TEST BANK for Lippincott Illustrated Reviews Pharmacology 7th Edition by Karen Whalen by ACADEMIAMILL

TEST BANK Pharmacology Illustrated Reviews

7th Edition Whalen Test Bank

TEST BANK

Pharmacology Illustrated Reviews 7th Edition Whalen Test Bank TABLE OF CONTENT Chapter 1: Pharmacokinetics Chapter 2: Drug–Receptor Interactions and Pharmacodynamics Chapter 3: The Autonomic Nervous System Chapter 4: Cholinergic Agonists Chapter 5: Cholinergic Antagonists Chapter 6: Adrenergic Agonists Chapter 7: Adrenergic Antagonists Chapter 8: Drugs for Neurodegenerative Diseases Chapter 9: Anxiolytic and Hypnotic Drugs Chapter 10: Antidepressants Chapter 11: Antipsychotic Drugs Chapter 12: Drugs for Epilepsy Chapter 13: Anesthetics Chapter 14: Opioids Chapter 15: Drugs of Abuse Chapter 16: CNS Stimulants Chapter 17: Antihypertensives Chapter 18: Diuretics Chapter 19: Heart Failure Chapter 20: Antiarrhythmics Chapter 21: Antianginal Drugs Chapter 22: Anticoagulants and Antiplatelet Agents Chapter 23: Drugs for Hyperlipidemia Chapter 24: Pituitary and Thyroid Chapter 25: Drugs for Diabetes Chapter 26: Estrogens and Androgens Chapter 27: Adrenal Hormones Chapter 28: Drugs for Obesity Chapter 29: Drugs for Disorders of the Respiratory System Chapter 30: Antihistamines Chapter 31: Gastrointestinal and Antiemetic Drugs Chapter 32: Drugs for Urologic Disorders Chapter 33: Drugs for Anemia Chapter 34: Drugs for Dermatologic Disorders Chapter 35: Drugs for Bone Disorders Chapter 36: Anti-inflammatory, Antipyretic, and Analgesic Agents Chapter 37: Principles of Antimicrobial Therapy Chapter 38: Cell Wall Inhibitors Chapter 39: Protein Synthesis Inhibitors Chapter 40: Quinolones, Folic Acid Antagonists, and Urinary Tract Antiseptics Chapter 41: Antimycobacterial Drugs Chapter 42: Antifungal Drugs Chapter 43: Antiprotozoal Drugs Chapter 44: Anthelmintic Drugs Chapter 45: Antiviral Drugs Chapter 46: Anticancer Drugs Chapter 47: Immunosuppressants Chapter 48: Clinical Toxicology

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Pharmacology Illustrated Reviews 7th Edition Whalen Test Bank Chapter 1: Pharmacokinetics MULTIPLE CHOICE 1. Which drugs will go through a pharmaceutic phase after it is administered? a. Intramuscular cephalosporins b. Intravenous vasopressors c. Oral analgesics d. Subcutaneous antiglycemics ANS: C When drugs are administered parenterally, there is no pharmaceutic phase, which occurs when a drug becomes a solution that can cross the biologic membrane. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: dm 3 TOP: NURSING PROCESS: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 2. The nurse is preparing to administer an oral medication and wants to ensure a rapid drug action. Which form of the medication will the nurse administer? a. Capsule b. Enteric-coated pill c. Liquid suspension d. Tablet ANS: C Liquid drugs are already in solution, which is the form necessary for absorption in the GI tract. The other forms must disintegrate into small particles and then dissolve before being absorbed. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: dm 3 TOP: NURSING PROCESS: Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

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3. The nurse is teaching a patient who will be discharged home with a prescription for an entericcoated tablet. Which statement by the patient indicates understanding of the teaching? a. I may crush the tablet and put it in applesauce to improve absorption. b. I should consume acidic foods to enhance absorption of this medication. c. I should expect a delay in onset of the drugs effects after taking the tablet. d. I should take this medication with high-fat foods to improve its action. ANS: C Enteric-coated tablets resist disintegration in the acidic environment of the stomach and disintegrate when they reach the small intestine. There is usually some delay in onset of actions after taking these medications. Enteric-coated tablets should not be crushed or chewed, which would alter the time and location of absorption. Acidic foods will not enhance the absorption of the medication. The patient should not to eat high-fat food before ingesting an enteric-coated tablet, because high-fat foods decrease the absorption rate. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 3 TOP: NURSING PROCESS: Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 4. A patient who is newly diagnosed with type 1 diabetes mellitus asks why insulin must be given by subcutaneous injection instead of by mouth. The nurse will explain that this is because a. absorption is diminished by the first-pass effects in the liver. b. absorption is faster when insulin is given subcutaneously. c. digestive enzymes in the gastrointestinal tract prevent absorption. d. the oral form is less predictable with more adverse effects. ANS: C Insulin, growth hormones, and other protein-based drugs are destroyed in the small intestine by digestive enzymes and must be given parenterally. Because insulin is destroyed by digestive enzymes, it would not make it to the liver for metabolism with a first-pass effect. Subcutaneous tissue has fewer blood vessels, so absorption is slower in such tissue. Insulin is given subcutaneously because it is desirable to have it absorb slowly. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: dm 3 TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

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5. The nurse is preparing to administer an oral medication that is water-soluble. The nurse understands that this drug a. must be taken on an empty stomach. b. requires active transport for absorption. c. should be taken with fatty foods. d. will readily diffuse into the gastrointestinal tract. ANS: B Water-soluble drugs require a carrier enzyme or protein to pass through the GI membrane. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: dm 4 TOP: NURSING PROCESS: Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 6. A nurse is preparing to administer an oral drug that is best absorbed in an acidic environment. How will the nurse give the drug? a. On an empty stomach b. With a full glass of water c. With food d. With high-fat food ANS: C Food can stimulate the production of gastric acid so medications requiring an acidic environment should be given with a meal. High-fat foods are useful for drugs that are lipid soluble. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 4 TOP: NURSING PROCESS: Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 7. The nurse is preparing an injectable drug and wants to administer it for rapid absorption. How will the nurse give this medication? a. IM into the deltoid muscle b. IM into the gluteal muscle c. SubQ into abdominal tissue d. SubQ into the upper arm ANS: A

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Drugs given IM are absorbed faster in muscles that have more blood vessels, such as the deltoid, rather than those with fewer blood vessels, such as the gluteals. Subcutaneous routes are used when absorption needs to be slower and more sustained. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 4 TOP: NURSING PROCESS: Planning MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 8. The nurse is reviewing medication information with a nursing student prior to administering an oral drug and notes that the drug has extensive first-pass effects. Which statement by the student indicates a need for further teaching about this medication? a. The first-pass effect means the drug may be absorbed into systemic circulation from the intestinal lumen. b. The first-pass effect means the drug may be changed to an inactive form and excreted. c. The first-pass effect means the drug may be changed to a metabolite, which may be more active than the original. d. The first-pass effect means the drug may be unchanged as it passes through the liver. ANS: A Drugs that undergo first-pass metabolism are absorbed into the portal vein from the intestinal lumen and go through the liver where they are either unchanged or are metabolized to an inactive or a more active form. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: dm 4 TOP: NURSING PROCESS: Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 9. The nurse prepares to change a patients medication from an intravenous to an oral form and notes that the oral form is ordered in a higher dose. The nurse understands that this is due to differences in a. bioavailability. b. pinocytosis. c. protein binding. d. tachyphylaxis. ANS: A

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Oral drugs may have less bioavailability because a lower percentage of the drug reaches the systemic circulation. Pinocytosis refers to the process by which cells carry a solute across a membrane. Protein binding can occur with both routes. Tachyphylaxis describes a rapid decrease in response to drugs that occurs when tolerance develops quickly. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: dm 4 TOP: NURSING PROCESS: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 10. The nurse is preparing to administer a drug and learns that it binds to protein at a rate of 90%. The patients serum albumin level is low. The nurse will observe the patient for a. decreased drug absorption. b. decreased drug interactions. c. decreased drug toxicity. d. increased drug effects. ANS: D Drugs that are highly protein-bound bind with albumin and other proteins, leaving less free drug in circulation. If a patient has a low albumin, the drug is not bound, and there is more free drug to cause drug effects. There would be increased absorption, increased interactions with other drugs, and increased toxicity. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 5 TOP: NURSING PROCESS: Evaluation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 11. The nurse is administering two drugs to a patient and learns that both drugs are highly protein-bound. The nurse may expect a. decreased bioavailability of both drugs. b. decreased drug effects. c. decreased drug interactions. d. increased risk of adverse effects. ANS: D Two drugs that are highly protein-bound will compete for protein-binding sites, leaving more

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free drug in circulation and an increased risk of adverse effects as well as increased bioavailability, increased drug effects, and increased drug interactions. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 5 TOP: NURSING PROCESS: Evaluation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 12. A patient has been taking a drug that has a protein-binding effect of 75%. The provider adds a new medication that has a protein-binding effect of 90%. The nurse will expect a. decreased drug effects of the first drug. b. decreased therapeutic range of the first drug. c. increased drug effects of the first drug. d. increased therapeutic range of the first drug. ANS: C Adding another highly protein-bound drug will displace the first drug from protein-binding sites and release more free drug increasing the drugs effects. This does not alter the therapeutic range, which is the serum level between drug effectiveness and toxicity. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 5 TOP: NURSING PROCESS: Nursing Intervention/Evaluation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 13. The nurse gives a medication to a patient with a history of liver disease. The nurse will monitor this patient for a. decreased drug effects. b. increased drug effects. c. decreased therapeutic range. d. increased therapeutic range. ANS: B Liver diseases such as cirrhosis and hepatitis alter drug metabolism by inhibiting the drugmetabolizing enzymes in the liver. When the drug metabolism rate is decreased, excess drug accumulation can occur and lead to toxicity.

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DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 6 TOP: NURSING PROCESS: Assessment/Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 14. The nurse gives 800 mg of a drug that has a half-life of 8 hours. How much drug will be left in the body in 24 hours if no additional drug is given? a. None b. 50 mg c. 100 mg d. 200 mg ANS: C Eight hours after the drug is given, there will be 400 mg left. Eight hours after that (16 hours), there will be 200 mg left. At 24 hours, there will be 100 mg left. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 6 TOP: NURSING PROCESS: Evaluation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 15. If a drug has a half-life of 12 hours and is given twice daily starting at 0800 on a Monday, when will a steady state be achieved? a. 0800 on Tuesday b. 0800 on Wednesday c. 0800 on Thursday d. 0800 on Friday ANS: B Steady-state levels occur at 3 to 5 half-lives. Wednesday at 0800 is 4 half-lives from the original dose. DIF: COGNITIVE LEVEL: Applying (Application) REF: Pages 6-7 TOP: NURSING PROCESS: Evaluation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 16. The nurse is preparing to administer a drug that is ordered to be given twice daily. The nurse reviews the medication information and learns that the drug has a half-life of 24 hours. What will the nurse do next?

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a. Administer the medication as ordered. b. Contact the provider to discuss daily dosing. c. Discuss every-other-day dosing with the provider. d. Hold the medication and notify the provider. ANS: B A drug with a longer half-life should be given at longer intervals to avoid drug toxicity. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 12 TOP: NURSING PROCESS: Planning MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 17. The nurse is caring for a patient who has taken an overdose of aspirin several hours prior. The provider orders sodium bicarbonate to be given. The nurse understands that this drug is given for which purpose? a. To counter the toxic effects of the aspirin b. To decrease the half-life of the aspirin c. To increase the excretion of the aspirin d. To neutralize the acid of the aspirin ANS: C Aspirin is a weak acid and is more readily excreted in alkaline urine. Sodium bicarbonate alkalizes the urine. It does not act as an antidote to aspirin, decrease the half-life, or neutralize its pH. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 7 TOP: NURSING PROCESS: Planning MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 18. The nurse is preparing to administer a drug that is eliminated through the kidneys. The nurse reviews the patients chart and notes that the patient has increased serum creatinine and blood urea nitrogen (BUN). The nurse will perform which action? a. Administer the drug as ordered. b. Anticipate a shorter than usual half-life of the drug. c. Expect decreased drug effects when the drug is given. d. Notify the provider and discuss giving a lower dose.

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ANS: D Increased creatinine and BUN indicate decreased renal function so a drug that is eliminated through the kidneys can become toxic. The nurse should discuss a lower dose with the provider. The drug will have a longer half-life and will exhibit increased effects with decreased renal function. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 7 TOP: NURSING PROCESS: Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 19. The nurse understands that the length of time needed for a drug to reach the minimum effective concentration (MEC) is the a. duration of action. b. onset of action. c. peak action time. d. time response curve. ANS: B The onset of action is the time it takes to reach the MEC. Duration of action is the length of time a drug has a pharmacologic effect. Peak action time occurs when the drug reaches its highest blood level. The time response curve is an evaluation of the other three measures. DIF: COGNITIVE LEVEL: Remembering (Knowledge) REF: dm 7 TOP: NURSING PROCESS: N/A MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 20. The nurse administers albuterol to a patient who has asthma. The albuterol acts by stimulating beta2-adrenergic receptors to cause bronchodilation. The nurse understands that albuterol is a beta-adrenergic a. agonist. b. antagonist. c. inhibitor. d. depressant. ANS: A An agonist medication is one that stimulates a certain type of cell to produce a response.

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DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: dm 8 TOP: NURSING PROCESS: N/A MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 21. The nurse is explaining to the patient why a nonspecific drug has so many side effects. Which statement by the patient indicates a need for further teaching? a. Nonspecific drugs can affect specific receptor types in different body tissues. b. Nonspecific drugs can affect a variety of receptor types in similar body tissues. c. Nonspecific drugs can affect hormone secretion as well as cellular functions. d. Nonspecific drugs require higher doses than specific drugs to be effective. ANS: D Nonspecific drugs can act on one type of receptor but in different body tissues, or a variety of receptor types, or act on hormones to produce effects. Nonspecific drugs do not require higher doses. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 8 TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 22. The nurse is preparing to give a dose of gentamicin to a patient and notes that the most recent serum gentamicin trough level was 2 mcg/mL. What will the nurse do next? a. Administer the drug as ordered. b. Administer the drug and monitor for adverse effects. c. Notify the provider to discuss decreasing the dose. d. Notify the provider to report a toxic drug level. ANS: D The trough drug level for gentamicin should be less than 2 mcg/mL. The nurse should not administer the drug and should notify the provider of the toxic level. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 10 TOP: NURSING PROCESS: Evaluation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 23. The nurse is preparing to administer the first dose of digoxin (Lanoxin) to a patient and notes that the dose ordered is much higher than the usual recommended dose. Which action will the

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nurse perform? a. Administer the dose as ordered. b. Give the dose and monitor for toxicity. c. Hold the dose until reviewing it with the provider. d. Refuse to give the dose. ANS: A Digoxin requires a loading dose when first prescribed. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 10 TOP: NURSING PROCESS: Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 24. The nurse administers a narcotic analgesic to a patient who has been receiving it for 1 day after orthopedic surgery. The patient reports no change in pain 30 minutes after the medication is given. The nurse recognizes that this patient is exhibiting a. drug-seeking behavior. b. drug tolerance. c. the placebo effect. d. tachyphylaxis. ANS: D Tachyphylaxis is a rapid decrease in response, or acute tolerance. Tolerance to drug effects can occur with narcotics, requiring increased doses in order to achieve adequate drug effects. Nurses often mistake drug-seeking behavior for drug tolerance. The placebo effect occurs when the patient experiences a response with an inactive drug.

Chapter 2: Drug–Receptor Interactions and Pharmacodynamics 1. Drugs do not metabolize the same way in all people. For what patient would a nurse expect to assess for an alteration in drug metabolism? A)

A 35-year-old woman with cervical cancer

A 41-year-old man with kidney stones

A 50-year-old man with cirrhosis of the liver

A 62-year-old woman in acute renal failure

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Ans:

C Feedback: The liver is the most important site of drug metabolism. If the liver is not functioning effectively, as in patients with cirrhosis, drugs will not metabolize normally so that toxic levels could develop unless dosage is reduced. A patient with cervical cancer or kidney stones would not be expected to have altered ability to metabolize drugs so long as no liver damage existed. The patient with renal failure would have altered excretion of the drugs through the renal system but metabolism would not be impacted.

2. A patient presents to the emergency department with a drug level of 50 units/mL. The half-life of this drug is 1 hour. With this drug, concentrations above 25 units/mL are considered toxic and no more drug is given. How long will it take for the blood level to reach the non-toxic range? A)

30 minutes

1 hour

2 hours

3 hours

Ans:

B Feedback: Half-life is the time required for the serum concentration of a drug to decrease by 50%. After 1 hour, the serum concentration would be 25 units/mL (50/2) if the body can properly metabolize and excrete the drug. After 2 hours, the serum concentration would be 12.5 units/mL (25/2) and reach the nontoxic range. In 30 minutes the drug level would be 37.5 units/mL, whereas in 3 hours the drug level would be 6.25.

3. A patient has recently moved from Vermont to Southern Florida. The patient presents to the clinic complaining of dizzy spells and weakness. While conducting the admission assessment, the patient tells the nurse that he have been on the same antihypertensive drug for 6 years and had stable blood pressures and no adverse effects. Since his move, he has been having problems and he feels that the drug is no longer effective. The clinic nurse knows that one possible reason for the change in the effectiveness of the drug could be what? A)

The impact of the placebo effect on the patients response.

The accumulative effect of the drug if it has been taken for many years.

The impact of the warmer environment on the patients physical status.

Problems with patient compliance with the drug regimen while on vacation.

Ans:

C Feedback:

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Antihypertensive drugs work to decrease the blood pressure. When a patient goes to a climate that is much warmer than usual, blood vessels dilate and the blood pressure falls. If a patient is taking an antihypertensive drug and moves to a warmer climate, there is a chance that the patients blood pressure will drop too low, resulting in dizziness and feelings of weakness. Even mild dehydration could exacerbate these effects. Most antihypertensives are metabolized and excreted and do not accumulate in the body. Patients must be very compliant with their drug regimen on vacation. After several years on an antihypertensive drug, the effects of that drug are known; therefore, the placebo effect should not be an issue. 4. An important concept taught by the nurse when providing medication teaching is the need to provide a complete list of medications taken to health care providers to avoid what? A)

Spending large amounts of money on medications

Allergic reactions to medications

Drugdrug interactions

Critical concentrations of medications in the body

Ans:

C Feedback: It is important that all health care providers have a complete list of the patients medications to avoid drugdrug interactions caused by one provider ordering a medication, unaware of another medication the patient is taking that could interact with the new prescription. Using the same pharmacist for all prescriptions will also help to prevent this from happening. Informing the provider of all medications taken will not reduce costs of medications, which is best accomplished by requesting generic medications. Allergies should be disclosed to all health care providers as well, but this is not why it is important to provide a complete list of medications taken. Critical concentrations are desirable because that is the amount of drug needed to cause a therapeutic effect, or, in other words, to have the effect the drug is prescribed for.

5. A pharmacology student asks the instructor what an accurate description of a drug agonist is. What is the instructors best response? A)

A drug that reacts with a receptor site on a cell preventing a reaction with another chemical on a different receptor site

A drug that interferes with the enzyme systems that act as catalyst for different chemical reactions

A drug that interacts directly with receptor sites to cause the same activity that a natural chemical would cause at that site

A drug that reacts with receptor sites to block normal stimulation, producing no effect

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Ans:

C Feedback: Agonists are drugs that produce effects similar to those produced by naturally occurring neurotransmitters, hormones, or other substances found in the body. Noncompetitive antagonists are drugs that react with some receptor sites preventing the reaction of another chemical with a different receptor site. Drugenzyme interactions interfere with the enzyme systems that stimulate various chemical reactions.

6. A nurse is caring for a patient who has been receiving a drug by the intramuscular route but will receive the drug orally after discharge. How does the nurse explain the increased dosage prescribed for the oral dose? A)

Passive diffusion

Active transport

Glomerular filtration

First-pass effect

Ans:

D Feedback: The first-pass effect involves drugs that are absorbed from the small intestine directly into the portal venous system, which delivers the drug molecules to the liver. After reaching the liver, enzymes break the drug into metabolites, which may become active or may be deactivated and readily excreted from the body. A large percentage of the oral dose is usually destroyed and never reaches tissues. Oral dosages account for the phenomenon to ensure an appropriate amount of the drug in the body to produce a therapeutic action. Passive diffusion is the major process through which drugs are absorbed into the body. Active transport is a process that uses energy to actively move a molecule across a cell membrane and is often involved in drug excretion in the kidney. Glomerular filtration is the passage of water and water-soluble components from the plasma into the renal tubule.

7. A nurse is working as a member of a research team involved in exploring the unique response to drugs each individual displays based on genetic make-up. What is this area of study is called? A)

Pharmacotherapeutics

Pharmacodynamics

Pharmacoeconomics

Pharmacogenomics

Ans:

D Feedback:

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Pharmacogenomics is the area of study that includes mapping of the human genome. In the future, medical care and drug regimens may be personally designed based on a patients unique genetic make-up. Pharmacotherapeutics is the branch of pharmacology that deals with the uses of drugs to treat, prevent, and diagnose disease. Pharmacodynamics involves how a drug affects the body. Pharmacoeconomics includes the costs involved in drug therapy. 8. The nurse uses what term to describe the drug level required to have a therapeutic effect? A)

Critical concentration

Dynamic equilibrium

Selective toxicity

Active transport

Ans:

A Feedback: A critical concentration of a drug must be present before a reaction occurs within the cells to bring about the desired therapeutic effect. A dynamic equilibrium is obtained from absorption of a drug from the site of drug entry, distribution to the active site, metabolism in the liver, and excretion from the body to have a critical concentration. Selective toxicity is the ability of a drug to attach only to those systems found in foreign cells. Active transport is the process that uses energy to actively move a molecule across a cell membrane and is often involved in drug excretion in the kidney.

9. A nurse is caring for a patient who is supposed to receive two drugs at the same time. What is the nurses priority action? A)

Wash her hands before handling the medications.

Consult a drug guide for compatibility.

Question the patient concerning drug allergies.

Identify the patient by checking the armband and asking the patient to state his name.

Ans:

B Feedback: A nurse should first consult a drug guide for compatibility when two or more drugs are being given at the same time. After compatibility is determined the medication can be administered. The nurse will perform hand hygiene, check for patient allergies, and ensure the right patient receives the medication by using two identifiers.

10. The nurse is talking with a group of nursing students who are doing clinical hours on the unit. A student asks if all intramuscular (IM) drugs are absorbed the same. What factor

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would the floor nurse tell the students to affect absorption of the IM administration of drugs? A)

Perfusion of blood to the subcutaneous tissue

Integrity of the mucous membranes

Environmental temperature

Blood flow to the gastrointestinal tract

Ans:

C Feedback: A cold environmental temperature can cause blood vessels to vasoconstrict and decreases absorption or in a hot environment vasodilate and increase absorption of IM medications. Blood flow to the subcutaneous tissues interferes with subcutaneous injection and blood flow to the gastrointestinal (GI) tract causes alterations in absorption for oral medications. The condition of mucous membranes can interfere with sublingual (under the tongue) and buccal (in the cheek) administration of drugs.

11. The patient is taking a drug that affects the body by increasing cellular activity. Where does this drug work on the cell? A)

Receptor sites

Cell membrane

Golgi body

Endoplasmic reticulum

Ans:

A Feedback: Many drugs are thought to act at specific areas on cell membranes called receptor sites. After the receptor site is activated, this in turn activates the enzyme systems to produce certain effects, such as increased or decreased cellular activity, changes in cell membrane permeability, or alterations in cellular metabolism. Receptor sites are generally located on the outside of cells and allow the drug to bypass the cell membrane. The Golgi body and endoplasmic reticulum are not involved in this process.

12. Several processes enable a drug to reach a specific concentration in the body. Together they are called dynamic equilibrium. What are these processes? (Select all that apply.) A)

Distribution to the active site

Biotransformation

Absorption from the muscle

Excretion

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Interaction with other drugs

Ans:

A, B, D Feedback: The actual concentration that a drug reaches in the body results from a dynamic equilibrium involving several processes: Absorption from the site of entry (can be from the muscle, the gastrointestinal (GI) tract if taken orally, of the subcutaneous tissue if given by that route); Distribution to the active site; biotransformation (metabolism) in the liver; excretion from the body. Interaction with other drugs is not part of the dynamic equilibrium.

13. A nurse is administering digoxin to a patient. To administer medications so that the drug is as effective as possible, the nurse needs to consider what? A)

Pharmacotherapeutics

Pharmacokinetics

Pharmacoeconomics

Pharmacogenomics

Ans:

B Feedback: When administering a drug, the nurse needs to consider the phases of pharmacokinetics so that the drug regimen can be made as effective as possible. Pharmacogenomics is the area of study that includes mapping of the human genome. Pharmacotherapeutics is the branch of pharmacology that deals with the uses of drugs to treat, prevent, and diagnose disease. Pharmacoeconomics includes all costs involved in drug therapy.

14. The nurse is explaining how medications work to a group of peers and explains that disruption of a single step in any enzyme system disrupts what? A)

Cell life

Cell membrane

Cell receptor sites

Cell function

Ans:

D Feedback: If a single step in one of the many enzyme systems is blocked, normal cell function is disrupted. Cell life and cell membrane may be impacted by disruption of some enzymes but not all enzymes. Receptor sites would not be disrupted by disruption in a single step in the enzyme system.

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15. The processes involved in dynamic equilibrium are key elements in the nurses ability to determine what? A)

Dosage scheduling

Amount of solution for mixing parenteral drugs

Timing of other drugs the patient is taking

How long the patient has to take the drug

Ans:

A Feedback: These processes are key elements in determining the amount of drug (dose) and the frequency of dose repetition (scheduling) required to achieve the critical concentration for the desired length of time. The processes in dynamic equilibrium are not key elements in determining the amount of diluents for intramuscular (IM) drugs; they do not aid in the timing of the other drugs the patient is taking or how long the patient has to take the drug.

16. What factor influences drug absorption? A)

Kidney function

Route of administration

Liver function

Cardiovascular function

Ans:

B Feedback: Drug absorption is influenced by the route of administration. IV administration is the fastest method; drug absorption is slower when given orally. Kidney function impacts excretion, liver function impacts metabolism, and cardiovascular function impacts distribution.

17. What does the lipid solubility of the drug influence? A)

Absorption of the drug

Metabolism of the drug

Excretion of the drug

Distribution of the drug

Ans:

D Feedback:

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Factors that can affect distribution include the drugs lipid solubility and ionization and the perfusion of the reactive tissue. The lipid solubility of a drug does not influence absorption, metabolism, or excretion. 18. The nursing students are learning about the half-life of drugs. A student asks the instructor to explain half-life. What is the instructors best response? A)

Half-life of a drug is the time it takes for the amount of drug in the body to decrease to half of the peak level it previously achieved.

Half-life is the amount of time it takes for the drug to be metabolized by the body.

Half-life is the amount of time it takes for half of the drug to reach peak level in the body.

Half-life of a drug is the time it takes for the drug to reach half its potential peak level in the body.

Ans:

A Feedback: The half-life of a drug is the time it takes for the amount of drug in the body to decrease to half the peak level it previously achieved. Therefore Options B, C, and D are not correct.

19. The patient is taking a 2-mg dose of ropinerol XR. The drug has a half-life of 12 hours. How long will it be before only 0.25 mg of this drug remains in the patients system? A)

24 hours

36 hours

48 hours

60 hours

Ans:

B Feedback: The half-life of a drug is the time it takes for the amount of drug in the body to decrease to half of the peak level it previously achieved. At 12 hours there will be 1 mg of the drug available to the body. At 24 hours there will be 0.5 mg; at 36 hours there will be 0.25 mg; at 48 hours there will be 0.125 mg, and at 60 hours there will be 0.0625 mg.

20. The patient has a diagnosis of multiple sclerosis and is taking the drug interferon beta-1a (Rebif). The patient takes this drug by subcutaneous injection three times a week. The dosage is 44 mcg per injection. If the patient takes an injection on Monday, how much of the drug would still be in the patients system when she takes her next injection on Wednesday, assuming the half-life of the drug is 24 hours? A)

22 mcg

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16.5 mcg

11 mcg

5.5 mcg

Ans:

C Feedback: The half-life of a drug is the time it takes for the amount of drug in the body to decrease to 1 half the peak level it previously achieved. On Tuesday, there would be 22 mcg remaining in the body, so option A is incorrect. On Wednesday 11 mcg would remain, so option C is the correct answer. At 12 hours before taking the next dose on Wednesday, there would be 16.5 mcg remaining. If the injection were not taken on Wednesday, 12 hours after the dose was due, there would be 5.5 mcg remaining.

21. The patient is a 6-year-old child who is taking 125 mg of amoxicillin every 6 hours. Assuming that the half-life of Amoxicillin is 3 hours, how much Amoxicillin would be in the childs body at the time of the next administration of the drug? A)

62.5 mg

46.875 mg

31.25 mg

15.625 mg

Ans:

C Feedback: The half-life of a drug is the time it takes for the amount of drug in the body to decrease to 1 half the peak level it previously achieved. Option A would occur at 3 hours after the original dose of amoxicillin. Option B would occur 4 1/2 hours after the original dose. Option C would occur at 6 hours after the original dose. Option D would occur at 7 1/2 hours after the original dose.

22. A drug with a half-life of 4 hours is administered at a dosage of 100 mg. How much of the drug will be in the patients system 8 hours after administration? A)

75 mg

50 mg

37.5 mg

25 mg

Ans:

D Feedback:

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The half-life of a drug is the time it takes for the amount of drug in the body to decrease to 1 half the peak level it previously achieved. Option A would occur 2 hours after administration of the drug. Option B would occur at 4 hours. Option C would occur at 6 hours. Option D would occur at 8 hours after the original administration of the drug. 23. The nurse administers amoxicillin 500 mg. The half-life of this drug is approximately 1 hour. At what point would the drug level in the body be 62.5 mg if the drug was not administered again? A)

1 hours after the original dose

2 hours after the original dose

3 hours after the original dose

4 hours after the original dose

Ans:

C Feedback: The half-life of a drug is the time it takes for the amount of drug in the body to decrease to one-half of the peak level it previously achieved. At a dose of 500 mg the drug level would be 250 mg in 1 hour, 125 mg in 2 hours, 62.5 mg in 3 hours, and 31.25 mg in 4 hours so the correct answer is 3 hours.

24. The nurse is caring for a patient who is receiving gentamicin, 250 mg and fluconazole (Diflucan), 500 mg at the same time. The nurse knows that if these two drugs competed with each other for protein-binding sites, what would this do? A)

Make the patient gentamicin deficient

Make the patient fluconazole deficient

Counteract any positive benefit the drugs would have

Alter the effectiveness of both drugs

Ans:

D Feedback: Some drugs compete with each other for protein-binding sites, altering effectiveness or causing toxicity when the two drugs are given together. Nothing in the scenario would indicate that the patient would be either Gentamicin or Diflucan deficient, nor does it indicate that these drugs cannot be given together because they would counteract each other.

25. The student nurse asks the instructor why a patient with a central nervous system infection is receiving antibiotics that will not cross the bloodbrain barrier. What is the instructors most correct response? A)

A severe infection alters the bloodbrain barrier to allow the drug to cross.

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A medication that is water soluble is more likely to cross the blood-brain barrier.

Antibiotics are the exception to the bloodbrain barrier and cross easily.

An infection that spreads outside the central nervous system helps drugs cross the barrier.

Ans:

A Feedback: Effective antibiotic treatment can occur only when the infection is severe enough to alter the bloodbrain barrier and allow antibiotics to cross. Lipid-soluble, not water-soluble, medications cross the bloodbrain barrier more easily and most antibiotics are lipid soluble, so they are not the exception. No matter where the infection originates, drugs must cross the bloodbrain barrier to treat central nervous system infections.

26. The patient is taking low dose aspirin daily for his heart. The nurse knows only a portion of the medication taken actually reaches the tissue due to what process? A)

Distribution

First-pass effect

Reduced absorption

Gastrointestinal circulation

Ans:

B Feedback: Drugs that are taken orally are usually absorbed from the small intestine directly into the portal venous system and then delivers these absorbed molecules into the liver, which immediately break the drug into metabolites, some of which are active and cause effects in the body, and some of which are deactivated and can be readily excreted from the body. As a result, a large percentage of the oral dose is destroyed at this point and never reaches the tissues. This process is not caused by distribution, absorption, or gastrointestinal circulation.

27. What needs to happen to the proteindrug complex for the drugs to reach the cells where the drug can act? A)

The proteindrug complex must break itself into smaller pieces to enter the capillaries.

The binding site on the protein picks up a chemical to make it soluble in the serum.

The drug must break away from the protein-binding site and float freely.

The drug must be dissolved in the plasma so it can enter the capillaries and then the tissues.

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Ans:

C Feedback: Most drugs are bound, to some extent, to proteins in the blood to be carried into circulation. The proteindrug complex is relatively large and cannot enter into capillaries and then into tissues to react. The drug must be freed from the proteins binding site at the tissues. This occurs without the introduction of another chemical or by dissolving in it plasma.

28. The nurse is reviewing the results of the patients laboratory tests. What must the nurse keep in mind when reviewing these results related to medication administration? A)

The patients emotional response to the disease process

The timing of the last dose of medication relative to when blood was drawn

The possibility of a druglaboratory test interaction

A change in the bodys responses or actions related to the drug

Ans:

C Feedback: The body works through a series of chemical reactions. Because of this, administration of a particular drug may alter results of tests that are done on various chemical levels or reactions as part of a diagnostic study. This druglaboratory test interaction is caused by the drug being given and not necessarily by a change in the bodys responses or actions. The patients emotional response or timing of the last dose is not important in druglaboratory interactions.

29. A patient has come to the clinic and been diagnosed with Lyme disease. The physician has ordered oral tetracycline. What is important for the nurse to include in the teaching plan about tetracycline? (Select all that apply.) A)

Do not take the drug with anything high in sodium content to keep from producing a state of hypernatremia in the body.

Do not take the drug with foods or other drugs that contain calcium.

Do not take the drug at the same time you take an iron supplement or with foods that are high in iron content.

Avoid exposure to the sun when taking this drug as it can turn your skin purple.

Avoid eating bananas at the same time you take this drug as the potassium content of the tetracycline can produce hyperkalemia in the body.

Ans:

B, C Feedback:

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The antibiotic tetracycline is not absorbed from the gastrointestinal (GI) tract if calcium or calcium products (e.g., milk) are present in the stomach. It cannot be taken with iron products because a chemical reaction occurs preventing absorption. Although tetracycline can increase sun sensitivity, it does not turn the skin purple. Patients who take tetracycline do not need to avoid eating bananas or foods that are high in potassium. 30. A nurse is caring for a patient taking multiple drugs and is concerned about a possible drugdrug interaction. What is the nurses first and best means of avoiding this problem? A)

Consult a drug guide.

Call the pharmacist.

Contact the provider.

Ask another nurse.

Ans:

A Feedback: Whenever two or more drugs are being given together, first consult a drug guide for a listing of clinically significant drugdrug interactions. Sometimes problems can be avoided by staggering the administration of the drugs or adjusting their dosages. Consulting the pharmacist is not wrong, but it would not be the first action to take. The nurse holds responsibility for his or her own practice so asking a health care provider or another nurse is based on the assumption that that professional is knowledgeable about all drugdrug interactions, which is likely not the case.

31. The nurse promotes optimal drug effectiveness by doing what? (Select all that apply.) A)

Incorporate basic history and physical assessment factors into the plan of care.

Evaluate the effectiveness of drugs after they have been administered.

Modify the drug regimen to modify adverse or intolerable effects.

Minimize the number of medications administered to patients.

Examine factors known to influence specific drugs if they are to be effective.

Ans:

A, B, C, E Feedback: Incorporate basic history and physical assessment factors into any plan of care so that obvious problems can be identified and handled promptly. If a drug simply does not do what it is expected to do, further examine the factors that are known to influence drug effects. Frequently, the drug regimen can be modified to deal with that influence. Minimizing the number of medications administered is usually not an option because each drug is ordered for a reason of necessity for the patient.

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32. The nurse administers a specific medication to an older adult patient every 4 hours. The patient has a history of chronic renal failure. Why would this patient be at risk for toxic drug levels? A)

Cumulative effect

First-pass effect

Drug interactions

Cross-tolerance effect

Ans:

A Feedback: If a drug is taken in successive doses at intervals that are shorter than recommended, or if the body is unable to eliminate a drug properly, the drug can accumulate in the body, leading to toxic levels and adverse effects. This is a cumulative effect. First-pass effect addresses the reduction of available drug when taken orally due to metabolism in the liver before the drug reaches the bloodstream. Drug interactions occur when taken with other drugs, food, or complementary alternative therapies. Cross-tolerance is resistance to drugs within the same class.

33. The patient, diagnosed with cancer, is receiving morphine sulfate (a potent narcotic pain reliever) to relieve cancer pain. Approximately every 7 days the medication is no longer effective in controlling the patients pain and a larger dose is needed to have the same effect. How might the nurse explain why this is happening? A)

Tolerance

Cumulation

Interactions

Addiction

Ans:

A Feedback: The body may develop a tolerance to some drugs over time. Tolerance may arise because of increased biotransformation of the drug, increased resistance to its effects, or other pharmacokinetic factors. When tolerance occurs, the amount of the drug no longer causes the same reaction. Therefore, increasingly larger doses are needed to achieve a therapeutic effect. Cumulative effect occurs when the drug is not properly eliminated and more of the drug is administered, resulting in toxic levels accumulating. Interactions occur when the drug reacts badly with another substance such as food, another drug, or an alternative or complementary therapy. Addiction is the psychological need for a substance.

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34. While administering a medication that the nurse has researched and found to have limited effectiveness, the patient tells the nurse, I have read all about this drug and it is such a wonder drug. Im so lucky my doctor prescribed it because I just know it will treat my problem. The nurse suspects this drug will be more effective than usual for this patient because of what effect? A)

Cumulative effect

First-pass effect

Placebo effect

Cross-tolerance effect

Ans:

C Feedback: A drug is more likely to be effective if the patient thinks it will work than if the patient believes it will not work. This is called the placebo effect. If a drug is taken in successive doses at intervals that are shorter than recommended, or if the body is unable to eliminate a drug properly, the drug can accumulate in the body, leading to toxic levels and adverse effects. This is a cumulative effect. First-pass effect addresses the reduction of available drug when taken orally due to metabolism in the liver before the drug reaches the bloodstream. Cross-tolerance is resistance to drugs within the same class.

35. The nurse administers an intravenous medication with a half-life of 24 hours but recognizes what factors in this patient could extend the drugs half-life? (Select all that apply.) A)

Gastrointestinal disease

Kidney disease

Liver disease

Cardiovascular disease

Route of administration

Ans:

B, C, D Feedback: Kidney disease could slow excretion and extend the drugs half-life. Liver disease could slow metabolism resulting in an extended half-life. Cardiovascular disease could slow distribution resulting in a longer half-life. Gastrointestinal disease would not impact halflife because the medication was injected directly into the bloodstream. Route of administration would not extend half-life because IV injection eliminates the absorption step in the process.

Chapter 3: The Autonomic Nervous System

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1. A nurse is preparing a drug for administration to a patient. The drug does not have an indicated use for the patients medical diagnosis. What should the nurse do? A)

Administer the drug as ordered.

Question the prescriber concerning the ordered drug.

Ask a coworker his or her thoughts about the ordered drug for the patient.

Ask the patient why the drug has been prescribed for him or her.

Ans:

B Feedback: If the nurse is not sure about giving a drug, the order should be questioned. The nurse should never give a medication that is not clear. Mistakes do happen and the drug ordered, if not approved for the condition that the patient has, could be an error on someones part. The person who wrote the order should be questioned, not a co worker, who probably does not know why an off-label drug is being used. It would be unprofessional and inappropriate to ask the patient about the drug.

2. According to Center for Disease Control and Prevention (CDC) recommendations, what is the role of the nurse in preparing for the possibility of bioterrorism? A)

Post updated information on signs and symptoms of infections caused by biological agents

Provide guidelines for treating patients exposed to, or potentially exposed to, biological agents

Remain current on recognition and treatment of infections caused by biological weapons

Advocate for increased funding for research involving bioterrorism and patient treatment

Ans:

C Feedback: Nurses need to remain current about recognition of and treatment for those exposed to biological weapons because nurses are often called upon to answer questions, reassure the public, offer educational programs, and serve on emergency preparedness committees. The CDC posts updated information on signs and symptoms of infections caused by biological agents that nurses would read. The CDC also provides guidelines for how to treat patients exposed to biological agents and the nurse must remain current on this information. Although nurses could advocate for funding, this is not usually the role of the nurse.

3. How can the nurse find the most up-to-date information about emergency preparedness related to bioterrorism agents?

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Read textbooks devoted to the topic.

Ask coworkers to explain current events.

Read journal articles about bioterrorism agents.

Visit the Centers for Disease Control and Prevention (CDC) Web site.

Ans:

D Feedback: The most current information will be found on the CDC Web site because new information can be posted immediately whereas textbooks and journal articles take time to print. Coworkers may or may not remain current on emergency preparedness and should not be the primary source of information.

4. The nurse is assessing a diabetic patient who has presented at the clinic reporting several hypoglycemic episodes during the past 3 weeks. The nurse questions the patient about the use of herbal or alternative therapies, suspecting what herbal remedy could cause the hypoglycemic episodes? A)

St. Johns wort

Kava

Fish oil

Ginseng

Ans:

D Feedback: Ginseng is known to decrease blood sugar levels. If the patient used this in combination with his or her oral antidiabetic agent, diet, and exercise, his or her blood sugar could drop below therapeutic levels. St. Johns wort interacts with many drugs, but not with antidiabetic agents. Kava is associated with liver toxicity. Fish oil has been associated with decreased coronary artery disease.

5. A 22-year-old patient calls the clinic and tells the nurse that she has been depressed and is thinking about taking St. Johns wort but wants to know if it is safe first. The nurse begins by questioning what other medications the patient takes and would be concerned about a drug-alternative drug interaction if the patient is also taking what type of medication? A)

Antihistamines

Analgesics

Antibiotics

Oral contraceptives

Ans:

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Feedback: St. Johns wort can interact with oral contraceptives that alter drug metabolism, which can decrease the effectiveness of the contraceptive. Analgesics, antibiotics, and antihistamines can be taken in combination with St. Johns wort without known adverse effects. 6. A patient tells the clinic nurse that he or she has been taking over-the-counter (OTC) Pepcid to relieve acid indigestion for several years. This is the first time the patient has ever reported this issue to a health care provider. As part of the teaching plan for this patient, the nurse explains what risk associated with not sharing OTC drug use with the provider? A)

The OTC drug could be more expensive than seeking health care advice.

The drug could mask symptoms of a serious problem that is undiagnosed.

Use of the drug could cause a rebound effect of Pepcid.

The drug could interact with several cold medicines.

Ans:

D Feedback: OTC drugs allow patients to self-diagnose and treat routine signs and symptoms without seeing a health care provider. This self-prescribed treatment, however, could mask a more serious underlying medical problem and result in a poor outcome for the patient. The issues of drug rebound and drug interaction need to be considered, but the safety issue related to self-diagnosis and self-prescription presents the greatest risk to the patient. Patients should always be encouraged to discuss the use of OTC products with their health care provider.

7. What patient populations would the nurse expect is most likely to be prescribed a drug for an off-label use? A)

Adolescent and middle-aged adult patients

Patients with diabetes or heart disease

Obstetric and neonatal patients

Pediatric and geriatric patients

Ans:

D Feedback: Drugs being used for an off-label purpose are commonly prescribed for pediatric and geriatric populations due to the lack of drug trial information and minimal premarket testing. Often a trial-and-error method is used in treating both the pediatric and geriatric populations when only adult information is known. The geriatric population responds to medication more like children because of their decreased ability to metabolize

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medications. Adolescents, especially later adolescents, use medications similarly to young adults as do middle-aged adults. Patients with different diagnoses are often involved in drug testing including those with diabetes and heart disease. Drugs are discouraged for use in obstetric patients. 8. A patient calls the clinic and asks to speak to a nurse. The patient questions the nurse about the use of a drug that was advertised on TV. The patient tells the nurse he or she is sure that the drug will make him or her feel the same way as described in the commercial. What response is most appropriate for the nurse to make? A)

Im glad that you want to be involved in treatment decisions but you are not qualified to decide what medications are best for your condition.

Its important to remember that drug advertisements emphasize the positive effects of drug therapy and not the adverse effects or contraindications.

You need to remember that the drugs being advertised are much more expensive than other drugs that have the same effect.

Ive seen those advertisements and I would want to take that medication too if I had the condition it was designed to treat.

Ans:

B Feedback: It would be important for the nurse to remind the patient that advertisements always emphasize the positive effects of drug therapy. The patient should not be discouraged from contributing to the plan of care by being told she is not adequately qualified to make decisions because no one is more qualified to make decisions about her own body. Although the drug may be more expensive, this is not a reason to choose or avoid a medication that could be more effective. Agreeing with the patient is not meeting the nurses obligation to teach and inform.

9. The clinic nurse is talking with a patient about information concerning a drug her or she bought online. What is the nurses responsibility to the patient concerning this information? A)

Encourage the patient to seek information about drugs from a pharmacist.

Explain that information obtained from the Internet is not always accurate.

Offer the patient a drug reference guide to read and learn more about the drug.

Interpret the information and explain it in terms that the patient will understand.

Ans:

D Feedback: The Internet can be a good reference for drug information. However, the amount and reliability of the information can be overwhelming. The nurse should always try to

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interpret the information and explain it in terms that the patient will understand. A pharmacist is a good resource person but may not be able to teach from a holistic perspective. Drug reference guides may be hard for the patient to understand and he or she would still need someone to interpret the information. 10. The triage nurse in the emergency department sees a patient suspected of abusing amphetamines brought in by friends. While assessing this patient, what would the nurse be likely to find if steroids are being abused? A)

Hypertension

Bradycardia

Drowsiness

Elated mood

Ans:

A Feedback: Increases in blood pressure, tachycardia, and insomnia are symptoms of amphetamine abuse. Elation can indicate abuse of cannabis.

11. The nursing instructor is discussing the off-label use of drugs. What group of drugs would the instructor tell the nursing students is often used for off-label indications? A)

Drugs used to treat psychiatric problems

Drugs used to treat gastrointestinal (GI) problems

Drugs used to treat cardiovascular problems

Drugs used to treat musculoskeletal problems

Ans:

A Feedback: Drugs often used for off-label indications include the drugs used to treat various psychiatric problems. Drugs used to treat GI, cardiovascular, or musculoskeletal problems do not fall in the category of frequent off-label uses.

12. The patient calls the clinic nurse and says, I looked this medication up on the Internet after it was prescribed yesterday and there is nothing in the literature about this drug being used to treat my disorder. Should I still take it? What is the nurses best response? A)

No, stop taking it immediately until I can consult with the doctor because it is obvious a mistake was made.

Oh, thats okay. Go ahead and take it because the doctor wouldnt order it if he or she didnt think it would be effective.

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It is quite common for drugs to be found to have positive effects for a condition not originally intended so it is safe to take.

Let me talk with the physician about why this medication was ordered for you and I will call you back.

Ans:

D Feedback: Off-label use is relatively common because new information is gathered when the drug is used by large numbers of people that may indicate another condition for which the drug is effective. However, if the nurse does not know for a fact that the drug prescribed is the right drug for the patients condition, it is always best to consult with the prescriber to make sure the patient is taking the right drug and to avoid a medication error. The medication may be perfectly safe so the patient should not be told the doctor made a mistake.

13. When a drug is ordered off-label, what must the nurse be clear about before administering the drug? (Select all that apply.) A)

Why the drug is being given

Its potential for problems

The research that has been done

The age group it was pretested on

The intended use

Ans:

A, B, E Feedback: Liability issues surrounding many of these uses are very unclear, and the nurse should be clear about the intended use, why the drug is being given, and its potential for problems. Knowing the age group it was pretested on and knowing the research that has been done are not factors the nurse needs to know before administering the drug.

14. It is important for the nurse to be aware of what related to the way drugs are marketed? A)

The adverse effects the advertisements do not mention

What magazines and Web sites contain the advertisement

What patients are seeing in the advertisements about these drugs

The name of the cheerful, happy models who are advertising these drugs

Ans:

C Feedback:

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As the marketing power for prescription drugs continues to grow, the nurse must be constantly aware of what patients are seeing, what the ads are claiming, and the real data behind the indications and contraindications for these hot drugs. The Food and Drug Administration regulates the information that needs to be contained within medication ads. Where the patient saw the ad and the actors in the ads are unimportant. 15. When evaluating information accessed over the Internet, an important question the nurse should teach the patient to ask is what? A)

Is the information anecdotal?

Where has this information been obtained?

Is this information paid for by the drug company?

How many patients have had input into the information?

Ans:

A Feedback: Many people do not know how to evaluate the drug-related information that they can access over the Internet. Is it accurate or anecdotal is an important concept for the nurse to teach the patient to assess to verify the accuracy of the information. Where the information came from is unimportant. It would be expected that all drug advertising is paid for by the drug company and this is not an important concern. Number of patients with input into the information is most likely none because information is gathered from health care professionals.

16. How has the patients access to drug information changed the way the patient interacts with the nurse and other health care providers? A)

Patients share information from research reports with health care providers.

Patients are contacting drug companies to see what their latest reports say.

Patients are more likely to challenge the health care provider with their own research.

Patients are more likely to self-prescribe and not obtain prescriptions from their health care provider.

Ans:

C Feedback: Access to consumer advertising, mass media health reports, and the Internet influence some patients to request specific treatments, to question therapy, and to challenge the health care provider. Consumers do not generally read research reports from medical facilities and contact drug companies to see what their reports say, and they cannot selfmedicate because many of these drugs require a prescription to obtain them.

17. What can make a nurse or any health care provider lose credibility with the patient?

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Being unprepared to deal with the disease of the week

Refusing to write prescriptions for the drug the patient requests

Not being knowledgeable about diseases described on House

Being prepared to discuss the role of concierge doctor

Ans:

A Feedback: Some health care providers have learned to deal with the disease of the week as seen on talk shows; others can be unprepared to deal with what was presented and may lose credibility with the patient.

18. Today, an abundance of information is available in the health care arena for consumers, resulting in the nurse encountering patients who have a much greater use of what? A)

Over-the-counter (OTC) therapies

Alternative therapies

Prescription drugs

Off-label drugs

Ans:

B Feedback: The patient now comes into the health care system burdened with the influence of advertising, the Internet, and a growing alternative therapy industry. Many patients no longer calmly accept whatever medication is selected for them. Indeed, an increasing number of patients are turning to alternative therapies with the belief that they will treat their disorder and reduce risk of adverse effects. Although more prescription drugs are used today, that is not related to abundant information. No indication exists of an increase in use of OTC or off-label drugs.

19. Because of the amount of care now being done in the home care setting, it is imperative that the nurse teach the patients what? (Select all that apply.) A)

Care givers educational level.

Generic names of medication

Over-the-counter (OTC) drugs that need to be avoided

Alleviation of adverse effects

How to calculate safe dosages

Ans:

B, C, D

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Feedback: The responsibility of meeting the tremendous increase in teaching needs of patients frequently resides with the nurse. Patients need to know exactly what medications they are taking (generic and brand names), the dose of each medication, and what each is supposed to do. Patients also need to know what they can do to alleviate some of the adverse effects that are expected with each drug (e.g., small meals if gastrointestinal upset is common, use of a humidifier if secretions will be dried and make breathing difficult), which OTC drugs or alternative therapies they need to avoid while taking their prescribed drugs, and what to watch for that would indicate a need to call the health care provider. 20. What concerns might the nurse legitimately have related to the use of alternative therapies? (Select all that apply.) A)

The Food and Drug Administration (FDA) does not test or regulate active ingredients.

The incidental ingredients are clearly marked on the label.

The dosage contained in each tablet may vary greatly.

No alternative therapies have been found to be effective.

Advertising of alternative products is not as restrictive or accurate.

Ans:

A, C, E Feedback: Alternative products are not controlled or tested by the FDA and advertising is not as restrictive or accurate as with classic drugs. Incidental ingredients are often unknown and strength of tablets may vary within the bottle depending on the conditions under which they were grown. While some alternative therapies have been found to be effective, there are others who have not been studied.

21. The nurse provides teaching to the patient using herbal therapies and includes what important information related to the effects of the herbal therapy? A)

They can interact with prescription drugs.

They always contain known ingredients.

They are natural so they are effective and safe.

The ingredients are natural, meaning toxicity is not a concern.

Ans:

A Feedback: Herbal therapies can produce unexpected adverse effects and toxic reactions, can interact with prescription drugs, and can contain various unknown ingredients that alter the therapies effectiveness and toxicity.

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22. When patients do not understand the information provided with their medication, whose responsibility is it to help them sort through and comprehend the meaning? A)

Care giver

Nurse

Patient

Physician

Ans:

B Feedback: Many pharmacies provide written information with each drug that is dispensed, but trying to organize these sheets of information into a usable and understandable form is difficult for many patients. The nurse is often the one who needs to sort through the provided information to organize, simplify, and make sense of it for the patient.

23. The nurse is providing an inservice on alternative therapies for peers and explains that the term alternative therapies includes what? A)

Holistic drug therapy

Hospice care

Nondrug measures

Home care

Ans:

C Feedback: Herbal medicines and alternative therapies are found in ancient records and have often been the basis for discovery of an active ingredient that is later developed into a regulated medication. Today, alternative therapies can also include non-drug measures, such as imaging and relaxation. Options A, B, and D are not included in alternative therapies.

24. The patient calls the clinic and talks to the nurse saying, I found the same drug the provider prescribed on the Internet and it is much cheaper. Is it safe for me to order my drug from this site? What is the nurses best response? A)

It is usually safe to order drugs from Internet Web sites if it is a reliable site.

Most drugs ordered online come from another country and are safely used there.

The drug you get will be the same chemical prescribed but the dosage may differ.

The Food and Drug Administration (FDA) has issued warnings to consumers about the risk of taking unregulated drugs.

Ans:

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Feedback: The FDA has begun checking these drugs when they arrive in this country and have found many discrepancies between what was ordered and what is in the product, as well as problems in the storage of these products. Some foreign brand names are the same as brand names in this country but are associated with different generic drugs. The FDA has issued many warnings to consumers about the risk of taking some of these drugs without medical supervision, reminding consumers that they are not protected by U.S. laws or regulations when they purchase drugs from other countries. 25. With the need to protect our environment, what is it now important for the nurse to teach patients to do? A)

Dispose of drugs no longer used on an annual basis.

Flush drugs down the toilet.

Bury unused in the yard.

Throw unused pill bottles in the trash in original containers.

Ans:

A Feedback: Patients should go through their medicine cabinet annually and dispose of drugs no longer used. Unused drugs should not be flushed down the toilet or buried in the yard because they seep into the community water supply. Pills should be removed from their bottle and mixed with an undesirable substance to prevent someone from using the medication if found.

26. The nurse receives a call from a frantic mother saying, My child swallowed some of my birth control pills. Should I give Ipecac? What is the nurses best response? A)

Yes, give Ipecac and follow the dosage directions on the bottle.

Ipecac is not effective for this use so you should not give it to your child.

Give the Ipecac only if you are absolutely sure your child swallowed the pills.

No, dont give Ipecac because it will cause your child to vomit and make a mess.

Ans:

B Feedback: Ipecac is a drug that the Food and Drug Administration tested in 2003 and found, despite its use for many years, that it was not effective in inducing vomiting in children suspected of poisoning. As a result, it is no longer used. The mother should be instructed not to give it and to call poison control to get up-to-date instructions on how to deal with this emergency. Whether the pills were swallowed, this child requires appropriate intervention because it is better to err on the side of caution. Making a mess is not a concern.

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27. The patient tells the nurse that he or she has begun ordering his or her medications over the Internet because it is cheaper. What statement made by the nurse in response to this information is accurate? A)

All drugs are manufactured with the same quality controls.

Any drug that is shipped into this country is safe to use.

Foreign drugs may have the same name as domestic drugs, but they are not the same drug.

If you order from Canada or Mexico, the drugs are safe because they undergo testing.

Ans:

C Feedback: The Food and Drug Administration has begun checking these drugs when they arrive in this country and have found many discrepancies between what was ordered and what is in the product, as well as problems in the storage of these products. Some foreign brand names are the same as brand names in this country but are associated with different generic drugs. Options A, B, and D are incorrect because not all drugs are manufactured the same and they are not always safe coming from another country.

28. The increasing number of patients who go to their health care provider and request a drug they have seen advertised on television or in a magazine has created what continuing challenge to health care providers? A)

Treating infections appropriately

Treating sicker patients

Prescribing cost-effectively

Staying knowledgeable about drug therapy

Ans:

D Feedback: As the marketing power for prescription drugs continues to grow, the health care provider must be constantly aware of what patients are seeing (or reading), what the commercials and ads are promising, and the real data behind the indications and contraindications for these hot drugs. It is a continuing challenge to stay up-to-date and knowledgeable about drug therapy.

29. Ipecac, formerly used as the drug of choice by parents for treatment of suspected poisoning in children, was tested by the Food and Drug Administration (FDA) in 2003. What was the finding of this testing? A)

Ipecac is ineffective for its intended use.

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Ipecac is the safest treatment for poisoning in children.

Ipecac was grandfathered in as an ineffective drug.

Ipecac induces vomiting.

Ans:

A Feedback: Ipecac, a formerly standard over-the-counter drug, was used for many years by parents to induce vomiting in children in cases of suspected poisoning or suspected drug overdose. The drug was finally tested and in 2003, the FDA announced that it was not found to be effective for its intended use. Although it was grandfathered in as an effective drug, this was not what the study researched. Ipecac is not effective and does not consistently induce vomiting.

30. Federal guidelines state that when advertising a drug, if the company states what the drug is used for, what other information must also be included in the advertisement? (Select all that apply.) A)

Symptoms

Contraindications

Adverse effects

Precautions

Cost

Ans:

B, C, D Feedback: If a drug advertisement states what the drug is used for, it must also state contraindications, adverse effects, and precautions. The advertisement does not have to state symptoms or cost.

31. The parent of a 2-year-old child is visiting his or her pediatric health care provider and shows the nurse the advertisement for allergy medication found in a magazine in the waiting room saying, This drug sounds like it would be far more effective to treat my sons asthma and Id only have to give it once a day. What is the nurses best response? A)

Talk with your health care provider about this drug, but be aware that advertisements do not always provide all the important information you need to know.

Oh, I need to throw that magazine away because so many people show me that ad and it is all complete nonsense with no truth to it at all.

Ive been seeing amazingly positive results from that medication so you are absolutely right to want to give it to your child.

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That drug is dangerous and should not be given to children under the age of 5 unless there are no other good options.

Ans:

A Feedback: The health care provider should make the decision about what medications are to be prescribed, not the nurse. However, the nurse can make the mother aware of the fact that there is often more that goes into choosing the correct drug than the bit of information disclosed in the advertisement. Becoming upset with the mother, agreeing with the mother, or frightening the mother about the medication is the wrong approach for the nurse to use.

32. The local news has been discussing a specific rare disorder that killed a child in the community this week, describing the symptoms of the disease as including nasal congestion, ear pain, and a cough. The pediatricians office is receiving numerous calls asking to make appointments to rule out this rare disease. What is the nurses best action? A)

Prepare a handout that describes the disorder discussed in the news in greater detail.

Tell parents their child is experiencing the common cold and do not need to be seen.

Direct all calls to the local news agency to answer questions and provide details.

Become familiar with the disorder and screen each call for more specific symptoms.

Ans:

A Feedback: The nurse needs to not only become more familiar with the disorder in the news, but also needs to be prepared to teach parents about the disease of the week to allay fears so a handout with detailed information would allow the parents to have something to consult after leaving the providers office. Turning parents away without seeing their child will increase fears and the office will lose credibility for lack of interest in their childs wellbeing. Directing calls to the news agencies will not provide parents with essential information. Screening calls without seeing the child could be potentially very dangerous.

33. The nurse is teaching the patient how to safely use the Internet for health information and includes what information in the teaching plan? A)

The Web site where information is obtained needs to be evaluated for credibility.

Most information found on the Internet is accurate.

Information on the Internet is most reliable when people give their reviews of the drug.

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Only a health care professional can tell whether a Web site is reliable.

Ans:

A Feedback: There are excellent sites for reliable drug information, but each site must be evaluated for credibility and the nurse can teach the patient things to look for to increase confidence in the site. However, a lot of information on the Internet is not accurate; the patient needs to learn how to recognize unreliable information when he or she comes across these sites. Just because a person reviews a drug and gives it multiple stars or a thumbs up does not mean the drug is any more effective or useful in the patients care.

34. The nursing instructor is teaching the class about how prescription drugs become overthe-counter (OTC) drugs and lists what factor as preventing a drug from becoming classified as OTC? A)

If the patient cannot reliably self-diagnose the condition the drug is intended to treat

If it would mask signs and symptoms of an underlying problem, the drug remains available by prescription only.

If the drug would cause toxic effects if not taken as directed, it remains a prescription drug.

OTC drugs must not have any adverse effects that could harm the patient.

Ans:

A Feedback: If a diagnosis requires medical intervention, such as hyperlipidemia, which can only be diagnosed through laboratory studies, there is no point in making the drug an OTC medication. Most, if not all, OTC drugs have the capacity to mask signs and symptoms of an underlying disease so this is not a factor in deciding if a drug can be sold OTC. All drugs have the potential for toxic effects if not taken as directed and virtually all drugs have the potential for adverse effects.

35. The nurse needs to ask what specific questions when collecting a drug history? (Select all that apply.) A)

Do you take any over-the-counter medications?

Do you take any herbal supplements?

Do you use any alternative therapies?

Do you take any natural supplements or vitamins?

What unusual therapies do you take?

Ans:

A, B, D

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Feedback: The nurse needs to specifically question the patients use of over-the-counter drugs, herbal supplements, natural supplements, and vitamins. Use of terms like alternative therapies or unusual therapies is too vague and may not elicit the kind of information needed. Chapter 4: Cholinergic Agonists MULTIPLE CHOICE 1. The nurse is preparing to administer a drug and learns that it is an indirect-acting cholinergic agonist. The nurse understands that this drug a. acts on muscarinic receptors. b. acts on nicotinic receptors. c. inhibits cholinesterase. d. inhibits cholinergic receptors. ANS: C Agents that inhibit cholinesterase, which is the enzyme that destroys acetylcholine, indirectly enhance the actions of acetylcholine. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: dm 270 TOP: NURSING PROCESS: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 2. A nursing student asks why a direct-acting cholinergic agonist drug that is selective to muscarinic receptors is described as being non-specific. The nurse will explain that this is because a. muscarinic receptors are present in many different tissues. b. the action of cholinesterase alters the bioavailability at different sites. c. these drugs can also affect nicotinic receptors. d. they vary in their reversible and irreversible effects. ANS: A Although drugs classified as direct-acting cholinergic agonists are primarily selective for muscarinic receptors, they are non-specific because muscarinic receptors are located in different sites, causing actions in various organs. They are not affected differently by cholinesterase activity and have negligible actions on nicotinic receptors. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: Pages 269-270 TOP: NURSING PROCESS: N/A MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 3. The nurse is preparing to administer bethanechol (Urecholine) to a patient who is experiencing urinary retention. The nurse notes that the patient has a blood pressure of 90/60 mm Hg and a heart rate of 98 beats per minute. The nurse will perform which action? a. Administer the drug and monitor urine output. b. Administer the medication and monitor vital signs frequently. c. Give the medication and notify the provider of the increased heart rate. d. Hold the medication and notify the provider of the decreased blood pressure.

