for fluid retention and edema with sodium-containing laxatives. The patient is not at risk for hypomagnesemia, hypochloremia, or hyperphosphatemia.

9. A patient is scheduled for a colonoscopy in the morning. Which laxative is most likely prescribed the evening before the colonoscopy? A) Psyllium (Metamucil) B) Polyethylene glycol–electrolyte solution (NuLYTELY) C) Castor oil D) Lactulose (Cephulac) Ans: B Feedback: Polyethylene glycol–electrolyte solution (NuLYTELY) is a nonabsorbable oral solution that induces diarrhea within 30 to 37 minutes and rapidly evacuates the bowel, usually within 4 hours for a colonoscopy. Psyllium is not strong enough for a colonoscopy preparation. Castor oil is not the most commonly prescribed preparation for a colonoscopy. Lactulose is normally used only when the serum ammonium level is elevated.

10. A patient is administered a stimulant cathartic. Which of the following is the most common adverse effect of a stimulant cathartic? A) Nausea B) Vomiting C) Diarrhea D) Rectal bleeding Ans: C Feedback: The stimulant cathartics are the strongest and most abused laxative products. These drugs act by irritating the GI mucosa and pulling water into the bowel lumen. As a result, feces are moved through the bowel too rapidly to allow colonic absorption of fecal water, so a watery stool is eliminated. Nausea, vomiting, and rectal bleeding

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should not routinely occur.

11. A patient with alcoholism and chronic liver failure is admitted to the medical unit. He is confused and has an elevated serum ammonia level. What laxative will the nurse administer to lower the serum ammonia level? A) Docusate sodium (Colace) B) Polyethylene glycol–electrolyte solution (NuLYTELY) C) Lactulose (Cephulac) D) Sorbitol Ans: C Feedback: Lactulose decreases production of ammonia in the intestine. Lactulose is a disaccharide that is not absorbed from the GI tract. It is used to treat hepatic encephalopathy. Docusate sodium only provides stool softening and has no effect on serum ammonia levels. Polyethylene glycol–electrolyte solution (NuLYTELY) is not used to decrease serum ammonia. Sorbitol is not used to decrease serum ammonia.

12. An older adult's constipation has not responded to first-line laxatives, so lactulose has been prescribed. The nurse should know that this medication achieves a therapeutic effect by which of the following means? A) Decreasing the viscosity of intestinal contents in the duodenum B) Pulling water into the intestinal lumen by osmotic pressure C) Irritating the intestinal mucous membrane D) Relaxing the muscle tone of the ileocecal valve and anal sphincter Ans: B Feedback: Lactulose (Chronulac, Cephulac) is a disaccharide that is not absorbed from the GI tract. It exerts laxative effects by pulling water into the intestinal lumen. It does not change muscle tone, change the viscosity of bowel contents, or irritate the intestinal epithelium.

13. A hospice patient is receiving opioids for treatment of cancer pain. Which laxative will best assist in the prevention of constipation? A) Lactulose (Cephulac) B) Stimulant C) Saline D) Bulk-forming Ans: B Feedback: Stimulant laxatives are the most commonly used laxative with these patients. Lactulose is not usually recommended. Saline laxatives are not recommended due to electrolyte imbalance. Bulk-forming laxatives are not usually recommended for patients with cancer because they may not be able to drink adequate amounts of fluid required with these medications.

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14. You are the nurse educating new parents on prevention and treatment of constipation with infants. What is the most effective and safest way to treat constipation in infants prior to bowel training? A) Milk of magnesia B) Sorbitol C) Dulcolax suppositories D) Glycerin suppositories Ans: D Feedback: Glycerin suppositories are often effective in infants and children. Milk of magnesia, sorbitol, and Dulcolax suppositories are not recommended.

15. Which of the following patients is at highest risk for alteration in bowel elimination? A) A patient who is paralyzed from a spinal cord injury B) A patient who has a diagnosis of type 2 diabetes C) A patient who has hypertension D) A patient who takes thyroid replacements Ans: A Feedback: Spinal lesions can often result in constipation. Thyroid replacements, high blood pressure, and hypertension are not risk factors for constipation.

16. A middle-aged patient is frustrated by her increasingly frequent episodes of constipation. She tells the nurse that she is highly reluctant to take medications. What nonpharmacologic measure should the nurse recommend? A) Adoption of a low-fat diet B) Use of a fiber supplement C) Daily consumption of 6 to 8 L of fluids D) Use of a ginger or ginseng supplement Ans: B Feedback: There is some evidence that fiber supplements improve the frequency and consistency of stools. No effectiveness data support increasing fluids beyond normal intake. Low fat intake, ginger, and ginseng are not noted to benefit patients with constipation.

17. An older adult has told the nurse practitioner that she has regularly drunk mineral oil to treat occasional episodes of constipation. The nurse should encourage the patient to explore other treatments because the use of oral mineral oil can result in A) edema from changes in intestinal solute content. B) paralytic ileus. C) rebound constipation.

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D) decreased absorption of drugs and vitamins. Ans: D Feedback: Oral use of mineral oil may cause potentially serious adverse effects, including decreased absorption of fat-soluble vitamins and some drugs and lipid pneumonia if aspirated into the lungs. Thus, mineral oil is not an oral laxative of choice in any condition. It is not noted to cause rebound constipation, paralytic ileus, or edema.

18. A surgical patient's postoperative orders include the twice-daily administration of docusate sodium. The patient is concerned about developing diarrhea from this medication, so the nurse has begun patient education. What should the nurse teach the patient about docusate sodium? A) “This medication will soften your stools over the next couple of days.” B) “You'll usually have a bowel movement within 2 to 3 hours of taking this.” C) “This medication will cause your bowels to contract more strongly than they normally do.” D) “This drug will help you pass regular stools while you're in the hospital, but you should not take it for more than 5 days.” Ans: A Feedback: Surfactant laxatives (e.g., docusate calcium or docusate sodium) decrease the surface tension of the fecal mass to allow water to penetrate into the stool. They also act as a detergent to facilitate admixing of fat and water in the stool. As a result, stools are softer and easier to expel. These agents have little, if any, laxative effect. Their main value is to prevent straining while expelling stool. They usually act within 1 to 3 days and should be taken daily.

19. A community health is conducting a health promotion session with a group from a local seniors' center. The nurse has addressed the issue of laxative overuse in this population. The nurse should highlight what consequence of the overuse of laxatives? A) Dependence B) Impaired absorption of water-soluble vitamins C) Fecal incontinence D) Abdominal pain Ans: A Feedback: Overuse of laxatives results in dependence. This is a significant problem among older adults and is more common than fecal incontinence, impaired vitamin absorption, or abdominal pain.

20. An adult resident of an assisted living facility has not responded appreciably to bulkforming laxatives so the primary care provider has prescribed bisacodyl. The nurse who oversees the care at the facility should know that this drug may be administered by what

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routes? Select all that apply. A) Oral B) Intravenous C) Subcutaneous injection D) Suppository E) Intramuscular injection Ans: A, D Feedback: Bisacodyl can be administered orally or by suppository. Parenteral administration is not possible.

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Chapter 40- Drug Therapy for Diarrhea 1. A patient with anorexia nervosa has taken a saline cathartic to lose weight. What is the patient at risk for? A) Constipation B) Diarrhea C) Bowel obstruction D) Hyponatremia 2. A grade school has an outbreak of gastroenteritis and vomiting with nearly half of the school—both students and staff—affected. Which organism is most likely the cause? A) Norwalk-like virus (calicivirus) B) Clostridium difficile C) Vibrio vulnificus D) E. coli 3. A cancer patient has intractable diarrhea that is not of an infectious nature. Which of the following medications will most likely be prescribed? A) Bismuth B) Pepto-Bismol C) Psyllium D) Opioids 4. An older adult patient is experiencing diarrhea. Which of the following is a likely cause of diarrhea? A) Fluid volume deficit B) Antihypertensive agents C) Laxative abuse D) Anemia 5. The physician orders bismuth subsalicylate (Pepto-Bismol) for your patient. What assessment is most important to make before administering this medication? A) Assess for pain B) Assess electrolytes C) Assess for allergy to aspirin D) Assess for allergy to opioids 6. A patient diagnosed with HIV/AIDS has diarrhea that is not responding to antidiarrheal agents. Which medication will best assist in treating this patient's diarrhea? A) Bismuth salts (Pepto-Bismol) B) Ciprofloxacin (Cipro) C) Cholestyramine (Questran) D) Octreotide acetate (Sandostatin)

7. A patient who has been experiencing liquid stools is prescribed polycarbophil (FiberCon). What is the reason for administering a bulk-forming laxative? A) Polycarbophil absorbs large amounts of water and decreases fluidity of stools. B) Polycarbophil will diminish the absorption of intestinal fiber and water. C) Polycarbophil will provide pain relief and decrease cramping and bloating. D) Polycarbophil will increase bile and diminish bacterial flora in the intestines. 8. A patient with Crohn's disease is experiencing diarrhea during an exacerbation of symptoms. What medication will the nurse most likely administer? A) Bismuth salts (Pepto-Bismol) B) Ciprofloxacin (Cipro) C) Cholestyramine (Questran) D) Octreotide acetate (Sandostatin) 9. A 20-month-old child is experiencing diarrhea. When planning the child's care, the nurse should prioritize assessments related to what health problem? A) Electrolyte deficiencies B) Anorectal bleeding C) Anal fissures D) Nausea 10. A patient is discharged with octreotide (Sandostatin) and has been given minimal patient teaching. What is the most important aspect of patient teaching for this patient? A) The importance of maintaining a diet high in fiber B) The administration of subcutaneous injections C) The concurrent use of bismuth subsalicylate and octreotide D) The administration of morphine to decrease pain 11. A woman is seen in the primary care provider's office with chronic severe diarrheapredominant irritable bowel syndrome, which has not responded to conventional therapy. Which medication should the nurse anticipate administering? A) Rifaximin (Xifaxan) B) Nitazoxanide (Alinia) C) Alosetron (Lotronex) D) Cholestyramine (Questran) 12. A patient has been treated successfully for diarrhea and has had only one loose bowel movement during the day. Which of the following foods should be introduced back into the diet first? A) Chicken breast B) Beef stew C) Baked potato D) Lentils

13. A patient is experiencing diarrhea and being treated with diphenoxylate (Lomotil). The presence of which condition requires that diphenoxylate (Lomotil) be administered cautiously? A) Edema B) Hepatorenal disease C) Congestive heart failure D) Cardiovascular insufficiency 14. A middle-aged female has presented to the emergency department (ED) after 36 hours of severe diarrhea that shows no sign of abating. The patient's family members are asking that the care team provide medications to resolve her diarrhea. The ED nurse should be aware that the use of diphenoxylate (Lomotil) would be contraindicated in which of the following circumstances? A) The patient has a documented history of laxative abuse. B) The patient's diarrhea is caused by the ingestion of toxins. C) The patient's diarrhea is attributable to psychosocial stress. D) The patient has an allergy to aspirin. 15. An older adult patient has received his third dose of diphenoxylate (Lomotil) and the nurse is monitoring the patient's bowel patterns closely. In addition to monitoring the number and consistency of the patient's stools, the nurse should prioritize what assessment? A) Assessment of cognition and neurological status B) Assessment of oxygen saturation and respiratory rate C) Assessment of nutritional status D) Assessment of fluid and electrolyte balance 16. A patient has contacted the clinic, stating to the nurse, “I've been taking Imodium for the past day-and-a-half, and my diarrhea shows no signs of slowing down.” The nurse should respond to the patient in the knowledge that Imodium should be discontinued if her diarrhea does not improve in the next A) 12 hours. B) 2 days. C) 3 to 4 days. D) week. 17. Which of the following patients with diarrhea would be most likely to be prescribed octreotide (Sandostatin)? A) A child who has been diagnosed with E. coli infection B) An older adult who has been abusing laxatives for several months C) A teenage patient who has been diagnosed with ulcerative colitis D) A patient with HIV/AIDS who has developed intractable diarrhea

18. A patient's severe diarrhea has necessitated treatment with polycarbophil (FiberCon). The nurse should caution the patient about the possibility of what adverse effect? A) Nausea and vomiting B) Headache and visual disturbances C) Abdominal fullness and bloating D) Gastroesophageal reflux 19. When reviewing a patient's medication history, the nurse observes that the patient has recently completed a course of treatment with nitazoxanide (Alinia). The nurse is justified in suspecting that the patient was infected with what microorganism? A) Giardia lamblia B) E. coli C) Salmonella D) Campylobacter jejuni 20. Cholestyramine (Questran) and colestipol (Colestid) are useful in treating diarrhea due to which of the following causes? A) Gram-positive bacterial infection B) Bile salt accumulation C) Retroviruses D) Autoimmune processes

1. Ans: B Feedback: A patient who uses laxatives, such as saline laxatives, and suffers from anorexia nervosa will be prone to diarrhea. The patient who takes a saline laxative will not suffer from constipation. The patient who takes a saline laxative will not be at risk for bowel obstruction. The patient who takes a saline cathartic will be at risk for hypernatremia, not hyponatremia.

2. Ans: A Feedback: An outbreak of gastroenteritis that is accompanied by vomiting and that affects both staff and students is most predominately caused by the Norwalk-like virus (calicivirus). Clostridium difficile is a nosocomial diarrhea that would not be characteristic of this population. Vibrio vulnificus is contamination of raw shellfish and would not be the cause of gastroenteritis. E. coli is a less likely cause.

3. Ans: D Feedback: Opioids are the most effective agents for symptomatic treatment of diarrhea. Bismuth and Pepto-Bismol are the same agents and would not be used for intractable, severe diarrhea. Psyllium would not be administered for diarrhea, except if there were a need to absorb toxins.

4. Ans: C Feedback: Laxative abuse is associated with diarrhea. This phenomenon is particularly common among older adults. Antihypertensive agents and anemia are not associated with diarrhea. Fluid volume deficit is a result, not cause, of diarrhea.

5. Ans: C Feedback: Bismuth salts have antibacterial and antiviral activity. Bismuth subsalicylate contains salicylate, and the patient should be assessed for an aspirin allergy before administration. It is important to assess for pain and electrolyte balance, but this is not the primary assessment to be made. The nurse would not need to assess for allergy to opioids because bismuth does not contain opioids.

6. Ans: D Feedback:

Octreotide acetate (Sandostatin) is a synthetic form of somatostatin that is effective in diarrhea related to HIV/AIDS. Bismuth salts are not used for diarrhea that does not respond to other agents. Ciprofloxacin will not be used to treat diarrhea. Cholestyramine will not be used to treat diarrhea.

7. Ans: A Feedback: Polycarbophil is an adsorbent drug that works by absorbing large amounts of water and produces stools of gelatin-like consistency. Polycarbophil will not diminish the absorption of intestinal fiber and water. Polycarbophil will cause abdominal discomfort and bloating. Polycarbophil has no effect on bacterial flora in the intestines.

8. Ans: C Feedback: Bile-binding drugs, such as cholestyramine (Questran) or colestipol, are useful in treating diarrheas due to bile salt accumulation in conditions such as Crohn's disease. Bismuth salts, ciprofloxacin, and octreotide are not typically administered to the patient with Crohn's disease.

9. Ans: A Feedback: If severe or prolonged, acute diarrhea may lead to serious fluid and electrolyte depletion, especially in young children and older adults.

10. Ans: B Feedback: If octreotide is taken at home, the home care nurse may need to teach the patient or a caregiver how to administer subcutaneous injections; this drug is not available orally. The patient should limit the intake of fiber. The patient would not be administered bismuth subsalicylate with octreotide. The patient would not be administered morphine to decrease pain related to diarrhea. 11. Ans: C Feedback: Alosetron (Lotronex) is a selective 5-HT3 receptor antagonist indicated for treating women with chronic severe diarrhea-predominant irritable bowel syndrome that has not responded to conventional therapy. Rifaximin (Xifaxan) is a nonsystemic antibiotic that would not be prescribed for this patient. Nitazoxanide (Alinia) is an antiprotozoal agent used for Giardia lamblia. Cholestyramine (Questran) is a bile-binding drug and is not the drug of choice for this patient.

12. Ans: C Feedback: Following diarrhea, bland foods should be introduced back into the diet, such as baked potato. The patient should not resume a diet with chicken, beef stew, or lentils until later.

13. Ans: B Feedback: Diphenoxylate should be used with extreme caution in patients with severe hepatorenal disease because hepatic coma may be precipitated. Edema, congestive heart failure, and cardiovascular insufficiency are not conditions in which cautious administration with diphenoxylate is needed. 14. Ans: B Feedback: Contraindications to the use of diphenoxylate with atropine include diarrhea caused by toxic materials, microorganisms that penetrate intestinal mucosa (e.g., pathogenic E. coli, Salmonella, Shigella), and antibiotic-associated colitis. Laxative abuse, allergies to aspirin, and the presence of stress do not contraindicate the safe use of Lomotil.

15. Ans: D Feedback: After drug administration, the nurse monitors the number and consistency of stools and fluid and electrolyte balance. The patient's fluid and electrolyte balance is more vulnerable during prolonged diarrhea than neurological, nutritional, or respiratory status.

16. Ans: A Feedback: In general, it is necessary to discontinue loperamide after 48 hours if clinical improvement has not occurred. 17. Ans: D Feedback: Diarrhea secondary to HIV/AIDS is an indication for treatment with octreotide. Laxative abuse, IBS, and E. coli infections would likely be treated with alternative antidiarrheal medications.

18. Ans: C Feedback: Polycarbophil may cause abdominal discomfort and bloating and may reduce the absorption of coadministered medications. It is not noted to cause nausea and vomiting, reflux, or headache.

19. Ans: A Feedback: Nitazoxanide (Alinia) is an antiprotozoal agent used specifically for treating diarrhea resulting from infection with Giardia lamblia or Cryptosporidium parvum. It is not used in the treatment of diarrhea associated with E. coli, Salmonella, or Campylobacter jejuni.

20. Ans: B Feedback: Cholestyramine (Questran) and colestipol (Colestid) are useful in treating diarrhea due to bile salt accumulation in conditions such as Crohn's disease or surgical excision of the ileum.

Chapter 41- Drug Therapy for Diabetes Mellitus 1. A patient with a diagnosis of diabetes is prescribed pramlintide (Symlin). How will this drug assist in controlling the patient's blood sugar? A) It slows gastric emptying. B) It blocks the absorption of food. C) It is absorbed by insulin. D) It increases the release of insulin. 2. A patient is diagnosed with type 1 diabetes. What distinguishing characteristic is associated with type 1 diabetes? A) Blood glucose levels can be controlled by diet. B) Exogenous insulin is required for life. C) Oral agents can control blood sugar. D) The disease always starts in childhood. 3. A patient is in diabetic ketoacidosis. The patient blood glucose level is over 600 mg/dL. The physician has ordered the patient to receive an initial dose of 25 units of insulin intravenously. What type of insulin will most likely be administered? A) NPH insulin B) Lente insulin C) Ultralente insulin D) Regular insulin 4. During a teaching session on the care of the diabetic patient, a family member asks why her daughter has a different insulin than her best friend. The nurse should make which of the following statements to explain the differences in insulin? A) “Insulin is prescribed based on the insurer's criteria for reimbursement.” B) “Insulin is prescribed based on the patient's age.” C) “Insulins have different onsets and durations of action.” D) “Insulin type is matched with the appropriate oral hypoglycemic agent.” 5. A patient asks the nurse why a quick-acting sugar given by mouth is better in the regulation of insulin than the use of intravenous glucose for a low blood sugar. Which of the following statements by the nurse represents the most appropriate response to this question? A) “The ingestion of food allows the digestive tract to stimulate vagal activity and the release of incretins.” B) “The combination of insulin and food will yield a higher blood sugar than intravenous glucose.” C) “Both food and intravenous glucose will produce changes similarly in the gastrointestinal tract to increase blood sugar.” D) “You are mistaken. The intravenous glucose yields a higher blood glucose through the release of incretins.”

6. A 58-year-old patient who has been living with diabetes since age 14 states he has pain in his feet and hands. What is this pain most likely a result of? A) A diabetes-related infectious process B) Peripheral neuropathy C) An autoimmune disorder D) Hypertension resulting from diabetes 7. A patient is to be administered glipizide (Glucotrol). Which of the following factors would contraindicate the administration of glipizide (Glucotrol) to this patient? A) A diagnosis of hypertension B) The ingestion of carbohydrates C) Allergy to sulfonamides D) Increase in alkaline phosphatase 8. A patient has been prescribed acarbose (Precose). What is the advantage of acarbose over alternative drugs? A) It can replace the use of insulin. B) The patient does not have to limit food intake. C) It delays the digestion of complex carbohydrates. D) It prevents alkalosis. 9. A patient who regularly takes metformin has developed a severe infection. How will the infection change his diabetic regimen? A) Metformin is contraindicated in the presence of an infection. B) Metformin will be given more frequently to decrease blood sugar. C) Metformin will result in better regulation of blood sugar. D) Metformin will allow the patient to decrease the absorption of glucose. 10. Sitagliptin (Januvia) is prescribed for a patient who has been diagnosed with type 2 diabetes. What is the action of sitagliptin (Januvia)? A) It blocks the S phase of the cell cycle. B) It slows the rate of inactivation of the incretin hormones. C) It is a synthetically prepared monosodium salt. D) It inhibits hydrogen, potassium, and ATPase. 11. A patient of Italian descent has been prescribed antidiabetic medications. Heavy intake of which of the following herbs should be avoided by this patient? A) Garlic B) Anise C) Basil D) Oregano

12. A patient has suffered from hypoglycemia twice in the past week. She states she eats one meal per day and snacks the rest of the day. What patient education will you provide for this patient? A) She should limit her alcohol with meals. B) She should increase her caloric intake. C) She should increase her protein intake during snacks. D) She should not eat at sporadic times. 13. An 8-month-old infant is admitted to the pediatric floor of the community hospital with a new diagnosis of diabetes. The patient is to receive 1 unit of regular insulin subcutaneously. How will that 1 unit be administered? A) It is administered orally. B) It is administered as U-5. C) It is administered with a TB syringe. D) It is administered as U-10. 14. A patient in his mid-30s has received a diagnosis of type 2 diabetes. Following his diagnosis, he has been meeting with a nurse regularly as well as performing extensive online research. Which of the patient's statements should prompt the nurse to perform further teaching? A) “I don't like getting this diagnosis, but I know that treatment now can prevent future health consequences.” B) “I'm disappointed, but I take some solace in the fact that I won't ever have to have insulin injections.” C) “People always tried to encourage me to lose weight, and I suppose they might have been right.” D) “From what I've learned, I know that the basic problem is that my pancreas can't keep up with my insulin needs.” 15. A nurse educator is explaining the pathophysiology of diabetes to a newly diagnosed patient. The patient does not understand why she had a “constant, insatiable thirst” in the months preceding her diagnosis. What phenomenon should the nurse describe? A) “The excess glucose in your blood accumulates in your blood vessels and neurons, including the neurons that control thirst.” B) “Excess glucose pulled more water through your kidneys and the increased urination caused thirst.” C) “Increased thirst is your body's attempt to dilute your blood because it contains too much glucose.” D) “When your body cells are starved for useful glucose, they signal your body to increase food and fluid intake.” Ans: B Feedback: When large amounts of glucose are present, water is pulled into the renal tubule. This results in a greatly increased urine output (polyuria). The excessive loss of fluid in urine leads to increased thirst (polydipsia). Glucose does not directly affect the thirst center.

16. A hospital patient with a diagnosis of type 1 diabetes is ordered Humulin R on a sliding scale. Based on the patient's blood glucose reading, the nurse administered 8 units of insulin at 07:45. The nurse recognizes the need to follow up this intervention and will reassess the patient's blood glucose level when the insulin reaches peak efficacy. The nurse should consequently check the patient's blood glucose level at what time? A) 08:15 B) Between 08:45 and 09:45 C) Between 09:45 and 10:45 D) Between 11:15 and 11:45 17. A patient's medication administration record specifies that the patient is to receive 20 units of NPH insulin at 08:00. Before administering this medication, the nurse must do which of the following? A) Massage the chosen injection site. B) Assess the patient's understanding of diabetes. C) Assess the patient's urine for the presence of glucose. D) Have a colleague confirm the dosage. 18. A hospital patient is to receive 4 units of regular insulin prior to lunch. The nurse knows that the lunch trays are usually distributed at approximately 12:15. The nurse should plan to administer the patient's insulin at what time? A) 12:15 B) 12:10 C) 11:45 D) D) 11:15 19. A patient will soon begin treatment for diabetes using glyburide. Which of the following conditions must be met in order for treatment to be effective? A) The patient must have functioning pancreatic beta cells. B) The patient must have hemoglobin A1C of 7%. C) The patient must not have hyperglycemia. D) The patient must be able to self-administer the medication. 20. A 69-year-old woman has been taking metformin for the treatment of type 2 diabetes for several years. Which of the following changes in the woman's laboratory values may demonstrate a need to discontinue the medication? A) A decrease in hemoglobin and hematocrit B) A decrease in glomerular filtration rate C) A decrease in potassium accompanied by an increase in sodium D) An increase in white blood cells

1. Ans: A Feedback: Pramlintide slows gastric emptying, helping to regulate the postprandial rise in blood sugar. Pramlintide does not block the absorption of food. Pramlintide is not absorbed by insulin. Pramlintide does not increase the release of insulin 2. Ans: B Feedback: Type 1 diabetes will result in eventual destruction of beta cells, and no insulin is produced. The blood glucose level can only be controlled by diet in type 2 diabetes. In type 2 diabetes, oral agents can be administered. Type 1 diabetes is diagnosed at many ages, not only in childhood.

3. Ans: D Feedback: Regular insulin has rapid onset of action and can be given via IV. It is the drug of choice for acute situations, such as diabetic ketoacidosis. Isophane insulin (NPH) is used for long-term insulin therapy. Lente insulin is an intermediate-acting insulin. Ultralente insulin is a long-acting insulin.

4. Ans: C Feedback: When insulin therapy is indicated, the physician may choose from several preparations that vary in composition, onset, duration of action, and other characteristics. Insulin is not prescribed based solely on cost. Insulin is not prescribed based solely on the patient's age. Insulin is not usually matched with oral hypoglycemic agents.

5. Ans: A Feedback: Oral glucose is more effective than intravenous glucose because glucose or food in the digestive tract stimulates vagal activity and induces the release of gastrointestinal hormones called incretins. The combination of insulin and food does not yield a higher blood glucose than intravenous insulin. Food stimulates the vagal nerve activity, but intravenous glucose does not. A statement that indicates that the patient is mistaken will belittle the patient and should be rephrased.

6. Ans: B Feedback: Pain in the feet and hands is related to changes in small blood vessels resulting in neuropathy. The long-term effect of diabetes can result in an infectious process, but the pain described is not indicative of an infection. Latent autoimmune diabetes of the adult

has an onset in adulthood and thus is not a long-term disorder. Hypertension is a longterm chronic effect of diabetes but is not what has been described with pain in the feet and hands. 7. Ans: C Feedback: Sulfonylureas are contraindicated in patients with hypersensitivity to them, with severe renal or hepatic impairment, and who are pregnant. A diagnosis of hypertension does not cause contraindication of sulfonylureas. The patient should consume carbohydrates in association with the oral hypoglycemic agent. An increase in alkaline phosphatase does not result in the contraindication of glipizide (Glucotrol).

8. Ans: C Feedback: Acarbose delays the digestion of complex carbohydrates into glucose and other simple sugars. Acarbose may be combined with insulin or an oral agent, usually a sulfonylurea. The patient will still need to remain on a diabetic dietary regime. The drug does not directly prevent acid–base imbalances.

9. Ans: A Feedback: Metformin is contraindicated in patients with diabetes complicated by fever, severe infections, severe trauma, major surgery, acidosis, and pregnancy. Metformin will not be given more frequently to decrease blood sugar. Metformin should be discontinued and is not administered for better regulation of blood sugar. Metformin will not decrease the absorption of glucose in this patient. 10. Ans: B Feedback: Sitagliptin (Januvia) minimizes the rate of inactivation of the incretin hormones to increase hormone levels and prolong their activity. Sitagliptin does not block the S phase of the cell cycle. Sitagliptin is not a synthetically prepared monosodium salt. Sitagliptin does not inhibit hydrogen, potassium, and ATPase.

11. Ans: B Feedback: Sitagliptin (Januvia) minimizes the rate of inactivation of the incretin hormones to increase hormone levels and prolong their activity. Sitagliptin does not block the S phase of the cell cycle. Sitagliptin is not a synthetically prepared monosodium salt. Sitagliptin does not inhibit hydrogen, potassium, and ATPase.

12. Ans: D Feedback: A regular dietary intake associated with the administration of insulin or oral hypoglycemic will prevent episodes of hypoglycemia. The patient should limit her alcohol consumption, but alcohol consumption does not contribute to hypoglycemia. The patient should not necessarily increase her caloric or protein intake. The patient should coordinate her exercise with her dietary intake, but dietary intake is not the cause of her hypoglycemia.

13. Ans: D Feedback: An infant should receive the dosage in a dilution strength of U-10. It is not administered orally, as U-5, or in a TB syringe.

14. Ans: B Feedback: Among people with type 2 diabetes, 20% to 30% require exogenous insulin at some point in their lives. Obesity is a major cause, and vigilant treatment can prevent future sequelae. The essence of type 2 diabetes is the pancreas' inability to meet insulin needs.

15. Ans: B Feedback: When large amounts of glucose are present, water is pulled into the renal tubule. This results in a greatly increased urine output (polyuria). The excessive loss of fluid in urine leads to increased thirst (polydipsia). Glucose does not directly affect the thirst center.

16. Ans: C Feedback: Humulin R peaks between 2 and 3 hours after administration.

17. Ans: D Feedback: Before administering insulin, patient safety requires that two nurses always check the dosage. Assessing the patient's understanding of the disease may or may not be appropriate or necessary at this time. Injection sites are not massaged before administration. It is not necessary to assess urine for the presence of glucose.

18. Ans: C Feedback: With regular insulin before meals, it is very important that the medication be injected 30 to 45 minutes before meals so that the insulin is available when blood sugar increases after meals.

19. Ans: A Feedback: Because glyburide stimulates pancreatic beta cells to produce more insulin, it is effective only when functioning pancreatic beta cells are present. The presence of normal blood glucose levels would render the medication unnecessary. Selfadministration is common but not absolutely necessary.

20. Ans: B Feedback: It is essential to discontinue metformin if renal impairment occurs. The other listed changes in laboratory values do not necessarily indicate that metformin should be discontinued.

Chapter 42- Drug Therapy for Hyperthyroidism and Hypothyroidism 1. A child is born with cretinism. What element was lacking in the mother's diet during pregnancy? A) Potassium B) Iodine C) Sodium D) Magnesium Ans: B Feedback: Cretinism is uncommon in the United States but may occur with a lack of iodine in the mother's diet. A lack of potassium, sodium, and magnesium in the mother's diet will not cause cretinism.

2. A patient suffers from hyponatremia, hypoglycemia, and lactic acidosis. What condition is most consistent with this clinical presentation? A) Myxedema coma B) Psychotic depression C) Cretinism D) Congenital hypothyroidism Ans: A Feedback: Myxedema coma is severe, life-threatening hypothyroidism characterized by coma, hypothermia, cardiovascular collapse, hypoventilation, and severe metabolic disorders, such as hyponatremia, hypoglycemia, and lactic acidosis.

3. A woman is started on propylthiouracil (PTU). What is the primary mode of action for propylthiouracil? A) Destroys part of the thyroid gland B) Inhibits production of thyroid hormone C) Suppresses the anterior pituitary hormones D) Stimulates the thyroid cells Ans: B Feedback: The thioamide drugs inhibit synthesis of thyroid hormone. Iodine preparations inhibit the release of thyroid hormones and cause them to be stored within the thyroid gland. Propylthiouracil does not destroy part of the thyroid gland. Propylthiouracil does not suppress the anterior pituitary hormones. Propylthiouracil does not sedate the central nervous system or suppress the cardiac output.

4. A patient with hypothyroidism is started on levothyroxine (Synthroid). What should the patient be taught regarding medication administration in the home setting? A) Take medication with milk or food. B) Do not exercise with the medication. C) Take the medication on an empty stomach.

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D) Levothyroxine has a short half-life. Ans: C Feedback: Levothyroxine (Synthroid) should be taken on an empty stomach to increase absorption. The medication should not be taken with food. Exercise has no effect on the administration of the medication. Levothyroxine has a long half-life of about 6 to 7 days.

5. A 5-year-old child is diagnosed with hypothyroidism. What will the patient likely develop if the condition is left untreated? A) Mental retardation B) Renal dysfunction C) An immune disorder D) Paralytic ileus Ans: A Feedback: If cretinism is untreated until the child is several months old, permanent mental retardation is likely to result. The patient will not suffer from renal dysfunction, an immune disorder, or paralytic ileus.

6. A patient has been diagnosed with myxedema. She currently takes ibuprofen (Motrin) for knee pain. For what is this patient at increased risk? A) Nephrotoxicity B) Pulmonary congestion C) Tachycardia D) Apnea Ans: A Feedback: A patient diagnosed with myxedema cannot metabolize and excrete drugs, so she is at an increased risk of developing nephrotoxicity. Pulmonary congestion, tachycardia, and apnea are not adverse effects related to myxedema or the administration of ibuprofen (Motrin).

7. A patient is scheduled for a thyroidectomy to treat thyroid cancer. What is the medication of choice administered preoperatively? A) Sodium iodide 131I (Iodotope) B) Methimazole (Tapazole) C) Propylthiouracil (PTU) D) Propranolol (Inderal) Ans: C Feedback: Propylthiouracil (PTU) is administered preoperatively for thyroidectomy. Sodium iodide131 (Iodotope) is a radioactive iodide that is used to destroy thyroid tissue.

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Methimazole (Tapazole) is similar to PTU but is not the drug of choice preoperatively. Propranolol (Inderal) is used to treat cardiovascular conditions, such as hypertension. It is not used in the preoperative phase of thyroidectomy.

8. A patient is to receive a medication that the nurse recognizes as an expectorant that is normally administered for the treatment of hyperthyroidism. Which medication will be administered? A) Propylthiouracil (PTU) B) Methimazole (Tapazole) C) Saturated solution of potassium iodide (SSKI) D) Sodium iodide131I (Iodotope) Ans: C Feedback: Saturated solution of potassium iodide (SSKI) is more often used as an expectorant but may be given as a preparation for thyroidectomy. Propylthiouracil (PTU) is not administered as an expectorant. Methimazole (Tapazole) is not administered as an expectorant. Sodium iodide 131I (Iodotope) is not administered as an expectorant.

9. A patient has been diagnosed with hyperthyroidism. She is scheduled to receive a medication to destroy the thyroid gland. Which medication will be administered? A) Propylthiouracil (PTU) B) Methimazole (Tapazole) C) Saturated solution of potassium iodide (SSKI) D) Sodium iodide 131I (Iodotope) Ans: D Feedback: Sodium iodide 131I (Iodotope) is a radioactive isotope of iodine. Therapeutic doses act by emitting beta and gamma rays, which destroy thyroid tissue and thereby decrease the production of thyroid hormones. Propylthiouracil (PTU) is not administered to destroy thyroid tissue. Methimazole (Tapazole) is not administered to destroy thyroid tissue. Saturated solution of potassium iodide (SSKI) is not administered to destroy thyroid tissue.

10. A patient is being administered propranolol (Inderal) to treat hypertension related to hyperthyroidism. Which condition will warrant the tapering and discontinuation of the propranolol (Inderal)? A) Hyperthyroidism B) Hypertension C) Angina pectoris D) Euthyroid state Ans: D Feedback: When the patient becomes euthyroid and hyperthyroid symptoms are controlled by

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definitive treatment measures, propranolol should be tapered and discontinued. Hyperthyroidism, hypertension, and angina pectoris all warrant the administration of propranolol (Inderal).

11. A patient is started on levothyroxine (Synthroid) for treatment of hypothyroidism. During patient teaching, how frequently can the dosage be increased until symptoms are relieved? A) Every 3 to 5 days B) Weekly C) Every 2 weeks D) Monthly Ans: C Feedback: Dosage is influenced by the choice of drug. As a general rule, initial dosage is relatively small. Dosage is gradually increased at approximately 2-week intervals until symptoms are relieved. The dosage is not increased in 3 to 5 days. The dosage is not increased in 1 week. The dosage is not increased monthly.

12. A patient is being treated for hypothyroidism and has developed symptoms of adrenal insufficiency. What medication will be added to the patient's medication regimen? A) Anti-infective agent B) Corticosteroid agent C) Nonsteroidal anti-inflammatory agent D) Antiadrenergic agent Ans: B Feedback: When hypothyroidism and adrenal insufficiency coexist, the adrenal insufficiency should be treated with a corticosteroid drug before starting thyroid replacement. Antiinfective agents, nonsteroidal anti-inflammatory agents, or antiadrenergic agents are not administered for adrenal insufficiency.

13. A patient has been diagnosed with hypothyroidism and admits to the nurse that she has heard of her thyroid gland but does not know the function of thyroid hormone. The nurse should explain the fact that thyroid hormone is responsible for A) regulating the levels of most other hormones in the body. B) stimulating the brain and sex organs. C) controlling the rate of cell metabolism throughout the body. D) regulating levels of glucose in the blood and body tissues. Ans: C Feedback: Thyroid hormones control the rate of cellular metabolism and thus influence the functioning of virtually every cell in the body. The heart, skeletal muscle, liver, and kidneys are especially responsive to the stimulating effects of thyroid hormones. The

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brain, spleen, and gonads are less responsive. Thyroid hormone does not primarily influence glucose levels or the function of the endocrine system.

14. Following the completion of diagnostic testing, an adult patient has received a diagnosis of hyperthyroidism. What nursing diagnosis should the nurse prioritize in this patient's care? A) Risk for hypothermia related to hyperthyroidism B) Constipation related to hyperthyroidism C) Risk for imbalanced nutrition: less than body requirements related to hyperthyroidism D) Anxiety related to hyperthyroidism Ans: D Feedback: Anxiety is characteristic of a hyperthyroid state. Constipation, cold intolerance, and loss of appetite are associated with hypothyroidism.

15. A 55-year-old female patient was successfully treated for thyroid storm earlier in the year. In subsequent health education, the nurse should caution the patient against excessive intake of what foods? A) Seafood and kelp B) Leafy green vegetables and beef C) Purine-rich foods D) Red wine and aged cheeses Ans: A Feedback: Iodine is associated with thyroid storm and is present in foods (especially seafood and kelp) and in radiographic contrast dyes. Reports of iodine-induced hyperthyroidism have been reported after ingestion of dietary sources of iodine.

16. Laboratory testing reveals that a patient is in a severely hyperthyroid state and propylthiouracil (PTU) has been prescribed. When providing health education related to this drug, what should the nurse teach the patient? A) “You'll need to take these pills every 8 hours.” B) “I'm going to show you how to perform your daily injection.” C) “At first, you'll come to the outpatient clinic for your IV infusion once per day.” D) “It's best to inject PTU into your abdomen rather than your arm.” Ans: A Feedback: PTU is well absorbed with oral administration. Because the half-life in the thyroid is relatively short, PTU must be given every 8 hours.

17. A patient is scheduled to begin a drug regimen for the treatment of hyperthyroidism. Prior to administering propylthiouracil (PTU), the nurse has reviewed the relevant black

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box warning and should teach the patient about the need for what form of follow-up? A) Serial complete blood counts B) Routine liver function testing C) Daily nonfasting blood glucose testing D) Chest radiographs every 3 months Ans: B Feedback: The FDA has issued a black box warning for PTU stating that severe liver injury resulting in death or acute liver failure may occur within 6 months of treatment. All patients should receive instructions about the signs and symptoms of acute liver failure. Routine liver function testing to assess for liver failure is important. There is no specific need for chest radiographs, CBCs, or glucose monitoring.

18. A nurse who provides care at a long-term care facility is preparing to administer a resident's scheduled dose of levothyroxine (Synthroid). What assessment should the nurse perform prior to administration? A) Level of consciousness and orientation B) Oxygen saturation level C) Heart rate D) Respiratory rate Ans: C Feedback: Regular monitoring of blood pressure and pulse is essential in older adults receiving Synthroid. As a general rule, levothyroxine should not be given if the resting heart rate is more than 100 beats per minute.

19. A home care nurse observes that a client's supply of Synthroid has run out in less than half the time that it should have. What assessment findings would be most consistent with overuse of Synthroid? A) Constipation and abdominal distention B) Hyperactivity and insomnia C) Bradycardia and hypotension D) Joint pain and decreased mobility Ans: B Feedback: Adverse effects of levothyroxine include signs and symptoms of hyperthyroidism. Other more serious adverse effects are tachycardia, cardiac dysrhythmias, angina pectoris, myocardial infarction, and heart failure. Nervousness, hyperactivity, insomnia, diarrhea, abdominal cramps, nausea, vomiting, weight loss, fever, and an intolerance to heat have also been reported. Bradycardia and constipation are associated with hypothyroidism.

20. An older adult patient has been using levothyroxine (Synthroid) for several years on an outpatient basis. The patient has recently sought care, with complaints that are

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consistent with hypothyroidism. To which of the patient's following statements may the nurse attribute the decreased effect of Synthroid? A) “I've been using a lot of antacids lately because of my indigestion.” B) “My daughter and I have started the Atkin's diet to try to lose some weight.” C) “Overall, I'd say that I'm under a lot of stress lately.” D) “I've stopped taking aspirin for my arthritis and started using Tylenol.” Ans: A Feedback: Antacids may decrease the effect of levothyroxine. Acetaminophen, stress, and high protein intake do not have this effect.

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1.A patient is scheduled for an exploratory surgery for cancer. What will cause the release of adrenocorticotropic hormone in response to this patient's psychological and physiological stress? A) Growth hormone release–inhibiting hormone (Somatostatin) B) Corticotropin-releasing hormone or factor (CRH or CRF) C) Growth hormone–releasing hormone (GHRH) D) Thyrotropin-releasing hormone (TRH) Ans: B Feedback: Corticotropin-releasing hormone or factor (CRH or CRF) causes release of corticotropin (adrenocorticotropic hormone) in response to stress and threatening stimuli. Growth hormone release–inhibiting hormone (somatostatin) inhibits release of growth hormone. Growth hormone–releasing hormone causes the release of growth hormone in response to low blood levels of GH. Thyrotropin-releasing hormone causes the release of TSH in response to stress, such as cold.

2.A patient has had surgery. After the surgical procedure, the patient starts to shiver and chill. What hormone will be released in response to the reaction to cold? A) Thyroid-stimulating hormone B) Luteinizing hormone C) Corticotropin D) Somatostatin Ans: A Feedback: Thyroid-stimulating hormone is released in response to stress, such as exposure to cold. Luteinizing hormone is released in response to gonadotropin-releasing hormone. Corticotropin stimulates the adrenal cortex to produce corticosteroids. Somatostatin inhibits the release of growth hormone.

3.A patient is suspected of having Cushing's disease. What hormone is used in the diagnosis of this disorder? A) Growth hormone B) Adrenocorticotropic hormone C) Thyroid-stimulating hormone D) Corticotropin-releasing hormone Ans: D Feedback: Corticotropin-releasing hormone can be used in the diagnosis of Cushing's disease. Growth hormone is released in response to low blood levels of growth hormone. Corticotropin-releasing hormone causes the release of corticotropin (adrenocorticotropic hormone) in response to stress. Thyroid-stimulating hormone regulates the secretion of

thyroid hormones.

4.A young man has begun weight training. Which hormone will be released in response to the increase in the size and number of muscle cells? A) Growth hormone B) Adrenocorticotropic hormone C) Thyroid-stimulating hormone D) Corticotropin-releasing hormone Ans: A Feedback: Growth hormone stimulates the growth of body tissues, including growth of muscle cells. Corticotropin-releasing hormone causes the release of corticotropin (adrenocorticotropic hormone) in response to stress. Thyroid-stimulating hormone regulates the secretion of thyroid hormones.

5. An adult is diagnosed with an increased low-density lipoprotein cholesterol level. What

A) B) C) D) Ans:

hormone level may be low based on this diagnosis? Adrenocorticotropic hormone (ACTH) Oxytocin Growth hormone Somatostatin C Feedback: In adults, deficient growth hormone can cause increased fat, reduced skeletal and heart muscle mass, reduced strength, reduced ability to exercise, and worsened cholesterol levels (increased low-density lipoprotein cholesterol). Adrenocorticotropic hormone, oxytocin, and somatostatin do not affect low-density lipoprotein.

6. When teaching young women about the hormones of reproduction, the nurse explains

A) B) C) D) Ans:

how the follicle matures and ruptures in ovulation. Which hormone is needed for this change? Luteinizing hormone (LH) Thyrotropin (TSH) Follicle-stimulating hormone (FSH) Leydig's cells A Feedback: LH is important in the maturation and rupture of the ovarian follicle. TSH regulates the secretion of thyroid hormones. FSH stimulates the functions of sex glands. Leydig's cells are stimulated by LH in men to secrete androgens.

7.A patient has been involved in a motor vehicle accident. Which hormone will be released in response to his blood loss? A) Luteinizing hormone (LH) B) Antidiuretic hormone (ADH) C) Oxytocin D) Melanocyte-stimulating hormone Ans: B Feedback: Antidiuretic hormone is also called vasopressin and is released in response to blood loss. Luteinizing hormone is important in ovulation. Oxytocin functions in childbirth and lactation. Melanocyte-stimulating hormone plays a role in skin pigmentation.

8.A patient has been diagnosed with acromegaly. Which of the following medications may be ordered to treat this endocrine disorder? A) Gonadorelin hydrochloride (Factrel) B) Octreotide (Sandostatin) C) Nafarelin (Synarel) D) Gonadorelin acetate (Lutrepulse) Ans: B Feedback: Prescribers order octreotide for patients with acromegaly to reduce levels of GH. Gonadorelin hydrochloride, nafarelin, and gonadorelin acetate are not administered to treat acromegaly.

9.A patient is suspected of having adrenal insufficiency. Which hormone may be administered to diagnose Addison's disease? A) Corticotropin (ACTH) B) Somatotropin (Humatrope) C) Octreotide (Sandostatin) D) Leuprolide (Lupron) Ans: A Feedback: Corticotropin (ACTH) is sometimes used as a diagnostic test to differentiate primary adrenal insufficiency (Addison's disease). Somatotropin is therapeutically equivalent to endogenous growth hormone. Octreotide (Sandostatin) is used for acromegaly. Leuprolide causes a decrease in testosterone and estrogen.

10.A patient is diagnosed with infertility. What medication may the nurse administer for the treatment of infertility? A) Thyrotropin alfa (Thyrogen)

B) C) D) Ans:

Pegvisomant (Somavert) Menotropins (Pergonal) Somatotropin (Humatrope) C Feedback: Menotropins (Pergonal) is administered in combination with HCG to induce ovulation. Thyrotropin alfa (Thyrogen) is a synthetic formulation of TSH used as a diagnostic adjunct for serum thyroglobulin. Pegvisomant (Somavert) is a growth hormone receptor antagonist used in the treatment of acromegaly in adults. Somatotropin (Humatrope) is administered to children for impaired growth.

11. An adolescent is being treated with growth hormone. When assessing for potential

A) B) C) D) Ans:

adverse effects, what assessment should the nurse prioritize? Deep tendon reflexes Level of anxiety Respiratory rate Blood glucose D Feedback: Somatropin decreases insulin sensitivity, resulting in hyperglycemia. Patients most at risk for increased insulin sensitivity are those with obesity, Turner's syndrome, or a family history of diabetes mellitus. Growth hormone can cause anxiety, but is not a priority assessment in this case. The respiratory rate is not the most important objective assessment in this case.

12. An adult patient has been diagnosed with a posterior pituitary lesion that has resulted in

A) B) C) D) Ans:

diabetes insipidus. The characteristic sign of this health problem is blood glucose levels 400 mg/dL. copious urine production. hyperglycemia that is unresponsive to exogenous insulin. Hematuria B Feedback: Characteristic features of DM include polyuria, with excretion of dilute urine ranging from 4 L to as much as 30 L. Hematuria does not normally occur, and blood glucose levels are not directly affected.

13.A patient with a traumatic head injury and a diagnosis of diabetes insipidus is being treated with intravenous vasopressin (Pitressin). What change in the patient's status would prompt the immediate cessation of the drug infusion?

A) B) C) D) Ans:

Infiltration at the IV site A sudden decrease in urine output The appearance of blood in the patient's urine A rapid increase in blood glucose A Feedback: When administering vasopressin intravenously, it is essential to use extreme caution due to the risk of extravasation of the medication, leading to tissue necrosis. Decreased urine output is a goal of treatment. Blood in the urine and changes in blood glucose levels are atypical events.

14.Somatropin has been prescribed for a child who has been diagnosed with growth hormone deficiency. When providing health education to the child's parents, what teaching point should then nurse prioritize? A) The correct technique for daily injections of the drug B) The importance of regular blood pressure monitoring C) The rationale for not crushing the extended-release tablet D) The need to limit the child's activity level for the duration of treatment Ans: A Feedback: Somatropin is administered by daily injections. Blood pressure monitoring and activity limitations are not necessary.

15.A girl who is 7 1/2 years old has received a diagnosis of precocious puberty from the pediatric endocrinologist. The nurse who collaborates with this physician should anticipate the administration of what drug? A) Menotropins (Pergonal) B) Thyrotropin alfa (Thyrogen) C) Cosyntropin (Cortrosyn D) Leuprolide acetate (Lupron) Ans: D Feedback: Leuprolide is useful for the treatment of central precocious puberty in children. Menotropins (Pergonal) stimulates ovulation. Cosyntropin (Cortrosyn) stimulates the adrenal cortex to synthesize and secrete adrenocortical hormones. Thyrotropin alfa (Thyrogen) stimulates the secretion of thyroglobulin.

16.A 13-year-old boy who is in the first percentile of height for his age has been referred for care. Which of the following assessment findings would contraindicate the safe and effective use of somatropin to treat his growth deficiency? A) The boy has not yet begun puberty.

B) C) D) Ans:

The boy has low serum albumin levels. The epiphyses of the boy's long bones have closed. The sutures of the boy's skull have not yet fully closed. C Feedback: Somatropin is ineffective when impaired growth is present after puberty, when the epiphyses of the long bones have closed. Low albumin is not a contraindication to the use of somatropin. The sutures of the skull close early in life.

17.A patient's current drug regimen includes intranasal administration of desmopressin acetate (DDAVP, Stimate). In this patient's plan of nursing care, what is the most likely desired outcome of treatment? A) The patient's urine output will not exceed 80 mL/h. B) The patient will gain 2 cm in height over the next 6 months. C) The patient will ovulate at least once over the next 8 weeks. D) The patient's vertical growth will cease in the next 4 weeks. Ans: A Feedback: Desmopressin acetate (DDAVP, Stimate) is the prototype posterior pituitary hormone medication. It is used to treat diabetes insipidus. Consequently, reduced urine output is the primary goal of treatment. The drug does not influence growth or ovulation.

18.A nurse reviews the current medication administration record of a patient who has recently been prescribed octreotide. The nurse performs this important safety action in order to prevent drug interactions that could result in A) increased growth. B) anaphylaxis. C) cardiac complications. D) respiratory arrest. Ans: C Feedback: Numerous medications combine with octreotide to result in a prolonged QT interval with an increased risk of ventricular dysrhythmia and cardiac arrest. Increased growth, anaphylaxis, and respiratory arrest are not noted adverse effects or the result of drug interactions with octreotide.

19.A child has been referred to a pediatric endocrinologist and has begun treatment with octreotide acetate. What nursing diagnosis should be noted in the child's plan of nursing care? A) Delayed growth and development B) Excess fluid volume

C) D) Ans:

Risk for deficient fluid volume Altered growth and development D Feedback: Acromegaly is the major clinical indication for the use octreotide. In this condition, growth is excessive, not delayed. Fluid volume is not directly affected.

20.A patient who is being cared for in the intensive care unit (ICU) is receiving desmopressin. In light of the black box warning that accompanies this drug, the ICU nurse should prioritize the assessment of which of the patient's laboratory values? A) Hematocrit B) Platelets C) Sodium D) Calcium Ans: C Feedback: The FDA has issued a black box warning stating that patients taking desmopressin can develop hyponatremia, leading to seizures. Consequently, assessment of sodium levels takes precedence over hematocrit, calcium, and platelet levels.

1. An elderly patient has been diagnosed with Paget's disease. Which serum electrolyte is

A) B) C) D) Ans:

altered in this disease process? Sodium Potassium Chloride Calcium D Feedback: Disorders of calcium and bone metabolism include hypocalcemia, hypercalcemia, osteoporosis, Paget's disease, and bone breakdown associated with breast cancer and multiple myeloma. Sodium, potassium, and chloride alterations are not primarily associated with Paget's disease.

2.A patient has been diagnosed with hyperplasia of the parathyroid gland. Which of the following alterations in blood values will you expect to observe? A) Hypercalcemia B) Hypoparathyroidism C) Hyperthyroidism D) Hypocalcemia Ans: A Feedback: Hyperparathyroidism is most often caused by a tumor or hyperplasia of a parathyroid gland. Hypoparathyroidism, hyperthyroidism, and hypothyroidism are not associated with hyperplasia of the parathyroid gland. Clinical manifestations and treatment of hyperparathyroidism are the same as those of hypercalcemia.

3.When a patient has an increased serum level of ionized calcium, which hormone will be released? A) Insulin B) Estrogen C) PTH D) Calcitonin Ans: D Feedback: Calcitonin is a hormone from the thyroid gland whose secretion is controlled by the concentration of ionized calcium in the blood flowing through the thyroid gland. When the serum level of ionized calcium is increased, secretion of calcitonin is increased. The serum level of calcium will not affect the release of insulin or estrogen. PTH is a response to low calcium levels.

4.A patient has a decreased calcium level. Which of the following will participate in raising the patient's calcium level? Vitamin D

B) C) D) Ans:

Vitamin C Ferrous sulfate Vitamin B12 A Feedback: Vitamin D is a fat-soluble vitamin that plays an important role in calcium and bone metabolism. Vitamin C, ferrous sulfate, and vitamin B12 do not play a role in calcium and bone metabolism.

5.A 55-year-old woman is diagnosed with a vitamin D deficit. What disorder results from this deficit? A) Chondromalacia B) Chondritis C) Osteomalacia D) Osteopenia Ans: C Feedback: In adults, vitamin D deficiency causes osteomalacia, a condition characterized by decreased bone density and strength. Chondromalacia is characterized as a softening of the patella. Chondritis is an inflammation of the cartilage. Osteopenia is a decrease in bone tissue.

6.The nurse is providing health education to an 80-year-old woman who has just been diagnosed with osteoporosis. Which of the following represents an accurate statement when teaching her about this diagnosis? A) “Osteoporosis is usually a result of a bone injury.” B) “Osteoporosis causes a risk for fractures.” C) “Osteoporosis results from nonmodifiable risk factors.” D) “Osteoporosis occurs only in women.” Ans: B Feedback: Osteoporosis results when bone strength is impaired, leading to increased porousness and vulnerability to fracture. Osteoporosis is not a result of fracture. Osteoporosis is partially preventable. Osteoporosis is not limited to the female gender.

7.A patient suffers from numbness and tingling around the mouth and has a positive Trousseau's sign after a thyroidectomy. Which of the following medications will be administered? A) Parenteral normal saline B) Parenteral potassium chloride C) Parenteral digoxin (Lanoxin) D) Parenteral calcium gluconate Ans: D

Feedback: The patient has acute hypocalcemia as evidenced by numbness and tingling around the mouth and a positive Trousseau's sign. An intravenous calcium salt, such as calcium gluconate, is given for acute symptomatic hypocalcemia. Parenteral normal saline may be administered, but it will not increase the calcium level. The administration of potassium chloride parenterally must be diluted and will not affect the calcium level. Parenteral digoxin (Lanoxin) will not be administered.

8.A 75-year-old patient with overall good health is to begin taking vitamin D supplements. What is the recommended supplement for her age? A) 100 International Units daily B) 200 International Units daily C) 600 International Units daily D) 800 International Units daily Ans: D Feedback: The recommended dietary allowance, or RDA, for vitamin D is 600 International Units for people 1 to 70 years of age and 800 International Units daily for adults 71 years and older to prevent and treat osteoporosis.

9.An older adult patient has been on oral corticosteroids to decrease the symptoms of chronic obstructive pulmonary disease. What is the patient at risk for developing? A) Osteoporosis B) Osteoarthritis C) Oat cell carcinoma D) Paget's disease Ans: A Feedback: Drugs used for hypercalcemia, such as corticosteroids, place the patient at risk for developing osteoporosis due to the demineralization of the bone. The patient is not at risk for developing osteoarthritis or oat cell carcinoma. Paget's disease is an inflammatory condition and is not caused by corticosteroid use.

10.A patient has been prescribed alendronate (Fosamax). Which of the following instructions should the patient be given regarding the administration of this medication? A) Take the medication with whole milk. B) Take the medication and lie down for 30 minutes. C) Take the medication on an empty stomach. D) Take the medication to increase bone resorption. Ans: C Feedback: Alendronate (Fosamax) must be taken on an empty stomach. Alendronate (Fosamax) should not be taken with milk or food. The patient should be sitting up or ambulatory for

30 minutes after taking the medication. The medication decreases bone resorption, not increases it.

11.A patient has undergone a thyroidectomy in which his parathyroid glands were also inadvertently removed. The patient's morning blood work reveals a serum calcium level of 3.1 mg/dL (normal 8.5 to 10.5 mg/dL). The nurse should consequently assess this patient's A) muscle tone. B) level of consciousness. C) respiratory rhythm. D) respiratory rate. Ans: A Feedback: Low calcium levels can result in tetany. Decreased LOC and altered respiratory function are not characteristic of hypocalcemia.

12.A community health nurse is leading a health promotion workshop during a community health fair. A participant has asked the nurse for advice on the necessity of calcium supplements. The nurse should respond in the knowledge that which of the following demographic groups frequently have low calcium levels? Select all that apply. A) Elementary-aged children B) Young women C) Middle-aged men D) Middle-aged women E) Older women Ans: B, E Feedback: Experts believe that the diets of most people of all ages, but especially of young women and older adults, are deficient in calcium.

13.An older adult resident of a long-term care facility has been prescribed calcium citrate to address her decreasing bone density. The nurse should review the resident's medication administration record knowing that what medication may decrease the effects of calcium? A) Hydrochlorothiazide B) Ibuprofen C) Prednisone D) Diltiazem (Cardizem) Ans: C Feedback: Corticosteroids reduce the effects of calcium by various mechanisms. Thiazide diuretics have the opposite effect. NSAIDs and calcium channel blockers do not appreciably affect the pharmacokinetics of calcium supplements.

14.A patient's low ionized calcium levels have necessitated an infusion of an IV calcium preparation. During the administration of this medication, the nurse should prioritize what assessment? A) Oxygen saturation levels B) Cardiac monitoring C) Assessment of cognition D) Assessment for visual changes Ans: B Feedback: Calcium imbalances can result in alterations in heart rate and rhythm; cardiac monitoring is thus necessary. The patient is less likely to experience alterations in respiratory function, cognition, or vision.

15.A middle-aged patient is proud of the fact that she is proactive with her health maintenance and tells the nurse that she has been taking 2400 International Units of vitamin D daily, stating, “More is better when it comes to vitamins.” The nurse should provide health teaching to the patient because her current vitamin D intake creates a risk for A) hypercalcemia. B) hyperphosphatemia. C) hypocalcemia. D) tetany. Ans: A Feedback: It is important to take vitamin D supplements cautiously and not overuse them; excessive amounts can cause serious problems, including hypercalcemia. Tetany is associated with hypocalcemia. Hypophosphatemia typically accompanies hypercalcemia.

16.A 72-year-old woman has been diagnosed with osteoporosis and has begun taking alendronate (Fosamax). The nurse should be aware that this drug can increase the woman's bone density by which of the following means? A) Decreasing renal excretion of calcium B) Increasing the binding of vitamin D to calcium ions C) Suppressing the function of osteoclasts D) Enhancing the function of osteoblasts Ans: C Feedback: Alendronate suppresses osteoclast activity on newly formed resorption surfaces, which reduces bone turnover. This means that bone formation exceeds resorption at remodeling sites, leading to progressive gains in bone mass. Fosamax does not enhance osteoblast function or affect the renal excretion of calcium. It does not influence the chemical interaction between vitamin D and calcium.

17.An 80-year-old woman has experienced recent declines in bone density and has consequently been deemed a candidate for treatment with alendronate (Fosamax). During health education, what teaching point should the nurse emphasize? A) “Your Fosamax will be most effective if you couple it with an increase in your consumption of dairy products.” B) “It's important that you not lie down for half an hour after taking your Fosamax.” C) “Make sure to let your care provider know promptly if you experience bone pain.” D) “You'll have less stomach upset if you take your Fosamax with some bland food.” Ans: B Feedback: The person must remain upright (with head elevated 90 degrees if in bed, sitting upright in a chair, or standing) for at least 30 minutes after administration of Fosamax. It is always necessary to take the drug with a full glass of water, not juice or coffee, at least 30 minutes before breakfast and before taking other drugs. Bone pain is a possible adverse effect, but prevention of esophageal ulceration is a priority. Increased dairy consumption is not vital.