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ANS: D Side effects of this medication are a decrease in the pulse rate and vasodilation, which can exacerbate bradycardia and hypotension. The nurse should hold the drug and notify the provider. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 271 TOP: NURSING PROCESS: Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 4. The nurse administers bethanechol (Urecholine) to a patient to treat urinary retention. After 30 minutes, the patient voids 800 mL of urine and reports having a loose stool but no cramping or gastrointestinal pain. The patients blood pressure is 110/70 mm Hg. The nurse will perform which action? a. Notify the provider of bethanechol adverse effects. b. Record the urine output and the blood pressure and continue to monitor. c. Request an order for intravenous atropine sulfate. d. Suggest another dose of bethanechol to the provider. ANS: B The patient is exhibiting desired effects and mild side effects of bethanechol, so the nurse should record information and continue to monitor the patient. There is no need to notify the provider, give an antidote, or repeat the dose. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 271 TOP: NURSING PROCESS: Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 5. The nurse is teaching a patient who will begin taking bethanechol (Urecholine). Which statement by the patient indicates a need for further teaching? a. Excessive sweating is a normal reaction to this medication. b. Excess salivation is a serious side effect. c. I should get out of bed slowly while taking this drug. d. I will not take the drug if my heart rate is less than 60 beats per minute. ANS: A Patients taking bethanechol should be instructed to report increased salivation and diaphoresis since they can be early signs of overdosing. They should also be taught to rise slowly to avoid orthostatic hypotension and to hold the drug if their heart rate is low. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 271 TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 6. The nurse is caring for a male patient with myasthenia gravis who will begin taking ambenonium chloride (Mytelase). When performing a health history, the nurse will be concerned about a history of which condition in this patient? a. Benign prostatic hypertrophy b. Chronic constipation c. Erectile dysfunction d. Upper respiratory infection ANS: A

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This drug is a reversible cholinesterase inhibitor and is given to increase muscle strength. Cholinesterase inhibitors are contraindicated in patients with urinary tract obstruction. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 271 TOP: NURSING PROCESS: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 7. The nurse is preparing to administer the anticholinergic medication benztropine (Cogentin) to a patient who has Parkinsons disease. The nurse understands that this drug is used primarily for which purpose? a. To decrease drooling and excessive salivation b. To improve mobility and muscle strength c. To prevent urinary retention d. To suppress tremors and muscle rigidity ANS: D Antiparkinson-anticholinergic drugs are used mainly to reduce tremors and muscle rigidity. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: dm 275 TOP: NURSING PROCESS: Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 8. The nurse is caring for a postoperative patient and notes that the patient received atropine sulfate preoperatively. Which assessment finding would prompt the nurse to notify the provider? a. Absent bowel sounds b. Drowsiness c. Dry mouth d. Heart rate of 78 beats per minute ANS: A These are all side effects of atropine. Absent bowel sounds can indicate a paralytic ileus. The other side effects are not harmful. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 276 TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 9. A patient who has irritable bowel syndrome would most likely receive which type of drug to treat this condition? a. An anticholinergic b. A cholinergic esterase inhibitor c. A muscarinic agent d. A nicotinic agent ANS: A Anticholinergic drugs are used to treat peptic ulcers and intestinal spasticity because of their actions to decrease gastric secretions and gastrointestinal spasms. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: dm 278 TOP: NURSING PROCESS: Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

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10. The nurse is teaching a patient about the use of an anticholinergic medication. What information will the nurse include when teaching this patient about this medication? a. Check your heart rate frequently to monitor for bradycardia. b. Drink extra fluids while you are taking this medication. c. Rise from a chair slowly to avoid dizziness when taking this drug. d. Use gum or lozenges to decrease dry mouth caused by this drug. ANS: D Anticholinergic medications cause dry mouth, so patients should be advised to use gum or lozenges to counter this side effect. Anticholinergics cause increased heart rate and increased blood pressure. Anticholinergics can cause urinary retention so patients should not increase fluid intake. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 277 TOP: NURSING PROCESS: Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 11. Which cholinesterase inhibitor would be prescribed for a patient who has Alzheimers disease? a. Ambenonium chloride (Myletase) b. Benztropine (Cogentin) c. Donepezil HCl (Aricept) d. Neostigmine methylsulfate (Prostigmin) ANS: C Donepezil is used to treat Alzheimers disease. Ambenonium and neostigmine are used to treat myasthenia gravis. Benztropine is used to treat Parkinsons disease. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: dm 272 TOP: NURSING PROCESS: Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 12. The nurse is teaching a patient who is going on a cruise about the use of transdermal scopolamine . What information will the nurse include when teaching this patient? a. Apply the patch as needed for nausea and vomiting. b. Apply the patch to your upper arm. c. Change the patch every 3 days. d. Restrict fluids while using this patch. ANS: C The transdermal scopolamine patch is designed to last for 72 hours. The patient should be taught to change it every 3 days. It works best when worn at all times and not just for symptomatic relief. The patch should be applied behind the ear. Patients should not restrict fluids. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 279 TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 13. The nurse is preparing to administer benztropine (Cogentin) to a patient who has Parkinsons disease. When performing an assessment, which aspect of the patients history would cause the nurse to hold the medication and notify the provider? a. Asthma

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b. Glaucoma c. Irritable bowel syndrome d. Motion sickness ANS: B Patients who have glaucoma should not take anticholinergic medications. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 279 TOP: NURSING PROCESS: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 14. The nurse is caring for a patient in the post-anesthesia recovery unit. The nurse notes that the patient received atropine sulfate 2 mg 30 minutes prior to anesthesia induction. The patient has received 1,000 mL of intravenous fluids and has 700 mL of urine in the urinary catheter bag. The patient reports having a dry mouth. The nurse notes a heart rate of 82 beats per minute. What action will the nurse perform? a. Administer a fluid bolus. b. Give the patient ice chips. c. Palpate the patients bladder. d. Reassess the patient in 15 minutes. ANS: C Atropine can cause urinary retention. The patients urine output is less than the fluid intake, so the nurse should palpate the bladder to assess for distension. Dry mouth is an expected side effect and does not indicate dehydration. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 274 TOP: NURSING PROCESS: Assessment/Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 15. A patient who has Parkinsons disease will begin treatment with benztropine (Cogentin). Which symptom of Parkinsons disease would be a contraindication for this drug? a. Drooling b. Muscle rigidity c. Muscle weakness d. Tardive dyskinesia ANS: D Tardive dyskinesia is a contraindication for this drug. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: dm 276 TOP: NURSING PROCESS: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 16. A patient who is intubated develops bradycardia because of vagal stimulation. Which medication will the nurse anticipate administering to treat this symptom? a. Atropine sulfate (Atropine) b. Benztropine (Cogentin) c. Bethanechol chloride (Urecholine) d. Metoclopramide (Reglan) ANS: A Atropine is used to treat bradycardia caused by vagal stimulation.

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DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: dm 274 TOP: NURSING PROCESS: Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 17. The nurse is preparing to administer tolterodine tartrate (Detrol LA) to a patient who has incontinence. Which symptom would be a contraindication for this drug? a. Decreased bowel sounds b. Drooling c. Gastric upset d. Pain ANS: A A decrease in bowel sounds could signal the beginning of paralytic ileus. Detrol is contraindicated in patients with paralytic ileus. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 276 TOP: NURSING PROCESS: Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies MULTIPLE RESPONSE 1. Cholinergic drugs have specific effects on the body. What are the actions of cholinergic medications? (Select all that apply.) a. Dilate pupils b. Decrease heart rate c. Stimulate gastric muscle d. Dilate blood vessels e. Dilate bronchioles f. Increase salivation g. Constrict pupils ANS: B, C, D, F, G Decreasing heart rate, stimulating gastric muscles, dilating blood vessels, increasing salivation, and constricting pupils are actions of the cholinergic drugs. Chapter 5: Cholinergic Antagonists 1. A student asks the pharmacology instructor to explain the action of anticholinergic agents. What would be the instructors best response? A)

They block nicotinic receptors.

They compete with serotonin for muscarinic acetylcholine receptor sites.

They act to block the effects of the parasympathetic nervous system.

They increase norepinephrine at the neuromuscular junction.

Ans:

C Feedback:

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Drugs that are used to block the effects of acetylcholine are called anticholinergic drugs. Because this action lyses, or blocks, the effects of the parasympathetic nervous system, they are also called parasympatholytic agents. The drug works by blocking only the muscarinic effectors in the parasympathetic nervous system. They compete with acetylcholine for the muscarinic acetylcholine receptor sites. They do not block the nicotinic receptors and have little or no effect at the neuromuscular junction. 2. A patient calls the clinic and talks to the nurse. The patient tells the nurse he or she is going on a cruise and is concerned about motion sickness. The patient says that a friend has recommended that he or she see his or her primary care physician to get a prescription for scopolamine. What adverse effect would the nurse inform the patient that using scopolamine may result in? A)

Pupil constriction

Tachycardia

Diarrhea

Urinary incontinence

Ans:

B Feedback: Scopolamine blocks the parasympathetic nervous system, which may result in dilated pupils and increased heart rate (i.e., tachycardia). Blocking the parasympathetic system also results in decreased GI activity and urinary bladder tone causing constipation and urinary retention.

3. A 29-year-old man is going on a company-sponsored deep-sea fishing trip in 2 weeks. He comes to the clinic requesting a scopolamine patch because he is afraid that he will get seasick. The medication is prescribed for him and the nurses instructions concerning use of the patch will include what? A)

Shave the area before applying the patch.

The patchs effectiveness will last about 72 hours.

When replacing the patch, apply the new patch in the same area.

Do not clean the application area before applying the patch.

Ans:

B Feedback: The scopolamine patch is replaced every 3 days (i.e., 72 hours). The scopolamine patch should be applied to a clean, dry, intact, and hairless area of the body. The area should not be shaved because abrasion of the skin could occur and lead to increased absorption. Patches should be placed at new sites each time to avoid skin irritation. The old patch should be removed and the area cleaned.

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4. The nurse is taking a health history on a new patient who has been prescribed propantheline(generic) as adjunctive therapy for peptic ulcers. While collecting the health history, what will the nurse specifically assess for? A)

Diabetes mellitus

Obsessive-compulsive disorder

Insomnia

Glaucoma

Ans:

D Feedback: Propantheline is contraindicated for a patient with glaucoma because the drug could result in increased intraocular pressure due to pupil dilation. Diabetes mellitus, obsessivecompulsive disorder, and insomnia are not recognized as being adversely affected by this drug.

5. A nurse is admitting a patient for outpatient eye surgery. The nurse routinely administers preoperative medications for eye surgery and is aware that an increased dosage of a mydriatic is likely when given to a member of what ethnic group? A)

African Americans

German Americans

Irish Americans

Scandinavian Americans

Ans:

A Feedback: African Americans with dark eyes usually require an increased dosage and may have a prolonged time to peak effect. The need for an increased dose appears to be related to the amount of pigment in the persons eyes because people with darker-pigmented eyes require a higher dose. German, Irish, and Scandinavian Americans generally have less pigmentation in their eyes and are therefore less likely to need a greater dose.

6. A patient has been newly diagnosed with irritable bowel syndrome (IBS). The nurse knows that the most likely choice of anticholinergic drug to be prescribed for this patient is what? A)

Atropine (generic)

Dicyclomine (generic)

Glycopyrrolate (Robinul)

Methscopolamine (Pamine)

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Ans:

B Feedback: Dicyclomine is the most likely choice of anticholinergic drug for IBS. It relaxes the GI tract and is a frequent choice in the treatment of hyperactive bowel and IBS. Atropine is used to decrease secretions, for bradycardia, pylorospasm, ureteral colic, relaxing the bladder, pupil dilation, and as an antidote for cholinergic drugs. Glycopyrrolate is used to decrease secretions and as an antidote for neuromuscular blockers. Methscopolamine is used as adjunctive therapy for ulcers.

7. A patient has come to the clinic for a follow-up visit. He or she has been taking glycopyrrolate (Robinul) for adjunctive management of his or her peptic ulcer disease for 1 year. What would the nurse question this patient about? A)

Diarrhea

Oral discomfort

Headaches

Dyspnea

Ans:

B Feedback: Patients taking anticholinergic drugs will have dry mucous membranes. Oral hygiene will be extremely important during glycopyrrolate therapy to avoid gum disease. The nurse should encourage the patient to suck on sugarless lozenges and perform frequent oral care. Diarrhea, headaches, or dyspnea should not be a concern with this drug.

8. A 73-year-old male with Parkinsons disease comes to the clinic for routine care. The man has a comorbidity of benign prostatic hyperplasia (BPH). An anticholinergic drug is prescribed for the patient. What is the priority teaching point the nurse must give to the patient in regard to his medication? A)

Avoid excessively hot environments.

Avoid driving his car while taking the drug.

Call his doctor if he cannot urinate.

Take the drug with food to avoid gastrointestinal (GI) upset.

Ans:

C Feedback: Due to the patients diagnosis and drug therapy, calling the doctor if he cannot urinate would be the most important instruction. Older men with BPH have difficulty urinating and if an anticholinergic drug is taken, this can lead to urinary retention and bladder sphincter spasm. The patient should be encouraged to empty his bladder before taking the

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drug. Because this is an anticholinergic drug, avoiding hot environmental temperatures (reduced ability to perspire) and driving or operating machinery (possible central nervous system effects) should also be encouraged as well as taking the medication with food to help with GI upsets. However, the highest priority is addressing urinary retention issues. 9. A patient has been given atropine to cause mydriasis and cycloplegia. What is the expected outcome for this patient? A)

Constricted pupils and blurred vision

Dilated pupils and improved vision

Dilated pupils and blurred vision

Dry eyes and constricted pupils

Ans:

C Feedback: Atropine can be used to cause dilated pupils, which is mydriasis resulting in cycloplegia, which is the inability of the lens of the eye to accommodate leading to blurred vision.

10. Because the effects of atropine are dose related, at what dose of atropine would the nurse expect to see a patient having difficulty speaking? A)

0.5 mg

1.0 mg

2.0 mg

5.0 mg

Ans:

D Feedback: Toxicity of atropine is dose related. With 5.0-mg dosage, the nurse would expect marked speech disturbances, difficulty swallowing, restlessness, fatigue, headache, dry and hot skin, difficulty voiding, and reduced intestinal peristalsis. With 0.5-mg dosage of atropine, slight cardiac slowing, dryness of the mouth, and inhibition of sweating would be noticed. Definite dryness of the mouth and throat, thirst, rapid heart rate, and pupil dilation would be evident with 1.0-mg dosage. With 2.0-mg dosage, the nurse would note rapid heart rate, palpitations, marked mouth dryness, dilated pupils, and some blurring of vision.

11. A 66-year-old woman presents at the clinic complaining of motion sickness. The physician orders a scopolamine patch. Which statement by the patient leads you to believe she knows how to use the patch? A)

I will place it on my chest each morning after I shower.

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I will use it only if I feel sick to my stomach.

I will change the patch every 4 hours. I can use the patches for 1 week.

I will change the patch every 3 days.

Ans:

D Feedback: The scopolamine patch should be applied to a clean, dry, intact, and hairless area of the body. The area should not be shaved because abrasion of the skin could occur and lead to increased absorption. Patches should be placed at new sites each time to avoid skin irritation. The old patch should be removed and the area where it had been should be cleaned.

12. A patient is scheduled for surgery in 2 hours. The physician orders preoperative medications glycopyrrolate (Robinul) 1 mg and meperidine (Demerol) 50 mg intramuscularly. The nurse would hold the medication and consult the provider if the patient had what disorder? A)

Tachycardia

Paralytic ileus

Hypertension

Diabetes mellitus

Ans:

B Feedback: These drugs are also contraindicated with any condition that could be exacerbated by blockade of the parasympathetic nervous system. These conditions include stenosing peptic ulcer, intestinal atony, paralytic ileus, gastrointestinal (GI) obstruction, severe ulcerative colitis, and toxic megacolon, all of which could be exacerbated with a further slowing of GI activity. Tachycardia, hypertension, and diabetes would not be contraindications to administration of glycopyrrolate.

13. The nurse is caring for a patient with atropine poisoning. What drug will the nurse administer to reverse these effects? A)

Bethanechol

Neostigmine

Edrophonium

Physostigmine

Ans:

D Feedback:

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Physostigmine can be used as an antidote for atropine poisoning. A slow intravenous injection of 0.5 to 4 mg (depending on the weight of the patient and the severity of the symptoms) usually reverses the delirium and coma of atropine toxicity. Physostigmine is metabolized rapidly, so the injection may need to be repeated every 1 to 2 hours until the atropine has been cleared from the system. 14. Because of the systemic effects of anticholinergic drugs, the nurse understands that older adults using these drugs are susceptible to what? A)

Heat stroke

Diarrhea

Urinary frequency

Hypotension

Ans:

A Feedback: Because older patients are more susceptible to heat intolerance owing to decreased body fluid and decreased sweating, extreme caution should be used when an anticholinergic drug is given that reduces sweating still further and can result in heat stroke. Older adults are not more susceptible to diarrhea, urinary frequency, and hypotension.

15. A 50-year-old female patient received atropine and meperidine (Demerol) preoperatively. After surgery, the patient complains of mouth dryness. What is the nurses best response? A)

Preoperative medications decrease saliva production but it is temporary and will improve.

This is the result of all of the blood and fluid you lost during surgery.

You are probably dehydrated. The IV fluids you are receiving will correct the problem.

The preoperative medication causes an electrolyte imbalance making your mouth feel dry.

Ans:

A Feedback: Patients receiving anticholinergic drugs must be monitored for dry mouth, difficulty swallowing, constipation, urinary retention, tachycardia, pupil dilation and photophobia, cycloplegia and blurring of vision, and heat intolerance caused by a decrease in sweating.

16. Anticholinergics have varied effects on the body. What is one of those effects? A)

Preventing vagal stimulation

Stimulating the release of acetylcholine

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Increasing respiratory tract secretions

Increasing secretion of sweat glands

Ans:

A Feedback: Adjunctive therapy to treat peptic ulcer, overactive gastrointestinal (GI) disorders; neurogenic bladder or cystitis; parkinsonism; biliary or renal colic; to decrease secretions pre-operatively; treatment of partial heart block associated with vagal activity; treatment of rhinitis or anticholinesterase poisoning.

17. Anticholinergic drugs are used in ophthalmology because they produce what effect? A)

Sedation

Pupil dilation

Pupil constriction

Decreased lacrimal secretions

Ans:

B Feedback: Patients receiving anticholinergic drugs must be monitored for dry mouth, difficulty swallowing, constipation, urinary retention, tachycardia, pupil dilation and photophobia, cycloplegia and blurring of vision, and heat intolerance caused by a decrease in sweating.

18. A male patient, age 75, is started on flavoxate (Urispas). What adverse effects should the patient be made aware of? A)

Rash

Headache

Weight gain

Blurred vision

Ans:

D Feedback: The patient should be warned of possible blurring of vision when taking this drug, which could put the patient at risk for injury if precautions are not taken. Adverse effects could include central nervous system adverse effects, such as blurred vision, pupil dilation and resultant photophobia, cycloplegia, and increased intraocular pressure, all of which are related to the blocking of the parasympathetic effects in the eye.

19. The nurse administers atropine preoperatively for what purpose?

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Providing sedation

Dilating the pupils

Relaxing bladder muscles

Decreasing secretions

Ans:

D Feedback: Atropine is administered preoperatively to reduce secretions, but added indications include gastrointestinal (GI) effects that reduce GI activity. Atropine has no sedating effects, and is not given preoperatively for its pupil dilation effects, or for its bladder muscle relaxation effects.

20. What is the recommended dosage for atropine for a patient with a bradycardia? A)

0.2 to 0.4 mg

0.3 to 0.5 mg

0.4 to 0.6 mg

0.5 to 0.7 mg

Ans:

C Feedback: The usual dosage for atropine is 0.4 to 0.6 mg intramuscularly, subcutaneously, or IV; use caution with older patients. The other options are incorrect dosages and therefore wrong.

21. When the nurse administers an anticholinergic drug to a child, the nurse would carefully assess for what effect that is more likely to occur in children than in adults? A)

Rashes

Pupil dilation

Heat intolerance

Tachycardia

Ans:

C Feedback: Children are often more sensitive to the adverse effects of the drugs, including constipation, urinary retention, heat intolerance, and confusion. Similar effects are seen in children related to pupil dilation. Tachycardia and rashes would not be associated with these drugs in children.

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22. The nurse is writing a plan of care for an older adult patient taking flavoxate. What is an appropriate goal for this patients plan of care? A)

The patient will have adequate pupil dilation within 24 hours.

The patient will experience fewer bronchospasms within 8 hours.

The patient will experience fewer symptoms of prostatitis within 24 hours.

The patient will show resolution of peptic ulcer within 2 weeks.

Ans:

C Feedback: Flavoxate is used to relieve symptoms of dysuria, urgency, nocturia, suprapubic pain, frequency, and incontinence associated with cystitis, prostatitis, urethritis, urethrocystitis, and urethrotrigonitis. As a result, the nurse would know the drug was working when the patient experienced fewer symptoms related to any one of these conditions. Because the drug is not indicated for pupil dilation, bronchospasm, or treatment of a peptic ulcer, the nurses outcomes would not be related to these conditions.

23. What drug would the nurse administer to treat a patient diagnosed with bronchospasm associated with chronic obstructive pulmonary disease (COPD)? A)

Atropine

Flavoxate

Glycopyrrolate

Ipratropium

Ans:

D Feedback: Ipratropium is indicated for the treatment of bronchospasm associated with COPD. Atropine is indicated for use to decrease secretions, bradycardia, pylorospasm, ureteral colic, relaxing of bladder, emotional liability with head injuries, antidote for cholinergic drugs, and pupil dilation. Flavoxate is used for the symptomatic relief of dysuria, urgency, nocturia, suprapubic pain, frequency, and incontinence associated with cystitis, prostatitis, urethritis, urethrocystitis, and urethrotrigonitis. Glycopyrrolate is indicated to decrease secretions before anesthesia or intubation, used orally as an adjunct for treatment of ulcers, to protect the patient from the peripheral effects of cholinergic drugs and to reverse neuromuscular blockade

24. A 72-year-old female patient is being discharged home from the hospital on newly prescribed anticholinergic drugs. A referral to the home health nurse has been made. What priority teaching point will the home health nurse emphasize when discussing the patients drugs? A)

Do not drive or use machinery.

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Take lots of hot baths or showers.

Keep the house warm to avoid a chill.

Limit intake of fluids.

Ans:

A Feedback: Safety precautions may be needed if blurred vision and dizziness occur. The patient should be urged not to drive or perform tasks that require concentration and coordination. The home care nurse would not teach the patient to take hot baths or showers. The patient would be cautioned about inability to perspire in hot environments and to avoid them. Fluid intake should not be limited.

25. The nurse is caring for a new mother who received atropine before undergoing a laparoscopic tubal ligation. The patient tells the nurse that she is breast-feeding her baby and asks whether she can breast-feed when she gets home. What is the nurses best response? A)

You can breast-feed when you get home because the drugs given before surgery will be out of your system.

You can breast-feed as soon as you get home because atropine will not cross into the breast milk.

Discard all breast milk for the next week and feed the baby formula before returning to breast-feeding.

Discard all breast milk for the next 24 hours and feed formula until tomorrow when you can nurse your baby.

Ans:

D Feedback: Lactating mothers should not breast-feed after receiving atropine until the drug has been fully excreted. Because atropine crosses into breast milk and the duration of action is 4 hours, it is safest to have the mother wait 24 hours to breast-feed, continuing to pump and discard the milk while feeding the infant formula. After 24 hours, she can return to breastfeeding because any atropine in breast milk will be eliminated. There is no need to wait a week and although the drug may be out of the bloodstream, the milk in her breast will still contain atropine.

26. The patient, who takes an anticholinergic medication, tells the nurse how much he or she enjoys experimenting with different herbal teas. What herbs will the nurse caution the patient to avoid? (Select all that apply.) A)

Burdock

Thyme

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Rosemary

Parsley

Tumeric

Ans:

A, C, E Feedback: The risk of anticholinergic effects can be exacerbated if anticholinergic agents are combined with burdock, rosemary, or turmeric and used as herbal therapy. Advise patients who use herbal therapies to avoid these combinations. Nothing indicates that thyme or parsley is contraindicated with anticholinergic medications.

27. A 27-year-old male patient is taking an anticholinergic drug as adjunctive therapy to treat his peptic ulcer disease. The patient comes to the clinic and tells the nurse that he feels his heart beating. What adverse effect is the patient experiencing from the anticholinergic medication? A)

Tachypnea

Tachycardia

Hypotension

Urinary frequency

Ans:

B Feedback: Tachycardia and palpitations are possible adverse effects related to blocking of the parasympathetic effects on the heart; this would give the sensation of a heart beating. Tachypnea, hypotension, and urinary frequency are not generally adverse effects of anticholinergic medications and they would not be evident the way the patient described.

28. The 10-year-old child is brought to the respiratory clinic and is prescribed ipratropium (Atrovent). Prior to administering the medication, what would the nurse assess for? A)

Cardiac disorders

Hypertension

Recent injuries

Breath sounds

Ans:

D Feedback: The nurse would assess breath sounds because ipratropium is indicated for treatment of bronchospasm so it is important to get a baseline assessment to determine whether the

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drug improves the patients condition after administration. Cardiac disorders, hypertension, and recent injuries are all valid assessments but are likely to have been assessed during admission history taking and are not related to the purpose of administering the drug. 29. The nurse is caring for a patient who has just been started on hyoscyamine (Symax and others) as adjunctive therapy for his or her peptic ulcers. When developing this patients plan of care, what nursing diagnosis would the nurse establish related to the purpose of administering this drug? A)

Chronic pain related to peptic ulcer disease

Impaired urinary elimination related to bladder relaxation

Risk for hyperthermia related to decreased ability to perspire

Decreased cardiac output related to cardiovascular effects

Ans:

A Feedback: All these nursing diagnoses could be used for the patient receiving an anticholinergic drug, but only chronic pain is related to the drug this patient is receiving and the purpose for which it is being administered.

30. What does parasympathetic nervous system blockade cause? (Select all that apply.) A)

Decrease in heart rate

Decrease in urinary bladder tone

Increase in heart rate

Pupil constriction

Decrease in gastrointestinal (GI) activity

Ans:

B, C, E Feedback: Parasympathetic nervous system blockade causes an increase in heart rate, decrease in GI activity, decrease in urinary bladder tone and function, and pupil dilation and cycloplegia.

31. The patient was involved in a motor vehicle accident and experienced a severe closed head injury resulting in increased intracranial pressure. While intubating the patient, his or her heart rate dropped and did not return to acceptable levels after the tube was in place so the nurse received an order to administer atropine. The physician is performing an exam to determine whether brain death has occurred. What assessment for brain death will be postponed until all atropine is excreted and no longer exerting an effect. A)

Pupil response

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Electroencephalogram

Brainstem reflexes

Computed tomographic scan of the brain

Ans:

A Feedback: One test for neurological function is to shine a light in the patients eyes to test pupil reaction to light. Because this patient has received atropine, pupils will be dilated and will not react normally to light. This could be mistaken as an indication of brain death if the nurse did not know atropine had been administered. This test will be postponed until the pupils are no longer dilated by the medication. The other tests would not have to be postponed because of atropine.

32. The nurse is caring for a patient who is unconscious and requires an anticholinergic drug to treat bradycardia. What drug can the nurse administer IV for this purpose? A)

Ipratropium (Atrovent)

Dicyclomine (generic)

Methscopolamine (Pamine)

Atropine (generic)

Ans:

D Feedback: Atropine can be given intramuscularly (IM), subcutaneously, or IV for the treatment of bradycardia. Ipratropium is administered by inhalation to treat bronchospasm. Dicyclomine is used to treat irritable or hyperactive bowel and can be given orally or IM. Methscopolamine is administered orally to treat peptic ulcers.

33. What is the proper dosage of scopolamine administered by the nurse transdermally to reduce nausea and vomiting associated with motion sickness? A)

0.32 to 0.65 mg

1.5 mg

3 mg

3.5 mg

Ans:

B Feedback:

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The scopolamine transdermal patch is 1.5 mg. If administered subcutaneously (SC) or intamuscularly (IM), the dosage would be 0.32 to 0.65 mg. Pediatric dosage is 0.006 mg/kg subcutaneous, IM, or IV. 34. The nurse receives an order to administer glycopyrrolate 0.002 mg/kg to the pediatric patient preoperatively. The patient weighs 14 lbs. If 1 pound = 2.2 kg, how many kilograms would the nurse administer to this patient? A)

0.013 mg

0.13 mg

0.028 mg

0.28 mg

Ans:

A Feedback: Begin by calculating the childs weight in kilogram 14 lbs/2.2 kg = 6.36 kg. Multiply childs weight in kg by dosage in kg 6.36 0.002 = 0.01272 rounded to 0.013 mg.

35. A mother calls the pediatric clinic and tells the nurse the family is planning a crosscountry trip to visit some attractions the children will enjoy. Her 2-year-old child gets motion sickness soon after starting the car and she would like some scopolamine patches to use. What is the nurses best response? A)

One patch lasts for 3 days. How long will you be driving?

Children cannot receive scopolamine orally or by patch.

It might be better to use the oral form of the drug only on days it is needed.

Scopolamine loses effectiveness if it is used for several days.

Ans:

B Feedback: Scopolamine does not come in a pediatric oral or patch formulation. Scopolamine can only be given subcutaneously, or IV. Because children cannot use the patch, asking how many days they will be traveling or suggesting oral prescription when that form is not available is incorrect. Scopolamine does not lose effectiveness.

Chapter 6: Adrenergic Agonists MULTIPLE CHOICE 1. The nurse is caring for a patient who has asthma and administers a selective beta2-adrenergic agonist to treat bronchospasm. The nurse will expect this drug to also cause which side effect? a. Increased blood glucose

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b. Increased blood pressure c. Increased heart rate d. Increased gastrointestinal (GI) motility ANS: A Drugs that act on beta2 receptors activate glyconeogenesis in the liver causing increased blood glucose. Selective beta2 drugs act on beta2 receptors only and not on beta1 receptors, so they do not cause increased blood pressure or increased heart rate. Adrenergic agonists cause decreased GI motility. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: dm 256 TOP: NURSING PROCESS: Planning MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 2. A patient who has asthma is diagnosed with hypertension. The nurse understands that which drug will be safe to give this patient? a. Pindolol (Visken) b. Metoprolol (Lopressor) c. Nadolol (Corgard) d. Propranolol (Inderal) ANS: B Metoprolol is a selective adrenergic blocker that has a greater affinity for receptors that decrease heart rate and blood pressure and is less likely to cause bronchospasm. The other adrenergic blockers are not selective and can cause bronchoconstriction. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: dm 263 TOP: NURSING PROCESS: Planning MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 3. The nurse administers subcutaneous epinephrine to a patient who is experiencing an anaphylactic reaction. The nurse should expect to monitor the patient for which symptom? a. Bradycardia b. Decreased urine output c. Hypotension d. Nausea and vomiting ANS: B Epinephrine can cause renal vasoconstriction and thereby reduce renal perfusion and decrease urinary output. Epinephrine causes tachycardia and elevates blood pressure. Nausea and vomiting are not expected to occur. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 258 TOP: NURSING PROCESS: Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 4. An adult patient is brought to the emergency department for treatment of an asthma exacerbation. The patient uses inhaled albuterol as needed to control wheezing. The nurse notes expiratory wheezing, tremors, restlessness, and a heart rate of 120 beats per minute. The nurse suspects that the patient has a. over-used the albuterol. b. not been using albuterol.

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c. taken a beta-adrenergic blocker. d. taken a monoamine oxidase (MAO) inhibitor. ANS: A High doses of albuterol may affect beta1 receptors, causing an increase in heart rate. Patients having an asthma exacerbation may over-use their albuterol inhalers when seeking relief. Patients may have wheezing and increased heart rate during an untreated asthma exacerbation, but they will not have tremors and restlessness. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 259 TOP: NURSING PROCESS: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 5. The nurse is caring for a patient who is receiving intravenous dopamine (Intropin). The nurse notes erythema and swelling at the IV insertion site. What is the nurses initial action? a. Apply warm soaks to the area. b. Monitor the patient closely for hypertension. c. Obtain an order for an electrocardiogram. d. Notify the provider of a need for phentolamine mesylate (Regitine). ANS: D Extravasation of dopamine causes tissue necrosis; if extravasation occurs, the antidote phentolamine mesylate should be infiltrated into the area. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 262 TOP: NURSING PROCESS: Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 6. The nurse is teaching a patient how to use phenylephrine HCl (Neo-Synephrine) nasal spray to treat congestion from a viral upper respiratory infection. What instruction will the nurse give the patient? a. Stop using the medication after 3 days. b. Spray the medication into the nose while lying supine. c. Use frequently since systemic side effects do not occur. d. Use the medication with any other over-the-counter medications. ANS: A Nurses should explain to patients that continuous use of nasal sprays containing adrenergic agonists may result in rebound nasal congestion; these sprays should not be used more than 3 days. To avoid systemic absorption, spray should be administered while the patient is in an upright position. The medication may cause systemic side effects and should not be routinely used with other OTC cold medications. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 261 TOP: NURSING PROCESS: Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 7. The nurse is caring for a patient who will begin taking atenolol (Tenormin). What information will the nurse include when teaching the patient about taking this medication? a. The drug must be taken twice daily. b. The patient must rise slowly from a chair or bed. c. The medication is safe to take during pregnancy.

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d. Use NSAIDs as needed for mild to moderate pain. ANS: B The side effects commonly associated with beta blockers include bradycardia, hypotension, and dizziness. Patients should be instructed to use caution when rising from a sitting or lying position to avoid orthostatic hypotension. Atenolol may be taken once daily. Atenolol is contraindicated in the pregnant patient. NSAIDs decrease the effects of beta blockers and should be avoided. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 263 TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 8. The nurse is caring for a patient who has recently begun taking atenolol (Tenormin) to treat hypertension. The patient reports dizziness, nausea, vomiting, and decreased libido since beginning the medication. What will the nurse do? a. Hold the next dose until the provider can be notified of these side effects. b. Reassure the patient that these symptoms are common and not worrisome. c. Recommend that the patient discuss these effects with the provider. d. Suggest that the patient request a different beta-adrenergic blocker. ANS: C Beta-adrenergic blockers can cause these side effects, which are often dose-related. Patients experiencing these side effects should be encouraged to discuss them with their providers. Beta blockers should not be discontinued abruptly, or rebound symptoms may occur. Since symptoms may be dose-related, reassuring the patient is not correct. All beta blockers have similar side effects. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 262 TOP: NURSING PROCESS: Evaluation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 9. A patient will begin taking albuterol (Proventil) to treat asthma. When teaching the patient about this drug, the nurse will make which recommendation? a. Report rapid or irregular heart rate. b. Drink 8 to 16 extra ounces of fluid each day. c. Monitor serum glucose daily. d. Take a calcium supplement. ANS: A High dosages of albuterol may affect beta1 receptors, causing an increase in heart rate that could be dangerous. It is not necessary to consume extra fluids or take a calcium supplement while using this drug. Serum glucose may be elevated slightly, but this is not a concern in non-diabetic patients. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 262 TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 10. A patient is taking doxazosin mesylate (Cardura) 1 mg per day to treat hypertension. The nurse notes a blood pressure of 110/72 mm Hg and a heart rate of 92 beats per minute. The nurse will contact the provider to discuss which change to the drug regimen? a. Changing to a beta-adrenergic blocker

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b. Decreasing the drug dose c. Increasing the drug dose d. Adding a diuretic ANS: A Alpha-adrenergic blockers can cause orthostatic hypotension and reflex tachycardia. Beta blockers do not cause reflex tachycardia. Decreasing or increasing the drug dose is not recommended. Diuretics are added if blood pressure is not well-controlled. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 262 TOP: NURSING PROCESS: Evaluation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 11. A patient who has Raynauds disease will begin taking an alpha-adrenergic blocker. The patient asks the nurse how the drug works to treat symptoms. The nurse explains that alphaadrenergic blockers treat Raynauds disease by causing a. decreased peripheral vascular resistance. b. orthostatic hypotension. c. reflex tachycardia. d. vasodilation. ANS: D Alpha-adrenergic blockers can be used to treat peripheral vascular disease because they cause vasodilation. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: dm 263 TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 12. A nurse is teaching a patient how to use phenylephrine (Neo-Synephrine) nasal spray. To avoid systemic absorption, the nurse teaches the patient to perform which action? a. Apply pressure to the nose after spraying. b. Administer the spray while in the supine position. c. Insert the spray while sitting up. d. Exhale deeply while injecting the nasal spray. ANS: C The patient should insert the spray while sitting up to avoid it being absorbed systemically. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 262 TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 13. A patient will be discharged on beta blockers. Which skill is essential for the nurse to teach the patients family? a. How to prepare a low-sodium diet b. Assessments to detect fluid retention c. How to monitor heart rate and blood pressure d. Early signs of changing level of consciousness ANS: C Because of the action and side effects of beta blockers, heart rate and blood pressure should be monitored frequently.

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DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 263 TOP: NURSING PROCESS: Planning MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 14. The nurse is caring for a patient whose provider has just ordered a switch from atenolol (Tenormin) to reserpine. When preparing the patient to take this medication, what will the nurse do? a. Ask about herbal supplements. b. Counsel that NSAIDs are safe to take with reserpine. c. Teach about potential side effects of mood elevation and euphoria. d. Tell the patient to expect immediate therapeutic effects. ANS: A St. Johns wort may antagonize hypotensive effects of reserpine. Reserpine should not be taken with NSAIDs. Side effects include depression, not mood elevation. Therapeutic effects may take 2 to 3 weeks. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 263 TOP: NURSING PROCESS: Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 15. The patient has been started on a treatment regimen that includes atenolol (Tenormin) and complains to the nurse of feeling weak. Which is the best response from the nurse? a. I will hold your next dose of the medication. b. You may need an increase in your next dose of the medication. c. This is an adverse reaction to the medication. I will stop the drug. d. This is a side effect of the medication. I will notify your physician. ANS: D Weakness can be a side effect of atenolol. Beta blockers should not be stopped abruptly. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 264 TOP: NURSING PROCESS: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 16. The nurse is performing an admission assessment on a patient who has recently begun taking reserpine. The patient reports using St. Johns wort. The nurse anticipates that the patient will have a. hypotension. b. hypertension. c. bradycardia. d. tachycardia. ANS: B St. Johns wort antagonizes the hypotensive effects of reserpine, causing hypertension. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 263 TOP: NURSING PROCESS: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 17. The patient has been ordered to receive Sudafed to treat nasal congestion. The nurse performing an admission assessment learns that the patient has diabetes mellitus. What action is

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appropriate for the nurse to take? a. Administer the medication as ordered. b. Contact the provider to discuss a lower dose. c. Give the medication and monitor serum glucose closely. d. Hold the medication and contact the provider. ANS: D Sympathetic drugs should not be taken by patients with diabetes. The medication should not be given. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 261 TOP: NURSING PROCESS: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies MULTIPLE RESPONSE 1. The nurse caring for a patient who is taking an adrenergic agent will expect which side effects? (Select all that apply.) a. Dilated pupils b. Increased heart rate c. Increase gastrointestinal motility d. Vasodilation e. Bronchospasm f. Relaxed uterine muscles ANS: A, B, F Adrenergic agents stimulate the sympathetic nervous system, evoking the fight or flight response. This response increases those functions needed to respond to stress (increased heart rate to perfuse muscles, bronchodilation to increase oxygen exchange). Adrenergic drugs shunt blood away from the reproductive tract and gastrointestinal organs as these functions are not needed during a fight or flight response. Chapter 7: Adrenergic Antagonists 1. The nurse administers an adrenergic blocking agent in order to prevent release of what neurotransmitter? A)

Epinephrine

Norepinephrine

Serotonin

Gamma-aminobutyric acid (GABA)

Ans:

B Feedback: Adrenergic blocking agents prevent norepinephrine from being released from the adrenal medulla or from the nerve terminal from activating the receptor, which blocks

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sympathetic nervous system effects. Epinephrine, serotonin, and GABA are not associated with this process. 2. What medication, if ordered for an 8-year-old patient, should the nurse question? (Select all that apply.) A)

Amiodarone (Cordarone) 400 mg orally per 24 hours

Labetalol (Normodyne) 100 mg orally b.i.d.

Phentolamine (Regitine) 1 mg intramuscularly 1 to 2 hours before surgery

Prazosin (Minipress) 3 mg orally t.i.d.

Carvedilol (Coreg) 6.25 mg orally b.i.d.

Ans:

A, B, E Feedback: Amiodarone, labetalol, and carvedilol are not indicated for pediatric use and do not have established pediatric dosages. Phentolamine and prazosin have established pediatric dosages and would not need to be questioned.

3. A nurse is working with a patient who is taking an adrenergic blocking agent. While assessing the patients medication history, the nurse discovers that the patient takes several alternative therapies. What herb is the nurse concerned may interact with the adrenergic blocking agent and affect the patients blood glucose level? A)

Ginseng

Nightshade

Di huang

Saw Palmetto

Ans:

C Feedback: Di huang is an alternative therapy that can lower blood glucose when used in combination with adrenergic blocking agents. Ginseng increases antihypertensive effects; nightshade slows the heart rate; and saw palmetto increases the risk of urinary tract complications when used in combination with adrenergic blocking agents.

4. A priority nursing assessment for a patient who is to receive an alpha- or beta-adrenergic blocking agent would be what? A)

Monitoring respiratory rate

Checking blood glucose level

Measuring urine output

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Assessing heart rate

Ans:

D Feedback: The most serious adverse effect would be severe bradycardia, so the nurses priority would be assessing the heart rate. If the patient were identified as having diabetes, then monitoring blood glucose levels would become important because these drugs can aggravate diabetes by blocking sympathetic response including masking the usual signs and symptoms of hypoglycemia and hyperglycemia. Respiratory rate could be impacted if the patient was identified as having a condition causing bronchospasm and diabetes because the combination could worsen both conditions. Measuring urine output should be part of the patients care, but it is not the priority assessment.

5. Bisoprolol (Zebeta) would be the drug of choice for which patient with a diagnosis of hypertension? A)

A 7-year-old patient

A 15-year-old patient

A 37-year-old patient

A 69-year-old patient

Ans:

D Feedback: Bisoprolol is the drug of choice for older adults. It is not associated with as many adverse effects in the elderly and regular dosing profiles can be used. This drug does not have an established pediatric dosage. Although the 37-year-old patient is an adult, there are additional choices for this patient, with a more favorable adverse effect profile.

6. What would be the teaching priority for a diabetic patient being treated with a nonselective beta-blocker? A)

To take his own pulse

To weigh himself once a week at the same time of day

To avoid smoke-filled rooms

To understand signs and symptoms of hypo- or hyperglycemic reaction

Ans:

D Feedback: Because the beta-blockers stop the signs and symptoms of a sympathetic stress reaction, the signs and symptoms associated with hypo- or hyperglycemia, the diabetic patient taking a beta-blocker will need to understand this and learn new indicators of these

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reactions. Taking his pulse, weekly weighing, and avoiding smoke-filled rooms are good health practices and should be done, but not specifically needed by a diabetic patient taking a beta-blocker. 7. The nurse is caring for a patient who is receiving an adrenergic blocking agent. While writing the care plan for this patient what nursing diagnoses would be most appropriate concerning comfort? A)

Acute pain related to cardiovascular and systemic effects

Decreased cardiac output related to cardiovascular effects

Ineffective airway clearance related to lack of bronchodilating effects

Deficient knowledge regarding drug therapy

Ans:

A Feedback: All four options would be appropriate nursing diagnoses for a patient receiving an adrenergic blocking agent. However, acute pain would be the only nursing diagnosis related to the patients comfort level.

8. A nurse is providing discharge instructions to a patient who is taking atenolol (Tenormin) to treat hypertension. What would the nurse teach the patient regarding a possible drugdrug interaction? A)

Antibiotics

Oral contraceptives

Nonsteroidal anti-inflammatory drugs (NSAIDs)

Antifungal agents

Ans:

C Feedback: A decreased hypertensive effect can occur if a beta-selective adrenergic blocking agent is used in combination with NSAIDs. If this combination is used, the patient should be monitored closely and dosage adjustments made. Antibiotics, oral contraceptives, and antifungal agents are not known to have a drugdrug interaction.

9. A busy patient with many responsibilities is to have a medication ordered to treat her hypertension. To increase compliance with drug therapy, what drug would be a good choice for this patient? A)

Acebutolol (Sectral)

Atenolol (Tenormin)

Bisoprolol (Zebeta)

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Metoprolol (Lopressor)

Ans:

D Feedback: Metoprolol would be the best choice because it has an extended release form that only needs to be taken once a day, which should increase patient compliance. Acebutolol, atenolol, and bisoprolol do not come in extended release forms.

10. The nurse provides patient teaching for a patient who has a new order for nadolol (Corgard) to treat hypertension. What statement by the patient concerning nadolol (Corgard) would indicate that the teaching has been effective? A)

I should cover my head at all times while I am outdoors.

Since I am taking this drug, I no longer need to worry about diet and exercise.

I will not stop taking this drug abruptly and will talk to my doctor before discontinuing.

I may have a very dry mouth while taking this drug.

Ans:

C Feedback: A patient receiving an adrenergic blocker must be aware that abruptly stopping the medication may result in a serious reaction. When changing medications or discontinuing their use, these drugs need to be tapered off gradually. This drug is not associated with photophobia or the anticholinergic effect of dry mouth. If the teaching were effective, the patient would be aware that he would need to continue lifestyle modifications, including diet and exercise.

11. The nurse frequently administers propranolol (Inderal) as treatment for what condition? A)

Hypotension

Angina

Prevent first myocardial infarction (MI)

Cluster headaches

Ans:

B Feedback: The beta-adrenergic blocking agents are used to treat cardiovascular problems (hypertension, angina, migraine headaches) and to prevent reinfarction after MI. The prototype drug, propranolol, was in fact the most prescribed drug in the country in the 1980s and is still considered a first-line drug. Propranolol does not prevent first MIs and it is not used for hypotension or cluster headaches.

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12. A patient with benign prostatic hypertrophy (BPH) has been prescribed prazosin (Minipress) and asks the nurse what this is going to do for him. The nurses response will include what action to explain the purpose of taking this medication? A)

Decreasing vascular tone and vasodilation

Reducing the size of the prostate to reduce pressure on the urethra

Relaxing the bladder and prostate and improving urine flow

Lowering blood pressure

Ans:

C Feedback: Alpha1-selective adrenergic blocking agents block smooth muscle receptors in the prostate, prostatic capsule, prostatic urethra, and urinary bladder neck, which leads to a relaxation of the bladder and prostate and improved flow of urine in male patients. Although they also block the postsynaptic alpha1-receptor sites, causing a decrease in vascular tone and vasodilation that leads to a fall in blood pressure without the reflex tachycardia that occurs when the presynaptic alpha2-receptor sites are blocked, this is not the purpose for administering the drug to a patient with BPH. They do not reduce the size of the prostate.

13. The nurse is caring for a 55-year-old patient receiving metoprolol (Lopressor). What statement by the patient would lead the nurse to believe that he needs additional instruction? A)

If I have side effects from the medication, I will contact my physician before I stop taking it.

I can take over-the-counter (OTC) cold medication while on metoprolol.

I will take the medication on an empty stomach.

I will report a weight gain of 2 pounds or more in 1 week.

Ans:

B Feedback: OTC medications can interact to increase or decrease the effects of antiadrenergic drugs. Antacids decrease the effects of beta-adrenergic blocking drugs. Decreased antihypertensive effects result when taken with ibuprofen. Other options reflect correct statements and would not indicate that the patient would need further instruction.

14. Nonselective adrenergic blocking agents have a variety of therapeutic uses. Which agent is used for the treatment of heart failure? A)

Carvedilol (Coreg)

Sotalol (Betapace)

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Propranolol (Inderal)

Tamsulosin (Flomax)

Ans:

A Feedback: available orally and is used to treat hypertension as well as congestive heart failure and left ventricular dysfunction after a myocardial infarction. Sotalol is a nonselective betaadrenergic blocking agent used to treat potentially life-threatening ventricular arrhythmias and to maintain normal sinus rhythm in patients with atrial fibrillation or flutter. Propranolol is a nonselective beta-adrenergic blocking agent used for treatment of hypertension, angina, idiopathic hypertrophic subaortic stenosis (IHSS)induced palpitations, angina and syncope, some cardiac arrhythmias induced by catecholamines or digoxin, pheochromocytoma; prevention of reinfarction after myocardial infarction; prophylaxis for migraine headache (which may be caused by vasodilation and is relieved by vasoconstriction, although the exact action is not clearly understood); prevention of stage fright (which is a sympathetic stress reaction to a particular situation); and treatment of essential tremors. Tamsulosin is used to treat benign prostatic hyperplasia and is analpha1-selective adrenergic blocking agent.

15. Before administering a nonselective adrenergic blocker, what should the nurse assess? A)

Pulse and blood pressure

Bowel sounds and appetite

Serum albumin level

Serum sodium and potassium levels

Ans:

A Feedback: Monitor vital signs and assess cardiovascular status including pulse, blood pressure, and cardiac output to evaluate for possible cardiac effects. Although assessment of bowel sounds, appetite, serum albumin level, or serum sodium and potassium levels may be important to patient care, they are not related to administration of a nonselective adrenergic blocking agent.

16. A 75-year-old male patient was admitted to the unit with angina. He was started on nadolol (Corgard). The patient asks why he is taking this medication because he does not have high blood pressure. What is the nurses best response? A)

Some beta-blockers have been approved as antianginal agents.

This medication will prevent blood pressure problems later on.

This drug will prevent you from developing an arrhythmia.

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This medication will reduce benign prostatic hypertrophy (BPH) as well as treat heart failure.

Ans:

A Feedback: Decreased heart rate, contractility, and excitability, as well as a membrane-stabilizing effect, lead to a decrease in arrhythmias, a decreased cardiac workload, and decreased oxygen consumption. The juxtaglomerular cells are not stimulated to release renin, which further decreases the blood pressure. These effects are useful in treating hypertension and chronic angina and can help to prevent reinfarction after a myocardial infarction by decreasing cardiac workload and oxygen consumption. Corgard will not prevent blood pressure problems, arrhythmias, or glaucoma in the future. Corgard is not used to treat BPH.

17. In what patient is propranolol (Inderal) contraindicated? A)

26-year-old man with viral myocarditis

45-year-old woman with heart failure who suffered a myocardial infarction

42-year-old man with hypertension

65-year-old woman with persistent migraines

Ans:

B Feedback: Beta-adrenergic blocking agents are contraindicated in patients with bradycardia, heart failure, and heart block. The drug would not be contraindicated in the other patients.

18. What assessment finding indicates to the nurse that timolol (Timoptic) has been effective? A)

The patients blood pressure increases.

The patients intraocular pressure is reduced.

The patients pulse is reduced.

The patients angina is reduced.

Ans:

B Feedback: Timolol and carteolol are available in an ophthalmic form of the drug for reduction of intraocular pressure in patients with open-angle glaucoma. A decrease in intraocular pressure would indicate it has been effective. Timolol can also be used to treat hypertension but an increase in blood pressure would indicate the drug was not effective.

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Reduced pulse rate and reduced angina would not be related to this drug, especially if it was given in ophthalmic form when very little of the drug is absorbed systemically. 19. The student nurse is studying for a pharmacology exam and notices that many of the adrenergic blocking antagonists drugs studied in class have what suffix? A)

-aine

-lol

-azole

-triptan

Ans:

B Feedback: The suffix -lol is seen in many of the drug names for adrenergic blocking antagonists. The suffix -aine would indicate a topical anesthetic, whereas -azole indicates an antifungal, and the suffix -triptan relates to the triptans.

20. A 23-year-old female patient presents at the clinic with a migraine headache. What betaadrenergic blocking agent might the physician prescribe for the prophylactic prevention of future migraine headaches? A)

Propranolol (Inderal)

Nadolol (Corgard)

Timolol (Blocadren)

Sotalol (Betapace)

Ans:

A Feedback: Propranolol is indicated for the treatment of hypertension, angina pectoris, idiopathic hypertrophic subaortic stenosis, supraventricular tachycardia, tremor; prevention of reinfarction after myocardial infarction; adjunctive therapy in pheochromocytoma; prophylaxis of migraine headache; and management of situational anxiety. The other options do not treat or prevent migraine headaches.

21. A 5-year-old African American patient has been admitted to the pediatric intensive care unit with pheochromocytoma. The physician has ordered phentolamine. The nurse knows that the other indication for phentolamine is what? A)

Migraine headaches

Extravasation of IV norepinephrine or dopamine

Life-threatening arrhythmias

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Heart failure

Ans:

B Feedback: Phentolamine (Regitine) is used for the prevention of cell death and tissue sloughing after extravasation of intravenous norepinephrine or dopamine, and severe hypertension reactions caused by manipulation of the pheochromocytoma before and during surgery; diagnosis of pheochromocytoma. Phentolamine would not be indicated for treatment of migraine headaches, life-threatening arrhythmias, or heart failure.

22. The nurse is caring for a well-known stage actor who has suddenly developed severe stage fright that is preventing him from working. What drug does the nurse suspect will be prescribed for this patient? A)

Carteolol (Cartrol)

Nebivolol (Bystolic)

Nadolol (Corgard)

Propranolol (Inderal)

Ans:

D Feedback: One of the indications for use of propranolol is prevention of stage fright, which is a sympathetic stress reaction to a particular situation. None of the other options are indicated for this use.

23. The nurse assesses the patient receiving phentolamine (Regitine) and suspects what finding is an adverse effect of the medication? A)

Hypertension

Wheezing

Tachycardia

Depressed respirations

Ans:

C Feedback: Patients receiving phentolamine often experience extensions of the therapeutic effects, including hypotension, orthostatic hypotension, angina, myocardial infarction, cerebrovascular accident, flushing, tachycardia, and arrhythmiaall of which are related to vasodilation and decreased blood pressure. Headache, weakness, and dizziness often occur in response to hypotension. Nausea, vomiting, and diarrhea may also occur.

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Hypertension, wheezing, and depressed respiration would not be associated with phentolamine. 24. The home care nurse is caring for a patient newly prescribed a nonselective beta-blocking agent. What would the nurse include in the teaching plan related to this drug? (Select all that apply.) A)

Take with meals.

Change position slowly.

Avoid driving or operating hazardous machinery.

Warn of possible increase in libido.

Increase activity levels as much as possible.

Ans:

A, B, C Feedback: Patients should be taught to change position slowly, avoid driving or operating hazardous machinery, and to pace activities as a result of potential dizziness from orthostatic hypotension in order to avoid injury. Patients should take medicine with meals when possible. Drug is more likely to decrease libido than increase it. Activity levels should be paced and care should be taken not to overdo.

25. The nurse is discharging a 35-year-old patient with diabetes who has been prescribed an adrenergic blocking agent. What is the priority teaching point for the nurse to discuss with this patient? A)

Monitor blood glucose levels closely and report any instability

Document signs and symptoms of hyperglycemia and hypoglycemia

Reduce carbohydrate intake more than usual while taking the new drug

Increase insulin dosage to compensate for the drugs effect in increasing blood sugar

Ans:

A Feedback: It is important for the patient to be instructed to monitor blood sugar levels more frequently because adrenergic blocking agents mask the normal hypo- and hyperglycemic manifestations that normally alert patients such as sweating, feeling tense, increased heart rate, and rapid breathing. There is no need to change the diet or the diabetic medications. There may be no signs and symptoms to record because they are blocked by the adrenergic blocker.

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26. The home care nurse is providing teaching for a 59-year-old patient taking a nonselective beta-blocker. The nurse teaches the patient the importance of notifying the prescribing physician when what occurs related to this medication? A)

If the patients pulse stays above 100 bpm for 3 or more days

If the patient has a sudden onset of a cough

If the patient falls

If the patients pulse falls below 60 bpm for 3 or more days

Ans:

B Feedback: Bronchospasm, cough, rhinitis, and bronchial obstruction are related to loss of bronchodilation of the respiratory tract and vasodilation of mucous membrane vessels so a sudden onset of a cough or difficulty breathing should be immediately reported to the health care provider. Other options may need to be reported but not in relation to the nonselective beta-blocking medication.

27. A 31-year-old male patient has been prescribed propranolol to reduce and prevent angina. What will the nurse assess this patient for related to the medication? (Select all that apply.) A)

Sleep disturbance

Impotence

Bronchospasm

Gastric pain

Tachycardia

Ans:

B, C, D Feedback: Adverse effects of propranolol that the nurse would assess for include allergic reaction, bradycardia, heart failure, cardiac arrhythmias, cerebrovascular accident, pulmonary edema, gastric pain, flatulence, impotence, decreased exercise tolerance, and bronchospasm.

28. Which nonselective alpha-adrenergic blocking agent is still used? A)

Metoprolol

Propranolol

Timolol

Phentolamine

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Ans:

D Feedback: Of the nonselective alpha-adrenergic blocking agents, only phentolamine is still used today. Metoprolol is a beta1-selective adrenergic blocking agent. Timolol and propranolol are nonselective beta-adrenergic blocking agents.

29. The labor and delivery nurse assists with the delivery of a newborn to a woman taking an adrenergic blocker for a congenital heart defect. What organ systems may be affected in the newborn by these drugs? (Select all that apply.) A)

Cardiovascular

Respiratory

Central nervous system (CNS)

Gastrointestinal (GI)

Genitourinary (GU)

Ans:

A, B, C Feedback: Adrenergic blockers can affect labor, and babies born to mothers taking these drugs may exhibit adverse cardiovascular, respiratory, and CNS effects. Problems with the GI and GU systems have not been reported.

30. Beta-adrenergic blocking drugs are used in children for disorders similar to those in adults. What adrenergic blocking agent is used during surgery for pheochromocytoma? A)

Propranolol

Prazosin

Phentolamine

Guanethidine

Ans:

C Feedback: Phentolamine is used during surgery for pheochromocytoma in children. Prazosin is used to treat hypertension in children. Propranolol and guanethidine are not indicated for use in children with a pheochromocytoma.

31. What are the therapeutic and adverse effects associated with the adrenergic blocking agents related to? A)

Receptor-site specificity

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Sympathetic nervous system manifestations

Norepinephrine release

Function of the nerve terminal

Ans:

A Feedback: The therapeutic and adverse effects associated with these drugs are related to their adrenergic-receptor-site specificity; that is, the ability to react with specific adrenergic receptor sites without activating them, thus preventing the typical manifestations of sympathetic nervous system (SNS) activation. By occupying the adrenergic receptor site, they prevent norepinephrine released from the nerve terminal or from the adrenal medulla from activating the receptor, thus blocking the SNS effects.

32. The specificity of the adrenergic blocking agents allows the clinician to select a drug to do what? A)

Have the desired effect

Multiply undesired effects

Increase specificity with higher serum blood levels

Improving concentration in the body

Ans:

A Feedback: This specificity allows the clinician to select a drug that will have the desired therapeutic effects without the undesired effects that occur when the entire sympathetic nervous system is blocked. In general, however, the specificity of adrenergic blocking agents depends on the concentration of drug in the body. Most specificity is lost with higher serum drug levels.

33. What agents are used primarily to treat cardiac-related conditions? (Select all that apply.) A)

Nonselective adrenergic blocking agents

Nonselective alpha-adrenergic blocking agents

Alpha1-selective adrenergic blocking agents

Nonselective beta-adrenergic blocking agents

Beta1-selective adrenergic blocking agents

Ans:

A, D, E Feedback:

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Drugs that block both alpha- and beta-adrenergic receptors are primarily used to treat cardiac-related conditions. Phentolamine, a nonselective alpha-adrenergic blocking agent, is used to treat extravasation of IV norepinephrine or dopamine and hypertension related to a pheochromocytoma. Alpha1-selective adrenergic blocking agents are used for treatment of hypertension and benign prostatic hyperplasia. The beta-adrenergic blocking agents are used to treat cardiovascular problems (hypertension, angina, migraine headaches) and to prevent reinfarction after myocardial infarction. Beta1-selective adrenergic blocking agents are used for treating hypertension, angina, and some cardiac arrhythmias. 34. The patient takes labetalol and is scheduled for surgery. The anesthesiologist plans to use halothane as one of the anesthetic agents. The nurse consults with the anesthesiologist to ensure awareness the patients medication history knowing that the combination of labetalol and halothane will have what effect? A)

Excessive hypotension

Hypoglycemia

Conduction system disturbances

Vomiting

Ans:

A Feedback: There is increased risk of excessive hypotension if any of these drugs is combined with volatile liquid general anesthetics such as enflurane, halothane, or isoflurane. The effectiveness of diabetic agents is increased, leading to hypoglycemia when such agents are used with these drugs. Carvedilol has been associated with potentially dangerous conduction system disturbances when combined with verapamil or diltiazem. Vomiting is not associated with this combination of drugs.

35. The 64-year-old patient has smoked since age 15 and has been diagnosed with chronic obstructive pulmonary disease. What classification of adrenergic blocking antagonist would be safest for this patient to treat angina? A)

Nonselective adrenergic blocking agents

Nonselective alpha-adrenergic blocking agents

Alpha1-selective adrenergic blocking agents

Beta1-selective adrenergic blocking agents

Ans:

D Feedback: Beta1-selective adrenergic blocking agents have an advantage over the nonselective betablockers in some cases. Because they do not usually block beta2-receptor sites, they do

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not block the sympathetic bronchodilation that is so important for patients with lung diseases or allergic rhinitis. Consequently, these drugs are preferred for patients who smoke or who have asthma, any other obstructive pulmonary disease, or seasonal or allergic rhinitis. Nonselective adrenergic blocking agents block both alpha- and betaadrenergic receptors exacerbating respiratory conditions by the loss of norepinephrines effect of bronchodilation. Nonselective alpha-adrenergic blocking agents are not used to treat angina. Alpha1-selective adrenergic blocking agents are not used to treat angina. Chapter 8: Drugs for Neurodegenerative Diseases MULTIPLE CHOICE 1. An older patient exhibits a shuffling gait, lack of facial expression, and tremors at rest. The nurse will expect the provider to order which medication for this patient? a. Carbidopa-levodopa (Sinemet) b. Donepezil (Aricept) c. Rivastigmine (Exelon) d. Tacrine (Cognex) ANS: A This patient is exhibiting signs of Parkinsons disease and should be treated with carbidopalevodopa. The other drugs are used to treat Alzheimers disease. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 317 TOP: NURSING PROCESS: Assessment MSC: NCLEX: Physiological Integrity: Pathophysiology 2. A nursing student asks the nurse to differentiate the pathology of Alzheimers disease from that of Parkinsons disease. Which description is correct? a. Alzheimers disease involves a possible excess of acetylcholine and neuritic plaques. b. Alzheimers disease is caused by decreased amounts of dopamine and degeneration of cholinergic neurons. c. Parkinsons disease is characterized by an imbalance of dopamine and acetylcholine. d. Parkinsons disease involves increased dopamine production and decreased acetylcholine. ANS: C Parkinsons disease (PD) is characterized by an imbalance of dopamine (DA) and acetylcholine (ACh) caused by an unexplained degeneration of the dopaminergic neurons allowing the excitatory response of acetylcholine to exceed the inhibitory response of dopamine. Alzheimers disease (AD) may result from decreased ACh, degeneration of cholinergic neurons, and neuritic plaques. Dopamine does not appear to play a role in Alzheimers disease. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: dm 315 TOP: NURSING PROCESS: N/A MSC: NCLEX: Physiological Integrity: Pathophysiology 3. The spouse of a patient newly diagnosed with mild, unilateral symptoms of Parkinsons disease (PD) asks the nurse what, besides medication, can be done to manage the disease. The nurse will a. counsel the spouse that parkinsonism is a normal part of the aging process in some people. b. recommend exercise, nutritional counseling, and group support to help manage the disease. c. tell the spouse that the disease will not progress if mild symptoms are treated early.