18.A 79-year-old woman has been diagnosed with osteoporosis, and the nurse is reviewing the risks and benefits of Fosamax, which her care provider has prescribed. The patient should be instructed to seek prompt medical attention if she develops which of the following? A) Esophageal bleeding B) Fever C) Sudden fatigue D) Musculoskeletal pain Ans: A Feedback: Esophageal erosion and ulcers can result in hemorrhage, which is a medical emergency. Fever, fatigue, and musculoskeletal pain warrant follow-up, but none is an emergency.

19.A patient has been admitted in acute hypercalcemia and has been determined to have a serum calcium level of 12.9 mg/dL. The emergency department nurse's priority intervention is A) administration of IV calcitonin. B) administration of IV normal saline. C) oxygen supplementation. D) subcutaneous administration of exogenous parathyroid hormone (PTH). Ans: B Feedback: Acute hypercalcemia is a medical emergency, and rehydration is a priority; it is essential to administer an IV saline solution. Calcitonin is not administered by the IV route. PTH is not administered exogenously and would exacerbate hypercalcemia.

20.An elderly adult woman has been diagnosed with postmenopausal osteoporosis and has been prescribed calcitonin. The nurse should anticipate administration by what route? A) Oral B) Topical C) Intranasal D) Intravenous Ans: C Feedback: Calcitonin can be administered by the intranasal route for the treatment of osteoporosis. It is not given orally, topically, or intravenously.

1.An adult patient has been experiencing severe lethargy and fatigue over the past several days, and she describes herself as feeling “shaky.” Random blood glucose testing reveals a glucose level of 38 mg/dL, but the woman denies any significant change in her diet. The care team should suspect the possibility of what health problem? A) Chronic renal failure B) Acute renal failure C) Cushing's disease D) Adrenal insufficiency Ans: D Feedback: Any patient with unexplained severe hypoglycemia requires assessment for adrenal insufficiency. Cushing's disease and kidney disease do not result in hypoglycemia.

2.A patient who has been taking oral prednisone for several months abruptly ceased treatment several days ago on the advice of a family member. The patient has now been admitted to the emergency department with signs and symptoms that are characteristic of addisonian crisis. When assessing this patient, the nurse should prioritize what assessment? A) Assessment of urine for ketones B) Assessment of serum potassium levels C) Assessment for adventitious lung sounds D) Assessment for venous thromboembolism Ans: B Feedback: In addisonian crisis, the loss of sodium leads to retention of potassium, resulting in symptoms of hyperkalemia. As a result, vigilant monitoring of serum potassium levels is more important than respiratory effects, urinalysis, or hypercoagulation.

3.A 38-year-old patient has been living with Addison's disease for many years and has achieved adequate symptom control through lifestyle modifications and drug therapy. However, the patient has now been admitted to the hospital in addisonian crisis. Which of the nurse's following assessment questions is most appropriate? A) “Have you been under an unusual amount of stress lately?” B) “How would you describe your diet over the last few days?” C) “When was the last time that you drank any alcohol?” D) “Has your urine output been typical for the past few days?” Ans: A Feedback: Acute adrenal crisis, or addisonian crisis, is a life-threatening condition that occurs when Addison's disease is the underlying problem and the patient is exposed to minor illness or increased stress. Diet, alcohol use, and impaired urinary function are less likely

contributors.

4.A patient's recent symptoms of unexplained fatigue and listlessness have prompted a referral to the endocrinology department. A plasma corticotropin (ACTH) stimulation test for adrenal insufficiency is being performed. Following the administration of ACTH, what finding would confirm the suspected diagnosis? A) Low cortisol levels B) Stupor C) Increased levels of CRH D) Signs of Cushing's disease Ans: A Feedback: Confirming the diagnosis of adrenocortical insufficiency requires a short plasma corticotropin (ACTH) stimulation test. The examiner administers corticotropin in the morning, and a subnormal blood cortisol level in the morning and afternoon confirms the diagnosis. CRH is a precursor to ACTH, and would not be directly affected. Cushing's disease is adrenocortical excess, with high cortisol levels.

5.A patient with suspected adrenal insufficiency has been administered 1 mcg of cosyntropin (Cortrosyn) as an IV bolus. Serum testing 30 minutes later reveals a markedly elevated level of cortisol. What conclusion should the nurse infer from this finding? A) The patient has normal adrenocortical function. B) The patient has primary adrenal insufficiency. C) The patient has secondary adrenal insufficiency. D) The patient has Addison's disease. Ans: A Feedback: The low-dose test involves the administration of 1 mcg of cosyntropin (Cortrosyn) as an IV bolus. In people with normal adrenocortical function, an increase in cortisol occurs in 20 minutes.

A) B)

6.A 26-year-old woman's gradual development of a “moon face,” coupled with protracted weight gain, has caused the nurse practitioner to suspect the possibility of Cushing's disease. When explaining this health problem to the patient, how should the nurse describe it? “Cushing's disease happens when your pituitary gland doesn't stimulate your other glands enough.” “Cushing's disease is a result of an overproduction of steroid hormones by your kidneys.”

C) D) Ans:

“Cushing's disease most often happens when people are taking corticosteroid medications and stop them abruptly.” “Cushing's disease often results from a growth on your kidney that causes inadequate production of steroids.” B Feedback: The cause of Cushing's disease is adrenocortical excess. Cessation of exogenous steroids can precipitate addisonian crisis. Dysfunction of pituitary gland is an atypical cause. Tumors may cause overproduction, not underproduction, of corticosteroids.

7.A patient with a diagnosis of Cushing's disease has been admitted to the emergency department after taking a fall on the sidewalk outside her apartment building. This patient's underlying disease process creates increased risks of A) hemorrhage and impaired hemostasis. B) fractures and impaired wound healing. C) neurovascular complications and rhabdomyolysis. D) bruising and hematoma. Ans: B Feedback: Cushing's disease results in low bone density and impaired wound healing. It does not typically cause impaired hemostasis or neurovascular problems.

8.The results of a young man's plasma corticotropin (ACTH) stimulation test have confirmed a diagnosis of Addison's disease. The nurse has consequently provided health education around the necessity of hormone replacement therapy. The patient has asked the nurse, “How long am I going to have to take these medications?” How should the nurse best respond? A) “You'll need to take these for the rest of your life.” B) “You'll have to take these until you can pass the corticotropin stimulation test without them.” C) “You'll have to take these until your kidneys regain their normal level of function.” D) “You'll need to take these until your symptoms have been stable for at least 6 months.” Ans: A Feedback: Lifetime hormone replacement is necessary in persons with Addison's disease.

9.A child has received a diagnosis of Addison's disease, and the nurse is providing health education to the child's family around hormone replacement therapy. When planning this child's care, the nurse should know that hormone replacement therapy constitutes a risk

A) B) C) D) Ans:

for what nursing diagnosis? Latex allergic response Deficient fluid volume Delayed growth and development Impaired gas exchange C Feedback: Hydrocortisone may affect growth velocity. It is unlikely to affect allergy response, or respiration. Fluid volume excess, not deficit, is a possibility.

10.Hydrocortisone has been prescribed to a patient for the treatment of Addison's disease, and the patient will soon be discharged. The nurse should encourage the patient to take this medication A) at least 30 minutes before or 2 hours after meals. B) at bedtime. C) before 9 AM D) with an antacid. Ans: C Feedback: Administration of hydrocortisone should take place every morning before 9 AM. This minimizes HPA suppression. People should take the oral preparation with food to decrease gastric irritation.

11.A patient will soon begin long-term treatment with hydrocortisone after being diagnosed with Addison's disease. In order to mitigate the potentially adverse effect of this treatment regimen, the nurse should encourage the patient to increase her intake of what nutrient? A) Water B) Calcium C) Sodium D) Potassium Ans: B Feedback: Due to the potential for reduced bone density, patients should be encouraged to increase calcium intake if hydrocortisone is administered for a prolonged period. Increased sodium, potassium, and water intake are not recommended.

12.A patient with a long-standing diagnosis of Addison's disease has been taking hydrocortisone for several years, achieving adequate symptom control. In recent weeks, the patient has experienced profound stress resulting from the collapse of his small business and subsequent conflict with his business partner. How might the presence of these stressors affect the patient's medication regimen?

A) B) C) D) Ans:

The patient should take his scheduled hydrocortisone later in the day. The ratio of mineralocorticoids to glucocorticoids should be adjusted. The patient's hydrocortisone should be temporarily withheld. The patient may temporarily require a higher dose of hydrocortisone. D Feedback: During times of increased stress, the dosage of the medication may need to be increased. There would be no need to change the ratio of mineralocorticoids to glucocorticoids or to take the medications later in the day.

13.A patient with a diagnosis of Addison's disease has had fludrocortisone acetate (Florinef Acetate) added to his medication regimen by his endocrinologist. What is the most plausible rationale for this change in treatment? A) The patient's anterior pituitary gland is overstimulated. B) The patient requires increased mineralocorticoid supplementation. C) The patient's adrenal cortex has become resistant to hydrocortisone. D) The patient's GI tract is unable to tolerate hydrocortisone. Ans: B Feedback: If a patient with Addison's disease requires additional mineralocorticoid supplementation, then fludrocortisone acetate (Florinef Acetate) may be indicated. Pituitary dysfunction, GI intolerance, and resistance to hydrocortisone are not plausible rationales.

14.A patient with Cushing's disease will soon begin treatment with ketoconazole. When planning the patient's care, the nurse should be cognizant of the black box warning for this drug and consequently monitor what laboratory values? A) White blood cell differential B) Blood urea nitrogen and creatinine C) AST, ALT, and GGT D) Hemoglobin, hematocrit, and red blood cell count Ans: C Feedback: The FDA has issued a black box warning stating that ketoconazole can cause hepatotoxicity. As a result, monitoring of liver function may be a priority over assessment of white cells, red cells, and renal function.

15. When assessing for therapeutic effects of mitotane in a patient with adrenocortical

A) B) C)

carcinoma, the nurse should expect to identify a decrease in agitation. an audible S3. a decrease in blood pressure.

D) Ans:

a decrease in urine output. C Feedback: A decrease in blood pressure is an expected therapeutic effect of mitotane. An audible S3 is not expected. Mitotane does not address agitation or high urine output.

1.A 4-year-old child is brought to the pediatric clinic by his mother. She states, “I don't know what to do with him. He is in constant motion. He won't sit for more than a few seconds and he is doing something else. He often throws his toys and yells loudly, even compared with other kids his age.” The child is diagnosed with attention deficit hyperactivity disorder. Which of the following medications will most likely be administered in conjunction with treatment? A) ACE inhibitors B) SSRIs C) Central nervous system stimulants D) MAO inhibitors Ans: C Feedback: ADHD is characterized by persistent hyperactivity, short attention span, difficulty completing tasks, restlessness, and impulsivity. The diagnosis has increased in recent years, with a concomitant increase in the use of prescribed CNS stimulants for its treatment. SSRIs, ACE inhibitors, and MAOIs are not typically used.

2.A patient visits the occupational health office of the factory in which he works. He has fallen asleep on the line and has a history of muscle weakness. This instance is not the first time he has fallen asleep on the line. From what disease process does the occupational health nurse suspect the patient is suffering? A) Sleep apnea B) Insomnia C) Narcolepsy D) Substance abuse Ans: C Feedback: Narcolepsy is characterized by daytime sleep attacks in which the person goes to sleep at any place or at any time. Sleep apnea is episodes of apnea during sleep. Insomnia is the inability to sleep. This patient is not exhibiting signs and symptoms of substance abuse.

3.A patient suffers from narcolepsy. Which of the following aspects of patient teaching should be provided? A) Take 250 mg of caffeine daily. B) Avoid working shifts. C) Take a lengthy nap every afternoon. D) Increase the Ritalin dose as needed. Ans: B Feedback: The patient who is diagnosed with sleep apnea should avoid shift work. Caffeine use may or may not be indicated. The patient should ideally not take naps. The patient should not

increase the Ritalin dose without the input of the primary health provider.

4.A child is prescribed an amphetamine for attention deficit hyperactivity disorder. Which of the following effects provide evidence that the medications are working? A) Improved grades B) Increased sleep quality C) Lethargy D) Polyphagia Ans: A Feedback: Amphetamines used with ADHD improve academic performance. Amphetamines often decrease sleep. Amphetamines will not result in lethargy. Amphetamines decrease appetite and do not cause polyphagia.

5.A patient is taking dextroamphetamine for ADHD. He has developed constipation since beginning therapy. Which of the following should the patient be taught? A) Take an OTC laxative daily. B) Increase fiber intake. C) Take diphenoxylate hydrochloride (Lomotil). D) Take metronidazole (Flagyl). Ans: B Feedback: A patient who is experiencing constipation should be instructed to increase fiber in his diet. The patient should not take a laxative. The patient should not be instructed to take diphenoxylate hydrochloride (Lomotil) because it is an antidiarrheal agent. The patient should not be given metronidazole (Flagyl).

6.A neonate is suffering from apnea. Which of the following medications may be administered as a respiratory stimulant? A) Caffeine and methylphenidate B) Caffeine and Mefoxitin C) Caffeine and sodium benzoate D) Caffeine and sodium bicarbonate Ans: C Feedback: The combination of caffeine and sodium benzoate is occasionally used as a respiratory stimulant in neonates. Caffeine is not mixed with methylphenidate. Caffeine is not mixed with Mefoxitin. Caffeine is not mixed with sodium bicarbonate for this indication.

7.A patient has been treated with dextroamphetamine for ADHD. At the age of 16 years,

A) B) C) D) Ans:

she is diagnosed with hyperthyroidism. What intervention should be implemented with this patient? Discontinue the high-calorie diet. Assess the patient for pulmonary edema. Discontinue the amphetamines. Administer a proton pump inhibitor. C Feedback: Amphetamines are contraindicated upon the development of hyperthyroidism. The patient will require a higher calorie count, not a discontinuation of a high-calorie count. The patient will not require an assessment for pulmonary edema. The patient will only require a proton pump inhibitor if gastric hyperacidity occurs.

8.A teenage boy is on amphetamine therapy for attention deficit hyperactivity disorder. The care provider has suggested a “drug holiday” for July and August. What is the purpose of this drug holiday? A) To minimize weight loss B) To prevent hyperthyroidism C) To allow electrolyte imbalances to resolve D) To slow bone resorption Ans: A Feedback: Dextroamphetamine often causes loss of appetite, and the health care provider may stop the medication during the months when the child is not in school. A drug holiday, as this is called, helps decrease weight loss and growth suppression. It does not address potential electrolyte imbalances, thyroid imbalances, or the process of bone remodeling.

9.A patient is seen in the ambulatory care clinic with a complaint of insomnia. What should the nurse assess in regard to the complaint of insomnia? A) Daily intake of caffeine-containing products B) The amount of exercise in which the patient engages C) The family history of insomnia and sleep D) Possible use of amphetamines Ans: A Feedback: The daily intake of caffeine should be assessed to determine if the intake is sufficient to disturb sleep. The amount of exercise the patient engages in is important but not as critical as caffeine consumption. The family history of insomnia and sleep is not critical to assess. Amphetamines also have the potential to disrupt sleep, but caffeine use is far more prevalent.

10.A female patient asks the nurse how much caffeine is safe to consume per day. What is the recommended amount of caffeine for a nonpregnant woman? A) 125 mg of caffeine B) 250 mg of caffeine C) 500 mg of caffeine D) 1 g of caffeine Ans: B Feedback: Some authorities recommend that normal, healthy, nonpregnant adults consume not more than 250 mg of caffeine daily. 125 mg of caffeine is lower than the recommended safe amount of consumption. 500 mg to 1 g is more than the recommended daily consumption of caffeine.

11.A patient who suffers from asthma is given theophylline. Theophylline will have an increased effect if taken with A) Ritalin. B) atomoxetine (Strattera). C) modafinil (Provigil). D) caffeine. Ans: D Feedback: Caffeine increases the effects of theophylline. Ritalin, Provigil, and Strattera are noted to have this effect.

12.A patient is being prescribed dextroamphetamine for the treatment of ADHD. During health education, the nurse should make the patient aware of the black box warning relating to A) the risks of kidney failure. B) the potential for abuse. C) the risk of stroke with excessive doses. D) the potential for unstable blood glucose levels. Ans: B Feedback: A black box warning makes users of dextroamphetamine aware of the drug's high abuse potential. Black box warnings do not address the potential for renal failure, stroke, or unstable blood sugars.

B) C) D) Ans:

09:45 to 10:30 AM 10:30 to 11:45 AM 13:00 to 14:00 PM A Feedback: Atomoxetine is rapidly absorbed with peak plasma levels in 1 to 2 hours. If he takes the medication at 07:00 AM, it will peak at 08:00 to 09:00 AM.

14.A patient with narcolepsy is placed on a central nervous system stimulant. What is the central nervous system stimulant of choice to treat narcolepsy? A) Atomoxetine (Strattera) B) Guarana C) Caffeine D) Modafinil (Provigil) Ans: D Feedback: Modafinil (Provigil) is used to treat narcolepsy. Atomoxetine is administered for ADHD. Guarana is the main ingredient in caffeine and is not administered for narcolepsy. Caffeine is not administered for narcolepsy.

15.A boy has been diagnosed with ADHD and has been prescribed Ritalin. The boy's mother tells the nurse that she does not understand why a stimulant would help him, stating, “If anything, he's completely overstimulated, not understimulated!” What should the nurse explain to the mother about the therapeutic use of Ritalin? A) Ritalin helps with the symptoms of ADHD, but the reasons for this are not well understood. B) Ritalin stimulates the parasympathetic nervous system, resulting in increased control of behavior. C) Ritalin stimulates the limbic system, which regulates control over behavior and affect. D) Ritalin enhances the function of dopamine, which regulates cognition. Ans: A Feedback: The efficacy of Ritalin in ADHD is paradoxical and not well understood. It does not significantly affect dopamine levels or the function of the limbic system and parasympathetic nervous system.

16. After experiencing two workplace accidents in which he fell asleep, a 30-year-old

construction worker has been diagnosed with narcolepsy. The patient admits that he is embarrassed to receive this diagnosis and is adamant that no one find out about it. The

A) B) C) D) Ans:

nurse should respond to the patient by explaining what aspect of the etiology? “This is the result of neurological factors over which you have no direct control.” “In a lot of cases, making improvements to your sleep habits can resolve narcolepsy.” “This is something that runs in certain families, and it's not your fault that this has happened.” “This usually stems from suppressed emotions, so counseling usually helps greatly.” A Feedback: Narcolepsy is a neurological sleep disorder, not the result of mental illness or psychological problems. It is most likely due to a number of genetic abnormalities, but family history is not noted to be highly significant.

17.A 13-year-old boy has been taking dextroamphetamine for the treatment of ADHD since he was 10, achieving significant improvements in behavior and mood. When assessing the boy during a scheduled follow-up appointment, the nurse should prioritize what physical assessment? A) Abdominal girth and assessment for peripheral edema B) Measurement of height and body weight C) Visual acuity and hearing ability D) Assessment of deep tendon reflexes and peripheral pulses Ans: B Feedback: Suppression of weight and height may occur in children taking amphetamines, and the nurse ensures that growth is monitored during drug therapy. Assessments for edema, diminished reflexes, and sensory deficits are not normally warranted.

18.A high school boy has been brought to the emergency department (ED) by his friends who state that he has taken a “whole handful of Dex” and is now lapsing in and out of consciousness. The ED nurse should prioritize what assessment related to dextroamphetamine overdose? A) Blood glucose monitoring B) Cognitive assessment C) Lung function testing D) Cardiac monitoring Ans: D Feedback: Dextroamphetamine misuse may cause sudden death or serious cardiovascular events. It is essential to obtain a baseline electrocardiogram (ECG) and blood pressure reading. These assessments are priorities over blood glucose monitoring, respiratory assessment,

and cognitive assessment.

19.A 12-year-old girl has undergone an extensive diagnostic workup that has resulted in a diagnosis of ADHD. The prescriber has reviewed the benefits and risks of dextroamphetamine therapy, and the nurse is now reviewing the correct schedule for taking the drug. The child should most likely take her dextroamphetamine at what times? A) 07:00 and 11:30 B) 07:30, 11:30, 16:30, and 20:00 C) 08:00 and 20:00 D) 09:00, 14:00, and 19:00 Ans: A Feedback: People should take the first dose of dextroamphetamine on awakening or early in the day and the last dose at least 6 hours before bedtime. Twice-daily dosing is most common.

20.Methylphenidate will be used to treat a 9-year-old boy's ADHD. In light of this drug's most common adverse effects, the nurse who is working with the family should implement what strategy? A) A strategy to ensure that the boy maintains normal bladder function B) A plan to address the boy's loss of appetite C) A plan to enhance the boy's self-esteem D) A strategy to regularly monitor the boy's blood glucose levels Ans: B Feedback: Like dextroamphetamine, methylphenidate often causes loss of appetite. Plans to address this should be in place at the beginning of therapy. Frequent blood glucose monitoring and actions to maintain bladder function are not likely necessary. Self-esteem should likely be addressed during treatment, but reduced self-esteem is not an adverse effect of methylphenidate.

1. A patient has atony of the smooth muscle of the gastrointestinal tract. Which type of medication may be administered to increase smooth muscle strength? A) Anticholinergic drugs B) Cholinergic drugs C) Muscle relaxants D) Selective serotonin reuptake inhibitors 2. A patient is diagnosed with Alzheimer's disease. The nurse should anticipate administering which of the following medications? A) Bethanechol (Urecholine) B) Neostigmine (Prostigmin) C) Donepezil (Aricept) D) Physostigmine salicylate (Antilirium) 3. A patient with myasthenia gravis is administered neostigmine (Prostigmin). How does this drug produce its therapeutic effect? A) It stimulates the sympathetic nervous system. B) It stimulates the parasympathetic nervous system. C) It stimulates the cardiac smooth muscle. D) It stimulates the respiratory system. 4. A patient is administered edrophonium (Tensilon) to confirm the diagnosis of myasthenia gravis. What effect will the edrophonium (Tensilon) have 30 minutes after the medication administration, which will confirm the diagnosis? A) Improved breathing B) Decreased fatigue C) Decreased muscle spasms D) Increased urinary output 5. A patient with myasthenia gravis is administered pyridostigmine (Mestinon) for the first time. She asks the nurse the reason why she has been changed to this medication. Which of the following is the nurse's best response? A) “Pyridostigmine (Mestinon) will allow you to awaken with the ability to swallow.” B) “Pyridostigmine (Mestinon) can be taken every other day.” C) “Pyridostigmine (Mestinon) is a faster-release form of cholinergic agent.” D) “Pyridostigmine (Mestinon) is taken one time per day for better control.” 6. A patient is diagnosed with a paralytic ileus. Which of the following medications will be administered to treat a paralytic ileus? A) Neostigmine (Prostigmin) B) Donepezil (Aricept) C) Bethanechol (Urecholine)

Ambenonium (Mytelase)

7. When administering anticholinesterase drugs, what assessment finding would indicate the patient is experiencing a toxic effect of the medication? A) Loss of consciousness B) Abdominal distention C) Hypertension D) Muscle weakness 8. A patient has been receiving bethanechol (Urecholine) for 1 week. One hour after the dose is administered, he develops sweating, flushing, abdominal cramps, and nausea. What is the rationale for the development of these symptoms? A) Myasthenic crisis B) Cholinergic overdose C) Anaphylactic reaction D) Pulmonary edema 9. A patient who is being treated for myasthenia gravis is receiving neostigmine, and her pulse drops to 50 after the administration. Which medication should be administered to treat the bradycardia? A) Atropine B) Pseudoephedrine C) Propranolol (Inderal) D) Bethanechol (Urecholine) 10. Which of the following medications is administered for ingestion of clitocybe mushrooms? A) Pyridostigmine (Mestinon) B) Donepezil (Aricept) C) Rivastigmine (Exelon) D) Atropine sulfate 11. A 33-year-old female patient with a recent history of visual disturbances and dysphagia has just been diagnosed with myasthenia gravis. The nurse should recognize that this patient's health problem is ultimately attributable to what pathophysiological process? A) Idiopathic overproduction of anticholinesterase B) Autoimmune destruction of acetylcholine receptors C) Demyelination of parasympathetic nerve pathways D) Deficient synthesis of dopamine by the substantia nigra

12. A 40-year-old woman has received a diagnosis of myasthenia gravis (MG) and is scheduled to begin treatment with oral neostigmine in her home. When providing relevant health education, the nurse should emphasize that successful control of MG symptoms will primarily depend on A) matching each dose of neostigmine to the severity of symptoms at that time. B) making lifestyle modifications to prioritize a healthy diet and regular activity. C) adhering strictly to the prescribed administration schedule. D) developing acceptance of the functional deficits that result from MG. 13. An accidental overdose of neostigmine has prompted the emergency administration of atropine. When assessing the patient, the emergency department nurse should take into account that this intervention will not relieve the effects of neostigmine on A) skeletal muscle. B) smooth muscle. C) the heart. D) glands. 14. A middle-aged female patient has been admitted to the outpatient treatment unit of the hospital for an edrophonium (Tensilon) test. Shortly after the administration of the medication, the patient reports that her muscle strength is significantly weaker than before the test. The nurse who is participating in the test should recognize that this finding is suggestive of what diagnosis? A) Alzheimer's disease B) Anticholinergic crisis C) Myasthenia gravis D) Cholinergic crisis 15. Following recent changes in memory and personality, a 72-year-old man is undergoing neurological testing to rule out Alzheimer's disease. The nurse is aware that this disease is characterized by what pathophysiological phenomena? Select all that apply. A) Meningiomas B) Neuritic plaques C) Neurofibrillary tangles D) Arteriovenous malformations (AVMs) E) Gliomas 16. An 80-year-old man has been diagnosed with early-stage Alzheimer's disease and has begun treatment with donepezil (Aricept). When providing health education to the patient and his wife, the nurse should identify what goal of treatment? A) Remission of Alzheimer's disease B) Cure of Alzheimer's disease C) Improvement of cognition and function D) Resolution of memory and cognitive deficits

17. An older adult patient with a diagnosis of moderate Alzheimer's disease will soon return home with her husband. How can the nurse best facilitate the safe and effective administration of donepezil in the home setting? A) Have the patient explain the rationale for drug therapy repeatedly before discharge. B) Provide a detailed drug monograph to the patient and her husband and offer to answer any questions. C) Assess the patient's need for home care. D) Teach the patient's husband to administer the medication in a timely and safe manner. 18. A nurse is conducting health education with a man who has Alzheimer's disease and his daughter, who is his primary caregiver. The man has been deemed to be a good candidate for treatment with donepezil (Aricept) and will soon begin taking this medication. What teaching point should the nurse convey? A) “Aricept should be taken 1 hour before or 2 hours after any dairy products.” B) “It's important to take this medication at bedtime.” C) “Aricept should be taken with food to reduce the chance of stomach upset.” D) “If you don't notice any cognitive improvement within 2 weeks, the drug should be discontinued.” 19. A man with a neurogenic bladder secondary to a spinal tumor has been taking bethanechol. The patient has illuminated his call light, and the nurse has found him anxious, diaphoretic, and visibly flushed. Following a safety assessment, what action should the nurse take? A) Prepare to administer an IV dose of epinephrine to mitigate the effects of acetylcholine. B) Contact the physician as the patient may be experiencing a cholinergic crisis. C) Insert a Foley catheter as the patient may have excessive urine in his bladder. D) Assess the volume of the patient's bladder contents using a bladder ultrasound. 20. A military nurse is part of a team reviewing the appropriate response to chemical weapons attacks, including sarin, tabun, and soman. When reviewing the physiology of a response to such drugs, the nurse should identify what goal of treatment? A) Restore anticholinesterase function. B) Restore GABA function. C) Restore dopamine function. D) Increase serotonin reuptake.

1. Ans: B Feedback: Cholinergic drugs are used to treat atony of the smooth muscle of the gastrointestinal tract and urinary systems. Anticholinergic agents will decrease muscle strength. Muscle relaxants will decrease muscle strength. Selective serotonin reuptake inhibitors are not used for atony of the smooth muscle of the gastrointestinal tract.

2. Ans: C Feedback: Donepezil (Aricept) is used to treat mild to moderate Alzheimer's disease. Bethanechol (Urecholine) produces smooth muscle contractions and is not used to treat Alzheimer's disease. Neostigmine (Prostigmin) is not used to treat Alzheimer's disease; it is used to treat myasthenia gravis. Physostigmine is not used to treat Alzheimer's disease; it is an antidote for overdose of anticholinergic drugs.

3. Ans: B Feedback: Neostigmine (Prostigmin) stimulates the parasympathetic nervous system. It does not stimulate the sympathetic nervous system, cardiac system, or respiratory system.

4. Ans: A Feedback: Edrophonium (Tensilon) is used to diagnose myasthenia gravis. After administration, it will improve breathing in patients who have myasthenia gravis. Edrophonium will not decrease fatigue. Edrophonium will not decrease muscle spasms or increase urinary output.

5. Ans: A Feedback: Pyridostigmine is a slow-release form that is taken at bedtime and allows the patient the ability to swallow in the morning. Pyridostigmine is usually taken two times per day, not every other day. Pyridostigmine is a slow-release form, not a fast-release form. Pyridostigmine is taken two times per day, not one time per day.

6. Ans: C Feedback: Bethanechol (Urecholine) produces smooth muscle contractions and is used for obstructive conditions of the gastrointestinal tract. Neostigmine is used to treat myasthenia gravis. Donepezil is used to treat Alzheimer's disease. Ambenonium is used to treat myasthenia gravis.

7. Ans: D Feedback: The administration of anticholinesterase medications can result in profound muscle weakness. Decreased LOC, abdominal distention, and hypertension are not characteristic adverse effects of the anticholinesterase medications.

8. Ans: B Feedback: A patient who suffers cholinergic overdose will experience sweating, flushing, abdominal cramps, and nausea. An accurate diagnosis may be determined from timing in relation to medication. Signs and symptoms having an onset within approximately 1 hour after a dose of anticholinesterase drug are likely to be caused by cholinergic crisis. Signs and symptoms beginning 3 hours or more after a drug dose are more likely to be caused by myasthenic crisis. These symptoms are not the result of anaphylaxis or pulmonary edema.

9. Ans: A Feedback: Atropine will reverse the muscarinic effects of cholinergic crisis. Pseudoephedrine will not affect bradycardia in this patient. Propranolol (Inderal) will not affect the bradycardia. Bethanechol will increase the bradycardia.

10. Ans: D Feedback: Atropine sulfate is the specific antidote for mushroom poisoning. Pyridostigmine, donepezil, and rivastigmine are all cholinergic agents that would contribute to the symptoms of toxicity.

11. Ans: B Feedback: Myasthenia gravis occurs when antibodies produced by the body's own immune system block, alter, or destroy the receptors for acetylcholine at the neuromuscular junction, which prevents muscle contraction from occurring. The disease does not involve dopamine deficits, demyelination, or excess anticholinesterase.

12. Ans: C Feedback: Strict adherence to timely medication administration promotes optimal blood levels of neostigmine and optimal symptom control. Doses are not typically matched to shortterm symptom severity, except in emergencies. Lifestyle modifications and acceptance may

be of benefit, but pharmacologic therapy is of paramount importance in the treatment of MG.

13. Ans: A Feedback: Atropine reverses only the muscarinic effects of cholinergic drugs, primarily in the heart, smooth muscle, and glands. Atropine does not interact with nicotinic receptors and therefore cannot reverse the nicotinic effects of skeletal muscle weakness due to overdose of indirect anticholinergic drugs.

14. Ans: D Feedback: If the edrophonium test makes the patient even weaker, the diagnosis is cholinergic crisis.

15. Ans: C, D Feedback: The neuropathologic hallmarks of Alzheimer's disease are neuritic plaques and neurofibrillary tangles. Gliomas, meningiomas, and AVMs are not associated with Alzheimer's disease.

16. Ans: C Feedback: The goal of drug therapy for Alzheimer's disease is to slow the loss of memory and cognition, thus preserving the independence of the individual person for as long as possible. Remission, cure, and resumption of preillness levels of memory and cognition are unrealistic goals.

17. Ans: D Feedback: It is important for the home care nurse to work with responsible family members in such cases to ensure accurate drug administration. Assessing the family's need for home care may be warranted, but this action does not necessarily ensure safe drug administration. The presence of moderate Alzheimer's disease may preclude effective patient teaching. Written teaching materials must normally be supplemented by other forms of teaching.

18. Ans: B Feedback:

Aricept should normally be taken at bedtime. It does not have to be taken with food. Dairy does not interfere with pharmacokinetics. The drug should be continued even if improvement is not noticeable.

19. Ans: B Feedback: The presence of sweating and skin flushing in a patient taking bethanechol is suggestive of a cholinergic crisis. This is a medical emergency that warrants prompt intervention by the care team. This problem is not treated with epinephrine. Assessing the patient's bladder or inserting a Foley catheter is not sufficient.

20. Ans: A Feedback: These drugs are irreversible anticholinesterase agents. The goal of treatment, such as atropine administration, is to restore normal function of anticholinesterase and rid synapses of excessive acetylcholine.

1.A 60-year-old male patient has developed a tremor of the right hand with a pill-rolling motion. Upon interviewing the patient, he states he sustained several head injuries playing football. Based on this information, what do you suspect the patient is suffering from? A) Seizure disorder B) Degenerative joint disease C) Amyotrophic lateral sclerosis D) Parkinson's disease Ans: D Feedback: Parkinson's disease is a chronic, progressive, degenerative disorder of the central nervous system characterized by resting tremor, bradykinesia, rigidity, and postural instability. The patient is not experiencing degenerative joint disease. The patient is not showing signs of symptoms of a seizure disorder. The patient has rigidity with tremors, not the signs of muscle weakness that are found in amyotrophic lateral sclerosis.

2.A patient has developed symptoms of rigidity and bradykinesia. Which of the following medications has been linked to secondary parkinsonism? A) Haloperidol B) Furosemide (Lasix) C) Psyllium hydrophilic mucilloid (Metamucil) D) Valproic acid (Valproate) Ans: A Feedback: Drugs that deplete dopamine stores or block dopamine receptors, including the older antipsychotic drugs (phenothiazines and haloperidol), reserpine, and metoclopramide, can produce movement disorders such as secondary parkinsonism. Furosemide does not deplete dopamine stores. Psyllium does not deplete dopamine stores. Valproic acid does not deplete dopamine stores.

A) B) C) D)

3.A patient is being treated for Parkinson's disease and has been prescribed both levodopa (L-dopa) and carbidopa (Lodosyn). Why is this course of combination treatment most effective? Levodopa restores dopamine and carbidopa decreases peripheral breakdown of levodopa. Levodopa decreases the toxic effects of carbidopa to reduce the extrapyramidal reaction. Carbidopa increases the peripheral breakdown of levodopa to hasten its onset and peak. Levodopa and carbidopa, when combined, enhance voluntary movement to improve gait.

Ans:

A Feedback: Levodopa restores dopamine levels and, in combination with carbidopa, decreases the peripheral breakdown of levodopa and allows more to reach the brain. Levodopa does not decrease the toxic effects of carbidopa to reduce the extrapyramidal reaction. Carbidopa does not increase the peripheral breakdown of levodopa to increase its effectiveness. Levodopa and carbidopa combined do not exacerbate abnormal voluntary movement to increase gait.

4.A patient who suffers from Parkinson's disease is being treated with levodopa/carbidopa. Which of the following disorders will result in the discontinuation of this drug based on a disease-related contraindication? A) Human immune deficiency virus B) Human papillomavirus C) Transient ischemic attacks D) Narrow-angle glaucoma Ans: D Feedback: Since levodopa can dilate pupils and raise intraocular pressure, it is contraindicated in narrow-angle glaucoma. Levodopa is not contraindicated in patients with human immune deficiency virus. Levodopa is not contraindicated in patients with human papillomavirus. Levodopa is not listed as a contraindication with TIAs.

5.A patient with long-standing Parkinson's disease has been prescribed entacapone (Comtan). The patient asks the nurse to describe exactly how this medication works. Which of the following responses is most appropriate? A) “Entacapone is best given parenterally to relieve symptoms.” B) “Entacapone inhibits COMT so that dopamine is active for a longer time.” C) “It increases the metabolism of levodopa in the bloodstream.” D) “It increases the amount of dopamine that your brain creates.” Ans: B Feedback: Entacapone is a COMT inhibitor. COMT plays a role in brain metabolism of dopamine. Entacapone is administered orally, not parenterally. Entacapone does not increase the metabolism of dopamine in the bloodstream. It inhibits the metabolism of levodopa in the blood stream. Entacapone is 90% excreted in the biliary tract and feces and 10% in the urine.

6.A patient with Parkinson's disease is being treated with rasagiline (Azilect). This medication inhibits the metabolism of dopamine by monoamine oxidase. Which of the

A) B) C) D) Ans:

following foods should the patient be instructed to avoid? Cheddar cheese and Polish sausage Ham and rye bread Roast beef and horseradish Dairy products A Feedback: Cheddar cheese and Polish sausage are high in tyramine, which produces a lifethreatening reaction of hypertension when combined with rasagiline. The other listed foods are not high in tyramine.

7.A patient with Parkinson's disease has been prescribed rasagiline. When educating this patient on this medication, which herbal supplement has the potential to produce hyperpyrexia and death with rasagiline? A) Ginger B) Dextromethorphan C) Garlic D) St. John's wort Ans: D Feedback: Rasagiline administered with the herbal supplement St. John's wort will enhance the stimulation of serotonergic receptors to cause hyperpyrexia and death. Dextromethorphan can produce the same reaction but is not an herbal supplement. Ginger and garlic are herbal supplements but will not produce hyperpyrexia and death.

8.An 80-year-old patient has been prescribed an anticholinergic agent for treatment of Parkinson-related symptoms. What patient education should be provided? A) “Avoid high environmental temperatures.” B) “Anticholinergics increase mental alertness.” C) “It is safe to take Sudafed for a cold.” D) “You may experience urinary incontinence.” Ans: A Feedback: Anticholinergic drugs decrease sweating and may cause heat stroke. The patient should be instructed to avoid high environmental temperatures. Anticholinergic agents will decrease mental alertness. Sudafed will produce anticholinergic effects and should not be administered. Anticholinergic agents produce urinary retention, not incontinence.

9.A 77-year-old male patient with Parkinson's disease will soon begin treatment with levodopa, carbidopa, and entacapone (Stalevo). Prior to starting this course of treatment, the nurse must ensure that

A) B) C) D) Ans:

the patient has committed to having weekly blood work drawn for the next 2 months. the patient has completed an anticholinergic challenge in a clinical setting. the patient's existing dose of levodopa has been reduced. the patient has a prognosis for complete recovery from Parkinson's disease. C Feedback: Patients whose medication regime is being changed to Stalevo should be administered levodopa and the adjunctive entacapone. The levodopa dose should be adjusted prior to the conversion to Stalevo therapy. Weekly blood work and the completion of an anticholinergic challenge are not necessary. Complete recovery from Parkinson's disease is not a realistic goal.

10.The nurse is teaching a woman who has Parkinson's disease about the dietary implications of her upcoming treatment with levodopa/carbidopa. What should the nurse teach this patient? A) “It's important to take this medication on a full stomach so that it doesn't make you nauseous.” B) “Most people find that it's best to take this medication at bedtime, provided you haven't snacked in the evening.” C) “If possible, try to eat extra protein when you're taking this medication.” D) “Dairy products will make this medication ineffective, so make sure you don't take them at the same time.” Ans: A Feedback: Levodopa/carbidopa is administered with or just after food or following a meal to reduce nausea and vomiting. Levodopa/carbidopa is not administered with a high-protein diet. Dairy products do not interfere with pharmacokinetics.

11.A woman is admitted to the emergency department with a diagnosis of sinus bradycardia. The patient has been prescribed atropine 0.5 mg IV. How often can atropine be administered? A) Every 24 hours B) Every 6 hours C) Every 30 minutes D) Every 3 to 5 minutes Ans: D Feedback: Atropine 0.5 mg should be administered IV every 3 to 5 minutes and may be repeated up to 3 mg. Atropine can be administered every 24 hours, but this administration is not the recommended therapy for bradycardia. Atropine can be administered every 6 hours, but

this administration is not the recommended therapy for bradycardia. Atropine can be given in 30 minutes, but this administration is not the recommended therapy for bradycardia.

12.A patient is administered atropine to increase the heart rate. What is the action of atropine? A) It blocks the parasympathetic vagal stimulation. B) It exacerbates the parasympathetic vagal stimulation. C) It provides long-acting antihistamine blockage. D) It blocks cell wall synthesis of gram-negative bacilli. Ans: A Feedback: Moderate to large doses of atropine increase the heart rate by blocking parasympathetic vagal stimulation. The exacerbation of the parasympathetic vagal stimulation is opposite the effect of atropine. The blockage of histamine is seen with the antihistamine medications, not anticholinergic agents. Atropine does not block cell wall synthesis.

13.A patient has been administered atropine for sinus bradycardia. Which of the following symptoms is noted with large doses of atropine? A) Pallor B) Flushing C) Edema D) Incontinence Ans: B Feedback: Large doses of atropine cause facial flushing because of dilation of blood vessels in the neck. Pallor, edema, and incontinence are not caused by dilation of blood vessels in the neck.

14.A patient is scheduled for a hemithyroidectomy. She has been prescribed an anticholinergic agent prior to surgery. Why is it important to administer the anticholinergic agent in the preoperative phase? A) It will prevent tachycardia. B) It will decrease respiratory secretions. C) It will decrease gastric motility. D) It relaxes the detrusor muscle. Ans: B Feedback: In preoperative patients, the nurse assesses for diminished secretions, particularly when an anticholinergic is administered for head and neck surgery. The administration of an anticholinergic agent will not prevent tachycardia. Anticholinergic agents do decrease

gastric motility, but this rationale is not a reason for administration in the preoperative phase. The anticholinergic agents cause relaxation of the detrusor muscle, but this rationale is not the reason for administration of the medication in the preoperative phase.

15. The physician orders benztropine mesylate (Cogentin). What disease process would

A) B) C) D) Ans:

contraindicate the administration of this anticholinergic medication? Diabetes mellitus Myocardial infarction Narrow-angle glaucoma Hyperparathyroidism C Feedback: Narrow-angle glaucoma will result in increased intraocular pressure, and the patient should not receive the anticholinergic agent. Patients who suffer from diabetes mellitus, myocardial infarction, or hyperparathyroidism can normally be administered anticholinergic agents.

16. The physician has ordered scopolamine transdermally for motion sickness. Which of the

A) B) C) D) Ans:

following statements by the patient indicates an understanding of the medication's administration guideline? “I will place it on my chest each morning.” “I will use it when I am sick to my stomach.” “I will change the patch every 4 hours.” “I will change the patch every 3 days.” D Feedback: Scopolamine is used for motion sickness. The disk (Transderm-V) protects against motion sickness for 72 hours. The scopolamine patch is applied behind the ear, not to the chest. The patch is used prior to the patient experiencing nausea. The patch is not changed every 4 hours.

17.A patient with myasthenia gravis is experiencing rhinorrhea. Which of the following medications should not be administered to the patient? A) Azelastine hydrochloride (Astelin) B) Ipratropium (Atrovent) C) Fexofenadine (Allegra) D) Nedocromil sodium (Tilade) Ans: B Feedback: Ipratropium (Atrovent) is administered for rhinorrhea, but is contraindicated in patients who have been diagnosed with myasthenia gravis because of its anticholinergic effects.

Azelastine hydrochloride (Astelin), fexofenadine (Allegra), and nedocromil sodium (Tilade) are not contraindicated for patients with myasthenia gravis.

18.A patient is suffering from urinary urgency and frequency. Which of the following medications will assist in treating the patient's symptoms of urinary frequency? A) Belladonna tincture B) Homatropine hydrobromide C) Hyoscyamine (Anaspaz) D) Ipratropium (Atrovent) Ans: C Feedback: Hyoscyamine (Anaspaz) is a belladonna alkaloid used in genitourinary disorders characterized by spasm, increased secretion, and increased motility. Belladonna tincture is used for GI disorders because of its antispasmodic effect. Homatropine hydrobromide is used as an eyedrop to produce mydriasis and cycloplegia. Ipratropium (Atrovent) is used to treat rhinorrhea.

19.A patient has been diagnosed with chronic obstructive pulmonary disease. The patient is to be administered tiotropium bromide (Spiriva HandiHaler). The patient's creatinine level is 25. What is the patient at risk for developing? A) Drug toxicity B) Pneumonia C) Hepatotoxicity D) Central nervous system depression Ans: A Feedback: The patient has an elevated creatinine level. Tiotropium bromide is eliminated by the renal system, and patients with moderate to severe renal dysfunction should be carefully monitored for drug toxicity.

20.A patient has been administered chlorpromazine (Thorazine) for many years to treat his psychotic disorder. He has recently developed extrapyramidal symptoms related to longterm administration of this drug. Which of the following medications can be administered to assist in relieving these symptoms? A) Diazepam (Valium) B) Darifenacin (Enablex) C) Trihexyphenidyl (Trihexy) D) Trospium chloride (Sanctura) Ans: C Feedback: Trihexyphenidyl (Trihexy) is used in the treatment of parkinsonism and extrapyramidal

reactions caused by antipsychotic drugs. Valium is a benzodiazepine and is not used for this purpose. Darifenacin is used for the treatment of overactive bladder. Trospium chloride (Sanctura) reduces the tone of the smooth muscle in the bladder.

1.A surgical patient has highly elevated AST and ALT levels. Standard orders specify that she is to receive morphine sulfate 10 mg postoperatively. What action should the nurse take prior to administering the medication? A) Draw up half of the medication for administration. B) Notify the physician for a reduced dosage. C) Assess the patient's respiratory status. D) Assess the patient's pain tolerance. Ans: B Feedback: Morphine and meperidine form pharmacologically active metabolites. Thus, liver impairment can interfere with metabolism, and kidney impairment can interfere with excretion. Drug accumulation and increased adverse effects may occur if dosage is not reduced. The nurse cannot administer half of the medication without a physician's order. It is important to assess the patient's respiratory status before administration, but this action is not the primary intervention in this case. Narcotics prior to surgery are administered to increase pain tolerance during the surgical procedure, not during the preoperative phase.

2.An outpatient has been prescribed hydrocodone for back pain related to a compression fracture. Which of the following interventions should the patient be taught regarding the medication administration? A) Consume a diet high in fiber. B) Decrease activity due to pain. C) Elevate the lower extremities. D) Take aspirin with the medication. Ans: A Feedback: Hydrocodone is an opioid, which, in the gastrointestinal tract, slows motility. To prevent constipation, the patient should consume a diet high in fiber. A decrease in activity due to pain will increase constipation. Elevating the lower extremities will not increase or decrease pain. Hydrocodone should not be routinely combined with aspirin unless prescribed by the physician.

3.A hospice patient has been ordered morphine (Roxanol) 5 mg sub-Q every 2 hours. Roxanol contains 10 mg/mL. How many milliliters will be administered? A) 0.25 mL B) 0.5 mL C) 1 mL D) 2 mL Ans: B Feedback:

5 mg/X = 10 mg/mL. The calculation results in 0.5 mL. The administration of 0.25, 1, or 2 mL is incorrect.

4.A patient who suffers from cancer pain is receiving morphine every 2 hours. For which of the following should the family be taught to assess while the patient is on morphine? A) Diarrhea B) Respiratory depression C) Lung sounds D) Urinary incontinence Ans: B Feedback: The administration of morphine can result in respiratory depression. The family should be taught to assess the patient for respiratory depression. Morphine sulfate can be administered to treat severe diarrhea. The patient's lung sounds are important to assess, but only after the nurse assesses for respiratory depression. Morphine does not cause urinary incontinence.

5.A patient is admitted to the surgical division after a mastectomy. The patient has a PCA pump and states to you that she is fearful she will overdose on morphine. Which of the following interventions is most appropriate to teach the patient? A) “The pump will administer all of the doses, so you don't have to worry.” B) “If you follow the instructions, that won't happen to you.” C) “The device is preset, so you cannot receive more than you need.” D) “The device will give you a placebo when you press it often.” Ans: C Feedback: PCA pumps deliver a basic amount of analgesic by continuous infusion, with the patient injecting additional doses when needed. The amount of the drug is preset and limited. The pump will administer a basal rate, but the patient can administer the medication at preset intervals. Telling the patient not to worry is not effective teaching or use of therapeutic communication. Telling the patient to follow the instructions is not effective teaching or use of therapeutic communication. Instructing the patient on a placebo is not effective teaching or use of therapeutic communication.

A) B) C)

6.A patient has been given MS Contin. You enter the room and the patient is unresponsive. His respirations are 6 breaths per minute. What medication will be ordered for the patient? Naloxone (Narcan) Capsaicin (Zostrix) Butorphanol (Stadol)

D) Ans:

Nalbuphine (Nubain) A Feedback: Naloxone (Narcan) has long been the drug of choice to treat respiratory depression caused by an opioid. Capsaicin is made from cayenne pepper and applied topically for pain relief. Butorphanol (Stadol) is a synthetic, Schedule IV agonist similar to morphine in analgesic effects and ability to cause respiratory depression. Nalbuphine (Nubain) is a synthetic analgesic used for moderate to severe pain.

7.A patient has been administered an opioid. For which of the following effects should the patient be assessed? A) Oliguria B) Decreased level of consciousness C) Edema D) Tachycardia Ans: B Feedback: Opioids will produce decreased LOC then respiratory depression. Oliguria is not a result of the administration of an opioid. Edema is not a result of the administration of an opioid. Tachycardia is not a result of the administration of an opioid.

8.A nurse is teaching a patient about her prescription for Tylenol #3 that she will take at home. This medication consists of acetaminophen and what other drug? A) Codeine B) Acetylsalicylic acid (aspirin) C) Methadone (Dolophine) D) Tramadol (Ultram) Ans: A Feedback: Tylenol #3 is acetaminophen (Tylenol) and codeine. Acetylsalicylic acid (aspirin) is not combined with acetaminophen (Tylenol). Methadone (Dolophine) is not combined with Tylenol. Tramadol (Ultram) is not combined with Tylenol.

9.A patient is near the end of life and has developed increased respiratory secretions and labored breathing. The physician is likely to order which of the following medications to decrease these symptoms? A) Meclizine (Antivert) B) Ampicillin C) Naloxone (Narcan) D) Morphine sulfate Ans: D

Feedback: Morphine is used for the treatment of acute pulmonary edema. Meclizine (Antivert) is given for dizziness. Ampicillin is used to treat infection. Naloxone (Narcan) is the opioid antidote.

10.A patient has been receiving morphine sulfate 5 mg IV every 4 hours for the past several days. She states that the pain is not being relieved as well as it was in the past. What is the reason for this development? A) She has developed a dependency on the morphine. B) She has metastatic cancer and is dying. C) She has greater pain with inactivity. D) She has developed tolerance to morphine. Ans: D Feedback: Larger-than-usual doses of morphine are required to treat pain in opiate-tolerant people. The patient has not developed a dependence on morphine. A patient with metastatic cancer will require increasing pain management, but this feature is not the rationale for the patient's statement. The increased pain is not related to inactivity.

11.In which of the following patients should the nurse question the physician's order for IV morphine? A) An 88-year-old female with failure to thrive B) A 45-year-old female, 1-day postoperative mastectomy C) An 8-year-old male with a fractured femur D) A 17-year-old female, 1-day postoperative appendectomy Ans: A Feedback: Opioid analgesics should be used cautiously in older adults, especially if they are debilitated. Treatment with morphine 1 day after mastectomy is appropriate for pain management. The treatment of pain with morphine is appropriate for a patient with a fractured femur. The treatment of pain with morphine is appropriate for a patient who is 1-day postoperative for an appendectomy.

12.A 30-year-old male patient has been ordered Demerol 75 mg IM every 4 hours after a fractured femur. What action should the nurse take? A) Give the medication as ordered. B) Administer half the dose. C) Call the physician for a smaller dose. D) Give the dose by mouth. Ans: A Feedback:

The patient should be administered the full dose of medication, which is within dosing recommendations. A male patient with a fractured femur who has adequate hepatic and renal function should not receive a lower dose of Demerol and should not receive the medication by mouth.

13.A nurse is instructing a patient on the administration of an opioid medication. What medication effect will most likely develop? A) Lower extremity paresthesia B) Drowsiness C) Occipital headache D) Polyuria Ans: B Feedback: Drowsiness and sedation are results of central nervous system depression. The patient will not develop lower extremity paresthesia, occipital headache, or polyuria. If these effects develop, they are not related to the opioid medication.

14.A patient has been ordered a fentanyl patch known as Duragesic for chronic pain. What patient teaching should be provided to the patient and family? A) Remove the patch every 3 days. B) Apply it to the chest only. C) Apply it for breakthrough pain. D) Remove it daily and clean skin. Ans: A Feedback: Duragesic has a slow onset of action, but lasts about 72 hours. Duragesic can be applied to other areas of the skin, not solely on the chest. Duragesic is not applied for breakthrough pain. Duragesic is not removed daily.

15. What is the most effective way to evaluate the patient's pain response after administering

A) B) C) D) Ans:

an opioid analgesic? Observe the patient when he/she is not aware you are assessing him/her. Ask another nurse to assess the patient's response to the medication. Using a pain scale, ask the patient to describe the pain. Ask the family to determine the patient's response to the pain. C Feedback: Asking the patient to describe the pain using a pain scale is the most effective assessment of pain response. Observing the patient when he/she is unaware is an objective assessment and does not represent a true pain experience. Asking another nurse to assess the patient's response will not provide accurate data. Asking the family to determine the

patient's response will not provide accurate data.

16. Nonopioid analgesics may sometimes be added to a narcotic analgesic. What action will

A) B) C) D) Ans:

result? Antagonism Additive effect Interference Increased excretion B Feedback: Aspirin and Tylenol are added to narcotic analgesics for additive effects of pain relief without the addition of narcotic adverse effects. Aspirin and Tylenol do not provide an antagonistic effect. Aspirin and Tylenol do not cause an interference of action. Aspirin and Tylenol will not increase excretion.

17.A 16-year-old has been brought to the emergency department by his football coach after twisting his ankle during a practice drill. Diagnostic testing reveals a fracture. This patient is experiencing what type of pain? A) Acute somatic pain B) Acute cutaneous pain C) Visceral pain D) Neuropathic pain Ans: A Feedback: Sprains and other traumatic injuries are examples of acute somatic pain. Somatic pain results from stimulation of nociceptors in skin, bone, muscle, and soft tissue. Visceral pain, which is diffuse and not well localized, results when nociceptors are stimulated in abdominal or thoracic organs and their surrounding tissues. Neuropathic pain is caused by lesions or physiologic changes that injure peripheral pain receptors, nerves, or the central nervous system. Cutaneous pain is not a recognized category.

18.A patient with traumatic injuries describes his current pain as being “unbearable.” The pathophysiology of pain begins with a signal from A) myelin sheaths. B) nociceptors. C) baroceptors. D) synapses. Ans: B Feedback: For a person to feel pain, the signal from nociceptors in peripheral tissues must be transmitted to the spinal cord, then to the hypothalamus and cerebral cortex in the brain.

Myelin sheaths, synapses, and baroceptors are not directly involved in pain transmission.

19.A 54-year-old woman is being admitted to the postsurgical unit following a transverse rectus abdominis myocutaneous (TRAM) flap. The patient's care plan specifies the use of preemptive analgesia. This approach to pain control will involve A) frequent administration of high-dose opioids. B) simultaneous use of analgesics from different drug classes. C) alternating administration of opioid antagonists with opioid agonists. D) patient-controlled analgesia. Ans: B Feedback: Preemptive analgesia is used to reduce postsurgical pain by simultaneously administering medications from different drug classes to suppress pain by blocking multiple pain pathways. It is not synonymous with PCA and does not require alternation between opioid agonists and antagonists.

20.Following the administration of pentazocine (Talwin) to a patient with moderate pain, the nurse should assess for what change in the patient's vital signs? A) Increased blood pressure B) Decreased oxygen saturation C) Increased temperature D) Increased respiratory rate Ans: A Feedback: Talwin may cause increased blood pressure. It does not typically cause deoxygenation, fever, or tachypnea.

Chapter 50- Drug Therapy With Local Anesthetics 1. A patient has suffered a severe laceration to his thumb and index finger during a workplace accident, and local anesthetic is to be utilized to facilitate suturing. Which of the patient's following statements should prompt the nurse to provide further health education? A) “I have to admit I'm relieved that they'll be freezing my hand before they stitch it up.” B) “I'm feeling pretty queasy about getting stitches, so I'm glad they'll be knocking me out.” C) “They told me that it will take a few hours before I can feel my hand again.” D) “If I understand correctly, I won't be able to move my hand normally for a while after getting the anesthesia.” Ans: B Feedback: Local anesthesia is differentiated from general anesthesia in that there is no loss of consciousness. “Freezing” is an accurate description. Normal motor control and sensation return after a period of time.

2. Spinal anesthesia will be used to perform a patient's scheduled bunionectomy. What should the nurse teach the patient about the administration of this form of anesthesia? A) It will cause a significant, but temporary, decrease in level of consciousness. B) It will be injected at the level of C7 to T2. C) It will be injected between T8 and T9. D) It will be injected into the cerebrospinal fluid. Ans: D Feedback: Spinal anesthesia involves injecting the anesthetic agent into the cerebrospinal fluid, usually in the lumbar spine. It does not cause a significant decrease in level of consciousness.

3. Resetting of a patient's fracture will take place under local anesthetic. These anesthetics reduce movement and sensation by decreasing the permeability of the nerve cell membrane to ions. What is the most important ion that participates in this process? A) Calcium B) Magnesium C) Sodium D) Potassium Ans: C Feedback: Local anesthetics decrease the permeability of the nerve cell membrane to ions, especially sodium.

4. A patient who suffered a laceration while doing woodwork in his garage will have his wound treated under local anesthesia achieved using lidocaine and epinephrine. The nurse who will assist with the procedure should recognize that epinephrine performs what function in this situation?

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A) Promoting vasodilation B) Prolonging the effects of lidocaine C) Preventing adverse effects of lidocaine D) Blocking the afferent nerve pathways Ans: B Feedback: Lidocaine has a rapid effect, and, when combined with epinephrine, this effect is prolonged. Epinephrine can promote vasoconstriction, not vasodilation, and it neither prevents adverse effects nor blocks afferent nerve pathways.

5. A patient's chronic venous ulcer on the lower lateral surface of his leg requires incision and debridement (I & D). The nurse should anticipate that lidocaine will be administered by which of the following routes? A) Intravenous B) Topical C) Injection D) Nebulized Ans: C Feedback: Injectable lidocaine is used for infiltration of the skin or subcutaneous administration prior to minor surgical procedures, such as I & D. Nebulized administration of lidocaine is reserved for lung procedures. Topical administration would be insufficient, and IV administration is not warranted.

6. A patient with hand trauma following a gunshot wound currently has bier block anesthesia with lidocaine. What assessment finding should signal the nurse to the possibility that the patient has local anesthetic systemic toxicity (LAST)? A) The patient has become intensely anxious and agitated. B) The patient has complained of nausea and had an episode of blood-tinged emesis. C) The patient's heart rate has become bradycardic and irregular. D) The patient states that he still has sensation in his hand. Ans: A Feedback: Initial symptoms of LAST may include analgesia, circumoral numbness, metallic taste, tinnitus or auditory changes, and agitation. Nausea, dysrhythmias, and continued sensory nerve function do not suggest LAST.

7. An older adult patient has sought care for the treatment of hemorrhoids, and the care provider has prescribed topical lidocaine. The nurse should teach the patient that full pain relief will normally be achieved how long after application of lidocaine? A) 5 to 10 minutes B) 15 to 30 minutes C) 20 to 60 minutes

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D) 90 minutes to 2 hours Ans: C Feedback: Following topical administration of lidocaine, the area becomes numb in 20 to 60 minutes.

8. A patient undergoing chemotherapy for the treatment of lung cancer has developed stomatitis. Oral lidocaine viscous has consequently prescribed by the primary caregiver. To minimize the patient's chance of aspiration, the nurse should encourage the patient to A) take small bites of food and small sips of fluid after administration. B) adopt a minced and pureed diet for the duration of treatment. C) remain in a high Fowler's position for 90 minutes following the use of lidocaine viscous. D) avoid eating or drinking for 1 hour following the use of lidocaine viscous. Ans: D Feedback: Patients should not drink fluids or eat after gargling with viscous lidocaine for at least 60 minutes due to risk of aspiration. Upright positioning will not mitigate this risk. A textured diet is unnecessary.

9. A patient has been administered lidocaine in anticipation of a bronchoscopy and lung biopsy. What change in status would the nurse recognize as a potential hypersensitivity to lidocaine? A) Audible wheeze B) Pleural pain C) Audible S3 D) Hemoptysis Ans: A Feedback: It is necessary to assess the respiratory status and lung sounds for signs of bronchospasm related to hypersensitivity after lidocaine administration. An audible wheeze is suggestive of bronchospasm. Pleural pain, audible S3, and hemoptysis are less likely to be a direct result of hypersensitivity.

10. A woman who is in her second trimester of pregnancy has suffered burns to her forearm from a steaming kettle. What amide local anesthetic can the nurse safely administer by the topical route during pregnancy? A) Lidocaine B) Mepivacaine (Carbocaine, Polocaine) C) Bupivacaine (Marcaine, Sensorcaine) D) Dibucaine (Nupercainal) Ans: D Feedback: Dibucaine (Nupercainal) is local anesthetic administered topically to the affected area to

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induce pain relief. It is not absorbed systemically; therefore, it is considered safe during pregnancy. The other amides are not approved for use during pregnancy.