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d. tell the spouse that medication therapy can be curative if drugs are begun in time. ANS: B PD is a progressive disorder. Nonpharmacologic measures can lessen symptoms and help patients and families cope with the disorder. Although the aging process may contribute to the development of PD, it is not necessarily a normal part of aging. Treatment may slow the progression but does not arrest or cure the disease. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: dm 315 TOP: NURSING PROCESS: Nursing Intervention MSC: NCLEX: Physiological Integrity: Pathophysiology 4. A patient who has Parkinsons disease is being treated with the anticholinergic medication benztropine (Cogentin). The nurse will tell the patient that this drug will have which effect? a. Helping the patient to walk faster b. Improving mental function c. Minimizing symptoms of bradykinesia d. Reducing some of the tremors ANS: D Benztropine is given to reduce rigidity and some of the tremors. It does not enhance walking or reduce bradykinesia or improve mental function. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: dm 317 TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 5. The nurse is preparing to administer a first dose of benztropine (Cogentin) to a patient diagnosed with parkinsonism. The nurse would notify the patients provider if the patient had a history of which condition? a. Asthma b. Glaucoma c. Hypertension d. Irritable bowel disease ANS: B Patients with a history of glaucoma should not take anticholinergic medications. Anticholinergics are not contraindicated in patients who have asthma, hypertension, or irritable bowel disease. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 317 TOP: NURSING PROCESS: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 6. The nurse is caring for a patient who is receiving trihexyphenidyl (Artane) to treat parkinsonism. The patient reports having a dry mouth, and the nurse notes a urine output of 300 mL in the past 8 hours. Which action will the nurse perform? a. Encourage increased oral fluids. b. Obtain an order for intravenous fluids. c. Report the urine output to the provider. d. Request an order for renal function tests. ANS: C Urinary retention can occur with anticholinergic medications. Dry mouth is a harmless side

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effect. The nurse should report the lower than expected urine output to the provider. Increasing fluid intake will not increase urine output in the patient with urinary retention. Renal function tests are not indicated since this is a neuromuscular problem of the bladder caused by the medication. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 317 TOP: NURSING PROCESS: Evaluation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 7. A nursing student asks the nurse why patients who have parkinsonism receive a combination of carbidopa and levodopa. The nurse will explain that the combination product a. allows larger doses of levodopa to be given without causing increased adverse reactions. b. causes more levodopa to be converted to dopamine before crossing the blood-brain barrier. c. eliminates almost all drug side effects of both levodopa and carbidopa. d. reduces peripheral side effects by inhibiting decarboxylase in the peripheral nervous system. ANS: D Without carbidopa, about 99% of levodopa is converted to dopamine before crossing the bloodbrain barrier, causing peripheral adverse effects. When carbidopa is added, the enzyme decarboxylase is inhibited, allowing levodopa to cross into the brain before being converted to the active metabolite dopamine. The result is less levodopa required to achieve the desired effect. The drug still has many side effects, but the peripheral effects are lessened. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: dm 317 TOP: NURSING PROCESS: N/A MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 8. Which antiviral medication improves symptoms of Parkinsons disease in some patients? a. Acyclovir (Zovirax) b. Amantadine HCl (Symmetrel) c. Interferon (INF) d. Zanamivir (Relenza) ANS: B Amantadine is an antiviral drug that acts on dopamine receptors and is sometimes used to treat Parkinsons disease (PD). The other drugs listed do not work for PD patients. DIF: COGNITIVE LEVEL: Remembering (Knowledge) REF: dm 318 TOP: NURSING PROCESS: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 9. A patient who has parkinsonism has been taking carbidopa-levodopa and has shown improvement in symptoms but develops dystonic movements, nausea, and vomiting. Which medication will the nurse expect the provider to order for this patient to replace carbidopalevodopa? a. Amantadine HCl (Symmetrel) b. Benztropine (Cogentin) c. Bromocriptine mesylate (Parlodel) d. Tacrine (Cognex) ANS: C Bromocriptine is often used for patients who do not tolerate carbidopa-levodopa. Amantadine is

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useful for treating Parkinsons disease but does not have sustained effects. Benztropine is given to reduce muscle rigidity and some tremors. Tacrine is used to treat Alzheimers disease. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: dm 318 TOP: NURSING PROCESS: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 10. A patient who has parkinsonism will begin taking selegiline HCl (Eldepryl) to treat symptoms. What information will the nurse include when teaching this patient about this drug? a. Avoid consuming foods that are high in tyramine. b. This drug will prevent the need to take levodopa. c. You may have red wine with dinner on occasion. d. You will not have serious drug interactions with this drug. ANS: A Selegiline (Eldepryl) inhibits monoamine oxidase-B, and it has similar adverse reactions to other monoamine oxidase inhibitors. Patients should be cautioned against consuming foods containing tyramine because of the risk of hypertensive crisis. Red wine is high in tyramine. Use of this drug may delay, but will not prevent, the need for levodopa. Severe adverse drug interactions may occur between this drug and tricyclic antidepressants. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 319 TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 11. A patient who has parkinsonism will begin taking carbidopa-levodopa. What information will the nurse include when teaching this patient about this medication? a. Call your health care provider immediately if your urine or perspiration turn a dark color. b. Rise slowly from your bed or your chair to avoid dizziness and falls. c. Take the drug with foods high in protein to improve drug delivery. d. Discontinue the drug if you experience insomnia. ANS: B Carbidopa-levodopa can cause orthostatic hypotension, so patients should be taught to take care when getting out of bed or a chair. Darkening of the urine and perspiration is a harmless side effect. Patients should take the drug with low-protein foods to improve drug transport to the CNS. Carbidopa-levodopa should not be discontinued abruptly because rebound parkinsonism may occur; insomnia is an expected adverse effect of the drug, and the patient should report this effect to his or her health care provider. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 317 TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 12. The nurse is teaching a patient who has Parkinsons disease about the side effects of carbidopa-levodopa. Which statement by the patient indicates a need for further teaching? a. I may experience urinary retention, dry mouth, and constipation. b. I may feel dizzy at first, but this side effect will go away with time. c. I should report nightmares and mental disturbances to my provider. d. I should take the drug with food to increase absorption. ANS: D

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Taking carbidopa-levodopa with food decreases absorption of the drug, although gastrointestinal distress may decrease when the medication is taken with food. Cholinergic side effects are common. Orthostatic hypotension occurs early and will resolve over time. Nightmares and mental disturbances should be reported. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 318 TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 13. A patient is taking entacapone (Comtan) along with carbidopa-levodopa to treat parkinsonism. The nurse notes that the patients urine is orange in color. The nurse will a. notify the provider of possible drug toxicity. b. reassure the patent that this is a harmless side effect. c. request an order for liver function tests. d. request an order for a urinalysis. ANS: B Entacapone can cause the urine to be dark yellow to orange. It does not indicate drug toxicity, liver effects, or changes in renal function. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 321 TOP: NURSING PROCESS: Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 14. The nurse is caring for an 80-year-old patient who has Alzheimers disease who will begin taking rivastigmine (Exelon). What will the nurse include in the plan of care for this patient? a. Administer the drug once daily. b. Assist the patient to stand and walk. c. Give the drug with food to increase absorption. d. Use nonsteroidal anti-inflammatory drugs (NSAIDs) instead of acetaminophen for pain. ANS: B Patients taking rivastigmine for Alzheimers disease are at risk for falls and loss of balance. Caregivers should assist with standing and walking. The drug is taken twice daily, and it should be taken on an empty stomach. NSAIDs increase gastrointestinal side effects. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 322 TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 15. The nurse is providing teaching for the family of a patient who has been newly diagnosed with Alzheimers disease (AD). Which statement by the family member indicates understanding of the teaching? a. Alzheimers disease is a chronic, progressive condition. b. Alzheimers disease affects memory but not personality. c. The onset of Alzheimers disease is usually between 65 and 75 years. d. With proper treatment, symptoms of this disease can be arrested. ANS: A AD is chronic and progressive, and there is no cure. It affects memory and personality. The onset is usually between 45 and 65 years. Symptoms cannot be arrested but may be slowed with treatment.

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DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 321 TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 16. The nurse is teaching a family member about an elderly parents new prescription for tacrine (Cognex) to treat Alzheimers disease (AD). The family member asks what to expect from this drug. The nurse will respond that the patient will a. demonstrate improved ambulation. b. have reversal of all symptoms. c. have decreased deterioration of cognition. d. show improved communication ability. ANS: C Tacrine can help to increase cognitive function for patients with mild to moderate AD. For the most part, drugs to treat AD do not result in improvement of symptoms but help slow the progress. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 324 TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 17. The nurse is helping to develop a plan of care for a patient who has advanced Alzheimers disease. The patient will be taking a new medication. Which is a realistic goal for this patient? a. Demonstrate improved cognitive function. b. Exhibit improved ability to provide self-care. c. Receive appropriate assistance for care needs. d. Show improved memory for recent events. ANS: C For the most part, drugs to treat AD do not result in improvement of symptoms but help slow the progress. The most realistic care plan for a patient with advanced AD is that they will receive appropriate and safe care. Chapter 9: Anxiolytic and Hypnotic Drugs MULTIPLE CHOICE 1. The nurse is caring for a patient who has begun taking chlorpromazine HCl (Thorazine) 75 mg BID to treat schizophrenia. A family member tells the nurse that the patients agitation, hallucinations, and delusional symptoms have improved, but the patient continues to withdraw from social interaction and wont bathe unless reminded to do so. The nurse will tell the family member that a. all symptoms will eventually resolve over time with this medication. b. the patient may need an increased dose of the antipsychotic medication. c. these results may indicate that the patient does not have schizophrenia. d. they should consider discussing adding another medication. ANS: D Chlorpromazine is a typical antipsychotic medication; drugs in this class manage positive symptoms rather than the negative symptoms of withdrawal and poor self-care. It is not likely

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that the negative symptoms will improve over time with this medication. Increasing the dose will not improve control of negative symptoms. This patient exhibits signs of schizophrenia. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 373 TOP: NURSING PROCESS: Nursing Intervention MSC: NCLEX: Psychosocial Integrity 2. The nurse is assessing a young adult patient with schizophrenia who recently began taking fluphenazine (Prolixin). The patient is exhibiting spasms of facial muscles along with grimacing, and the nurse notes upward eye movements. The nurse suspects which side effect? a. Acute dystonia b. Akathisia c. Pseudoparkinsonism d. Tardive dyskinesia ANS: A Acute dystonia can occur within days of taking typical antipsychotics, and facial muscle spasms, grimacing, and upward eye movements are characteristic of this side effect. Akathisia is characterized by restlessness, pacing, and difficulty standing still. Pseudoparkinsonism is characterized by stooped posture, pill-rolling, shuffling gait, and tremors at rest. Tardive dyskinesia manifests as protrusion and rolling of the tongue, smacking of the lips, and involuntary movement of the body and extremities. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: dm 375 TOP: NURSING PROCESS: Assessment/Evaluation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 3. The nurse is preparing to administer loxapine (Loxitane) 50 mg to a patient who has schizophrenia. The patient has been taking this medication twice daily for 15 months. The nurse notes smacking lip movements and involuntary movements of all extremities. Which action by the nurse is correct? a. Administer the medication as ordered to treat these symptoms of psychosis. b. Hold the dose and notify the provider of these medication adverse effects. c. Request an order for an anticholinergic medication such as benztropine (Cogentin). d. Suggest that the provider increase the dose to 125 mg twice daily. ANS: B Tardive dyskinesia manifests as protrusion and rolling of the tongue, smacking of the lips, and involuntary movement of the body and extremities and is a serious adverse effect of antipsychotic medications. The provider should be notified, so the drug can be stopped and a different medication ordered. These are not symptoms of psychosis. Anticholinergic medications are used to combat acute dystonia. Increasing the dose of this medication would only exacerbate these adverse effects. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 375 TOP: NURSING PROCESS: Assessment/Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 4. A patient who takes loxapine (Loxitane) to treat schizophrenia is noted to be restless and fidgety and is pacing around the room. The nurse caring for this patient will perform which action?

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a. Contact the provider to discuss changing to benztropine (Cogentin). b. Notify the provider of these symptoms and request an order for lorazepam (Ativan). c. Question the patient about adherence to the drug regimen. d. Recognize these signs of a serious adverse drug reaction and notify the provider. ANS: B The patient is exhibiting signs of akathisia and should be treated with an antianxiety drug. Benztropine is an anticholinergic used to combat acute dystonia side effects. These are not signs of psychosis, so it is not necessary to question whether or not the patient is taking the medication. These side effects are not as serious as those with tardive dyskinesia. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 375 TOP: NURSING PROCESS: Assessment/Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 5. A patient arrives in the emergency department with dehydration. The patient reports taking fluphenazine (Prolixin) to treat schizophrenia. The nurse notes rigid muscles and an altered mental status. The patient has a temperature of 103.6 F, a heart rate of 98 beats per minute, and a blood pressure of 90/58 mm Hg. The nurse will anticipate administering which medication? a. Dantrolene (Dantrium) b. Haloperidol (Haldol) c. Propranolol (Inderal) d. Tetrabenazine (Xenazine) ANS: A The patient is exhibiting signs of neuroleptic malignant syndrome. Muscle relaxants, such as dantrolene, are usually given. Haloperidol is used to treat psychosis. Propranolol is used for treating akathisia. Tetrabenazine is sometimes used to treat symptoms of tardive dyskinesia. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 372 TOP: NURSING PROCESS: Assessment/Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 6. The parent of a young adult who has schizophrenia is concerned that the patient spits out pills that are given. The nurse will suggest contacting the patients provider to discuss which intervention? a. Changing to a liquid form of the mediation b. Providing a home health nurse to supervise medication administration c. Teaching the patient the importance of taking the medication d. Weekly intramuscular injections of the medication ANS: A Noncompliance is common with antipsychotic medications. If patients spit out or hide pills, a liquid form can be used. A home health nurse is costly and unnecessary. Teaching the patient the importance of the medication is essential, but not always effective if the patient does not want to comply. Weekly intramuscular injections may be used if using the liquid form is not effective. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 373 TOP: NURSING PROCESS: Planning/Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

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7. The nurse is preparing to administer intramuscular haloperidol (Haldol) to a patient who has schizophrenia. What action will the nurse perform? a. Massage the site after injecting the medication to ensure complete absorption. b. Teach the patient to return every week to receive medication doses. c. Use a small bore needle when injecting the medication. d. Use the Z-track method and inject the medication into deep muscle tissue. ANS: D Haloperidol is a viscous liquid and should be injected deep into muscle tissue using a Z-track method. The injection site should not be massaged. Injections of long-term preparations of haloperidol are given every 2 to 4 weeks. Nurses should use a large-bore needle when injecting haloperidol. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 374 TOP: NURSING PROCESS: Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 8. The nurse is teaching a patient who will be discharged home on a typical antipsychotic medication to treat schizophrenia. Which statement by the patient indicates a need for further teaching? a. I should not drink alcohol while taking this medication. b. I should use a heating pad to treat muscle spasms while taking this medication. c. I should use sunscreen while taking this medication. d. I will need frequent blood tests while taking this medication. ANS: B Dystonia can cause muscle spasms and should be reported to the provider who can prescribe medications to treat this adverse effect. Patients should not drink alcohol, should use sunscreen, and will need close monitoring of lab values while taking these medications. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 372 TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 9. A patient who is about to begin taking the atypical antipsychotic medication clozapine (Clozaril) is concerned about side effects. What information will the nurse include when teaching the patient about this medication? a. You are more likely to experience dry mouth, constipation, and urinary retention. b. You may experience weight gain, drowsiness, and headaches. c. You will not experience extrapyramidal side effects with this medication. d. You will not need frequent lab work while taking this medication. ANS: B Weight gain, drowsiness, and headaches are common side effects of non-typical antipsychotic medications. Anticholinergic side effects are less likely than with typical antipsychotics. Extrapyramidal side effects can occur, even though they are less likely. Clozapine can cause agranulocytosis, so patients who are taking this drug require frequent monitoring. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: dm 378 TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

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10. A family member of a patient who has been taking fluphenazine (Prolixin) for 3 months calls to report that the patient is exhibiting agitation and restlessness. The nurse learns that the patients delusional thinking and hallucinations have stopped since taking the medication. The nurse will perform which action? a. Reassure the family member that tolerance to these side effects will subside over time. b. Remind the family member that complete drug effects may not occur for several more weeks. c. Suggest that the family member contact the provider to discuss an order for a benzodiazepine. d. Tell the family member to withhold the medication and notify the patients provider. ANS: C The patient is exhibiting signs of akathisia and should receive a benzodiazepine. Patients usually do not experience tolerance to these drug side effects. The patient is experiencing resolution of symptoms. Discontinuing antipsychotics abruptly may lead to withdrawal symptoms. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 380 TOP: NURSING PROCESS: Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 11. A patient has been taking risperidone (Risperdal) for 2 weeks. The patient reports drowsiness and headache. What will the nurse do? a. Counsel the patient to request changing to aripiprazole (Abilify). b. Reassure the patient that these are common side effects of the medication. c. Suggest that the patient have serum glucose testing. d. Suggest that these may be signs of agranulocytosis. ANS: B Drowsiness and headaches are common side effects of atypical antipsychotics. Changing to aripiprazole will not improve the symptoms, since this drug is in the same drug class. These symptoms do not indicate altered serum glucose levels or agranulocytosis. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 377 TOP: NURSING PROCESS: Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 12. The nurse is performing a medication history on a patient who reports taking lorazepam (Ativan) for the past 6 months to treat an anxiety disorder. The patient states that the medication is not working as well as previously. The nurse will a. contact the provider to discuss changing to another benzodiazepine. b. notify the provider and discuss increasing the dose of lorazepam. c. suspect worsening of the anxiety disorder. d. understand that the patient has developed tolerance to this drug. ANS: D It is recommended that benzodiazepines be prescribed no longer than 3 or 4 months since the effectiveness lessens after 4 months as patients develop tolerance to the drug. Changing to another benzodiazepine will not change this. Increasing the dose is not indicated. This does not indicate worsening of the underlying disorder. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 380 TOP: NURSING PROCESS: Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

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13. A patient who is taking chlorpromazine calls the clinic to report having reddish-brown urine. What action will the nurse take? a. Notify the provider and request orders for creatinine clearance and BUN levels. b. Reassure the patient that this is a harmless side effect of this medication. c. Tell the patient to come to the clinic for a urinalysis. d. Tell the patient to discard any drug on hand and request a new prescription. ANS: B Aliphatic phenothiazines, such as chlorpromazine, can cause a harmless pink or red-brown urine discoloration. There is no need to evaluate renal function with creatinine clearance, BUN, or urinalysis. The discoloration does not indicate that the medication has expired. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 380 TOP: NURSING PROCESS: Assessment/Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 14. A patient has begun taking buspirone hydrochloride (BuSpar) 7.5 mg twice daily to treat acute anxiety and calls 1 week later to report little change in symptoms. What will the nurse tell the patient? a. Therapeutic effects may not be evident for another week. b. The provider may need to increase the dose to 15 mg twice daily. c. Notify the provider and request an order for another anxiolytic. d. Stop taking the drug and notify the provider that it doesnt work. ANS: A Buspirone hydrochloride may not be effective until 1 to 2 weeks after continuous use. It is not necessary to increase the dose at this time. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 381 TOP: NURSING PROCESS: Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 15. A patient who is taking fluphenazine (Prolixin) to treat psychosis is experiencing symptoms of acute dystonia. While performing a medication history, the nurse learns that the patient takes herbal medications. Which herbal supplement would be of concern? a. Ginkgo b. Ginseng c. Kava kava d. St. Johns wort ANS: C Kava kava may increase the risk and severity of dystonia when taken with phenothiazines. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: dm 371 TOP: NURSING PROCESS: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 16. A patient is brought to the emergency department with decreased respirations and somnolence. The nurse notes a heart rate of 60 beats per minute and a blood pressure of 80/58 mm Hg. The patient is known to take alprazolam (Xanax) to treat anxiety. Which medication will the nurse anticipate the provider to order? a. Benztropine (Cogentin)

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b. Flumazenil (Romazicon) c. Lorazepam (Ativan) d. Propranolol (Inderal) ANS: B Flumazenil is the recommended benzodiazepine antagonist to treat overdose of benzodiazepines. This patient is unconscious and has bradycardia and hypotension, so the antagonist medication is indicated. Benztropine is an anticholinergic used to treat acute dystonia in patients taking phenothiazines. Lorazepam is a benzodiazepine and would only intensify the symptoms. Propranolol is a beta blocker used to treat akathisia in patients taking phenothiazines. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 384 TOP: NURSING PROCESS: Assessment/Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 17. A patient arrives in the emergency department complaining of difficulty breathing, dizziness, sweating, and heart palpitations. The patient reports having had similar episodes previously. The nurse will expect the provider to order which medication? a. Flumazenil (Romazicon) b. Haloperidol (Haldol) c. Lorazepam (Ativan) d. Propranolol (Inderal) ANS: C The patient is exhibiting signs of acute anxiety, so the anxiolytic lorazepam will be given. Flumazenil is a benzodiazepine antagonist, given for overdose of benzodiazepines. Haloperidol is given for acute psychosis. Propranolol is a beta blocker, used to treat akathisia in patients taking phenothiazines. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 381 TOP: NURSING PROCESS: Assessment/Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 18. The nurse is teaching a patient about taking an anxiolytic agent to treat grief-related anxiety. Which statement by the patient indicates understanding of the teaching? a. I may have wine with dinner to help with relaxation. b. I may need to take this medication for up to a year. c. I may stop taking the medication when my symptoms go away. d. I should try psychotherapy or a support group in addition to the medication. ANS: D Psychotherapy or support groups should be part of therapy, with anxiolytics added as needed. Patients taking anxiolytic medications should not consume alcohol. Anxiolytic medications are generally given for a maximum of 3 to 4 months. Patients should not stop the medications abruptly. Chapter 10: Antidepressants MULTIPLE CHOICE

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1. A nurse performs a medication history on a newly admitted patient. The patient reports taking amitriptyline (Elavil) 75 mg at bedtime for 6 weeks to treat depression. The patient reports having continued fatigue, lack of energy, and depressed mood. The nurse will contact the provider to discuss which intervention? a. Beginning to taper the amitriptyline b. Changing to a morning dose schedule c. Giving the amitriptyline twice daily d. Increasing the dose of amitriptyline ANS: A The response to tricyclic antidepressants (TCAs) should occur after 2 to 4 weeks of therapy. If there is no improvement at this time, the TCA should be gradually withdrawn and an SSRI prescribed. TCAs should never be stopped abruptly. TCAs cause fatigue and drowsiness, so they should be given at bedtime. Changing the dose or the dosing schedule are not indicated. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 387 TOP: NURSING PROCESS: Evaluation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 2. The nurse is teaching a patient who will begin taking doxepin (Sinequan) to treat depression. Which statement by the patient indicates a need for further teaching? a. I should expect results within 2 to 4 weeks. b. I should increase fluids and fiber while taking this medication. c. I should take care when rising from a sitting to standing position. d. I will take the medication in the morning before breakfast. ANS: D Tricyclic antidepressants (TCAs) should begin to show effects within 1 to 4 weeks. Tricyclic antidepressants are known to cause orthostatic hypotension and constipation, so patients should be counseled on how to minimize these effects. TCAs should be taken at bedtime because of their tendency to cause drowsiness. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 392 TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 3. A patient who is taking amitriptyline (Elavil) reports constipation and dry mouth. The nurse will give the patient which instruction? a. Increase fluid intake. b. Notify the provider. c. Request another antidepressant. d. Stop taking the medication immediately. ANS: A Constipation and dry mouth are common side effects of tricyclic antidepressants (TCAs), and patients should be taught to manage these symptoms. There is no need to notify the provider or to switch medications unless the side effects become too uncomfortable. Patients should not stop taking TCAs abruptly.

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DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 397 TOP: NURSING PROCESS: Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 4. A patient who has had a loss of interest in most activities, weight loss, and insomnia is diagnosed with a major depressive disorder and will begin taking fluoxetine (Prozac) daily. The patient asks about the weekly dosing that a family member follows. What will the nurse tell the patient about a weekly dosing regimen? a. It can be used after daily maintenance dosing proves effective and safe. b. It is used after a trial of tricyclic antidepressant medication fails. c. It is not effective for this type of depression and its symptoms. d. It will cause more adverse effects than daily dosing regimens. ANS: A Before weekly dosing is begun, the patient should respond to a daily maintenance dose of 20 mg/day without serious effects. It is not necessary to undergo a trial of tricyclic antidepressants (TCAs). Weekly dosing is used for this type of depression, and although it may have some adverse effects, these are not more common than with daily dosing. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 388 TOP: NURSING PROCESS: Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 5. A patient has been taking sertraline (Zoloft) 20 mg/mL oral concentrate, 1 mL daily for several weeks and reports being unable to sleep well. What will the nurse do next? a. Ask the patient what time of day the medication is taken. b. Counsel the patient to take the medication at bedtime. c. Recommend asking the provider about weekly dosing. d. Suggest that the patient request a lower dose. ANS: A Selective serotonin reuptake inhibitors (SSRIs) cause nervousness and insomnia. Patients can minimize these effects by taking the drug in the morning. The nurse should assess this with this patient. Taking the medication at bedtime will only increase the insomnia. Requesting a lower dose or changing to weekly dosing are not recommended. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: dm 392 TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 6. A patient has been taking paroxetine (Paxil) 20 mg per day for 2 weeks and reports headaches, nervousness, and poor appetite. Which action will the nurse take? a. Counsel the patient to take the medication with food. b. Reassure the patient that these side effects will decrease over time. c. Suggest that the patient discuss a lower dose with the provider. d. Tell the patient to stop taking the drug and contact the provider. ANS: B These are common side effects of SSRIs and will subside over time. Taking the medication with food will not affect these side effects. Lowering the dose is not indicated. Patients should not abruptly stop taking SSRIs.

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DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 388 TOP: NURSING PROCESS: Evaluation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 7. A patient who has been diagnosed with social anxiety disorder will begin taking venlafaxine (Effexor). The nurse who performs a medication and dietary history will be concerned about ingestion of which substance or drug? a. Coffee b. Grapefruit juice c. Oral hypoglycemic drug d. St. Johns wort ANS: D The concurrent interaction of venlafaxine and St. Johns wort may increase the risk of serotonin syndrome and neuroleptic malignant syndrome. Oral hypoglycemic drugs are concerning for patients who take lithium. Coffee and grapefruit juice is to be avoided by patients who take monoamine oxidase inhibitors DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 388 TOP: NURSING PROCESS: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 8. A male patient has been taking venlafaxine (Effexor) 37.5 mg daily for 2 weeks and reports ejaculation dysfunction and urinary retention. What action will the nurse take? a. Contact the provider to discuss decreasing the dose. b. Reassure the patient that these are common side effects. c. Report potential serious adverse effects to the provider. d. Withhold the dose until the provider is notified. ANS: B Venlafaxine can cause ejaculation dysfunction and urinary retention, and these side effects tend to be transient and treatable. Decreasing the dose is not indicated, and these are not serious adverse effects. Withholding the dose is not indicated. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 389 TOP: NURSING PROCESS: Evaluation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 9. A patient who has been taking a monoamine oxidase (MAO) inhibitor for several months will begin taking amoxapine (Asendin) instead of the MAO inhibitor. The nurse will counsel the patient to begin taking the amoxapine a. along with the MAO inhibitor for several months. b. at least 14 days after discontinuing the MAO inhibitor. c. the day after the last dose of the MAO inhibitor. d. while withdrawing the MAO inhibitor over several weeks. ANS: B Amoxapine is an atypical antidepressant that should not be taken with MAO inhibitors and should not be used within 14 days of taking an MAO inhibitor.

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DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: dm 389 TOP: NURSING PROCESS: Planning MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 10. A patient who has been diagnosed with depression asks why the provider has not ordered a monoamine oxidase (MAO) inhibitor to treat the disorder. The nurse will explain to the patient that MAO inhibitors a. are more expensive than other antidepressants. b. are no longer approved for treating depression. c. can cause profound hypotension. d. require strict dietary restrictions.ANS: D MAO inhibitors have many food and drug interactions that can be fatal, and patients must adhere to strict dietary restrictions while taking these drugs. They are not more expensive than the newer antidepressants. They remain approved for treating depression. MAO inhibitors cause profound hypertension. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: dm 389 TOP: NURSING PROCESS: Planning MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 11. A patient who takes a monoamine oxidase (MAO) inhibitor asks the nurse about taking overthe-counter medications to treat cold symptoms. Which medication will the nurse counsel the patient to avoid while taking an MAO inhibitor? a. Diphenhydramine b. Guaifenesin c. Pseudoephedrine d. Saline nasal spray ANS: C MAO inhibitors can cause hypertensive crises, which can be fatal when taken with sympathomimetic drugs such as pseudoephedrine. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 391 TOP: NURSING PROCESS: Planning MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 12. A patient who has a major depressive disorder has been taking fluoxetine (Prozac) 20 mg daily for 3 months and reports improved mood, less fatigue, and an increased ability to concentrate. The patients side effects have diminished. What will the nurse counsel this patient to discuss with the provider? a. Changing to once-weekly dosing b. Decreasing the dose to 10 mg daily c. Discontinuing the medication d. Increasing the dose to 30 mg daily ANS: A Once patients have demonstrated control of symptoms with decreased side effects on the maintenance dose of 20 mg daily, patients may begin once-weekly dosing. The 20-mg dose is

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maintenance dosing, so decreasing or increasing the dose is not indicated. Patients should not stop taking the medication abruptly. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 388 TOP: NURSING PROCESS: Planning MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 13. A patient who has been diagnosed with a major depression disorder has been ordered to take doxepin (Sinequan). The nurse will contact the provider if the patients medical history reveals a history of which condition? a. Asthma b. Glaucoma c. Hypertension d. Hypoglycemia ANS: B Antidepressants, such as doxepin, that cause anticholinergic-like symptoms are contraindicated if the patient has glaucoma. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 394 TOP: NURSING PROCESS: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 14. The nurse is preparing to administer a dose of lithium (Lithibid) to a patient who has been taking the drug as maintenance therapy to treat bipolar disorder. The nurse assesses the patient and notes tremors and confusion. The patients latest serum lithium level was 2 mEq/L. Which action will the nurse take? a. Administer the dose. b. Hold the dose and notify the provider. c. Request an order for a higher dose. d. Request an order for a lower dose. ANS: B The patient has symptoms of lithium toxicity, and the serum drug level is in toxic range. The nurse should hold the dose and notify the provider. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 396 TOP: NURSING PROCESS: Evaluation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 15. The nurse assesses a patient who is taking lithium (Lithibid) and notes a large output of clear, dilute urine. The nurse suspects which cause for this finding? a. Cardiovascular complications b. Expected lithium side effects c. Increased mania d. Lithium toxicity ANS: D An increased output of dilute urine is a sign of lithium toxicity.

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DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: dm 397 TOP: NURSING PROCESS: Evaluation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 16. The nurse provides teaching for a patient who will begin taking lithium (Lithibid). Which statement by the patient indicates understanding of the teaching? a. I may drink tea or cola but not coffee. b. I may stop taking the drug when mania symptoms subside. c. I should consume a sodium-restricted diet. d. I should drink 2 to 3 liters of fluid each day. ANS: D Patients taking lithium should be encouraged to maintain adequate fluid intake of 2 to 3 L/day initially and then 1 to 2 L/day as maintenance. Patients should not drink any caffeine-containing drinks, including tea and cola. Patients must continue taking lithium even when symptoms subside, or else symptoms will recur. It is not necessary to consume a sodium-restricted diet. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 397 TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 17. A patient who has recently begun taking lithium (Lithibid) calls the clinic to report nausea, vomiting, anorexia, and drowsiness. What will the nurse do next? a. Contact the provider to obtain an order for a serum lithium level. b. Reassure the patient that these symptoms are common and transient. c. Tell the patient that the lithium dose is probably too low. d. Tell the patient to stop taking the medication immediately. ANS: A Early symptoms of lithium toxicity include nausea and vomiting, anorexia, and drowsiness. The nurse should obtain an order for a lithium level to evaluate this. Patients should be encouraged to report these symptoms if they occur. Patients should never be counseled to stop the medication abruptly. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 397 TOP: NURSING PROCESS: Evaluation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 18. The nurse is preparing to administer paroxetine HCl (Paxil) to a 70-year-old patient. The nurse understands that this patient may require a. a decreased dose. b. an increased dose. c. every other day dosing. d. more frequent dosing. ANS: A Older adults usually need a lower dose of antidepressants. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: dm 392 TOP: NURSING PROCESS: Assessment/Planning MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

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19. A patient who has a history of migraine headaches is diagnosed with bipolar disorder. The nurse might expect the provider to order which medication for this patient? a. Carbamazapine (Tegretol) b. Divalproex (Valproate) c. Lamotrigine (Lamictal) d. Lithium citrate (Eskalith) ANS: B All of these medications may be used to treat bipolar disorder, but divalproex is also indicated for migraine prophylaxis. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: dm 394 TOP: NURSING PROCESS: Planning MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies MULTIPLE RESPONSE 1. The nurse is teaching a patient about foods to avoid when taking isocarboxazid (Marplan). Which foods will the nurse instruct the patient to avoid? (Select all that apply.) a. Bananas b. Bread c. Eggs d. Red wine e. Sausage f. Yogurt ANS: A, D, E, F Aged cheeses and wines are the chief foods that are prohibited. Any food containing tyramine, which has sympathomimetic effects, can cause a hypertensive crisis. This includes bananas, sausage, and yogurt. Chapter 11: Antipsychotic Drugs 1. A group of patients are being screened to see which patients would be the best candidate for a psychotherapeutic drug trial that helps people concentrate longer on activities. Which patient would be best suited for this trial? A)

A 28-year-old salesperson who alternates between overactivity and periods of depression

A 32-year-old hyperactive nursing student who cannot focus long enough to take a test

A 55-year-old physician who suddenly falls asleep during the day without warning

A 16-year-old youth who say he can make the light turn on by pointing at it and hears voices

Ans:

B Feedback:

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Attention-deficit disorders involve various conditions characterized by an inability to concentrate on one activity for longer than a few minutes. The nursing student needing accommodations has an attention-deficit disorder. The salesperson exhibits signs of mania, which are characterized by periods of extreme overactivity and excitement followed by extreme depression. The physician is experiencing narcolepsy, which is defined as daytime sleepiness and sudden periods of loss of wakefulness. The teenager is schizophrenic and is exhibiting paranoia, hallucinations, and delusions. 2. What nursing intervention is appropriate for a 70-year-old female patient receiving lithium? A)

Instruct the patient to use barrier contraceptives.

Monitor blood glucose levels.

Monitor fluid and sodium intake.

Encourage the patient to check daily for weight loss.

Ans:

C Feedback: Older patients, and especially those with renal impairment, should be encouraged to maintain adequate hydration and salt intake. Decreased dosages may also be necessary with the elderly. A 70-year-old patient would not be concerned about the use of contraceptives. These drugs alone do not affect glucose levels. Weight loss is usually not associated with lithium use.

3. A nurse is caring for a patient who is taking lithium for mania. The nurses assessment includes a notation of a lithium serum level of 2.4 mEq/L. The nurse anticipates seeing what? A)

Fine tremors of both hands

Slurred speech

Clonic movements

Nausea and vomiting

Ans:

C Feedback: Serum levels of 2 to 2.5 mEq/L may produce ataxia, clonic movements, possible seizures, and hypotension. Fine hand tremors, slurred speech, and nausea and vomiting are indicative of lithium levels less than 1.5 mEq/L.

4. The nurse administers chlorpromazine intramuscularly to the preoperative patient who is extremely anxious about surgery in the morning. What priority teaching point will the nurse provide this patient?

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Remain recumbent for at least 30 minutes after the injection.

Do not eat for 1 hour after the drug is administered.

Encourage fluids with the goal of 3,000 mL/d.

Avoid eating avocados and oranges when taking this medication.

Ans:

A Feedback: When giving a parenteral form of an antipsychotic, the patient should remain recumbent to decrease the risk of injury if orthostatic hypotension occurs. Eating after drug injection should not interfere with the drugs absorption and although adequate hydration should be maintained there is no need to increase fluid intake. Avocados and oranges are not contraindicated in patients receiving this medication.

5. The nurse is presenting an in-service at a childrens unit on hyperactivity. The nurse is told that a 6-year-old on the unit is being treated with methylphenidate (Ritalin). The presenting nurse talks about discharge teaching for this patient and the importance of monitoring what? A)

Long bone growth

Visual acuity

Weight and complete blood count

Urea and nitrogen levels

Ans:

C Feedback: Methylphenidate is associated with weight loss, bone marrow suppression, and cardiac arrhythmias. Weight, blood count, and cardiac function should be monitored regularly. The drug is not associated with renal dysfunction, visual changes, or growth retardation, so those values would not need to be regularly evaluated as part of drug therapy.

6. The nurse is caring for a patient taking an oral neuroleptic medication. What is the nurses priority assessment to monitor for? A)

Urge incontinence

Orthostatic hypotension

Bradycardia

Tardive dyskinesia

Ans:

D Feedback:

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The nurse would monitor for and teach the patient and family about tardive dyskinesias because it is such a common adverse effect with continued use of the drug. Oral neuroleptic agents do not cause urge incontinence, orthostatic hypotension, or bradycardia. 7. A psychotic patient is admitted through the emergency department. The physician has ordered chlorpromazine (Thorazine) 25 mg intramuscularly. After administration of the medication, what is the nurses priority to evaluate? A)

The patients ability to ambulate

Return of the patients appetite

A decrease in psychotic symptoms

Blood pressure and pulse

Ans:

C Feedback: The nurse will evaluate the effectiveness of the drug in diminishing psychotic symptoms because this is the purpose of administering the drug. Monitoring blood pressure, pulse, and appetite is part of all patient care but is not the priority evaluation criterion for this patient. The ability to ambulate and maintain adequate nutrition would be assessed but is not the priority evaluation for this patient.

8. A patient diagnosed with bipolar disorder is to be discharged home in 48 hours. The nurse has completed patient teaching regarding the use of lithium. What statement by the patient indicates an understanding of their responsibility? A)

I will increase my salt intake.

I will increase my fluid intake.

I will decrease my salt intake.

I will decrease my fluid intake.

Ans:

B Feedback: To maintain a therapeutic lithium level, the patient must increase fluids. A decrease in consumption of fluids can lead to toxicity. An increase in salt intake can lead to lithium excretion and a decrease in effectiveness. A decrease in salt intake can cause retention, also leading to toxicity. Adequate salt intake is necessary to keep serum levels in therapeutic range but need not be increased or decreased.

9. A patient has just been prescribed a phenothiazine. During patient teaching about this drug, what would be important for the nurse to tell the patient? A)

The urine can turn pink or reddish.

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The urine output will be decreased.

Diarrhea can be an adverse effect.

Hyperexcitability can occur.

Ans:

A Feedback: Phenothiazines can cause the urine to turn pink or reddish. The patient should be informed that this is a simple color change and is not caused by blood in his urine. Decreased urine output is not associated with this drug. Constipation is usually an adverse effect of the drug. Drowsiness, not hyperexcitability, can occur.

10. A patient, in the manic phase of bipolar disorder, is being discharged home on an antimanic drug. What antimanic drug is used for long-term maintenance of bipolar disorders? A)

Aripiprazole (Abilify)

Lamotrigine (Lamictal)

Quetiapine (Seroquel)

Ziprasidone (Geodon)

Ans:

B Feedback: Lamotrigine is used for long-term maintenance of bipolar disorders. Aripiprazole and ziprasidone are used for acute manic and mixed episodes of bipolar disorders. Quetiapine is used as adjunct or monotherapy for the treatment of manic episodes associated with bipolar disorder.

11. A 16-year-old youth has just been diagnosed with schizophrenia. The parents ask the nurse what causes schizophrenia. What would be the nurses best response? A)

Schizophrenia is caused by pain that the brain perceives.

Schizophrenia is thought to occur due to trauma experienced in childhood.

Schizophrenia is thought to reflect a fundamental biochemical abnormality.

Schizophrenia is caused by seizure activity in the brain.

Ans:

C Feedback: This disorder, which seems to have a very strong genetic association, may reflect a fundamental biochemical abnormality. Mental disorders are now thought to be caused by

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some inherent dysfunction within the brain that leads to abnormal thought processes and responses. Schizophrenia is not caused by pain, childhood trauma, or seizure activity. 12. A patient on chlorpromazine is feeling better and decides they no longer need their medication. The nurse teaches the patient that abrupt withdrawal of a typical antipsychotic medication can result in what? A)

Insomnia

Tardive dyskinesia

Somnolence

Constipation

Ans:

A Feedback: Sudden withdrawal can cause cholinergic effects such as diarrhea, gastritis, nausea, vomiting, dizziness, arrhythmias, drooling, and insomnia. Abrupt withdrawal of a typical antipsychotic generally does not cause tardive dyskinesia, somnolence, or constipation.

13. A patients medication has been changed to clozapine (Clozaril). The nurse evaluates this patient for which life-threatening adverse effect? A)

Renal insufficiency

Emphysema

Neuroleptic malignant syndrome

Cerebrovascular accident (CVA)

Ans:

C Feedback: Neuroleptic malignant syndrome can be a life-threatening adverse effect of atypical nonphenothiazines. Renal insufficiency, emphysema, and CVA are not commonly seen adverse effects of atypical non-phenothiazines.

14. The nurse is caring for an adolescent patient who began taking an antipsychotic drug last month to treat newly diagnosed schizophrenia. The drug has not been effective and the mother asks the nurse if this means the adolescents symptoms cannot be controlled by drugs. What is the nurses best response? A)

Patients commonly have to try different drugs until the most effective drug is identified.

Some patients do not respond to drugs and have to rely solely on behavior therapy.

Most likely your child was not taking the medication properly as prescribed.

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He may need to take multiple drugs before effects will be seen that control his symptoms.

Ans:

A Feedback: A patient who does not respond to one drug may react successfully to another agent. Responses may also vary because of cultural issues. The selection of a specific drug depends on the desired potency and patient tolerance of the associated adverse effects. It is not common to have a patient who does not demonstrate some improvement from medications so it would be incorrect to tell the mother the child wont respond to any drug after trying only one medication. There is no indication the drug was taken improperly and even properly administered drugs will not work on all patients. Multiple drug therapy is not indicated by the question.

15. Haloperidol is a typical antipsychotic drug. What adverse effect is associated with this drug? A)

Bradycardia

Bradypnea

Extrapyramidal effects

Hypoglycemia

Ans:

C Feedback: Haloperidol produces a relatively low incidence of hypotension and sedation and a high incidence of extrapyramidal effects. Haloperidol does not generally produce bradycardia, bradypnea, or hypoglycemia.

16. The pharmacology instructor is explaining to their class the difference between the typical and the atypical groups of antipsychotic drugs. What medication would the instructor explain to the students has fewer extrapyramidal effects and greater effectiveness than older antipsychotic drugs in relieving negative symptoms of schizophrenia? A)

Chlorpromazine (Thorazine)

Clozapine (Clozaril)

Thiothixene (Navane)

Haloperidol (Haldol)

Ans:

B Feedback:

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Advantages of clozapine include improvement of negative symptoms without causing the extrapyramidal effects associated with older antipsychotic drugs. Chlorpromazine is a typical antipsychotic, one of the older drugs, which does cause the extrapyramidal effects. Navane is part of the thioxanthene group of typical antipsychotics. This group of drugs has low sedative and hypotensive effects but can cause extrapyramidal effects. Haloperidol is a butyrophenone group drug used in psychiatric disorders. Usually, it produces a relatively low incidence of hypotension and sedation and a high incidence of extrapyramidal effects. 17. The nurse, providing teaching about a typical antipsychotic newly prescribed for the patient, cautions against use of alcohol with the drug by explaining it will have what effect? A)

Prolonged QT interval

Increased central nervous system (CNS) depression

Increased anticholinergic effects

Increased gastrointestinal (GI) adverse effects

Ans:

B Feedback: Antipsychoticalcohol combinations combinations result in an increased risk of CNS depression, and antipsychoticanticholinergic combinations lead to increased anticholinergic effects, so dosage adjustments are necessary. Patients should not take thioridazine or ziprasidone with any other drug associated with prolongation of the QT interval. Increase in GI adverse effects is not associated with concurrent use of alcohol.

18. The nurse is caring for four patients. Which patient would the nurse know that clozapine (Clozaril) is contraindicated for? A)

17-year-old adolescent

23-year-old with diabetes insipidus

32-year-old with osteoarthritis

45-year-old with bone marrow depression

Ans:

D Feedback: Clozapine is associated with bone marrow suppression, a life-threatening decrease in white blood cells. Because of their wide-ranging adverse effects, antipsychotic drugs may cause or aggravate various conditions. They should be used very cautiously in patients with liver damage, coronary artery disease, cerebrovascular disease, Parkinsonism, bone marrow depression, severe hypotension or hypertension, coma, or severely depressed states. Options A, B, and C are incorrect.

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19. The physician has ordered olanzapine (Zyprexa) for a new patient. What laboratory test should be done before administration of olanzapine? A)

Blood glucose

Urine specific gravity

Cholesterol

Hemoglobin and hematocrit

Ans:

A Feedback: Olanzapine has been associated with weight gain, hyperglycemia, and initiation or aggravation of diabetes mellitus. Other options are not necessary for patients taking olanzapine unless a secondary diagnosis indicates a need.

20. Parents bring a 15-year-old boy into the clinic. The parents tell the nurse that there is a family history of schizophrenia and they fear their son has developed the disease. What symptoms, if described by the family, would support their conclusion? A)

He hears and interacts with voices no one else can hear.

He is overactive and always so excitable.

He falls asleep in the middle of a sentence.

He cannot concentrate and his grades are suffering.

Ans:

A Feedback: Characteristics of schizophrenia include hallucinations, paranoia, delusions, speech abnormalities, and affective problems. Overactivity and excitement are associated with mania. Falling asleep suddenly describes narcolepsy. Difficulty concentrating and failing grades is associated with attention deficient disorders.

21. The patient taking an antipsychotic drug asks the nurse how long he will continue to feel the effects of the drug after stopping the medication. What is the nurses best response? A)

2 to 4 hours

2 to 4 weeks

2 to 4 months

6 months

Ans:

D Feedback:

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The antipsychotics are widely distributed in the tissues and are often stored there, being released for up to 6 months after the drug therapy has been stopped. 22. The nurse works on an inpatient mental health unit. When administering antipsychotic medications, what patient would the nurse expect to require a standard dosage? A)

African American adolescent diagnosed with schizophrenia

Malaysian middle adult diagnosed with bipolar disorder

Iranian older adult diagnosed with schizophrenia

Caucasian young adult diagnosed with bipolar disorder

Ans:

D Feedback: Only the Caucasian young adult has no indications for administering a smaller than usual dosage. African Americans respond more rapidly to antipsychotic medications and have a greater risk for development of disfiguring adverse effects, such as tardive dyskinesia. Consequently, these patients should be started off at the lowest possible dose and monitored closely. Patients in Asian countries (e.g., India, Turkey, Malaysia, China, Japan, Indonesia) receive lower doses of neuroleptics and lithium to achieve the same therapeutic response as seen in patients in the United States. Arab American patients metabolize antipsychotic medications more slowly than Asian Americans do and may require lower doses to achieve the same therapeutic effects as in Caucasians.

23. Psychosis is a severe mental illness characterized by what? A)

Disordered thought

Increased social interaction

Hypoactivity with aggressiveness

Paranoid hallucinations

Ans:

A Feedback: Antipsychotic drugs are used mainly for the treatment of psychosis, a severe mental disorder characterized by disordered thought processes; blunted or inappropriate emotional responses; bizarre behavior ranging from hypoactivity to hyperactivity with agitation, aggressiveness, hostility, and combativeness; social withdrawal in which a person pays less-than-normal attention to the environment and other people; deterioration from previous levels of occupational and social functioning (poor self-care and interpersonal skills); hallucinations; and paranoid delusions.

24. The nurse is caring for a patient newly diagnosed with schizophrenia. His parents say they have heard the term before but do not really understand exactly what schizophrenia means. How would the nurse describe the disorder? (Select all that apply.)

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Thought disorder

Difficulty functioning in society

Hallucinations can be auditory, visual, or sensory

Can be cured with the correct medications

Enter into fugue state in most cases

Ans:

A, B, C, D Feedback: Mental disorders are thought process disorders that may be caused by some inherent dysfunction within the brain. A psychosis is a thought disorder, and schizophrenia is the most common psychosis in which delusions and hallucinations are hallmarks. Hallucinations can be auditory, visual, or sensory. Patients diagnosed with schizophrenia have difficulty functioning in society. Schizophrenic patients do not generally go into fugue states and it certainly is not a common disorder.

25. A 7-year-old boy is admitted to the pediatric behavioral health unit with a diagnosis of an acute psychotic episode. Aripiprazole has been ordered. Before administering the medication, what is the nurses first priority? A)

Weigh the patient.

Obtain baseline vital signs.

Call the physician.

Administer the medication between meals.

Ans:

C Feedback: Of the antipsychotics, chlorpromazine, haloperidol, pimozide, prochlorperazine, risperidone, thioridazine, and trifluoperazine are the only ones with established pediatric regimens. Aripiprazole has dosages for children 13 to 17 years of age but would not be appropriate for a 7-year-old child. Weighing the patient and obtaining baseline vital signs is necessary assessment data but is not the first priority. There is nothing to indicate medications should be administered between meals.

26. The nurse admits a patient newly diagnosed with schizophrenia to the inpatient mental health unit. What is the priority reason for why the nurse includes the family when collecting the nursing history? A)

The patient may not be able to provide a coherent history.

The patient may not be able to speak due to reduced level of consciousness.

The family will feel better if they are included in the process.

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The patient will be less anxious if the family listens while he answers questions.

Ans:

A Feedback: Schizophrenia, the most common psychosis, is characterized by delusions, hallucinations, and inappropriate responses to stimuli. As a result, the patient may be unable to provide a coherent history and may be unaware of his behaviors considered dysfunctional. There is no reason to suspect the patient cannot speak and reducing anxiety is not the priority rationale for including family. While family is included in treatment, the goal is to treat the patient and not make the family feel better if actions were not in the patients best interests.

27. The nurse is teaching the soon-to-be-discharged patient, diagnosed with schizophrenia, about his medications. What is a priority teaching point for this patient? A)

The patient must eat three nutritious meals daily.

Over-the-counter medications may be taken with antipsychotic drugs.

Cough medicines potentiate the actions of antipsychotic drugs.

Alcohol consumption should be avoided.

Ans:

D Feedback: Alcohol consumption should be avoided because it increases the central nervous system (CNS) effects of the drug and may cause excessive drowsiness and decreased awareness of safety hazards in the environment. Some patients may find it easier and more effective to eat five small meals rather than three nutritious meals. While promoting good nutrition is good practice, it is not the priority. Drugdrug interactions with antipsychotic drugs are common so the nurse would teach the patient not to take any medication without consulting with the doctor or a pharmacist to make sure it is safe.

28. What antiepileptic medication might the nurse administer to treat bipolar disorder? A)

Apriprazole (Abilify)

Cyclobenzaprine (Flexeril)

Lamotrigine (Lamictal)

Temazepam (Restoril)

Ans:

C Feedback: Lamotrigine is an antiepileptic agent used for long-term maintenance of patients with bipolar disorders because it decreases occurrence of acute mood episodes. Apriprazole is

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an atypical antipsychotic and is not an antiepileptic medication. Flexeril is a muscle relaxant and Temazepam is a hypnotic agent. None of these medications are indicated for the treatment of bipolar disorder. 29. A patient, who is 77 years old, is admitted with a diagnosis of dementia. Haloperidol (Haldol) has been ordered for this patient. What nursing considerations would govern the nurses actions? (Select all that apply.) A)

It is classed as an atypical antipsychotic.

A lowered dosage is indicated for older adult.

It often has a hyperactive effect on patients.

It should not be used to control behavior with dementia.

It should only be given every other day.

Ans:

B, D Feedback: Haloperidol is classified as a typical antipsychotic with a high risk of extrapyramidal effects and lower risk for hypotension and sedation. Older patients may be more susceptible to the adverse effects of antipsychotic drugs. All dosages need to be reduced and patients monitored very closely for toxic effects and to provide safety measures if central nervous system effects do occur. They should not be used to control behavior with dementia. Haloperidol does not have a hyperactive effect on patients; it should not be given on an every-other-day schedule.

30. Which drug does not have a recommended pediatric dose? A)

Pimozide (Orap)

Lithium salts (Lithotabs)

Haloperidol (Haldol)

Risperidone (Risperdal)

Ans:

B Feedback: Lithium does not have a recommended pediatric dose; the drug should not be administered to children younger than 12 years old. Pimozide, haloperidol, and risperidone all have recommended pediatric doses.

31. The mother of a child diagnosed with attention-deficit syndrome receives a prescription for a central nervous system (CNS) stimulant to treat her child. The mother asks the nurse, I dont understand why were giving a stimulant to calm him down? What is the nurses best response to this mother?

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It helps the reticular activating system (RAS), a part of the brain, to be more selective in response to incoming stimuli.

It helps energize the child so they use up all of their available energy and then they can focus on quieter stimuli.

No one truly understands why it works but it has been demonstrated to be very effective in treating ADHD.

The drugs work really well and you will see a tremendous change in your child within a few weeks without any other treatment.

Ans:

A Feedback: The paradoxical effect of calming hyperexcitability through CNS stimulation seen in attention-deficit syndrome is believed to be related to increased stimulation of an immature RAS, which leads to the ability to be more selective in response to incoming stimuli. CNS stimulants do not cause the child to use all his energy, the effect is thought to be understood, and telling the mother the drug just works without any explanation is not appropriate and may result in noncompliance with pharmacology therapy if the mother does not understand why the drug is given.

32. The nurse is teaching the mother of a child diagnosed with attention-deficit hyperactivity disorder how to administer methylphenidate (Ritalin). When would the nurse instruct the mother to administer this drug? A)

Administer at lunch every day.

Administer at breakfast every day.

Administer at dinner every day.

Administer at bedtime.

Ans:

B Feedback: Several long-acting formulations of methylphenidate have become available that allow the drug to be given only once a day. It should always be given in the morning because administration at dinnertime or bedtime could result in insomnia.

33. A child was diagnosed with attention-deficit hyperactivity disorder and methylphenidate was prescribed for treatment to be taken once a day in a sustained release form. On future visits what is a priority nursing assessment for this child? A)

Weight and height

Breath sounds and respiratory rate

Urine output and kidney function

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Electrocardiogram (ECG) and echocardiogram

Ans:

A Feedback: The nurse needs to carefully track this childs weight and height because the drug can cause weight loss, anorexia, and nausea that could result in slowed or absent growth. There would be no need to monitor breath sounds, respiratory rate, urine output, and kidney function. Although arrhythmias may occur as an adverse effect necessitating an ECG, there is no need to perform echocardiograms.

34. The nurse is preparing to administer methylphenidate to the child admitted to the pediatric unit after breaking a leg when jumping off the garage roof at home. Where will the nurse find the medication? A)

In the patients drawer

In the refrigerator

At the patients bedside

In the controlled substance cabinet

Ans:

D Feedback: Methylphenidate is a controlled medication due to risk for physical and psychological dependence. As a result, the drug would be found in the controlled substance cabinet.

35. The nurse is caring for a child receiving a central nervous system (CNS) stimulant who was admitted to the pediatric intensive care unit following repeated seizures after a closed head injury. The physician orders phenytoin to control seizures and lorazepam to be administered every time the child has a seizure. What is the nurses priority action? A)

Call the doctor and question the administration of phenytoin.

Call the doctor and question the administration of lorazepam.

Wait 24 hours before beginning to administer phenytoin.

Wait 24 hours before beginning to administer lorazepam.

Ans:

A Feedback: The combination of CNS stimulants with phenytoin leads to a risk of increased drug levels. Patients who receive such a combination should be monitored for toxicity. There is no contraindication for use of lorazepam.

Chapter 12: Drugs for Epilepsy

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MULTIPLE CHOICE 1. A patient is diagnosed with epilepsy and asks the nurse what may have caused this condition. The nurse explains that epilepsy is most often a. caused by head trauma. b. idiopathic in origin. c. linked to a stroke. d. related to brain anoxia. ANS: B Of all seizure cases, 75% are primary, or idiopathic, with no known cause. The remaining are secondary and may be related to head trauma, stroke, or anoxic events. DIF: COGNITIVE LEVEL: Remembering (Knowledge) REF: dm 304 TOP: NURSING PROCESS: Assessment MSC: NCLEX: Physiological Integrity: Pathophysiology 2. A patient who has epilepsy will begin an anticonvulsant medication. The patient asks the nurse how long the medication will be necessary. How will the nurse respond? a. The medication is usually taken for a lifetime. b. The medication will be given until you are seizure-free. c. You will need to take the medication for 3 to 5 years. d. You will take the medication as needed for seizure activity. ANS: A Anticonvulsants are given to prevent seizures and are usually taken throughout the patients lifetime. Stopping the medication will lead to recurrence of seizures in most patients. Some patients may attempt to stop taking the medications after 3 to 5 years of no seizure activity. Anticonvulsants are not given as needed. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 305 TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 3. The nurse is providing teaching to the parents of a 5-year-old child who will begin taking phenytoin (Dilantin). What information will the nurse include when teaching these parents about their childs medication? a. Drug interactions are uncommon with phenytoin. b. There are very few side effects associated with this drug. c. The therapeutic range of phenytoin is between 15 and 30 mcg/mL. d. Your child may need a higher dose than expected. ANS: D Drug dosage for phenytoin is age-related and children, who have a rapid metabolism, may need higher doses than those used for newborns and adults. Phenytoin has many drug interactions and many side effects. The therapeutic range is 10-20 mcg/mL. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 306 TOP: NURSING PROCESS: Planning/Nursing Intervention: Patient Teaching MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

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4. The nurse is caring for a patient who has a seizure disorder. The nurse notes that the patient has reddened gums that bleed when oral care is given. The nurse recognizes this finding as a. an adverse effect of the phenytoin. b. a drug interaction with aspirin. c. a symptom of hepatotoxicity. d. a sign of poor self-care. ANS: A Hydantoins commonly cause gingival hyperplasia, which causes overgrowth of reddened gum tissue that bleeds easily. It is not a sign of a drug interaction or a symptom of hepatotoxicity. It does not indicate a lack of self-care. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 306 TOP: NURSING PROCESS: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 5. The nurse is preparing to administer phenytoin (Dilantin) to a patient who has a seizure disorder. The patient appears drowsy, and the nurse notes that the last random serum drug level was 18 mcg/mL. What action will the nurse take? a. Administer the dose since the patient is not toxic. b. Contact the provider to discuss decreasing the phenytoin dose. c. Give the drug and monitor closely for adverse effects. d. Report drug toxicity to the providers. ANS: A Drowsiness is a common side effect of phenytoin and is not cause for alarm. The patients drug level is normal, since 10-20 mcg/mL is the therapeutic range. The nurse should administer the dose. It is not necessary to decrease the dose or monitor the patient more closely than usual. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 306 TOP: NURSING PROCESS: Evaluation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 6. The nurse is preparing to administer phenytoin to an 80-year-old patient and notes the following order: IVP phenytoin 50 mg. The nurse will perform which action? a. Administer the undiluted drug through a Y-tube over two minutes. b. Contact the provider to question the route and the dose. c. Dilute the drug in dextrose solution and infuse over 15 to 20 minutes. d. Request an order to administer the drug intramuscularly. ANS: A Intravenous phenytoin should be administered undiluted through a 3-way stopcock or Y-tubing. In older patients it should be infused at a rate of 25 mcg/min. The dose and the route are appropriate. Phenytoin will precipitate in dextrose solution. Intramuscular injection is very irritating to tissues and is not used. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 306 TOP: NURSING PROCESS: Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 7. The nurse is preparing to assist with blood collection on a newly admitted patient who has been taking phenytoin for several years. The provider has ordered a complete blood count and

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liver function tests. Which other blood test will the nurse discuss with the provider? a. Blood glucose b. Coagulation studies c. Renal function tests d. Serum electrolytes ANS: A Patients who have taken hydantoins for long periods might have an elevated blood sugar. The nurse should discuss this test with the provider. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 306 TOP: NURSING PROCESS: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 8. A patient who takes phenytoin reports regular alcohol consumption. The nurse might expect a serum phenytoin level in this patient to be in which range? a. 5 to 10 mcg/mL b. 10 to 20 mcg/mL c. 20 to 30 mcg/mL d. 30 to 50 mcg/mL ANS: A Chronic ingestion of alcohol increases hydantoin metabolism, which would decrease serum drug levels. The therapeutic range is 10 to 20 mcg/mL, so a level lower than this may be expected in patients who consume alcohol regularly. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 306 TOP: NURSING PROCESS: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 9. A patient has recently begun taking phenytoin (Dilantin) for a seizure disorder. The nurse notes a reddish-brown color to the patients urine. Which action will the nurse take? a. Ask the provider to order a serum drug level. b. Reassure the patient that this is a harmless side effect. c. Report possible thrombocytopenia to the provider. d. Request an order for a urinalysis and creatinine clearance. ANS: B Reddish-brown urine is a harmless side effect of phenytoin. The nurse should reassure the patient. It is not necessary to order a serum drug level or renal function studies. It is not a symptom of thrombocytopenia. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 307 TOP: NURSING PROCESS: Evaluation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 10. A female patient who takes phenytoin for epilepsy becomes pregnant. The nurse will notify the patients provider and will anticipate that the provider will take which action? a. Add valproic acid (Depakote) for improved seizure control. b. Change the medication to phenobarbital (Luminal). c. Closely monitor this patients serum phenytoin levels. d. Discontinue all anticonvulsant medications.

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ANS: B Phenytoin has serious teratogenic effects, so women who are pregnant should not take it. Phenobarbital is typically used because possible teratogenic effects are less pronounced. Teratogenicity increases with multiple anticonvulsants. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 306 TOP: NURSING PROCESS: Planning MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 11. The nurse is caring for a patient who has been diagnosed with petit mal seizures. The nurse will anticipate teaching this patient about which antiepileptic medication? a. Carbamazepine (Tegretol) b. Ethosuximide (Zarontin) c. Phenobarbital (Luminal) d. Phenytoin (Dilantin) ANS: B Ethosuximide is used to treat petit mal seizures. The other drugs are not used to treat petit mal seizures. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 307 TOP: NURSING PROCESS: Planning MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 12. An intubated child is brought to the emergency department while having a seizure that has been progressing for 20 minutes. Which drug will the nurse anticipate administering to this patient? a. Diazepam (Valium) b. Phenobarbital (Luminal) c. Phenytoin (Dilantin) d. Valproic acid (Depakote) ANS: A Diazepam is given to patients in status epilepticus and is administered IV. The other anticonvulsant medications do not have a rapid onset and are not used for emergencies. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 307 TOP: NURSING PROCESS: Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 13. A patient will begin taking the antiepileptic drug ethosuximide (Zarontin) and asks the nurse whether to take the drug with or without food. The nurse will counsel the patient to take this medication a. at bedtime. b. 1 hour before meals. c. 2 hours after meals. d. with meals. ANS: D Gastric irritation is common with ethosuximide, so patients should be counseled to take it with food. It is given twice daily.

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DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 309 TOP: NURSING PROCESS: Planning/Nursing Intervention: Patient Teaching MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 14. A patient has recently begun taking carbamazepine (Tegretol) as an adjunct medication to treat refractory seizures. The patient has a serum carbamazepine level of 18 mcg/mL. What action will the nurse take? a. Ask the patient about usual dietary preferences. b. Reassure the patient that this is a therapeutic drug level. c. Report a subtherapeutic drug dose to the provider. d. Suspect a drug-drug interaction. ANS: A This patients carbamazepine level is high. When taken with grapefruit juice, an interaction may occur that causes toxicity. The nurse should question the patient about food and fluid preferences. The therapeutic level is 5 to 12 mcg/mL. This is a toxic level, not subtherapeutic. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 308 TOP: NURSING PROCESS: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 15. The nurse is performing a health history on a patient who is ordered to begin therapy with valproic acid (Depakote) to treat epilepsy. Which aspect of the patients medical history will cause the nurse to be concerned? a. Chronic obstructive pulmonary disease b. Gastrointestinal disease c. Liver disease d. Renal disease ANS: C Valproic acid can elevate liver enzymes. Patients with a history of liver disease should be monitored closely while taking this drug. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 308 TOP: NURSING PROCESS: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 16. A woman who is pregnant is taking an anticonvulsant medication to treat a seizure disorder. The nurse will ensure that the patient takes which dietary supplement toward the end of her pregnancy? a. Folate (folic acid) b. Iron c. Vitamin C d. Vitamin K ANS: D Anticonvulsants act as inhibitors of vitamin K and can contribute to hemorrhage in infants shortly after birth. Women taking these drugs should receive vitamin K within the last week to 10 days of their pregnancies.

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DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: dm 308 TOP: NURSING PROCESS: Planning MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 17. A parent expresses concern that a 5-year-old child may develop epilepsy because the child experienced a febrile seizure at age 18 months. What will the nurse tell this parent? a. A child who has had a febrile seizure is considered to have epilepsy. b. A small percentage of children who have febrile seizures develop epilepsy. c. I recommend discussing prophylactic anticonvulsant drugs with the provider. d. Treat fevers aggressively with aspirin and NSAIDs to prevent seizures. ANS: B Epilepsy develops in 2.5% of children who have one or more febrile seizures. One febrile seizure does not cause a diagnosis of epilepsy. Prophylactic anticonvulsants are given to high-risk patients. Children should not receive aspirin for fever because of the risk of Reyes syndrome. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 308 TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 18. A 25 year-old female patient will begin taking phenytoin for epilepsy. The patient tells the nurse she is taking oral contraceptives (OCPs). Which response will the nurse give? a. Continue taking OCPs because phenytoin is not safe during pregnancy. b. You should use a backup method of contraception along with OCPs. c. You should stop taking OCPs because of drug-drug interactions with phenytoin. d. You should take low-dose aspirin while taking these medications to reduce your risk of stroke. ANS: B Female patients who take oral contraceptives and anticonvulsants should be advised to use a backup method of contraception because of reduced effectiveness of OCPs. Patients should be cautioned to consult with a provider if considering pregnancy because of the teratogenic effects of anticonvulsants. Patients should not stop taking OCPs and do not need to take precautions against stroke. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 311 TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 19. The nurse provides teaching for a patient who will begin taking phenytoin. Which statement by the patient indicates understanding of the teaching? a. If I develop a rash, I should take diphenhydramine to control the itching. b. If I experience bleeding gums, I should stop taking the medication immediately. c. I may develop diabetes while I am taking this medication. d. I should not be alarmed if my urine turns reddish-brown. ANS: D Phenytoin will cause reddish-brown colored urine. Patients should be counseled to report a rash to the provider because it could be a serious adverse reaction. Bleeding gums are common, but patients should never stop taking anticonvulsants abruptly, or they may develop seizures. Changes in blood glucose may occur but do not necessarily result in diabetes.