11. A hospital patient's medication administration record specifies the parenteral administration of lidocaine before a tissue biopsy to be performed later in the day. What action should the nurse take in response to this order? A) Obtain an order for epinephrine in order to potentiate the action of lidocaine. B) Contact the prescriber because administration should be performed by a physician or nurse anesthetist. C) Administer a 500 mL bolus of normal saline to ensure adequate vascular volume. D) Assess the patient's need for an antihistamine to be on hold during administration of the lidocaine. Ans: B Feedback: A physician or nurse anesthetist administers the injectable form of lidocaine. A fluid bolus, an antihistamine, and epinephrine are not necessarily indicated.

12. Spinal anesthesia using procaine has been ordered for a patient prior to revision of the patient's ankle hardware. This drug achieves anesthesia by A) preventing the influx of sodium into nerve cells. B) increasing the action of anticholinesterase in nerve synapses. C) antagonizing nociceptors. D) agonizing opioid receptors in the CNS. Ans: A Feedback: Procaine decreases the influx of sodium into the nerve cell and depresses depolarization to prevent conduction of the nerve impulse. It does not alter the function of nociceptors, opioid receptors, or anticholinesterase.

13. The nurse is assessing a patient who was recently administered procaine for local anesthesia. Which of the following assessment findings would suggest the possibility of adverse effects? A) Increased temperature B) Increased heart rate C) Decreased blood pressure D) Lethargy Ans: B Feedback: Following administration of procaine, the nurse assesses the CNS for excitability and the cardiovascular status for tachycardia and hypertension, leading to cardiovascular collapse. Lethargy, hypotension, and fever are not typical adverse effects.

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14. A nurse is planning the care of a patient whose laceration requires the use of local anesthesia. The nurse recognizes that there is a risk to the patient who has local anesthesia due to what nursing diagnosis? A) Disturbed sensory perception B) Autonomic dysreflexia C) Self-care deficit D) Latex allergy response Ans: A Feedback: The absence of sensory perception means that patients are at risk for injuring the anesthetized body part without their knowledge. Autonomic dysreflexia and latex allergy response are not plausible risks. The brief action of local anesthetics means that self-care deficit is rarely an issue.

15. A woman's prolonged epistaxis (nosebleed) following a basketball injury has created a need for anesthesia and vasoconstriction of the nasal mucous membranes. These therapeutic effects can best be achieved with what drug? A) Prilocaine B) Procaine hydrochloride C) Bupivacaine D) Cocaine hydrochloride Ans: D Feedback: Topical cocaine is an anesthetic administered to the ear, nose, or throat to produce adequate anesthesia and vasoconstriction of the mucous membranes. The other listed anesthetics are not typically used for this purpose.

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1.Prior to her elective hip replacement surgery, the nurse is explaining the basic characteristics of general anesthesia to the patient. The nurse should perform this education in the understanding that general anesthesia is best understood as A) a nonreversible, temporary state of unresponsiveness. B) a state of reversible unconsciousness. C) stage N2 non–rapid eye movement sleep. D) stage N3 non–rapid eye movement sleep. Ans: B Feedback: General anesthesia is defined as a medication-induced reversible unconsciousness with loss of protective reflexes. There is the misconception that general anesthesia is a deep sleep.

2.A perioperative nurse is explaining the process of general anesthesia in anticipation of the adult patient's imminent bowel resection. When describing the phase of induction, the nurse should explain that this is usually achieved by what means? A) Intramuscular injection of anesthetics and benzodiazepines B) Intravenous administration of opioid analgesics C) Subcutaneous injection of a rapid-acting anesthetic D) Intravenous administration of anesthetics Ans: D Feedback: The administration of a general anesthetic can be divided into three phases. The first phase is induction, which is rendering the patient unconscious by using inhalation anesthetics, intravenous anesthetics, or both. Adult patients usually receive a rapid-acting intravenous anesthetic medication. IM medications, sub-Q medications, and opioids are not used.

3.An adult patient who is currently undergoing rhinoplasty has developed the characteristic signs and symptoms of malignant hyperthermia. The operating room nurse should anticipate what intervention? A) Hemodialysis B) Tracheal intubation C) IV administration of naloxone (Narcan) D) IV administration of dantrolene sodium (Dantrium) Ans: D Feedback: The treatment for malignant hyperthermia consists of intravenous dantrolene sodium (Dantrium), oxygenation and hyperventilation, hydration, and body cooling. The patient will already be intubated. Narcan and dialysis are not indicated.

4.The operating room nurse is reading the anesthesiologist's consult of a 30-year-old female patient who will undergo surgical repair of a meniscus tear later that day. The nurse reads that total intravenous anesthesia (TIVA) is indicated. What is the most likely rationale for this intervention? A) The patient has a diagnosis of chronic obstructive pulmonary disease (COPD). B) The patient's insurer does not reimburse for inhaled anesthesia. C) The patient has previously experienced severe postoperative nausea and vomiting. D) The patient is in the first trimester of pregnancy. Ans: C Feedback: In patients who have history of severe postoperative nausea and vomiting, the anesthetist may substitute the inhalation anesthetic with a technique called total intravenous anesthesia (TIVA). TIVA is not necessarily indicated in patients who are pregnant or who have COPD. Insurance considerations would not normally be an absolute indication for the use of TIVA.

5.A certified registered nurse anesthetist is describing the minimum alveolar concentration (MAC) of isoflurane. How will the addition of nitrous oxide or IV anesthetics affect the MAC of isoflurane? A) The MAC will remain the same. B) The MAC will decrease. C) The MAC of isoflurane will not be relevant. D) The MAC will be more difficult to calculate. Ans: B Feedback: With the addition of other medications such as opioids, intravenous anesthetics, or nitrous oxide, the MAC values decrease.

6.A patient is scheduled to undergo craniofacial surgery, a procedure that will necessitate the use of propofol. The operating use nurse should be aware that alternative medications will be absolutely necessary in order to produce what effect in the patient? A) Amnesia B) Euphoria C) Analgesia D) Hypnosis Ans: C Feedback: Propofol produces amnesia, euphoria, and hypnosis. It therefore blocks the perception of pain. It does not, however, provide analgesia.

7. The anesthesiologist has specified that ketamine will be included in a surgical patient's

A) B) C) D) Ans:

balanced anesthesia. When in postanesthetic recovery, the nurse should assess for what adverse effect of this medication? Labile blood pressure Increased intracranial pressure Hyperventilation and respiratory alkalosis Delirium and agitation D Feedback: Ketamine can produce emergence delirium, hallucinations, and unpleasant dreams (BlackBox). Symptoms of this effect may include confusion, agitation, and nystagmus. The drug preserves blood pressure and does not cause hyperventilation or increased ICP.

8. Vecuronium will be administered to a surgical patient to facilitate intubation and achieve

A) B) C) D) Ans:

balanced anesthesia. This medication induces paralysis by antagonizing acetylcholine receptors at neuromuscular junctions. potentiating the effects of acetylcholinesterase in synapses. crossing the blood–brain barrier and agonizing cerebellar function. binding with serotonin and inhibiting its neuromuscular effects. A Feedback: Because vecuronium is structurally similar to ACh, it binds to the receptors on the muscle and prevents normal function of ACh, producing skeletal muscle paralysis. The drug does not influence the physiology of serotonin, the cerebellum, or acetylcholinesterase. ACh is a neurotransmitter that stimulates muscle contraction at the neuromuscular junction.

9.A 39-year-old patient has been diagnosed with thyroid cancer and will have a thyroidectomy performed. During surgery in this nerve-rich and highly vascular region of the body, the patient may require vecuronium. What will be the primary purpose of this medication? A) To ensure that the patient does not move during surgery B) To prevent intraoperative vomiting C) To protect the patient's airway during surgery D) To induce hypnosis and amnesia Ans: A Feedback: Delicate repairs, such as neck surgery and neurosurgery, may require the use of neuromuscular agents to prevent movement and subsequent damage. Vecuronium is not used to prevent nausea and vomiting, to protect the patient's airway, or to induce hypnosis and amnesia.

10.A surgical patient's balanced anesthesia includes the use of vecuronium. What nursing

A) B) C) D) Ans:

action should the operating room nurses prioritize? Monitoring the patient for signs of increased level of consciousness Assessing and protecting the patient's airway Protecting the patient's skin integrity Monitoring the patient's deep tendon reflexes B Feedback: The maintenance of the patient's airway and respiratory function following the administration of neuromuscular blocking agents such as vecuronium is the most important nursing implication. The importance of airway protection supersedes that of DTR assessment, assessing LOC, and maintaining skin integrity, though each of these is a valid consideration.

11.A patient will undergo an endoscopy with conscious sedation using midazolam (Versed). The nurse who is participating in this procedure should monitor the patient closely for signs of A) increased intracranial pressure. B) respiratory depression. C) hemorrhage. D) rhabdomyolysis. Ans: B Feedback: Following administration of midazolam, continuous monitoring for respiratory depression is required, and if necessary, age-specific resuscitative measures should be implemented. Increased ICP, rhabdomyolysis, and hemorrhage are less likely than respiratory depression.

12.A 55-year-old woman will have a partial mastectomy performed as treatment for breast cancer. The anesthesiologist has informed the operating room nurse that opioids will be used to supplement anesthesia. What opioid is most likely to be utilized? A) Codeine B) Oxycodone C) Fentanyl D) Meperidine Ans: C Feedback: A synthetic opioid that is about 100 times more potent than morphine sulfate, fentanyl can be used to supplement sedation, regional techniques, and general anesthesia. Codeine, meperidine, and oxycodone do not have intraoperative applications. Narcan (naloxone) antidote.

1.A patient has been diagnosed with migraines after experiencing headaches of increasing severity. When providing health education to this patient about her new diagnosis, what should the nurse convey? A) The etiology of migraines is thought to have a genetic component. B) Migraines are typically the result of prolonged psychosocial stress. C) Migraines can be a precursor to transient ischemic attacks (TIAs) or stroke. D) The pathophysiology of migraine headaches involves a disruption in the limbic system. Ans: A Feedback: Migraines demonstrate a familial pattern, and authorities believe that they are inherited as autosomal dominant traits with incomplete penetrance. Stress may precipitate a migraine, but this is not an aspect of the etiology. They are not a precursor to TIAs or stroke, and they do not involve disruption of the limbic system.

2.A middle-aged patient describes her headaches as “utterly debilitating” and tells the nurse, “It's hard to explain, but I just know when one is coming, and I'm never wrong.” This patient's statement suggests that she has what diagnosis? A) Migraines B) Cluster headaches C) Tension headaches D) Ischemic headaches Ans: A Feedback: The severity of her headaches coupled with the fact that she experiences a prodrome suggests that she experiences migraines. This clinical presentation is not typical of cluster headaches or tension headaches. Ischemic headache is not a recognized subtype.

3.A young man has been diagnosed with migraines, and the nurse is teaching him about abortive therapy. The primary goal of this form of therapy will be to A) permanently correct the patient's brain physiology. B) ensure that the patient experiences fewer migraine headaches. C) relieve the symptoms of the patient's migraines. D) foster coping skills that will allow the patient to live with his migraines. Ans: C Feedback: Abortive therapy is the administration of medications to treat the symptoms of migraine headache. These medications do not provide a permanent correction of pathophysiological neurological function, and they are not preventative. Coping skills are not provided through medications.

4.A patient who lives with migraines has been prescribed naproxen. The nurse should recognize that this drug achieves a therapeutic effect through which of the following means? A) Demyelinizing pain fibers in the CNS B) Selectively antagonizing opioid receptors in the CNS C) Inhibiting the synthesis of COX-1 and COX-2 D) Slowing the reuptake of serotonin and acetylcholine in brain synapses Ans: C Feedback: Naproxen is a nonselective inhibitor of cyclooxygenase resulting in the inhibition of prostaglandin synthesis of COX-1 and COX-2. It does not involve serotonin, acetylcholine, or opioid receptors.

5.A nurse has administered a scheduled dose of naproxen to a hospital patient who has been taking the drug for several weeks. What assessment finding should cause the nurse to suspect that the patient is experiencing adverse effects of this drug treatment? A) There is an increase in the patient's neutrophils but no increase in temperature. B) The patient's stool tests positive for occult blood. C) The patient complains of itchy, dry skin. D) The patient has peripheral edema and there is a steady increase in the patient's weight. Ans: B Feedback: GI bleeding is a significant adverse effect of naproxen. This drug does not typically cause leukocytosis, dry skin, or fluid imbalances.

6.The nurse at a long-term care facility is assessing a new resident's current medication regimen, and the resident states that she often takes an OTC remedy when she experiences a migraine. She has brought the bottle with her, and the nurse notes it to be Anacin Advanced Headache Formula. The nurse should document that the patient takes which drugs? Select all that apply. A) Codeine B) Acetaminophen C) Aspirin D) Caffeine E) Naproxen Ans: B, C, D Feedback: Anacin Advanced Headache Formula and other similar OTC formulations include acetaminophen, aspirin, and caffeine.

7.A patient who is well-known to the clinic asked if it would safe for him to take Excedrin Extra Strength for the treatment of a severe headache. The nurse is well aware of this patient's medical history and should advise against using this medication based on what aspect of his current health status? A) The patient has not adhered to previous treatment regimens. B) The patient has a chronic venous ulcer on his lower leg. C) The patient has a diagnosis of liver cirrhosis. D) The patient is a smoker. Ans: C Feedback: People with hepatic impairment should not receive this combination agent on an ongoing basis. They may not metabolize acetaminophen in this combined medication effectively, leading to hepatotoxicity. Lack of previous adherence, cigarette smoking, and the presence of skin ulcers do not necessarily contraindicate the use of this drug.

8.A young woman who is 14 weeks pregnant has sought care because she has been experiencing migraine headaches with increasing severity and frequency in recent months. She states, “My headaches used to be something I could live with, but now they're affecting every other part of my life.” The patient has conducted online research and requested a prescription for ergotamine. How will this patient's current health status affect the clinician's response to this request? A) The patient can safely use ergotamine but must be monitored for blood dyscrasias. B) The patient must use a reduced dose of ergotamine until she has given birth. C) The patient must wait until she has given birth before taking ergotamine. D) The patient cannot safely take ergotamine until she has weaned her infant. Ans: D Feedback: Pregnancy and lactation are contraindications to the use of ergotamine.

9.A patient has been treated for migraines on an ongoing basis and the care provider has just prescribed sumatriptan. Which of the following is the priority intervention for patient education? A) “You might get dizzy and lightheaded after you take sumatriptan, but this is normal.” B) “It's important that you never take Tylenol within 12 hours of sumatriptan.” C) “Make sure that you stop taking ergotamine before you get this prescription filled.” D) “You will likely experience a brief worsening of your migraine before this drug relieves the pain.” Ans: C Feedback: It is important to ask the patient about recent administration ergot alkaloids. The ergot

alkaloids should not be given within 24 hours of the administration of triptans. Signs of low blood pressure should be reported promptly, and there is no particular reason to avoid acetaminophen. Triptans do not make symptoms worse before they provide relief.

10.A nurse is teaching a patient how to take Imitrex in the home setting in order to maximize therapeutic benefit while reducing the risk of adverse effects. The nurse should teach the patient to take Imitrex A) before breakfast each day. B) on days when migraines may be anticipated. C) as soon as the earliest symptoms of migraine are sensed. D) when the pain of a migraine becomes too much to bear. Ans: C Feedback: It is important to administer sumatriptan at the onset of migraine symptoms. The drug is not taken on a daily, scheduled basis and is not used as a preventative treatment.

11.A middle-aged patient has not achieved adequate symptom relief of migraines with firstline therapies, and the clinician is considering the use of frovatriptan (Frova). The patient's concurrent use of what medication would contraindicate the safe use of frovatriptan? A) Albuterol (Ventolin) B) Metformin C) Atorvastatin (Lipitor) D) Fluoxetine (Prozac) Ans: D Feedback: Frovatriptan (Frova) interacts unfavorably with selective serotonin reuptake inhibitors and may lead to serotonin syndrome. Ventolin, metformin, and Lipitor do not present a risk for interactions.

12.A woman in her 40s has been living with migraines for many years, and these have only just been identified as being linked to her menstrual cycles. Estradiol has been prescribed, which the nurse will administer A) intravenously. B) transcutaneously. C) intramuscularly. D) sublingually. Ans: B Feedback: Estradiol for the treatment of migraines is administered by the transcutaneous route (dermal patch).

13.A nurse in surgical daycare is completing a preoperative assessment of a woman who will undergo hip arthroplasty. The nurse has questioned the woman about her daily use of gabapentin (Neurontin), and the woman has stated that she takes this drug to treat her migraines. What role does this drug play in migraine treatment? A) It reduces the intensity of menstrual migraines. B) It prevents migraines from occurring. C) It relieves acute migraine pain. D) It lengthens the aura that precedes a migraine. Ans: B Feedback: Studies have shown that gabapentin is effective in reducing the frequency of migraines. Gabapentin is not an abortive treatment.

14.A patient experiences debilitating migraines on a frequent basis and has had oral prochlorperazine (Compazine) added as an adjuvant medication to abortive therapy. When teaching the patient to take this drug safely in the home setting, the nurse should emphasize what teaching point? A) The importance of taking the pill whole and not crushing or splitting it B) The importance of having a bimonthly complete blood count (CBC) drawn C) The need to avoid taking the drug after eating fatty food D) The need to be aware of the potential for hypotension Ans: A Feedback: When taking prochlorperazine orally, it is important to swallow it whole and not chew or crush the tablets. Blood work is not warranted, and there is no need to avoid fatty food prior to taking the drug. Compazine is not noted to cause hypotension.

15.Mrs. Gonzaga is a 60-year-old woman who first began having headaches during the onset of menopause and who has subsequently been diagnosed with migraines. She tearfully explains to the nurse how her husband downplays her health condition and tells her that she needs to “just push through a headache.” She describes how her migraines have limited her ability to provide childcare for her young grandchildren and explains that she is unable to keep up her garden. The nurse should identify what nursing diagnosis when planning Mrs. Gonzaga's care? A) Ineffective health maintenance related to migraine headaches B) Ineffective role performance related to migraine headaches C) Situational low self-esteem related to migraine headaches D) Spiritual distress related to migraine headaches Ans: B

Feedback: Many nursing diagnoses likely apply to this patient's situation, but there is evidence that she grieves her inability to perform a caregiving role for her grandchildren. There is no evidence that the patient's health maintenance is inadequate or that she has low selfesteem. Spiritual distress is also not in evidence.

1.A patient has a left temporal brain tumor. He smells an odor of ammonia prior to experiencing rapid rhythmic jerking movements. What is the odor of ammonia classified as? A) Chemical agent evoked by the tumor B) An aura prior to the seizure activity C) The metastatic process of tumor growth D) The inhibition of serotonin and acetylcholine Ans: B Feedback: The smell of ammonia is an aura, which is a warning prior to seizure activity. The tumor will not evoke a chemical agent prior to the seizure. The metastatic process will not evoke a chemical smell. The chemical smell is not related to the inhibition of serotonin and acetylcholine.

2.A patient has been taking phenytoin (Dilantin) for a seizure disorder. He has recently run out of his medication and has not obtained a refill. What is the patient at risk for developing? A) Hypotension B) Migraine headaches C) Status epilepticus D) Depression Ans: C Feedback: In a person taking medications for a diagnosed seizure disorder, the most common cause of status epilepticus is abruptly stopping AEDs. Abruptly stopping phenytoin will not cause hypotension. Abruptly stopping phenytoin will not cause migraine headaches. Abruptly stopping phenytoin will not cause depression.

3.A patient is admitted to the emergency room in status epilepticus. What medication may be administered intravenously to assist in reducing seizure activity? A) Diazepam (Valium) B) Hydromorphone (Dilaudid) C) Insulin D) Meperidine (Demerol) Ans: A Feedback: IV diazepam is an adjunctive skeletal muscle relaxant administered for the treatment of severe recurrent convulsive seizures and status epilepticus. Ethosuximide (Zarontin) is not administered for status epilepticus. Meperidine (Demerol) and insulin are not administered for status epilepticus.

4.An 80-year-old patient has severe pain after a case of shingles. The pain is noted along the shoulder and back. He states the pain is so severe he cannot sleep. What is the primary medication that will relieve this pain? A) Meperidine (Demerol) B) Morphine sulfate (MS Contin) C) Naproxen sodium (Naprosyn) D) Gabapentin (Neurontin) Ans: D Feedback: Gabapentin is the first oral medication approved by the FDA for the management of postherpetic neuralgia. Meperidine will provide pain relief but is not effective in postherpetic neuralgia. Morphine sulfate will provide pain relief but is not effective in postherpetic neuralgia. Naproxen sodium will decrease inflammation but is not effective for postherpetic neuralgia.

5.A patient who has been taking valproic acid (sodium valproate) for a seizure disorder is asking the nurse about getting pregnant. Why is pregnancy discouraged in women who are being treated for seizure disorders? A) Seizure disorders are genetic. B) Seizure disorders are familial. C) Antiepilepsy drugs decrease fertility. D) Antiepilepsy drugs are teratogenic. Ans: D Feedback: Antiepileptic drugs such as valproic acid must be used cautiously during pregnancy because they are teratogenic. Seizure disorders are not normally genetic or familial. Antiepilepsy medications do not decrease fertility.

6.A patient is being treated for a seizure disorder with phenytoin (Dilantin). He is admitted to the emergency room with sinus bradycardia. What action will occur regarding his antiepileptic agent? A) Phenytoin (Dilantin) dose will be reduced. B) Phenytoin (Dilantin) will be discontinued. C) Phenytoin (Dilantin) will be given every other day. D) Phenytoin (Dilantin) dose will be increased. Ans: B Feedback: Phenytoin should be discontinued immediately because it is contraindicated in patients with sinus bradycardia. Reducing the frequency of administration would likely be insufficient.

7.A patient is admitted to the hospital with severe dehydration and also has decreased albumin levels. What effect will the patient's current status have if a prescribed dose of phenytoin (Dilantin) is administered? A) Potentially toxic serum level B) Reduced serum level C) Increased seizure activity D) Thromboembolism Ans: A Feedback: Phenytoin is highly bound to plasma proteins and only a fraction is not bound to albumin; hypoalbuminemia will result in toxic serum levels of phenytoin. A reduced serum level of phenytoin will not be seen with hypoalbuminemia. The patient will not suffer from increased seizure activity. The patient will not suffer from thromboembolism.

8.The nurse has been educating the patient on the self-administration of phenytoin (Dilantin). Which of the following statements by the patient demonstrates an understanding of the medication? A) “I'll only take the drug when I feel an impending seizure.” B) “I'll reduce my dose if I remain seizure free.” C) “I'll make sure to take the drug with food.” D) “I'll stop taking the drug if I don't have a seizure for 8 weeks.” Ans: C Feedback: Phenytoin should be taken with food to reduce the chance of stomach upset. It should be taken on a regular basis, and not only when a seizure occurs. The patient should not arbitrarily reduce his or her dose of phenytoin. Abrupt cessation can cause seizures.

9.A patient suffers from trigeminal neuralgia. What antiepileptic agent may be used to treat this disorder? A) Phenytoin (Dilantin) B) Carbamazepine (Tegretol) C) Fosphenytoin (Cerebyx) D) Ethosuximide (Zarontin) Ans: B Feedback: Carbamazepine (Tegretol) is prescribed to treat trigeminal neuralgia. Phenytoin is not administered for trigeminal neuralgia. Fosphenytoin is not administered for trigeminal neuralgia. Ethosuximide is not administered for trigeminal neuralgia.

10.A child suffers from absence seizures and has been prescribed acetazolamide (Diamox). The nurse should know that this medication is an adjuvant medication useful in the

A) B) C) D) Ans:

treatment of seizures. What is the therapeutic action of Diamox? It slows the action potential of neurons. It slows the reuptake of acetylcholine. It suppresses the limbic and reticular systems. It controls fluid secretion in the CNS. D Feedback: The sulfonamide diuretic acetazolamide (Diamox) controls fluid secretion in the CNS; it is thought to inhibit CNS carbonic anhydrase to decrease neuronal excitability.

11.A patient has been diagnosed with a brain tumor, which has caused partial seizure activity. The patient is being treated with gabapentin (Neurontin). After administering the medication, the nurse should assess the patient because of the potential for what adverse effect? A) Tetany B) Hypersensitivity C) Paradoxical seizures D) CNS depression Ans: D Feedback: The most common adverse effects of gabapentin are associated with CNS depression and include dizziness, somnolence, insomnia, and ataxia. The drug has not been noted to cause tetany, hypersensitivity reactions, or paradoxical seizures.

12.A patient with impaired liver function is suffering from a seizure disorder that most often results in partial seizures. Which of the following AEDs may be administered to a patient with impaired liver function? A) Oxcarbazepine (Trileptal) B) Fosphenytoin (Cerebyx) C) Carbamazepine (Tegretol) D) Levetiracetam (Keppra) Ans: D Feedback: Levetiracetam (Keppra) is not primarily metabolized in the liver. Oxcarbazepine (Trileptal) is metabolized in the liver. Fosphenytoin (Cerebyx) is metabolized in the liver. Carbamazepine (Tegretol) is metabolized in the liver.

13.A patient is admitted to the hospital for severe back spasms and pain. Which of the following skeletal muscle relaxants will act peripherally on the muscle itself? A) Cyclobenzaprine (Flexeril) B) Carisoprodol (Soma)

C) D) Ans:

Methocarbamol (Robaxin) Dantrolene sodium (Dantrium) D Feedback: Dantrolene is the only skeletal muscle relaxant that acts peripherally on the muscle itself; it inhibits the release of calcium in skeletal muscle cells, thereby decreasing the strength of muscle contraction. The other listed drugs act centrally.

14.A patient is recovering from a stroke and has developed severe muscle contractions. Which of the following medications will inhibit the release of calcium in skeletal muscle cells? A) Dantrolene sodium (Dantrium) B) Baclofen (Lioresal) C) Carisoprodol (Soma) D) Cyclobenzaprine (Flexeril) Ans: A Feedback: Dantrium relieves spasticity by inhibiting the release of calcium in skeletal muscle cells. Lioresal, Soma, and Flexeril act centrally.

15.A patient with multiple sclerosis is admitted to the medical division for treatment of severe spasticity. What medication is used to treat spasticity and is administered intrathecally? A) Baclofen (Lioresal) B) Carisoprodol (Soma) C) Diazepam (Valium) D) Dantrolene (Dantrium) Ans: A Feedback: Baclofen is used to treat spasticity in MS and spinal cord injuries. It can be administered intrathecally. Carisoprodol is used to relieve discomfort from acute, painful musculoskeletal disorders. Diazepam is used to relieve muscle spasms but not used intrathecally. Dantrolene is used to treat malignant hyperthermia but not multiple sclerosis.

16.A patient is admitted with acute, painful muscle spasms and suffers from intermittent porphyria, an inherited enzyme deficiency. Which of the following muscle relaxants is contraindicated due to the patient's history of porphyria? A) Baclofen (Lioresal) B) Carisoprodol (Soma) C) Diazepam (Valium)

D) Ans:

Dantrolene (Dantrium) B Feedback: Carisoprodol is used to relieve discomfort from acute, painful musculoskeletal disorders. It is contraindicated in patients with intermittent porphyria. Baclofen is not known to be contraindicated with porphyria. Diazepam is not known to be contraindicated with porphyria. Dantrolene is not known to be contraindicated with porphyria.

17.A patient with muscle spasms is administered cyclobenzaprine (Flexeril). Which adverse effect should the nurse assess for with this medication? A) Muscle spasms B) Insomnia C) Drowsiness D) Urinary incontinence Ans: C Feedback: A common adverse effect with cyclobenzaprine (Flexeril) is drowsiness. The patient will not experience muscle spasms, insomnia, or urinary incontinence.

18.A patient has been started on dantrolene (Dantrium). What is the most serious adverse effect about which the patient should be instructed? A) Metabolic acidosis B) Hypercarbia C) Renal calculi D) Hepatitis Ans: D Feedback: The most serious adverse effect of oral dantrolene is fatal hepatitis. Metabolic acidosis, hypercarbia, and renal calculi are not adverse effects of oral dantrolene.

19.A patient has been started on cyclobenzaprine (Flexeril). For the duration of treatment, the nurse should teach the patient to avoid A) OTC vitamin supplements. B) alcohol. C) stool softeners. D) fatty foods. Ans: B Feedback: Increased CNS depression occurs when cyclobenzaprine is combined with alcohol or other CNS depressants. There is no particular need for the patient to avoid fatty foods, stool softeners, or vitamin supplements.

20.A patient is taking tizanidine (Zanaflex) to treat spasticity from multiple sclerosis. Which of the following adverse effects of muscle relaxants is most pronounced with this medication? A) Hypotension B) Dark black urine C) Excessive salivation D) Eczema Ans: A Feedback: Hypotension is the most significant adverse effect of tizanidine. Dark black urine, excessive salivation, and eczema are not adverse effects of tizanidine.

Multiple Choice 1. A patient is having seizure activity, and the physician has ordered diazepam (Valium) to be given parenterally. If this medication is administered intravenously, when will its onset of action be observed? A) 1 to 5 minutes B) 7 to 10 minutes C) More than 10 minutes D) Less than 1 minute Ans: A Chapter: 53 Client Needs: D-2 Cognitive Level: Comprehension Difficulty: Easy Integrated Process: Nursing Process Objective: 3 Page and Header: 988, Pharmacokinetics Feedback: Intravenous diazepam (Valium) is administered intravenously to decrease seizure activity and has a 1- to 5-minute onset of action. Diazepam (Valium) decreases seizure activity in less than 7 to 10 minutes. Diazepam (Valium) should decrease seizure activity in less than 10 minutes. Diazepam (Valium) will take more than 1 minute to begin working.

2. A patient suffers from insomnia and is prescribed flurazepam. This medication has a longer half-life than 24 hours. Which of the following contributes to the long half-life of this medication and other benzodiazepines? A) Metabolism by cytochrome P450 B) Presence of active metabolites C) Excretion by the renal system D) Movement of calcium in the cell Ans: B Chapter: 53 Client Needs: D-2 Cognitive Level: Comprehension Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Page and Header: 988, Pharmacokinetics Feedback: Benzodiazepines differ mainly in their plasma half-lives, production of active metabolites, and clinical uses. Drugs with half-lives longer than 24 hours form active metabolites that also have long half-lives and tend to accumulate, especially in older adults and people with impaired liver function. Flurazepam is not metabolized by cytochrome P450. Flurazepam is excreted in the renal system but does not contribute to the effect on the half-life. Flurazepam does not contribute to movement of calcium in the cell.

3. A patient is given midazolam (Versed) in combination with an opioid in the preoperative phase before a laparoscopic cholecystectomy. What does the administration of midazolam (Versed) assist in minimizing? A) Oral secretions B) Anxiety C) Hypotension D) Muscle tone Ans: B Chapter: 53 Client Needs: D-2 Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Page and Header: 991, Other Drugs in the Class

Feedback: Midazolam (Versed) provides preoperative sedation and mechanical ventilation. It does not reduce secretions, increase blood pressure, or reduce muscle tone.

4. A patient's medication regimen for treatment of anxiety has been changed from a benzodiazepine. The patient asks the nurse what likely prompted his care provider to change his medication. What is the nurse's best response? A) “Your doctor may have been concerned about causing depression.” B) “Your doctor may have been worried about the possibility of convulsions.” C) “Long-term use of benzodiazepines can result in dependency.” D) “Long-term use of benzodiazepines can cause insomnia.” Ans: C Chapter: 53 Client Needs: D-3 Cognitive Level: Application Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 5 Page and Header: 988, Benzodiazepines Feedback: Although benzodiazepines are effective anxiolytics, long-term use is associated with concerns over tolerance, dependency, withdrawal, lack of efficacy for treating the depression that often accompanies anxiety disorders, and the need for multiple daily dosing with some agents. They do not cause insomnia, convulsions, or depression.

5. A patient has developed excessive sedation and respiratory depression. The patient has been taking a benzodiazepine and has diminished liver function. Which of the following medications will reduce the effects of sedation and respiratory depression in this patient? A) Olmesartan medoxomil (Benicar) B) Pancrelipase (Pancrease) C) Pamidronate disodium (Aredia) D) Flumazenil (Romazicon) Ans: D Chapter: 53 Client Needs: D-2 Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 990, Adverse Effects

Feedback: Toxic effects of benzodiazepines include excessive sedation, respiratory depression, and coma. Flumazenil (Romazicon) is a specific antidote that competes with benzodiazepines for benzodiazepine receptors and reverses toxicity. Olmesartan medoxomil (Benicar) is an angiotensin II receptor antagonist that is used to treat hypertension. Pancrelipase (Pancrease) is used for enzyme replacement therapy. Pamidronate disodium is used as a bone metabolism regulator.

6. A patient is being observed for acute benzodiazepine withdrawal symptoms. Which of the following symptoms is characteristic of this problem? A) Bradycardia B) Agitation C) Lethargy D) Diaphoresis Ans: B Chapter: 53 Client Needs: D-2 Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Page and Header: 991, Assessing for Adverse Effects Feedback: Common signs and symptoms of withdrawal include increased anxiety, psychomotor agitation, insomnia, irritability, headache, tremor, and palpitations. Bradycardia, lethargy, and diaphoresis are uncharacteristic.

7. A patient is administered a benzodiazepine for anxiety. Which of the following will place the patient at risk for benzodiazepine toxicity? A) Decreased albumin B) Increased calcium C) Decreased potassium D) Low bicarbonate Ans: A Chapter: 53 Client Needs: D-3 Cognitive Level: Analysis Difficulty: Diffcult Integrated Process: Nursing Process Objective: 3

Page and Header: 990, Use in Patients With Renal or Hepatic Impairment Feedback: Patients with liver disease are at risk for adverse effects with drugs that are highly bound to plasma proteins. Increased calcium will not contribute to benzodiazepine toxicity. Decreased potassium will not have a direct impact on benzodiazepine toxicity. The normal bicarbonate will not contribute to benzodiazepine toxicity.

8. An older adult patient suffers from generalized anxiety disorder. The use of benzodiazepines in this patient population creates a risk for what adverse effect? A) Seizures B) Falls C) Dysrhythmias D) Sexual dysfunction Ans: B Chapter: 53 Client Needs: A-2 Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Page and Header: 990, Use in Older Adults Feedback: Adverse effects of benzodiazepines may contribute to falls and other injuries unless patients are carefully monitored and safeguarded. Seizures, dysrhythmias, and sexual dysfunction are not characteristic adverse effects.

9. A 77-year-old patient is suffering from insomnia. Which of the following medications can be most safely administered to this patient to induce sleep? A) Alprazolam (Xanax) B) Clonazepam (Klonopin) C) Diazepam (Valium) D) Temazepam (Restoril) Ans: D Chapter: 53 Client Needs: D-2 Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Page and Header: 991, Other Drugs in the Class

Feedback: Temazepam (Restoril) is eliminated by conjugation with glucuronide. Thus, temazepam (Restoril) is the drug of choice for patients who are elderly, have liver disease, or are taking drugs that interfere with hepatic drug–metabolizing enzymes. Alprazolam (Xanax) is not administered for insomnia. Clonazepam (Klonopin) is not administered for insomnia. Diazepam (Valium) is not administered for insomnia.

10. A child with night terrors is administered a benzodiazepine agent. Why must the nurse follow the child's health status closely? A) The child is more likely to develop insomnia. B) The child is more likely to develop dependence. C) The child is more vulnerable to adverse effects. D) The child is more vulnerable to hepatotoxicity. Ans: C Chapter: 53 Client Needs: D-2 Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing Process Objective: 3, 5 Page and Header: 990, Use in Children Feedback: Children may be more sensitive to its effects of this drug, namely mood and/or mental changes. Hepatotoxicity, insomnia, and dependence are not among the most common adverse effect.

11. When administering benzodiazepines, which of the following medications should be considered the drug of first choice? A) Lorazepam (Ativan) B) Estazolam (Prosom) C) Temazepam (Restoril) D) Triazolam (Halcion) Ans: A Chapter: 53 Client Needs: D-2 Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Page and Header: 991, Other Drugs in the Class

Feedback: Lorazepam (Ativan) is probably the benzodiazepine of first choice. The drug provides rapid tranquilization of patients experiencing agitation. Administered intravenously, it reduces nausea and vomiting as well as anxiety and induces procedural amnesia. Lorazepam has a slow onset of action (5 to 20 minutes) because of delayed brain penetration but an intermediate to prolonged duration.

12. A patient is admitted to the intensive care unit with a diagnosis of septicemia. In addition to relieving agitation and anxiety, what is a rationale for using benzodiazepines in the treatment of a critically ill patient? A) Increased diffusion and perfusion B) Decreased cardiac workload C) Increased level of consciousness D) Decreased blood pH Ans: B Chapter: 53 Client Needs: D-2 Cognitive Level: Application Difficulty: Diffcult Integrated Process: Nursing Process Objective: 3 Page and Header: 990, Use in Patients With Critical Illness Feedback: Antianxiety and sedative–hypnotic drugs are often useful in critically ill patients to relieve stress, anxiety, and agitation. Their calming effects decrease cardiac workload (e.g., heart rate, blood pressure, force of myocardial contraction, myocardial oxygen consumption) and respiratory effort. They do not decrease blood pH, increase diffusion and perfusion, or increase LOC.

13. A patient is scheduled to undergo a bronchoscopy for the investigation of a bronchial mass. What benzodiazepine should the clinic nurse anticipate administering for conscious sedation? A) Triazolam (Halcion) B) Midazolam (Versed) C) Oxazepam (Serax) D) Chlordiazepoxide (Librium) Ans: B Chapter: 53 Client Needs: D-2 Cognitive Level: Application Difficulty: Moderate

Integrated Process: Nursing Process Objective: 3 Page and Header: 989, Table 53.2 Feedback: Midazolam (Versed) is frequently used for conscious sedation during invasive procedures. Halcion, Serax, and Librium are not typically used for this purpose.

14. A middle-aged woman has become increasingly debilitated by anxiety, to the extent that she has sought medical help. After a thorough assessment, her care provider has diagnosed her with an anxiety disorder. The etiology of anxiety involves which of the following physiological processes? A) Stimulation of the parasympathetic nervous system B) Stimulating effects of somatotropin C) Increased activation of the autonomic nervous system D) Adrenocortical suppression Ans: C Chapter: 53 Client Needs: D-4 Cognitive Level: Comprehension Difficulty: Moderate Integrated Process: Nursing Process Objective: 1 Page and Header: 984, Pathophysiology Feedback: Clinical manifestations of anxiety include overactivity of the autonomic nervous system, such as dyspnea, palpitations, tachycardia, sweating, dry mouth, dizziness, nausea, and diarrhea. Somatotropin is not directly involved, and the adrenal cortex is not suppressed during times of anxiety. The parasympathetic nervous system is not stimulated during times of anxiety.

15. A patient's current medical status includes multiple comorbidities. In recent months, the patient has been complaining of insomnia that has begun to have a significant impact on his quality of life. What aspect of this patient's health is most likely to cause insomnia? A) The patient has hypothyroidism. B) The patient is morbidly obese. C) The patient has chronic pain. D) The patient has type 2 diabetes. Ans: C Chapter: 53 Client Needs: D-4 Cognitive Level: Analysis

Difficulty: Easy Integrated Process: Nursing Process Objective: 2 Page and Header: 986, Etiology Feedback: Chronic pain is commonly associated with insomnia. Diabetes, obesity, and hypothyroidism are not normally associated with insomnia.

16. In the 18 months following the death of his wife, a middle-aged man has been taking benzodiazepines on a daily basis. He has expressed to the nurse his desire to stop taking these medications. In order to minimize the chances of withdrawal symptoms, the nurse knows that the patient will likely be advised to A) taper down his dose of benzodiazepines over a prolonged period of time. B) replace the benzodiazepine with a herbal supplement in anticipation of stopping the medication. C) replace the immediate-acting form of the drug with a long-acting form. D) replace the benzodiazepine with an anticonvulsant. Ans: A Chapter: 53 Client Needs: D-2 Cognitive Level: Application Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 3 Page and Header: 988, Benzodiazepines Feedback: To avoid withdrawal symptoms, it is necessary to taper benzodiazepines gradually before discontinuing them completely. Long-acting benzodiazepines, anticonvulsants, and herbal remedies are not recommended in the effort to prevent withdrawal.

17. A patient with a history of alcoholism is being treated in the intensive care unit for multiple trauma following a motor vehicle accident. The patient is currently being treated with lorazepam (Ativan) to treat signs of alcohol withdrawal as well as hydromorphone (Dilaudid) for the pain of injuries. The intensive care nurse should prioritize what assessments? A) Arterial blood gases B) Respiratory rate and oxygen saturation C) Deep tendon reflexes and pupillary response D) Cardiac rate and rhythm Ans: B Chapter: 53

Client Needs: D-2 Cognitive Level: Application Difficulty: Diffcult Integrated Process: Nursing Process Objective: 5 Page and Header: 988, Use Feedback: The combination of opioids and benzodiazepines creates a significant risk for CNS depression; respiratory function is consequently an important focus of assessment. It would likely supersede other assessments, even though each may be warranted.

18. A 77-year-old woman who experiences significant anxiety has been taking diazepam for several months. She was brought to the clinical earlier this week by her daughter, who stated that her mother had been behaving in an uncharacteristically confused manner. The clinician discontinued the patient's diazepam. Three days later, the daughter states that her mother has still been having problems with impaired memory and confusion. The nurse should consider what possible explanation for the patient's current status? A) Benzodiazepines can occasionally cause permanent alterations in personality and level of consciousness. B) The patient may have decreased liver function. C) The patient may have been experiencing a hypersensitivity to the drug, rather than an adverse effect. D) The adverse effects of benzodiazepines can persist for several days after stopping the drug. Ans: D Chapter: 53 Client Needs: D-2 Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 990, Adverse Effects Feedback: Both therapeutic effects and adverse effects of diazepam are more likely to occur after 2 or 3 days of therapy than initially. Such effects accumulate with chronic usage and persist for several days after the drug is discontinued. Hypersensitivity and decreased liver function are unlikely. Benzodiazepines do not cause permanent changes in cognition.

19. A patient's severe family tragedy 1 year ago resulted in depression and insomnia. Which of the following hypnotics may be safely taken for longer-term treatment of insomnia? A) Lorazepam (Ativan) B) Eszopiclone (Lunesta)

C) Chloral hydrate D) Oxazepam (Serax) Ans: B Chapter: 53 Client Needs: D-2 Cognitive Level: Knowledge Difficulty: Easy Integrated Process: Nursing Process Objective: 4 Page and Header: 993, Eszopiclone Feedback: Eszopiclone (Lunesta) is the first oral nonbenzodiazepine hypnotic to receive FDA approval for long-term use (£12 months).

20. A nurse has noted that a newly admitted patient has been taking ramelteon (Rozerem) for the past several weeks. The nurse is justified in suspecting that this patient was experiencing what problem prior to starting this drug? A) Somnambulism (sleepwalking) B) Difficulty falling asleep at night C) Early morning waking D) Frequent nighttime awakenings Ans: B Chapter: 53 Client Needs: D-2 Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Nursing Process Objective: 4 Page and Header: 995, Ramelteon Feedback: Ramelteon (Rozerem), the newest oral nonbenzodiazepine hypnotic, has received FDA approval for the long-term treatment of insomnia characterized by difficulty with sleep onset.

Multiple Choice 1. A woman has a history of long periods of depression interspersed with hypomanic episodes. What mood disorder is the patient most likely suffering from? A) Bipolar disorder type I B) Bipolar disorder type II C) Situational depression D) Coping disorder Ans: B Chapter: 54 Client Needs: D-4 Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Nursing Process Objective: 2, 5 Page and Header: 1004, Overview of Bipolar Disorder Feedback: Bipolar disorder type II is characterized by episodes of major depression plus hypomanic episodes and occurs more frequently in women. Bipolar disorder type I is characterized by episodes of major depression plus mania and occurs equally in men and women. Situation depression lasts a shorter amount of time and is related to life events. A coping disorder is not related to hypomania.

2. A patient is admitted for assessment because of his history of inappropriately flamboyant and extroverted behavior coupled with risk-taking behaviors. The wife states he has also had periods of major depression but refuses to seek help. From what mood disorder is the patient most likely suffering? A) Schizophrenia B) Depression C) Bipolar disorder type I D) Bipolar disorder type II Ans: C Chapter: 54 Client Needs: D-4 Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Nursing Process Objective: 2, 5 Page and Header: 1004, Overview of Bipolar Disorder Feedback: Bipolar disorder type I is characterized by episodes of major depression plus mania and occurs equally in men and women. Schizophrenia results from abnormal brain synapses and includes a wide variety of diseases. Depression is a mood disorder, but does not exhibit periods of mania. Bipolar disorder type II is characterized by episodes of major depression plus hypomanic episodes and occurs more frequently in women.

3. A patient suffers from depression and states feelings of gloom and inability to perform the activities of daily living. The normal function of which neurotransmitter is most likely impaired? A) Acetylcholine B) Epinephrine C) Insulin D) Serotonin Ans: D Chapter: 54 Client Needs: D-4 Cognitive Level: Comprehension Difficulty: Easy Integrated Process: Nursing Process Objective: 1 Page and Header: 1001, Monoamine Neurotransmitter Dysfunction Feedback: Serotonin helps regulate several behaviors that are disturbed in depression.

Acetylcholine is a neurotransmitter with action in the cardiac and skeletal muscle. Acetylcholine has a limited impact in depression. Epinephrine is not associated with depression, though norepinephrine is implicated. Insulin is released by the pancreas to regulate blood sugar.

4. A patient has been taking a selective serotonin reuptake inhibitor for the treatment of depression. Which of the following represents the action of the medication? A) Selective serotonin reuptake inhibitors block GABA. B) Selective serotonin reuptake inhibitors prevent serotonin from being reabsorbed. C) Selective serotonin reuptake inhibitors increase serotonin synthesis. D) Selective serotonin reuptake inhibitors increase the number of serotonin binding sites. Ans: B Chapter: 54 Client Needs: D-2 Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing Process Objective: 3, 4 Page and Header: 1008, Action Feedback: Fluoxetine and the other SSRIs block the reabsorption of the neurotransmitter serotonin in the brain. This helps elevate mood. SSRIs do not increase serotonin synthesis or the number of binding sites. They do not influence the role of GABA.

5. An 8-year-old child is being seen in the clinic. The mother states he suffers from bed-wetting at least four times per week. What medication is effective in treating enuresis in children? A) Amitriptyline (Elavil) B) Duloxetine (Cymbalta) C) Imipramine (Tofranil) D) Venlafaxine (Effexor) Ans: C Chapter: 54 Client Needs: D-4 Cognitive Level: Application Difficulty: Diffcult Integrated Process: Nursing Process Objective: 3 Page and Header: 1005, Use Feedback: Imipramine (Tofranil) is approved for treating childhood enuresis in children older than 6 years. Amitriptyline (Elavil) is a tricyclic antidepressant but is not used for childhood

enuresis. Duloxetine (Cymbalta) is a serotonin–norepinephrine reuptake inhibitor that is used for depression. Venlafaxine (Effexor) is a serotonin–norepinephrine reuptake inhibitor that is used for depression.

6. An elderly patient is admitted to the medical unit after a fall. At home he is taking amitriptyline (Elavil) 20 mg three times per day. What adverse effect could be related to the patient's fall? A) Urinary frequency B) Urinary retention C) Visual disturbances D) Orthostatic hypotension Ans: D Chapter: 54 Client Needs: D-4 Cognitive Level: Application Difficulty: Diffcult Integrated Process: Nursing Process Objective: 6 Page and Header: 1005, Use in Older Adults Feedback: Orthostatic hypotension is an adverse effect related to amitriptyline (Elavil). Urinary retention (not frequency) is an adverse effect of amitriptyline but is not related to the falls. Visual disturbances are not a common adverse effect.

7. A 40-year-old man has been prescribed fluoxetine (Prozac). The patient states he has not continued the prescribed therapy even though his depression improved. What assessment is most important for the nurse to make? A) Assess for sexual dysfunction. B) Assess for hypotension. C) Assess for pain and discomfort. D) Assess for cardiac dysrhythmia. Ans: A Chapter: 54 Client Needs: D-4 Cognitive Level: Application Difficulty: Diffcult Integrated Process: Nursing Process Objective: 6 Page and Header: 1008, Adverse Effects

Feedback: Fluoxetine (Prozac) produces adverse effects, such as sexual dysfunction. It is imperative that the nurse assess for sexual dysfunction, which is a major reason for noncompliance in men. The assessment of hypotension is not accurate without symptoms of hypotension. The assessment of pain or discomfort is not accurate in this patient. The assessment of cardiac dysrhythmia is not accurate in this patient.

8. A patient is to be switched from fluoxetine (Prozac) to isocarboxazid (Marplan). What patient education is most important when changing from fluoxetine (Prozac)? A) Wait 5 days before starting isocarboxazid (Marplan). B) Wait 1 week before starting isocarboxazid (Marplan). C) Wait 2 weeks before starting isocarboxazid (Marplan). D) Wait 5 weeks before starting isocarboxazid (Marplan). Ans: D Chapter: 54 Client Needs: D-4 Cognitive Level: Application Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 3, 6 Page and Header: 1008, Adverse Effects Feedback: If a patient is taking fluoxetine (Prozac) and is being switched to isocarboxazid (Marplan), the fluoxetine should be discontinued at least 5 weeks before starting the MAO inhibitor. Waiting less time than this before starting the isocarboxazid (Marplan) will place the patient at risk for serotonin syndrome.

9. Duloxetine (Cymbalta) is being considered in the treatment of a patient's depression. Which of the following laboratory values would prevent the patient from being treated with this medication? A) Decreased hemoglobin level B) Decreased potassium level C) Increased ALT D) Increased erythrocyte sedimentation rate Ans: C Chapter: 54 Client Needs: D-4 Cognitive Level: Analysis Difficulty: Diffcult Integrated Process: Nursing Process

Objective: 2 Page and Header: 1012, Other Drugs in the Class Feedback: Duloxetine (Cymbalta) is highly protein bound, extensively metabolized by CYP2D6 and CYP1A2 enzymes in the liver, and excreted by the kidneys. It is not recommended for use in patients with severe renal or any degree of liver impairment. Low hemoglobin, elevated potassium, and increased ESR do not necessarily preclude the use of Cymbalta.

10. A patient has been prescribed phenelzine sulfate (Nardil), which is an MAO inhibitor. Which of the following foods should the patient avoid eating? A) Mashed potatoes and roast beef B) Aged Swiss cheese and bratwurst C) Tortellini in cream sauce D) Anise cookies and milk Ans: B Chapter: 54 Client Needs: D-3 Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Nursing Process Objective: 6 Page and Header: 1007, Box 54.3 Feedback: When taking an MAO inhibitor, the following foods should be avoided: aged cheeses and meats, concentrated yeast extracts, sauerkraut, and fava beans. None of the other listed foods is problematic.

11. A patient has been prescribed mirtazapine (Remeron). How will it decrease migraine headaches and depression? A) It increases concentration of endogenous epinephrine. B) It blocks the presynaptic alpha2-adrenergic receptors. C) It acts on the dopamine only receptors in the brain. D) It inhibits norepinephrine and serotonin reuptake. Ans: B Chapter: 54 Client Needs: D-4 Cognitive Level: Comprehension Difficulty: Diffcult Integrated Process: Nursing Process Objective: 4

Page and Header: 1015, Mirtazapine Feedback: Mirtazapine blocks presynaptic alpha2-adrenergic receptors (which increase the release of norepinephrine), serotonin receptors, and histamine H1 receptors. Consequently, the drug decreases anxiety, agitation, insomnia, and migraine headaches as well as depression.

12. A patient suffers from insomnia secondary to temporomandibular joint pain. Which of the following selective serotonin reuptake inhibitors is most effective for treating insomnia? A) Fluoxetine (Prozac) B) Olanzapine (Zyprexa) C) Citalopram hydrobromide (Celexa) D) Trazodone (Desyrel) Ans: D Chapter: 54 Client Needs: D-4 Cognitive Level: Application Difficulty: Diffcult Integrated Process: Nursing Process Objective: 4 Page and Header: 1015, Trazodone Feedback: Trazodone (Desyrel) is administered more often for sedation and sleep than depression. Fluoxetine (Prozac) is not administered for sleep. Olanzapine (Zyprexa) is not administered for sleep. Citalopram hydrobromide is not administered for sleep.

13. A patient is being treated for bipolar disorder with lithium carbonate (Eskalith). He also suffers from congestive heart failure and hypertension. The patient has an increased fluid volume and has recently had difficulty breathing. What laboratory value will most affect the action of the patient's lithium carbonate? A) Increased hematocrit B) Increased sodium level C) Increased potassium level D) Increased white blood cell count Ans: B Chapter: 54 Client Needs: D-4 Cognitive Level: Application Difficulty: Diffcult Integrated Process: Nursing Process Objective: 6

Page and Header: 1015, Use in Patients With Renal Impairment Feedback: A sodium excess causes more lithium to be excreted and may lower lithium levels to nontherapeutic ranges. An increased lithium level would not be noted with a patient who has fluid volume excess and hypertension. An increased potassium level is unlikely with fluid volume excess. An increased white blood cell count is indicative of infection, from which the patient does not suffer.

14. A patient with a diagnosis of depression states to the nurse that she has started taking St. John's wort to help her feel better and tolerate the demands of parenting. The patient has been taking an SSRI for the past several months. The nurse should teach that patient that this combination may result in A) worsened symptoms of depression. B) blood dyscrasias. C) dangerous drug interactions. D) hemostatic instability. Ans: C Chapter: 54 Client Needs: D-3 Cognitive Level: Application Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 6 Page and Header: 1015, Use in Patients With Renal Impairment; 1016, Box 54.7 Feedback: Combining St. John's wort with antidepressants can cause serious adverse effects. These effects do not typically include worsened depression, alterations in coagulation, or dyscrasias.

15. A patient has been taking lithium carbonate (Eskalith) for many years to treat bipolar disorder. Which of the following diets will require the dose of lithium carbonate (Eskalith) be reduced? A) Low calorie B) Low carbohydrate C) Low sodium D) Low residue Ans: C Chapter: 54 Client Needs: D-4 Cognitive Level: Application

Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 1017, Box 54.9 Feedback: A low-salt (sodium) diet will impair lithium secretion, so the dose of lithium should be reduced. The administration of a low-calorie diet will not affect the dose of lithium. The administration of a low-carbohydrate diet will not affect the dose of lithium. The administration of a low-residue diet will not affect the dose of lithium.

16. A patient treated for bipolar disorder with lithium carbonate (Eskalith) is scheduled for a lithium blood level. What is the therapeutic serum lithium level? A) 0.5 to 1.2 mEq/L B) 1.5 to 2.0 mEq/L C) 2.7 to 2.9 mEq/L D) 2.75 to 3.25 mEq/L Ans: A Chapter: 54 Client Needs: D-4 Cognitive Level: Knowledge Difficulty: Diffcult Integrated Process: Nursing Process Objective: 5 Page and Header: 1017, Administering the Medication Feedback: The therapeutic serum lithium level is 0.5 to 1.2 mEq/L. A serum lithium level of 2.7 to 2.9 mEq/L is toxic. A serum lithium level of 1.5 to 2.0 mEq/L is toxic. A serum lithium level of 2.75 to 3.25 mEq/L is toxic.

17. A 34-year-old man was diagnosed with depression several weeks ago and began taking citalopram (Celexa) 10 days ago. He has now scheduled an appointment at the clinic and has told the nurse that he intends to stop taking the drug, stating, “I don't feel any less depressed than I did before I started taking these pills.” How should the nurse best respond to the patient's statement? A) “I'll pass that information along to your care provider; a different drug might be more appropriate for you.” B) “I'd encourage you to continue with the drug; it can take several weeks before it improves your mood.” C) “People who take this drug often think they don't feel better because the changes in mood are incremental and subtle.” D) “It could be that one of the other medications or supplements you're taking is negating the

effects of Celexa.” Ans: B Chapter: 54 Client Needs: D-2 Cognitive Level: Application Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 6 Page and Header: 1008, Pharmacokinetics Feedback: Steady-state blood levels of SSRIs are achieved slowly, over several weeks. This aspect of pharmacokinetics is more likely than a possible drug interaction. The patient should expect to sense an eventual improvement in mood, and it would be premature to change medications.

18. A high school–aged girl has been suffering from major depression for several months, and she has begun treatment with an SSRI. In light of the black box warning accompanying SSRIs, the nurse should prioritize which of the following assessments? A) Assessment for venous thromboembolism (VTE) B) Assessment of cardiac rate and rhythm C) Assessment for hypomanic state D) Assessment for suicidal ideation Ans: D Chapter: 54 Client Needs: D-1 Cognitive Level: Application Difficulty: Diffcult Integrated Process: Nursing Process Objective: 4, 6 Page and Header: 1005, Use in Children Feedback: The FDA has issued a black box warning alerting health care providers to the increased risk of suicidal ideation in children, adolescents, and young adults 18 to 24 years of age when taking antidepressant medications. VTE, arrhythmias, and hypomania are not likely adverse effects.

19. A patient with a diagnosis of major depression has failed to respond to treatment with SSRIs, and the use of venlafaxine is being considered. The psychiatric nurse would recognize that this drug may have a therapeutic effect by which of the following means? A) Slowing the reuptake of endorphins in the CNS

B) Increasing levels of serotonin and norepinephrine C) Stimulating synthesis and potentiating the action of dopamine D) Slowing the reuptake of acetylcholine in brain synapses Ans: B Chapter: 54 Client Needs: D-2 Cognitive Level: Comprehension Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Page and Header: 1011, Pharmacokinetics and Action Feedback: Venlafaxine increases the levels of serotonin and norepinephrine in the brain by preventing the reuptake of these neurotransmitters known to play an important part in mood. It does not directly affect endorphins or acetylcholine. The drug weakly inhibits dopamine reuptake.

20. An elderly woman tells the nurse that she was successfully treated with phenelzine (Nardil) during a bout of severe depression in the 1970s. Her mood has been worsening in recent years as she has dealt with the death of her husband and functional declines. As a result, she has asked the nurse if her care provider is likely to prescribe this same drug. What fact should underlie the nurse's response to the patient? A) Cognitive behavioral therapy has been found to be more effective than MAO inhibitors, so they are rarely prescribed. B) In most situations, MAO inhibitors have been largely superseded by tricyclic antidepressants. C) The risks of serious drug interactions and food interactions mean that MAO inhibitors are rarely used. D) MAO inhibitors are rarely used because serum levels must be monitored with blood work every 2 weeks. Ans: C Chapter: 54 Client Needs: D-2 Cognitive Level: Application Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 6 Page and Header: 1012, Monoamine Oxidase Inhibitors Feedback: MAO inhibitors are rarely used in clinical practice today, mainly because they may interact with some foods and drugs to produce severe hypertension and possible heart attack or stroke. Serum levels do not need to be monitored. The potential benefits of cognitive behavioral therapy do not affect prescribers' decisions to use MAO inhibitors. SSRIs have become the first line of treatment for depression, replacing tricyclic antidepressants.

1.A person is seen wandering the streets and talking in an animated way to people who are not there. From what disorder do you suspect the person is suffering? A) Confusion B) Delusions C) Psychosis D) Depression Ans: C Feedback: The patient is suffering from psychosis, which is a severe mental disorder characterized by disordered thought processes. Delusions are false beliefs that persist in the absence of reason or evidence and are also a symptom of a psychosis. Depression is a disorder and symptom that is not as severe as a psychotic disorder. Confusion is a more generic term that denotes a lack of clear thinking.

2.A patient is admitted to the hospital for cardiac surgery and has just come up to the postsurgical unit from the recovery room. He develops unprecedented confusion and states, “I see bugs up and down the walls. They are going to get me.” The nurse suspects the patient is suffering from what symptom? A) Depression B) Delusions C) Delirium D) Schizophrenia Ans: C Feedback: The patient is suffering from delirium as a postoperative complication. Delusions are false beliefs that persist in the absence of reason or evidence. Schizophrenia is a variety of disorders and not a single symptom.

3.A teenage boy has begun to exhibit the characteristic signs and symptoms of schizophrenia. During his mother's pregnancy, during what time in development could she have experienced an intrauterine insult? A) Conception B) First trimester C) Second trimester D) Third trimester Ans: C Feedback: The neurodevelopmental model proposes that schizophrenia results when abnormal brain synapses are formed in response to an intrauterine insult during the second trimester of pregnancy, when neuronal migration is normally taking place. At conception, no implantation in the uterus has occurred. The first trimester is prior to neuronal migration. The third trimester is after neuronal migration.

4.A patient is experiencing an episode of psychosis. He is belligerent, loud, and abusive when you enter the room. What is the best response by the nurse during future interactions? A) Respond to him in an assertive tone. B) Use a calm, soft voice. C) Delegate care to the technician. D) Place him in the quiet room. Ans: B Feedback: The most therapeutic communication technique for this patient is to use a calm, soft voice. To respond to the patient in a loud tone will increase his agitation. Delegating care to the patient care technician can increase the patient's agitation based on the fact that the unlicensed caretaker may not possess strong therapeutic communication skills. Placing the patient in a quiet room will not affect any changes in his behavior and may increase his hallucinations.

5.A patient who has a diagnosis of schizophrenia is likely to have which of the following pathophysiologic effects? A) Increased dopamine B) Increased serum potassium C) Decreased numbers of glutamate receptors D) Decreased interaction with GABA Ans: A Feedback: The patient suffering from schizophrenia has increased dopamine activity in the brain. The amount of potassium would cause other physiological symptoms, but not affect schizophrenic symptoms. The patient with schizophrenia will have widespread glutamate receptors, not decreased glutamate receptors. In addition, the glutamatergic system interacts with the dopaminergic and gamma-aminobutyric acid systems and possibly other neurotransmission systems.