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DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 307 TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 20. A parent of a child who has been taking valproic acid (Depakote) for several years calls the clinic to report a recent recurrence of seizures and states that the child is having 3 or 4 seizuresper week. The nurse will perform which action? a. Ask the parent about to describe the childs drug regimen. b. Request an order for a serum valproic acid level. c. Suggest that the parent take the child to the emergency department. d. Tell the parent that the provider will increase the childs dose of Depakote. ANS: A Questions pertaining to medication adherence are a no-cost, non-invasive way of troubleshooting cause of decreased drug effect. The serum drug level will be assessed next. Children may need changes in doses as they grow. The child is not in status epilepticus so does not need to go to the emergency department. The dose will not be increased until the serum drug level is known. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 308 TOP: NURSING PROCESS: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 21. A pregnant woman who is in labor has a blood pressure of 189/110 mm Hg and exhibits muscle contractions followed by jerking of her arms and legs. The nurse will prepare to administer which medication to this patient? a. Carbamazepine (Tegretol) b. Diazepam (Valium) c. Magnesium sulfate d. Phenobarbital (Luminal) ANS: C Magnesium sulfate is used to control seizures during eclampsia. Chapter 13: Anesthetics 1. To decrease sympathetic stimulation in balanced anesthesia type of what agent would be used? A)

Antihistamines

Antiemetics

Narcotics

Sedative-hypnotics

Ans:

D Feedback:

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Sedative-hypnotics relax the patient, facilitate amnesia, and decrease sympathetic stimulation. Antihistamines decrease the chance of allergic reaction and help dry secretions. Antiemetics decrease the nausea and vomiting associated with gastrointestinal (GI) depression. Narcotics aid in the analgesic and sedative effects. 2. During what stage of anesthesia would the nurse see the patients skeletal muscles relax and return of regular respirations? A)

Stage 1: Analgesia stage

Stage 2: Excitement stage

Stage 3: Surgical anesthesia stage

Stage 4: Medullary paralysis

Ans:

C Feedback: Stage 3 is surgical anesthesia, which involves relaxation of skeletal muscles and return of regular respirations. During this stage, eye reflexes and pupil dilation are progressively lost. Surgery can be safely performed in this stage. Stage 1 refers to the loss of pain sensation; stage 2 involves a period of excitement with sympathetic stimulation (e.g., tachycardia, increased respirations, blood pressure changes); and stage 4 involves deep central nervous system depression with loss of respiratory and vasomotor center stimuli. Death can occur rapidly at this stage if adequate support is not supplied.

3. The nurse is developing a plan of care for the patient undergoing general anesthesia. What is a priority of care for this patient? A)

Encourage clear fluids.

Increase oxygen.

Reassure the patient that about safety.

Maintain regular repositioning.

Ans:

D Feedback: The patient would need to be moved or turned periodically to prevent skin breakdown and the formation of decubitus ulcers if the surgery lasted longer than an hour. Muscle paralysis resulting from the medications used in general anesthesia would prevent the patient from shifting himself or herself to relieve increase pressure. A patient receiving a general anesthetic would be unconscious, require respiratory support, and be connected to a mechanical ventilator to maintain respirations. Increased oxygen would not be indicated unless oxygen levels were less than adequate, and the patient would not receive anything by mouth eliminating option A. Reassurance would not be necessary for the unconscious patient.

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4. A plan of care formulated by an operating room (OR) nurse includes four nursing diagnoses. Which diagnoses will the nurse include that is directly related to safety? A)

Deficient knowledge regarding drug therapy

Disturbed sensory perception (kinesthetic, tactile) related to anesthesia

Risk for impaired skin integrity related to immobility

Risk for injury related to central nervous system (CNS) depressive effects of drugs

Ans:

D Feedback: The nursing diagnosis, which directly relates to safety, is high risk for injury. The other three options are only indirectly related to safety. While in the OR, the patient under general anesthetic is unable to express safety concerns and must rely completely on the surgeon and OR staff for protection.

5. What nursing interventions would help minimize the risk of a headache in a patient recovering from spinal anesthesia? A)

Administer a triptan intramuscularly.

Administer morphine intravenously.

Maintain patient in recumbent position.

Place patient in Trendelenburg position.

Ans:

C Feedback: Patients receiving spinal anesthesia should remain in a recumbent position for as long as 12 hours. Triptan would not be effective because it is indicated for treatment of migraine headaches. Morphine would treat the headache but would not prevent it.

6. An extremely anxious patient is beginning to awaken in the postanesthesia care unit. He or she states that his or her arms and legs feel like tree trunks and that they are hard to move. He or she also complains that his or her head feels fuzzy and that the right words will not come to his or her. What is the priority nursing intervention for this patient? A)

Provide analgesic medication for the discomfort.

Stay with patient as much as possible and provide reassurance.

Provide fluids to increase his or her wakefulness.

Encourage the patient to turn from side to side periodically.

Ans:

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Feedback: Most patients are disoriented and confused when awaking from anesthesia. It would be most important for the nurse to be with the patient as much as possible and reassure the patient that everything is as expected. Providing pain medication is important and may be needed during recovery if the patient reports pain, but would not be useful in treating the reported symptoms. The nurse would not provide fluids to patients immediately after surgery until ensuring the swallow reflex has returned and bowel motility has resumed. The nurse will help the patient turn from side to side, but this is not the priority nursing action at this time. However, the most effective nursing action for anxious postoperative patients is for the nurse to stay with them as much as possible. 7. The patient appears awake but is unconscious and has no response to painful stimuli. What medication does the nurse suspect this patient has received? A)

Thiopental (Pentothal)

Midazolam (Generic)

Ketamine (Ketalar)

Propofol (Diprivan)

Ans:

C Feedback: Ketamine has been associated with a bizarre state of unconsciousness in which the patient appears to be awake but is unconscious and cannot feel pain. This drug, which causes sympathetic stimulation with increase in blood pressure and heart rate, may be helpful in situations when cardiac depression is dangerous. Thiopental is a barbiturate anesthetic. Midazolam and propofol are nonbarbiturate anesthetics. None of these medications have this type of effect.

8. Which nonbarbiturate anesthetic when used with halothane (Fluothane) can cause severe cardiac depression? A)

Droperidol (Inapsine)

Etomidate (Amidate)

Ketamine (Ketalar)

Propofol (Diprivan)

Ans:

C Feedback: If ketamine and halothane are used in combination, severe cardiac depression with hypotension and bradycardia may occur. Use of droperidol, etomidate, and propofol with halothane should not be a concern.

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9. The operating room nurse is developing the care plan for a 10-year-old child with asthma who is scheduled for a tonsillectomy and who will receive halothane as the anesthetic agent. Why is this an appropriate drug for this patient? A)

Halothane is metabolized in the liver.

Halothane dilates the bronchi.

Halothane is excreted unchanged in the urine.

Halothane causes an accumulation of secretions.

Ans:

B Feedback: Halothane is of particular benefit to a child with asthma because it dilates bronchi. Halothane is inhaled drug so it is not metabolized in the liver or excreted in the urine. It does not cause an accumulation of secretions.

10. The nurse should recognize what drug is classified as an amide local anesthetic? A)

Lidocaine (Xylocaine)

Benzocaine (Dermoplast)

Chloroprocaine (Nesacaine)

Tetracaine (Pontocaine)

Ans:

A Feedback: Lidocaine is an example of an amide anesthetic. Benzocaine, chloroprocaine, and tetracaine are ester anesthetics.

11. A 21-year-old patient is positioned on the operating room table in preparation for knee surgery. After the anesthesiologist induces the patient, what is the next phase of anesthesia? A)

Induction

Maintenance

Recovery

Medullary paralysis

Ans:

D Feedback: Induction is the period from the beginning of anesthesia until stage 3, or surgical anesthesia, is reached. After induction comes the maintenance phase from stage 3 until

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the surgical procedure is complete. A slower, more predictable anesthetic, such as a gas anesthetic, may be used to maintain the anesthesia after the patient is in stage 3. This is followed by the recovery period that begins with the discontinuation of anesthesia. Medullary paralysis is the depth of anesthesia known as stage 4. Option C is a distracter. 12. The nurse is collecting a nursing history from a preoperative patient who is to receive local anesthesia. While taking the admission history, the patient says she is allergic to lidocaine. What is the nurses priority action? A)

Notify the anesthesiologist.

Cancel the surgery.

Notify the surgeon.

Tell the perioperative nurse.

Ans:

A Feedback: The priority action is to inform the anesthesiologist who will administer the anesthetic because local anesthesia often involves use of lidocaine. It is not within the nurses scope of practice to cancel surgery. Notifying the surgeon and the perioperative nurse is appropriate but is not the priority of care.

13. The nurse is caring for a patient in stage 2 of general anesthesia. What is the care priority for this patient? A)

Rub the patients back.

Monitor vital signs.

Provide eye care.

Reposition the patient.

Ans:

B Feedback: Stage 2, the excitement stage, is a period of excitement and often combative behavior, with many signs of sympathetic stimulation (e.g., tachycardia, increased respirations, blood pressure changes). Monitoring vital signs can be lifesaving at this stage. Eye care is important in stages 3 and 4. Rubbing the patients back and repositioning the patient are not indicated in this stage of anesthesia.

14. The patient received midazolam in combination with an inhaled anesthetic and a narcotic during surgery. The postanesthesia care unit (PACU) nurse anticipates this combination of drugs will have what impact on the patients stay in the unit? A)

Increased use of medications to offset adverse effects

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Extended time needed in the unit

Decreased nursing support needed

Increased analgesics needed

Ans:

B Feedback: Midazolam is associated with increased toxicity and length of recovery when used in combination with inhaled anesthetics, other central nervous system depressants, narcotics, propofol, or thiopental. Because this patient received both narcotics and inhaled anesthetics, the nurse will anticipate this patients time in the PACU will be extended. The patient is likely to need fewer analgesics because it will take longer for the patient to wake from anesthesia, which will also mean fewer medications will be used. Until the patient is awake, he or she will need continuous nursing support.

15. The nurse is caring for a patient in the emergency department with a 2-inch laceration to the left arm caused by broken glass. The nurse suspects the local anesthetic will be administered by what method? A)

Topical Administration

Infiltration

Field block

Nerve block

Ans:

B Feedback: Infiltration local anesthesia involves injecting the anesthetic directly into the tissues to be treated (e.g., sutured, drilled, cut). This injection brings the anesthetic into contact with the nerve endings in the area and prevents them from transmitting nerve impulses to the brain. Topical administration would not be absorbed deeply enough to prevent pain. Field block would be used in a larger area (e.g., the entire area required surgical repair). Nerve block would anesthetize a far larger area than is required for 2-inch laceration.

16. A nurse is caring for a patient who received thiopental as an anesthetic agent during surgery. What adverse effects would the nurse attribute to the medication? A)

Tachycardia

Urinary retention

Tachypnea

Headache

Ans:

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Feedback: Adverse effects of thiopental include emergence delirium, headache, restlessness, anxiety, cardiovascular depression, respiratory depression, apnea, salivation, hiccups, and rashes. Tachycardia, tachypnea, and urinary retention are not usually associated with this drug. 17. The nurse is caring for a patient who will receive an epidural block. What procedure is this patient likely to be having? A)

Rhinoplasty

Inguinal hernia repair

Removal of a brain tumor

Closed reduction of the right humerus

Ans:

B Feedback: Nerve block is a method of administering local anesthesia by injecting the anesthetic at some point along the nerve or nerves that run to and from the region in which the loss of pain sensation or muscle paralysis is desired. Several types of nerve blocks are possible. Epidural anesthesia is an injection of the drug into the epidural space where the nerves emerge from the spinal cord. As a result, only an inguinal hernia repair would be an appropriate procedure for administering an epidural. Surgery performed about the spinal cord, such as surgery on the nose or brain, could not be anesthetized by injection of medication into the spinal cord. Closed reduction of the right humerus would not be performed using a local anesthetic.

18. The operating room nurse is taking the patient into the operating room when the patient says his grandmother almost died from a high fever in surgery 15 years ago. The nurse shares this information with the surgical team, recognizing this information indicates the patient is at risk for what? A)

An allergic reaction to anesthesia

Malignant hyperthermia

Anxiety

Hypothermia

Ans:

B Feedback: The nurse assesses for a personal or family history of malignant hyperthermia, which may be triggered by the use of general anesthetics. Identifying patients at risk is imperative because the mortality rate is very high. All of these drugs have the potential to trigger

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malignant hyperthermia and should be used with caution in any patient at high risk. The patients anxiety is to be expected, all patients are at risk for hypothermia because they are often uncovered in a cold room. Allergy to anesthesia must always be considered a possibility but there is no indication of a higher than normal risk in this patient. 19. The circulating nurse in the day surgery center is caring for a patient who is to receive a local anesthetic. What potential complications will the nurse monitor for? (Select all that apply.) A)

Malignant hypothermia

Pain

Blurred vision

Peripheral vasodilation

Nausea

Ans:

C, D, E Feedback: Adverse effects of local anesthetics are associated with the route of administration and the amount of drug that is absorbed systemically. These effects are related to the blockade of nerve depolarization throughout the system. Effects that may occur include central nervous system effects such as headache (especially with epidural and spinal anesthesia), restlessness, anxiety, dizziness, tremors, blurred vision, and backache; gastrointestinal (GI) effects such as nausea and vomiting; cardiovascular effects such as peripheral vasodilation, myocardial depression, arrhythmias, and blood pressure changes, all of which may lead to fatal cardiac arrest; and respiratory arrest. There is no such problem as malignant hypothermia (the condition is malignant hyperthermia) and pain may be caused by the procedure but not the anesthetic.

20. What nursing diagnosis would a circulating nurse use on his or her intraoperative patients who receive general anesthesia? (Select all that apply.) A)

Disturbed sensory perception

Risk for hypovolemia

Risk for latex allergy response

Disturbed body image

Anxiety

Ans:

A, C, E Feedback: Nursing care of patients receiving general or local anesthetics should include safety precautions to prevent injury and skin breakdown, support and reassurance to deal with

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the loss of sensation and mobility, and patient teaching regarding what to expect to decrease stress and anxiety. Risk for hypovolemia and disturbed body image would be applicable to some surgical procedures but would not be related to general anesthesia. 21. The patient receives lidocaine as a local anesthetic before insertion of a chest tube. After the procedure the patient tells the nurse, The area is still numb. How long will this last? What is the nurses best response? A)

15 minutes

1 hour

2 hours

4 hours

Ans:

C Feedback: The onset of intramuscular lidocaine is 5 to 10 minutes, peaks within 5 to 15 minutes, and the duration of action is 2 hours. Options A, B, and D are distracters.

22. The pharmacology instructor is explaining balanced anesthesia to the students. What agents would the instructor say are involved in balanced anesthesia? (Select all that apply.) A)

Neuromuscular junction blockers

Narcotics

Anticholinergics

Salicylates

Nonsteriodal anti-inflammatory drugs (NSAIDs)

Ans:

A, B, C Feedback: Balanced anesthesia involves giving a variety of drugs with specific effects to achieve analgesia, relax muscles, and invoke unconsciousness and amnesia. Classification of drugs administered includes anticholinergics, rapid intravenous anesthetics, inhaled anesthetics, neuromuscular junction blockers, and narcotics. Balanced anesthesia does not include use of salicylates or nonsteroidal anti-inflammatory drugs.

23. The nurse is caring for a patient who received halothane as an anesthetic agent. The patient will require additional surgery. When can halothane be used again without risk of halothanes recovery syndrome? A)

1 week

2 weeks

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3 weeks

4 weeks

Ans:

C Feedback: Halothanes recovery syndrome is characterized by fever, anorexia, nausea, vomiting, and eventual hepatitis, which can progress to fatal hepatic necrosis. Although this syndrome is rare, halothane is not used more frequently than every 3 weeks to reduce patient risk. Other options are incorrect.

24. A 54-year-old patient with chronic obstructive pulmonary disease is admitted for emergency surgery. What anesthetic agent would be dangerous to use on this patient? A)

Enflurane

Desflurane

Sevoflurane

Isoflurane

Ans:

B Feedback: Desflurane is associated with a collection of respiratory reactions, including cough, increased secretions, and laryngospasm. The other options have far fewer respiratory adverse effects and would be safer for use in this patient.

25. The nurse is admitting a 35-year-old patient to the preoperative unit in preparation for an elective inguinal hernia repair procedure to be performed under general anesthesia. What is the nurses initial priority nursing assessment? A)

Assess the patients anxiety.

Start an IV.

Show the family the waiting area.

Weigh the patient.

Ans:

D Feedback: Weighing the patient is an initial priority because his or her weight will be used to determine appropriate dosing of all medications and will establish a baseline used for evaluation of any potential adverse effects. Other options are all actions the nurse will need to perform, but none are of higher priority than weighing the patient.

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26. A very anxious patient asks the nurse what type of anesthesia they will have for a scheduled tooth extraction. The nurse would describe what type of local anesthetic in laymens terms? A)

Topical

Infiltration

Field block

Nerve block

Ans:

C Feedback: Field block local anesthesia involves injecting the anesthetic all around the area that will be affected by the procedure or surgery. This is more intense than infiltration anesthesia because the anesthetic agent comes in contact with all of the nerve endings surrounding the area. This type of block is often used for tooth extractions. Topical would not be appropriate because it would not absorb deeply enough to block pain impulses in the root of the tooth. Nerve block would not be possible for oral surgery.

27. The nurse receives a patient into the postanaesthesia care unit who has had surgery using the anesthetic agent methohexital. The nurse anticipates the patients need for what in the postoperative period? A)

Assistance in maintaining respirations

Assistance in moving lower extremities

Positioning in Semi-Fowlers position

Analgesia to control the patients pain

Ans:

D Feedback: Methohexital lacks analgesic properties so the patient may require postoperative analgesics to control pain. The patient who has surgery under methohexital does not generally require assistance in maintaining respirations or assistance in moving their lower extremities. They also do not generally require positioning in a semi-Fowlers position.

28. The emergency room nurse is teaching a class for newly hired graduate nurses on the different types of local anesthetic agents. How would the nurse differentiate lidocaine and procaine as a local anesthetic agent? A)

Lidocaine is an amide that is broken down slowly and this can lead to toxicity.

Lidocaine is an ester that cannot become toxic in the system because of rapid metabolism.

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Procaine is an amide that is broken down immediately in the tissues.

Procaine is metabolized by the liver with risk of toxicity and is classified as an ester.

Ans:

A Feedback: The ester local anesthetics are broken down immediately in the plasma by enzymes known as plasma esterases. The amide local anesthetics are metabolized more slowly in the liver. Serum levels of these drugs can become elevated and lead to toxicity. Lidocaine is an amide and procaine is an ester.

29. A nursing student in a pharmacology class asks the instructor why nitrous oxide is used for dental surgery. What is the instructors most accurate response? A)

Nitrous oxide stays in the body for a long time.

Nitrous oxide does not cause pressure in body compartments.

Nitrous oxide does not cause muscle relaxation.

Nitrous oxide does not need to be administered with oxygen.

Ans:

C Feedback: Nitrous oxide is a potent analgesic; it is used frequently for dental surgery because it does not cause muscle relaxation. It moves quickly in and out of the body so duration of action is short and recovery after dental work is quick. Nitrous oxide does need to be given in combination with oxygen to avoid hypoxia in the patient.

30. The nurse is admitting a patient to the postanesthesia care unit (PACU) who received halothane and ketamine as anesthesia. What is the nurses priority assessment? A)

Blood pressure and pulse

Respirations and airway

Pain and respirations

Temperature and airway

Ans:

A Feedback: If halothane and ketamine are used in combination, severe cardiac depression with hypotension and bradycardia may occur. If these agents must be used together, the patient should be monitored closely. Pain, respirations, airway, and temperature are all assessments the nurse will collect on any patient in the PACU, but they are not priority assessments associated with combining ketamine and halothane.

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31. The nurse is assisting while the physician is suturing a wound in the urgent care clinic. The physician asks for lidocaine with epinephrine. The nurse identifies the primary reason for adding epinephrine to the lidocaine is what effect? A)

It will sting more when it is injected into the tissue.

Risk of systemic absorption is increased.

Local effect is increased.

Bleeding at the wound site is increased.

Ans:

C Feedback: There is less risk of systemic absorption and increased local effects if these drugs are combined with epinephrine. Epinephrine causes vasoconstriction, which reduces bleeding, slows absorption, and makes the duration of effect longer. It does sting more when injected, but that is not a reason to use it.

32. The nurse is caring for a patient scheduled for surgery who is to receive a barbiturate as part of the planned balanced anesthesia. What drugs, if taken by the patient, could result in a clinically important drugdrug interaction with the barbiturate? (Select all that apply.) A)

Thyroid hormone

Ibuprofen

Oral contraceptive

Theophylline

Anticoagulant

Ans:

C, D, E Feedback: Caution must be used when these drugs are used with any other central nervous system suppressants. Barbiturates can cause decreased effectiveness of theophylline, oral anticoagulants, beta-blockers, corticosteroids, hormonal contraceptives, phenylbutazones, metronidazole, quinidine, and carbamazepine. Combinations of barbiturate anesthetics and narcotics may produce apnea more commonly than occurs with other analgesics. Thyroid hormone and ibuprofen have no known drug interactions with barbiturates.

33. The nurse is caring for a patient experiencing malignant hyperthermia. What medication will be administered to treat this condition? A)

Midazolam

Dantrolene

Halothane

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Thiopental

Ans:

B Feedback: Dantrolene is the preferred treatment for malignant hyperthermia and should always be readily available whenever anesthetics are used that could trigger the syndrome. Midazolam and thiopental are barbiturates whereas halothane is a volatile gas that can trigger malignant hyperthermia.

34. The nurse is caring for a patient who will undergo cardioversion in the patients room this morning. The patient will receive propofol as anesthetic during the procedure. What are the benefits of using propofol for this procedure? (Select all that apply.) A)

It has a very rapid clearance.

It produces less of a hangover effect.

It allows for quick recovery from anesthesia.

Its onset of action is 5 minutes.

It is painless to inject IV.

Ans:

A, B, C Feedback: Propofol often is used for short procedures because it has a very rapid clearance and produces much less of a hangover effect and allows for quick recovery. It is a very shortacting anesthetic with a rapid onset of action of 30 to 60 seconds. Propofol often causes local burning on injection.

35. The nurse applies a topical anesthetic to reduce sensation at the site while starting an IV. What age group is at greatest risk for systemic absorption of the topical anesthetic? A)

Older adult

Infant

Toddler

Adolescent

Ans:

B Feedback: When topically applying a local anesthetic, it is important to remember that there is greater risk of systemic absorption and toxicity with infants. Therefore, the other options are incorrect.

Chapter 14: Opioids

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MULTIPLE CHOICE 1. The nurse is evaluating a patient 2 hours after giving a dose of 30 mg of codeine with acetaminophen for postoperative pain after abdominal surgery. The patient reports a pain level of 7 on a scale of 1 to 10. The nurse notes a heart rate of 110 beats per minute, a respiratory rate of 28 breaths per minute, and a blood pressure of 180/90 mm Hg. Which action will the nurse take? a. Administer the next dose of codeine one hour early. b. Ask the provider if the codeine dose can be increased. c. Contact the provider to ask if a dose of ibuprofen may be given now. d. Request an order for oxycodone with acetaminophen (Percocet). ANS: D The patient is showing signs of moderate to severe pain unrelieved by codeine, so the nurse should request a more potent opioid analgesic such as oxycodone. Codeine is effective for mild to moderate pain so will not be effective for this patient even if the dose is increased. The medication should not be given more frequently than every 4 hours. Ibuprofen is used for musculoskeletal pain and not postoperative pain. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 361 TOP: NURSING PROCESS: Evaluation/Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 2. The nurse is teaching a female patient who will begin taking 2 tablets of 325 mg acetaminophen every 4 to 6 hours as needed for pain. Which statement by the patient indicates understanding of the teaching? a. I may take acetaminophen up to 6 times daily if needed. b. I should increase the dose of acetaminophen if I drink caffeinated coffee. c. If I take oral contraceptive pills, I should use back-up contraception. d. It is safe to take acetaminophen with any over-the-counter medications. ANS: A The maximum daily dose of acetaminophen is 4000 mg. If this patient takes 650 mg/dose 6 times daily, this amount is safe. Taking acetaminophen with caffeine increases the effect of the acetaminophen. Taking acetaminophen with OCPs decreases the effect of the acetaminophen but does not diminish the effect of the OCP. Many over-the-counter medications contain acetaminophen, so patients should be advised to read labels carefully to avoid overdose. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 355 TOP: NURSING PROCESS: Planning MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 3. The parent of a 5-year-old child asks the nurse to recommend an over-the-counter pain medication for the child. Which analgesic will the nurse recommend? a. Acetaminophen (Tylenol) b. Aspirin (Ecotrin) c. Diflunisal (Dolobid) d. Ibuprofen (Motrin) ANS: A Acetaminophen is safe to give children and does not cause gastrointestinal upset or interfere with

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platelet aggregation. Aspirin carries an increased risk of Reyes syndrome in children. Diflunisal (Dolobid) is not available over the counter. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 355 TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 4. The nurse is performing an admission assessment on an adolescent who reports taking extrastrength acetaminophen (Tylenol) regularly to treat daily headaches. The nurse will notify the patients provider and discuss an order for a. a selective serotonin receptor agonist (SSRA). b. hydrocodone with acetaminophen for headache pain. c. liver enzyme tests. d. serum glucose testing. ANS: C Large doses or overdoses of acetaminophen can be toxic to hepatic cells, so when large doses are administered over a long period, liver function should be assessed. Daily headaches are not typical of migraine headaches, so SSRA medication is not indicated. Hydrocodone with acetaminophen is not indicated without further evaluation of headaches. Serum glucose is not indicated. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 355 TOP: NURSING PROCESS: Assessment/Planning MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 5. The nurse is caring for a postoperative older patient who received PO hydrocodone with acetaminophen (Lortab) 45 minutes prior after reporting a pain level of 8 on a scale of 1 to 10. The patient reports a pain level of 4, and the nurse notes a respiratory rate of 20 breaths per minute, a heart rate of 92 beats per minute, and a blood pressure of 170/95 mm Hg. Which action will the nurse take? a. Contact the provider and request an order for a more potent opioid analgesic. b. Reassess the patient in 30 minutes. c. Request an order for ibuprofen to augment the opioid analgesic. d. Suggest that the patient use nonpharmacologic measures to relieve pain. ANS: A Even though the patient reports decreased pain, the patients vital signs indicate continued discomfort. The nurse should contact the provider to request a stronger analgesic. The pain medication should have been effective within 30 minutes. Ibuprofen is used for musculoskeletal pain. Nonpharmacologic measures may be useful, but the patient still needs a stronger analgesic. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 355 TOP: NURSING PROCESS: Nursing Intervention/Evaluation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 6. The nurse is providing teaching to a patient who will begin taking aspirin to treat arthritis pain. Which statement by the patient indicates a need for further teaching? a. I should increase fiber and fluids while taking aspirin. b. I will call my provider if I have abdominal pain. c. I will drink a full glass of water with each dose.

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d. I will notify my provider of ringing in my ears. ANS: A Aspirin is not constipating, so patients do not need to be counseled to consume extra fluids and fiber. Abdominal pain can occur with gastrointestinal bleeding, and tinnitus (ringing in the ears) can be an early sign of toxicity, so patients should be taught to contact their provider if these occur. Taking a full glass of water with each dose helps minimize gastrointestinal side effects. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 355 TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 7. An adolescent female has dysmenorrhea associated with heavy menstrual periods. The patients provider has recommended ibuprofen (Motrin). When teaching this patient about this drug, the nurse will tell her that ibuprofen a. may decrease the effectiveness of oral contraceptive pills. b. may increase bleeding during her period. c. should be taken on an empty stomach to increase absorption. d. will decrease the duration of her periods. ANS: B When nonsteroidal antiinflammatory drugs (NSAIDs) are used to treat dysmenorrhea, excess bleeding may occur during the first 2 days of a period. NSAIDs do not decrease the effect of OCPs. NSAIDs are irritating to the stomach, so patients should take with food or a full glass of water. NSAIDs will not decrease the duration of periods. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: dm 355 TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 8. The emergency department nurse is caring for a patient who has received morphine sulfate for severe pain following an injury. The nurse performs a drug history and learns that the patient takes St. Johns wort for symptoms of depression. The nurse will observe this patient closely for an increase in which opioid adverse effect? a. Constipation b. Pruritis c. Respiratory depression d. Sedation ANS: D St. Johns wort can increase the sedative effects of opioids. It does not enhance other side effects. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: dm 358 TOP: NURSING PROCESS: Planning/Evaluation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 9. The nurse is performing an admission assessment on a stable patient admitted after a motor vehicle accident. The patient reports having bad pain. What will the nurse do first? a. Administer acetaminophen (Tylenol). b. Ask the patient to rate the pain on a 1 to 10 scale. c. Attempt to determine what type of pain the patient has. d. Request an order for an intravenous opioid analgesic.

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ANS: B To ascertain severity of pain, the nurse should ask the patient to rate the pain on a scale of 1 to 10. Further assessments include location and type of pain. Pain medication should be given after the severity of pain is assessed so that an appropriate analgesic may be given. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 353 TOP: NURSING PROCESS: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 10. The nurse assumes care of a patient in the post-anesthesia care unit (PACU). The patient had abdominal surgery and is receiving intravenous morphine sulfate for pain. The patient is asleep and has not voided since prior to surgery. The nurse assesses a respiratory rate of 10 breaths per minute and notes hypoactive bowel sounds. The nurse will contact the surgeon to report which condition? a. Paralytic ileus b. Respiratory depression c. Somnolence d. Urinary retention ANS: B The patients respiratory rate of 10 breaths per minute is lower than normal and is a sign of respiratory depression, which is a common adverse effect of opioid analgesics. The other effects may occur with opioids but are also not expected this soon after abdominal surgery. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 354 TOP: NURSING PROCESS: Evaluation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 11. One hour after receiving intravenous morphine sulfate, a patient reports generalized itching. The nurse assesses the patient and notes clear breath sounds, no rash, respirations of 14 breaths per minute, a heart rate of 68 beats per minute, and a blood pressure of 110/70 mm Hg. Which action will the nurse take? a. Administer naloxone to reverse opiate overdose. b. Have resuscitation equipment available at the bedside. c. Prepare an epinephrine injection in case of an anaphylactic reaction. d. Reassure the patient that this is a common side effect of this drug. ANS: D Pruritis is a common opioid side effect and can be managed with diphenhydramine. Patients developing anaphylaxis will have urticaria and hypotension, and these patients will need epinephrine and resuscitation. Respiratory depression is a sign of morphine overdose, which will require naloxone. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 359 TOP: NURSING PROCESS: Evaluation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 12. The nurse administers nalbuphine (Nubain) to a patient who is experiencing severe pain. Which statement by the patient indicates a need for further teaching about this drug? a. I may experience unusual dreams while taking this medication. b. I may need to use a laxative when taking this drug.

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c. I should ask for assistance when I get out of bed. d. I should expect to have more frequent urination. ANS: D A common side effect of opioid agents is urinary retention. Patients should notify the nurse if they cannot void. Side effects may include unusual dreams, constipation, and dizziness. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 364 TOP: NURSING PROCESS: Planning/Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 13. The nurse is caring for a patient who was admitted with a fractured leg and for observation of a closed head injury after a motor vehicle accident. The patient reports having pain at a level of 3 on a 1 to 10 pain scale. The nurse will expect the provider to order which analgesic medication for this patient? a. Acetaminophen (Tylenol) PO b. Hydromorphone HCl (Dilaudid) IM c. Morphine sulfate PCA d. Transdermal fentanyl (Duragesic) ANS: A Use of opioid analgesics is contraindicated for patients with head injuries because of the risk of increased intracranial pressure. If opioids are necessary because of severe pain, they must be given in reduced doses. This patient is experiencing mild pain, so acetaminophen is an appropriate analgesic. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 360 TOP: NURSING PROCESS: Planning/Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 14. Which patient may require a higher than expected dose of an opioid analgesic? a. A patient with cancer b. A patient with a concussion c. A patient with hypotension d. A patient 3 days after surgery ANS: A Opioids are titrated for oncology patients until pain relief is achieved or the side effects become intolerable, and extremely high doses may be required. Patient with closed head injuries should receive reduced doses of opioids if at all to reduce the risk of increased intracranial pressure. Patients with hypotension should receive reduced doses to prevent further decrease in blood pressure. Patients who are 3 days post-operation should not be experiencing severe pain. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 360 TOP: NURSING PROCESS: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 15. The nurse assesses an older patient 60 minutes after administering 4 mg of intravenous morphine sulfate (MS) for postoperative pain. The patients analgesia order is for 2 to 5 mg of MS IV every 2 hours. The nurse notes that the patient is lying very still. The patients heart rate is 96 beats per minute, respiratory rate is 14 breaths per minute, and blood pressure is 140/90 mm Hg. When asked to rate the level of pain, the patient replies just a 5. The nurse will perform

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which action? a. Give 3 mg of MS at the next dose. b. Give 5 mg of MS at the next dose. c. Request an order for an oral opioid to give now. d. Request an order for acetaminophen to give now. ANS: B Older patients often minimize pain when asked, so the nurse should evaluate nonverbal cues to pain such as elevated heart rate and blood pressure and the fact that the patient is lying very still. The nurse should increase the dose the next time the pain medication is given. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 363 TOP: NURSING PROCESS: Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 16. A postoperative patient has a history of opioid abuse. Which analgesic medication will the nurse expect the provider to order for this patient? a. Buprenorphine (Buprenex) b. Butorphanol tartrate (Stadol) c. Naloxone (Narcan) d. Pentazocine (Talwin) ANS: A Buprenorphine is an opioid agonist-antagonist analgesic and was developed to help decrease opioid abuse. Butophanol and pentazocine are also in this class, but reports say that they cause dependence. Naloxone is an opioid antagonist and is given to reverse the effects of opioids if toxicity occurs. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 364 TOP: NURSING PROCESS: Planning MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 17. The nurse checks on a patient who has received sumatriptan (Imitrex) for treatment of a migraine headache. The patient reports moderate improvement in headache pain and reports feeling dizzy. The nurse notes a blood pressure of 160/85 mm Hg. Which action by the nurse is correct? a. Notify the provider of the dizziness. b. Notify the provider of the increased blood pressure. c. Plan to administer a second dose in 1 hour. d. Request an order for intranasal sumatriptan. ANS: B Triptans can cause increased blood pressure, which is an adverse drug reaction and should be reported to the provider. Dizziness is a common side effect but not potentially life-threatening. The second dose should not be given if the patient is experiencing elevated blood pressure. Intranasal sumatriptan has the same adverse effects. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 366 TOP: NURSING PROCESS: Nursing Intervention/Evaluation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

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18. The nurse is caring for a 6-year-old child who had surgery that morning. The child is awake and lying very still in bed and wont respond when the nurse asks about pain. The nurse will perform which action? a. Ask the child to rate the pain on a scale of 1 to 10. b. Encourage the child to request pain medication when needed. c. Evaluate the childs pain using an ouch scale. d. Plan to administer pain medication if the child begins to cry. ANS: C Some children will not verbalize discomfort even when they have severe pain because they fear injections. Nurses may use an ouch scale or a faces scale to evaluate pain if the child wont respond. Waiting for severe pain is not appropriate. Chapter 15: Drugs of Abuse MULTIPLE CHOICE 1. The nurse is teaching a group in the community about drug abuse. Which statement by the nurse is correct? a. Cue-induced cravings eventually disappear after long periods of abstinence by the person addicted to drugs. b. Drug abuse and drug addiction are synonymous terms, describing dependence on drugs. c. Drug addiction is characterized by emotional, mental, and sometimes physical dependence. d. Drug addiction occurs when physical dependence is present. ANS: C Drug addiction occurs when emotional and mental dependence on a drug are present. Although physical dependence may often occur, it is not always present. Cue-induced cravings may diminish after long abstinence but do not disappear completely. Drug abuse may occur without addiction. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: dm 42 TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching MSC: NCLEX: Psychosocial Integrity: Dependency 2. The nurse is caring for a patient who is being treated for chronic alcohol intoxication. The nurse notes that the patients serum alcohol level is 0.40 mg%. The patient is awake and talkative even though this is a potentially lethal dose. The nurse recognizes this as alcohol a. addiction.

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b. dependence. c. misuse. d. tolerance. ANS: D Intoxication is a state of being influenced by a drug or other substance and may be a very small amount in the drug-nave person or a potentially lethal amount in the chronic user. This person has developed tolerance to alcohol and is able to have a potentially lethal amount without severe effects. Addiction describes a state of emotional, mental, and physical dependence on a drug. Dependence describes physical need for the drug such that when the drug is stopped, withdrawal symptoms occur. Misuse refers to using a drug or substance to excess. DIF: COGNITIVE LEVEL: Applying (Application) REF: Pages 42-43 TOP: NURSING PROCESS: Assessment MSC: NCLEX: Psychosocial Integrity: Dependency 3. What does the nurse understand must occur in order to produce withdrawal syndrome? a. Addiction b. Craving c. Drug tolerance d. Physical dependence ANS: D Patients who develop a physical dependence on a drug will experience withdrawal syndrome when the drug is stopped. Addiction and cravings can occur without physical dependence. Tolerance refers to a decrease in drug effects with repeated use. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 43 TOP: NURSING PROCESS: N/A MSC: NCLEX: Psychosocial Integrity: Dependency 4. The nurse is counseling a patient who wants to stop smoking. Which statement by the nurse is correct? a. Bupropion (Zyban) is effective and does not have serious adverse effects. b. Nicotine replacement therapies are effective and eliminate the need for behavioral therapy. c. Varenicline (Chantix) may be used short-term for 1 to 2 months. d. You may experience headaches and increased appetite for several months after stopping

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smoking. ANS: D Headaches and increased appetite are common during nicotine withdrawal and may last for several months. Bupropion is effective but has many serious effects. Nicotine replacement therapy does not eliminate the need for behavioral therapy. Varenicline is used for at least 4 months. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 45 TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching MSC: NCLEX: Psychosocial Integrity: Dependency 5. A patient with asthma has been using a nicotine transdermal 24-hour patch for 3 weeks to quit smoking. The patient reports having difficulty sleeping. What action will the nurse take? a. Ask the provider for a prescription for Nicotrol NS. b. Recommend removing the patch at bedtime. c. Suggest using an 18-hour patch instead. d. Tell the patient to stop the patch and join a support group. ANS: C The patient should try an 18-hour patch to help with sleep. Nicotrol is not a good option for patients with asthma. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 47 TOP: NURSING PROCESS: Nursing Intervention MSC: NCLEX: Psychosocial Integrity: Dependency 6. The nurse is discussing smoking cessation with a nurse colleague who smokes. Which statement indicates a readiness to quit smoking? a. I dont smoke around my children or inside the house. b. I want to stop smoking, but I will need help to do it. c. I will quit so my co-workers will stop harassing me about it. d. If I cut down gradually, I should be able to quit. ANS: B Patients exhibit readiness when they state a desire to quit along with a request for professional assistance. Other factors, such as children or co-workers, do not indicate a desire to quit.

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DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 59 TOP: NURSING PROCESS: Nursing Intervention/Planning MSC: NCLEX: Psychosocial Integrity: Dependency 7. A patient is using the Commit lozenge 2 mg to help quit smoking and reports nausea and indigestion. The nurse will instruct the patient to perform which action? a. Allow the lozenge to dissolve slowly over 20 to 30 minutes. b. Chew the lozenge thoroughly before swallowing it. c. Increase to 4 mg and use less often. d. Take the lozenge with food and a full glass of water. ANS: A The patient should allow the lozenge to dissolve slowly. Chewing or swallowing the lozenge increases gastrointestinal side effects. Increasing the dose and decreasing the frequency are not recommended. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 47 TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching MSC: NCLEX: Psychosocial Integrity: Dependency 8. A patient is brought to the emergency department by a family member. The patient reports seeing colored lights and describes feeling bugs crawling under the skin. The nurse suspects that this patient is abusing which drug? a. Alcohol b. Cocaine c. LSD d. Methamphetamine ANS: B A stimulant psychosis can occur with chronic use of any stimulant and, with cocaine, progresses to visual hallucinations of colored lights and tactile hallucinations of bugs crawling under the skin. These are not signs of abuse with alcohol, LSD, or methamphetamine. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: dm 47 TOP: NURSING PROCESS: Assessment MSC: NCLEX: Psychosocial Integrity: Dependency

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9. The nurse is caring for a patient who is chronically irritable and anxious and prone to violent behaviors. The patient has several teeth missing and has dental caries in the remaining teeth. The nurse suspects previous chronic use of which drug? a. Alcohol b. Cocaine c. LSD d. Methamphetamine ANS: D Patients previously exposed to methamphetamine use will exhibit these symptoms, and the physical effects of extended methamphetamine use are notable tooth decay and dermatologic deterioration. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: dm 50 TOP: NURSING PROCESS: Assessment MSC: NCLEX: Psychosocial Integrity: Dependency 10. The nurse is teaching a patient who has completed detoxification for alcohol abuse who will be discharged home with a prescription for disulfiram (Antabuse). Which statement by the patient indicates understanding of the teaching? a. Even topical products containing alcohol can have serious adverse effects while I am taking this drug. b. If I experience drowsiness or skin rash, I should discontinue this drug immediately. c. It is safe to take a product containing alcohol one week after the last dose of disulfiram. d. This drug acts by blocking the pleasurable effects of alcohol. ANS: A Disulfiram causes an unpleasant and potentially fatal reaction if alcohol is consumed while taking it and can even occur with topical products containing alcohol. Drowsiness and skin rash arent common adverse effects. The effects of disulfiram do not wear off for up to 2 weeks after the last dose. It does not block the pleasurable effects of alcohol. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 53 TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching MSC: NCLEX: Psychosocial Integrity: Dependency

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11. A patient who has a long history of alcohol abuse is admitted to the hospital for detoxification. In addition to medications needed to treat withdrawal symptoms, the nurse will anticipate giving intravenous a. dopamine to restore blood pressure. b. fluid boluses to treat dehydration. c. glucose to prevent hypoglycemia. d. thiamine to treat nutritional deficiency. ANS: D Thiamine should be given to prevent Wernickes encephalopathy in patients treated for alcoholism. If glucose is indicated, the thiamine should be given first. Other treatments are given as indicated. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 53 TOP: NURSING PROCESS: Nursing Intervention/Planning MSC: NCLEX: Psychosocial Integrity: Dependency 12. A patient arrives in the emergency department in an acute state of alcohol intoxication and reports chronic consumption of several six packs of beer every day for the past year. The nurse anticipates administering which medication or treatment? a. Chlordiazepoxide (Librium) b. Disulfiram (Antabuse) c. Gastric lavage d. Vasoconstrictors ANS: A To prevent acute withdrawal and delirium tremens, a long-acting benzodiazepine, such as chlordiazepoxide, is given. Disulfiram would cause an acute drug interaction. Gastric lavage should no longer be performed, and vasoconstrictors are not indicated. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 53 TOP: NURSING PROCESS: Nursing Intervention MSC: NCLEX: Psychosocial Integrity: Dependency 13. A patient who is unconscious arrives in the emergency department with clammy skin and constricted pupils. The nurse assesses a respiratory rate of 8 to 10 breaths per minute. The

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paramedics report obvious signs of drug abuse in the patients home. The nurse suspects that this patient has had an overdose of which substance? a. Alcohol b. LSD c. An opioid d. Methamphetamine ANS: C Opioid overdose is characterized by constricted pupils and respiratory depression. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 55 TOP: NURSING PROCESS: Assessment MSC: NCLEX: Psychosocial Integrity: Dependency 14. A patient is brought to the emergency department after ingesting an overdose of lorazepam (Ativan) several hours prior. The patient has a respiratory rate of 6 to 10 breaths per minute and is unconscious. The nurse will prepare to perform which action? a. Administer activated charcoal. b. Give flumazenil (Romazicon). c. Give naloxone (Narcan). d. Perform gastric lavage. ANS: B Flumazenil is the antidote for benzodiazepine overdose. Activated charcoal is used for asymptomatic patients who have recently consumed the drug. Gastric lavage should no longer be performed for treatment. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 54 TOP: NURSING PROCESS: Nursing Intervention MSC: NCLEX: Psychosocial Integrity: Dependency 15. A patient with a history of opioid abuse will be discharged home with buprenorphine to help prevent relapse. Which product will the nurse anticipate the provider to order? a. Buprenex b. Suboxone c. Subutex

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d. Vivitrol ANS: A Buprenex is an agonist-antagonist opioid that can be used for detoxification and maintenance therapy because it has a low potential for abuse. Suboxone and Subutex have abuse potential. Vivitrol does not contain buprenorphine and does not prevent cravings. DIF: COGNITIVE LEVEL: Applying (Application) REF: Pages 55-56 TOP: NURSING PROCESS: Nursing Intervention/Planning MSC: NCLEX: Psychosocial Integrity: Dependency 16. The nurse is teaching a patient who will be discharged home with naltrexone (ReVia) after treatment for opioid addiction. What information will the nurse include in the teaching for this patient? a. This drug will help control cravings. b. You may take this drug once weekly. c. ReVia blocks the pleasurable effects of opioids. d. If you discontinue this drug abruptly, you will have withdrawal symptoms. ANS: C ReVia acts by blocking the pleasurable effects of opioids. It can precipitate withdrawal when given to opioid-dependent patients. This drug does not control cravings, and it is taken once daily or every other day. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 56 TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching MSC: NCLEX: Psychosocial Integrity: Dependency Test Bank MULTIPLE CHOICE 1. The nurse is teaching a group in the community about drug abuse. Which statement by the nurse is correct? a. Cue-induced cravings eventually disappear after long periods of abstinence by the person addicted to drugs. b. Drug abuse and drug addiction are synonymous terms, describing dependence on drugs.

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c. Drug addiction is characterized by emotional, mental, and sometimes physical dependence. d. Drug addiction occurs when physical dependence is present. ANS: C Drug addiction occurs when emotional and mental dependence on a drug are present. Although physical dependence may often occur, it is not always present. Cue-induced cravings may diminish after long abstinence but do not disappear completely. Drug abuse may occur without addiction. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: dm 42 TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching MSC: NCLEX: Psychosocial Integrity: Dependency 2. The nurse is caring for a patient who is being treated for chronic alcohol intoxication. The nurse notes that the patients serum alcohol level is 0.40 mg%. The patient is awake and talkative even though this is a potentially lethal dose. The nurse recognizes this as alcohol a. addiction. b. dependence. c. misuse. d. tolerance. ANS: D Intoxication is a state of being influenced by a drug or other substance and may be a very small amount in the drug-nave person or a potentially lethal amount in the chronic user. This person has developed tolerance to alcohol and is able to have a potentially lethal amount without severe effects. Addiction describes a state of emotional, mental, and physical dependence on a drug. Dependence describes physical need for the drug such that when the drug is stopped, withdrawal symptoms occur. Misuse refers to using a drug or substance to excess. DIF: COGNITIVE LEVEL: Applying (Application) REF: Pages 42-43 TOP: NURSING PROCESS: Assessment MSC: NCLEX: Psychosocial Integrity: Dependency 3. What does the nurse understand must occur in order to produce withdrawal syndrome? a. Addiction b. Craving

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c. Drug tolerance d. Physical dependence ANS: D Patients who develop a physical dependence on a drug will experience withdrawal syndrome when the drug is stopped. Addiction and cravings can occur without physical dependence. Tolerance refers to a decrease in drug effects with repeated use. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 43 TOP: NURSING PROCESS: N/A MSC: NCLEX: Psychosocial Integrity: Dependency 4. The nurse is counseling a patient who wants to stop smoking. Which statement by the nurse is correct? a. Bupropion (Zyban) is effective and does not have serious adverse effects. b. Nicotine replacement therapies are effective and eliminate the need for behavioral therapy. c. Varenicline (Chantix) may be used short-term for 1 to 2 months. d. You may experience headaches and increased appetite for several months after stopping smoking. ANS: D Headaches and increased appetite are common during nicotine withdrawal and may last for several months. Bupropion is effective but has many serious effects. Nicotine replacement therapy does not eliminate the need for behavioral therapy. Varenicline is used for at least 4 months. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 45 TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching MSC: NCLEX: Psychosocial Integrity: Dependency 5. A patient with asthma has been using a nicotine transdermal 24-hour patch for 3 weeks to quit smoking. The patient reports having difficulty sleeping. What action will the nurse take? a. Ask the provider for a prescription for Nicotrol NS. b. Recommend removing the patch at bedtime. c. Suggest using an 18-hour patch instead. d. Tell the patient to stop the patch and join a support group. ANS: C

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The patient should try an 18-hour patch to help with sleep. Nicotrol is not a good option for patients with asthma. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 47 TOP: NURSING PROCESS: Nursing Intervention MSC: NCLEX: Psychosocial Integrity: Dependency 6. The nurse is discussing smoking cessation with a nurse colleague who smokes. Which statement indicates a readiness to quit smoking? a. I dont smoke around my children or inside the house. b. I want to stop smoking, but I will need help to do it. c. I will quit so my co-workers will stop harassing me about it. d. If I cut down gradually, I should be able to quit. ANS: B Patients exhibit readiness when they state a desire to quit along with a request for professional assistance. Other factors, such as children or co-workers, do not indicate a desire to quit. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 59 TOP: NURSING PROCESS: Nursing Intervention/Planning MSC: NCLEX: Psychosocial Integrity: Dependency 7. A patient is using the Commit lozenge 2 mg to help quit smoking and reports nausea and indigestion. The nurse will instruct the patient to perform which action? a. Allow the lozenge to dissolve slowly over 20 to 30 minutes. b. Chew the lozenge thoroughly before swallowing it. c. Increase to 4 mg and use less often. d. Take the lozenge with food and a full glass of water. ANS: A The patient should allow the lozenge to dissolve slowly. Chewing or swallowing the lozenge increases gastrointestinal side effects. Increasing the dose and decreasing the frequency are not recommended. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 47 TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching MSC: NCLEX: Psychosocial Integrity: Dependency

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8. A patient is brought to the emergency department by a family member. The patient reports seeing colored lights and describes feeling bugs crawling under the skin. The nurse suspects that this patient is abusing which drug? a. Alcohol b. Cocaine c. LSD d. Methamphetamine ANS: B A stimulant psychosis can occur with chronic use of any stimulant and, with cocaine, progresses to visual hallucinations of colored lights and tactile hallucinations of bugs crawling under the skin. These are not signs of abuse with alcohol, LSD, or methamphetamine. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: dm 47 TOP: NURSING PROCESS: Assessment MSC: NCLEX: Psychosocial Integrity: Dependency 9. The nurse is caring for a patient who is chronically irritable and anxious and prone to violent behaviors. The patient has several teeth missing and has dental caries in the remaining teeth. The nurse suspects previous chronic use of which drug? a. Alcohol b. Cocaine c. LSD d. Methamphetamine ANS: D Patients previously exposed to methamphetamine use will exhibit these symptoms, and the physical effects of extended methamphetamine use are notable tooth decay and dermatologic deterioration. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: dm 50 TOP: NURSING PROCESS: Assessment MSC: NCLEX: Psychosocial Integrity: Dependency 10. The nurse is teaching a patient who has completed detoxification for alcohol abuse who will be discharged home with a prescription for disulfiram (Antabuse). Which statement by the

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patient indicates understanding of the teaching? a. Even topical products containing alcohol can have serious adverse effects while I am taking this drug. b. If I experience drowsiness or skin rash, I should discontinue this drug immediately. c. It is safe to take a product containing alcohol one week after the last dose of disulfiram. d. This drug acts by blocking the pleasurable effects of alcohol. ANS: A Disulfiram causes an unpleasant and potentially fatal reaction if alcohol is consumed while taking it and can even occur with topical products containing alcohol. Drowsiness and skin rash arent common adverse effects. The effects of disulfiram do not wear off for up to 2 weeks after the last dose. It does not block the pleasurable effects of alcohol. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 53 TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching MSC: NCLEX: Psychosocial Integrity: Dependency 11. A patient who has a long history of alcohol abuse is admitted to the hospital for detoxification. In addition to medications needed to treat withdrawal symptoms, the nurse will anticipate giving intravenous a. dopamine to restore blood pressure. b. fluid boluses to treat dehydration. c. glucose to prevent hypoglycemia. d. thiamine to treat nutritional deficiency. ANS: D Thiamine should be given to prevent Wernickes encephalopathy in patients treated for alcoholism. If glucose is indicated, the thiamine should be given first. Other treatments are given as indicated. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 53 TOP: NURSING PROCESS: Nursing Intervention/Planning MSC: NCLEX: Psychosocial Integrity: Dependency 12. A patient arrives in the emergency department in an acute state of alcohol intoxication and reports chronic consumption of several six packs of beer every day for the past year. The nurse

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anticipates administering which medication or treatment? a. Chlordiazepoxide (Librium) b. Disulfiram (Antabuse) c. Gastric lavage d. Vasoconstrictors ANS: A To prevent acute withdrawal and delirium tremens, a long-acting benzodiazepine, such as chlordiazepoxide, is given. Disulfiram would cause an acute drug interaction. Gastric lavage should no longer be performed, and vasoconstrictors are not indicated. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 53 TOP: NURSING PROCESS: Nursing Intervention MSC: NCLEX: Psychosocial Integrity: Dependency 13. A patient who is unconscious arrives in the emergency department with clammy skin and constricted pupils. The nurse assesses a respiratory rate of 8 to 10 breaths per minute. The paramedics report obvious signs of drug abuse in the patients home. The nurse suspects that this patient has had an overdose of which substance? a. Alcohol b. LSD c. An opioid d. Methamphetamine ANS: C Opioid overdose is characterized by constricted pupils and respiratory depression. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 55 TOP: NURSING PROCESS: Assessment MSC: NCLEX: Psychosocial Integrity: Dependency 14. A patient is brought to the emergency department after ingesting an overdose of lorazepam (Ativan) several hours prior. The patient has a respiratory rate of 6 to 10 breaths per minute and is unconscious. The nurse will prepare to perform which action? a. Administer activated charcoal. b. Give flumazenil (Romazicon).

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c. Give naloxone (Narcan). d. Perform gastric lavage. ANS: B Flumazenil is the antidote for benzodiazepine overdose. Activated charcoal is used for asymptomatic patients who have recently consumed the drug. Gastric lavage should no longer be performed for treatment. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 54 TOP: NURSING PROCESS: Nursing Intervention MSC: NCLEX: Psychosocial Integrity: Dependency 15. A patient with a history of opioid abuse will be discharged home with buprenorphine to help prevent relapse. Which product will the nurse anticipate the provider to order? a. Buprenex b. Suboxone c. Subutex d. Vivitrol ANS: A Buprenex is an agonist-antagonist opioid that can be used for detoxification and maintenance therapy because it has a low potential for abuse. Suboxone and Subutex have abuse potential. Vivitrol does not contain buprenorphine and does not prevent cravings. DIF: COGNITIVE LEVEL: Applying (Application) REF: Pages 55-56 TOP: NURSING PROCESS: Nursing Intervention/Planning MSC: NCLEX: Psychosocial Integrity: Dependency 16. The nurse is teaching a patient who will be discharged home with naltrexone (ReVia) after treatment for opioid addiction. What information will the nurse include in the teaching for this patient? a. This drug will help control cravings. b. You may take this drug once weekly. c. ReVia blocks the pleasurable effects of opioids. d. If you discontinue this drug abruptly, you will have withdrawal symptoms. ANS: C

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ReVia acts by blocking the pleasurable effects of opioids. It can precipitate withdrawal when given to opioid-dependent patients. This drug does not control cravings, and it is taken once daily or every other day.

Chapter 16: CNS Stimulants MULTIPLE CHOICE 1. The nurse is performing a medication history on a patient who reports using phentermine HCl (Suprenza) 15 mg/day for the past 3 months as an appetite suppressant. The nurse will contact the patients provider to discuss a. changing the medication to phentermine-topiramate (Qsymia). b. increasing the dose to 37.5 mg/day since tolerance has likely occurred. c. initiating a slow taper of the phentermine. d. stopping the drug immediately since long-term use is not recommended. ANS: C The nurse should discuss a gradual taper of the medication with the provider. Patients using anorexiants should not stop taking them abruptly because depression and withdrawal symptoms may occur. Phentermine-topiramate is recommended for short-term use only. Patients should not use these medications longer than 12 weeks, so increasing the dose is not indicated. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 289 TOP: NURSING PROCESS: Planning/Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 2. A patient reports having recurring headaches described as 1 to 2 headaches per day for several weeks. The nurse understands that these headaches are most likely descriptive of which type of headache? a. Cluster headache b. Migraine headache c. Simple headache d. Tension headache ANS: A Cluster headaches reoccur 1 to 3 times daily in a period lasting from approximately 2 weeks to 3 months. Migraine headaches are severe and characterized by an aura prior to the headache. Tension headaches are related to stress. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: dm 285 TOP: NURSING PROCESS: Assessment MSC: NCLEX: Physiological Integrity: Pathophysiology 3. The nurse is caring for a patient who has migraine headaches. The patient reports having these headaches more frequently. Which is an appropriate recommendation for this patient? a. Avoid chocolate and caffeine. b. Engage in strenuous exercise. c. Have a glass of red wine with dinner.

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d. Take ibuprofen prophylactically. ANS: A Triggering factors for migraine headache include foods such as chocolate, caffeine, and red wine. Intense physical exertion can trigger migraines. Prophylactic ibuprofen is not indicated. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 285 TOP: NURSING PROCESS: Nursing Intervention MSC: NCLEX: Physiological Integrity: Pathophysiology 4. The nurse is caring for a 7-year-old child who has difficulty concentrating and completing tasks and who cannot seem to sit still. Which diagnostic test may be ordered to assist with a diagnosis of attention deficit/hyperactivity disorder (ADHD) in this child? a. Computerized tomography (CT) of the head b. Electrocardiogram (ECG) c. Electroencephalogram (EEG) d. Magnetic resonance imaging (MRI) of the brain ANS: C A child with ADHD may have abnormal EEG findings. CT, MRI, and ECG tests are not diagnostic for ADHD. DIF: COGNITIVE LEVEL: Remembering (Knowledge) REF: dm 285 TOP: NURSING PROCESS: Assessment MSC: NCLEX: Physiological Integrity: Pathophysiology 5. A patient has been using an amphetamine drug as an anorexiant for several weeks and asks the nurse about long-term adverse effects of this type of medication. The nurse will explain to the patient that these drugs a. can cause cardiac dysrhythmias. b. contribute to the development of narcolepsy. c. do not have severe effects when used properly. d. will cause orthostatic hypotension. ANS: A Amphetamines can cause adverse effects in the central nervous, endocrine, gastrointestinal, and cardiovascular systems even when used as directed. Cardiac dysrhythmias can occur with continued use. Amphetamines do not cause narcolepsy or hypotension. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: dm 285 TOP: NURSING PROCESS: Nursing Intervention MSC: NCLEX: Psychosocial Integrity: Pharmacological and Parenteral Therapies 6. The nurse is teaching a child and a parent about taking methylphenidate (Ritalin) to treat attention deficit/hyperactivity disorder (ADHD). Which statement by the parent indicates understanding of the teaching? a. I should give this drug to my child at bedtime. b. My child should avoid products containing caffeine. c. The drug should be stopped immediately if my child develops aggression. d. We should monitor my childs weight since weight gain is common. ANS: B Methylphenidate is a stimulant, so other stimulants such as caffeine should be avoided because a

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high plasma caffeine level can be fatal. The medication should be taken in the morning. Patients should be taught not to stop the drug abruptly to avoid withdrawal symptoms. Weight loss is common. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 286 TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 7. The parent of a child who is taking amphetamine (Adderall) to treat attention deficit/hyperactivity disorder (ADHD) asks the provider to recommend an over-the-counter medication to treat a cold. What will the nurse tell the parent? a. Avoid any products containing pseudoephedrine or caffeine. b. Never give over-the-counter medications with Adderall. c. Sudafed is a safe and effective decongestant. d. Use any over-the-counter medication from the local pharmacy. ANS: A Adderall is a stimulant, so other stimulants, such as caffeine and pseudoephedrine, should be avoided because a high plasma caffeine level can be fatal. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 285 TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 8. The nurse is checking an 8-year-old child who has attention deficit/hyperactivity disorder (ADHD) into a clinic for an annual well-child visit. The child takes methylphenidate HCl (Ritalin). Which assessments are especially important for this child? a. Heart rate, respiratory rate, and oxygen saturation b. Height, weight, and blood pressure c. Measures of fine- and gross-motor development d. Nausea, vomiting, and gastrointestinal upset ANS: B Methylphenidate may cause growth suppression, so the childs height and weight should be assessed. Methylphenidate may also increase blood pressure, so the nurse should pay careful attention to blood pressure. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 286 TOP: NURSING PROCESS: Assessment/Evaluation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 9. The parent of an adolescent who has taken methylphenidate 20 mg/day for 6 months for attention deficit/hyperactivity disorder (ADHD) brings the child to clinic for evaluation of a recent onset of nausea, vomiting, and headaches. The parent expresses concern that the child seems less focused and more hyperactive than before. What will the nurse do next? a. Ask the child whether the drug is being taken as prescribed. b. Contact the provider to discuss increasing the dose to 30 mg/day. c. Recommend taking the drug with meals to reduce gastrointestinal side effects. d. Report signs of drug toxicity to the patients provider. ANS: A Nausea, vomiting, and headaches can occur with drug withdrawal, along with a recurrence of

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symptoms. The nurse should ask the child about drug compliance. Methylphenidate should be taken 30 to 45 minutes before meals, not with meals. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 287 TOP: NURSING PROCESS: Evaluation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 10. The nurse is teaching a parent about methylphenidate (Ritalin) to treat attention deficit/hyperactivity disorder (ADHD). Which statement by the parent indicates understanding of the teaching? a. I should consult a pharmacist when giving my child OTC medications. b. I will only give my child diet soft drinks while administering this medication. c. Medication therapy means that behavioral therapy will not be necessary. d. Weight gain is a common side effect of this medication. ANS: A Since many OTC medications contain stimulants, parents should consult a pharmacist or the provider before giving them with methylphenidate. Diet soft drinks often contain caffeine, a stimulant, and should be avoided with methylphenidate use. Behavioral therapy should still be an essential part of the treatment for ADHD. Weight loss is common. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 286 TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 11. The parent of an obese 10-year-old child asks the nurse about medications to aid in weight loss. Which response by the nurse is correct? a. Anorexiants are often used to jump start a weight loss regimen in children. b. Children are able to use over-the-counter anorexiants on a long-term basis. c. Children under 12 years of age should not use weight loss drugs. d. Side effects of anorexiants occur less often in children. ANS: C Anorexiants should not be given to children under age 12 years. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: dm 288 TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 12. The nurse is working in a neonatal intensive care unit and is caring for an infant who is experiencing multiple periods of apnea and bradycardia. Which drug will the nurse expect to administer? a. Albuterol (Proventil) b. Caffeine (Cafcit) c. Doxapram (Dopram) d. Methylphenidate (Ritalin) ANS: B Caffeine is given to newborns that are experiencing apnea spells. The other drugs are not used for this purpose.