6.A patient has been prescribed an antipsychotic agent to relieve psychotic symptoms. Which of the following goals of care is the priority? A) The patient will demonstrate independent health maintenance. B) The patient will interact therapeutically with peers. C) The patient will participate in activities of daily living. D) The patient will remain safe. Ans: D Feedback: Safety is a priority over other goals. Goals such as participation in ADLs, health maintenance, and participation in relationships are valid, but safety is a priority.

7.A patient in her 60s has been living with schizophrenia since she was a young woman and

A) B) C) D) Ans:

was treated with chlorpromazine for many years. The nurse who is meeting the patient for the first time observes that the patient continually smacks her lips and appears to be chewing. The nurse should recognize that this patient is likely experiencing what problem? Tardive dyskinesia Akathisia Dystonias Neuroleptic malignant syndrome A Feedback: Tardive dyskinesia occurs as the result of long-term use of chlorpromazine. Patients may experience lip smacking, tongue protrusion, and facial grimaces and may have choreic movements of trunk and limbs. Akathisia is a form of restlessness, and dystonias are uncoordinated movements. Neuroleptic malignant syndrome is an acute complication.

8.An elderly patient with a long-standing history of schizophrenia has been admitted to the hospital for treatment of hyponatremia. The nurse reviews the patient's medical chart and reads that the patient was previously treated with phenothiazine antipsychotics. What medication may this patient have been treated with? A) Aminophylline (Theophylline) B) Acetylsalicylic acid (aspirin) C) Chlorpromazine (Thorazine) D) Dantrolene sodium (Dantrium) Ans: C Feedback: Chlorpromazine (Thorazine) is the prototype phenothiazine. Aminophylline (Theophylline) is a xanthine agent administered to increase bronchioles. Acetylsalicylic acid (aspirin) and dantrolene sodium (Dantrium) are not phenothiazines.

9.A patient who was diagnosed with schizophrenia in 1962 was prescribed chlorpromazine (Thorazine). The patient has been taking the medication for more than 40 years. What adverse effect will the patient most likely experience? A) Hypertension B) Extrapyramidal effects C) Central nervous system agitation D) Urinary frequency Ans: B Feedback: A patient who has taken chlorpromazine (Thorazine) on a long-term basis will be at risk for late extrapyramidal effects. Hypertension is not an adverse effect of chlorpromazine, but hypotension is an adverse effect. Central nervous system agitation is not an adverse effect of chlorpromazine, but central nervous system depression is an adverse effect. Urinary frequency is not an adverse effect of chlorpromazine, but urinary retention is an adverse effect.

10.A child suffers from tics and verbal outbursts in the classroom and while he is awake. The patient is prescribed haloperidol (Haldol). What disease process is haloperidol (Haldol) used to treat? A) Muscular dystrophy B) Early-onset dementia C) Tourette's syndrome D) Myasthenia gravis Ans: C Feedback: Haloperidol (Haldol) is used in treating Tourette's syndrome, which is a disorder characterized by involuntary movements and vocalizations. Muscular dystrophy is not treated with atypical antipsychotics. Alzheimer's disease is not normally treated with atypical antipsychotics. Myasthenia gravis is not treated with atypical antipsychotics.

11.A patient is prescribed clozapine (Clozaril). The patient and family should be instructed on the adverse effects of this medication. What laboratory test is most important in the first months of the medication regime? A) Weekly liver enzymes B) Daily INR C) Monthly creatinine levels D) Regular complete blood counts Ans: D Feedback: Clozapine (Clozaril) is associated with life-threatening decrease in white blood cells (agranulocytosis). It is essential to monitor the complete blood count due to this risk. Weekly liver enzymes are not recommended when administering clozapine. Monthly creatinine levels and INR monitoring are not recommended with clozapine therapy.

12.A patient is prescribed olanzapine (Zyprexa) for the treatment of schizophrenia. The patient tells the nurse he is voiding three times each night and is always thirsty. Based on the adverse effects of this medication, what should the nurse suspect the patient has developed? A) Urinary tract infection B) Diabetes mellitus C) Renal calculi D) Hyperthyroidism Ans: B Feedback: The development of polyuria and polydipsia is indicative of diabetes mellitus. Olanzapine has been associated with weight gain, hyperglycemia, and initiation or aggravation of diabetes mellitus. Urinary tract infection is not considered an adverse effect with olanzapine. Renal calculus is not an adverse effect of olanzapine. Hyperthyroidism is not

an adverse effect of olanzapine.

13.A patient diagnosed with schizophrenia is being seen by the home care nurse. What is the most important aspect of patient teaching with this patient? A) Maintain the medication regimen. B) Report signs of neuralgia. C) Stop medications if weight gain occurs. D) Limit alcohol intake to two drinks per day. Ans: A Feedback: The patient should be instructed to maintain the medication regime to control symptoms of schizophrenia. Reporting signs of neuralgia is not taught because the medication does not have this effect. The medications will cause weight gain and should not be stopped in the event that weight gain develops. The use of alcohol is strictly prohibited with antipsychotic agents.

14.A patient with schizophrenia has been taking haloperidol for several years. The care team and the patient have collaborated and chosen to transition the patient to an atypical antipsychotic in an effort to reduce adverse effects and maximize therapeutic effects. In order to reduce the patient's risk of extrapyramidal effects during this transition, the care team should do which of the following? A) Gradually taper the dose of haloperidol. B) Have a 2- to 3-week “drug holiday” between stopping the haloperidol and starting the atypical antipsychotic. C) Administer haloperidol and the atypical antipsychotic drug concurrently for 6 to 8 weeks. D) Arrange for weekly electroconvulsive therapy during the time of transition. Ans: A Feedback: When discontinuing haloperidol, it is essential to taper the dosage to prevent extrapyramidal symptoms. If the medication is abruptly discontinued, the patient is at risk for this condition. A drug holiday would exacerbate symptoms, and ECT is not indicated. Concurrent administration of two drugs has the potential to exacerbate adverse effects.

15.A psychiatric nurse is discussing the advantages of atypical antipsychotics with the parents of a teenage girl who has been diagnosed with schizophrenia. When comparing these drugs with the older, typical antipsychotics, what advantage should the nurse cite? A) Lower cost B) The possibility of oral administration C) Reduced adverse effects D) Absence of black box warnings Ans: C Feedback:

Atypical antipsychotics may be more effective in relieving some symptoms than typical antipsychotics, and they usually produce milder adverse effects. A major drawback is the high cost of these drugs. All antipsychotics are available for the oral route. There are several black box warnings relating to atypical antipsychotics.

16.A 22-year-old man's increasingly bizarre behavior has culminated in a diagnosis of schizophrenia. In light of current treatment modalities for schizophrenia, the nurse should anticipate that the patient is most likely to be prescribed what drug? A) Chlorpromazine (Thorazine) B) Olanzapine (Zyprexa) C) Haloperidol (Haldol) D) Prochlorperazine (Compazine) Ans: B Feedback: The "atypical" antipsychotics, such as olanzapine, are the drugs of choice, especially for patients who are newly diagnosed with schizophrenia.

17.A psychiatric nurse is providing care for a female patient with schizophrenia whose medication regimen includes oral chlorpromazine. When administering this medication, the nurse should do which of the following? A) Have the patient hold the drug under her tongue for at least 30 seconds. B) Administer the drug 1 to 2 hours before bedtime. C) Administer the drug on alternating days. D) Instruct the patient to avoid dairy products for 1 hour before and 2 hours after administration. Ans: B Feedback: For oral administration of chlorpromazine, the nurse should give doses 1 to 2 hours before bedtime; peak sedation occurs in about 2 hours. The drug is not given on alternating days, and there is no need to avoid dairy products. It is unnecessary for the patient to hold the drug under her tongue.

18.A patient has been achieving an acceptable reduction in his positive and negative signs of schizophrenia after several weeks of treatment with clozapine. The patient has asked the nurse if it is acceptable for him to have “a few drinks from time to time.” How should the nurse best respond to the patient's inquiry? A) “If you notice that your symptoms are worsening when you drink, you should stop doing it.” B) “That shouldn't present a problem, provided you make sure that you're safe when you do it.” C) “That's okay in most cases, but it's advisable to limit it to beer and wine and to avoid spirits.” D) “When you're taking clozapine, it's best to avoid drinking alcohol altogether.”

Ans:

D Feedback: Alcohol increases central nervous system depression in patients taking clozapine; patients should ideally abstain from drinking alcohol.

19.A patient's medication administration record orders the IM administration of chlorpromazine. When administering this drug, the nurse should A) observe the patient while he or she self-administers the drug. B) administer the drug into the deltoid muscle with a 1 1/2-inch needle. C) have the patient massage the injection site for 1 to 2 minutes after the injection. D) have the patient lie down for 30 to 60 minutes after the injection. Ans: D Feedback: For IM administration of chlorpromazine, the nurse should have the patient lie down for 30 to 60 minutes after the injection to prevent orthostatic hypotension. Massage is unnecessary, and the ventrogluteal site is used. Self-administration is not the norm.

20.Parenteral haloperidol has been ordered for a patient who is experiencing an acute psychotic episode. The nurse should recognize what primary goal of treatment? A) Increased insight into delusional thinking B) Increased sophistication of thinking C) Decreased agitation and combativeness D) Decreased CNS stimulation Ans: C Feedback: When haloperidol is given for acute psychotic episodes, the nurse observes for sedation, decreased agitation, combativeness, and psychomotor activity. Insight, clarity of thinking, and decreased CNS stimulation are not short-term priorities during an acute psychotic episode.

1. A 4-year-old child is brought to the pediatric clinic by his mother. She states, “I don't know what to do with him. He is in constant motion. He won't sit for more than a few seconds and he is doing something else. He often throws his toys and yells loudly, even compared with other kids his age.” The child is diagnosed with attention deficit hyperactivity disorder. Which of the following medications will most likely be administered in conjunction with treatment? A) ACE inhibitors B) SSRIs C) Central nervous system stimulants D) MAO inhibitors Ans: C Feedback: ADHD is characterized by persistent hyperactivity, short attention span, difficulty completing tasks, restlessness, and impulsivity. The diagnosis has increased in recent years, with a concomitant increase in the use of prescribed CNS stimulants for its treatment. SSRIs, ACE inhibitors, and MAOIs are not typically used.

2. A patient visits the occupational health office of the factory in which he works. He has fallen asleep on the line and has a history of muscle weakness. This instance is not the first time he has fallen asleep on the line. From what disease process does the occupational health nurse suspect the patient is suffering? A) Sleep apnea B) Insomnia C) Narcolepsy D) Substance abuse Ans: C Feedback: Narcolepsy is characterized by daytime sleep attacks in which the person goes to sleep at any place or at any time. Sleep apnea is episodes of apnea during sleep. Insomnia is the inability to sleep. This patient is not exhibiting signs and symptoms of substance abuse.

3. A patient suffers from narcolepsy. Which of the following aspects of patient teaching should be provided? A) Take 250 mg of caffeine daily. B) Avoid working shifts. C) Take a lengthy nap every afternoon. D) Increase the Ritalin dose as needed. Ans: B Feedback: The patient who is diagnosed with sleep apnea should avoid shift work. Caffeine use may or may not be indicated. The patient should ideally not take naps. The patient should not increase the Ritalin dose without the input of the primary health provider.

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4. A child is prescribed an amphetamine for attention deficit hyperactivity disorder. Which of the following effects provide evidence that the medications are working? A) Improved grades B) Increased sleep quality C) Lethargy D) Polyphagia Ans: A Feedback: Amphetamines used with ADHD improve academic performance. Amphetamines often decrease sleep. Amphetamines will not result in lethargy. Amphetamines decrease appetite and do not cause polyphagia.

5. A patient is taking dextroamphetamine for ADHD. He has developed constipation since beginning therapy. Which of the following should the patient be taught? A) Take an OTC laxative daily. B) Increase fiber intake. C) Take diphenoxylate hydrochloride (Lomotil). D) Take metronidazole (Flagyl). Ans: B Feedback: A patient who is experiencing constipation should be instructed to increase fiber in his diet. The patient should not take a laxative. The patient should not be instructed to take diphenoxylate hydrochloride (Lomotil) because it is an antidiarrheal agent. The patient should not be given metronidazole (Flagyl).

6. A neonate is suffering from apnea. Which of the following medications may be administered as a respiratory stimulant? A) Caffeine and methylphenidate B) Caffeine and Mefoxitin C) Caffeine and sodium benzoate D) Caffeine and sodium bicarbonate Ans: C Feedback: The combination of caffeine and sodium benzoate is occasionally used as a respiratory stimulant in neonates. Caffeine is not mixed with methylphenidate. Caffeine is not mixed with Mefoxitin. Caffeine is not mixed with sodium bicarbonate for this indication.

7. A patient has been treated with dextroamphetamine for ADHD. At the age of 16 years, she is diagnosed with hyperthyroidism. What intervention should be implemented with this patient? A) Discontinue the high-calorie diet.

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B) Assess the patient for pulmonary edema. C) Discontinue the amphetamines. D) Administer a proton pump inhibitor. Ans: C Feedback: Amphetamines are contraindicated upon the development of hyperthyroidism. The patient will require a higher calorie count, not a discontinuation of a high-calorie count. The patient will not require an assessment for pulmonary edema. The patient will only require a proton pump inhibitor if gastric hyperacidity occurs.

8. A teenage boy is on amphetamine therapy for attention deficit hyperactivity disorder. The care provider has suggested a “drug holiday” for July and August. What is the purpose of this drug holiday? A) To minimize weight loss B) To prevent hyperthyroidism C) To allow electrolyte imbalances to resolve D) To slow bone resorption Ans: A Feedback: Dextroamphetamine often causes loss of appetite, and the health care provider may stop the medication during the months when the child is not in school. A drug holiday, as this is called, helps decrease weight loss and growth suppression. It does not address potential electrolyte imbalances, thyroid imbalances, or the process of bone remodeling.

9. A patient is seen in the ambulatory care clinic with a complaint of insomnia. What should the nurse assess in regard to the complaint of insomnia? A) Daily intake of caffeine-containing products B) The amount of exercise in which the patient engages C) The family history of insomnia and sleep D) Possible use of amphetamines Ans: A Feedback: The daily intake of caffeine should be assessed to determine if the intake is sufficient to disturb sleep. The amount of exercise the patient engages in is important but not as critical as caffeine consumption. The family history of insomnia and sleep is not critical to assess. Amphetamines also have the potential to disrupt sleep, but caffeine use is far more prevalent.

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D) 1 g of caffeine Ans: B Feedback: Some authorities recommend that normal, healthy, nonpregnant adults consume not more than 250 mg of caffeine daily. 125 mg of caffeine is lower than the recommended safe amount of consumption. 500 mg to 1 g is more than the recommended daily consumption of caffeine.

11. A patient who suffers from asthma is given theophylline. Theophylline will have an increased effect if taken with A) Ritalin. B) atomoxetine (Strattera). C) modafinil (Provigil). D) caffeine. Ans: D Feedback: Caffeine increases the effects of theophylline. Ritalin, Provigil, and Strattera are noted to have this effect.

12. A patient is being prescribed dextroamphetamine for the treatment of ADHD. During health education, the nurse should make the patient aware of the black box warning relating to A) the risks of kidney failure. B) the potential for abuse. C) the risk of stroke with excessive doses. D) the potential for unstable blood glucose levels. Ans: B Feedback: A black box warning makes users of dextroamphetamine aware of the drug's high abuse potential. Black box warnings do not address the potential for renal failure, stroke, or unstable blood sugars.

13. A 13-year-old child is started on atomoxetine (Strattera) for ADHD. The patient and his family should be taught about the peak plasma levels of the medication. He takes his medication at 07:00 AM. When will this medication reach its peak plasma level? A) 08:00 to 09:00 AM B) 09:45 to 10:30 AM C) 10:30 to 11:45 AM D) 13:00 to 14:00 PM Ans: A Feedback: Atomoxetine is rapidly absorbed with peak plasma levels in 1 to 2 hours. If he takes the medication at 07:00 AM, it will peak at 08:00 to 09:00 AM.

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14. A patient with narcolepsy is placed on a central nervous system stimulant. What is the central nervous system stimulant of choice to treat narcolepsy? A) Atomoxetine (Strattera) B) Guarana C) Caffeine D) Modafinil (Provigil) Ans: D Feedback: Modafinil (Provigil) is used to treat narcolepsy. Atomoxetine is administered for ADHD. Guarana is the main ingredient in caffeine and is not administered for narcolepsy. Caffeine is not administered for narcolepsy.

15. A boy has been diagnosed with ADHD and has been prescribed Ritalin. The boy's mother tells the nurse that she does not understand why a stimulant would help him, stating, “If anything, he's completely overstimulated, not understimulated!” What should the nurse explain to the mother about the therapeutic use of Ritalin? A) Ritalin helps with the symptoms of ADHD, but the reasons for this are not well understood. B) Ritalin stimulates the parasympathetic nervous system, resulting in increased control of behavior. C) Ritalin stimulates the limbic system, which regulates control over behavior and affect. D) Ritalin enhances the function of dopamine, which regulates cognition. Ans: A Feedback: The efficacy of Ritalin in ADHD is paradoxical and not well understood. It does not significantly affect dopamine levels or the function of the limbic system and parasympathetic nervous system.

16. After experiencing two workplace accidents in which he fell asleep, a 30-year-old construction worker has been diagnosed with narcolepsy. The patient admits that he is embarrassed to receive this diagnosis and is adamant that no one find out about it. The nurse should respond to the patient by explaining what aspect of the etiology? A) “This is the result of neurological factors over which you have no direct control.” B) “In a lot of cases, making improvements to your sleep habits can resolve narcolepsy.” C) “This is something that runs in certain families, and it's not your fault that this has happened.” D) “This usually stems from suppressed emotions, so counseling usually helps greatly.” Ans: A Feedback: Narcolepsy is a neurological sleep disorder, not the result of mental illness or psychological problems. It is most likely due to a number of genetic abnormalities, but family history is not noted to be highly significant.

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17. A 13-year-old boy has been taking dextroamphetamine for the treatment of ADHD since he was 10, achieving significant improvements in behavior and mood. When assessing the boy during a scheduled follow-up appointment, the nurse should prioritize what physical assessment? A) Abdominal girth and assessment for peripheral edema B) Measurement of height and body weight C) Visual acuity and hearing ability D) Assessment of deep tendon reflexes and peripheral pulses Ans: B Feedback: Suppression of weight and height may occur in children taking amphetamines, and the nurse ensures that growth is monitored during drug therapy. Assessments for edema, diminished reflexes, and sensory deficits are not normally warranted.

18. A high school boy has been brought to the emergency department (ED) by his friends who state that he has taken a “whole handful of Dex” and is now lapsing in and out of consciousness. The ED nurse should prioritize what assessment related to dextroamphetamine overdose? A) Blood glucose monitoring B) Cognitive assessment C) Lung function testing D) Cardiac monitoring Ans: D Feedback: Dextroamphetamine misuse may cause sudden death or serious cardiovascular events. It is essential to obtain a baseline electrocardiogram (ECG) and blood pressure reading. These assessments are priorities over blood glucose monitoring, respiratory assessment, and cognitive assessment.

19. A 12-year-old girl has undergone an extensive diagnostic workup that has resulted in a diagnosis of ADHD. The prescriber has reviewed the benefits and risks of dextroamphetamine therapy, and the nurse is now reviewing the correct schedule for taking the drug. The child should most likely take her dextroamphetamine at what times? A) 07:00 and 11:30 B) 07:30, 11:30, 16:30, and 20:00 C) 08:00 and 20:00 D) 09:00, 14:00, and 19:00 Ans: A Feedback: People should take the first dose of dextroamphetamine on awakening or early in the day and the last dose at least 6 hours before bedtime. Twice-daily dosing is most

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common.

20. Methylphenidate will be used to treat a 9-year-old boy's ADHD. In light of this drug's most common adverse effects, the nurse who is working with the family should implement what strategy? A) A strategy to ensure that the boy maintains normal bladder function B) A plan to address the boy's loss of appetite C) A plan to enhance the boy's self-esteem D) A strategy to regularly monitor the boy's blood glucose levels Ans: B Feedback: Like dextroamphetamine, methylphenidate often causes loss of appetite. Plans to address this should be in place at the beginning of therapy. Frequent blood glucose monitoring and actions to maintain bladder function are not likely necessary. Selfesteem should likely be addressed during treatment, but reduced self-esteem is not an adverse effect of methylphenidate.

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1.A patient has a long history of heavy alcohol use and has been admitted to the hospital for traumatic injuries after a motor vehicle accident. How should the nurse best assess the patient for physical dependence on alcohol? A) Assess the patient's perceptions of his coping strategies. B) Assess whether the patient ever feels guilty about his drinking. C) Assess the patient for signs and symptoms of alcohol withdrawal. D) Assess the patient's typical alcohol intake. Ans: C Feedback: Physical dependence involves physiologic adaptation to chronic use of a drug so that withdrawal, or unpleasant symptoms, occurs when the drug is stopped, when its action is antagonized by another drug, or when its dosage is decreased. Assessment of coping strategies, alcohol intake, and the patient's feelings about his drinking are relevant, but none directly addresses the possibility of physical dependence.

2.A patient is admitted to the hospital for treatment of a stasis ulcer of the right leg. The patient's history indicates he has abused alcohol in the past, and he typically consumes at least eight alcoholic beverages daily. What symptoms should the nurse assess the patient for? A) Confusion, hallucination, agitation, tremors B) Denial, manipulation, combativeness C) Depression, remorse, withdrawal from reality D) Suspicion, mania, stubbornness, fear Ans: A Feedback: Delirium tremens, the most serious form of alcohol withdrawal, is characterized by confusion, disorientation, delusions, visual hallucinations, and other signs of acute psychosis. Denial, manipulation, combativeness, depression, remorse, withdrawal from reality, suspicion, mania, stubbornness, and fear are not symptoms of alcohol withdrawal.

3.A patient was admitted to the emergency room with acute alcohol intoxication and has been diagnosed with alcohol abuse after subsequent assessment and treatment. What are the goals of long-term treatment of this patient's substance abuse disorder? A) Detoxification, abstinence, and prevention of relapse B) Withdrawal, reeducation, and compliance C) Withdrawal, abstinence, and accountability D) Assessment, planning, and intervention Ans: A Feedback: The major goals of treatment for substance abuse are detoxification, initiation of abstinence, and prevention of relapse. Withdrawal may occur, but this is not a goal of

treatment. The nursing process may be utilized, but the steps of the process are not the goals of treatment.

4.A patient is admitted to the inpatient alcohol rehabilitation program. What medication will the patient most likely be prescribed to treat alcohol withdrawal syndromes? A) Clonidine (Catapres) B) Methyldopa (Aldomet) C) Chlordiazepoxide (Librium) D) Atenolol (Tenormin) Ans: C Feedback: Benzodiazepines antianxiety agents are the drugs of choice for treating alcohol withdrawal syndromes. Chlordiazepoxide is administered to patients for acute withdrawal syndrome. Clonidine is not a benzodiazepine and is not prescribed for acute alcohol syndrome. Methyldopa is not a benzodiazepine and is not prescribed for acute alcohol syndrome. Atenolol is not a benzodiazepine and is not prescribed for acute alcohol syndrome.

5.A 77-year-old patient is admitted for the treatment of a fracture, and the nurse has identified that the patient has a history of heavy alcohol use. At what point should the care team administer pharmacologic treatments for alcohol withdrawal? A) After skeletal muscle relaxants have taken effect B) As soon as the patient shows signs of withdrawal C) After cognitive behavioral therapy has begun D) After treatment for the patient's acute injuries has been completed Ans: B Feedback: Treatment with chlordiazepoxide for alcohol withdrawal should begin as soon as the clinician identifies that the patient needs it. It is unsafe to delay treatment of withdrawal. Muscle relaxants are not indicated in the treatment of alcohol withdrawal.

6.A patient is admitted to the emergency room suffering from symptoms of alcohol withdrawal. The nurse should plan care with the goal of preventing which of the following? A) Bradycardia B) Hypotension C) Seizures D) Gastrointestinal bleeding Ans: C Feedback: In acute alcohol withdrawal, a goal of treatment is to prevent seizures. Bradycardia is not

the primary symptom of acute alcohol withdrawal. Hypotension is not the primary symptom of acute alcohol withdrawal. Gastrointestinal bleeding results from heavy alcohol use but is not the primary symptom of acute alcohol withdrawal.

7.A patient who suffers from alcoholism is prescribed disulfiram (Antabuse). How does this medication assist the patient in refraining from ingestion of alcohol? A) Allows the accumulation of acetaldehyde B) Increases the level of serotonin C) Increases the level of acetylcholine D) Decreases stimulation of the CNS Ans: A Feedback: Disulfiram interferes with hepatic metabolism of alcohol and allows accumulation of acetaldehyde. Disulfiram does not increase the level of serotonin. Disulfiram does not increase the level of acetylcholine. Disulfiram does not decrease the stimulation of the central nervous system.

8.A patient who has long abused alcohol is being treated with disulfiram (Antabuse). The patient currently takes phenytoin (Dilantin) for an underlying seizure disorder. Based on the interaction of these two medications, what will need to be adjusted in the medication administration? A) The patient will require more frequent administration of disulfiram (Antabuse). B) The patient will require a larger dose of disulfiram (Antabuse). C) The patient will require a reduced dose of phenytoin (Dilantin). D) The patient will require phenytoin (Dilantin) to be administered twice daily. Ans: C Feedback: The patient will require a reduced dose of phenytoin (Dilantin) because disulfiram interferes with the metabolism of phenytoin. The patient will not require more frequent administration of disulfiram. The patient will not require a larger dose of disulfiram. The patient will not require increased administration of phenytoin.

9.A patient is taking disulfiram (Antabuse) and later consumes several shots of vodka. What effect will be produced from the combination of alcohol and disulfiram? A) Hypertension B) Vomiting C) Hyperalertness D) Oral bleeding Ans: B Feedback: Disulfiram interferes with hepatic metabolism of alcohol and allows the accumulation of

acetaldehyde. If alcohol is ingested during disulfiram therapy, acetaldehyde causes headaches, confusion, seizures, chest pain, flushing, palpitations, hypotension, sweating, blurred vision, nausea, vomiting, and a garlic-like aftertaste. Disulfiram will not cause hypertension, increased alertness, or bleeding.

10.A 22-year-old male is brought to the emergency room due to an overdose of diazepam (Valium). What drug will be administered in the emergency room to treat the overdose? A) Disulfiram (Antabuse) B) Flumazenil (Romazicon) C) Methadone (Dolophine) D) Naloxone (Narcan) Ans: B Feedback: Flumazenil (Romazicon) is a specific antidote that can reverse benzodiazepine-induced sedation, coma, and respiratory depression. Disulfiram is not administered to reverse benzodiazepine overdose. Methadone is not administered to reverse benzodiazepine overdose. Naloxone is not administered for benzodiazepine overdose.

11.A patient is being treated for opioid abuse after many years of cocaine and heroin use. The nurse should anticipate that this patient will be treated with what drug? A) Disulfiram (Antabuse) B) Flumazenil (Romazicon) C) Methadone (Dolophine) D) Naloxone (Narcan) Ans: C Feedback: Opioid withdrawal symptoms are treated with methadone. Naloxone is used to treat acute opioid intoxication or overdose, but it is not used to treat opioid abuse.

12.A nurse is providing health education for the family of a patient who has a substance use disorder. How should the nurse best explain the etiology of this disorder? A) “Substance abuse is multifactorial and involves genetics, personality, and culture.” B) “Substance abuse is considered to be primarily a cultural concept, since definitions vary widely across time and place.” C) “Many different factors contribute to substance abuse, but the primary ones are lack of willpower and impaired coping.” D) “Substance abuse is a complex phenomenon, and science has not yet begun to truly understand the phenomenon.” Ans: A Feedback: Researchers have identified a number of factors in the predisposition to substance abuse

and dependence. These factors include genetics, personality, and culture. The disorder is not, however, solely rooted in culture or wholly misunderstood. It is simplistic to understand the disorder as resulting from impaired coping and lack of willpower.

13.A patient with a diagnosis of endocarditis has been admitted, and the care team is aware that IV opioid use is the origin of the patient's infection. The patient is open to the idea of treatment for her substance abuse disorder. When planning this aspect of the patient's care, what goal should the nurse first address? A) Compliance with treatment B) Safe detoxification C) Taking ownership of the problem D) Adequate stimulation of the CNS Ans: B Feedback: The major goals of treatment for substance abuse are detoxification, initiation of abstinence, and prevention of relapse. Ensuring the patient's safety during detoxification is a priority over compliance with treatment. Taking ownership and providing CNS stimulation are not priority goals.

14.A man has asked the care team to consider the use of benzodiazepines to treat his wife's severe alcoholism. The use of benzodiazepines for this purpose may be contraindicated in what circumstances? A) The patient is acutely intoxicated. B) The patient denies the severity of her addiction. C) The patient has previously been treated with benzodiazepines. D) The patient is also addicted to nicotine. Ans: A Feedback: If the patient's vital signs are depressed during acute intoxication, the use of benzodiazepines is contraindicated. Denial, previous treatment with benzodiazepines, and nicotine addiction do not contraindicate this treatment.

15.A 33-year-old patient with a diagnosis of alcoholism is to be treated with chlordiazepoxide on an inpatient basis. When a nurse is administering this medication, he or she should do which of the following actions? A) Monitor the patient's vital signs closely during IV administration B) Administer the oral form of the medication if the patient is combative C) Assess the patient's cardiac status prior to administering each dose D) Promptly stop administering the medication once status improvements are noted Ans: A

Feedback: The nurse should take the patient's vital signs regularly when giving the IV form of this drug, as well as observe and document subjective and objective reports by the patient. Combative patients usually require a parenteral route of administration, and it is unnecessary to perform a full cardiac assessment before each dose. Usage should be tapered, and not stopped abruptly, in order to prevent rebound CNS stimulation.

16.A patient was admitted with a diagnosis of a gastrointestinal bleed, the latest of several hospital admissions that have been attributed to his alcohol abuse. The addictions medicine specialist has prescribed disulfiram, which will A) prevent the patient from experiencing euphoria if he drinks alcohol. B) produce unpleasant reactions if the patient drinks alcohol. C) intensify the patient's CNS depression if he drinks alcohol. D) result in a depressed mood if he drinks alcohol. Ans: B Feedback: Disulfiram inhibits the enzyme aldehyde dehydrogenase to block the oxidation of alcohol. The resulting accumulation of acetaldehyde produces an unpleasant reaction when disulfiram is consumed with alcohol. The effects do not include prevention of euphoria, increased CNS depression, or depressed mood, however.