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DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: dm 288 TOP: NURSING PROCESS: Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 13. A college-age student is brought to the emergency department by friends after consuming NoDoz tablets along with several cups of coffee and a few energy drinks. The patient is complaining of nausea and diarrhea and appears restless. The nurse understands that a. arrhythmias and convulsions may occur. b. caffeine dependence does not occur. c. effects of the substances will wear off shortly. d. severe adverse effects do not occur. ANS: A Caffeine and other stimulants can cause cardiac arrhythmias and seizures. Caffeine dependence may occur. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: dm 288 TOP: NURSING PROCESS: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 14. A patient is brought to the emergency department with a drug overdose causing respiratory depression. Which drug will the nurse expect to administer? a. Albuterol (Proventil) b. Caffeine (Cafcit) c. Doxapram (Dopram) d. Methylphenidate (Ritalin) ANS: C Doxapram is given to treat respiratory depression caused by drug overdose. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: dm 289 TOP: NURSING PROCESS: Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 15. A patient reports difficulty staying awake during the daytime in spite of getting adequate sleep every night. Which medication will the nurse expect the provider to order for this patient? a. Caffeine (NoDoz) b. Methylphenidate (Ritalin) c. Modafinil (Provigil) d. Theophylline ANS: C Modafinil is given to treat narcolepsy. Chapter 17: Antihypertensives MULTIPLE CHOICE 1. A patient is diagnosed with borderline hypertension and states a desire to make lifestyle changes to avoid needing to take medication. The nurse will recommend which changes? a. Changing from weight bearing exercise to yoga

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b. Decreased fluid intake and increased potassium intake c. Stress reduction and increased protein intake d. Weight reduction and decreased sodium intake ANS: D Weight loss decreases the stress on the heart and the afterload. Decreasing salt intake decreases the amount of retained fluid. Changing to yoga from weight-bearing exercise, limiting fluids, and increasing potassium are not indicated. Stress reduction is recommended, but increasing protein is not. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 634 TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching MSC: NCLEX: Health Promotion Model 2. A patient has a blood pressure of 135/85 mm Hg on three separate occasions. The nurse understands that this patient should be treated with a. a beta blocker. b. a diuretic and a beta blocker. c. a diuretic. d. lifestyle changes. ANS: D Prehypertension is defined as a systolic pressure of 120 to 139 and a diastolic pressure between 80 and 89. Drug therapy is recommended if the blood pressure is greater than 20/10 over the goal, which would be140/90. Prehypertension is generally treated first with lifestyle changes. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: dm 635 TOP: NURSING PROCESS: Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 3. A patient has a blood pressure of 155/95 mm Hg. The nurse understands that this patients risk of cardiovascular disease is greater than normal. a. two times b. three times c. four times d. six times ANS: C Cardiovascular disease (CVD) risk doubles with each increase of 20/10 mm Hg above normal, starting at 115/75 mm Hg. This patients blood pressure is 40/20 above normal, which increases the risk four times. A blood pressure of 135/85 would be two times greater. The patients risk would still be four times greater with a blood pressure of 155/70 or 130/95, since systolic and diastolic blood hypertension are each powerful predictors of CVD. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 635 TOP: NURSING PROCESS: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 4. The nurse is caring for an African-American patient who has been taking a beta blocker to treat hypertension for several weeks with only slight improvement in blood pressure. The nurse will contact the provider to discuss a. adding a diuretic medication.

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b. changing to an ACE inhibitor. c. decreasing the beta blocker dose. d. doubling the beta blocker dose. ANS: A African Americans do not respond well to beta blockers and ACE inhibitors, but do tend to respond to diuretics and calcium channel blockers. Changing to an ACE inhibitor or altering the beta blocker dose are not indicated. Hypertension in African-American patients can be controlled by combining beta blockers with diuretics. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 636 TOP: NURSING PROCESS: Nursing Intervention/Planning MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 5. The nurse understands that a medication such as carvedilol (Coreg) may not be effective in an African-American patient because of its effects on a. cardiac contractility. b. heart rate. c. renin release. d. vascular resistance. ANS: C African Americans are more likely to be susceptible to low-renin hypertension. Beta blockers reduce heart rate, contractility, and renin release, and there is a greater hypotensive response in patients with higher renin levels. Changes in heart rate, contractility, and vascular resistance explain why there is some response in this group. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: dm 636 TOP: NURSING PROCESS: Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 6. The nurse is preparing to care for a Native-American patient who has hypertension. The nurse understands that which antihypertensive medication would be most effective in this patient? a. Acebutolol (Sectral) b. Captopril (Capoten) c. Carteolol HCl (Cartrol) d. Metoprolol (Lopressor) ANS: B Captopril is an angiotensin II inhibitor. Native-American patients do not respond well to beta blockers. Acebutolol, carteolol, and metoprolol are all beta blockers. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: dm 634 TOP: NURSING PROCESS: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 7. The nurse is caring for an 80-year-old patient who has just begun taking a thiazide diuretic to treat hypertension. What is an important aspect of care for this patient? a. Encouraging increased fluid intake b. Increasing activity and exercise c. Initiating a fall risk protocol d. Providing a low potassium diet

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ANS: C Older patients experience a higher risk of orthostatic hypotension when taking antihypertensive medications. Fall risk also increases with a need for increased trips to the bathroom. A fall risk protocol should be implemented. Increasing fluids and activity and limiting potassium are not indicated. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 645 TOP: NURSING PROCESS: Planning MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 8. The nurse is performing an assessment on a patient who will begin taking propranolol (Inderal) to treat hypertension. The nurse learns that the patient has a history of asthma and diabetes. The nurse will take which action? a. Administer the medication and monitor the patients serum glucose. b. Contact the provider to discuss another type antihypertensive medication. c. Request an order for renal function tests prior to administering this drug. d. Teach the patient about the risks of combining herbal medications with this drug. ANS: B Patients with chronic lung disease are at risk for bronchospasm with beta blockers, especially those like propranolol which are non-selective. Beta blockers, with the exception of carvedilol, also decrease the efficacy of many oral antidiabetic medications. The nurse should discuss a change in medications to one that does not carry this risk. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 636 TOP: NURSING PROCESS: Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 9. The nurse is admitting a patient who has been taking minoxidil (Loniten) to treat hypertension. Prior to beginning therapy with this medication, the patient had a blood pressure of 170/95 mm Hg and a heart rate of 72 beats per minute. The nurse assesses the patient and notes a blood pressure of 130/72 mm Hg and a heart rate of 78 beats per minute, and also notes a 2.2-kg weight gain since the previous hospitalization and edema of the hands and feet. The nurse will contact the provider to discuss which intervention? a. Adding hydrochlorothiazide to help increase urine output b. Adding metoprolol (Lopressor) to help decrease the heart rate c. Increasing the dose of minoxidil to lower the blood pressure d. Restricting fluids to help with weight reduction ANS: A Minoxidil is a direct-acting vasodilator which can cause sodium and water retention. Combining this drug with a diuretic can help reduce edema by increasing urine output. If the patient were tachycardic, a beta blocker might be added. It is not necessary to increase the minoxidil dose or to restrict fluids. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 643 TOP: NURSING PROCESS: Assessment/Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 10. The nurse is teaching a patient who has hypertension about long-term management of the disease and a beta blocker. The patient reports typically consuming 1 to 2 glasses of wine each

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evening with meals. How will the nurse respond? a. Beta blockers and wine cause a reflex hypertension. b. Four to 6 ounces of wine is considered safe with these medications. c. Wine in moderation helps you relax and get better blood pressure control. d. Wine increases the hypotensive effects of the beta blocker. ANS: D Patients who take beta blockers should avoid all alcohol because it increases the hypotensive effects. It does not cause reflex hypertension. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 637 TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 11. A patient who has recently begun taking captopril (Capoten) to treat hypertension calls a clinic to report a persistent cough. The nurse will perform which action? a. Instruct the patient to go to an emergency department because this is a hypersensitivity reaction. b. Reassure the patient that this side effect is nothing to worry about and will diminish over time. c. Schedule an appointment with the provider to discuss changing to an angiotensin II receptor blocker (ARB). d. Tell the patient to stop taking the drug immediately since this is a serious side effect of this drug. ANS: C An angiotensin-converting enzyme (ACE) inhibitor, such as captopril, can cause a constant, irritated cough. The cough will stop with discontinuation of the drug, and many patients can switch to an ARB medication. It does not indicate a hypersensitivity reaction. The cough will not diminish while still taking the drug. The patient does not need to stop taking the drug immediately. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 645 TOP: NURSING PROCESS: Evaluation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 12. The nurse is preparing to administer an angiotensin-converting enzyme (ACE) inhibitor to a patient who has hypertension. The nurse notes peripheral edema and swelling of the patients lips. The patient has a blood pressure of 160/80 mm Hg and a heart rate of 76 beats per minute. What is the nurses next action? a. Administer the dose and observe carefully for hypotension. b. Hold the dose and notify the provider of a hypersensitivity reaction. c. Notify the provider and request an order for a diuretic medication. d. Request an order for serum electrolytes and renal function tests. ANS: B The patient has signs of angioedema which indicates a hypersensitivity reaction. The nurse should hold the dose and notify the provider. Giving the dose will make the reaction more serious. These are not signs of edema, so a diuretic is not indicated. Electrolytes and renal function tests are not indicated.

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DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 645 TOP: NURSING PROCESS: Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 13. The nurse is caring for a patient who will begin taking captopril (Capoten) for hypertension. The nurse reviews the patients laboratory test results and notes increased BUN and creatinine. Which action will the nurse take? a. Administer the captopril and monitor vital signs. b. Contact the provider to discuss changing to fosinopril (Monopril). c. Obtain an order for intravenous fluids to improve urine output. d. Request an order to add hydrochlorothiazide (HydroDIURIL). ANS: B Patients who have renal insufficiency will not require a decrease in dose with fosinopril, as they would with other angiotensin-converting enzyme (ACE) inhibitors. If captopril is given, it should be given in a reduced dose. Increased IV fluids are not indicated. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 635 TOP: NURSING PROCESS: Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 14. The nurse is caring for a patient who experiences a rapid rise in blood pressure. The nurse will contact the provider to discuss administering which medication? a. Amlodipine (Norvasc) b. Nifedipine (Procardia) c. Nifedipine extended release (Procardia XL) d. Verapamil (Calan) ANS: B The short-acting nifedipine is used to treat rapid rises in blood pressure but cannot be used for out-patient treatment at high dosages because of an increased risk for sudden cardiac death. The other drugs are not used for rapid rise in BP. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: dm 647 TOP: NURSING PROCESS: Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 15. The nurse is caring for a 70-year-old patient who has recently begun taking amlodipine (Norvasc) 5 mg/day to control hypertension. The nurse notes mild edema of the patients ankles, a blood pressure of 130/70 mm Hg, and a heart rate of 80 beats per minute. The patient reports flushing and dizziness. The nurse will notify the provider and a. ask to decrease the dose to 2.5 mg/day. b. discuss twice daily dosing. c. request an order for a diuretic. d. suggest adding propranolol to the regimen. ANS: A This patient is experiencing side effects of the medication. Elderly patients often require lower doses, so the nurse should ask about a dose reduction. Older adults generally require 2.5 to 5.0 mg/day. Twice daily dosing is not recommended. Unless edema persists, a diuretic is not indicated.

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DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 647 TOP: NURSING PROCESS: Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies MULTIPLE RESPONSE 1. The nurse teaches a patient about antihypertensive medication. Which statements by the patient indicate understanding of the teaching? (Select all that apply.) a. I should be careful when I stand up from a chair. b. I should not add extra salt to my foods. c. If I have side effects, I should stop taking the drug immediately. d. If my blood pressure returns to normal, I can stop taking this drug. e. I may need to take a combination of drugs, including diuretics. f. I will not need to make lifestyle changes since I am taking a medication. ANS: A, B, E The patient receiving an antihypertensive medication should be warned to rise slowly to avoid orthostatic hypotension. Patients should be counseled to continue to make lifestyle changes, including decreasing sodium. Often, more than one medication is required. Patients should not stop taking the drug abruptly to avoid rebound hypertension and will not stop the drug when blood pressure returns to normal. Chapter 18: Diuretics MULTIPLE CHOICE 1. The nurse is preparing to administer the first dose of hydrochlorothiazide (HydroDIURIL) 50 mg to a patient who has a blood pressure of 160/95 mm Hg. The nurse notes that the patient had a urine output of 200 mL in the past 12 hours. The nurse will perform which action? a. Administer the medication as ordered. b. Encourage the patient to drink more fluids. c. Hold the medication and request an order for serum BUN and creatinine. d. Request an order for serum electrolytes and administer the medication. ANS: C Thiazide diuretics are contraindicated in renal failure. This patient has oliguria and should be evaluated for renal failure prior to administration of the diureticespecially in the absence of known renal failure for this patient. Drinking more fluids will not increase urine output in patients with renal failure. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 623 TOP: NURSING PROCESS: Assessment/Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 2. The nurse is preparing to administer doses of hydrochlorothiazide (HydroDIURIL) and digoxin (Lanoxin) to a patient who has heart failure. The patient reports having blurred vision. The nurse notes a heart rate of 60 beats per minute and a blood pressure of 140/78 mm Hg. Which action will the nurse take? a. Administer the medications and request an order for serum electrolytes.

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b. Give both medications and evaluate serum blood glucose frequently. c. Hold the digoxin and notify the provider. d. Hold the hydrochlorothiazide and notify the provider. ANS: C When thiazide diuretics are taken with digoxin, patients are at risk of digoxin toxicity because thiazides can cause hypokalemia. The patient has bradycardia and blurred vision, which are both signs of digoxin toxicity. The nurse should hold the digoxin and notify the provider. Serum electrolytes may be ordered, but the digoxin should not be given. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 623 TOP: NURSING PROCESS: Nursing Intervention/Evaluation MSC: NCLEX: Physiological Integrity: Pathophysiology 3. The nurse is teaching a patient about taking hydrochlorothiazide. Which statement by the patient indicates a need for further teaching? a. I may need extra sodium and calcium while taking this drug. b. I should eat plenty of fruits and vegetables while taking this medication. c. I should take care when rising from a bed or chair when Im on this medication. d. I will take the medication in the morning to minimize certain side effects. ANS: A Patients do not need extra sodium or calcium while taking thiazide diuretics. Thiazide diuretics can lead to hypokalemia, so patients should be counseled to eat fruits and vegetables that are high in potassium. Patients can develop orthostatic hypotension and should be counseled to rise from sitting or lying down slowly. Taking the medication in the morning helps to prevent nocturia-induced insomnia. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 624 TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 4. The nurse is caring for a patient who is to begin receiving a thiazide diuretic to treat heart failure. When performing a health history on this patient, the nurse will be concerned about a history of which condition? a. Asthma b. Glaucoma c. Gout d. Hypertension ANS: C Thiazides block uric acid secretion and elevated levels can contribute to gout. Patients with a history of gout should take thiazide diuretics with caution; they may need behavioral and/or pharmacologic changes to their gout treatment. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 626 TOP: NURSING PROCESS: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 5. The nurse is caring for a patient who develops marked edema and a low urine output as a result of heart failure. Which medication will the nurse expect the provider to order for this patient?

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a. Digoxin (Lanoxin) b. Furosemide (Lasix) c. Hydrochlorothiazide (HydroDIURIL) d. Spironolactone (Aldactone) ANS: B Furosemide is a loop diuretic and is given when the patients condition warrants immediate removal of body fluid, as in heart failure. Digoxin improves cardiac function but does not remove fluid quickly. The other diuretics may be used when immediate fluid removal is not necessary. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 627 TOP: NURSING PROCESS: Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 6. The nurse is caring for a patient who is receiving furosemide (Lasix) and an aminoglycoside antibiotic. The nurse will be most concerned if the patient reports which symptom? a. Dizziness b. Dysuria c. Nausea d. Tinnitus ANS: D The interaction of furosemide and an aminoglycoside can produce ototoxicity in the patient. Tinnitus is a sign of ototoxicity. Dizziness can occur as a result of diuretic therapy but not necessarily as a result of this combination. Dysuria and nausea are not common signs of these drugs interacting. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 627 TOP: NURSING PROCESS: Evaluation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 7. The nurse is teaching a patient who will begin taking furosemide. The nurse learns that the patient has just begun a 2-week course of a steroid medication. What will the nurse recommend? a. Consume licorice to prevent excess potassium loss. b. Report a urine output greater than 600 mL/24 hours. c. Obtain an order for a potassium supplement. d. Take the furosemide at bedtime. ANS: C The interaction of furosemide and a steroid drug can result in an increased loss of potassium. Patients should take a potassium supplement. Patients should avoid licorice while taking furosemide, partially due to the hypokalemic effects of both substances. Urine output greater than 600 mL/24 hours is normal. Patients should take furosemide in the morning to avoid nocturia. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 623 TOP: NURSING PROCESS: Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 8. The nurse is caring for a patient who has metabolic alkalosis and is experiencing fluid overload. The provider orders acetazolamide (Diamox). The patient reports right-sided flank pain

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after taking this medication. The nurse suspects that this patient has developed which condition? a. Gout b. Hemolytic anemia c. Metabolic acidosis d. Renal calculi ANS: D Carbonic anhydrase inhibitors, such as acetazolamide, are used to treat patients who are in metabolic alkalosis and need a diuretic. They can cause electrolyte imbalance, metabolic acidosis, hemolytic anemia, and renal calculi. This patient has right-sided flank pain, which occurs with renal calculi. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 629 TOP: NURSING PROCESS: Evaluation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 9. A patient has begun taking spironolactone (Aldactone) in addition to a thiazide diuretic. With the addition of the spironolactone, the nurse will counsel this patient to a. continue taking a potassium supplement daily. b. recognize that abdominal cramping is a transient side effect. c. report decreased urine output to the provider. d. take these medications at bedtime. ANS: C Caution must be used when giving potassium-sparing diuretics to patients with poor renal function, so patients should be taught to report a decrease in urine output. Patients taking potassium-sparing diuretics are at risk for hyperkalemia, so they should not take potassium supplements. Abdominal cramping should be reported to the provider. The medications should be taken in the morning for patients who sleep during the night. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 629 TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 10. The nurse notes a blood pressure of 160/90 mm Hg in a patient taking a thiazide diuretic. The patient reports taking an herbal medication that a friend recommended. Which herbal product is likely, given this patients blood pressure? a. Ginkgo b. Hawthorne c. Licorice d. St. Johns wort ANS: A Increased blood pressure can result when ginkgo is used in combination with a thiazide diuretic. Hawthorne can potentiate hypotension. Licorice can increase potassium loss, leading to hypokalemia. St. Johns wort is not listed as an herbal alert substance with thiazide diuretics. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: dm 624 TOP: NURSING PROCESS: Evaluation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

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11. The nurse is caring for a patient who is taking hydrochlorothiazide (HydroDIURIL) and digoxin (Lanoxin). Which potential electrolyte imbalance will the nurse monitor for in this patient? a. Hypermagnesemia b. Hypernatremia c. Hypocalcemia d. Hypokalemia ANS: D Thiazide diuretics can cause hypokalemia, which enhances the effects of digoxin and can lead to digoxin toxicity. Thiazides can cause hypercalcemia. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: dm 622 TOP: NURSING PROCESS: Evaluation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 12. A patient has been taking spironolactone (Aldactone) to treat heart failure. The nurse will monitor for a. hyperkalemia. b. hypermagnesemia. c. hypocalcemia. d. hypoglycemia. ANS: A Spironolactone is a potassium-sparing diuretic and can cause hyperkalemia. Chapter 19: Heart Failure 1. A patient presents to the emergency department with rales, wheezing, and blood-tinged sputum. What does the nurse recognize that these symptoms indicate? A)

Cardiomyopathy

Cardiomegaly

Valvular heart disease

Pulmonary edema

Ans:

D Feedback: In left-sided heart failure, the left ventricle pumps inefficiently resulting in a backup of blood into the lungs causing pulmonary vessel congestion and fluid leaks into the alveoli and lung tissue. As more fluid continues to collect in the alveoli, pulmonary edema develops. The patient will present with rales, wheezes, blood-tinged sputum, low oxygenation, and development of a third heart sound. Cardiomyopathy can occur as a result of a viral infection, alcoholism, anabolic steroid abuse, or a collagen disorder. It causes muscle alterations and ineffective contraction and pumping. Cardiomegaly is an enlargement of the heart due to compensatory mechanisms in congestive heart failure

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(CHF) and leads to ineffective pumping and eventually exacerbated CHF. Valvular heart disease leads to an overload of the ventricles because the valves do not close adequately causing blood to leak backward. This causes muscle stretching and increased demand for oxygen and energy. 2. What electrolyte inactivates troponin and allows actin and myosin to form a bridge enabling the muscle fibers to contract? A)

Magnesium

Calcium

Potassium

Sodium

Ans:

B Feedback: Calcium must be present to deactivate troponin so that actin and myosin can react to form actinomycin bridges. Potassium, sodium, and magnesium do not affect troponin.

3. A 62-year-old African American man diagnosed with congestive heart failure and hypertension has BiDil included in his drug therapy. What nursing assessment finding would indicate the patient is developing a complication from this drug? A)

Alopecia

Photosensitivity

Anorexia

Orthostatic hypotension

Ans:

D Feedback: Orthostatic hypotension is an adverse effect of a combination of isosorbide dinitrate and hydralazine called BiDil. This could lead to safety concerns and should be addressed in drug teaching for this patient. Alopecia, photosensitivity, and anorexia are not adverse effects related to this drug.

4. The nurse is preparing digoxin for an infant. What is the nurses priority intervention? A)

To perform hand hygiene

To have another nurse check dosage calculations

To check the childs apical pulse

To identify the patient by checking the ID bracelet

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Ans:

B Feedback: The margin of safety for the dosage of this drug is very narrow in children. The dosage needs to be very carefully calculated and should be double-checked by another nurse before administration. The other options are important and the nurse should implement all three. However, these actions are of lower priority.

5. A patient asks the nurse what cardiac glycosides do to improve his condition. What is the nurses best response? A)

They decrease the force of myocardial contractions.

They help renal blood flow and increase urine output.

They increase heart rate.

They increase conduction velocity.

Ans:

B Feedback: Cardiac glycosides increase intracellular calcium and allow more calcium to enter myocardial cells. This action causes an increased force of myocardial contraction, an increased cardiac output, and renal perfusion that increases urine output. Cardiac glycosides also serve to slow the heart rate and decrease conduction velocity.

6. What is the priority nursing assessment for a patient who is about to begin digoxin therapy? A)

Blood glucose levels

Neurological function

Kidney function

Liver function

Ans:

C Feedback: Digoxin is primarily excreted unchanged in the urine, so caution should be exercised if renal impairment is present. Blood glucose levels and neurological and liver function would not be a priority assessment related to digoxin therapy.

7. A triage nurse in the emergency department is assessing a 78-year-old man. It is determined that the patient is experiencing severe digoxin toxicity. What drug will the nurse administer immediately? A)

Inamrinone (Inocor)

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Digoxin immune Fab (Digibind)

Verapamil hydrochloride (Calan)

Quinidine sulfate

Ans:

B Feedback: Digoxin immune Fab is an antigen-binding fragment derived from specific antidigoxin antibodies. The drug is used for the treatment of life-threatening digoxin intoxication when serum levels are greater than 10 ng/mL. Inamrinone is a phosphodiesterase inhibitor that acts as a cardiotonic agent. Verapamil hydrochloride is a calcium channel blocker. Quinidine is an antiarrhythmic agent that when taken with digoxin increases both the therapeutic and toxic effects of digoxin.

8. The nurse is providing patient teaching to a patient who has been prescribed digoxin. The patient tells the nurse that she occasionally use herbals and other alternative therapies. What herb would the nurse warn the patient to avoid taking with digoxin? A)

Black cohosh

Ginseng

Saw palmetto

Valerian

Ans:

B Feedback: Digoxin toxicity can occur if the drug is taken concurrently with licorice, ginseng, or hawthorn. St. Johns wort and psyllium have been shown to decrease the effectiveness of digoxin, so that combination should be avoided. There is no drug-to-drug interaction with black cohosh, saw palmetto, or valerian.

9. The nurse administers an IV phosphodiesterase inhibitor. What drug will result in forming a precipitate if given via the same IV line without adequate flushing? A)

Albuterol (Proventil)

Nifedipine (Procardia)

Furosemide (Lasix)

Lovastatin (Mevacor)

Ans:

C Feedback:

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Furosemide, when given with a phosphodiesterase inhibitor, forms precipitates; therefore, this combination should be avoided. Use alternate lines if both of these drugs are being given IV. There are no known drug-to-drug interactions with albuterol, nifedipine, or lovastatin. 10. A 6-year-old child weighing 60 pounds has been prescribed oral digoxin (Lanoxin) 30 mcg/kg as a loading dose. How many milligram will she be given? A)

0.218 mg

0.418 mg

0.618 mg

0.818 mg

Ans:

D Feedback: First, using the formula: 2.2 pounds and 60 pounds: multiplied by kg, determine the childs weight in kg (60/2.2 = 27.27 kg). Next, using the formula: amount of drug prescribed times weight in kg, determine the dose in mcg the child should receive (30 multiplied by 27.27 = 0. 818 mcg). Then to determine the amount of mg the child should receive, use the formula: 1 mg: 1,000 mcg = X mg: 818 mcg (818/1,000 = 0.818 mg).

11. The nurse assesses the patient before administering digoxin (Lanoxin) and withholds the drug and notifies the physician with what finding? A)

Respiratory rate falls below 14

History reveals liver failure

Pulse is 44 beats/min

Blood pressure is 72/40 mm Hg

Ans:

C Feedback: Monitor apical pulse for 1 full minute before administering the drug to assess for adverse effects. Hold the dose if the pulse is less than 60 beats/min in an adult or less than 90 beats/min in an infant; retake pulse in 1 hour. If pulse remains low, document pulse, withhold the drug, and notify the prescriber.

12. When a drug is said to increase the force of contraction of the heart muscle, the nurse appropriately uses what term? A)

Positive chronotropic

Positive inotropic

Negative inotropic

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Negative dromotropic

Ans:

B Feedback: Sympathetic stimulation causes an increase in heart rate, blood pressure, and rate and depth of respirations, as well as a positive inotropic effect (increased force of contraction) on the heart and an increase in blood volume (through the release of aldosterone). A negative inotropic effect would be one that decreased the force of a contraction. A negative dromotropic effect is one that slows the conduction of the impulse through the atrioventricular node. A positive chronotropic effect is one that increases the heart rate.

13. The nurse, caring for a patient who is receiving cardiac glycosides to treat heart failure, will teach the patient to follow what diet? A)

High sodium, low potassium, high fat

Low sodium, low potassium, low fat

High iron, high calcium, high potassium

Low sodium, high potassium, low fat

Ans:

D Feedback: Restrict dietary sodium to reduce edema in patients receiving cardiac glycosides. If the patient is hyponatremic or using a potassium-losing diuretic, increase potassium in diet, as well as limit fat intake to reduce weight and atherogenic activity.

14. What order for a digitalizing dose of digoxin (Lanoxin) for a 62-year-old man would the nurse consider appropriate and safe to administer? A)

1.25 mg IV now

0.75 mg orally now

0.25 mg orally every day

1 mg intramuscularly every 4 hours 24 hours

Ans:

B Feedback: Digoxin: Adult: loading dose 0.75 to 1.25 mg orally or 0.125 to 0.25 mg IV, then oral maintenance dose of 0.125 to 0.25 mg/d; decrease dose with renal impairment.

15. After administering an IV dose of digoxin, the nurse would expect to see effects within what period of time? A)

30 to 120 minutes

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5 to 30 minutes

1 hour

2 hours

Ans:

B Feedback: The drug has a rapid onset of action and rapid absorption (30 to 120 minutes when taken orally, 5 to 30 minutes when given IV).

16. The patient taking digoxin (Lanoxin) has developed an infection. What antibiotic can the nurse safely administer to this patient? A)

Zithromax

Erythromycin

Tetracycline

Cyclosporine

Ans:

A Feedback: Zithromax may be given without impacting the effects of digoxin. There is a risk of increased therapeutic effects and toxic effects of digoxin if it is taken with verapamil, amiodarone, quinidine, quinine, erythromycin, tetracycline, or cyclosporine. If digoxin is combined with any of these drugs, it may be necessary to decrease the digoxin dose to prevent toxicity. If one of these drugs has been part of a medical regimen with digoxin and is discontinued, the digoxin dose may need to be increased.

17. The 96-year-old patient is receiving digoxin (Lanoxin) and furosemide (Lasix). In the morning, the patient complains of a headache and nausea. What will the nurse do first? A)

Contact the patients physician immediately.

Check her laboratory values and vital signs.

Administer acetaminophen and Maalox.

Give her clear liquids and have her lie down.

Ans:

B Feedback: The nurse will check the patients digoxin level and electrolytes. Assessing vital signs is important because the risk of cardiac arrhythmias could increase due to the patients receiving furosemide, which is a potassium-losing diuretic. The adverse effects most frequently seen with the cardiac glycosides include headache, weakness, drowsiness, and

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vision changes (a yellow halo around objects is often reported). Gastrointestinal (GI) upset and anorexia also commonly occur. Only after checking lab values and assessing vital signs might the nurse call the physician. Acetaminophen and Maalox would not be indicated. Having her lie down and restricting her diet to clear liquids would be appropriate but not the first actions. 18. The nurse provides teaching about digoxin to the 62-year-old patient. The nurse evaluates patient understanding and determines further teaching is needed when the patient says she will do what? A)

Take the medication daily in the morning.

Take her pulse before taking her dose.

Weigh herself daily at the same time.

Take the medication with a meal.

Ans:

D Feedback: Avoid administering the oral drug with food or antacids to avoid delays in absorption. The other answers are appropriate actions for the patient to take when self-administering digoxin.

19. When administering milrinone (Primacor), the nurse will assess the patient for what common adverse effect? A)

Hypoglycemia

Confusion

Hypotension

Seizures

Ans:

C Feedback: The adverse effects most frequently seen with these drugs are ventricular arrhythmias (which can progress to fatal ventricular fibrillation), hypotension, and chest pain. Hypoglycemia, confusion, and seizures are not generally adverse effects of milrinone.

20. The nurse administers a cardiac glycoside for what therapeutic effect? A)

To decrease cardiac output

To decrease afterload

To increase ventricular rate

To increase the force of the contraction of the heart

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Ans:

D Feedback: Cardiac glycosides exert a negative cardiotonic and positive inotropic effect. They do not decrease cardiac output, decrease afterload, or increase the ventricular rate of the heart.

21. After administering digoxin, what assessment finding would indicate to the nurse that the drug was having the desired effect? A)

Increased heart size

Increased urinary output

Decreased respiratory rate

Increased heart rate

Ans:

B Feedback: As cardiac output improves, so does urinary output due to increased renal perfusion. Respiratory rate and heart size would not be impacted by the drug, although ventricular hypertrophy is a common finding in patients with heart failure. Heart rate would decrease as the force of contraction increases, ejecting more blood with each contraction.

22. What assessment finding would indicate the patients left-sided heart failure is worsening? A)

Increased jugular venous pressure

Liver enlargement

Increased crackles in lung fields

Increased pulse rate

Ans:

C Feedback: Fluid may accumulate in the lungs due to left sided heart failure. Patients may evidence dyspnea, tachypnea, and orthopnea. Right-sided failure would include increased jugular venous pressure and liver enlargement. Pulse rate could increase or decrease depending on medications administered.

23. Which drug is in the class of drugs called human B-type natriuretic peptides? A)

Bosentan (Tracleer)

Milrinone (Primacor)

Digoxin (Lanoxin)

Nesiritide (Natrecor)

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Ans:

D Feedback: Nesiritide is the only drug currently available in a class of drugs called human B-type natriuretic peptides. Digoxin is a cardiac glycoside. Milrinone is a phosphodiesterase inhibitor. Bosentan is an endothelin receptor antagonist.

24. The nurse reviews the patients lab results and recognizes the patient is at risk for digoxin toxicity due to what electrolyte imbalance? A)

Hyperkalemia

Hypokalemia

Hypernatremia

Hyponatremia

Ans:

B Feedback: Electrolyte abnormalities (e.g., increased calcium, decreased potassium, decreased magnesium) could alter the action potential and change the effects of the drug. Hypokalemia and hypomagnesemia increase cardiac excitability and ectopic pacemaker activity leading to dysrhythmias.

25. What common action do both cardiac glycosides and phosphodiesterase inhibitors have in common related to therapeutic action? A)

Blocking the enzyme phosphodiesterase

Increasing cellular calcium

Developing ventricular arrhythmias

Metabolizing in the liver and excreted in the urine

Ans:

B Feedback: The phosphodiesterase inhibitors block the enzyme phosphodiesterase. This blocking effect leads to an increase in myocardial cell cyclic adenosine monophosphate (cAMP), which increases calcium levels in the cell (Figure 44.4). Increased cellular calcium causes a stronger contraction and prolongs the effects of sympathetic stimulation, which can lead to vasodilation, increased oxygen consumption, and arrhythmias. Digoxin also increases intracellular calcium and allows more calcium to enter myocardial cells during depolarization.

26. The nurse evaluates an improvement in the patients heart failure (HF) status based on what assessment finding?

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Using fewer pillows to sleep

Increased skin turgor

Heart rate regular

Improved mental status

Ans:

A Feedback: The degree of HF is often calculated by the number of pillows required to get relief (e.g., one-pillow, two-pillow, or three-pillow orthopnea). Fluid overload is associated with HF so skin turgor is not an indicator of improvement. Regular heart rate and normal cognition can be found with acute flare-ups of HF so these findings would not indicate improvement.

27. The nurse suspects the patient may have toxic levels of digoxin in the bloodstream when what is assessed? (Select all that apply.) A)

Irregular heart rhythms

Nausea

Anorexia

Headache

Peripheral edema

Ans:

A, B, C Feedback: Digoxin toxicity is a serious syndrome that can occur when digoxin levels are too high. The patient may present with anorexia, nausea, vomiting, malaise, depression, irregular heart rhythms including heart block, atrial arrhythmias, and ventricular tachycardia. Peripheral edema is indicative of heart failure, not digoxin toxicity. Headache is not usually associated with digoxin toxicity.

28. The patient has been prescribed inamrinone (Inocor). Before administering the drug the nurse needs to know the drug has what pharmacokinetic effect? A)

Decrease in cyclic adenosine monophosphate (cAMP)

Decrease in cardiac output

Increase in cardiac preload

Increase in cAMP

Ans:

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Feedback: Inamrinone is a phosphodiesterase inhibitor that blocks the enzyme phosphodiesterase. This blocking effect leads to an increase in myocardial cell cAMP, which increases calcium levels in the cell. These drugs do not decrease cardiac output or increase cardiac preload. 29. The patient has just been prescribed milrinone (Primacor). The nurse recognizes the drug is contraindicated due to the patients allergy to what? A)

Penicillins

Salicylates

Opioids

Bisulfites

Ans:

D Feedback: Phosphodiesterase inhibitors are contraindicated in the presence of allergy to the drug or to bisulfites. Penicillins, salicylates, and opioids have no contraindications when used with milrinone.

30. The nurse administers a human B-type natriuretic peptide with the expectation it will have what action? A)

Decrease blood volume

Increase force of cardiac contraction

Reduce venous return

Lighten the hearts workload

Ans:

C Feedback: Human B-type natriuretic peptides are normally produced by myocardial cells as a compensatory response to increased cardiac workload and increased stimulation by the stress hormones. They bind to endothelial cells, leading to dilation and resulting in decreased venous return, peripheral resistance, and cardiac workload. They also suppress the bodys response to the stress hormones, leading to increased fluid loss and further decrease in cardiac workload. Diuretics decrease blood volume, cardiac glycosides increase force of contraction, and vasodilators lighten the hearts workload.

31. The nurse expects the patients heart failure (HF) is caused by what diagnosis that is responsible for 95% of the cases diagnosed? A)

Cardiomyopathy

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Hypertension

Congenital anomaly

Coronary artery disease (CAD)

Ans:

D Feedback: CAD is the leading cause of HF, accounting for approximately 95% of the cases diagnosed. CAD results in an insufficient supply of blood to meet the oxygen demands of the myocardium. Consequently, the muscles become hypoxic and can no longer function efficiently. When CAD evolves into a myocardial infarction, muscle cells die or are damaged, leading to an inefficient pumping effort. Cardiomyopathy, hypertension, and congenital anomaly are rarely associated with heart failure.

32. The nurse prepares to administer a phosphodiesterase inhibitor by what route? A)

Oral

B) IV C)

Subcutaneous

Intramuscular

Ans:

B Feedback: Phosphodiesterase inhibitors are only given IV. They cannot be given orally, intramuscularly, or subcutaneously.

33. The nurse is caring for a patient who has digoxin toxicity. As the nurse assesses the changes in the patients daily activities, what finding could indicate the cause of the toxic level? A)

The patient has been sleeping more lately.

The patient took nitroglycerin for chest pain twice yesterday.

The patients daughter brought her a bag of licorice that she has been enjoying.

The patients intake of sodium increased lately because shes been eating seafood.

Ans:

C Feedback: Increased digoxin toxicity has been reported with ginseng, hawthorn, and licorice. Patients should be advised to avoid these combinations. Increased sodium intake will exacerbate the patients heart failure, which might explain why she is sleeping more and requiring nitroglycerin but these actions did not contribute to the digoxin toxicity.

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34. The nurse admits a patient to the constant care unit with a digoxin level of 11 ng/mL and a serum potassium level of 5.2 mEq/L. Digoxin immune Fab is administered. The next day, the patients digoxin level remains elevated. What action does the nurse anticipate? A)

Administer digoxin immune Fab again.

Administer a reduced dosage of digoxin.

Continue to monitor the patients digoxin level daily.

Notify the health care provider of the elevated level.

Ans:

C Feedback: Serum digoxin levels will be very high and unreliable for about 3 days after the digoxin immune Fab infusion because of the high levels of digoxin in the blood. The patient should not be redigitalized for several days to 1 week after digoxin immune Fab has been used, because of the potential of fragments remaining in the blood. There is no need to notify the health care provider or to administer digoxin immune Fab again.

35. The nurse is preparing to administer a digitalizing dosage of digoxin to a geriatric patient. What factors will the nurse assess for first to avoid digoxin toxicity? (Select all that apply.) A)

Renal function

Low body mass

Hydration

Assessment of pulse

Cognitive function

Ans:

A, B, C Feedback: Factors that may contribute to elevated digoxin levels include impaired renal function, low body mass, and dehydration. Assessment of pulse and cognitive function are always important when caring for a geriatric patient, but they will not contribute to elevated digoxin levels.

Chapter 20: Antiarrhythmics 1. A patient with a history of atrial fibrillation has had a worsening of his or her condition. The nurse knows that the drug of choice for long-term stabilization of atrial fibrillation following electrocardioversion is what? A)

Disopyramide (Norpace)

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Moricizine (Ethmozine)

Procainamide (Pronestyl)

Quinidine (generic)

Ans:

D Feedback: Quinidine is often the drug of choice for long-term stabilization of atrial fibrillation after the rhythm is converted by electrocardioversion. Quinidine is a class I antiarrhythmic and stabilizes the cell membrane by binding to sodium channels, depressing phase 0 of the action potential, and changing the duration of the action potential. Disopyramide, moricizine, and procainamide are all used in the treatment of life-threatening ventricular arrhythmias.

2. What class of antiarrhythmics drug blocks potassium channels, prolonging phase 3 of the action potential and slowing the rate and conduction of the heart? A) I B) II C) III D) IV

Ans:

C Feedback: The class III antiarrhythmics block potassium, prolonging phase 3 of the action potential, which prolongs repolarization and slows the rate and conduction of the heart. Class I drugs block the sodium channels in the cell membrane during an action potential. Class II drugs are beta-adrenergic blockers that block beta-receptors, causing a depression of phase 4 of the action potential. Class IV drugs block calcium channels in the cell membrane leading to a depression of depolarization and a prolongation of phases I and II of repolarization, which slows automaticity.

3. The nurse is caring for a pediatric patient who has been diagnosed with paroxysmal atrial tachycardia. The order reads digoxin 10 mcg/kg orally. The child weighs 44 pounds. How many mcg will the nurse administer? A)

50 mcg

100 mcg

150 mcg

200 mcg

Ans:

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Feedback: The nurse will administer 200 mcg. (2.2 pounds: 1 kg = X: 20 kg, 20(10) = 200 mcg). 4. The nurse is providing drug teaching about quinidine in preparation for the patients discharge. The nurse discusses drugfood interactions and advises the patient to drink what? A)

Apple juice

Grapefruit juice

Milk

Orange juice

Ans:

A Feedback: Apple juice would be the best choice. Quinidine requires a slightly acidic urine (normal state) for excretion. Patients receiving quinidine should avoid foods that alkalinize the urine (e.g., citrus juices, vegetables, antacids, milk products), which could lead to increased quinidine levels and toxicity. Grapefruit juice has been shown to interfere with the metabolism of quinidine, leading to increased serum levels and toxic effects; this combination should be avoided.

5. A patient has had sotalol (Betapace) ordered for treatment of a ventricular arrhythmia. What will the nurse consider when administering the drug? A)

Sotalol has a very short duration of action

Food increases the bioavailability of the drug

Absorption of sotalol is decreased by the presence of food

The drug is best administered intramuscularly

Ans:

C Feedback: This drug should not be taken with food because absorption is decreased. The drug should be given 1 hour before or 2 hours after a meal. Adenosine, not sotalol, has a very short duration of action and food increases the bioavailability of propranolol. Sotalol is administered by oral route only.

6. The nurse is caring for a patient who reports insomnia since starting the antiarrhythmic agent prescribed for him or her. What antiarrhythmic agent would the nurse expect this patient is taking? A)

Disopyramide (Norpace)

Amiodarone (Cordarone)

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Procainamide (Pronestyl)

Propranolol (Inderal)

Ans:

D Feedback: Class II antiarrhythmics can cause insomnia. The adverse effects associated with class II antiarrhythmics are related to the effects of blocking beta-receptors in the sympathetic nervous system. CNS effects include dizziness, insomnia, unusual dreams, and fatigue. Disopyramide and procainamide are class I agents and do not cause insomnia. Amiodarone is a class III drug and is not associated with insomnia.

7. A patient with impaired renal function is to receive dofetilide (Tikosyn) for conversion of atrial fibrillation. What is the nurses priority assessment before administering the drug? A)

Check the patients creatinine level.

Measure the urine output.

Listen to breath sounds.

Measure the PR interval on the electrocardiogram.

Ans:

A Feedback: When giving dofetilide to a patient with renal dysfunction, the dosage must be calculated according to the patients creatinine level to ensure the therapeutic effect while limiting toxicity. This drug can only be administered by oral route. Intake and output as well as breath sounds may need to be assessed but are not related to administering the drug. A patient in atrial fibrillation will not have a measurable PR interval.

8. A nurse is caring for a patient who has had disopyramide (Norpace), ordered. Before administering disopyramide (Norpace) what is the nurses priority action to maintain safety? A)

Offer the patient something to drink.

Ask the patient if he or she needs to void.

Raise all side rails.

Place the call button within reach.

Ans:

C Feedback: When administering disopyramide, the nurse should make sure that all side-rails are up. The central nervous system effects of the drug can include dizziness, drowsiness, fatigue, twitching, mouth numbness, slurred speech, vision changes, and tremors that can progress

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to convulsions. The other three options are appropriate and placing the call button within reach can also be considered a safety measure; however nothing has a higher priority than raising the beds side-rails. 9. The nurse sees a patient in an outpatient setting who is given a new prescription for an antiarrhythmic medication to treat premature atrial contractions (PAC). The nurse has limited time with the patient and addresses what priority nursing diagnosis? A)

Decreased cardiac output

Alteration in comfort

Deficient knowledge

Potential for injury

Ans:

C Feedback: The patient received a new prescription and needs information about how to take the medication, when to call the provider, and potential adverse effects so the priority nursing diagnosis is deficient knowledge. It is unknown what arrhythmia the patient is treating and without this information it is impossible to know what the impact on cardiac output, comfort and potential for injury may be.

10. You are caring for a patient who takes an antiarrhythmic agent. What would be a priority nursing assessment before administering this drug? A)

Assess mental status.

Assess breath sounds.

Assess pulses and blood pressure.

Assess urine output.

Ans:

C Feedback: The nurse should continually monitor cardiac rate and rhythm when administering an antiarrhythmic agent to detect potentially serious adverse effects and to evaluate drug effectiveness. All of the other options are appropriate assessments but are not the priority assessment.

11. The nurse is caring for a patient receiving propranolol. What problems, reported by the patient, does the nurse suspect is caused by the drug? (Select all that apply.) A)

Seizures

Rash

Atrioventricular (AV) block

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Bronchospasm

Dreams

Ans:

C, D, E Feedback: The adverse effects associated with class II antiarrhythmics are related to the effects of blocking beta-receptors in the sympathetic nervous system. Central nervous system effects include dizziness, insomnia, unusual dreams, and fatigue. Cardiovascular symptoms can include hypotension, bradycardia, AV block, arrhythmias, and alterations in peripheral perfusion. Respiratory effects can include bronchospasm and dyspnea. GI problems frequently include nausea, vomiting, anorexia, constipation, and diarrhea. Other effects to anticipate include a loss of libido, decreased exercise tolerance, and alterations in blood glucose levels. Seizures and rash are not usually associated with the adverse effects of propranolol.

12. The nurse teaches the patient receiving propranolol (Inderal) at home for management of a ventricular dysrhythmia to monitor what parameter? A)

Daily fluid intake

Daily blood pressure

Weekly weight

Weekly pulse

Ans:

B Feedback: Hypotension can occur with propranolol, which is a beta-blocker, so patients should check their blood pressure and pulse every day. Propranolol does not require that fluid intake be measured. propranolol also will not require daily weight taking, but it may be necessary with a diagnosis of propranolol.

13. The emergency department nurse is administering IV lidocaine to a patient. What adverse effect of lidocaine therapy should the nurse assess for? A)

Dysphagia

Dizziness

Excessive bruising

Tinnitus

Ans:

B Feedback:

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Adverse effects include dizziness, light-headedness, fatigue, arrhythmias, cardiac arrest, nausea, vomiting, anaphylactoid reactions, hypotension, and vasodilation. Dysphagia, bruising, and tinnitus are not usually associated with lidocaine. 14. The nurse administers a bolus of lidocaine and follows it with a continuous infusion at what rate? A)

0.25 to 0.75 mg/min

1 to 4 mg/min

6 to 8 mg/min

10 to 20 mg/min

Ans:

B Feedback: Lidocaine may be delivered at 1 to 4 mg/min after a bolus. Therefore, the other options are incorrect.

15. The nurse administers what drug to terminate supraventricular tachycardia? A)

Lidocaine (Lidocaine Parenteral)

Flecainide (Tambocor)

Adenosine (Adenocard)

Dronedarone (Multaq)

Ans:

C Feedback: Adenosine depresses conduction at the atrioventricular node and is used to restore NSR (normal sinus rhythm) in patients with paroxysmal supraventricular tachycardia. Adenosine is used to treat supraventricular tachycardias, including those caused by the use of alternate conduction pathways in adults. Lidocaine is used to treat life-threatening ventricular arrhythmias during myocardial infarction or cardiac surgery; it is also used as a bolus injection in emergencies when monitoring is not available to document exact arrhythmia. Flecainide is used to treat life-threatening ventricular arrhythmias in adults; prevention of paroxysmal atrial tachycardia (PAT) in symptomatic patients with no structural heart defect. Dronedarone is used to treat paroxysmal or persistent atrial fibrillation or atrial flutter in patients with multiple risk factors for coronary artery disease who are currently in sinus rhythm or scheduled for conversion.

16. For what condition would the nurse expect to administer lidocaine via IV drip? A)

Decrease in arterial oxygen saturation (SaO2)

Increase in blood pressure

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Multiple premature ventricular contractions (PVCs)

Increase in intracranial pressure (ICP)

Ans:

C Feedback: Lidocaine drips are indicated for the treatment of life-threatening ventricular arrhythmias such as long or frequent runs of PVCs. Lidocaine would not be indicated for the treatment of hypoxia, hypertension, or increased ICP.

17. The nurse is caring for a patient who takes an antiarrhythmic agent and is reporting a complete lack of appetite. Which cardiac antiarrhythmic agent would the nurse suspect the patient is taking? A)

Diltiazem (Cardizem)

Propranolol (Inderal)

Lidocaine (Lidocaine Parenteral)

Amiodarone (Cordarone)

Ans:

B Feedback: Propranolol frequently causes gastrointestinal (GI) problems such as nausea, vomiting, anorexia, constipation, and diarrhea. Diltiazem could cause nausea and vomiting but would not cause anorexia. Lidocaine can lead to changes in taste, nausea, and vomiting but does not cause anorexia. Amiodarone has adverse effects including nausea, vomiting, GI distress, weakness, dizziness, hypotension, heart failure, arrhythmia, a potentially fatal liver toxicity, and ocular abnormalities but does not cause anorexia.

18. A 92-year-old patient is being sent home on disopyramide (Norpace) for a ventricular arrhythmia. He asks the nurse why he must continue to take this drug. The nurses best response would be that failure to treat a ventricular arrhythmia may what? A)

Lead to renal failure

Result in hypertension

Result in death

Cause heart failure

Ans:

C Feedback: Ventricular arrhythmias cause a dramatic reduction in cardiac output and will result in death if not treated. The patient needs to be taught the importance of taking his

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medication every day as ordered. Generally, ventricular arrhythmias are not associated with renal failure, hypertension, or heart failure. 19. The nurse is providing drug teaching for a patient who is to be discharged taking dofetilide (Tikosyn). What drug will the nurse teach the patient to avoid due to a drugdrug interaction? A)

Cimetidine

Furosemide

Acetaminophen

Antacids

Ans:

A Feedback: There is an increased risk of serious adverse effects if dofetilide is combined with ketoconazole, cimetidine, or verapamil, so these combinations should be avoided. There is no known increased risk associated with furosemide, acetaminophen, or antacids but other specific drugdrug interaction are reported, so it is important to check a current drug handbook before administering these medications.

20. The patient asks the nurse, Will I have to take this antiarrhythmic agent for the rest of my life? The nurse, having reviewed the CAST study, responds by saying what? A)

Yes, you will have to take this drug for life.

The drug is indicated for short-term treatment of life-threatening ventricular arrhythmias.

This drug may need to be changed but youll take an antiarrhythmic for life.

After the arrhythmia is corrected, the drug will be stopped.

Ans:

B Feedback: The CAST study, a large research study run by the National Heart and Lung Institute, found that long-term treatment of arrhythmias may have an uncertain effect on mortality, and in some cases may actually lead to increased cardiac death, which is the basis for the current indication for antiarrhythmics to be used only short-term to treat life-threatening ventricular arrhythmias.

21. What patient factor would result in the nurse administering a reduced dosage of disopyramide (Norpace)? A)

Dehydration

Hypertension

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Renal impairment

Chronic diarrhea

Ans:

C Feedback: Caution should be used with renal or hepatic dysfunction, which could interfere with the biotransformation and excretion of these drugs. Caution is not indicated with the findings of dehydration, hypertension, or chronic diarrhea.

22. The nurse is administering an intravenous infusion of amiodarone (Cordarone). What should the nurse be aware of? A)

The possible drugdrug interaction with nonsteroidal anti-inflammatory drugs (NSAIDs)

The possible development of very serious cardiac arrhythmias

The possible development of peripheral edema

The possible development of a fatal renal toxicity

Ans:

B Feedback: Amiodarone has been associated with a potentially fatal liver toxicity rather than a renal toxicity, ocular abnormalities, and the development of very serious cardiac arrhythmias. Sotalol may have a loss of effectiveness if combined with NSAIDs. Diltiazem is associated with peripheral edema.

23. The nurse reviews the patients medical history and determines class II antiarrhythmics are contraindicated due to the patients history of what condition? A)

Asthma

Colitis

Migraine headache

Antidiarrheals

Ans:

A Feedback: Class II antiarrhythmics are contraindicated in patients with asthma because they could worsen the condition due to blockage of beta-receptors. They are not contraindicated in patients with colitis, migraine headache, or diarrhea.

24. What would the nurse teach the diabetic patient to monitor for when beginning a class II antidysrhythmic drug regimen in addition to insulin?

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Weight loss

Reduced peripheral perfusion

Hypoglycemia

Exercise intolerance

Ans:

C Feedback: Increased hypoglycemia is possible if these drugs are combined with insulin; so patients should be taught to monitor their blood sugar levels often. Recurrent hypoglycemic episodes may indicate the need to reduce insulin dosage, but this advice would need to come from the health care provider. Class II antiarrhythmic drugs are normally not associated with weight loss, reduced peripheral perfusion, or exercise intolerance.

25. The nurse assesses the patients rhythm strip and notes several premature ventricular contractions, which the nurse recognizes is caused by what? A)

Stimulation of the ventricles from an ectopic focus in the ventricles

Stimulation of the ventricles from the atrioventricular node

Stimulation of the ventricles from the Purkinje fibers

Stimulation of the ventricles from the bundle of His

Ans:

A Feedback: Premature ventricular contractions are stimulations of the cells caused by an ectopic focus in the ventricles causing an early contraction. The source of these ectopic foci could be anywhere within the ventricles, but the end result is reduced cardiac output due to reduced force of contraction.

26. When the nurse is caring for a patient with a cardiac arrhythmia, the priority goal for the patient is what? A)

To maintain nutritional intake

To maintain fluid intake

To maintain cardiac output

To maintain urine output

Ans:

C Feedback:

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Disruptions in the normal rhythm of the heart can interfere with myocardial contractions and affect the cardiac output, the amount of blood pumped with each beat. Arrhythmias that seriously disrupt cardiac output can be fatal. Therefore, the primary goal of treating a cardiac arrhythmia is to maintain adequate cardiac output to support life. The other goals may be important to individual patient care, but sustaining life takes priority. 27. The nurse is caring for a 3-year-old awaiting a heart transplant who requires an antiarrhythmic agent to control a supraventricular arrhythmia. What drug, if ordered, would the nurse question? A)

Digoxin

Propranolol

Procainamide

Verapamil

Ans:

D Feedback: Verapamil should be avoided in children and, if ordered, would require the nurse to question the drug. Adenosine, propranolol, procainamide, and digoxin have been successfully used to treat supraventricular arrhythmias, with propranolol and digoxin being the drugs of choice for long-term management.

28. The nurse suspects drug toxicity in the patient who has been receiving lidocaine by infusion over the past 2 days to control a ventricular arrhythmia. What assessment would the nurse perform to determine the accuracy of the suspicion of toxicity? A)

Neurological assessment

Serum lidocaine level

Renal function studies

Hepatic function studies

Ans:

B Feedback: If lidocaine is used for ventricular arrhythmias related to cardiac surgery or digoxin toxicity, serum levels should be monitored regularly to determine the appropriate dose and to avoid the potential for serious proarrhythmias and other adverse effects. Neurological assessment may indicate adverse effects but would not confirm lidocaine toxicity. Renal and hepatic function would not confirm lidocaine toxicity.

29. The nurse performs an electrocardiogram and finds the older adult patient is in atrial fibrillation (AF). Time of onset is unknown but could be as long as 3 months earlier when the patient was last assessed. What drug will the nurse expect to be ordered?

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Anticoagulant

Digoxin

Quinidine

Ibutilide

Ans:

A Feedback: If the onset of AF is not known and it is suspected that the atria may have been fibrillating for longer than 1 week, the patient is better off staying in AF without drug therapy or electrocardioversion. Prophylactic oral anticoagulants are given to decrease the risk of clot formation and emboli being pumped into the system. In 2011, the American Heart Association and American College of Cardiology endorsed dabigatran (Pradaxa) as the anticoagulant of choice for prophylaxis in AF. Conversion in this case could result in potentially life-threatening embolization of the lungs, brain, or other tissues. Administration of other antiarrhythmics would not be indicated.

30. What nursing assessment will the nurse perform to determine the hemodynamic effect of the patients arrhythmia? A)

Obtain an electrocardiographic rhythm strip.

Obtain a serum drug level.

Assess the patients level of consciousness.

Assess the patients blood pressure (BP) and pulse rate.

Ans:

D Feedback: BP and pulse rate are indicators of the hemodynamic effect of arrhythmias and are nursing measures that do not require a physicians order. Obtaining an electrocardiogram or checking drug levels requires a physicians order. The patient will be conscious and alert with non-life-threatening arrhythmias, even when cardiac output is reduced. Serum drug levels would indicate the therapeutic or toxic level of drugs in the body but would not indicate hemodynamic effects of the drug.

31. What class of antiarrhythmics will the nurse administer to the patient in symptomatic paroxysmal tachycardia because it markedly depresses phase 0 with extreme slowing of conduction? A)

Class Ib

Class Ic

Class II

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Class III

Ans:

B Feedback: Class Ic drugs markedly depress phase 0, with a resultant extreme slowing of conduction, but have little effect on the duration of the action potential. As a result, they are indicated for the treatment of paroxysmal tachycardia. Class Ib drugs depress phase 0 somewhat and actually shorten the duration of the action potential. The class II antiarrhythmics are beta-adrenergic blockers that block beta-receptors, causing a depression of phase 4 of the action potential. The class III antiarrhythmics block potassium channels and slow the outward movement of potassium during phase 3 of the action potential, thus prolonging it.

32. What class of antiarrhythmic agents does the nurse administer to slow the outward movement of potassium during phase 3 of the action potential? A)

Class Ib

Class Ic

Class II

Class III

Ans:

D Feedback: The class III antiarrhythmics block potassium channels and slow the outward movement of potassium during phase 3 of the action potential, prolonging it. Class Ib drugs depress phase 0 somewhat and actually shorten the duration of the action potential. Class Ic drugs markedly depress phase 0, with a resultant extreme slowing of conduction, but have little effect on the duration of the action potential. The class II antiarrhythmics are betaadrenergic blockers that block beta-receptors, causing a depression of phase 4 of the action potential.

33. What class of antiarrhythmic agents does the nurse administer to depress generation of the action potentials and delaying phases 1 and 2 of repolarization? A)

Class Ib

Class II

Class III

Class IV

Ans:

D Feedback:

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The class IV antiarrhythmics block the movement of calcium ions across the cell membrane, depressing the generation of action potentials and delaying phases 1 and 2 of repolarization, which slows automaticity and conduction. Class Ib drugs depress phase 0 somewhat and actually shorten the duration of the action potential. The class II antiarrhythmics are beta-adrenergic blockers that block beta-receptors, causing a depression of phase 4 of the action potential. The class III antiarrhythmics block potassium channels and slow the outward movement of potassium during phase 3 of the action potential, thus prolonging it. 34. The nurse is teaching a class for newly hired cardiac care nurses and is discussing dronedarone (Multaq). What statement, if made by the nurse, is accurate? (Select all that apply.) A)

Dronedarone has properties of all four classes of antiarrhythmics.

Dronedarone reduces the risk of hospitalization in patients in atrial fibrillation.

Dronedarone has many drugdrug interactions that need to be reviewed.

It is an oral drug taken once a day.

Common adverse effects of dronedarone include ventricular arrhythmias.

Ans:

A, B, C Feedback: Dronedarone has properties of all four classes of antiarrhythmics and the mechanism by which it helps suppress atrial arrhythmias is not fully understood. It is used to reduce the risk of hospitalization in patients with paroxysmal or persistent atrial fibrillation or flutter who have risk factors for cardiovascular disease and who are in sinus rhythm or are scheduled to be converted to sinus rhythm. The drug is taken orally twice a day. Many drugdrug interactions have been associated with the drug and this situation should always be reviewed before starting or stopping any drugs while on this drug. Grapefruit juice should not be consumed while taking this drug. The most common adverse effects seen with dronedarone are heart failure, prolonged QT interval, nausea, diarrhea, and rash. It should never be used during pregnancy because it has been associated with fetal abnormalities.

35. What class of antiarrhythmic agent would the nurse be most likely to administer to a lactating new mother? A)

Class Ib

Class II

Class III

Class IV

Ans:

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Feedback: Class I, III, and IV agents should not be used during lactation; if they are needed, another method of feeding the baby should be used. This leaves only class II drugs for consideration if the mother is lactating. Chapter 21: Antianginal Drugs 1. A nurse is providing patient teaching to a patient who has been experiencing unstable angina. What will the nurses explanation of this condition include? A)

A coronary vessel has become completely occluded and is unable to deliver blood to your heart.

The pain is caused by a spasm of a blood vessel, not just from the vessel narrowing.

There is serious narrowing of a coronary artery that is causing a reduction in oxygen to the heart.

Your bodys response to a lack of oxygen in the heart muscle is pain.

Ans:

C Feedback: Unstable angina is described as increased narrowing of coronary arteries with the heart experiencing episodes of ischemia even at rest. If a coronary vessel is completely occluded and unable to deliver blood to the cardiac muscle, a myocardial infarction has occurred. Prinzmetals angina is an unusual form of angina caused by spasm of the blood vessel and not just by vessel narrowing. Although pain is the bodys response to ischemia in the heart muscle, this description could encompass angina or a myocardial infarction and is not specific enough to explain the condition.

2. The nurse cautions the patient taking nadolol (Corgard) for angina that they may experience what adverse effect? A)

Dry mouth

Decreased exercise tolerance

Constipation

Problems with urination

Ans:

B Feedback: Nadolol is a beta-blocker that can cause a decreased tolerance to exercise because of the inability to experience the effects of the stress reaction. Dry mouth, constipation, and

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problems with urination are effects often seen with anticholinergic drugs but not with beta-blockers. 3. A patient who has been taking cyclosporine to prevent rejection of a kidney transplant has had diltiazem ordered. Why would the nurse question this order? A)

Serious diltiazem toxicity could occur.

The combination may result in elevated or even toxic cyclosporine levels.

The combination could lead to kidney rejection.

A kidney recipient would not effectively excrete the diltiazem.

Ans:

B Feedback: Potentially serious adverse effects to keep in mind include increased serum levels and toxicity of cyclosporine if they are taken with diltiazem. This combination is not associated with diltiazem toxicity. A functioning implanted kidney should still excrete diltiazem. This drug would not cause rejection of a transplanted kidney.

4. A nurse is teaching the patient newly prescribed sublingual nitroglycerin how to take the medication. What will the nurse instruct the patient to do first? A)

To check his radial pulse

To place the tablet in the buccal cavity

To take a sip of water

To lie down for 15 minutes before administration

Ans:

C Feedback: The nurse should instruct the patient to take a sip of water to moisten the mucous membranes so the tablet will dissolve quickly. The patient does not need to take his pulse or lie down before drug administration. For sublingual administration, the patient will place the tablet under his tongue and not in the buccal cavity (cheek area).

5. The nurse, caring for a patient taking a beta-blocker and a nitrate to treat angina, recognizes the need for careful monitoring as the result of what secondary diagnosis? A)

Chronic obstructive pulmonary disease (COPD)

Rheumatoid arthritis (RA)

Irritable bowel syndrome (IBS)

Chronic urinary tract infection (UTI)

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Ans:

A Feedback: The nurse should assess for COPD, because the effect of beta-blockers in reducing effects of the sympathetic nervous system could exacerbate the respiratory condition. RA, IBS, and chronic UTI are not affected by the use of beta-blockers or nitrates to treat angina.

6. What drug would the nurse administer to the patient to control angina caused by atherosclerosis that would also slow the development of further plaque buildup on the arterial wall? A)

Diltiazem (Cardizem)

Propranolol (Inderal)

Amyl Nitrates (generic)

Isosorbide dinitrate (Isordil)

Ans:

A Feedback: Diltiazem is a calcium channel blocker that is indicated to treat Prinzmetals angina, chronic angina, effort-associated angina, and hypertension. Research has indicated these agents slow the development of atherosclerosis. Beta-blockers are indicated for long-term management of angina caused by atherosclerosis, but they do not slow the development of plaque deposits on the artery wall. Propranolol is a beta-blocker. Isosorbide dinitrate and amyl nitrate are nitrates and are indicated for relief acute anginal pain, but they are not used to prevent angina and have no effect on the progression of atherosclerosis.

7. An older adult patient who is taking metformin (Glucophage) has just been seen in the clinic. The doctor has ordered metoprolol (Toprol) for angina. What assessment data should the nurse monitor due to this drug combination? A)

Blood pressure

Blood glucose

Heart rate

Intake and output

Ans:

B Feedback: Metformin is an antidiabetic drug and the nurse should monitor the patients blood glucose frequently throughout the day. The patient will not have the usual signs and symptoms of hypoglycemia or hyperglycemia. Blood pressure, heart rate, and intake and output would not be affected by this drugdrug combination.

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8. A patient is to receive diltiazem (Cardizem) 360 mg/d orally in four divided doses. How many mg will the nurse administer per dose? A)

30 mg

60 mg

90 mg

120 mg

Ans:

C Feedback: The patient will take 90 mg/dose (360 divided by 4 doses equals 90 mg/dose). Therefore, the other options are incorrect.

9. The patient, diagnosed with angina, tells the nurse he is having chest pain. There is an order for oral sublingual nitroglycerin as needed. What action should the nurse take? A)

Place two nitroglycerin tablets under the patients tongue and call the physician.

Place one tablet under the patients tongue and repeat every 5 minutes for total of three tablets until pain has been relieved.

Have the patient swallow a tablet with a full glass of water and repeat in 10 minutes.

Apply a nitroglycerin transdermal patch to the patients back.

Ans:

B Feedback: The correct administration for sublingual administration is to place one tablet under the patients tongue and repeat every 5 minutes for a total of three tablets until pain is relieved. If pain is not relieved after three sublingual tablets, the health care provider should be notified. Transdermal application would be inappropriate and nitroglycerin is not swallowed. Administering two tablets at one time would be an inappropriate dosage and could cause serious adverse effects.

10. The nurse is caring for a patient who is complaining of chest pain. The nurse is to administer 40 mg of isosorbide dinitrate (Isordil) to the patient. What is the nurses priority assessment before administering the drug? A)

Jaundice

Headache

Anemia

Sinusitis

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Ans:

C Feedback: The nurse should assess for anemia because the decrease in cardiac output could be detrimental in a patient who already has a decreased ability to deliver oxygen because of a low red blood cell count. Jaundice and sinusitis would not be a contraindication to the drug. Headache is an adverse effect of isosorbide and would be expected after administration of the drug.

11. A 49-year-old patient is admitted with uncontrolled chest pain. He is currently taking nitroglycerin (Nitrostat). His physician orders nifedipine (Adalat) added to his regimen. The nurse should observe the patient for what adverse effects? A)

Hypokalemia

Renal insufficiency

Hypotension

Hypoglycemia

Ans:

C Feedback: Both nitroglycerin and nifedipine have hypotension as a potential adverse effect so frequent assessment of blood pressure is important. Other cardiovascular effects include bradycardia, peripheral edema, and heart block. Skin effects include flushing and rash. Adverse effects do not include renal insufficiency, hypokalemia, or hypoglycemia.

12. What statements by the 54-year-old patient indicates an understanding of the nurses teaching about how to take sublingual nitroglycerin? A)

A headache means a toxic level has been reached.

I can take up to 3 tablets at 5-minute intervals.

I can take as much nitroglycerin as I need because it is not habit forming.

If I become dizzy after taking the medication, I should stop taking it.

Ans:

B Feedback: Sublingual nitroglycerin may be taken at 5-minute intervals up to a maximum of three doses to relieve anginal chest pain. Headaches are very common due to vasodilation and do not indicate a toxic level. Nitroglycerin causes significant peripheral vasodilation in addition to its therapeutic effects of coronary artery dilation so no more than three tablets should be taken, even though it is not habit forming. Dizziness could be an adverse effect of the drug or a manifestation of inadequate cardiac output, but it would not indicate the patient should stop taking it.

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13. When the nurse administers a beta-adrenergic blocker to the patient with angina, the nurse expects the drug will help to control angina, but it also has what other effect? A)

Increased heart rate

Increased oxygen consumption

Decreased strength of heart muscle contraction

Decreased urinary output

Ans:

C Feedback: Beta-blockers competitively block beta-adrenergic receptors in the heart and kidneys, decreasing the influence of the sympathetic nervous system on these tissues and the excitability of the heart. As a result, it decreases the strength of cardiac contraction, reducing cardiac output, which results in lowered blood pressure and decreased cardiac workload. It does not impact urinary output.

14. The nurse is caring for a patient who takes nitroglycerin sublingually. When providing patient education, the nurse would tell the patient that she can expect relief of chest pain within what period of time? A)

1 to 3 minutes

5 to 10 minutes

15 to 20 minutes

30 to 60 minutes

Ans:

A Feedback: Nitroglycerin acts within 1 to 3 minutes. Other options are incorrect.

15. When providing patient education about nitroglycerin to the patient, what would the nurse include in the teaching plan about a nitroglycerin patch? A)

It only has to be administered once a week.

It is more effective than tablets in treating angina.

It has a longer duration of action.

It is faster acting than the tablets.

Ans:

C Feedback:

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Transdermal nitroglycerin has a long 24-hour duration of action compared with the sublingual form that lasts 30 to 60 minutes or oral tablets that last 8 to 12 hours. Transdermal patches are neither more nor less effective, but rather it is the speed of onset and duration of action that differ. 16. Which statement by the patient would lead the nurse to believe that he has understood the teaching provided regarding angina? A)

I will not exercise because it precipitates angina.

As long as I take the medicine, I need make no lifestyle change.

There is no correlation between my hypertension and angina.

Heavy meals and cigarette smoking can precipitate an angina attack.

Ans:

D Feedback: Avoid stressful activities, especially in combination. For example, if you eat a big meal, do not drink coffee or alcoholic beverages with that meal. If you have just eaten a big meal, do not climb stairs; rest for a while. However, exercise is important and should not be eliminated, but managed in coordination with other activities. Smoking causes vasoconstriction that can result in angina attacks so lifestyle changes like reducing fat and calories in the diet, moderate exercise, reducing alcohol intake and avoiding smoking are all healthful choices. Hypertension does increase the risk of angina and coronary artery disease.

17. The nurse is caring for a patient who is taking a calcium-channel blocker. What adverse effects would the nurse caution this patient about? A)

Hypertension and tachycardia

Headache and dizziness

Itching and rash

Nausea and diarrhea

Ans:

B Feedback: The adverse effects associated with these drugs are related to their effects on cardiac output and on smooth muscle. Central nervous system (CNS) effects include dizziness, light-headedness, headache, and fatigue. Gastrointestinal (GI) effects can include nausea and hepatic injury related to direct toxic effects on hepatic cells. Cardiovascular effects include hypotension, bradycardia, peripheral edema, and heart block. Skin effects include flushing and rash. The adverse effects do not, however, include diarrhea, hypertension, tachycardia, or itching.

18. The nurse assesses patients receiving nifedipine (Adalat) for what adverse effects?

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Ascites

Asthma

Peripheral edema

Tetany

Ans:

C Feedback: Peripheral edema, heart block, bradycardia, and hypotension can occur with calciumchannel blockers. Asthma, ascites, and tetany are not associated with these drugs.

19. What adverse reaction does the nurse anticipate if the 56-year-old patient takes his betablocker with clonidine? A)

Hypertension

Bradycardia

Angina

Syncope

Ans:

A Feedback: A paradoxical hypertension occurs when clonidine is given with beta-blockers, and an increased rebound hypertension with clonidine withdrawal may also occur. It is best to avoid this combination. Bradycardia, angina, and syncope are not associated with this drug combination.

20. An asthmatic patient taking beta-blockers should be assessed by the nurse for what potential adverse reaction? A)

Bronchospasm

Hypoglycemia

Pleural effusion

Pneumonia

Ans:

A Feedback: Bronchospasm can occur with beta blockade. The patient would not have to be observed for hypoglycemia, pleural effusion, or pneumonia.

21. The nurse should instruct the patient to take what action if three nitroglycerin tablets taken sublingually are not effective in eliminating chest pain?

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To call 911

To call her health care provider

To lie down after taking an aspirin

To take more tablets until pain subsides

Ans:

A Feedback: Instruct patient that a sublingual dose may be repeated in 5 minutes if relief is not felt, for a total of three doses, if pain persists, the patient or a family member should call 911 to ensure proper medical support if a myocardial infarction should occur. She should not waste time by calling the health care provider; she can lie down while waiting for the ambulance to arrive, she should not take more tablets.

22. The nurse is caring for a patient who takes metoprolol for angina. The patient asks how long it takes for the medicine to work. What is the nurses best response? A)

15 minutes

30 minutes

1 hour

90 minutes

Ans:

A Feedback: Oral metoprolol has an onset of action of 15 minutes. Other options are incorrect.

23. The nurse teaches the patient wearing a nitroglycerin patch to avoid what? A)

Exercise

Alcoholic beverages

Milk products

Synthetic fabrics

Ans:

B Feedback: Patients should be taught to avoid or at least decrease use of coffee, cigarettes, and alcoholic beverages. There is no need to avoid exercise, milk, or synthetic fabrics.

24. The nurse is caring for a patient who is taking a sustained-release (SR) oral nitrate. How should the nurse instruct this patient to take the medication?

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With water

Sublingually until absorbed

With milk or milk products

1 hour after eating

Ans:

A Feedback: Give SR forms with water, and caution the patient not to chew or crush them, because these preparations need to reach the gastrointestinal (GI) tract intact to avoid overdosage. They are not dissolved sublingually but swallowed whole. They are best taken on an empty stomach 1 hour before meals.

25. An adult patient who experiences angina pectoris with exertion is informed by the nurse that the leading cause of angina is what? A)

Smoking

Inadequate cardiac output

Infarction of the myocardium

Coronary atherosclerosis

Ans:

D Feedback: The person with atherosclerosis has a classic supply-and-demand problem. The heart may function without a problem until increases in activity or other stresses place a demand on it to beat faster or harder. Normally, the heart would stimulate the vessels to deliver more blood when this occurs, but the narrowed vessels are not able to respond and cannot supply the blood needed by the working heart. The heart muscle then becomes hypoxic. This imbalance between oxygen supply and demand is manifested as pain, or angina pectoris, which literally means suffocation of the chest. Atherosclerosis of the coronary artery can block the coronary artery completely leading to infarction. Smoking causes further vasoconstriction, increasing risk of myocardial infarction or angina. Damage to the heart muscle causes a decrease in cardiac output.

26. The nurse is caring for a patient prescribed ranolazine. The patient asks why this drug is different from the beta-blocker that he was previously taking. What is the nurses best response? A)

This drug does not slow your heart rate.

This drug increases myocardial oxygen demand.

This drug slows the QT intervals.

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This maintains blood pressure with no hypotensive effects.

Ans:

A Feedback: The newest drug approved for the treatment of angina is a piperazine acetamide agent called ranolazine. The mechanism of action of this drug is not understood. It prolongs QT intervals, does not slow heart rate or blood pressure, but decreases myocardial oxygen demand.

27. After the patients anginal pain is relieved he says to the nurse, That nitroglycerin works great. How does it do that? What is the nurses best response? A)

Nitroglycerin decreases the amount of oxygen needed by the heart to function.

Nitroglycerin makes the coronary arteries open much wider.

Nitroglycerin promotes growth of new, smaller arteries to supply oxygen to the heart.

Nitroglycerin decreases preload and afterload.

Ans:

A Feedback: The main effect of nitrates seems to be related to the drop in blood pressure that occurs. The vasodilation causes blood to pool in veins and capillaries, decreasing preload, while the relaxation of the vessels decreases afterload. The combination of these effects greatly reduces the cardiac workload and the demand for oxygen, thus bringing the supply-anddemand ratio back into balance. Because coronary artery disease causes a stiffening and lack of responsiveness in the coronary arteries, the nitrates probably have very little effect on increasing blood flow through the coronary arteries, so it would be incorrect to say that the coronary arteries become much wider. Although both preload and afterload are reduced, this is an explanation that the patient would not understand, so it is inappropriate. Nitroglycerin does not promote growth of compensatory circulation.

28. An adult patient has had symptoms of unstable angina during admission to the hospital. What is the most appropriate nursing diagnosis? A)

Deficient knowledge about underlying disease and methods for avoiding complications

Anxiety related to fear of death

Ineffective tissue perfusion (total body) related to reduced oxygen supply to the heart

Noncompliance related to failure to accept necessary lifestyle changes

Ans:

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Feedback: The most appropriate nursing diagnosis is ineffective tissue perfusion related to reduced oxygen supply to the heart because this is the cause of the patients pain. Further assessment would be needed to determine whether the patient lacks knowledge, fears death, or has made the necessary lifestyle changes. 29. The nurse is preparing to administer sublingual nitroglycerin to a patient for the first time and warns that the patient may experience what right after administration? A)

Nervousness or paresthesia

Throbbing headache or dizziness

Drowsiness or blurred vision

Tinnitus or diplopia

Ans:

B Feedback: Headache and dizziness commonly occur at the start of nitroglycerin therapy. When administering nitroglycerin, the nurse must use caution to avoid self-contamination, especially with the topical paste formulation because the nurse can experience the same symptoms. However, the patient usually develops a tolerance. Nervousness, paresthesia, drowsiness, blurred vision, tinnitus, and diplopia do not occur as a result of nitroglycerin therapy.

30. A patient is diagnosed with Prinzmetals angina. What drug would the nurse expect to administer to this patient? A)

Nadolol

Diltiazem

Propranolol

Metoprolol

Ans:

B Feedback: Calcium channel blockers are indicated for the treatment of Prinzmetals angina because these drugs relieve coronary artery vasospasm, increasing blood flow to the muscle cells. Diltiazem is a calcium channel blocker. Beta-blockers are not indicated for the treatment of Prinzmetals angina because they could cause vasospasm due to blocking of betareceptor sites. Propranolol, nadolol, and metoprolol are beta-blockers.

31. The nurse is caring for a patient diagnosed with human immunodeficiency virus (HIV) and newly diagnosed angina. What drug would the nurse question if ordered?

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Ranolazine (Ranexa)

Nitroglycerin (generic)

Propranolol

Diltiazem

Ans:

A Feedback: Drugdrug interactions can occur with ketoconazole, diltiazem, verapamil, macrolide antibiotics, and HIV protease inhibitors; these combinations should be avoided because ranolazine levels may become extremely high. The nurse should get a complete list of current medications and consult with the health care provider regarding drug interactions before administering the medication as ordered. Nitroglycerin, propranolol, and diltiazem have no contraindication with medications used to treat HIV.

32. Other than angina, what other medical condition might the nurse treat by administering nitroglycerin? A)

Muscular dystrophy

Pulmonary embolisms

Polycythemia

Anal fissures

Ans:

D Feedback: In 2011, a nitroglycerin in ointment form, Rectiv 0.4%, was approved for the treatment of moderate to severe anal fissures. There is no documented benefit to the use of nitroglycerin to treat muscular dystrophy, pulmonary embolisms, or polycythemia.

33. What would the nurse teach the patient about potency of nitroglycerin? (Select all that apply.) A)

The tablet should fizzle or burn when placed under the tongue.

Protect the drug from heat and light.

Always replace when past the expiration date.

Older tablets may require you to use two tablets at one time.

Nitroglycerin does not lose its potency easily.

Ans:

A, B, C Feedback:

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Ask the patient if the tablet fizzles or burns, which indicates potency. Always check the expiration date on the bottle and protect the medication from heat and light because these drugs are volatile and lose potency easily. 34. The nurse teaches the patient how to use topical nitroglycerin and includes what teaching points in the teaching plan? (Select all that apply.) A)

Rotate application sites.

Assess the skin for signs of breakdown.

Make sure no one touches the side with the medication.

Do not shower with the patch in place.

Increase fluid intake to avoid hypotension.

Ans:

A, B, C Feedback: Rotate the sites of topical forms of nitroglycerin to lower the risk of skin abrasion and breakdown; monitor for signs of skin breakdown to arrange for appropriate skin care as needed. Care should be taken not to touch the side of the patch with the medication by the patient or anyone assisting in applying the patch. The patient may shower with the patch in place. There is no need to increase fluid intake but patients should be encouraged to maintain adequate intake.

35. The provider orders isosorbide dinitrate as oral maintenance drug to prevent angina. What dosage would the nurse administer without need to question the dose? A)

2.5 mg

80 mg

40 mg

5 mg

Ans:

B Feedback: A maintenance oral dose of isosorbide dinitrate is 10 to 40 mg every 6 hours. Sublingual dose is 2.5 to 5 mg, sustained release is 40 to 80 mg, and the chewable tablet is 5 mg.

Chapter 22: Anticoagulants and Antiplatelet Agents 1. A patient is admitted to the hospital with deep vein thrombosis. A 10,000-unit dose of heparin is administered subcutaneously. What drug does the nurse keep on hand to reverse the effects of heparin if the patient begins to bleed?

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Antithrombin (Thrombate III)

Desirudin (Iprivask)

Protamine sulfate

Vitamin K

Ans:

C Feedback: The antidote for heparin is protamine sulfate. This drug forms stable salts as soon as it comes in contact with heparin. The reaction immediately reverses heparins anticoagulation effects. Vitamin K reverses the effect of warfarin. Antithrombin and desirudin are anticoagulants that would not be administered with heparin.

2. Prior to beginning anticoagulant therapy, the nurse will question the female patient about what? A)

Last menstrual period

Peptic ulcers

Urinary tract infection

Weight

Ans:

B Feedback: The nurse should screen for conditions that could be exacerbated by increased bleeding tendencies, including hemorrhagic disorders, recent trauma, spinal puncture, gastrointestinal (GI) ulcers, recent surgery, intrauterine device placement, tuberculosis, presence of indwelling catheters, and threatened abortion. Beginning anticoagulant therapy with active peptic ulcers could result in severe bleeding. Last menstrual period, urinary tract infection, and weight should not impact anticoagulant therapy.

3. The nurse is caring for a female patient who is nursing her 3-month-old infant. What will the nurse instruct the patient to do prior to starting heparin to treat venous thrombosis? A)

Wait an hour after taking the anticoagulant before feeding the infant.

Push fluids to clear the drug from her system before feeding the infant.

Find another method of feeding the infant while taking this drug.

Continue breast-feeding because heparin does not enter breast milk.

Ans:

D Feedback:

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Although some adverse fetal effects have been reported with its use during pregnancy, heparin does not enter breast milk, and so it is the anticoagulant of choice if one is needed during lactation. As a result, there is no need to wait an hour, push fluids, or find another method of feeding the baby. 4. The nurse receives a patient having an acute myocardial infarction (MI) to the emergency department. What drug will the nurse administer before transferring the patient to a larger facility? A)

Anagrelide (Agrylin)

Clopidogrel (Plavix)

Ticlopidine (Ticlid)

Tenecteplase (TNKase)

Ans:

D Feedback: Arrange to administer tenecteplase to reduce mortality associated with acute MI as soon as possible after the onset of symptoms because the timing for the administration of tenecteplase is critical to resolve the clot before permanent damage occurs to the myocardial cells. Anagrelide is used to treat essential thrombocytopenia. Clopidogrel is used to treat patients who are at risk for ischemic events; ticlopidine is used to reduce the risk of thrombotic stroke.

5. A nurse is preparing to discharge a patient newly prescribed warfarin (Coumadin). While assessing the patients knowledge of the drug, what would indicate that the patient needs further instruction concerning drug therapy? A)

I love to eat homegrown tomatoes in the summer.

I take aspirin for my arthritis.

I walk 2 miles a day.

I drink a glass of wine about once a week.

Ans:

B Feedback: Increased bleeding can occur if a salicylate is taken in combination with warfarin. The nurse will instruct the patient to stop taking aspirin. Walking, eating tomatoes, and drinking an occasional glass of wine should not interfere with the therapeutic effects of warfarin.

6. The nurse is caring for a patient with a fever and severe diarrhea in addition to thrombophlebitis. How will this patients condition impact the clotting process? A)

Depleted production of Hageman factor

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Increased production of thrombin

Activation of plasminogen

Reduced production of fibrinolysin

Ans:

C Feedback: Plasminogen is the basis for the clot-dissolving system. It is converted to plasmin (fibrinolysin) by several factors including Hagemans factor, which is factor XII found in circulating blood. Activated thrombin breaks down fibrinogen to form fibrin threads, which form a clot inside the blood vessel. Patients with diarrhea or fever could alter the normal clotting process by, respectively, loss of vitamin K from the intestine or activation of plasminogen.

7. The nurse is caring for a patient who received protamine sulfate in error. The patient is not receiving, and has never received, heparin. What effect does the nurse assess for in this patient? A)

Coagulation effects

No effect

Anticoagulant effects

Antiplatelet effects

Ans:

C Feedback: Paradoxically, if protamine is given to a patient who has not received heparin, it has anticoagulant effects. Protamine is normally used as an antidote to heparin overdose but if heparin was not administered, it does not have coagulation or antiplatelet effects. Since it has anticoagulant effects it cannot be said to have no effect.

8. A patient is being discharged home on warfarin. The discharge teaching by the nurse should include a warning to avoid what? A)

St. Johns wort

Tarragon

Ginkgo

Saw palmetto

Ans:

C Feedback:

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Many of the herbal remedies are known to alter blood coagulation and should be avoided when taking anticoagulants. Patients taking these drugs should be cautioned to avoid angelica, cats claw, chamomile, chondroitin, feverfew, garlic, Ginkgo, goldenseal, grape seed extract, green leaf tea, horse chestnut seed, psyllium, and turmeric. If a patient who is taking an anticoagulant presents with increased bleeding and no other interaction or cause is found, question the patient about the possibility of use of herbal therapies. St. Johns wort, tarragon, and saw palmetto are not implicated as having an interaction with anticoagulants. 9. The nurse administers clopidogrel (Plavix) appropriately to the patient with what condition? A)

Maintaining the patency of grafts

Treating peripheral artery disease

Preventing emboli from valve replacements

Dissolving a pulmonary embolus and improving oxygenation

Ans:

B Feedback: Clopidogrel is used to inhibit platelet aggregation, decreasing the formation of clots in narrowed or injured blood vessels like those found in peripheral artery disease. Maintaining the patency of grafts or preventing emboli from valve replacements would be accomplished using an anticoagulant. Dissolving emboli would be accomplished using streptokinase or a similar enzyme to stimulate the conversion of plasminogen to plasmin.

10. The nurse is caring for a patient who is going home on warfarin (Coumadin). What lab test will the patient require to evaluate therapeutic effects of the drug? A)

Activated partial thromboplastin time (APTT) only

International normalized ratio (INR) only

Prothrombin time (PT) and INR

PT and APTT

Ans:

C Feedback: PT and INR are ordered to evaluate for therapeutic effects of warfarin. Normal values of PT is 1.3 to 1.5 times the control value and the ratio of PT to INR is 2 to 3.5.

11. What drug would the nurse administer for its antiplatelet effects? (Select all that apply.) A)

Ticlid

Iprivask

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Arixtra

ReoPro

Activase

Ans:

A, D Feedback: Antiplatelet agents available for use include abciximab (ReoPro), anagrelide (Agrylin), aspirin, cilostazol (Pletal), clopidogrel (Plavix), dipyridamole (Persantine), eptifibatide (Integrilin), ticlopidine (Ticlid), ticagrelor (Brilinta), and tirofiban (Aggrastat). Iprivask and Arixtra are anticoagulants, and Actuvase is a thrombolytic agent.

12. A 76-year-old patient is receiving IV heparin 5,000 units every 8 hours. An activated thromboplastin time (aPTT) is drawn 1 hour before the 8:00 AM dose; the aPTT is at 3.5 times the control value. What is the nurses priority action? A)

Give a larger dose to increase the aPTT.

Give the dose as ordered and chart the results.

Check the patients vital signs prior to administering the dose.

Hold the dose and call the result to the physician.

Ans:

D Feedback: The therapeutic level of heparin is demonstrated by an activated partial thromboplastin time (aPTT) that is 1.5 to 3 times the control value. The patients value is 3.5 times control, which indicates clotting time is a bit too delayed and the dosage will likely either be reduced or a dosage may be held according to the order received from the physician. It would be inappropriate to give two doses at once, give the dose and chart the results, or simply check the vital signs without holding the dose and calling the physician.

13. The nurse evaluates the effects of warfarin (Coumadin) by monitoring what laboratory test? A)

Red blood cell count (RBC)

Activated thromboplastin time (APT)

Prothrombin time (PT) and international normalized ratio (INR)

Platelet count

Ans:

C Feedback:

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The warfarin dose is regulated according to the INR. INR is based upon the PT. The other options are incorrect. 14. The nurse discovers a patient receiving warfarin is bleeding. What drug would the nurse prepare to counteract this drug? A)

Vitamin E

Vitamin K

Protamine sulfate

Calcium gluconate

Ans:

C Feedback: Injectable vitamin K is used to reverse the effects of warfarin. Protamine sulfate is used to reverse the effects of heparin. Vitamin E reduces effects of warfarin but is not used for that purpose. Calcium gluconate would not be indicated for this patient.

15. The nurse evaluates that additional patient teaching is needed regarding anticoagulants when the patient states that he will do what? A)

Carry a Medic Alert card with him.

Report to the lab once a month.

Use acetaminophen for arthritis pain.

Use a disposable safety razor to shave.

Ans:

D Feedback: The patient should use an electric razor to shave rather than a disposable razor that could nick his skin and increase risk of bleeding. Carrying a MedicAlert card, getting regular follow-up lab work, and use of acetaminophen would all be appropriate actions that would not indicate the need for further teaching.

16. The nurse teaches the patient taking warfarin (Coumadin) to minimize foods high in vitamin K including what type of food? A)

Eggs

Dairy products

Citrus fruits

Green leafy vegetables

Ans:

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Feedback: Injectable vitamin K is used to reverse the effects of warfarin. Vitamin K is responsible for promoting the liver synthesis of several clotting factors. When these pathways have been inhibited by warfarin, clotting time is increased. If an increased level of vitamin K is provided, more of these factors are produced, and the clotting time can be brought back within a normal range. Green leafy vegetables are high in vitamin K and should be avoided or minimized in the diet to prevent reversal of warfarin effects. The other food options are not high in vitamin K. 17. The nurse evaluates teaching about warfarin (Coumadin) is successful when the patient makes what statement? A)

If I miss a dose, I will take two pills the next day.

I will check with the pharmacist before taking any herbal supplements.

I will increase the dark-green leafy vegetables in my diet.

I will take a multivitamin daily.

Ans:

B Feedback: Warfarin is involved in many drugdrug and drugherb interactions so the patients statement about checking with the doctor before starting any new drugs or supplements would be correct. The other statements made by the patient indicate the need for further teaching because he or she should not take two pills after missing a dose, there is no need to increase green leafy vegetables containing vitamin K, and multivitamin use is contraindicated.

18. The nurse assesses blood in the urine of the 73-year-old patient receiving warfarin (Coumadin) this morning. What actions will the nurse take? (Select all that apply.) A)

Assess prothrombin time (PT).

Assess international normalized ratio (INR).

Expect to administer protamine sulfate.

Expect to administer vitamin K.

Assess partial thromboplastin time (PTT).

Ans:

A, B, D Feedback: Vitamin K is the antidote for warfarin. PT and INR are used to assess therapeutic levels of warfarin. PTT is used to assess therapeutic levels of heparin. Protamine sulfate is given as an antidote for heparin.

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19. The nurse is caring for a patient following repeat coronary artery bypass grafting who has excessive bleeding. What systemic hemostatic drug will the nurse expect to administer? A)

Thrombin recombinant

Microfibrillar collagen

Human fibrin sealant

Aminocaproic acid (Amicar)

Ans:

D Feedback: The hemostatic drug that is used systemically is aminocaproic acid (Amicar). Topical hemostatic agents include absorbable gelatin (Gelfoam), human fibrin sealant (Artiss, Evicel), microfibrillar collagen (Avitene), thrombin (Thrombinar, Thrombostat), and thrombin recombinant (Recothrom).

20. The 86-year-old patient, admitted with thrombophlebitis, is being sent home on enoxaparin (Lovenox). The nurse evaluates that he understands why enoxaparin is being used if he states that it will do what? A)

Inhibit the formation of additional clots

Stimulate production of certain clotting factors

Prevent the blood from clotting

Dissolve the clot

Ans:

A Feedback: Low-molecular-weight heparins inhibit thrombus and clot formation by blocking factors Xa and IIa. Because of the size and nature of the molecules, these drugs do not greatly affect thrombin, clotting, or the PT; therefore, they cause fewer systemic adverse effects.

21. What intervention does the nurse include in the plan of care for a patient receiving a continuous intravenous infusion of heparin? A)

Avoiding intramuscular injections

Assessing for symptoms of respiratory depression

Measuring hourly urinary outputs

Monitoring BP hourly

Ans:

A Feedback:

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The most commonly encountered adverse effect of the anticoagulants is bleeding, ranging from bleeding gums during toothbrushing to severe internal hemorrhage. Avoid all invasive procedures, including giving IM injections, while the patient is on heparin therapy. It would not be necessary to assess for respiratory depression, measure hourly output, or monitor the BP hourly as related because of heparin administration. 22. The nurse is sending a patient home who will remain on anticoagulant therapy. What teaching point does the nurse make when teaching the patient about the drug? (Select all that apply.) A)

Brush teeth gently with soft bristle brush.

Wear or carry a MedicAlert notification.

Warning signs of bleeding include fatigue, pallor, and increased heart rate.

Treat minor side effects with over-the-counter (OTC) medications.

Obtain follow-up lab work regularly as ordered.

Ans:

A, B, C, E Feedback: Patients should be taught to avoid bleeding risk by brushing teeth gently, using electric razors, and avoiding dangerous activities or falls that could cause bleeding. The patient should have a MedicAlert to notify other health care providers of anticoagulant therapy. Teach patients to recognize the signs of blood loss and stress the importance of follow-up lab work. Patients should be taught to avoid adding any new medication, prescription or OTC, without first talking to the health care provider or pharmacist to ensure safety.

23. Indications for the nurse to administer heparin include what? (Select all that apply.) A)

Treatment of hemophilia

Prevention and treatment of pulmonary emboli

Treatment of atrial fibrillation with embolization

Prevention and treatment of venous thrombosis

Diagnosis and treatment of disseminated intravascular coagulation (DIC)

Ans:

B, C, D, E Feedback: Indications include prevention and treatment of venous thrombosis and pulmonary emboli, treatment of atrial fibrillation with embolization, and diagnosis and treatment of DIC. Heparin is not given to patients with hemophilia because the drug would worsen bleeding.

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24. The nurse is caring for a child who needs anticoagulation therapy. What drug is approved for pediatric use? A)

Heparin

Dabigatran

Rivaroxaban

Low-molecular-weight heparins

Ans:

A Feedback: Heparin is approved for pediatric use. If heparin is used, the dosage should be carefully calculated based on weight and age. It should be verified by another person before the drug is administered. Dabigatran and rivaroxaban are not approved for use in children. The safety of low-molecular-weight heparins has not been established in children.

25. When the nurse administers warfarin it is expected that the drug will have what effect on the body? A)

Decrease in production of vitamin Kdependentt clotting factors

Increase in prothrombin

Increase in vitamin Kdependent factors in the liver

Increase in procoagulation factors

Ans:

A Feedback: Warfarin, an oral anticoagulant drug, causes a decrease in the production ovitamin Kdependent clotting factors in the liver. The eventual effect is a depletion of these clotting factors and a prolongation of clotting times. It is used to maintain a state of anticoagulation in situations in which the patient is susceptible to potentially dangerous clot formation. It does not increase prothrombin, vitamin Kdependent factors in the liver, or procoagulation factors.

26. When the nurse administers heparin it is anticipated the drug will have what action on the patients body? A)

Binds to factor X

Blocks the formation of thrombin

Binds to factor Xa

Promotes the inactivation of factor VIII

Ans:

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Feedback: Heparin blocks the formation of thrombin from prothrombin. Heparin does not bind to factors X and Xa. Heparin does not inactivate factor VIII. 27. A young man has been diagnosed with hemophilia and the nurse is planning his discharge teaching and includes what teaching point? A)

Using nonsteroidal anti-inflammatory drugs (NSAIDs) for mild pain

Preventing trauma to the body

Receiving IV factor VIII therapy at home

Understanding the condition is an X-linked recessive disorder

Ans:

B Feedback: The nurses thorough patient teaching must include the name of the drug, dosage prescribed, measures to avoid adverse effects, warning signs of problems, and the need for periodic monitoring and evaluation. Hemophilia A is an X-linked recessive disorder that primarily affects males. Approximately 90% of persons with hemophilia produce insufficient quantities of the factor VIII. The prevention of trauma is important in people with hemophilia. The other options are incorrect.

28. The nurse admits a 32-year-old woman who takes oral contraceptives; she is expected to need aminocaproic acid postoperatively. The nurse recognizes this patient is at risk for what? A)

Hypercoagulation

Bleeding

Pregnancy

Infertility

Ans:

A Feedback: Aminocaproic acid is associated with the development of hypercoagulation states if it is combined with oral contraceptives or estrogens. Oral contraceptives do not increase the risk of pregnancy, bleeding, or infertility.

29. The nurse reviews the patients lab values and determines warfarin therapy is at therapeutic levels with what lab result? A)

Partial thromboplastin time (PTT) 1.5 to 2.5 times the control

Prothrombin time (PT) 1.3 to 1.5 times the control

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International normalized ratio (INR) of 3 to 4

Activated partial thromboplastin time (aPTT) 3 to 4 times the control

Ans:

B Feedback: Warfarin is at therapeutic level when the INR is 2 to 3.5 and the PT is 1.3 to 1.5 times control. PTT and aPTT should be 1.5 to 2.5 to indicate heparin dosage is at therapeutic level.

30. The patient receives a new diagnosis of peripheral artery disease and the nurse anticipates an order for what drug? A)

Clopidogrel

Persantine

Aspirin

Warfarin

Ans:

A Feedback: Clopidogrel (Plavix) is indicated for the treatment of patients who are at risk for ischemic events; patients with a history of myocardial infarction, peripheral artery disease, or ischemic stroke; and patients with acute coronary syndrome. Persantine, aspirin, and warfarin would not be indicated for this patient.

31. The nurse admits a patient in acute respiratory distress secondary to pulmonary emboli. What drug will the nurse administer to lyse the clots? A)

Urokinase

Tenecteplase

Rivaroxaban

Fondaparinux

Ans:

A Feedback: Urokinase is used for lysis of pulmonary emboli and treatment of coronary thrombosis. Reteplase is used to treat coronary artery thrombosis associated with an acute myocardial infarction. Rivaroxaban is used to prevent deep vein thromboses that may lead to pulmonary emboli. Fondaparinux is used to treat and prevent venous thromboembolic events.

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32. The nurse is caring for a postpartum patient admitted to the intensive care unit with a diagnosis of disseminated intravascular coagulation (DIC). What is the drug of choice to treat this problem? A)

Heparin

Urokinase

Aspirin

Warfarin

Ans:

A Feedback: The treatment of choice for DIC is heparin, an anticoagulant. It prevents the clotting phase from being completed, thus inhibiting the breakdown of fibrinogen. It may also help avoid hemorrhage by preventing the body from depleting its entire store of coagulation factors. None of the other medications listed in this question are indicated for treatment of DIC and may, in fact, make the condition worse.

33. By what route will the nurse administer the antihemophilic agent to the patient with hemophilia following a car accident? A)

Oral

Topical

C)IV D)

Sublingual

Ans:

C Feedback: All antihemophilic agents are administered IV and are not available for administration by any other route.

34. The nurse administers agents that control bleeding to patients with hemophilia and what other condition? A)

Liver disease

Lymes disease

Disseminated intravascular coagulation (DIC)

Pheochromocytoma

Ans:

A Feedback:

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Drugs to control bleeding are also given to patients with liver disease because liver disease prohibits clotting factors and proteins needed for clotting from being produced in adequate quantities. Lymes disease, DIC, and pheochromocytoma are not indications for administration of agents to control bleeding. 35. The nurse is caring for a pediatric patient with hemophilia who receives antihemophilic factor several times a year. What should this patient be regularly screened for? (Select all that apply.) A)

HIV

Hepatitis

Anemia

Infection

Cardiomyopathy

Ans:

A, B, C Feedback: The most common adverse effects associated with antihemophilic agents involve risks associated with the use of blood products (e.g., in a patient with hepatitis or AIDS). Patients with hemophilia should also be monitored for anemia secondary to blood loss. There is no associated risk for infection or cardiomyopathy.

Chapter 23: Drugs for Hyperlipidemia MULTIPLE CHOICE 1. A female patient has serum lipid levels performed, which reveal a total cholesterol of 285 mg/dL, triglycerides of 188 mg/dL, a low-density lipoprotein (LDL) of 175 mg/dL, and a highdensity lipoprotein (HDL) of 40 mg/dL. The patients blood pressure is 138/72 mm Hg. The nurse may expect the provider to order which medication for this patient? a. Amlodipine and atorvastatin (Caduet) b. Colestipol HCl (Colestid) c. Fenofibrate (TriCor) d. Niacin and lovastatin (Advicor) ANS: D The combination drug of niacin and lovastatin is indicated for hypercholesterolemia and mixed dyslipidemia. Niacin raises HDL, so would be helpful in this patient who has low HDL. Combination drugs are used to enhance the antihyperlipidemic effect. Amlodipine and atorvastatin in combination are used for patients with hyperlipidemia and elevated blood pressure. Colestipol HCl is used to reduce cholesterol and LDL levels but has no effect on HDL or triglycerides. Fenofibrate is used to treat type IV and V hyperlipidemia, characterized by elevated very-low-density lipoprotein and triglycerides.

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DIF: COGNITIVE LEVEL: Analyzing (Analysis) REF: dm 666 TOP: NURSING PROCESS: Assessment/Planning MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 2. A patient has a serum cholesterol level of 270 mg/dL. The patient asks the nurse what this level means. Which response by the nurse is correct? a. You have a high risk for coronary artery disease. b. You have a moderate risk for coronary artery disease. c. You have a low risk for coronary artery disease. d. You have no risk for coronary artery disease. ANS: A A value of 270 mg/dL for serum cholesterol puts the patient at high risk. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 665 TOP: NURSING PROCESS: Assessment MSC: NCLEX: Physiological Integrity: Pathophysiology 3. A patient begins taking cholestyramine (Questran) to treat hyperlipidemia. The patient reports abdominal discomfort and constipation. The nurse will provide which instruction to the patient? a. Increase fluid and slowly increase fiber intake. b. Stop taking the medication immediately. c. Take an over-the-counter laxative. d. Take the medication on an empty stomach. ANS: A Cholestyramine can cause gastrointestinal upset and constipation, and these symptoms can be reduced with increased fluids and foods high in fiber. Stopping the medication is not indicated. Over-the-counter laxatives are not recommended until other methods have been tried. Giving the medication on an empty stomach will not relieve the discomfort. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 666 TOP: NURSING PROCESS: Evaluation/Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 4. A patient has been taking cholestyramine (Questran) to treat hyperlipidemia type II. The patient reports abdominal cramping and constipation. The patients serum low- density lipoprotein (LDL) has decreased from 170 mg/dL to 110 mg/dL, and triglycerides have not changed from 150 mg/dL since beginning the medication. The provider changes the medication to colesevelam HCl (Welchol).The patient asks the nurse why the medication was changed, and the nurse will explain that colesevelam HCl is ordered for which reason? a. It has fewer side effects. b. It has more convenient dosing. c. It provides greater LDL reduction. d. It provides greater triglyceride reduction. ANS: A Colesevelam is similar to cholestyramine but has fewer gastrointestinal side effects. This patient has demonstrated good results with the bile acid sequestrant, so the provider needs to offer a preparation with fewer adverse effects. Both drugs are given twice daily.

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DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 666 TOP: NURSING PROCESS: Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 5. A patient is admitted to the hospital, and the provider orders gemfibrozil (Lopid) 600 mg twice daily, 30 minutes prior to meals. The nurse learns that the patient takes warfarin (Coumadin) once daily. The nurse will contact the provider to discuss a. decreasing the dose of gemfibrozil. b. giving the warfarin at noon. c. increasing the dose of warfarin. d. ordering frequent INR levels. ANS: D Gemfibrozil is highly protein-bound and competes for receptor sites with drugs such as warfarin. The anticoagulant dose should be decreased, and the INR should be closely monitored. Decreasing the dose of gemfibrozil is not recommended. Giving the warfarin at a different time of day does not change this drug interaction. The warfarin dose should be decreased not increased. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 666 TOP: NURSING PROCESS: Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 6. A patient begins taking nicotinic acid (Niacin) and reports dizziness and flushing of the skin. The nurse will perform which action? a. Contact the provider to discuss decreasing the dose. b. Counsel the patient to increase fluid intake. c. Request an order for renal function tests. d. Schedule the medication to be taken with meals. ANS: A Flushing of the skin and dizziness are common side effects of nicotinic acid, but with careful drug titration and concomitant use of aspirin, these effects can be minimized. Increasing fluid intake or taking with food does not alter these adverse effects. Nicotinic acid can affect liver enzymes not renal function. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 668 TOP: NURSING PROCESS: Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 7. A patient has been taking atorvastatin (Lipitor) for several months to treat hyperlipidemia. The patient reports muscle weakness and tenderness. The nurse will counsel the patient to a. ask the provider about switching to simvastatin. b. contact the provider to report these symptoms. c. start taking ibuprofen to combat these effects. d. stop taking the medication immediately. ANS: B Patients taking statins should report immediately any muscle aches or weakness, which can lead to rhabdomyolysis, a muscle disintegration that can become fatal. All statins carry this risk, so changing to another statin is not indicated. Ibuprofen may be useful, but notifying the provider is

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essential. Patients should not abruptly discontinue statins without discussing this with the provider. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 666 TOP: NURSING PROCESS: Evaluation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 8. The nurse provides teaching to a patient who will begin taking simvastatin (Zocor) to treat hyperlipidemia. Which statement by the patient indicates understanding of the teaching? a. I may have diarrhea as a result of taking this medication. b. I may stop taking this medication when my lipid levels are normal. c. I will need an annual eye examination while taking this medication. d. I will increase my intake of vitamins A, D, and E while taking this medication. ANS: C The statins can affect visual acuity, so patients should be counseled to have annual eye examinations for assessment of cataract formation. The bile acid sequestrants, not statins, cause diarrhea. Statin drug therapy is lifelong or until behavioral changes prove equally effective (uncommon). Bile acid sequestrants, not statins, decrease the absorption of fat-soluble vitamins. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 670 TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 9. A patient, who has intermittent claudication, has been taking 400 mg of pentoxifylline (Trental) three times daily with meals for 2 weeks. The patient calls the clinic and reports mild flushing, occasional gastrointestinal upset, and continued pain in both legs. How will the nurse advise the patient? a. Expect side effects to diminish as drug effects increase in several weeks. b. Notify the provider of the continued pain and request increasing the dose. c. Take a daily aspirin tablet to enhance the effects of pentoxifylline. d. Take the medication 1 hour before or 2 hours after a meal. ANS: A Patients should be counseled that the desired therapeutic effects may take to 3 months. This patients side effects are mild and therefore do not warrant discontinuing the drug. This patient is receiving the maximum recommended dose. Aspirin is not indicated. Taking the medication with meals and not on an empty stomach minimizes gastrointestinal effects. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 671 TOP: NURSING PROCESS: Evaluation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 10. A patient will begin taking simvastatin (Zocor) to decrease serum cholesterol. When teaching the patient about this medication, the nurse will counsel the patient to take which action? a. Return to the clinic annually for laboratory testing. b. Take care when rising from a sitting to standing position. c. Take the medication in the evening for best effect. d. Use ibuprofen as needed for muscle aches and pain. ANS: C Simvastatin is given in the evening. Laboratory tests are performed every 3 to 6 months, not

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annually. Statins do not cause postural hypotension. Patients taking statins should report muscle aches and weakness immediately. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 670 TOP: NURSING PROCESS: Planning MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 11. A patient will begin taking rosuvastatin calcium (Crestor) to treat hyperlipidemia. The patient asks the nurse how to take the medication for best effect. Which statement by the nurse is correct? a. Increase your fluid intake while taking this medication. b. Stop taking the medication if you develop muscle aches. c. Take the medication with food to improve absorption. d. You may increase dietary fat while taking this medication. ANS: A Patients taking antihyperlipidemics should be advised to increase fluid intake. It is not necessary to take with food. Patients should never stop taking a statin without consulting the provider. Patients should continue a low-fat diet while taking statins. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 668 TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies MULTIPLE RESPONSE 1. A patient with high cholesterol is ordered to take atorvastatin (Lipitor). What information will be included in the patient teaching? (Select all that apply.) a. Dietary management is not a priority with this medication. b. The medication should be taken on an empty stomach. c. The medicine should be taken with a full glass of water. d. The patient should watch for body aches or gastrointestinal upset as side effects. e. The patient should have renal function tests frequently. f. The patient should have liver function tests frequently. ANS: C, D, F This medication is most effective with careful monitoring of diet. Atorvastatin does not affect renal function. Chapter 24: Pituitary and Thyroid MULTIPLE CHOICE 1. The parents of an 11-year-old boy ask about growth hormone therapy for their child who is shorter than his 10-year-old sister. The nurse will tell the parents that growth hormone a. does not affect other hormones when given. b. is available as an oral tablet to be taken once daily. c. is given after tests prove that it is necessary. d. may be given until the childs desired height is reached. ANS: C

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Growth hormone is given only when growth hormone deficiency is determined. It cannot be given orally. It antagonizes insulin secretion and thus can lead to the development of diabetes mellitus. It cannot be given after the epiphyses are fused. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: dm 743 TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 2. The nurse is caring for a patient who is receiving growth hormone. Which assessment will the nurse monitor daily? a. Complete blood count b. Height and weight c. Renal function d. Serum glucose ANS: D Growth hormone antagonizes insulin secretion, so serum glucose should be monitored. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 743 TOP: NURSING PROCESS: Assessment/Evaluation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 3. The parents of a 16-year-old boy who plays football want their child to receive growth hormone to improve muscle strength. What will the nurse tell the parents? a. Growth hormone may be used to improve strength in young athletes. b. If the epiphyses are not fused, growth hormone may be an option. c. Small doses of growth hormone may be used indefinitely for this purpose. d. Using growth hormone to build muscle mass is not recommended. ANS: D Athletes should be advised not to take growth hormone to build muscle because of its effects on blood sugar and other side effects. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: dm 743 TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 4. Which would be a contraindication for hormone therapy with somatropin (Genotropin) in a school-age child? a. Asthma b. Dwarfism c. Enuresis d. Prader-Willi syndrome ANS: D Fatalities associated with risks of taking growth hormone with Prader-Willi syndrome have been reported, so it is contraindicated in patients with this syndrome. It is not contraindicated in patients with asthma or enuresis. Dwarfism is an indication for hormone therapy. DIF: COGNITIVE LEVEL: Remembering (Knowledge) REF: dm 743 TOP: NURSING PROCESS: Planning MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

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5. A child exhibits acromegaly caused by a tumor that cannot be destroyed with radiation. Which medication will most likely be used to treat this child? a. Bromocriptine mesylate (Parlodel) b. Octreotide acetate (Sandostatin) c. Somatrem (Protropin) d. Somatropin (Genotropin) ANS: A Bromocriptine is a prolactin-release inhibitor and is used to inhibit release of growth hormone from the pituitary gland if the tumor cannot be destroyed by radiation. Octreotide may be used as well, but it is expensive and is typically used as adjunct therapy to radiation. Somatrem and somatropin are used to treat growth hormone deficiency and would make acromegaly worse. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: dm 743 TOP: NURSING PROCESS: Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 6. The nurse is caring for a patient who has hypothyroidism. To assist in differentiating between primary and secondary hypothyroidism, the nurse will expect the provider to order which drug? a. Liothyronine sodium (Cytomel) b. Liotrix (Thyrolar) c. Methimazole (Tapazole) d. Thyrotropin (Thytropar) ANS: D Thyrotropin is a purified extract of thyroid-stimulating hormone and is used as a diagnostic agent to differentiate between primary and secondary hypothyroidism. Liothyronine and liotrix are thyroid replacement drugs. Methimazole is used to decrease thyroid hormone secretion. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 743 TOP: NURSING PROCESS: Planning/Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 7. The nurse administers intravenous corticotropin (Acthar) to a patient. A serum cortisol level drawn 60 minutes later shows no change in serum cortisol levels from prior to the dose. What is the nurses first action? a. Notify the provider to discuss a possible non-functioning adrenal gland. b. Recognize the need for an increased dose to treat pituitary insufficiency. c. Request an order for a second dose of corticotropin to treat cortisone deficiency. d. Request an order to repeat the serum cortisol level in 1 to 2 hours. ANS: A Corticotropin is given to diagnose adrenal gland disorders as well as to treat adrenal gland insufficiency. When given intravenously, the serum cortisol level should increase within 30 to 60 minutes if the adrenal gland is functioning. The nurse should report adrenal gland dysfunction. The provider will determine how to treat. Since the levels should increase in 30 to 60 minutes, there is no need to repeat the test in 1 to 2 hours. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 743 TOP: NURSING PROCESS: Evaluation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

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8. The nurse provides teaching for a patient receiving corticotropin. The nurse will instruct the patient to contact the provider if which condition occurs? a. Bruising b. Constipation c. Myalgia d. Nausea ANS: A Ecchymosis is an adverse reaction to corticotropin and should be reported. Constipation and nausea are known side effects but are not serious. Myalgia is not common. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 755 TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 9. The nurse is caring for a patient who has experienced head trauma in a motor vehicle accident. The patient is having excessive output of dilute urine. The nurse will notify the provider and will anticipate administering which medication? a. Calcifediol (Calderol) b. Corticotropin (Acthar) c. Prednisolone (AK-Pred) d. Vasopressin (Pitressin) ANS: D The posterior pituitary gland secretes antidiuretic hormone (ADH) (vasopressin). When there is a deficiency of ADH, sometimes caused by head trauma, patients excrete large amounts of dilute urine. ADH replacement is necessary to prevent fluid imbalance. Calcifediol is used to treat parathyroid disorders. Corticotropin and prednisolone do not prevent diuresis. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 745 TOP: NURSING PROCESS: Planning/Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 10. The nurse is preparing to administer piperacillin to a patient to treat an infection caused by pseudomonas. The nurse learns that the patient receives corticotropin to treat multiple sclerosis. The nurse will request an order for a. a different antibiotic. b. blood glucose monitoring. c. cardiac monitoring. d. serum electrolytes. ANS: D Corticotropin can interact with piperacillin to cause hypokalemia, so serum electrolytes should be monitored. It is not necessary to change the antibiotic. Blood glucose monitoring and cardiac monitoring are not indicated. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 755 TOP: NURSING PROCESS: Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 11. The nurse is caring for a patient who is receiving desmopressin acetate (DDAVP). Which assessments are important while caring for this patient?

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a. Blood pressure and serum potassium b. Heart rate and serum calcium c. Lung sounds and serum magnesium d. Urine output and serum sodium ANS: D Desmopressin is an antidiuretic hormone. The nurse should monitor intake and output as well as serum sodium levels. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 755 TOP: NURSING PROCESS: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 12. A 35-year-old woman reports lethargy, difficulty remembering things, facial edema, dry skin, and cessation of menses. The nurse notes a heart rate of 60 beats per minute and a weight increase of 5 pounds from a previous visit. The nurse will notify the provider of which possible condition? a. Cretinism b. Early menopause c. Hyperthyroidism d. Myxedema ANS: D Myxedema is severe hypothyroidism characterized by this womans symptoms. Cretinism is congenital hypothyroidism. Early menopause is not characterized by memory loss, facial edema, dry skin, or bradycardia. Hyperthyroidism would include tachycardia and weight loss. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 747 TOP: NURSING PROCESS: Assessment MSC: NCLEX: Physiological Integrity: Pathophysiology 13. A patient is admitted to the hospital to treat hypothyroidism. For rapid improvement in symptoms, the nurse will expect to administer which medication? a. Levothyroxine sodium (Synthroid) b. Liothyronine (Cytomel) c. Liotrix (Thyrolar) d. Thyroid desiccated (Armour Thyroid) ANS: B Liothyronine has a short half-life and rapid onset of action and is not recommended for maintenance therapy but is used as initial therapy for severe myxedema. Levothyroxine is the drug of choice for replacement therapy. Liotrix is a second-line drug. Thyroid desiccated is used for hypothyroidism to reduce goiter size. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 747 TOP: NURSING PROCESS: Planning MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 14. A patient who takes warfarin (Coumadin) and digoxin (Lanoxin) develops hypothyroidism and will begin taking levothyroxine (Synthroid). The nurse anticipates which potential adjustments in dosing for this patient? a. Decreased digoxin and decreased warfarin

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b. Decreased digoxin and increased warfarin c. Increased digoxin and decreased warfarin d. Increased digoxin and increased warfarin ANS: C Thyroid preparations increase the effect of oral anticoagulants, so the warfarin dose may need to be decreased. Levothyroxine can decrease the effectiveness of digoxin, so this dose may need to be increased. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 749 TOP: NURSING PROCESS: Planning/Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 15. A patient who takes the oral antidiabetic agent metformin (Glucophage) will begin taking levothyroxine (Synthroid). The nurse will teach this patient to monitor for a. hyperglycemia. b. hypoglycemia. c. hyperkalemia. d. hypokalemia. ANS: A Insulin and oral antidiabetic drugs may need to be increased in patients taking levothyroxine. Patients should be taught to monitor for hyperglycemia, because of the reduced effects of these drugs. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: dm 746 TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 16. A patient who has hyperthyroidism will begin treatment with an antithyroid medication. The patient asks the nurse about dietary requirements. The nurse will counsel the patient to avoid which food(s)? a. Fava beans b. Foods high in purine c. Grapefruit d. Shellfish ANS: D Patients should be advised about the effects of iodine and its presence in foods such as shellfish. There is no need to avoid fava beans, purine, or grapefruit. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 750 TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 17. The nurse is caring for a patient who is being treated for hypothyroidism. The patient reports insomnia, nervousness, and flushing of the skin. Before notifying the provider, the nurse will perform which action? a. Assess serum glucose to evaluate possible hypoglycemia. b. Check the patients heart rate to assess for tachycardia. c. Perform an assessment of hydration status. d. Take the patients temperature to evaluate for infection.

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ANS: B The patient has signs of a thyroid crisis, which can occur with excess ingestion of thyroid hormone. The nurse should evaluate heart rate before notifying the provider. These are not symptoms of hypoglycemia. The symptoms are not indicative of infection. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 750 TOP: NURSING PROCESS: Assessment/Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 18. A patient with Graves disease exhibits tachycardia, heat intolerance, and exophthalmos. Prior to surgery, which drug is used to alter thyroid hormone levels? a. Liotrix (Thyrolar) b. Propranolol (Inderal) c. Propylthiouracil (PTU) d. Thyroid (Thyrotab) ANS: C Propylthiouracil is a potent antithyroid drug used in preparation for a subtotal thyroidectomy. Liotrix and thyroid are used as thyroid replacement. Propranolol is used to treat hypertension associated with hyperthyroidism. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 748 TOP: NURSING PROCESS: Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 19. A patient has hypocalcemia caused by parathyroid hormone deficiency. Which medication will the nurse anticipate giving to this patient? a. Calcitonin b. Calcitriol c. Calcium d. Vitamin D ANS: B Calcitriol is given for management of hypocalcemia caused by parathyroid hormone deficiency. Calcitonin is used to treat hyperparathyroidism. Calcium and vitamin D are not useful in parathyroid deficiency. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 749 TOP: NURSING PROCESS: Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 20. A patient is receiving a glucocorticoid medication to treat an inflammatory condition, and the provider has ordered a slow taper in order to discontinue this medication. The nurse explains to the patient that this is done to prevent which condition? a. Acromegaly b. Adrenocortical insufficiency c. Hypertensive crisis d. Thyroid storm ANS: B Patients receiving glucocorticoids stop making their own cortisol. These drugs should be tapered slowly to allow the body to resume making this hormone. Acromegaly is associated with growth

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hormone hypersecretion. Hypertensive crisis and thyroid storm are associated with thyroid replacement. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 751 TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 21. A patient is taking prednisolone and fludrocortisone (Florinef). When teaching this patient about dietary intake, the nurse will instruct the patient to consume a diet a. high in carbohydrates. b. high in fat. c. high in protein. d. low in potassium. ANS: C Patients receiving fludrocortisone are at risk for negative nitrogen balance and should consume a high-protein diet. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: dm 754 TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 22. A patient who takes high-dose aspirin to treat arthritis will need to take prednisone to treat an acute flare of symptoms. What action will the nurse perform? a. Observe the patient for hypoglycemia. b. Monitor closely for increased urine output. c. Observe the patient for hypotension. d. Request an order for enteric-coated aspirin. ANS: D Glucocorticoids can increase gastric distress, so an enteric-coated aspirin product is indicated. Glucocorticoids increase the risk of hypoglycemia, fluid retention, and hypertension. Chapter 25: Drugs for Diabetes MULTIPLE CHOICE 1. The nurse is teaching a group of nursing students about diabetes. The nurse explains that which type of diabetes is the most common? a. Type 1 diabetes mellitus b. Type 2 diabetes mellitus c. Diabetes insipidus d. Secondary diabetes ANS: B Type 2 diabetes mellitus is the most common type of diabetes. DIF: COGNITIVE LEVEL: Remembering (Knowledge) REF: dm 759 TOP: NURSING PROCESS: Assessment MSC: NCLEX: Physiological Integrity: Pathophysiology

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2. A patient develops type 2 diabetes mellitus. The nurse will explain that this type of diabetes a. is generally triggered by medications. b. is not as common as type 1 diabetes. c. is often related to heredity and obesity. d. will not require insulin therapy. ANS: C Type 2 diabetes is often caused by obesity and hereditary factors. Secondary diabetes is triggered by medications. Type 2 diabetes is the most common type of diabetes. Patients with type 2 diabetes may become insulin-dependent. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: dm 759 TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching MSC: NCLEX: Physiological Integrity: Pathophysiology 3. A patient who is overweight is being evaluated for diabetes. The patient has a blood glucose level of 160 mg/dL and a hemoglobin A1c of 5.8%. The nurse understands that this patient has which condition? a. Diabetes mellitus b. Hypoglycemia c. Normal blood levels d. Prediabetes ANS: D Patients with a hemoglobin A1c between 5.7% and 6.4% are considered to have prediabetes. A level of 6.5% or more indicates diabetes. The patient is hyperglycemic. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 759 TOP: NURSING PROCESS: Assessment MSC: NCLEX: Physiological Integrity: Pathophysiology 4. The nurse is teaching a patient who is newly diagnosed with type 1 diabetes mellitus about insulin administration. Which statement by the patient indicates a need for further teaching? a. I may use a chosen site daily for up to a week. b. I should give each injection a knuckle length away from a previous injection. c. I will not be concerned about a raised knot under my skin from injecting insulin. d. Insulin is absorbed better from subcutaneous sites on my abdomen. ANS: C Lipohypertrophy is a raised lump or knot on the skin surface caused by repeated injections into the same site, and this can interfere with insulin absorption. Patients are encouraged to use the same site for a week, giving each injection a knuckle length away from the previous injection. Insulin absorption is greater when given in abdominal areas. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 760 TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 5. The nurse is teaching a patient how to administer insulin. The patient is thin with very little body fat. The nurse will suggest injecting insulin a. by pinching up the skin and injecting straight down. b. in the abdomen only with the needle at a 90-degree angle.

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c. subcutaneously with the needle at a 45- to 60-degree angle. d. using the thigh and buttocks areas exclusively. ANS: C In a thin person, with little fatty tissue, the needle is inserted at a 45- to 60-degree angle. In other patients, a 45- to 90-degree angle is acceptable. There is no recommendation for preferring one site over another. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 760 TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 6. The nurse receives the following order for insulin: IV NPH (Humulin NPH) 10 units. The nurse will perform which action? a. Administer the dose as ordered. b. Clarify the insulin type and route. c. Give the drug subcutaneously. d. Question the insulin dose. ANS: B Only regular insulin can be given intravenously. The nurse should clarify the order. It is not correct to give Humulin NPH insulin IV. The nurse should not administer the drug by a different route without first discussing with the provider. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 760 TOP: NURSING PROCESS: Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 7. The nurse will administer parenteral insulin to a patient who will receive a mixture of NPH (Humulin NPH) and regular (Humulin R). The nurse will give this medication via which route? a. Intradermal b. Intramuscular c. Intravenous d. Subcutaneous ANS: D Insulin is given by the subcutaneous route. Only regular insulin may be given IV. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: dm 760 TOP: NURSING PROCESS: Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 8. The nurse is teaching a patient about home administration of insulin. The patient will receive regular (Humulin R) and NPH (Humulin NPH) insulin at 0700 every day. What is important to teach this patient? a. Draw up the medications in separate syringes. b. Draw up the NPH insulin first. c. Draw up the regular insulin first. d. Draw up the medications after mixing them in a vial. ANS: C Patients should be instructed to draw up regular insulin first so that NPH is not mixed into the

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vial of regular insulin. It is not necessary to use separate syringes. Patients do not mix the medications in a vial. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 760 TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 9. A patient is ordered to receive insulin lispro at mealtimes. The nurse will instruct this patient to administer the medication at which time? a. 5 minutes before eating b. 15 minutes after eating c. 30 minutes before eating d. 10 minutes after eating ANS: A Lispro acts faster than other insulins, and patients should be taught to give this medication not more than 5 minutes before eating. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: dm 760 TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 10. The parent of a junior high-school child who has type 1 diabetes asks the nurse if the child can participate in sports. The nurse will tell the parent a. that strenuous exercise is not recommended for children with diabetes. b. that the child must be monitored for hyperglycemia while exercising. c. to administer an extra dose of regular insulin prior to exercise. d. to send a snack with the child to eat just prior to exercise. ANS: D Patients generally need less insulin with increased exercise, so the child should consume a snack to prevent hypoglycemia. Exercise is an integral part of diabetes management. Hypoglycemia is more likely to occur, and extra insulin is not indicated. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 765 TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 11. A patient has administered regular insulin 30 minutes prior but has not received a breakfast tray. The patient is experiencing nervousness and tremors. What is the nurses first action? a. Administer glucagon. b. Give the patient orange juice. c. Notify the kitchen to deliver the tray. d. Perform bedside glucose testing. ANS: B The patient is symptomatic and has hypoglycemia. The nurse should give orange juice. Glucagon is given for patients unable to ingest carbohydrates. The kitchen should be notified, and bedside glucose testing should be performed, but only after the patient is given carbohydrates.

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DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 765 TOP: NURSING PROCESS: Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 12. A patient who has type 1 diabetes mellitus asks the nurse about using a combination insulin product such as Humalog 75/25. The nurse will tell the patient that use of this product a. depends on individual insulin needs. b. is useful for patient with insulin resistance. c. means less rotation of injection sites. d. requires refrigeration at all times. ANS: A Combination products are convenient because the patient does not have to mix insulin, but the products depend on individual needs, since the doses are fixed. They are not used for patients with insulin resistance. Patients must continue to rotate injection sites. They do not require refrigeration after first use. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: dm 760 TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 13. The patient asks the nurse about storing insulin. Which response by the nurse is correct? a. All insulin vials must be refrigerated. b. Insulin will last longer if kept in the freezer. c. Opened vials of insulin must be discarded. d. Some combination pens do not require refrigeration. ANS: D Some combination pens do not require refrigeration after first use. Storing insulin in the freezer is not recommended. Opened vials may either be kept at room temperature for a month or refrigerated for 3 months. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: dm 761 TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 14. A patient who has insulin-dependent diabetes mellitus must take a glucocorticoid medication for osteoarthritis. When teaching this patient, the nurse will explain that there may be a need to a. decrease the glucocorticoid dose. b. decrease the insulin dose. c. increase the glucocorticoid dose. d. increase the insulin dose. ANS: D Glucocorticoids can cause hyperglycemia, so the insulin dose may need to be increased. Changing the glucocorticoid dose is not recommended. Decreasing the insulin dose will only compound the hyperglycemic effects. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: dm 761 TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

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15. Which statement by a patient who will begin using an external insulin pump indicates understanding of this device? a. I will have an increased risk for hypoglycemia. b. I will leave this on when bathing or swimming. c. I will not need to count carbohydrates anymore. d. I will still need to monitor serum glucose. ANS: D Patients using an insulin pump will still monitor serum glucose and count carbohydrates. The advantage of the pump is that it is programmed to deliver continuous rapid-acting insulin in varying amounts at different times throughout the day. Changes in food intake can alter the risk for hypoglycemia if the pump is not adjusted accordingly. They must be removed when bathing or swimming. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 764 TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 16. A patient who is unconscious and has a pulse is brought to the emergency department. The patient is wearing a Medic-Alert bracelet indicating type 1 diabetes mellitus. The nurse will anticipate an order to administer a. cardiopulmonary resuscitation (CPR). b. glucagon. c. insulin. d. orange juice. ANS: B This patient is most likely hypoglycemic and will need a carbohydrate. Glucagon is given parenterally if patients are unable to ingest a carbohydrate, such as orange juice. CPR is not indicated. Insulin will compound the hypoglycemia. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 765 TOP: NURSING PROCESS: Planning/Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 17. A patient who has type 2 diabetes mellitus asks the nurse why the provider has changed the oral antidiabetic agent from tolbutamide (Orinase) to glipizide (Glucotrol). The nurse will explain that glipizide a. has a longer duration of action. b. has fewer gastrointestinal side effects. c. may be taken on an as-needed basis. d. results in less hypoglycemic potential. ANS: A Glipizide is a second-generation oral antidiabetic agent. It has a longer duration of action than the first-generation antidiabetic agents such as tolbutamide. It has many gastrointestinal side effects. It is taken once daily, not as needed. It has greater hypoglycemic activity than firstgeneration antidiabetics.