17.A patient with a well-known history of heroin use has begun addiction treatment. The nurse had administered the patient's daily dose of methadone. The nurses should know that this medication aids in treating opioid addiction because it does which of the following? A) Acts as an agonist at opioid receptors and prevents withdrawal symptoms B) Acts as an opioid antagonist and causes unpleasant symptoms if the patient uses opioids C) Acts on the limbic system and the reticular system to suppress brain activity associated with addiction D) Depresses the CNS to a similar degree as opioids, aiding in detoxification Ans: A Feedback: Methadone is an agonist at specific opioid receptors in the CNS. Its action allows it to prevent symptoms of withdrawal. It does not cause unpleasant effects if the patient uses opioids and does not act directly on the limbic system or reticular system.

18.A patient has been brought to the emergency department by paramedics. The patient's known history and highly agitated state are suggestive of cocaine-induced psychosis. What assessment should the nurse prioritize prior to administering pharmacologic

A) B) C) D) Ans:

treatments? Assessment of blood glucose levels Assessment of cranial nerve function Lung auscultation Cardiovascular assessment D Feedback: Cocaine intoxication carries a high risk for cardiac dysrhythmias. Consequently, cardiovascular assessment would be a priority over lung auscultation, assessment of cranial nerve function, or assessment of blood glucose levels.

19.A 15-year-old boy with a complex psychosocial history is being treated for inhalant abuse. When providing health education to this boy, the nurse should cite which of the following risks associated with inhalant abuse? A) Hyperactivity B) Psychological dependence C) Physiological dependence D) Organ damage Ans: D Feedback: Inhalants can harm the brain, liver, heart, kidneys, and lungs, and abuse of any drug during adolescence may interfere with brain development. Dependence has not been definitively demonstrated, and hyperactivity is not a risk.

20.A patient is being treated for addiction to cocaine and heroin and will begin treatment with naltrexone (ReVia). If the patient uses an opioid after taking this drug, the nurse should expect what effect? A) The patient will experience a decline in neurological function. B) The patient will experience visual disturbances and unpleasant hallucinations. C) The patient will not experience the usual physiological effects of opioids. D) The patient will experience a sudden onset of nausea and vomiting. Ans: C Feedback: Naltrexone (ReVia) is a pure opioid antagonist that blocks opioids from occupying receptor sites, thereby preventing their physiologic effects. It will not cause neurological deficits, GI upset, or hallucinations.

1. A patient is diagnosed with a fungal infection of the eye. What of the following medications is the most likely the cause of the fungal infection of the eye? A) Ophthalmic corticosteroid B) Systemic antibiotic agent C) Mydriatic D) Saline ophthalmic drops Ans: A Feedback: Fungal infections commonly occur and may often be attributed to frequent use of ophthalmic antibiotics and corticosteroids. Systemic antibiotic agents are not the cause of fungal infections of the eye. Mydriatics are not the cause of fungal infections of the eye. Saline ophthalmic drops are not the cause of fungal infections of the eye. 2. A patient states that his eyes are “watering” excessively, and he claims that he has a gritty feeling of the eye. What common eye disorder is suspected? A) Hordeolum B) Blepharitis C) Conjunctivitis D) Glaucoma Ans: C Feedback: Conjunctivitis is a common eye disorder with redness, tearing, itching, edema, and gritty sensations of the eye. Hordeolum is a sty. Blepharitis is a chronic infection of glands and lash follicles on the margins of the eyelids. Glaucoma is a disease with an increased intraocular pressure.

3. A patient has a foreign body in the right eye. What medication will most likely be administered before removal of the foreign body? A) Cortisporin ointment B) Proparacaine eye drops C) Cephalosporin orally D) Atropine eye drops Ans: B Feedback: Proparacaine is a commonly used agent to provide anesthetic. One drop is instilled in the affected eye prior to removing the foreign body. Cortisporin ointment would not routinely be administered before foreign body removal. Cephalosporin is not administered. Atropine eye drops are not administered for this purpose.

4. A patient is scheduled for cataract surgery. What anesthetic agent should the nurse prepare to administer? A) Acetazolamide (Diamox) B) Pilocarpine (Pilocar)

C) D) Ans:

Dipivefrin (Propine) Lidocaine D Feedback: Injectable local anesthetics are administered by ophthalmologists, usually for eye surgery. Lidocaine is commonly used; it has a rapid onset and lasts 1 to 2 hours. Acetazolamide (Diamox) is not used as an anesthetic agent. Pilocarpine (Pilocar) is not used as an anesthetic agent. Dipivefrin (Propine) is not used as an anesthetic agent.

5. A patient is prescribed ophthalmic corticosteroids. What eye disorder may result from long-term use of ophthalmic corticosteroids? A) Conjunctivitis B) Hordeolum C) Glaucoma D) Blepharitis Ans: C Feedback: Long-term use of corticosteroid ophthalmic agents may result increased IOP, optic nerve damage, defects in visual acuity, and fields of vision, cataracts, and secondary ocular infections.

6. A patient is predicted to benefit from dexamethasone eye drops. The presence of what eye disorder would contraindicate the use of this drug? A) Fungal infection B) Nearsightedness C) Cataracts D) Bacterial conjunctivitis Ans: A Feedback: Contraindications to dexamethasone include corneal or conjunctival viral disease caused by herpes simplex, vaccina, or varicella. Also, other contraindications are mycobacterial and fungal infection of the eye as well as advanced glaucoma and hypersensitivity to corticosteroids.

7. A patient is scheduled for an ophthalmic examination. Which of the following medications will be administered? A) Pseudoephedrine hydrochloride B) Epoetin alfa (Epogen) C) Phenylephrine D) Pilocarpine (Pilocar) Ans: C Feedback: Phenylephrine is used to dilate the pupil before ophthalmic examinations.

Pseudoephedrine hydrochloride is used to relieve nasal congestion. Epoetin alfa is used to treat bone marrow depression. Pilocarpine reduces intraocular pressure.

8. A patient is being administered phenylephrine in an outpatient clinic. Which of the following conditions requires that phenylephrine be administered cautiously? A) Cataracts B) Hypothyroidism C) Diabetes mellitus D) Hypertension Ans: D Feedback: Adrenergic mydriatics should be used cautiously in patients with hypertension, cardiac dysrhythmias, arteriosclerotic heart disease, and hyperthyroidism. Patients with cataracts, hypothyroidism, and diabetes mellitus can safely be administered phenylephrine.

9. A patient's medication administration record include daily timolol maleate eye drops. The nurse should identify what goal of therapy when planning this patient's care? A) Decrease intraocular pressure. B) Constrict pupils. C) Promote lacrimation. D) Improve visual acuity. Ans: A Feedback: The purpose of the administration of beta-blocking drugs such as timolol is to decrease the IOP. Beta-blockers are not used to promote lacrimation, improve vision, or constrict the pupils.

10. A nurse is administering eye drops of two different drugs to a patient. How long should the nurse wait between the instillation of the first medication and the second medication? A) At least 1 minute B) At least 5 minutes C) At least 15 minutes D) At least 20 minutes Ans: B Feedback: When multiple eye drops are required, there should be an interval of 5 to 10 minutes between drops. The drops should not be as close as 1 minute. The drops will not need to be separated by 15 to 20 minutes.

11. A patient is administering eye drops. What should the patient be taught in order to

A) B) C) D) Ans:

decrease systemic absorption of eye drops? Lie supine for 1 minute after instillation. Apply pressure for 2 minutes over the tear duct. Apply pressure for 5 minutes over the tear duct. Remain still for 10 minutes after instillation C Feedback: Systemic absorption of eye drops can be decreased by closing the eye and applying pressure over the tear duct for 3 to 5 minutes after instillation. Pressure should not be applied to the tear duct for less than 3 minutes or greater than 5 minutes. It is unnecessary to remain still or supine after instillation.

12. A child with glaucoma is being treated with short-acting mydriatics. Which cycloplegic will be administered with the mydriatic agent? A) Tropicamide B) Cortisporin C) Phenylephrine D) Acetazolamide (Diamox) Ans: A Feedback: Children with glaucoma are treated with mydriatics and cycloplegics, such as tropicamide. The child with glaucoma is not treated with cortisporin, phenylephrine, or acetazolamide.

13. A nurse is providing health education about the way the normal intraocular pressure (IOP) is maintained. The nurse should explain that normal IOP results from which of the following? A) Consistent production and resorption of tears B) Consistent feedback from baroreceptors located throughout the retina C) A balance between production and drainage of aqueous humor D) Two-way interaction between the medulla oblongata and the eye Ans: C Feedback: Normally, production and drainage of aqueous humor are approximately equal, and the intraocular pressure (IOP) is normal. IOP is not dependent of tear production, baroreceptors in the eye, or stimulation from the medulla.

14. A resident of a long-term care facility was referred to an outpatient ophthalmology clinic for assessment, and the nurse has received the clinical report. The nurse reads that the resident's intraocular pressure was elevated above clinical norms. The nurse should recognize that the resident is at risk of A) cataracts. B) glaucoma.

C) D) Ans:

myopia. conjunctivitis. B Feedback: Glaucoma is characterized by increased IOP, possibly damaging the optic nerve, which transmits images to the brain. If damage to the optic nerve from high IOP continues, glaucoma leads to loss of vision. Cataracts, myopia, and conjunctivitis are not the results of increased IOP.

15. A nurse who provides care in an ophthalmology clinic has an order to instill atropine eye drops to a patient prior to the patient's clinical examination. What health education should the nurse provide prior to this intervention? A) “These drops might sting a little bit, and they will make you temporarily sensitive to light.” B) “These eye drops will make it more difficult to close your eyes, but this will pass in a few hours.” C) “These drops will make your pupil temporarily constrict so that your eye can be examined more closely.” D) “These drops will make your eyes very bloodshot and sensitive, but this is only temporary.” Ans: A Feedback: The nurse instructs patients about the effects of atropine such as photophobia and stinging on administration. Atropine does not make it difficult to close the eyes, and it causes pupil dilation, not constriction.

16. The nurse has administered a scheduled dose of phenylephrine to a patient. The nurse would recognize that a therapeutic effect has been achieved by which of the following assessment findings? A) The cornea can be manipulated without causing the patient to blink. B) The patient acknowledges an improvement in visual acuity. C) The patient's pupils neither dilate nor constrict in response to light. D) The inner aspect of the patient's eye can be visualized. Ans: D Feedback: Uses of phenylephrine (ophthalmic) include mydriasis prior to ophthalmic procedures. Consequently, the nurse assesses whether the inner aspect of the eye can be visualized 15 minutes after administration. Phenylephrine does not inhibit blinking, improve vision, or eliminate light accommodation.

17. A patient's sudden increase in IOP has necessitated the oral administration of glycerin (Osmoglyn). When assessing the patient for adverse effects related to this intervention, the nurse should prioritize which of the following?

A) B) C) D) Ans:

Assessment for signs and symptoms of acid–base imbalances Assessment for signs and symptoms of fluid volume deficit Monitoring of serum potassium and sodium levels Monitoring of aPTT and INR B Feedback: Adverse effects of glycerin relate to decreased fluid volume. The most serious of these conditions is hyperosmolar nonketotic coma. Consequently, the nurse should prioritize assessments that are focused on the signs and symptoms of fluid volume deficit.

18. A nurse is providing care for a patient who is on the third day of her prescribed course of ciprofloxacin eye drops. The nurse should conclude that this patient most likely has a diagnosis of what health problem? A) Astigmatism B) Cataracts C) Conjunctivitis D) Increased IOP Ans: C Feedback: Uses of ciprofloxacin include the treatment of corneal ulcer and bacterial conjunctivitis. This drug is not used to treat cataracts, increased IOP, or astigmatism.

Chapter 59

1. A young boy has just returned home from his family's tropical vacation and is now complaining of worsening tenderness in his right ear. He is subsequently diagnosed with otitis externa. What causative factor of this infection should the nurse suspect? A) Immunocompromised state resulting from sleep deprivation while on vacation B) The potential for foodborne pathogens ingested while on vacation C) Frequent swimming and water sports while the boy was on vacation D) Ear trauma related to pressurization and depressurization while flying Ans: C Feedback: People whose ears are frequently exposed to moisture are more prone to the development of otitis externa. Swimming is a more likely cause of infection than pressure changes, foodborne pathogens, or impaired immunity.

2. A pediatric nurse practitioner has diagnosed a 4-year-old girl with otitis media. The nurse should understand that infectious microorganisms likely entered the girl's middle ear by what means? A) Through an alteration in the eustachian tube B) Through the external ear C) From within the cochlea or vestibule D) From the interstitial spaces in the middle ear Ans: A Feedback: The causative pathogens implicated in otitis media include Haemophilus influenzae, Streptococcus pneumoniae, and Moraxella catarrhalis. They enter the middle ear as a result of an alteration in the eustachian tube, not from the inner ear, external ear, or interstitial spaces.

3. A patient has responded appreciably to first-line treatments for necrotizing otitis externa, and the care team is concerned about the possible progression of the disease. The nurse should be aware that this infection has the potential to progress to A) meningitis. B) osteomyelitis. C) necrotizing fasciitis. D) epiglottitis. Ans: B Feedback: The advancement of necrotizing otitis externa results in osteomyelitis of the skull and temporomandibular joint. It does not cause meningitis, necrotizing fasciitis, or epiglottitis.

4. A 12-year-old boy has been diagnosed with acute otitis externa. The patient's mother has asked if oral medications might be more effective than ear drops. The nurse should respond in the knowledge that systemic medications for the treatment of otitis externa

A) B) C) D) Ans:

are only indicated in what circumstances? The infection is accompanied by ear discharge. The patient is allergic to penicillins. The patient is unable to self-administer ear drops. A deep tissue infection develops. D Feedback: For acute otitis externa, use of topical agents, as opposed to systemic agents, is more common. Systemic medications are indicated only if a deep tissue infection develops outside the external canal or if immunocompromised status is an issue. Allergy status, ability to self-administer, and the presence or discharge are not indications for systemic antibiotics.

5. The nurse is providing health education for the parents of a child whose otitis media has warranted treatment with Cortisporin Otic. The nurse should explain that this medication contains which of the following components? Select all that apply. A) An analgesic B) A topical anesthetic C) An antibiotic D) A steroid E) An immunomodulator Ans: C, D Feedback: Health care providers use the combination drug Cortisporin Otic (neomycinñpolymyxin Bñhydrocortisone) for the treatment of acute external otitis media. Neomycin and polymyxin B are antibiotics, which combat bacterial infections. Hydrocortisone is a steroid, which reduces the actions of chemicals in the body that cause inflammation, redness, and swelling. This medication does not contain analgesics, anesthetics, or immunomodulators.

6. A child's primary health care provider has prescribed Cortisporin Otic for a child who has otitis media in her right ear. What administration instructions should the nurse provide to the parents of the child? A) ìPut one drop into her right ear each morning.î B) ìPlace two drops in her right ear each morning and then again before bedtime.î C) ìPut one to two drops in her right ear whenever you notice discharge or she complains of pain.î D) ìPlace three drops into her ear four times a day.î Ans: D Feedback: For children 6 months and older, 3 drops of Cortisoprin Otic are instilled into the affected ear three to four times daily. Dosage is not matched to acute symptoms.

7. A nurse is demonstrating the correct technique for instilling antibiotic ear drops into a child's ear canal. The nurse should teach the child's caregivers to do which of the following? A) Have the child lie supine during instillation of the ear drops. B) Have the child lie still for 30 to 45 minutes after instilling the ear drops. C) Place a cotton ball in the ear canal after instilling the ear drops. D) Rinse the child's ear canal with normal saline prior to instilling the ear drops. Ans: C Feedback: The proper administration of ear drops requires tilting the head toward the opposite shoulder, pulling the superior aspect of the auricle upward, and instilling the ear drops into the ear canal. The patient should then lie on the side opposite the side of administration for 20 minutes. To maximize medication absorption, the patient should have a cotton ball placed in the ear canal. Supine positioning is not used, and the ear canal does not need to be rinsed prior to drug administration.

8. The nurse is providing care for a teenager with otitis media. When assessing the patient for potentially adverse effects of Cortisporin Otic, what question should the nurse ask? A) ìHave you developed a fever since you started to use the ear drops?î B) ìHave you been getting any headaches since you started taking the drops?î C) ìHas there been any blood that you've noticed in your outer ear?î D) ìHave you noticed any loss of hearing since you started taking the drops?î Ans: D Feedback: It is also necessary to assess the patient taking Cortisporin Otic for signs of hearing loss due to ototoxicity. Fever, bleeding, and headaches are not typical adverse effects.

9. An adult patient has been assessed in the emergency department and diagnosed with necrotizing otitis externa. The primary care provider has prescribed ciprofloxacin. In preparation for administering this medication, what action should the nurse perform? A) Establish intravenous access. B) Remove as much cerumen as possible from the patient's ear canal. C) Flush the affected ear with warmed sterile water. D) Establish a sterile field around the perimeter of the ear. Ans: A Feedback: Ciprofloxacin (Cipro) is the drug of choice for necrotizing otitis externa. Initially, administration is intravenous, until symptoms decrease; then it is oral. Consequently, IV access is necessary for the initiation of treatment. This is a priority over rinsing the ear or removing cerumen. It is unnecessary to create a sterile field.

10. A pediatric nurse is providing inpatient care for a child who was diagnosed with necrotizing otitis externa. The child is currently being treated with ciprofloxacin. What

A) B) C) D) Ans:

microorganism is the most likely cause of this child's infection? Aspergillus Candida albicans Pseudomonas aeruginosa Escherichia coli C Feedback: Health care providers use ciprofloxacin for the treatment of Pseudomonas aeruginosa in patients with necrotizing otitis externa. If the causative agent is Aspergillus, amphotericin B is the drug of choice. E. coli and Candida are not typically implicated in cases of necrotizing otitis externa.

11. A woman was diagnosed with necrotizing otitis externa and will soon begin a course of oral ciprofloxacin. When providing health education to this patient, the nurse should emphasize the need to temporarily avoid A) calcium antacids. B) fatty foods. C) grapefruit juice. D) foods containing purines. Ans: A Feedback: Patients should not take oral ciprofloxacin within 2 hours of eating dairy products, calcium-fortified juices, antacids, zinc, or iron. There is no specific need to avoid fatty foods, grapefruit juice, or high-purine foods.

12. A 4-year-old boy was diagnosed with acute otitis media and began a course of oral amoxicillin. The boy's mother has contacted the clinic and states that there has been no significant improvement in her son's ear infection since beginning the antibiotics 3 days ago. The nurse should consider which of the following explanations for this phenomenon? A) The boy has not been receiving the medication consistently. B) The boy's ear infection has a viral etiology. C) The boy's ear infection is caused by an antibiotic-resistant microorganism. D) The medication should have been prescribed parenterally. Ans: B Feedback: Many people with acute otitis media do not benefit from antibiotics because the cause of their illness is viral, not bacterial. This possibility is more likely than incorrect administration or antibiotic resistance. Parenteral administration would be no more effective in this case.

13. A patient has been taking oral amoxicillin to treat otitis media for the past 6 days and has told the nurse that his ear is now ìback to normal.î He asks the nurse if he can now

A) B) C) D) Ans:

stop taking his antibiotics. How should the nurse respond? ìThat's excellent that you're feeling better, but it's important to keep taking the antibiotics until they're all finished.î ìTry reducing your dose by half. If your ear infection gets worse, resume the dose you've been taking until now.î ìYou should stop taking the antibiotics because if you don't, it could cause antibiotic resistance.î ìYou can likely stop taking the antibiotics, but keep them on hand in case your infection returns.î A Feedback: The patient should take the full course of antibiotics and not discontinue them, even if the otitis media seems to be improving. Stopping prematurely can cause antibiotic resistance.

14. A child's otitis media has resulted in pain and fever. The child's mother has asked the nurse to recommend OTC remedies to address these problems. Which of the following recommendations is most likely to be safe and effective? A) Concurrent use of ASA and ibuprofen for 3 days B) Alternating doses of acetaminophen and ibuprofen C) Monotherapy with ASA until symptoms improve D) Use of an OTC antihistamine and acetaminophen Ans: B Feedback: Alternating acetaminophen and ibuprofen every 4 hours over a 3-day period to control fever in young children (ages 6ñ36 months) has been shown to be more effective than monotherapy with either agent. ASA is contraindicated in children, and an antihistamine is unnecessary.

15. A young adult has been diagnosed with otitis media. When planning this patient's care, what nursing diagnosis is the most likely priority? A) Hyperthermia related to infectious process B) Infection related to presence of microorganisms C) Disturbed auditory sensory perception related to otitis media D) Chronic pain related to otitis media Ans: B Feedback: Infection is the essence of otitis media, and would be a priority over other diagnoses such as hyperthermia or temporary hearing loss. The pain associated with this disorder would be acute, not chronic.

1.A teenager is using a tanning bed two times per week. Which cells within the skin change color in response to the tanning bed's lights? A) Melanocytes B) Stratum corneum C) Merkel cells D) Dermis Ans: A Feedback: Melanocytes are pigment-producing cells located at the junction of the epidermis and the dermis. The stratum corneum, Merkel cells, and dermis do not perform this role.

2.A teenager is being treated for acne vulgaris. Which oral antibiotics may be prescribed to treat acne? A) Neomycin and vancomycin B) Gentamicin and Rocephin C) Tetracycline and erythromycin D) Bacitracin and polymyxin B Ans: C Feedback: Commonly used oral antibiotics for acne treatment include tetracycline, doxycycline, minocycline, and erythromycin. Neomycin and vancomycin are not used to treat acne. Gentamicin and Rocephin are not used to treat acne. Bacitracin and polymyxin B are not used to treat acne.

3.A young mother is seen in the clinic with her young children. It is May, and the family is planning to go to the beach for vacation. Which of the following aspects of patient teaching is most important? A) “Try to stay indoors as much as possible.” B) “Apply SPF 30 sunscreen to the children before sun exposure.” C) “Be sure that each child wears a hat at the beach.” D) “Apply Neosporin to any skin abrasions your children get.” Ans: B Feedback: Dermatologists recommend sunscreen preparations that block both UVA and UVB and have a sun protective factor of SPF value 30 or higher. It is unnecessary to avoid all outdoor locations. The mother should apply a hat, but this advice is not the most important health promotion intervention; this does not prevent sun damage to most skin surfaces. The mother should be cautious with the application of Neosporin.

4.A 17-year-old woman is prescribed isotretinoin (Accutane) for severe acne vulgaris. Which of the following is the most important intervention related to the administration of this medication? Effective contraception must accompany this medication.

B) C) D) Ans:

Administer the medication on an empty stomach to decrease discomfort. The tablets should be crushed if they are too large to swallow. Administer a vitamin A supplement daily to enhance effectiveness. A Feedback: The administration of retinoids requires adequate contraceptive practices in women. Retinoids should be given with food, not on an empty stomach. The tablets should not be crushed. The patient should not take vitamin A or a multivitamin because of the retinoid toxicity.

5.A college sophomore has sought care because of her worsening acne. Before beginning a medical regime that includes a retinoid, which of the following laboratory tests must be negative? A) Throat culture B) Skin culture C) Stool for occult blood D) Pregnancy test Ans: D Feedback: The female patient should have a negative pregnancy test before beginning retinoid therapy. It is not necessary to have a negative throat culture or skin culture. If the patient has a positive stool for occult blood, the cause should be determined but is not affected by retinoid therapy.

6.A teenage male patient is administered isotretinoin (Accutane) for severe acne. When teaching the teen and his parents about the medication, which of the following assessments should be routinely made? A) Assess blood pressure. B) Assess blood lipid levels. C) Assess for euphoria. D) Assess for increased weight. Ans: B Feedback: The administration of isotretinoin is linked with increased blood lipid levels. The parents and teen should be taught that lipid levels should be periodically assessed. The assessment of blood pressure is not imperative. The patient should be assessed for depression, not euphoria. The patient will not need his weight assessed.

A) B) C)

7.The physician orders tretinoin (Retin-A) for the treatment of acne. Which of the following instructions should be provided? “You will see positive results in 1 week” “Apply the medication two to three times a day.” “Apply the topical medication one time per day.”

D) Ans:

“Apply the medication for 1 hour and remove it.” C Feedback: Tretinoin is applied one time per day. Positive results from the medication will be noted in 12 weeks, not 1 week. The medication should not be applied two to three times per day. The medication should not be applied for 1 hour and then removed.

8.A teenager has acne that requires treatment. The physician does not want to use retinoids because of the adverse effects. Which of the following medication regimens will likely be most effective? A) Topical azelaic acid B) Topical benzoyl peroxide C) Topical clindamycin D) Topical clindamycin with benzoyl peroxide Ans: D Feedback: Combination products of topical clindamycin or erythromycin and benzoyl peroxide are more effective than antibiotics alone. Azelaic acid and benzoyl peroxide are effective but not as effective as combination medications. Topical clindamycin is effective, but combination medications may be more effective.

9.A patient has a severe reaction to poison ivy. Which of the following medications will be most effective? A) Topical antihistamines B) Corticosteroids C) Emollients D) Analgesics Ans: B Feedback: Corticosteroids are used to treat the inflammation present in many dermatologic conditions. They are most often applied topically but also may be given orally or parenterally. Emollients and analgesics would be ineffective. Antihistamines are not administered topically.

10.A patient has psoriasis and has been prescribed coal tar (Balnetar). How will this prescription be administered? A) Topically B) Orally in divided daily doses C) Orally in the morning D) Parenterally at bedtime Ans: A Feedback: Coal tar is administered topically.

11.A child who has not received the chickenpox vaccine has developed the chickenpox virus. The child has itching related to the chickenpox pustules. Which of the following herbal preparations would be helpful to decrease itching? A) Coal tar (Balnetar) B) Colloidal oatmeal (Aveeno) C) Clindamycin D) Bacitracin (Bacillin) Ans: B Feedback: Oat preparations, such as Aveeno, are used topically to treat minor skin irritation. Coal tar is not used for this child; it is primarily administered for psoriasis and dermatitis. Clindamycin is not administered to treat minor skin irritation. Bacitracin is not administered to relieve itching related to chickenpox.

12.A patient has rosacea. Which of the following medications is most effective in treating rosacea? A) Topical metronidazole (Flagyl) B) Oral nystatin (Mycostatin) C) Oral prednisone D) Topical hydrocortisone Ans: A Feedback: Topical metronidazole is commonly used for rosacea. Oral Mycostatin is not used for rosacea. Oral prednisone is not used for rosacea. Topical hydrocortisone is not used for rosacea.

13.A patient has a bacterial skin infection. Which medication can be applied to the lesion? A) Bacitracin B) Benzoyl peroxide C) Butenafine (Mentax) D) Clotrimazole (Lotrimin) Ans: A Feedback: Bacitracin is used to treat a bacterial skin infection. Butenafine is an antifungal agent. Clotrimazole is used to treat tinea infections. Benzoyl peroxide is used to treat acne.

14.A patient has developed urticaria following the administration of an oral antibiotic. What substance most commonly mediates the formation of the wheals that characterize urticaria? A) Cytokines B) CD4+ lymphocytes

C) D) Ans:

Histamine Interleukin C Feedback: Histamine is the most common mediator of urticaria; it causes vasodilation, increased vascular permeability, and pruritus. Cytokines, including interleukin, and CD4+ lymphocytes do not usually mediate the development of urticaria.

15.An older adult who resides in a long-term care facility has been diagnosed with oral candidiasis (thrush). When considering factors that may have contributed to this health problem, the nurse should prioritize which of the following? A) The resident recently completed a course of broad-spectrum antibiotics. B) The resident takes metformin for the treatment of type 2 diabetes. C) The resident has been using OTC skin emollients several times a day. D) The resident was immunized against the influenza virus 1 week ago. Ans: A Feedback: Oral candidiasis (thrush) involves mucous membranes of the mouth. It often occurs as a superinfection after the use of broad-spectrum systemic antibiotics. Oral antihyperglycemics, skin emollients, and vaccinations do not contribute to thrush.

16.A topical corticosteroid has been prescribed for short-term use on an infant's skin. When planning the use of a topical medication for an infant, what principle should guide the nurse's actions? A) Topical medications on infants' skin must be covered with an impermeable barrier. B) Infants' skin is more permeable to medication than older patients'. C) Infants have more subcutaneous fat than older patients, so higher concentrations of topical medications are often necessary. D) Systemic drugs are preferable to topical medications in the care of infants. Ans: B Feedback: With topical medications, cautious use is recommended with infants and young children due to the fact they have more permeable skin and are more likely to absorb the topical drugs. Infants have significant subcutaneous fat, but this does not necessitate higher concentrations of drugs. Topical drugs do not necessarily have to be covered with a barrier following administration.

17.A patient has been diagnosed with severe atopic dermatitis and treatment with tacrolimus (Protopic) ointment has been deemed necessary. When planning this patient's care, the nurse should ensure that the patient has been informed of what risk? A) Risk of chemical burn injury B) Increased risk of developing psoriasis or type IV hypersensitivity C) Risk of opportunistic fungal infection that may become systemic

D) Ans:

Increased risks of skin cancer and lymphoma D Feedback: Tacrolimus has a black box warning about a possible increased risk of skin cancer and lymphoma. It is not noted to cause fungal infections, psoriasis, or chemical burn injuries.

18.A 15-year-old boy has begun acne treatment using a combination ointment of clindamycin and benzoyl peroxide. The nurse should teach the boy to expect maximum results in how long? A) 5 to 7 days B) 1 to 2 weeks C) 3 to 5 weeks D) 8 to 12 weeks Ans: D Feedback: Best results of combination acne treatments require 8 to 12 weeks of therapy, and maintenance therapy is usually required.

19.A young adult began acne treatment several weeks ago using a combination ointment and has presented for a follow-up appointment at the clinic. When assessing the patient for adverse effects of treatment, what question should the nurse prioritize? A) “Have you found that the ointment makes your skin a lighter color?” B) “Do you find that the ointment makes your pimples bleed more easily?” C) “Do your eyes burn when you apply the ointment to your face?” D) “Is the skin on your face uncomfortably dry since you began using the ointment?” Ans: D Feedback: Adverse effects of topical antibiotics include erythema, peeling, dryness, and burning as well as development of resistant strains of P. acnes. Such ointments are not expected to produce eye irritation, bleeding, or changes in skin tone.

20.A nurse practitioner has discussed the possible risks and benefits of isotretinoin treatment with a patient who has acne vulgaris. The nurse should be aware that this medication achieves a reduction in the signs and symptoms of acne by what method? A) Stimulating phagocytosis in the epidermis and dermis B) Suppressing the production of sebum C) Enhancing humoral immunity D) Inhibiting the function of sudoriferous glands Ans: B Feedback: The antiacne effects of isotretinoin include suppression of sebum production, inhibition of comedone formation, and inhibition of inflammation. The drug does not stimulate immune function or reduce the function of sweat glands.