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DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: dm 768 TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 18. A patient who has been taking a sulfonylurea antidiabetic medication will begin taking metformin (Glucophage). The nurse understands that this patient is at increased risk for which condition? a. Hypoglycemia b. Hyperglycemia c. Renal failure d. Respiratory distress ANS: C Metformin can lead to renal failure. It does not produce hypoglycemia or hyperglycemia. It does not increase the risk of respiratory distress. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: dm 769 TOP: NURSING PROCESS: Planning MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 19. A 45-year-old patient who is overweight has had a diagnosis of type 2 diabetes for 2 years. The patient uses 20 units of insulin per day. The patients fasting blood glucose (FBG) is 190 mg/dL. The patient asks the nurse about using an oral antidiabetic agent. The nurse understands that oral antidiabetic agents a. cannot be used if the patient is overweight. b. cannot be used once a patient requires insulin. c. may be used since this patient meets criteria. d. may not be used since this patients fasting blood glucose is too high. ANS: C Patients who require less than 40 units of insulin per day and who have a fasting blood glucose less than or equal to 200 mg/dL are candidates for oral antidiabetic agents. Being overweight is an indication, not a contraindication. Chapter 26: Estrogens and Androgens MULTIPLE CHOICE 1. A woman is taking a combination oral contraceptive and asks the nurse why progestin is necessary. The nurse will explain that progestin helps prevent pregnancy by which method? a. Altering the quantity and viscosity of cervical mucus b. Inhibiting proliferative and secretory changes in the endometrium c. Increasing motility of muscles and cilia in the fallopian tubes d. Stimulating a surge in luteinizing hormone ANS: A Progestin alters the quantity and viscosity of cervical mucus, making it thick and hostile to sperm penetration. Estrogen inhibits proliferative and secretory changes in the endometrium. Progestin decreases muscle and ciliary motility and decreases the LH surge.

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DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: dm 847 TOP: NURSING PROCESS: Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 2. A woman will begin taking a combination oral contraceptive (COC) that has a higher estrogenic activity than her previous COC. When teaching this woman about the new product, the nurse will explain that she may experience which effect(s)? a. Cyclic breast changes and chloasma b. Decreased dysmenorrhea and menorrhagia c. Decreased libido d. Weight gain and fatigue ANS: A Increased estrogenic activity may include side effects such as cyclic breast changes and chloasma as well as increased dysmenorrhea and menorrhagia. Increased progestin causes decreased libido, weight gain, and fatigue. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: dm 847 TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 3. A woman who has recently begun taking a combination oral contraceptive calls the clinic to report breakthrough bleeding. The nurse will a. advise her to use a backup method of contraception. b. counsel her to continue taking the contraceptive as prescribed. c. recommend discussing an alternative contraceptive with her provider. d. suggest that she perform a home pregnancy test to rule out pregnancy. ANS: B Breakthrough bleeding is more common at the start of COC use, and there is no evidence that an episode of bleeding is associated with a decrease in the COCs effectiveness as long as the patient continues to take the pill as prescribed. She does not need to use backup contraception. Unless the bleeding continues and is problematic, there is no need to change products. A pregnancy test is not indicated. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 847 TOP: NURSING PROCESS: Evaluation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 4. A young woman who is taking Ortho-Tri-Cyclen for contraception tells the nurse that her provider has told her it will help to treat her acne. The nurse explains that this is because this product is a. high in progestin. b. low in androgenic activity. c. low in estrogen. d. triphasic. ANS: B Products with low androgenic activity help to reduce acne.

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DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: dm 847 TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 5. The nurse is caring for a woman who will begin taking ibuprofen to treat arthritis. The woman tells the nurse that she takes Yasmin for contraception. The nurse will perform which action? a. Counsel the patient to use a backup method of contraception while taking ibuprofen. b. Notify the provider to discuss an alternate combination oral contraceptive. c. Suggest a COX-2 inhibitor instead of ibuprofen for arthritis pain. d. Tell the patient to use a lower dose of ibuprofen to prevent adverse effects. ANS: B Yasmin contains drospirenone, which is derived from spironolactone. Drospirenone can alter water and electrolyte balances in women, and women taking this product should avoid NSAIDs to avoid compounding this effect. The provider may want to consider another COC product. It does not alter fertility. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 848 TOP: NURSING PROCESS: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 6. A woman who is taking a combined oral contraceptive (COC) that contains 21 days of active pills and 7 days of inert pills reports having headaches accompanying withdrawal bleeding every month. The nurse will a. counsel her to take ibuprofen to counter these side effects. b. notify her provider to discuss these adverse effects. c. recommend a Loestrin Fe product. d. suggest she ask her provider about Mircette. ANS: D Mircette provides 2 inert pills and 5 pills with 10 mcg of ethinyl estradiol during the counter phase, which helps to decrease withdrawal bleeding and headaches. Loestrin counters withdrawal bleeding but does not help with headaches. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 848 TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 7. A woman who is using a NuvaRing transvaginal contraceptive product calls to report that the ring has slipped out while sleeping. The nurse will instruct the patient to rinse the ring with lukewarm water, reinsert the ring, and a. abstain from sexual intercourse for 24 hours. b. replace it with a new ring as soon as possible. c. take an oral contraceptive product for 2 weeks. d. use a backup method of contraception for 7 days. ANS: D If the NuvaRing slips out, it should be rinsed off and reinserted. If it has been out longer than 3 hours, the woman should be counseled to use a backup method of contraception.

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DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 852 TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching MSC: NCLEX: Health Promotion and Maintenance: Aging 8. A 35-year-old woman asks the nurse about oral contraceptives. The nurse learns that the patient smokes and has a family history of venous thromboembolism (VTE). The nurse will suggest that the patient a. discuss a progestin-only oral contraceptive with her provider. b. may want to consider having a tubal ligation. c. use a transdermal contraceptive product. d. will not be a candidate for oral contraceptive products. ANS: A Patients who smoke or who have an increased risk of VTE may be candidates for progestin-only products. A 35-year-old woman may still want children in the future, so recommending a tubal ligation is not indicated. Transdermal products contain estrogen and carry the same risks as COCs. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 852 TOP: NURSING PROCESS: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 9. A woman comes to the clinic for a Depo-Provera injection. The nurse reviews her medical record and notes that it has been 100 days since her last injection. What action will the nurse perform? a. Administer Depo-Provera 150 mg IM. b. Give Depo-Provera 300 mg IM. c. Perform a pregnancy test. d. Suggest she wait until she has had a period. ANS: C Women should receive Depo-Provera injections every 13 weeks. Patients who are late for injections (13 weeks plus 1 day) will need to rule out pregnancy before receiving the next injection. Patients who are eligible receive 150 mg IM. It is not correct to give a higher dose. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 853 TOP: NURSING PROCESS: Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 10. A 45-year-old woman reports cessation of menses for the past 6 months and asks the nurse if she needs to continue using contraception. The nurse will tell her a. that she may discontinue using contraception. b. that she most likely has premature ovarian failure. c. to begin hormone therapy to prevent menopausal symptoms. d. to continue using contraception for at least 6 more months. ANS: D Women should use contraception until menstruation has ceased for 1 year if they do not wish to become pregnant. Premature ovarian failure occurs when menstruation stops before age 40 years. It is not necessary to treat menopausal symptoms until they occur.

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DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 862 TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 11. A 45-year-old woman who has not had a period for 15 months reports severe hot flashes and poor sleep. The nurse reviews information about hormone replacement therapy and tells this woman that hormone therapy a. is very safe and may be used freely to treat menopausal symptoms. b. may be used indefinitely to treat menopausal symptoms. c. should be used at the lowest dose possible for less than 5 years. d. will be necessary to prevent osteoporosis caused by estrogen depletion. ANS: C Women should use hormone therapy at the lowest dose possible for a period of less than 5 years. It carries risks for breast cancer and cardiovascular disease and cannot be used indefinitely. Hormone therapy can help slow osteoporosis, but it does not prevent osteoporosis and is not recommended for this use. Chapter 27: Adrenal Hormones 1. The nurse administers fludrocortisone (Florinef) to a patient diagnosed with salt-losing adrenogenital syndrome and then assesses for what therapeutic action? A)

Development of hypokalemia and elevated serum glucose level

An increase in sodium and water reabsorption and potassium excretion

Headache, edema, weakness, arrhythmias, and hypertension

Sodium and water depletion along with potassium retention

Ans:

B Feedback: Fludrocortisones therapeutic effects include an increase in sodium and water reabsorption with potassium excretion. Headache, edema, weakness, arrhythmias, and hypertension are adverse, and not therapeutic, effects. Hypokalemia is possible but glucose levels should not be impacted.

2. When developing a plan of care for the patient receiving a glucocorticoid, what nursing diagnosis would be of highest priority? A)

Deficient fluid volume related to water retention

Risk for injury related to muscle weakness

Imbalanced nutrition: less than body requirements

Risk for infection related to immunosuppression

Ans:

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Feedback: Risk for infection related to immunosuppression would be the appropriate nursing diagnosis because steroids suppress the immune system, which puts the patient at risk for infection. Nutritional imbalance is more likely to be more than body requirements than less than body requirements. Excess fluid volume is more appropriate than deficient fluid volume. Glucocorticoids are not associated with muscle weakness. 3. What glucocorticoids could the nurse only administer orally? A)

Cortisone (Cortone Acetate)

Hydrocortisone (Cortef)

Prednisone (Deltasone)

Triamcinolone (Aristocort)

Ans:

C Feedback: Prednisone is available in oral form only and is used for replacement therapy for adrenal insufficiency, and treatment of allergic and inflammatory disorders. Cortisone can be administered orally or intramuscularly and is used for replacement therapy. Hydrocortisone, used for replacement therapy, is administered by the oral, IV, intramuscular, topical, ophthalmic, rectal, and intra-articular routes. Triamcinolone is administered by the oral, intramuscular, inhalant, intra-articular, and topical routes and is used for treatment of allergic and inflammatory disorders and in the management of asthma.

4. The mother asks the nurse for a steroid cream to put on her infants diaper rash. What teaching will the nurse provide the mother? (Select all that apply.) A)

Topical corticosteroids are very effective treatment for diaper rash.

Topical corticosteroid application should not be occluded with a diaper.

Topical corticosteroids should not be applied to open lesions.

Use of topical corticosteroids should be limited in children.

Topical corticosteroids should be applied in a thick coat to the rash.

Ans:

B, C, D Feedback: Topical use of corticosteroids should be limited in children because their body surface area is comparatively large and the amount of the drug absorbed in relation to weight is greater than in an adult. When the medication is used in children, it should be applied sparingly and the area should not be occluded with a diaper. The nurse should not make a judgment nor should he or she allow a patient or family member to dictate a treatment

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just because he or she wants it. More effective treatments for diaper rash than corticosteroids are available. 5. An older adult patient taking high-dose corticosteroids to treat arthritis requests a pneumonia vaccine. What is the nurses best response? A)

Pneumonia vaccines are only given if you are at risk for serious pulmonary problems.

Live virus vaccines cannot be given to people who are significantly immunosuppressed.

Patients taking corticosteroids are well protected from viruses and do not need vaccines.

Corticosteroids interact with the pneumococcal vaccine to create serious adverse effects.

Ans:

B Feedback: Corticosteroids block the inflammatory response and are very helpful in conditions such as arthritis. However, they also block the immune response, making a person immunosuppressed. The vaccine would not be given to this patient because of the increased risk for infection. An older adult would be considered at high risk for pneumonia so getting the vaccine would be encouraged if not for taking corticosteroids. Corticosteroids do not protect against viruses. The vaccine is contraindicated because of risk for infection and not because of a potential drugdrug interaction.

6. A patient who is steroid dependent due to adrenocortical insufficiency calls the clinic and is very upset, telling the nurse of the extreme stress he or she is experiencing right now. What does the nurse expect the health care provider will order concerning his or her medication? A)

The dosage may continue as ordered.

The medication may be discontinued until stress declines.

The dosage of the medication may be increased.

The dosage of the medication may be decreased.

Ans:

C Feedback: The patients body will initiate a stress reaction. Normally, activation of the stress reaction can cause release of adrenocorticotropic hormone (ACTH) and secretion of the adrenocortical hormones. A patient with adrenocortical insufficiency may not be able to supplement the increased need for ACTH. The stress reaction may block the immune and inflammatory systems, making the body more susceptible to pathogens. Therefore, an

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increase in medication may be necessary to prevent further adrenal insufficiency and to meet the increased demands for corticosteroids in the body under stress. 7. A nurse is providing patient education to a patient who has had corticosteroids prescribed. What drug will the nurse teach the patient to avoid while taking the corticosteroids? A)

Aspirin

Dimenhydrinate (Dramamine)

Ibuprofen (Advil)

Famotidine (Pepcid)

Ans:

A Feedback: Serum levels and effectiveness may decrease if corticosteroids are combined with salicylates. Dimenhydrinate, ibuprofen, and famotidine have not been found to produce drugdrug interaction.

8. The nurse is caring for a patient with a heightened stress response following a fearful experience. When assessing this patient, what findings will the nurse attribute to this response? (Select all that apply.) A)

Elevated serum blood glucose

Reduced inflammatory response

Heightened immune response

Increased blood volume

Extreme hunger

Ans:

A, B, D Feedback: The stress response causes an increase in blood volume and a release of glucose for energy. It also slows the rate of protein production and blocks the activities of the inflammatory and immune systems, which reserves energy. This patient is unlikely to be hungry.

9. The nurse is providing patient education to a patient taking a glucocorticoid and advises the patient to take his or her medication at what time of the day? A)

At bedtime

With the noon meal

At 3:00 PM

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Immediately on awakening in the morning

Ans:

D Feedback: Glucocorticoids should be taken immediately on awaking in the morning to mimic the normal diurnal pattern. The peak levels of cortisol usually come between 6:00 and 8:00 AM. The levels then fall off slowly and reach a low in the late evening with the lowest levels around midnight. For those patients who work night shifts, the schedule would be changed to accommodate their sleep pattern. Waiting until later in the day could result in sleeplessness.

10. An 8-year-old with asthma has been prescribed triamcinolone (Aristocort). What dosage of medication would the nurse appropriately deliver? A)

One inhalation per day

One inhalation b.i.d.

Two inhalations every 3 hours

Two inhalations t.i.d.

Ans:

D Feedback: Pediatric dosage is individualized based on severity and response. However, children between 6 and 12 years of age are prescribed one to two inhalations t.i.d. or q.i.d. The other options are incorrect based on the recommended dosage.

11. The nurse, caring for a patient experiencing stress, knows that activation of the stress reaction will cause the release of what? A)

Glucose

Aldosterone

Adrenocorticotropic hormone (ACTH)

Oxytocin

Ans:

C Feedback: Activation of the stress reaction through the sympathetic nervous system bypasses the usual diurnal rhythm and causes release of ACTH and secretion of the adrenocortical hormonesan important aspect of the stress (fight-or-flight) response. Glucose will eventually be released to supply energy, but first ACTH and adrenocortical hormones must stimulate this response. Aldosterone can be released without ACTH stimulation when the blood surrounding the adrenal gland is high in potassium. This is a direct

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stimulus for aldosterone release. Oxytocin is released to promote the let-down reflex in the lactating woman and to stimulate uterine contractions but is not involved in the stress response. 12. The nurse is developing a plan of care for an 84-year-old diabetic patient who is receiving oral hydrocortisone 40 mg daily for treatment of arthritis. What is this patients priority nursing intervention? A)

Increasing sodium in diet

Restricting protein in diet

Increasing fluids to 2,000 mL/d

Monitoring blood glucose levels frequently

Ans:

D Feedback: Caution should be used in patients with diabetes because the glucose-elevating effects disrupt glucose control. More frequent blood sugar monitoring is this patients priority intervention. Sodium, protein, and fluid intake do not need to be altered.

13. A patient with adrenal insufficiency has been admitted to the intensive care unit in adrenal crisis. What assessment findings support this diagnosis? (Select all that apply.) A)

Physiological exhaustion

Hypertension

Fluid shift

Shock

Septicemia

Ans:

A, C, D Feedback: Symptoms of adrenal crisis include physiological exhaustion, hypotension, fluid shift, shock, and even death. Hypotension rather than hypertension would be expected. Septicemia is a possible cause of adrenal crisis, not a symptom.

14. The nurse is providing discharge teaching for a patient prescribed prednisone to be taken on alternate days. The patient asks why he cannot take half a pill every day. What is the nurses best response? A)

To eliminate adverse side effects

To prolong therapeutic effects

To prevent steroid tolerance

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To decrease adrenal suppression

Ans:

D Feedback: Alternate-day maintenance therapy is used with short-acting drugs whenever possible to decrease the risk of adrenal suppression. Alternate-day therapy would not eliminate adverse effects or prolong therapeutic effects. There is no such thing as steroid tolerance.

15. The clinic nurse receives a call from the mother of a 4-year-old child on long-term corticosteroid therapy saying the child woke up with a cold and is pulling on his ear. What instructions will the nurse provide? A)

Encourage fluids, monitor his temperature, and he will be better in 3 days.

Take him to the emergency room (ER) immediately.

Bring him to the clinic to be seen today.

Hang up and call 911.

Ans:

C Feedback: Children receiving long-term therapy should be protected from exposure to infection. Special precautions should be instituted to avoid injury. If injuries or infections do occur, the child should be seen by a primary care provider as soon as possible. There is no need to treat this as an emergency so the mother need not rush the child to the ER or call 911, but she should be encouraged to have the child seen today at the clinic. It would not be appropriate to give home care instructions until he has been seen at the clinic.

16. When doing a shift assessment on the patient, the nurse would report what symptoms as a possible adverse effect of intranasal methylprednisolone? (Select all that apply.) A)

Headache

Impaired wound healing

Epistaxis

Hypotension

Nasal irritation

Ans:

A, B, C, D, E Feedback: Intranasal administration of hydrocortisone can result in headache, nausea, nasal irritation, fungal infections, epistaxis, rebound congestion, perforation of the nasal septum, anosmia, and urticaria. Systemically administered hydrocortisone has many

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possible adverse effects including impaired wound healing and hypotension, but these would not be likely to be associated with intranasal administration of hydrocortisone. 17. The nurse is providing dietary teaching to the patient on long-term mineralocorticoid therapy and includes what teaching point? A)

Decreasing sodium

Increasing calcium

Increasing vitamin D

Increasing potassium

Ans:

D Feedback: Mineralocorticoids cause sodium and water retention and potassium excretion. These patients benefit from a diet with increased potassium. They would not decrease sodium intake as the drug is often administered for the purpose of increasing serum sodium levels. Calcium and vitamin D intake would be the same for this patient as any other patient of similar age and gender.

18. The nurse anticipates an order for a glucocorticoid when caring for a patient with what condition? A)

Hypoglycemia

Appendicitis

Arthritis

Septicemia

Ans:

C Feedback: Glucocorticoids are indicated for the short-term treatment of many inflammatory disorders, to relieve discomfort, and to give the body a chance to heal from the effects of inflammation. They block the actions of arachidonic acid, which leads to a decrease in the formation of prostaglandins and leukotrienes. Without these chemicals, the normal inflammatory reaction is blocked. Hypoglycemia would more safely be treated with glucose. Appendicitis and septicemia are infections that would contraindicate the use of glucocorticoids because of the immunosuppressant effects of the drugs.

19. The 2-year-old patient with asthma is placed on a short-term dose of prednisone. What important instruction will the nurse provide the patient about this drug? A)

Increase intake of carbohydrates.

The child may receive immunizations while on this drug.

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Do not stop this medication suddenly; you will have to taper dosage gradually.

Reduce intake of protein until drug therapy is complete.

Ans:

C Feedback: Prednisone is usually ordered for short-term use with tapering dosage. It is important to instruct the parent to taper doses and to not just stop the drug suddenly when discontinuing from high doses so as to give the adrenal glands a chance to recover and produce adrenocorticoids. This is the priority instruction. Parents should also be told to wait to get the child immunizations until after drug therapy is completed. There is no need to alter carbohydrate or protein intake.

20. When caring for a patient receiving long-term therapy with corticosteroids, the nurse would plan care incorporating interventions aimed at preventing what? A)

Allergies

Inflammation

Infection

Anemia

Ans:

C Feedback: When planning care for a patient taking long-term corticosteroid therapy, the nurse needs to incorporate interventions aimed at reducing risk of infection because the patients immune system will be suppressed, which places the patient at increased risk. The nurse would not try to prevent the anti-inflammatory effects of the drug. The drug is not associated with causing allergies or anemia.

21. A 66-year-old female patient is on long-term oral glucocorticoid therapy to treat chronic obstructive pulmonary disease. When providing drug teaching, the nurse will inform this patient that she is at particular risk for what? A)

Hyponatremia

Spontaneous fractures

Respiratory depression

Ineffective temperature regulation

Ans:

B Feedback: Only spontaneous fractures are considered an adverse effect of glucocorticoids; this patient would be at increased risk because her age and gender put her at higher risk for

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osteoporosis, which also has the adverse effect of spontaneous fractures. Long-term glucocorticoid therapy is not associated with hyponatremia, respiratory depression, or ineffective temperature regulation. 22. The nurse provides teaching to a patient with chronic obstructive pulmonary disease who has been prescribed budesonide (Pulmicort) two puffs and fluticasone (Flovent) three puffs t.i.d. The nurse evaluates that further teaching is needed when the patient makes what statement? A)

Take all five puffs as quickly as possible.

Replace the inhalers before they run out.

Rinse the mouth after taking the medication.

Continue medication even when symptoms start to subside.

Ans:

A Feedback: The nurse needs to review how to administer the drug via inhalation because the patient must hold the medication in the airways as long as possible before exhaling and should not try to rush the treatment. The other statements are correct and would not require clarification.

23. The home health nurse provides patient teaching to his or her patient who is taking oral prednisolone. The nurse provides what instruction to reduce the occurrence of nausea? A)

Take with a meal.

Take 1 hour before meals.

Take before bedtime.

Split the dose into two equal doses.

Ans:

A Feedback: Steroids, taken on an empty stomach, would exacerbate the nausea. If the patient takes only one dose per day, it should be taken immediately after breakfast. If spaced throughout the day, eating something before taking the pill will reduce risk of nausea. Timing is dictated by frequency of administration, and if only taken once daily, the medication should be taken in the morning (so bedtime is inappropriate). Splitting the dose would decrease effectiveness and would be inappropriate for the nurse to suggest because it is outside the scope of nursing practice. Taking the medication before meals would mean it was being taken on an empty stomach.

24. What would be important for the nurse to teach the parents of a pediatric patient about the use of topical corticosteroids?

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Apply the medication sparingly.

Apply directly to open lesions.

After applying cover with a bandage.

Reapply as often as needed to keep the rash coated with the medication.

Ans:

A Feedback: Topical use of corticosteroids should be limited in children, because their body surface area is comparatively large, so that the amount of the drug absorbed in relation to weight is greater than in an adult. Apply sparingly and do not use in the presence of open lesions. Do not occlude treated areas with dressings or diapers, which may increase the risk of systemic absorption.

25. The nurse is teaching the patient who will require long-term corticosteroid therapy how to reduce the risk of infection. What suggestions will the nurse include? A)

Avoid large crowds of people tightly packed together.

Avoid working in areas with other people.

Avoid exercising to reduce risk of injury.

Avoid touching other people who may carry germs.

Ans:

A Feedback: With long-term therapy, the importance of avoiding exposure to infectioncrowded areas, people with colds or the flu, activities associated with injuryshould be stressed. If an injury or infection should occur, the patient should be encouraged to seek medical care. These patients do not need to avoid work, exercise, or touching others but they should use good hand hygiene to avoid infection from these sources.

26. The nurse is caring for an African American patient who received a kidney transplant and receives methylprednisolone for immunosuppression. What is the nurses priority assessment specific to this patient? A)

Assessing capillary refill time

Assessing cardiac rhythm

Assessing white blood cell count

Assessing blood glucose levels

Ans:

D Feedback:

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African Americans develop increased toxicity to the corticosteroid methylprednisoloneparticularly when it is used for immunosuppression after renal transplantation. This toxicity can include severe steroid-induced diabetes mellitus. A priority intervention with this patient is monitoring blood glucose levels. Assessment of capillary refill time and cardiac rhythm would not be indicated by the data supplied about this patient. White blood cell counts should be monitored on any patient receiving longterm corticosteroids but is not specific to this patient. 27. The nurse is caring for a patient who is diagnosed with protein-deficient malnutrition. Why would an order to administer androgens to this patient be appropriate? A)

Androgens reduce the bodys requirement for protein.

Androgens increase the bodys absorption of protein from the bowel.

Androgens stimulate protein production and decrease protein breakdown.

Androgens reduce carbohydrate metabolism and promote lipid absorption.

Ans:

C Feedback: Androgens are a form of the male sex hormone called testosterone. They affect electrolytes, stimulate protein production, and decrease protein breakdown, which will help to reverse the patients protein malnutrition in addition to a high-protein diet. They do not reduce the bodys need for protein, increase protein absorption from the bowel, or impact carbohydrate and lipid metabolism.

28. The nurse is caring for a patient who works night shift from 2200 (10 pm) to 0600 (6 am) and normally sleeps from 0800 (8 am) until 1600 (4 pm) each day. The nurse would teach this patient to take his or her corticosteroid at what time of the day? A)

06:00 (6 am)

08:00 (8 am)

16:00 (4 pm)

22:00 (10 pm)

Ans:

C Feedback: If a person works all night and goes to bed at 8 am, arising at 4 pm to carry on the days activities before going to work at 10 pm, the hypothalamus will release corticotropinreleasing hormone at about 4 pm in accordance with the new sleepwake cycle. It usually takes 2 or 3 days for the hypothalamus to readjust. A patient on this schedule who is taking replacement corticosteroids would then need to take them at 4 pm, or on arising. All other options would not be optimal.

29. For what reason might a nurse administer androgen injections to a 9-year-old boy?

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Ovarian atrophy

Dwarfism

Acromegaly

Hypogonadism

Ans:

D Feedback: Androgens are used pharmacologically to treat hypogonadism or to increase protein growth and red blood cell production. Androgens are not used in a male to treat ovarian atrophy. Androgens are not used to treat dwarfism or acromegaly.

30. A patient is taking low-dose corticosteroids on a long-term basis for chronic obstructive pulmonary disease. The nurse assesses this patient knowing prolonged use of corticosteroids puts the patient at risk for what? A)

Adrenal storm

Adrenal atrophy

Stunted growth

Hypothalamic insufficiency

Ans:

B Feedback: Prolonged use of corticosteroids suppresses the normal hypothalamicpituitary axis and leads to adrenal atrophy from lack of stimulation. The other options are all distracters for this question with no connection to long-term use of corticosteroids.

31. The nurse administers prednisone orally at 8 am. When would the nurse expect the drug to reach peak effect? A)

9 to 10 am

12 to 1 pm

8:30 to 9:00 am

4 to 6 pm

Ans:

A Feedback: Prednisones peak effect occurs 1 to 2 hours after administering the drug. If given at 8 am, the expected peak would occur between 9 and 10 am.

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32. Nursing care for the postoperative patient requiring long-term glucocorticoid therapy will be directed at overcoming what adverse effect of the drug? A)

Poor wound healing

Inflammation

Autoimmune response

Lack of mobility

Ans:

A Feedback: Patients taking long-term glucocorticoid therapy will have impaired wound healing so nursing care is directed toward promoting healing. The drug has an anti-inflammatory effect so that would not need to be overcome. There is no autoimmune response or lack of mobility so these do not have to be overcome.

33. The nurse is teaching a class for his or her peers about glucocorticoids. What will the nurse say is initially blocked, resulting in the drugs anti-inflammatory action? A)

Arachidonic acid

Phagocytes

Lymphocytes

Antibodies

Ans:

A Feedback: Glucocorticoids block the actions of arachidonic acid, which leads to a decrease in the formation of prostaglandins and leukotrienes. They also impair the ability of phagocytes to leave the bloodstream and move to injured tissues; they inhibit the ability of lymphocytes to act within the immune system, including blocking the production of antibodies. Blocking arachidonic acid is, however, the initial action.

34. What hormones does the adrenal medulla secrete? A)

Renin and erythropoietin

Norepinephrine and epinephrine

Epinephrine and dopamine

Dopamine and serotonin

Ans:

B Feedback:

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The adrenal medulla is actually part of the sympathetic nervous system (SNS). It is a ganglion of neurons that releases the neurotransmitters norepinephrine and epinephrine into circulation when the SNS is stimulated. 35. The adrenal cortex responds to adrenocorticotropic hormone (ACTH), which responds to corticotropin-releasing hormone (CRH) from the hypothalamus in a daily pattern called what? A)

Pituitary rhythm

hypothalamicpituitary axis

Diurnal rhythm

Circadian rhythm

Ans:

C Feedback: The adrenal cortex responds to ACTH released from the anterior pituitary. ACTH, in turn, responds to CRH released from the hypothalamus. This happens regularly during a normal day in what is called diurnal rhythm. Pituitary rhythm is a distracter; the term does not exist. The hypothalamicpituitary axis involves the interaction between the two glands. Circadian rhythm involves when people prefer to be most active, such as people who say they are morning people.

Chapter 28: Drugs for Obesity 1. When planning patient care the nurse recognizes what patient is at greatest risk of developing coronary artery disease? A)

A 32-year-old Asian American with total cholesterol of 120 mg/dL

A 62-year-old white American with total cholesterol of 260 mg/dL

A 48-year-old African American with total cholesterol of 198 mg/dL

A 26-year-old Native American with total cholesterol of 150 mg/dL

Ans:

B Feedback: White Americans have the highest incidence of coronary artery disease (CAD). This patient has total cholesterol of 260 mg/dL, which is considered high according to the Third Report of the National Cholesterol Education Program Expert Panel. The other three patients could be at risk due to cultural risk factors such as hypertension, diabetes, high (HDL) and low density lipoprotein (LDL) levels, and HDL level to cholesterol ratio. However, their total cholesterol levels fall within normal or desirable range.

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2. The nurse is assessing a patient who reports taking cholestyramine (Questran) mixed with diet cola twice per day. What is an appropriate nursing diagnosis for this patient? A)

Acute pain related to central nervous system and GI effects

Constipation related to GI effects

Noncompliance related to how the drug is taken

Deficient knowledge regarding drug therapy

Ans:

D Feedback: Cholestyramine should be mixed with water or other noncarbonated fluids so the nurse now recognizes the need for medication teaching and chooses the nursing diagnosis related to deficient knowledge. Nothing in this question indicates that the patient is experiencing any adverse effects from the drug so that pain and constipation would not be optimal nursing diagnoses. Until the nurse assesses the patients understanding of how to take the drug, it would be incorrect to assume noncompliance when it may actually be lack of understanding.

3. A patient tells the nurse he has had an exacerbation of hemorrhoidal irritation. What drug would the nurse suspect is most likely to contribute to this adverse effect? A)

Bile acid sequestrants

Beta-hydroxy-beta-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors

Cholesterol absorption inhibitor

Fibrates

Ans:

A Feedback: Direct gastrointestinal (GI) irritation, including nausea, constipation that may progress to fecal impaction, and aggravation of hemorrhoids, may occur with use of bile acid sequestrants. GI irritation, and specifically irritation of hemorrhoids is not associated with use of HMG-CoA reductase inhibitors, cholesterol absorption inhibitors, or fibrates.

4. The nurse is engaged in patient teaching about a newly prescribed bile acid sequestrant that may be mixed with a carbonated beverage. What bile acid sequestrant is the nurse describing? A)

Cholestyramine (Questran)

Colesevelam (Welchol)

Colestipol (Colestid)

Ezetimibe (Zetia)

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Ans:

C Feedback: Colestipol can be mixed with a carbonated beverage. The mixture should be stirred and all of the liquid should be swallowed. Ezetimibe is a cholesterol absorption inhibitor and comes in tablet form. The other two options are bile acid sequestrants, but should not be taken with carbonated beverages. The carbonation interferes with the absorption of the drug.

5. The patient asks the nurse what atorvastatin (Lipitor), newly prescribed, will do. What expected outcome will the nurse describe? A)

Decrease in serum cholesterol only

Decrease in serum cholesterol and low density lipoprotein (LDL) levels

Decrease in sitosterol and serum cholesterol

Decrease in campesterol and LDL levels

Ans:

B Feedback: Atorvastatin is a beta-hydroxy-beta-methylglutaryl coenzyme A reductase inhibitor and should lower serum cholesterol and LDL levels as well as prevention of a first myocardial infarction and slow the progression of coronary artery disease. A decrease in serum cholesterol alone would result from the use of a bile acid sequestrant. A cholesterol absorption inhibitor would also decrease sitosterol and campesterol levels as well as decrease levels of serum cholesterol and LDL.

6. The nurse is taking a health history on a 38-year-old man who is taking atorvastatin (Lipitor) for high cholesterol. What will the nurse question specifically related to the safe use of this drug? A)

Alcohol

Nicotine

Caffeine

Herbal therapy

Ans:

A Feedback: Beta-hydroxy-beta-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors are contraindicated with active liver disease or a history of alcohol-related liver disease so it is important for the nurse to ask about the patients use of alcohol. Nicotine, caffeine, and herbal therapies are usually not identified as producing any drugdrug interactions with atorvastatin.

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7. A 9-year-old child has received an order for oral pravastatin (Pravachol) 40 mg/d for genetically linked hyperlipidemia. In preparation for patient teaching concerning this drug, what initial action will the nurse take? A)

Ask the parents to be present for the teaching session.

Determine the appropriate time to discuss the drug with the patient.

Question the doctor concerning the ordered dosage.

Review the childs normal daily dietary intake of fatty foods.

Ans:

C Feedback: The nurse should question the order initially. The dosage is twice the dose for a 9-yearold is expected to receive. The other options are appropriate and would be done. However, out of safety concerns, the nurse would clarify the dosage first.

8. The nurse is caring for a patient taking ezetimibe (Zetia) and monitors the patient for what common adverse effects? A)

Bloating and flank pain

europathy and flatulence

Mild abdominal pain and diarrhea

Constipation and flank pain

Ans:

C Feedback: The most common adverse effects of ezetimibe are mild abdominal pain and diarrhea. Bloating and flatulence are associated with bile acid sequestrants and the fibrates. Constipation is usually associated with bile acid sequestrants. Neuropathy and flank pain are usually not associated with lipid-lowering agents.

9. The nurse is preparing a patient for discharge who will receive a prescription for an betahydroxy-beta-methylglutaryl coenzyme A (HMG-CoA) inhibitor. What statement by the patient demonstrates that they have a clear understanding of the teaching provided by the nurse? A)

I will not need to follow that low-fat diet anymore because this drug will take care of my lipids.

I should plan to take this drug before bedtime, because my body makes lipids mostly at night.

After I start taking this drug, I will not have to worry about the exercise routine the doctor prescribed.

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I should take this drug first thing in the morning and make sure I drink a full glass of water.

Ans:

B Feedback: HMG-CoA inhibitors should be taken at bedtime because the body produces lipids mostly at night. Diet and exercise are still important when taking these drugs because the drug is most effective in combination with other lipid-lowering actions.

10. A patient taking atorvastatin (Lipitor) comes to the clinic with complaints of acute muscle pain not associated with exercise or injury. The nurse will ask questions to determine if this patient has been taking what contraindicated substance? A)

Over-the-counter (OTC) medications

Ginseng

Grapefruit juice

Saw palmetto

Ans:

C Feedback: Grapefruit juice can decrease the breakdown of atorvastatin, leading to increased serum levels and toxic adverse effects, including rhabdomyolysis. Patients on this drug should be cautioned to avoid drinking grapefruit juice. OTC drugs, ginseng, and saw palmetto are not associated with increased toxicity.

11. What are the most common adverse effects of lovastatin (Mevacor)? A)

Nausea, flatulence, and constipation

Increased appetite and blood pressure

Confusion and mental disorientation

Hiccups, sinus congestion, and dizziness

Ans:

A Feedback: GI problems such as nausea, vomiting, flatulence, constipation, or diarrhea can occur with lovastatin. Increased appetite is not associated with lovastatin but patients may think that taking this drug means they can now eat anything they want and this would indicate the need for further teaching. Confusion and mental disorientation are not associated with this drug. Hiccups, sinus congestion, and dizziness would require exploration for cause because they are not normally associated with lovastatin therapy.

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12. The patient receives a prescription for niacin and the nurse is teaching his or her about the medication. The nurse instructs the patient to call the provider if what common adverse effect of niacin occurs? A)

Hypotension

Abdominal pain

Vomiting

Diarrhea

Ans:

B Feedback: Niacin is associated with intense cutaneous flushing, nausea, and abdominal pain, making its use somewhat limited. It also increases serum levels of uric acid and may predispose patients to the development of gout. Hypotension, vomiting, and diarrhea are not normally associated with the drug.

13. The nurse is providing medication teaching to a patient who will begin taking niacin with a bile acid sequestrant. How does the nurse instruct the patient to take these two medications? A)

Both medications should be taken 4 to 6 hours apart.

Both medications should be taken in the morning.

One medication should be taken in the morning but the other is taken at bedtime.

Both medications can be taken at once just before going to bed.

Ans:

A Feedback: When niacin is prescribed with a bile acid sequestrant, the patient should be told to take the two medications 4 to 6 hours apart in the evening, with the niacin normally taken first.

14. The nurse is teaching a patient about a peroxisome proliferator receptor alpha activator named Trilipix (fenofibric acid). The patient asks what this drug does. What is the nurses best response? A)

Micelles are absorbed into the intestinal wall and combined with proteins to become chylomicrons.

The drug makes the liver use cholesterol to produce more bile acids.

The drug works in the brush border of the small intestine to prevent the absorption of dietary cholesterol.

The drug activates a specific hepatic receptor, resulting in increased breakdown of lipids and reduction in triglyceride levels.

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Ans:

D Feedback: Fenofibric acid is the first drug in this class. It activates a specific hepatic receptor that results in increased breakdown of lipids, elimination of triglyceride-rich particles from the plasma and reduction in the production to an enzyme that naturally inhibits lipid breakdown. The result is seen as a decrease in triglyceride levels, changes in low density lipoprotein production, which makes them more easily broken down in the body, and an increase in high density lipoprotein levels.

15. The nurse conducts a review of research related to Beta-hydroxy-beta-methylglutaryl coenzyme A inhibitors and finds the only one associated with data to show a reduction in coronary artery disease and incidence of myocardial infarction is what drug? A)

Pravastatin (Pravachol)

Lovastatin (Mevacor)

Atorvastatin (Lipitor)

Fluvastatin (Lescol)

Ans:

A Feedback: Pravastatin is the only statin with outcome data to show effectiveness in decreasing coronary artery disease and incidence of myocardial infarction (MI); it prevents a first MI even in patients who do not have a documented elevated cholesterol level. The other medications do not have any evidence of effectiveness for this patient.

16. Which drug is most effective in reducing serum triglyceride levels? A)

Beta-hydroxy-beta-methylglutaryl coenzyme A reductase inhibitors

Bile acid sequestrants

Fibrates

Niacin

Ans:

C Feedback: Fibrates decrease hepatic production of triglycerides. They are the most effective drugs for reducing serum triglycerides. The other options are incorrect.

17. The nurse is caring for a patient who takes fluvastatin (Lescol). Which laboratory value should be assessed regularly on this patient? A)

Blood urea nitrogen (BUN)

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Complete blood count (CBC)

Activated partial thromboplastin time

Liver function studies

Ans:

D Feedback: Increased concentrations of liver enzymes commonly occur, and acute liver failure has been reported with the use of atorvastatin and fluvastatin. Liver function studies should be monitored at the onset of therapy, at 6 and 12 weeks, and intermittently during course of therapy. The other tests would not be pertinent to this specific drug.

18. The nurse explains the action of a beta-hydroxy-beta-methylglutaryl coenzyme A (HMGCoA) reductase inhibitor as inhibiting what? A)

An enzyme that controls the final step in production of cellular cholesterol

An enzyme used immediately for energy

An enzyme that combines with proteins to become chylomicrons

An enzyme used to make bile acids

Ans:

A Feedback: HMG-CoA reductase is an enzyme that controls the final step in production of cellular cholesterol. Some fats are used immediately for energy. Bile acids act like detergents to break down or metabolize fats into small molecules called micelles, which are absorbed into the intestinal wall and combined with proteins to become chylomicrons, to allow transport throughout the circulatory system. Cholesterol is a fat that is used make bile acids.

19. A 54-year-old patient has a cholesterol level of 240 mg/dL. How would the nurse categorize this serum concentration of cholesterol? A)

Optimal

Desirable

High

Very high

Ans:

C Feedback: High is rated at or exceeding 240 mg/dL. Levels below 200 mg/dL are considered desirable, although lower levels may be preferred if the patient has a history of coronary

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artery disease. Low density lipoprotein (LDL) cholesterol below 100 mg/dL is considered optimal, whereas LDL levels above 190 or triglycerides above 500 mg/dL is considered very high. 20. The pharmacology instructor asks what drug inhibits peripheral breakdown of lipids, reduces low density lipoproteins (LDLs), and increases high density lipoprotein (HDL) concentrations. What is the correct answer? A)

Fenofibrate (Tricor)

Niacin (Niaspan)

Atorvastatin (Lipitor)

Gemfibrozil (Lopid)

Ans:

D Feedback: Gemfibrozil inhibits peripheral breakdown of lipids, reduces production of triglycerides and LDLs, and increases HDL concentrations. It is associated with gastrointestinal (GI) and muscle discomfort. Fenofibrate, niacin, and atorvastatin do not increase HDL concentrations.

21. A patient is being discharged on cholestyramine (Questran). Patient teaching should include what about this medication? A)

Should be administered with other medications

Should be administered 1 hour before or 4 to 6 hours after other medications

Should be administered 1 hour after other medications

Should be administered on an empty stomach

Ans:

B Feedback: Cholestyramine should be administered 1 hour before or 4 to 6 hours after other medications, because it may prevent the absorption of other drugs. Therefore, the other options are incorrect.

22. The patient is admitted to the acute care facility with a diagnosis of acute renal failure. While collecting the nursing history the patient reveals he was taking Pravastatin to reduce lipid levels and enjoyed a glass of grapefruit juice every morning. The patient complains of muscle pain. What does the nurse suspect caused this patients renal failure? A)

Gastric ulceration

Rhabdomyolysis

Congestive heart failure

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Drug Toxicity

Ans:

D Feedback: Grapefruit juice increases the risks of toxicity and rhabdomyolysis. However, toxicity would cause liver damage, whereas the breakdown of muscle that occurs with rhabdomyolysis results in kidney damage and acute renal failure. The patient identified no symptoms related to gastric ulceration or congestive heart failure.

23. The patient receives a prescription for a lipid lowering medication from the health care provider and, before discharge, asks the nurse what else he or she can do to improve his or her lipid levels besides just taking medication. What recommendation will the nurse make? (Select all that apply.) A)

Quitting smoking

Exercising

Following a low sodium diet

Reducing stress

Avoiding alcohol

Ans:

A, B, D Feedback: Lifestyle changes including low-fat diet, exercise, smoking cessation, and stress reduction should be tried before any antihyperlipidemic drug is used. Avoiding alcohol is not indicated as a means to lower serum lipid levels. Although a low sodium diet is a healthy choice, it is not associated with elevating lipid levels.

24. A patient is diagnosed as having an elevated cholesterol level. The nurse is aware that plaque on the inner lumen of arteries begins as what? A)

Fatty streaks

White blood cells (WBCs)

Foam cells

Platelets and fibrin

Ans:

A Feedback: Coronary artery disease is characterized by the progressive growth of atheromatous plaques, or atheromas, in the coronary arteries. These plaques, which begin as fatty streaks in the endothelium, eventually injure the endothelial lining of the artery, causing an inflammatory reaction. This inflammatory process triggers the development of

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characteristic foam cells, containing fats and WBCs that further injure the endothelial lining. Over time, platelets, fibrin, other fats, and remnants collect on the injured vessel lining and cause the atheroma to grow, further narrowing the interior of the blood vessel and limiting blood flow. 25. The nurse is teaching a 45-year-old patient about ways to lower cholesterol levels and explains that exercise has what effect? A)

Increases high density lipoproteins (HDLs) and decreases low density lipoproteins (LDL)

Increases LDL and decreases triglycerides

Decreases HDL and increases LDL

Decreases both HDL and LDL

Ans:

A Feedback: Moderate exercise increases HDL levels, which assist in lowering LDL levels. Exercise also decreases triglyceride levels.

26. The nurse teaches the patient at risk for coronary artery disease (CAD) that some risk factors can be controlled or modified. What modifiable factors would the nurse include? A)

Gender, obesity, family history, and smoking

Inactivity, stress, gender, and smoking

Obesity, inactivity, diet, and smoking

Stress, family history, and obesity

Ans:

C Feedback: The risk factors for CAD that can be controlled or modified include obesity, inactivity, diet, stress, and smoking. Gender and family history are risk factors that cannot be controlled.

27. The nurse is caring for a patient with high serum cholesterol and triglyceride levels. In teaching the patient about therapeutic lifestyle changes such as diet and exercise, the nurse explains that the desired goal for cholesterol levels is what? A)

High high density lipoprotein (HDL) values and high triglyceride values

Low soluble fiber

Elevated blood lipids, fasting glucose less than 100

Low low density lipoprotein (LDL) values and high HDL values

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Ans:

D Feedback: The desired goal for cholesterol readings is for a patient to have low LDL and high HDL values. HDL serves as a protective mechanism to reduce cholesterol so higher levels are desirable. High LDL levels increase plaque formation. Fiber does not contribute to risk for coronary artery disease (CAD) although a diet high in fiber is preferable. Elevated blood lipids are never desirable but control of blood sugar levels reduces CAD risk.

28. The nurse cares for a patient who is in her second trimester of pregnancy with extremely high serum cholesterol levels. What lipid lowering medication would be appropriate for the nurse to administer to this patient? A)

Colesevelam (Welchol)

Pravastatin (Pravachol)

Simvastatin (Zocor)

Atorvastatin (Lipitor)

Ans:

A Feedback: Bile acid sequestrants are the drug of choice for pregnant women if a lipid-lowering agent is needed. Women of child-bearing age should not take beta-hydroxy-beta-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors because they are in Pregnancy Category X. Pravastatin, simvastatin, and atorvastatin are all HMG-CoA reductase inhibitors.

29. The nurse is teaching the patient how to reduce risk for coronary artery disease (CAD). What condition does the nurse encourage the patient to control in order to reduce CAD risk? (Select all that apply.) A)

Obesity

Hypertension

Bradycardia

Depression

High stress levels

Ans:

A, B, E Feedback: Successful treatment in reducing risk for CAD involves reducing risk factors including decreasing dietary fats (decreasing total fat intake and limiting saturated fats seems to have the most impact on serum lipid levels); losing weight, which helps to decrease insulin resistance and the development of type 2 diabetes; eliminating smoking;

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increasing exercise levels; decreasing stress; and treating hypertension, diabetes, and gout. Depression and bradycardia have not been linked to CAD. 30. The nurse cares for a 10-year-old child brought to the clinic for an annual checkup who is diagnosed with hypercholesterolemia. What is the most common cause of hypercholesterolemia in children? A)

Gender

Diet

Familial connection

Exercise

Ans:

C Feedback: Familial hypercholesterolemia may be seen in children. Because of the importance of lipids in the developing nervous system, treatment is usually restricted to tight dietary restrictions to limit fats and calories. Gender, diet, or exercise-resistant hypercholesterolemia is possible in children, but they are not the most common causes.

31. The nurse is caring for an obese patient with hyperlipidemia who has tried to modify his diet to lose weight and control serum lipid levels without success. He is currently taking a combination of medications but his total cholesterol remains above 200. What future therapy might help this patient? A)

Endocannabinoid blocker

Bile acid sequestrant with niacin

Beta-hydroxy-beta-methylglutaryl coenzyme A (HMG-CoA) reductase and gemfibrozil

Peroxisome proliferator receptor alpha activator

Ans:

A Feedback: Blocking the endocannabinoid system results in feelings of satiety and decreased appetite, leading to weight loss; decreased release of growth hormone, increased oxygen and glucose use in the muscle, decreased fat synthesis in the liver, decreased levels of triglycerides and low density lipoproteins, and increased levels of high density lipoproteins, improving the lipid profile; increased sensitivity of insulin receptor sites, leading to decreased blood glucose levels; decreased fat production and storage; increased levels of adiponectin; and decreased activity of tumor necrosis factor, a proinflammatory agent, and decreased activity of C-reactive protein, which is associated with proinflammatory and prothrombotic states. Combining bile acid sequestrant with niacin or HMG-CoA with gemfibrozil is contraindicated. Peroxisome proliferator receptor alpha

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activators help to control lipid levels but do not contribute to dietary changes and appetite suppression. 32. The nurse provides patient teaching related to medication and lifestyle changes the patient can make to reduce serum lipid levels. One month later, the nurse evaluates the patient teaching as having been effective based on what data? (Select all that apply.) A)

Total cholesterol 184

High density lipoprotein (HDL) cholesterol 84

Low density lipoprotein (LDL) cholesterol 164

Triglycerides 184

Weight loss of 8 pounds

Ans:

A, B, E Feedback: Serum lab levels within the desirable level would indicate the teaching was effective; they include a total cholesterol level of less than 200, an HDL cholesterol level of higher than 40, an LDL cholesterol level of less than 129, and a triglyceride level of less than 50. Weight loss is also a positive outcome.

33. The nurse is caring for a 35-year-old woman taking a beta-hydroxy-beta-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitor to lower serum lipid levels. When teaching this patient about her medications what priority teaching point will the nurse include in the teaching plan? A)

Need for frequent ophthalmic examinations

Information about a cholesterol-lowering diet

Use of barrier contraceptives

Calling her doctor with any respiratory symptoms

Ans:

C Feedback: It is important to teach a woman of childbearing age taking HMG-CoA reductase inhibitors to use barrier contraceptives because there is a risk of severe fetal abnormalities associated with these drugs if taken during pregnancy. She should have routine ophthalmic examinations but does not need more frequent examinations. Cholesterol lowering diet should have been initiated before beginning medications to lower lipid levels. There are no associated respiratory risks with these medications so she would call the doctor with respiratory symptoms as she normally would.

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34. When providing patient teaching to a patient beginning therapy with a beta-hydroxy-betamethylglutaryl coenzyme A (HMG-CoA) reductase inhibitor, the nurse will explain the need for regular monitoring of what laboratory studies? (Select all that apply.) A)

Renal function tests

Liver function tests

Lipid panel

Hemoccult of stool

Albumin level

Ans:

A, B, C Feedback: It is important to monitor renal and liver function to identify early signs of toxicity or rhabdomyolysis. Monitoring lipid levels contributes to evaluation of the effectiveness of drug therapy. Hemoccult of stool would be more important with bile acid sequestrants that are associated with GI irritation. Altered albumin levels are not associated with HMG-CoA reductase inhibitors.

35. The nurse is preparing to teach the patient about diet therapy when beginning bile sequestrant medication to lower lipid levels. What important teaching point will the nurse include in the teaching plan? A)

Increasing carbohydrate intake

Reducing protein intake

Increasing fiber intake

Reducing fluid intake

Ans:

C Feedback: The nurse would want to teach this patient to increase fiber intake to avoid constipation that often occurs with this medication. Protein intake does not need to be reduced, but the patient should be taught to avoid fatty protein and instead meet protein needs with vegetable proteins, fish, and lean poultry. Carbohydrate intake should be reduced if weight loss is needed, otherwise no change is needed. Fluid intake should be maintained or increased if there are no diagnoses that would contraindicate fluid intake to help avoid constipation.

Chapter 29: Drugs for Disorders of the Respiratory System MULTIPLE CHOICE

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1. A patient who has narrow-angle glaucoma asks the nurse to recommend a medication to alleviate cold symptoms such as nasal congestion and runny nose. The nurse will suggest the patient talk to the provider about which medication? a. Azelastine (Astelin) b. Cetirizine (Zyrtec) c. Chlorpheniramine maleate (Chlor-Trimeton) d. Diphenhydramine (Benadryl) ANS: A Antihistamines have anticholinergic effects, which are contraindicated in patients with narrowangle glaucoma. Cetirizine and azelastin are second-generation antihistamines, with fewer anticholinergic side effects, but azelastine is a nasal spray and is less likely to have systemic side effects. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 574 TOP: NURSING PROCESS: Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 2. The nurse is caring for a patient who is receiving diphenhydramine. The nurse notes that the patient has not voided for 12 hours. What action will the nurse take? a. Encourage the patient to drink more fluids. b. Evaluate the bladder to check for distension. c. Request an order for an intravenous fluid bolus. d. Request an order for urinary catheterization. ANS: B Diphenhydramine has anticholinergic effects, including urinary retention. The nurse should assess for bladder distension to determine if this is the case. Encouraging the patient to drink more fluids or giving intravenous fluids may be necessary if the patient has oliguria secondary to dehydration. Urinary catheterization is not indicated until urinary retention has been identified. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 575 TOP: NURSING PROCESS: Evaluation/Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 3. A patient arrives in the emergency department after developing a rash, runny nose, and sneezing after eating strawberries. What action will the nurse expect to take first? a. Administer diphenhydramine. b. Administer epinephrine. c. Assess for urinary retention. d. Assess heart rate, respiratory rate, and lung sounds. ANS: D The patient probably has a food allergy, since eating strawberries is the precipitating event. The nurse should assess cardiac and respiratory status to determine whether the patient is developing an anaphylactic reaction. Diphenhydramine will be given for mild allergic symptoms of rash, runny nose, and sneezing, but epinephrine must be given for anaphylaxis. Urinary retention is a side effect of diphenhydramine and will be assessed if diphenhydramine is given.

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DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 575 TOP: NURSING PROCESS: Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 4. A patient who has seasonal allergies with a runny nose during the daytime reports increasing nighttime symptoms of coughing and sneezing that are interfering with sleep. The provider recommends diphenhydramine (Benadryl) at bedtime. What information will the nurse include when teaching the patient about this medication? a. Avoid fluids at bedtime to prevent urinary retention. b. This will help clear your daytime symptoms, too. c. You should be able to sleep better when you take this medication. d. You should take this medication on an empty stomach. ANS: C A side effect of diphenhydramine is drowsiness. Patients whose nighttime symptoms clear should be able to sleep better, especially with drowsiness side effects. Avoiding fluids does not prevent urinary retention. The half-life of diphenhydramine is short, so drug effects will not last through the next day. There is no need to take the medication on an empty stomach. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: dm 575 TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 5. The parents of a 3-year-old child tell the nurse that they are planning to give their child diphenhydramine (Benadryl) on a flight to visit the childs grandparents to help the child sleep during the flight. What will the nurse tell the parents about giving this drug? a. Administer 25 mg of diphenhydramine when using to induce sleep. b. Diphenhydramine may have the opposite effect and could cause agitation. c. Give the diphenhydramine about 5 minutes prior to takeoff. d. Loratadine should be used instead of diphenhydramine to minimize side effects. ANS: B Diphenhydramine can cause excitation in some children. Parents should be advised to expect this possible side effect. The correct dose of diphenhydramine for children at this age is 6.25 mg; 25 mg would be an overdose. Oral diphenhydramine has an onset of 15 to 45 minutes. Loratadine is a second-generation antihistamine and does not cause drowsiness. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 577 TOP: NURSING PROCESS: Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 6. The nurse is caring for a patient who is hospitalized for an asthma exacerbation. The patient reports taking diphenhydramine at home at night to help with symptoms of allergic rhinitis and cough. The nurse will contact the patients provider to request an order for which medication? a. Benzonatate (Tessalon Perles) b. Cetirizine (Zyrtec) c. Dextromethorphan hydrobromide (Benylin DM) d. Diphenhydramine (Benadryl) ANS: B Cetirizine is an antihistamine, which is indicated for this patients symptoms. Diphenhydramine is

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also an antihistamine but, because of its anticholinergic side effects, is contraindicated in patients with asthma. Benzonatate and dextromethorphan are anti-tussives and not antihistamines. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 576 TOP: NURSING PROCESS: Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 7. A patient is admitted to the hospital after developing pneumonia. During the admission assessment, the patient reports having used a nasal decongestant spray for the past few weeks but thinks the nasal congestion is getting worse. The nurse will a. request an order for a systemic decongestant medication. b. request an order so the patient can continue to use the decongestant spray. c. tell the patient the congestion will clear up after stopping the spray. d. tell the patient to increase oral fluid intake. ANS: C Use of nasal decongestants longer than 3 days can cause rebound congestion. This will clear up when the decongestant spray is discontinued for several days or weeks. A systemic decongestant is not indicated. Continuing the spray will increase the congestion. Increasing fluid intake is not recommended. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 577 TOP: NURSING PROCESS: Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 8. The patient who has nasal congestion asks the nurse to recommend a decongestant medication. The nurse performs a medication history and learns that the patient takes a beta blocker to treat hypertension. Which over-the-counter product will the nurse recommend? a. Diphenhydramine (Benadryl) b. Ephedrine HCl (Pretz-D) c. Phenylephrine nasal (NeoSynephrine Nasal) d. Loratadine (Claritin) ANS: C NeoSynephrine Nasal is a topical decongestant and causes less systemic side effects than ephedrine, which should not be given with beta blockers. Diphenhydramine and loratadine are antihistamines, not decongestants. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 578 TOP: NURSING PROCESS: Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 9. The nurse is providing teaching for a patient who will use intranasal dexamethasone (Decadron) after discharge home from the hospital. What information is important to include when teaching this patient about this drug? a. Dexamethasone may be used for year-round symptoms. b. Dexamethasone should be discontinued after 30 days. c. Dexamethasone should not be taken with antihistamines. d. Dexamethasone should not cause systemic steroid side effects. ANS: B Dexamethasone should not be used longer than 30 days because longer use increases the risk of

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systemic side effects. Dexamethasone should not be used year-round. It may be used in conjunction with antihistamines. Systemic side effects may occur. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: dm 578 TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 10. A patient asks the nurse about using dextromethorphan for cough. What information will the nurse include when teaching this patient about this drug? a. It does not cause sedation except at high doses. b. It may be used to treat cough for up to 2 weeks. c. It is non-narcotic, and it is OK to consume alcohol while taking this drug. d. It should not be taken by patients who have chronic obstructive pulmonary disease (COPD). ANS: D Dextromethorphan is contraindicated in patients with COPD. It may cause sedation at low doses. If a cough lasts longer than 1 week, patients should be instructed to contact their provider and not to continue to treat with over-the-counter antitussives. Alcohol can cause excess sedation when taken with dextromethorphan. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: dm 579 TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 11. A patient with chronic obstructive pulmonary disease (COPD) who has a persistent nonproductive cough asks about a medication that will not cause sedation. The nurse will encourage the patient to discuss which medication with the provider? a. Benzonatate HCl (Tessalon Perles) b. Dextromethorphan hydrobromide (Benylin DM) c. Guaifenesin and codeine d. Promethazine with dextromethorphan ANS: A Benzonatate will not cause sedation and is safe for patients with COPD. Dextromethorphan is contraindicated in patients with COPD. Codeine and promethazine cause sedation. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 580 TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 12. A patient who has a nonproductive cough will begin taking guaifenesin to help with secretions. When teaching this patient about the medication, the nurse will provide which instruction? a. Avoid driving or using heavy machinery. b. Drink extra water while taking the medication. c. Monitor urine output closely. d. Take with an oral antihistamine for better effects. ANS: B Guaifenesin is an expectorant, and patients taking this medication should be advised to increase fluid intake to at least 8 glasses of water per day. (Remember to assess for contraindications to increasing fluid intake [e.g., heart failure, kidney failure with dialysis, etc.].) Guaifenesin does

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not cause drowsiness or urinary retention. Antihistamines will dry secretions, making them harder to expectorate. 13. The nurse is caring for a patient recently diagnosed with mild emphysema and provides teaching about the disease and medications for treatment. Which statement by the patient indicates understanding of the medication regimen? a. I should use albuterol when my symptoms worsen. b. I will need to take oral prednisone on a daily basis. c. My provider will prescribe prophylactic antibiotics. d. My symptoms are reversible with proper medications. ANS: A Albuterol is used to treat bronchospasm during symptom flares. Oral prednisone is given for acute flares but not generally on a daily basis until symptoms are chronic and severe because of the risk of adrenal suppression. Prophylactic antibiotics are not given regularly because of the risk of antibiotic resistance. Symptoms of emphysema are not reversible. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 587 TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 14. The nurse is preparing to administer isoproterenol (Isuprel) to a patient who is experiencing an acute bronchospasm. The nurse understands that, because isoproterenol is a nonselective betaadrenergic agonist, the patient will experience which effects? a. Alpha- and beta-adrenergic agonist effects b. Anticholinergic effects c. A shorter duration of therapeutic effects d. Cardiac and pulmonary effects ANS: D Non-selective beta-adrenergic agonists affect both beta1 and beta2 receptors, causing both tachycardia and bronchodilation. Alpha receptors are not affected. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: dm 586 TOP: NURSING PROCESS: Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 15. A patient will be discharged home with albuterol (Proventil) to use for asthma symptoms. What information will the nurse include when teaching this patient about this medication? a. Failure to respond to the medication indicates a need for a higher dose. b. Monitor for hypoglycemia symptoms when using this medication. c. Palpitations are common with this drug even at normal, therapeutic doses. d. Overuse of this medication can result in airway narrowing and bronchospasm. ANS: D Excessive use of an aerosol drug can occasionally cause severe paradoxical airway resistance, so patients should be cautioned against overuse. Excessive use can also lead to tolerance and loss of drug effectiveness, but patients should not increase the dose because of the risk of bronchospasm and the increased incidence of adverse effects such as tremors and tachycardia. Hyperglycemia can occur. Palpitations are common with increased doses but not at therapeutic doses.

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DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 586 TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 16. A patient will begin using ipratropium bromide (Atrovent), albuterol (Proventil), and an inhaled glucocorticoid medication (steroid) to treat chronic bronchitis. When teaching this patient about disease and medication management, the nurse will instruct the patient to administer these medications in which order? a. Albuterol, ipratropium bromide, steroid b. Albuterol, steroid, ipratropium bromide c. Ipratropium bromide, albuterol, steroid d. Steroid, ipratropium bromide, albuterol ANS: A Patients who use a beta agonist should be taught to use it 5 minutes before administering ipratropium bromide, and ipratropium bromide should be given 5 minutes prior to an inhaled glucocorticoid. This helps the bronchioles to dilate so the subsequent medication can be deposited in the bronchioles for improved effect. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 588 TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 17. A provider has prescribed ipratropium bromide/albuterol sulfate (Combivent) for a patient who has chronic obstructive pulmonary disease (COPD). The nurse explains that this combination product is prescribed primarily for which reason? a. To be more convenient for patients who require both medications b. To improve compliance in patients who may forget to take both drugs c. To increase forced expiratory volume, an indicator of symptom improvement d. To minimize the side effects that would occur if the drugs are given separately ANS: C Combivent is more effective and has a longer duration of action than if either agent is used alone, and the two agents combined increase the FEV1. While it is more convenient and may improve compliance, this is not the primary reason for using it. The combination does not alter drug side effects. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 588 TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 18. The nurse is teaching a patient who will begin taking oral theophylline (Theo-Dur) when discharged home from the hospital. What information will the nurse include when teaching the patient about this drug? a. An extra dose should be taken when symptoms worsen. b. Anorexia and gastrointestinal upset are unexpected side effects. c. Avoid caffeine while taking this medication. d. Food will decrease the amount of drug absorbed. ANS: C Caffeine and theophylline are both xanthine derivatives and should not be taken together because

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of the increased risk of toxicity and severe adverse effects. Theophylline has a narrow therapeutic range and must be dosed carefully; patients should never increase or decrease the dose without consulting their provider. Gastrointestinal symptoms are common side effects. Food slows absorption but does not prevent the full dose from being absorbed. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 590 TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 19. The nurse is caring for a patient who is receiving intravenous theophylline. The patient complains of headache and nausea. The nurse will contact the provider to a. change the medication to an oral theophylline. b. obtain an order for a serum theophylline level. c. request an order for an analgesic medication. d. suggest an alternative methylxanthine medication. ANS: B Theophylline has a narrow therapeutic index and a risk for severe symptoms with toxic levels. When patients report symptoms of theophylline adverse effects, a serum drug level should be obtained. Giving an oral theophylline would only compound the problem if the patient has a toxic drug level. Analgesics may be used, but only after toxicity is ruled out. Adding a different methylxanthine will compound the symptoms and will likely result in drug interaction or unwanted synergism. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 590 TOP: NURSING PROCESS: Evaluation/Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 20. The nurse is caring for a patient who will begin taking theophylline at home. During the assessment, the nurse learns that the patient smokes. The nurse reports this to the provider and will expect the provider to a. decrease the dose of theophylline. b. increase the dose of theophylline. c. keep the theophylline dose as ordered. d. discontinue the theophylline. ANS: B Tobacco smoking increases the metabolism of theophylline, so the dose should be increased. Decreasing the dose will lead to subtherapeutic effects. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 589 TOP: NURSING PROCESS: Assessment/Planning MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 21. A patient who has been taking theophylline at home reports having palpitations and jitteriness. What action will the nurse take? a. Ask the patient if herbal medications are used. b. Notify the provider to report theophylline toxicity. c. Recommend that the patient increase fluid intake. d. Request an order for renal function studies. ANS: A

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Ephedra is a stimulant that potentiates theophylline and may increase side effects. Patients should be questioned about use of herbal medications. To determine toxicity, serum drug levels must be drawn; at this point, the patient reports symptoms of theophylline side effects. Increasing fluid intake will not alleviate symptoms. Renal function studies are not indicated. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 593 TOP: NURSING PROCESS: Assessment/Evaluation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 22. The nurse provides teaching for patient who will begin taking montelukast sodium (Singulair). The patient reports sensitivity to aspirin. Which statement by the patient indicates a need for further teaching? a. I will need to have periodic laboratory tests while taking this medication. b. I will not take ibuprofen for pain or fever while taking this drug. c. I will take one tablet daily at bedtime. d. I will use this as needed for acute symptoms. ANS: D Montelukast and other leukotriene receptor antagonists are not used to treat acute symptoms. Because they can affect liver enzymes, periodic liver function tests should be performed. Patients taking this drug should not use ibuprofen or aspirin for pain or fever if they have an aspirin sensitivity. Patients will achieve maximum effectiveness if the drug is taken in the evening. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 594 TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 23. A patient who uses an inhaled glucocorticoid medication reports having a sore tongue. The nurse notes white spots on the patients tongue and oral mucous membranes. After notifying the provider, the nurse will remind the patient to perform which action? a. Avoid using a spacer with the inhaled glucocorticoid medication. b. Clean the inhaler with hot, soapy water after each use. c. Consume yogurt daily while using this medication. d. Rinse the mouth thoroughly with water after each use. ANS: D When using inhaled glucocorticoid medications, Candida albicans oropharyngeal infections may be prevented by rinsing the mouth and throat with water after each dose. Patients should also use a spacer to reduce deposits of the drug in the oral cavity. The inhaler should be washed with warm water daily, but not after each use. There is no indication that yogurt is effective. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 595 TOP: NURSING PROCESS: Evaluation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 24. A patient will begin using an albuterol metered-dose inhaler to treat asthma symptoms. The patient asks the nurse about the difference between using an oral form of albuterol and the inhaled form. The nurse will explain that the inhaled form of albuterol a. has a more immediate onset than the oral form. b. may cause more side effects than the oral preparation. c. requires an increased dose in order to have therapeutic effects.

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d. will not lead to tolerance with increased doses. ANS: A Inhaled medications have more immediate effects than oral preparations. As long as they are used correctly, systemic side effects are less common. Less drug is needed for therapeutic effects, since the drug is delivered directly to target tissues. Increased doses will lead to drug tolerance. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 586 TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 25. The nurse is performing a medication history on a patient who reports long-term use of montelukast (Singulair) and an albuterol metered-dose inhaler (Proventil). The nurse will contact the provider to discuss an order for which laboratory tests? a. Cardiac enzymes and serum calcium b. Electrolytes and a complete blood count c. Liver function tests and serum glucose d. Urinalysis and serum magnesium ANS: C The beta2 agonists can increase serum glucose levels and montelukast can elevate liver enzymes, so these should be monitored in patients taking these medications. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 591 TOP: NURSING PROCESS: Planning MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 26. A patient is brought to the emergency department and reports having taken a lot of acetaminophen extra-strength tablets 16 hours prior. The nurse will expect the provider to order a. acetylcysteine (Mucomyst). b. dornase alfa (Pulmozyme). c. gastric lavage. d. renal enzyme tests. ANS: A Acetylcysteine is used as an antidote for acetaminophen overdose if given within 12 to 24 hours of ingestion. Dornase alfa is used to treat cystic fibrosis. Gastric lavage is no longer used as treatment. Liver enzyme tests are indicated since acetaminophen is hepatotoxic. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: dm 597 TOP: NURSING PROCESS: Planning/Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 27. A patient who is using inhaled cromolyn sodium (Intal) daily calls the clinic to report experiencing cough and a bad taste. The nurse will instruct the patient to perform which action? a. Drink water before and after using the inhaler. b. Schedule an appointment to discuss these effects with the provider. c. Stop taking the medication immediately. d. Use the inhaler only as needed for acute bronchospasms. ANS: A Cough and a bad taste are the most common side effects associated with cromolyn sodium, and

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these effects can be decreased by drinking water before and after using the drug. The effects are not serious and do not warrant discussion with the provider. Stopping the medication abruptly can cause a rebound bronchospasm. This medication is not useful in acute bronchospasm. Chapter 30: Antihistamines 1. A nurse has admitted a 10-year-old child to the short-stay unit. The child has complained of chronic headaches and his or her mother reports that he or she gives him or her acetaminophen (Tylenol) at least twice a day. What will the nurse evaluate? A)

Renal function

Hepatic function

Respiratory function

Cardiac function

Ans:

B Feedback: The nurse should evaluate the patients hepatic function. Severe hepatotoxicity can occur from overuse of acetaminophen. Significant interferences do not occur in the kidney, heart, or lung with acetaminophen.

2. The nurse is discussing ethnic differences in response to medication with your nursing students. What group of people would the nurse tell the students may have a decreased sensitivity to pain-relieving effects of anti-inflammatory drugs and should be educated concerning signs and symptoms of gastrointestinal bleeding from use of these drugs? A)

African Americans

White Americans

Hispanics

Asians

Ans:

A Feedback: African Americans have a documented decreased sensitivity to pain-relieving effects of many anti-inflammatory drugs. They also have an increased risk of developing GI adverse effects to these drugs. In general, White Americans, Hispanics, and Asians are at lower risk for these problems.

3. A patient, newly diagnosed with ulcerative colitis, has been admitted to the short-stay unit. What salicylates does the nurse anticipate will be ordered for this patient? A)

Balsalazide (Colazal)

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Sodium thiosalicylate (generic)

Choline magnesium trisalicylate (Tricosal)

Salsalate (Argesic)

Ans:

A Feedback: Balsalazide is delivered intact to the colon, where it delivers a local anti-inflammatory effect that is most effective for patients with ulcerative colitis. Choline salicylate and salsalate are used to treat pain, fever, and inflammation. Sodium thiosalicylate is used mainly for episodes of acute gout, for muscular pain, and to treat rheumatic fever.

4. The nurse is caring for a 66-pound child with orders for choline magnesium trisalicylate (Tricosal). The orders read 50 mg/kg/d PO in two divided doses. How many milligram will the patient receive per dose? A)

250 mg

500 mg

750 mg

1,000 mg

Ans:

C Feedback: First, the nurse must determine the childs weight in kilogram. One kg is equal to 2.2 pounds. Divide 2.2 into 66 to equal 30 kg. Multiply 50 mg times 30 kg to equal 1,500 mg. Divide 1,500 by 2 for the divided doses, which will equal 750 mg per dose.

5. A nurse is caring for a patient with severe rheumatoid arthritis who takes antiinflammatory agents on a regular basis. What medication should the nurse question if ordered by the physician to be taken in addition to the anti-inflammatory agent? A)

Oral antidiabetic agent

Calcium channel blocker

Beta-blocker

Antibiotic

Ans:

C Feedback: Nonsteroidal anti-inflammatory drugs have the potential to decrease antihypertensive effects from beta blockers if these drugs are taken at the same time. Patients who receive these combinations should be monitored closely and appropriate dosage adjustments

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made if needed. Drug interactions do not usually occur with oral antidiabetic agents, calcium channel blocking medications, or antibiotics. 6. A nurse is assessing a patient who has been taking nonsteroidal anti-inflammatory drugs (NSAID). What statement by the patient indicates to the nurse that the patient has a good understanding of the use of this therapy? A)

I drink a glass of wine just about every night.

I asked my doctor to check for blood in my stool regularly.

I do not like to swallow tablets so I crush them.

I drink as little water as possible when I take my medication.

Ans:

B Feedback: Taking certain anti-inflammatory drugs can irritate the gastric mucosa and increase the risk of bleeding; therefore, by asking his or her doctor to check his or her stool for bleeding, the nurse knows that the patient is aware of this. Alcohol and crushing the tablets can interfere with anti-inflammatory metabolism. A full glass of water should be taken with this medication to increase absorption.

7. A salicylate has been prescribed for a 15-year-old patient who has been diagnosed with arthritis. The mother is concerned about giving her child a salicylate. What salicylates could the nurse tell this mother are recommended for use in children? A)

Salsalate (Argesic)

Olsalazine (Dipentum)

Sodium thiosalicylate (generic)

Choline magnesium trisalicylate (Tricosal)

Ans:

D Feedback: Aspirin and choline magnesium trisalicylate are the only salicylates recommended for use in children. They should not be used when any risk of Reyes syndrome exists. Salsalate (Argesic), olsalazine (Dipentum), and sodium thiosalicylate (generic) have not been approved for pediatric use and do not provide pediatric dosing guidelines as a result.

8. A mother has brought her 6-year-old child to the clinic. The child has a fever of 102.8F and is diagnosed with the flu. What medication will the nurse suggest for this child? A)

Etanercept (Enbrel)

Penicillamine (Depen)

Acetaminophen (Tylenol)

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Aspirin (Bayer)

Ans:

C Feedback: Acetaminophen would be the suggested medication. It is prescribed for relief of pain and fever for influenza in children. Aspirin would be contraindicated because it increases the risk for Reyes syndrome. Etanercept and penicillamine are given for severe rheumatoid arthritis therapy.

9. A nurse is presenting an educational event for a group of new parents. One topic that the nurse addresses is the overuse of acetaminophen, which can cause liver toxicity. What would the nurse tell the parents it is important to do? A)

Do not give acetaminophen (Tylenol) unless you receive a doctors order.

Check the label of over-the-counter (OTC) medications carefully to watch for inclusions of acetaminophen in the ingredients.

Monitor their childs temperature carefully and regulate the Tylenol dose based on the fever.

Mix OTC childrens medications to get the best coverage for their childs symptoms.

Ans:

B Feedback: Inadvertent overdose with acetaminophen frequently occurs because of the combining of OTC drugs that contain the same ingredients. Parents should be taught to carefully check the labels of OTC products and follow the dosage guidelines. A prescription is not required for acetaminophen. Dosage guidelines are the best guide to follow to prevent overdose.

10. A mother asks the nurse how acetaminophen works. What statement best describes the therapeutic action of acetaminophen? A)

Acetaminophen (Tylenol) works by blocking the increase of interleukin-1.

Acetaminophen reacts with free-floating tumor necrosis (TNF) factor released by active leukocytes.

Acetaminophen acts directly on the hypothalamus to cause vasodilation and sweating.

Acetaminophen is taken up by macrophages, thus inhibiting phagocytosis and release of lysosomal enzymes.

Ans:

C Feedback:

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Acetaminophen acts on the hypothalamus to cause vasodilation and sweating to reduce fever. The mechanism of action as an analgesic is not understood. Anakinra (Kineret) blocks the increased interleukin-1, which is responsible for the degradation of cartilage in rheumatoid arthritis. Etanercept (Enbrel) reacts with free-floating TNF released by active leukocytes in autoimmune inflammatory disease to prevent the damage caused by TNF. Gold compounds are taken up by macrophages, which, in turn, inhibits phagocytosis and releases lysosomal enzymes, which causes damage associated with inflammation. 11. Antipyretic drugs (e.g., aspirin, ibuprofen, acetaminophen) often are used to alleviate the discomforts of fever and to protect vulnerable organs, such as the brain, from extreme elevations in body temperature. However, the use of aspirin in children is limited due to the possibility of what disease? A)

Munchausens syndrome

Guillain-Barr syndrome

Angelmans syndrome

Reyes syndrome

Ans:

D Feedback: Salicylates like aspirin are contraindicated for the treatment of childhood fevers because of the risk of Reyes syndrome in children and teenagers. Munchausens syndrome is an unusual condition characterized by habitual pleas for treatment and hospitalization for a symptomatic but imaginary acute illness. Guillain-Barr syndrome is an idiopathic, peripheral polyneuritis that occurs 1 to 3 weeks after a mild episode of fever associated with a viral infection or with immunization. Angelmans syndrome is an autosomal recessive syndrome characterized by jerky puppet-like movements, frequent laughter, mental and motor retardation, a peculiar open-mouthed facial expression, and seizures. Salicylates like aspirin are not contraindicated for patients with Munchausens syndrome, Guillain-Barr syndrome, or Angelmans syndrome.

12. A patient has been diagnosed with severe rheumatoid arthritis and hylan G-F 20 has been ordered. How is this drug given? A)

Injected into the joint

Orally

Sub Q

Ans:

A Feedback:

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Hyaluronidase derivatives (e.g., hylan G-F 20, sodium hyaluronate) have elastic and viscous properties. These drugs are injected directly into the joints of patients with severe rheumatoid arthritis of the knee. They seem to cushion and lubricate the joint and relieve the pain associated with degenerative arthritis. They are given weekly for 3 to 5 weeks and are not given by any other route. 13. A nurse is caring for a patient in the early stage of rheumatoid arthritis. The nurse would expect what medication classification to be used in the treatment of this patient? A)

Antimalarial agents

Nonsteroidal anti-inflammatory drugs (NSAIDs)

Xanthine oxidase inhibitors

Uricosuric agents

Ans:

B Feedback: NSAIDs are indicated for relief of the signs and symptoms of rheumatoid arthritis and osteoarthritis, for relief of mild to moderate pain, for treatment of primary dysmenorrhea, and for fever reduction. Antimalarial agents are used in the treatment of systemic lupus erythematosus. Xanthine oxidase inhibitors and uricosuric agents are used in the treatment of gout.

14. The nurse is caring for a patient who receives anakinra (Kineret) for arthritis. By what route will the nurse administer this medication? A)

Into the affected joint directly

Oral

Intramuscular

Subcutaneous

Ans:

D Feedback: Anakinra is administered subcutaneously every day and is often used in combination with other antiarthritis drugs. No other route is appropriate.

15. The nurse is preparing to administer a nonsteroidal anti-inflammatory drug (NSAID) to an older patient. What NSAID is associated with increased toxicity and should be avoided if possible? A)

Naproxen (Aleve)

Ibuprofen (Motrin)

Indomethacin (Indocin)

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Etodolac (Lodine)

Ans:

A Feedback: Geriatric warnings have been associated with naproxen, ketorolac, and ketoprofen because of reports of increased toxicity when they are used by older patients. These NSAIDs should be avoided in this population if possible. No such warnings exist for ibuprofen, indomethacin, or etodolac.

16. What medication used to treat rheumatic arthritis not only has anti-inflammatory effects but is also used in premature infants to close a patent ductus arteriosus? A)

Penicillamine

Indomethacin

Antimalarials

Prednisone

Ans:

B Feedback: Indomethacin given IV is used in premature infants to close a patent ductus arteriosus and avoid a surgical procedure. Penicillamine, antimalarials, and prednisone are not used for this purpose.

17. When the nurse learns that the patient with rheumatic arthritis is complaining of stomatitis, the nurse should further assess the patient for the adverse effects of what medication? A)

Corticosteroids

Gold-containing compounds

Antimalarials

Salicylate therapy

Ans:

B Feedback: Various adverse effects are common with the use of gold salts and are probably related to their deposition in the tissues and effects at that local level: stomatitis, glossitis, gingivitis, pharyngitis, laryngitis, colitis, diarrhea, and other GI inflammation; goldrelated bronchitis and interstitial pneumonitis; bone marrow depression; vaginitis and nephrotic syndrome; dermatitis, pruritus, and exfoliative dermatitis; and allergic reactions ranging from flushing, fainting, and dizziness to anaphylactic shock. The diseasemodifying antirheumatic drug (DMARD) category of antimalarials may cause visual

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changes, GI upset, rash, headaches, photosensitivity, and bleaching of hair. Tinnitus is associated with salicylate therapy. Hirsutism is associated with corticosteroid therapy. 18. A patient with rheumatoid arthritis is taking gold salts. What drugs should the nurse teach this patient that are contraindicated when taking gold salts? (Select all that apply.) A)

Antimalarials

Cytotoxic drugs

Salicylates

Penicillamine

Anticoagulants

Ans:

A, B, D Feedback: These drugs should not be combined with penicillamine, antimalarials, cytotoxic drugs, or immunosuppressive agents other than low-dose corticosteroids because of the potential for severe toxicity. No contraindication exists for therapy involving gold salts and salicylates or anticoagulants.

19. The nurse teaches a patient with rheumatic disease who is being prescribed salicylate therapy to monitor himself or herself for what? A)

Tinnitus

Visual changes

Stomatitis

Hirsutism

Ans:

A Feedback: Tinnitus is associated with salicylates. The disease-modifying antirheumatic drug (DMARD) category of antimalarials may cause visual changes, GI upset, skin rash, headaches, photosensitivity, and bleaching of hair. Eighth cranial nerve damage and stomatitis are associated with gold therapy. Hirsutism is associated with corticosteroid therapy.

20. The nurse assesses laboratory results related to blood clotting when the assigned patient takes what drug regularly? (Select all that apply.) A)

Salicylates

Nonsteroidal anti-inflammatory drugs (NSAIDs)

Gold compounds

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Acetaminophen

Disease-modifying antirheumatic drugs (DMARDs)

Ans:

A, B Feedback: Salicylates and NSAIDs can both inhibit blood clotting resulting in bleeding if not monitored. Gold compounds, acetaminophen, and DMARDs do not have a known impact on blood clotting.

21. What is chrysotherapy? A)

Treatment with antimalarials

Treatment with salicylates

Treatment with disease-modifying antirheumatic drugs (DMARDs)

Treatment with gold salts

Ans:

D Feedback: Chrysotherapy is the clinical name for treatment with gold salts in which gold is taken up by macrophages, which then inhibit phagocytosis. It is reserved for use in patients who are unresponsive to conventional therapy and can be very toxic. Options A, B, and C are incorrect.

22. What drugs used to treat rheumatoid arthritis are contraindicated in a patient who has a history of toxic levels of heavy metals? A)

Gold salts

COX-2 inhibitors

Propionic acids

Fenamates

Ans:

A Feedback: Gold salts can be extremely toxic and are contraindicated in the presence of any known allergy to gold, severe diabetes mellitus, congestive heart failure, severe debilitation, renal or hepatic impairment, hypertension, blood dyscrasias, recent radiation treatment, history of toxic levels of heavy metals, and pregnancy or lactation. COX-2 inhibitors, propionic acids, and fenamates have no contraindications related to prior toxic levels of heavy metals.

23. Which of these anti-inflammatory drugs have geriatric warnings? (Select all that apply.)

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Sulindac (Clinoril)

Indomethacin (Indocin)

Ketorolac (Toradol)

Naproxen (Naprosyn)

Ketoprofen (Orudis)

Ans:

C, D, E Feedback: Geriatric warnings have been associated with naproxen, ketorolac, and ketoprofen because of reports of increased toxicity when they are used by older patients. These nonsteroidal anti-inflammatory drugs should be avoided if possible. Sulindac and indomethacin are not associated with toxicity in older patients.

24. A patient presents at the emergency department complaining of dizziness, mental confusion, and difficulty hearing. What should the nurse suspect is wrong with the patient? A)

Anakinra toxicity

Ibuprofen toxicity

Salicylism

Acetaminophen toxicity

Ans:

C Feedback: Salicylism can occur with high dosage of aspirin. Dizziness, ringing in the ears, difficulty hearing, nausea, vomiting, diarrhea, mental confusion, and lassitude can occur. This combination of adverse effects is not associated with anakinra toxicity, ibuprofen toxicity, or acetaminophen toxicity.

25. A mother brings her 3-year-old child to the emergency department telling the nurse the child has eaten a bottle of baby aspirin. The mother cannot tell the nurse how many tablets were in the bottle. What dose of salicylate would be toxic in a child? A)

Ans:

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Feedback: Acute salicylate toxicity may occur at doses of 20 to 25 g in adults or 4 g in children. Therefore, options A, B, and D are incorrect. 26. A patient arrives at the emergency department brought by his or her friends. The friends tell the nurse that the patient has taken a whole bottle of aspirin. Blood work for salicylate toxicity is run. What does the nurse expect the results to be? A)

>5 g

>10 g

>15 g

>20 g

Ans:

D Feedback: Acute salicylate toxicity may occur at doses of 20 to 25 g in adults or 4 g in children. Options A, B, and C would not be high enough to indicate salicylate toxicity.

27. The nursing instructor is discussing COX-2 inhibitors with her nursing students. Where would the instructor tell her students that COX-2 inhibitors work? A)

At sites of trauma and injury

Wherever prostaglandins are present

At the sites of blood clotting

In the kidney

Ans:

A Feedback: The COX-2 inhibitors are thought to act only at sites of trauma and injury to more specifically block the inflammatory reaction. COX-1 is present in all tissues and seems to be involved in many body functions including blood clotting, protecting the stomach lining, and maintaining sodium and water balance in the kidney.

28. The clinic nurse is caring for a patient who is taking a COX-2 inhibitor and knows that this patient needs to be assessed for what? (Select all that apply.) A)

Bleeding time

Liver function

Altered hearing

Gastrointestinal (GI) effects

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Water retention

Ans:

A, D, E Feedback: COX-2 inhibitors have an impact on many body functions and patients receiving this therapy should be assessed for GI effects, changes in bleeding time, and water retention. Patients taking COX-2 inhibitors do not need to be evaluated for liver function or altered hearing because these are not common adverse effects.

29. Why do COX-2 inhibitors increase the risk for cardiovascular problems? (Select all that apply.) A)

Vasoconstriction is blocked.

Vasodilation is blocked.

Platelet clumping is blocked.

Water and sodium balance is altered.

Gastrointestinal (GI) integrity is altered.

Ans:

B, C Feedback: Recent studies suggest that COX-2 inhibitors may block some protective responses in the body, such as vasodilation and inhibited platelet clumping, which is protective if vessel narrowing or blockage occurs. Blocking this effect could lead to cardiovascular problems. Vasoconstriction is not blocked, water and sodium balance is not altered, and GI integrity is not impacted by COX-2 inhibitors but can be impacted by COX-1 inhibitors.

30. When nonsteroidal anti-inflammatory drugs (NSAIDs) are combined with loop diuretics, there is a potential for what? A)

Decreased antihypertensive effect

Decreased diuretic effect

Lithium toxicity

Anaphylactoid reactions

Ans:

B Feedback: Diuretic effect is often decreased when NSAIDs are taken with loop diuretics. There is a potential for decreased antihypertensive effect of beta-blockers if NSAIDs are combined and there have also been reports of lithium toxicity, especially when lithium is combined with ibuprofen.

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31. The nurse is caring for a patient who reports taking 800 mg of ibuprofen three times a day for relief of menstrual cramps. What lab results will the nurse find most significant in assessing this patient? A)

Complete blood count

White blood cell differential

Arterial blood gas

Cholesterol and triglyceride profile

Ans:

A Feedback: Ibuprofen, like all nonsteroidal anti-inflammatory drugs, can cause irritation to the GI mucosa and block platelet clumping, both of which can result in bleeding. Blood loss due to dysmenorrhea can exacerbate these risks so it is important to assess the complete blood count to monitor for excessive blood loss. White blood cell differential would be impacted by infection, which is not indicated here. Arterial blood gas, cholesterol, and triglyceride levels would not be impacted by ibuprofen.

32. When caring for a patient diagnosed with rheumatoid arthritis, the patient tells the nurse that he or she has had insufficient response to nonsteroidal anti-inflammatory drugs (NSAIDs) and his or her condition continues to worsen. What drug does the nurse anticipate will be ordered next for this patient? A)

Auranofin (Ridaura)

Ibuprofen (Motrin)

Acetaminophen (Tylenol)

Ketorolac (Toradol)

Ans:

A Feedback: Gold compounds such as auranofin are prescribed when more usual anti-inflammatory therapies are ineffective and the patients condition worsens despite weeks or months of standard pharmacological treatment. Ibuprofen and ketorolac are NSAIDs, which have been tried without good results. Acetaminophen is not an anti-inflammatory and would not be appropriate to control this patients condition.

33. The patient has been diagnosed with rheumatoid arthritis. She also reports pain in various muscle groups secondary to a diagnosis of fibromyalgia and dysmenorrhea with painful cramping during menses. What drug would be most effective in treating all three of this patients problems? A)

Naproxen (Naprosyn)

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Acetaminophen (Tylenol)

Etanercept (Enbrel)

Sodium hyaluronate (Hyalgan)

Ans:

A Feedback: Naproxen is effective in treating muscle pain, arthritis, and dysmenorrhea. Acetaminophen has no anti-inflammatory effects and would not be helpful for treating arthritis or dysmenorrhea other than some pain relief. Etanercept is useful only for treating rheumatoid arthritis; sodium hyaluronate is used to treat rheumatoid arthritis when other traditional treatment has been ineffective and the condition continues to worsen.

34. The nurse is teaching the patient, who has been newly prescribed etanercept (Enbrel), how to administer the medication. What statement is accurate? A)

Be sure to drink a whole glass of water when swallowing the pill.

Do not take this medication for at least 1 hour after taking an antacid.

You can use each of the subcutaneous injection sites to avoid tissue damage.

Inject this medication deeply into the muscle to promote absorption.

Ans:

C Feedback: Etanercept is given by injecting it into the subcutaneous tissues. The injection sites should be rotated to avoid tissue damage. Because it is not taken orally, there is no requirement related to amount of water to be taken or waiting an hour after taking an antacid. Etanercept is not injected into the muscle but rather into the subcutaneous tissue.

35. The pediatric patient has a fever and the nurse is preparing to administer an antipyretic. What drug would be the best choice for this patient? A)

Balsalazide (Colazal)

Naproxen (Naprosyn)

Indomethacin (Indocin)

Aspirin

Ans:

B Feedback: Naproxen is approved for pediatric use and has antipyretic properties. Balsalazide is used to treat ulcerative colitis and would not be appropriate for treating a fever. Indomethacin

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has anti-inflammatory effects but does not have antipyretic effects. Aspirin would not be appropriate for treating a child with a fever of unknown origin due to risk of Reyes syndrome. Chapter 31: Gastrointestinal and Antiemetic Drugs 1. What action does the histamine-2 antagonist administered by the nurse have on the human body that will help to prevent peptic ulcer disease? A)

Destroys Helicobacter pylori

Coats and protects the stomach lining

Increases the pH of the secreted hydrochloric acid

Reduces the amount of hydrochloric acid secreted

Ans:

D Feedback: Histamine-2 antagonists are administered to reduce the amount of hydrochloric acid secreted in the stomach, which helps to prevent peptic ulcer disease. H2 antagonists do not act as an antibiotic to kill bacteria (i.e., H. pylori) coat and protect the stomach lining like sucralfate (Carafate), or increase the pH of the secreted hydrochloric acid.

2. What classification of drugs does the nurse administer to treat peptic ulcers by suppressing the secretion of hydrochloric acid into the lumen of the stomach? A)

Antipeptic agents

Histamine-2 antagonists

Proton pump inhibitors

Prostaglandins

Ans:

C Feedback: Proton pump inhibitors suppress the secretion of hydrochloric acid into the lumen of the stomach. Antipeptic agents coat any injured area in the stomach to prevent further injury. H2 antagonists block the release of hydrochloric acid in response to gastrin. Prostaglandins inhibit secretion of gastrin and increase secretion of the mucous lining of the stomach.

3. The nurse is caring for a patient requiring digestive enzyme replacement therapy and establishes what appropriate nursing diagnosis for this patient? A)

Acute pain

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Risk for constipation

Risk for imbalanced nutrition

Bowel incontinence

Ans:

C Feedback: The nurse would be concerned about the patients nutritional status because lack of digestive enzymes results in malnutrition. Replacement digestive enzymes help the patient improve digestion and absorption of essential nutrients. Effectiveness of the therapy is determined by the patients ability to maintain balanced nutrition. The other three options are not applicable to the use of replacement digestive enzymes.

4. What nursing interventions are included in the plan of care for a patient receiving antacids to relieve GI discomfort? A)

Administer this drug with other drugs or food.

Administer the antacid 1 hour before or 2 hours after other oral medications.

Limit fluid intake to decrease dilution of the medication in the stomach.

Have the patient swallow the antacid whole and do not crush or chew the tablet.

Ans:

B Feedback: A patient taking antacids should be advised to take the antacid 1 hour before or 2 hours after other oral medications. These tablets are often chewed to increase effectiveness. Limiting fluid intake can result in rebound fluid retention so that patients should be encouraged to maintain hydration. It is not necessary to take an antacid with other drugs, nor with food.

5. An adult patient is prescribed cimetidine (Tagamet). A nurse will instruct the patient that an appropriate dosage and frequency of cimetidine is what? A)

20 mg PO b.i.d

150 mg PO b.i.d

300 mg PO at bedtime

800 mg PO at bedtime

Ans:

D Feedback: An appropriate dosage and frequency for cimetidine is 800 mg PO at bedtime. Also, 300 mg can be taken q.i.d at meals and at bedtime. Ranitidine is taken 150 mg daily or b.i.d.

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Famotidine is taken 20 mg PO b.i.d. Nizatidine can be taken 150 to 300 mg PO at bedtime. 6. The nurse develops a discharge teaching plan for a patient who was prescribed pancreatic enzyme replacement and includes what important teaching point? A)

Take the enzymes on an empty stomach.

Crush the capsules and take with food.

Avoid spilling the powder on the skin because it may be irritating.

Pancreatin and pancrelipase are interchangeable.

Ans:

C Feedback: Patients receiving pancreatic enzymes should be taught to avoid spilling the powder on the skin because it can be very irritating. The enzymes should be taken with food and are often in a powder form. Pancreatin and pancrelipase are not interchangeable.

7. A patient comes to the clinic complaining of acid indigestion and tells the nurse he is tired of buying over-the-counter (OTC) antacids and wants a prescription drug to cure the problem. What would the nurse specifically assess for? A)

Alkalosis

Hypocalcemia

Hypercholesterolemia

Rebound tenderness at McBurneys point

Ans:

A Feedback: Prolonged or excessive use of OTC antacids can lead to the development of metabolic alkalosis. Many antacids contain calcium so that low calcium levels would be unlikely. Because metabolic alkalosis is a concern, metabolic acidosis is unlikely. High cholesterol levels are not associated with OTC antacid use. Rebound tenderness at McBurneys point is related to appendicitis and not antacid use.

8. A patient with a duodenal ulcer is receiving sucralfate for short-term treatment. What will the nurse advise the patient to avoid? A)

Milk of Magnesia

Tums

Aluminum salts

Proton pump inhibitors

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Ans:

C Feedback: If aluminum salts (AlternaGEL) are taken concurrently with sucralfate, a risk of high aluminum levels and related aluminum toxicity exists. The combination of sucralfate and aluminum salts should be avoided or used with extreme caution. Adverse reactions with sucralfate are not associated with Milk of magnesia, Tums, or proton pump inhibitors.

9. A patient has been prescribed esomeprazole (Nexium). What statement by the patient does the nurse evaluate as indicating that he or she has a good understanding of his newly prescribed drug? A)

I should open the capsules and crush the drug into applesauce.

It is important that I take the drug after each meal.

I need to swallow the drug whole and not chew the capsules.

I should always take the drug with an antacid.

Ans:

C Feedback: Esomeprazole must be swallowed whole, not cut, crushed, or chewed, which would interfere with its effectiveness. The drug should not be taken with an antacid, which could interfere with absorption. The drug is taken once a day, not with each meal.

10. Which of these patients would the nurse expect to be the best candidate for misoprostol (Cytotec)? A)

A 12-year-old with obsessive-compulsive disorder

A 22-year-old pregnant patient

A 46-year-old trial lawyer with hypertension

An 83-year-old man with rheumatoid arthritis

Ans:

D Feedback: The 83-year-old man with rheumatoid arthritis is most likely to be taking nonsteroidal anti-inflammatory drugs (NSAIDs). Misoprostol is indicated for prevention of NSAID induced ulcers in adults at high risk for development of gastric ulcers. The other three patients would not be candidates for this drug.

11. When comparing the histamine-2 antagonists to each other the nurse recognizes that cimetidine (Tagamet) is more likely to cause which adverse effect? A)

Dizziness

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Headache

Gynecomastia

Somnolence

Ans:

C Feedback: Cimetidine was the first drug in this class to be developed. It has been associated with antiandrogenic effects, including gynecomastia and galactorrhea. Dizziness, headache, and somnolence are associated with all histamine-2 antagonists.

12. What H2 antagonist would the nurse consider the drug of choice for a patient with advanced liver failure? A)

Cimetidine

Nizatidine

Ranitidine

Famotidine

Ans:

B Feedback: Nizatidine differs from the other three drugs in that it is eliminated by the kidneys, with no first-pass metabolism in the liver. It is the drug of choice for patients with liver disease or dysfunction.

13. When caring for a patient diagnosed with a peptic ulcer, the nurse administers omeprazole (Prilosec) along with what antibiotic to eradicate Helicobacter pylori? A)

Gentamicin

Ketoconazole

Tetracycline

Amoxicillin

Ans:

D Feedback: Gastric acid pump or proton pump inhibitors are recommended for the short-term treatment of active duodenal ulcers, gastroesophageal reflux disease, erosive esophagitis, and benign active gastric ulcer; for the long-term treatment of pathologic hypersecretory conditions; as maintenance therapy for healing of erosive esophagitis and ulcers; and in combination with amoxicillin and clarithromycin for the treatment of H. pylori infection. The other options are not antibiotics used to eradicate H. pylori.

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14. What priority teaching point does the nurse include when instructing patients about the use of antacids? A)

Reduce calorie intake to reduce acid production.

Take before each meal and before bed.

Be aware of risk of acid rebound with long-term use.

Consider liquid diet if diarrhea occurs.

Ans:

C Feedback: Repeated use of antacids can result in rebound acid production because more gastrin is produced when pH of acid level decreases. Patients should be taught that long-term use of antacids requires follow-up care. Calorie and fluid intake does not need to be reduced because it is important to maintain nutrition, especially if diarrhea occurs. Antacids are taken at least 1 hour before or 2 hours after any other drug or meal.

15. For treatment of a gastric ulcer, what would the recommended dosing schedule of famotidine (Pepcid) be? A)

10 mg b.i.d

20 mg b.i.d

60 mg at bedtime

40 mg q am

Ans:

B Feedback: Famotidine should be administered 40 mg every day at bedtime or 20 mg b.i.d for treatment of a gastric ulcer. Options A, C, and D are not correct.

16. The 59-year-old patient has peptic ulcer disease and is started on sucralfate (Carafate). What is an appropriate nursing diagnosis related to this medication? A)

Risk for constipation related to GI effects

Risk for injury: bleeding

Imbalanced nutrition related to nausea

Deficient fluid volume

Ans:

A Feedback:

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The adverse effects associated with sucralfate are primarily related to its GI effects. Constipation is the most frequently seen adverse effect. Imbalanced nutrition, if seen, would be related to diarrhea or constipation and not nausea. Fluid volume deficit and bleeding are not common adverse effects of this drug. 17. The nurse is preparing a patient for discharge with a prescription for sucralfate (Carafate) and teaches the patient to take the medication when? A)

With meals

With an antacid before breakfast

1 hour before or 2 hours after meals and at bedtime

After each meal

Ans:

C Feedback: Administer drug on an empty stomach, 1 hour before or 2 hours after meals and at bedtime, to ensure therapeutic effectiveness of the drug. Administer antacids, if ordered, between doses of sucralfate and not within 30 minutes of taking the drug. Options A, B, and D are not correct.

18. The patient will receive ranitidine (Zantac) 150 mg PO at bedtime. Prior to administration, the nurse will inform the patient that common adverse effects related to this medication include what? A)

Tremors

Headache

Visual disturbances

Anxiety

Ans:

B Feedback: Headache, dizziness, somnolence, and mental confusion may occur with H2 antagonists. Visual disturbances, tremors, and anxiety are not normally associated with ranitidine.

19. The nurse administers ranitidine (Zantac) cautiously to patients with evidence of what conditions? A)

Renal disease

Diabetes mellitus

Pulmonary disease

Migraine headaches

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Ans:

A Feedback: All histamine-2 antagonists are eliminated through the kidneys; dosages need to be reduced in patients with renal impairment. No caution is necessary with Zantac therapy in people with diabetes, pulmonary disease, or migraine headaches.

20. The nurse would question an order for misoprostol if the patient was diagnosed with what condition? A)

Diabetes

Hypertension

Arthritis

Pregnancy

Ans:

D Feedback: This drug is contraindicated during pregnancy because it is an abortifacient. The other options are not correct.

21. The nurse is caring for a patient who has had impacted stools twice in the past month. What is an appropriate laxative for this patient? A)

Milk of Magnesia

Agoral Plain

Colace

Dulcolax

Ans:

B Feedback: Mineral oil (Agoral Plain) is not absorbed and forms a slippery coat on the contents of the intestinal tract. When the intestinal bolus is coated with mineral oil, less water is drawn out of the bolus and the bolus is less likely to become hard or impacted. Other options shown do not have this same effect of reducing the risk of another impaction as well as helping to eliminate stool.

22. The home health nurse is caring for a patient with encopresis who was started on mineral oil therapy. The nurse teaches the patient and family that a common adverse effect is what? A)

Nausea

Vomiting

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Leakage

Vitamin C deficiency

Ans:

C Feedback: Leakage and staining may be a problem when mineral oil is used and the stool cannot be retained by the external sphincter. Mineral oil does not cause nausea, vomiting, or vitamin C deficiency.

23. When would it be appropriate for the nurse to administer a cathartic laxative to the patient? (Select all that apply.) A)

Partial small-bowel obstruction

Appendicitis

After having a baby

After a myocardial infarction (MI)

After anthelmintic therapy

Ans:

C, D, E Feedback: Laxative, or cathartic, drugs are indicated for the short-term relief of constipation; to prevent straining when it is clinically undesirable (such as after surgery, myocardial infarction, or obstetric delivery); to evacuate the bowel for diagnostic procedures; to remove ingested poisons from the lower gastrointestinal (GI) tract; and as an adjunct in anthelmintic therapy when it is desirable to flush helminths from the GI tract. They are not indicated when a patient has an appendicitis or a partial small-bowel obstruction.

24. When would it be appropriate for the nurse to administer castor oil as a laxative? A)

To ease the passage of stool in the patient who recently had a baby

To remove ingested poisons from the lower gastrointestinal (GI) tract

To evacuate the bowel for diagnostic procedures

To treat chronic constipation

Ans:

C Feedback: Indications include evacuating the bowel for diagnostic procedures and for short-term treatment of constipation. Castor oil is not indicated to remove ingested poisons nor to ease the passage of stool after having a baby. This drug should only be used on a short-

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term basis and is not for the treatment of chronic constipation because repeated use will cause GI tract exhaustion. 25. For what action would the nurse administer magnesium citrate? A)

Block absorption of fats

Directly stimulate the nerve plexus in the intestinal wall

Form a slippery coat on the contents of intestine

Increase motility, increase fluid, and enlarge bulk of fecal matter

Ans:

D Feedback: Magnesium citrate is a rapid-acting, aggressive laxative that causes fecal matter to increase in bulk. It increases the motility of the gastrointestinal (GI) tract by increasing the fluid in the intestinal contents, which enlarges bulk, stimulates local stretch receptors, and activates local activity. It does not block absorption of fats, stimulate the nerve plexus, or form a slippery coat.

26. The nurse administers metoclopramide to the patient with what condition? A)

Chronic diabetic gastroparesis

Impaction

Encopresis

Patients requiring diagnostic procedures

Ans:

A Feedback: Indications for metoclopramide include relief of acute and chronic diabetic gastroparesis, short-term treatment of gastroesophageal reflux disorder in adults who cannot tolerate standard therapy, prevention of postoperative or chemotherapy-induced nausea and vomiting, facilitation of small-bowel intubation, stimulation of gastric emptying, and promotion of intestinal transit of barium. It would not be used for treatment of impaction, encopresis, and in patients requiring diagnostic procedures.

27. What drug does the nurse administer that inhibits intestinal peristalsis through direct effects on the longitudinal and circular muscles of the intestinal wall? A)

Bismuth subsalicylate

Loperamide

Paregoric

Magnesium citrate

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Ans:

B Feedback: Actions of loperamide include that it inhibits intestinal peristalsis through direct effects on the longitudinal and circular muscles of the intestinal wall, slowing motility and movement of water and electrolytes. Bismuth subsalicylate inhibits local reflexes. Paregoric works through action on CNS centers that cause GI spasm and slowing. Magnesium citrate is a laxative.

28. The family brings a patient to the emergency department saying he has been hallucinating and falls so deeply asleep he stops breathing when not stimulated. The nurse learns the patient has been self-treating diarrhea and suspects the patient was taking what medication? A)

Paregoric

Bismuth subsalicylate

Loperamide

Colace

Ans:

A Feedback: Opium derivatives, like paregoric, are associated with light-headedness, sedation, euphoria, hallucinations, and respiratory depression related to their effect on opioid receptors. Nonopioids such as bismuth subsalicylate and loperamide would not cause respiratory depression. Colace is a stool softener, not an antidiarrheal.

29. The nurse develops a teaching plan for a 77-year-old patient who has been prescribed loperamide PRN. The nurses priority teaching point is what? A)

May cause hallucinations or respiratory depression

Take drug after each loose stool

Drug remains in the bowel without being absorbed into the bloodstream

Avoid pregnancy and breast-feeding while taking drug.

Ans:

B Feedback: Loperamide is taken repeatedly after each loose stool. Teaching the patient when to take the drug is the priority teaching point. Paregoric, and not loperamide, can cause hallucinations and respiratory depression. The drug is absorbed systemically. It is unlikely a 77-year-old patient will get pregnant or breast-feed so this is not the highest priority.

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30. A patient receiving loperamide (Imodium) should be alerted by the nurse to what possible adverse effect? A)

Anxiety

Bradycardia

Fatigue

Urinary retention

Ans:

C Feedback: Patients should be aware that they should not drive or operate machinery while taking loperamide (Imodium) because it can cause fatigue. Anxiety, bradycardia, and urinary retention are not commonly associated with loperamide.

31. The patient had surgery 2 days ago and bowel motility has not returned. What drug might the nurse administer to stimulate the gastrointestinal (GI) tract? A)

Dexpanthenol

Docusate

Psyllium (Metamucil)

Senna

Ans:

A Feedback: Dexpanthenol is indicated for the prevention of intestinal atony or loss of intestinal muscle tone in postoperative adults. Docusate, psyllium, and senna are laxatives that would not be indicated for the postoperative patient with no bowel activity.

32. The hospice nurse is caring for a patient diagnosed with bone cancer who is receiving large doses of opioid medications to relieve pain. The patient has used other laxatives in the past to treat opioid-induced constipation but nothing is working now. What drug would the nurse request the family doctor to order for this patient? A)

Methylnaltrexone (Relistor)

Castor oil

Paregoric

Mineral oil

Ans:

A Feedback:

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Methylnaltrexone (Relistor) was approved in 2008 for the treatment of opioid-induced constipation in patients with advanced disease who are receiving palliative care and are no longer responsive to traditional laxatives. Castor oil, mineral oil, and paregoric would likely be ineffective in this patient. 33. The nurse, providing patient teaching, explains that difenoxin and diphenoxylate are chemically related to what medication? A)

Morphine

Demerol

Diphenhydramine

Diflucan

Ans:

B Feedback: Difenoxin and diphenoxylate are chemically related to meperidine and are used at doses that decrease gastrointestinal activity without having analgesic or respiratory effects.

34. The nurse collects a stool culture from a patient diagnosed with travelers diarrhea. What bacterium does the nurse expect the culture to grow? A)

scherichia coli

Staphylococcus aureus

Streptococcus type B

Pseudomonas

Ans:

A Feedback: Escherichia coli is the most common cause of travelers diarrhea. Staphylococcus, Streptococcus, and Pseudomonas would be highly unlikely to grow in the stool of a patient with travelers diarrhea.

35. The nurse administers lubiprostone (Amitiza) to the patient with irritable bowel syndrome and anticipates what therapeutic action from the drug? A)

Secretion of chloride-rich intestinal fluid leading to increased motility

Adding bulk to the fecal matter to ease the process of stooling

Irritation of the inner lining of the bowel to increase bowel motility

Stimulate the bowel by increasing innervation

Ans:

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Feedback: Lubiprostone is a locally acting chloride channel activator that increases the secretion of a chloride-rich intestinal fluid without changing sodium or potassium levels. Increasing the intestinal fluid leads to increased motility. It does not add bulk, irritate the inner lining, or innervate the bowel. 36. What is an appropriate nursing action for a hospitalized patient receiving aprepitant (Emend)? A)

Elevate the head of the bed.

Encourage fluids.

Take the patients temperature.

Place an NPO sign on the door.

Ans:

B Feedback: Because dehydration is an adverse effect of aprepitant, the nurse will want to encourage the patient to drink as much liquid as possible. Elevating the head of the bed would be unnecessary; the patients temperature would not be affected by aprepitant; we are encouraging fluids so placing an NPO sign on the door would not be appropriate for this patient.

37. The nurse is working in the medical station at a local amusement park. An adult is being seen complaining of dizziness and feelings of seasickness after going on several rides. What would the nurse suspect the patient may benefit from? A)

An anticholinergic

A histamine H2 blocker

Substance P/neurokinin 1 receptor antagonist

Cannabis

Ans:

A Feedback: Nausea and vomiting associated with motion sickness is best treated with an anticholinergic that acts as an antihistamine. Histamine H2 blockers affect gastric acid production. Substance P/neurokinin 1 receptor antagonists and cannabis are prescribed only as adjuncts to cancer chemotherapy drugs or other therapy.

38. A womens community group is attending the first-aid class the nurse is teaching. The nurse will instruct the women to do what if a child ingests a possible overdose of medication or other potential poison?

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Call an ambulance.

Make an appointment to see the health care provider.

Induce vomiting by sticking a finger down the childs throat.

Call the local poison control center and follow their directions.

Ans:

D Feedback: New guidelines suggest that potential ingestion with poison should prompt an immediate call to the local poison control center and then follow their directions. An ambulance may not be needed and it may take too long to get an appointment with a health care provider. Induction of vomiting could be harmful and does not represent the best treatment.

39. The nurse is caring for a child who has been vomiting intermittently for 24 hours. What is the drug of choice for children who need an antiemetic? A)

Dronabinol (Marinol)

Metoclopramide (Reglan)

Meclizine (Antivert)

Prochlorperazine (Compazine)

Ans:

D Feedback: Prochlorperazine is often the drug of choice with children because it has established oral, rectal, and parenteral doses. The other three options are not recommended for children.

40. The nurse is caring for a patient who has begun vomiting after undergoing bariatric surgery. When including this complication in the plan of care, what would be an appropriate nursing diagnosis related to the adverse effects of drowsiness and weakness associated with an antiemetic? A)

Acute pain related to central nervous system (CNS), skin, and gastrointestinal (GI) effects

Risk for injury related to CNS effects

Decreased cardiac output related to cardiac effects

Deficient knowledge regarding drug therapy

Ans:

B Feedback:

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Because the patient is experiencing CNS effects, the nurse will be concerned about the patients safety. The appropriate nursing diagnosis would be risk for injury related to CNS effect. Acute pain related to CNS, skin, and GI effects; decreased cardiac output related to cardiac effects; and deficient knowledge regarding drug therapy would not be appropriate because no evidence is provided in the question to support any of these diagnoses. 41. What medication, given with aprepitant (Emend), is used to effectively manage chemotherapy-induced emesis? A)

Bonamine

Dexamethasone

Phenergan

Ativan

Ans:

B Feedback: Aprepitant acts directly in the central nervous system to block receptors associated with nausea and vomiting with little to no effect on serotonin and dopamine levels, nor corticosteroid receptors. It is approved for use in treating nausea and vomiting associated with highly emetogenic antineoplastic chemotherapy, including cisplatin therapy. It is given orally, in combination with dexamethasone. Bonamine, Phenergan, and Ativan are not used in conjunction with Emend.

42. What symptom may be related to the use of dronabinol (Marinol)? A)

Bradycardia

Hypertension

Rash

Anxiety

Ans:

D Feedback: Dronabinol and nabilone are only approved for use in managing nausea and vomiting associated with cancer chemotherapy in patients who have not responded to other treatment. The exact mechanisms of action of dronabinol and nabilone are not understood. They are readily absorbed and metabolized in the liver, with excretion through bile and urine. They are controlled substances. Dronabinol is a category C-III controlled substance and nabilone is a category C-II substance. They must be used under close supervision because of the possibility of altered mental status. Dronabinol does not cause bradycardia, hypertension, or a rash.

43. People taking phenothiazines need to be assessed for extrapyramidal symptoms. What effects are considered adverse effects of the phenothiazines?

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Dysphoria, anxiety, and dizziness

Drowsiness, dystonia, and blurred vision

Dry mouth, blurred vision, and urinary retention

Hypertension, confusion, and shuffling gait

Ans:

B Feedback: Adverse effects include drowsiness, dystonia, photophobia, blurred vision, and discolored pink to red-brown urine. Adverse effects of the phenothiazines do not include dysphoria, urinary retention, or confusion.

44. A 57-year-old patient is to receive metoclopramide (Reglan) for nausea. What statement by the patient leads the nurse to believe that the patient has understood the nurses teaching? A)

During episodes of nausea, I will drink clear liquids.

I may be drowsy as a result of taking this medication.

This medication should be taken on a full stomach.

I will need to take supplemental potassium while I am taking this medication.

Ans:

B Feedback: Adverse effects include drowsiness, fatigue, restlessness, extrapyramidal symptoms, and diarrhea. The other statements are incorrect and would tell the nurse that this patient does not understand the teaching about this drug.

45. Prochlorperazine (Compazine) is contraindicated in which population? A)

Children under the age of 12 years

Preoperative patients

Pregnant women

People weighing <100 pounds

Ans:

C Feedback: Caution should be used in individuals with renal dysfunction, moderate liver impairment, active peptic ulcer, or during pregnancy and lactation. Compazine can be used in children under the age of 12, preoperative patients, and people weighing <100 pounds.

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Chapter 32: Drugs for Urologic Disorders 1. The clinic nurse is admitting a 39-year-old woman who has come to the clinic complaining of left-sided tenderness, fever, chills, and flank pain. What does the nurse suspect the patient has? A)

Cystitis

Kidney stones

Neurogenic bladder

Pyelonephritis

Ans:

D Feedback: The fever and chills indicate an inflammatory process. Flank pain and left-sided tenderness indicate kidney swelling within the capsule. These symptoms indicate pyelonephritis. Kidney stones cause intense pain; fever and chills would not be present. Cystitis and neurogenic bladder present with bladder-related symptoms such as frequency, urgency, burning, and bloating.

2. The nurse is caring for four patients. Which patient would flavoxate (Urispas), a urinary tract medication, be indicated for? A)

A 1-year-old girl

A 6-year-old boy

A 10-year-old boy

A 14-year-old girl

Ans:

D Feedback: Flavoxate prevents smooth muscle spasm in the urinary tract and can be given to children older than 12 years of age. Oxybutynin and phenazopyridine may be given to children 6 years old and older. Guidelines for use of an antispasmodic for a child younger than 6 have not been established.

3. The nurse is discussing the effects of doxazosin (Cardura) with a 65-year-old man who has just been diagnosed with benign prostatic hyperplasia (BPH). The patient asks the nurse whether the drug will make him impotent. After the discussion with the patient, the nurse determines that a potential priority nursing diagnosis could be what? A)

Sexual dysfunction related to adverse effects

Deficient knowledge regarding drug therapy

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Noncompliance with drug therapy related to adverse effects

Acute pain related to adverse effects

Ans:

C Feedback: The patient is concerned about his ability to perform sexually. Sexual dysfunction is a possible adverse effect and would be a concern for this patient. However, he has not started taking the drug. The nurse is concerned about noncompliance because of the possibility of this adverse effect. This is an important part of a mans life and most men would not want to take medication that would cause sexual dysfunction. Headache is an adverse effect of drugs used for BPH, but it can be tolerated and treated with an analgesic. Deficient knowledge about the drug is a concern, but usually men who know that sexual dysfunction is a possible adverse effect of a drug will find out all they can about the drug. Acute pain is not related to this drug.

4. A businesswoman who is leaving on a business trip the next day tells the nurse she knows she has cystitis and does not want to have to mess with medicine while she is gone. What drug would be a good choice for this patient? A)

Fosfomycin (Monurol)

Methenamine (Hiprex)

Nitrofurantoin (Furadantin)

Norfloxacin (Noroxin)

Ans:

A Feedback: Fosfomycin would be a good choice for this patient because it has the convenience of a single dose. Methenamine is taken either twice a day or up to four times a day. This drug could interfere with the patients busy schedule. Nitrofurantoin is also prescribed four times a day and would also be inconvenient for the patient. Norfloxacin is taken every 12 hours and could be inconvenient as well.

5. The nurse is performing patient teaching about the urinary anti-infective methenamine (Hiprex). What information is most important for the nurse to share with this patient? A)

Limit fluid intake.

Drink orange juice once a day.

Take the medication with food.

Take the medication at night before going to bed.

Ans:

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Feedback: The patient should take the medication with food to decrease GI adverse effects. The nurse would encourage the patient to increase fluid intake to flush the bladder and urinary tract frequently and decrease the opportunity for bacteria growth. Orange juice would be contraindicated because it could cause an alkaline rash and produce alkaline urine, which encourages bacterial growth. This drug is taken two to three times a day and not in a single dose at night. 6. The nurse is assessing a patient who is taking oxybutynin (Ditropan). What would be the priority nursing assessment for this patient? A)

Skin condition

Cardiac arrhythmia

Vision changes

Mental status

Ans:

C Feedback: The nurse should assess for vision changes and recommend an ophthalmologic examination during treatment to evaluate drug effects on intraocular pressure so that the drug can be stopped if intraocular pressure increases. A rash and changes in cardiac rhythm and rate are possible adverse effects. Also, disorientation (mental status) could be a concern. However, these effects can be treated and may not necessitate stopping the medication.

7. A patient is taking phenazopyridine (Azo-Standard) and ciprofloxacin (Cipro) for a urinary tract infection. What is the most important instruction the nurse needs to provide to the patient concerning this drug combination? A)

Do not be alarmed if your urine is a reddish-brown color.

Be sure to take your medication with food if you have GI irritation.

Increase your fluid intake. Drink lots of water.

If you notice yellowing of your eyes or skin, contact your health care provider immediately.

Ans:

D Feedback: Yellowing of the sclera and skin is a sign of drug accumulation in the body and a possible sign of hepatic (liver) toxicity. Phenazopyridine should not be used more than 2 days, especially if taken, as here, with an antibacterial agent (ciprofloxacin). The other suggested options are important and should be included in the instructions given the patient. However, the possibility of toxicity is the most important.

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8. A patient is taking pentosan polysulfate sodium (Elmiron) to decrease pain and discomfort associated with interstitial cystitis. What medication class may cause an adverse reaction when used with Elmiron? A)

Anticoagulants

Antihypertensives

Diuretics

Cardiac glycosides

Ans:

A Feedback: Anticoagulants may react with pentosan polysulfate sodium (Elmiron). This drug has anticoagulant and fibrinolytic effects, which could lead to potential or increased bleeding risks. Antihypertensives, diuretics, and cardiac glycosides do not cause drugdrug interactions with pentosan polysulfate sodium (Elmiron).

9. A pregnant woman is helping her elderly father with taking his medications. He is taking dutasteride (Avodart). The nurse will instruct the daughter to do what? A)

Crush the tablets to help facilitate swallowing.

Avoid touching any crushed or broken tablets.

Avoid direct contact with her father while he is on the medication.

Use a barrier contraceptive while helping her father prepare the drug.

Ans:

B Feedback: Dutasteride contains androgenic hormone blockers that could be absorbed through the skin if the tablets are crushed and broken. These hormone blockers could have negative effects on a fetus. The woman should be cautioned not to touch any crushed or broken tablets. Her father will not pose a threat to her because of this drug therapy. She should not need barrier contraceptives if she is pregnant.

10. A patient is being treated for benign prostatic hyperplasia (BPH). The patient asks the nurse how the medicine used to treat BPH is supposed to work. The nurse explains that the drug therapy is designed to relieve the symptoms associated with this condition by doing what? A)

Shrinking the gland and/or relaxing the sphincter of the bladder

Increasing testosterone levels to improve sexual functioning

Increasing blood pressure, which will increase blood flow to the area

Activate nitric acid, which will dilate blood vessels in the area to relieve pressure

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Ans:

A Feedback: Drugs given to treat BPH will block sympathetic activity to allow relaxation of the sphincter of the bladder or will decrease testosterone effects to shrink the gland and relieve symptoms. They do not increase testosterone levels or blood pressure. Dilating blood vessels would further congest the gland and increase symptoms.

11. The pharmacology students are learning about medications used to treat urinary tract problems. What symptoms does phenazopyridine treat? A)

Urinary retention

Hematuria

Pain and urgency

Hesitancy

Ans:

C Feedback: Phenazopyridine is an azo dye that acts as a urinary analgesic and relieves symptoms of dysuria, burning, and frequency and urgency of urination. Phenazopyridine does not treat urinary retention, hematuria, or hesitancy.

12. The nurse is providing health teaching to a 62-year-old female patient who has been started on norfloxacin (Noroxin). This patient should be taught to contact her physician if she experiences what adverse effect? A)

Polydipsia

Tachycardia

Confusion

Hypertension

Ans:

C Feedback: Urinary tract anti-infectives infrequently cause pruritus, urticaria, headache, dizziness, nervousness, and confusion. Norfloxacin is not known to cause polydipsia, tachycardia, or hypertension.

13. A 50-year-old man calls the clinic nurse and complains of gastrointestinal upset after taking nitrofurantoin (Furadantin) on an empty stomach. What recommendation should the nurse make? A)

Stopping the medication

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Taking vitamin C along with the medication

Taking the medicine with or after meals

Continuing to take the medicine on an empty stomach

Ans:

C Feedback: These adverse effects may result from GI irritation caused by the agent, which may be somewhat alleviated if the drug is taken with food, or from a systemic reaction to the urinary tract irritation. The nurse would not tell the patient to stop taking the medication without a physicians order to do so nor would the nurse tell the patient to continue taking the medication on an empty stomach. Advising the patient to take the medication along with vitamin C would be of no benefit to the patient described in the question.

14. A 72-year-old female clinic patient is started on cinoxacin (Cinobac) for a urinary tract infection. Before administering this drug, the nurse should assess the patient for what condition? A)

Asthma

Hypertension

Diabetes mellitus

Renal insufficiency

Ans:

D Feedback: Cinoxacin should be used with caution in the presence of renal dysfunction, which could interfere with the excretion and action of this drug. The patients having asthma, hypertension, or diabetes mellitus would not be a contraindication to the use of this drug.

15. The nurse is caring for a 79-year-old male patient who was admitted through the emergency room for mental status changes determined to be caused by a urinary tract infection. The patient is started on norfloxacin (Noroxin) before his discharge home. What adverse effect should the nurse observe this patient for? A)

Liver toxicity

Photosensitivity

Excess saliva

Congestive heart failure

Ans:

B Feedback:

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Adverse effects include photosensitivity, headache, dizziness, nausea, vomiting, dry mouth, and fever. Generally, adverse effects of norfloxacin do not include liver toxicity, bone marrow depression, or congestive heart failure. 16. A clinic patient has been prescribed phenazopyridine (Pyridium) for aid in treating a UTI. This patient should be informed that Pyridium will turn urine what color? A)

Bluish-green

Reddish-orange

Brown

Black

Ans:

B Feedback: Phenazopyridine turns urine reddish-orange, which may be mistaken for blood. It does not cause the urine to appear bluish-green, brown, or black.

17. A small group of nursing students are giving an oral presentation to their classmates about urinary tract infections (UTIs). What is a measure that can be used to encourage patients to use to reduce the risk of recurrent urinary tract infections? A)

Increase alkaline foods in your diet.

Take tub baths, soaking 15 minutes daily.

Use sterile gauze pads to cleanse after urinating.

Drink 2,000 to 3,000 mL of fluid daily.

Ans:

D Feedback: Many activities are necessary to help decrease bacteria in the urinary tract (e.g., hygiene measures, proper diet, forcing fluids), to facilitate the treatment of UTIs, and help the urinary tract anti-infectives be more effective. Forcing fluids increases the amount of urine that is excreted and prevents urine from sitting in the bladder. It is helpful to keep the urine acidic, not alkaline and avoid sitting in water. The importance of cleansing is to cleanse from front to back. The use of sterile wipes is not necessary.

18. What is the drug of choice in a patient with renal impairment who is being treated for a urinary tract infection (UTI)? A)

Salazopyrin

Silver sulfadiazine

Declomycin

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Fosfomycin

Ans:

D Feedback: The dosage of fosfomycin, given orally, does not need to be changed in cases of renal impairment. It is the only medication listed here that is used in the treatment of urinary tract infections. Declomycin may be used to inhibit antidiuretic hormone in the treatment of chronic inappropriate antidiuretic hormone secretion. Salazopyrin is used in ulcerative colitis. Silver sulfadiazine is used topically to treat Pseudomonas infections.

19. Urinary anti-infectives are used only to treat urinary tract infections (UTIs). What causes urinary anti-infectives to be so effective in treating UTIs? A)

They sterilize feces.

They act specifically within the urinary tract.

They reach high plasma levels in a short period of time.

They are excreted through the liver.

Ans:

B Feedback: Urinary tract anti-infectives act specifically within the urinary tract to destroy bacteria, either through a direct antibiotic effect or through acidification of the urine. They are not used in systemic infections because they do not attain therapeutic plasma levels. These drugs are usually excreted through the kidneys not through the liver, and they do not sterilize feces.

20. The nurse is caring for a patient who is taking a urinary anti-infective. What would the nurse need to assess this patient for? A)

Discolored urine

Jaundice

Signs and symptoms of continuing urinary tract infection (UTI)

Flank pain

Ans:

C Feedback: Monitor patient response to the drug (i.e., resolution of UTI and relief of signs and symptoms) and repeat culture and sensitivity tests as recommended for evaluation of the effectiveness of all of these drugs. It would not be necessary to assess for discolored urine, jaundice, or flank pain.

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21. The nurse is writing a plan of care for an 85-year-old male patient admitted through the emergency room with a severe urinary tract infection. What intervention, if noted on the care plan, would be an inappropriate for this patient? A)

Encourage the patient to drink cranberry juice as part of his daily fluid intake.

Avoid urinary catheterization when possible.

Force fluids unless contraindicated.

Administer antacids to decrease GI irritation caused by the medication.

Ans:

D Feedback: It would not be appropriate to administer antacids because it will cause the urine to be alkaline and provide more opportunity for bacterial growth. The patients should be encouraged to force fluids and to include cranberry juice in those fluids to help acidify the urine. Avoiding urinary catheterization is an important nursing intervention in all patients because catheterization can allow introduction of bacteria in the bladder.

22. A patient with benign prostatic hypertrophy (BPH) has been prescribed terazosin (Hytrin). How do alpha-adrenergic blockers, such as terazosin, assist in treating the symptoms of BPH? A)

They increase gastric motility.

They increase skeletal muscle contraction.

They inhibit contraction of the urinary bladder.

They decrease blood pressure.

Ans:

C Feedback: Alpha1-adrenergic blockers block postsynaptic alpha1-adrenergic receptors, which results in a dilation of arterioles and veins and a relaxation of sympathetic effects on the bladder and urinary tract. This action makes these drugs useful in the treatment of BPH. BPH is characterized by obstructed urine flow as the enlarged prostate gland presses on the urethra. Alpha1-blocking agents can decrease urinary retention and improve urine flow by relaxing muscles in the prostate and urinary bladder. Options A, B, and D are not correct.

23. A 72-year-old man presents at a blood donor drive. The patient tells the nurse he donates blood on a regular basis. While reviewing the patients medication history, the nurse notes he is taking dutasteride (Avodart) for his benign prostatic hyperplasia (BPH). What would the nurse know is a contraindication to this patient giving blood? A)

The testosterone blocking effects will be passed to those receiving the blood.

Blood donation may cause malignant hyperthermia to occur during the donation.

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Severe hypotension may occur during blood donation.

Malignant hypertension may occur during blood donation.

Ans:

A Feedback: Patients using either finasteride or dutasteride cannot donate blood for 6 months after the last dose to protect potential blood recipients from exposure to the testosterone blocking effects. The use of the drug dutasteride will not cause this patient to develop malignant hyperthermia, malignant hypertension, or severe hypotension during blood donation.

24. The clinic nurse is providing care for a patient with a urinary tract infection (UTI). Which drug would the nurse expect to administer to this patient? A)

Solifenacin

Pentosan polysulfate sodium

Norfloxacin

Alfuzosin

Ans:

C Feedback: Norfloxacin is a urinary anti-infective that is used in the treatment of adults with UTIs caused by susceptible strains of bacteria, uncomplicated urethral and cervical gonorrhea, and prostatitis caused by Escherichia coli. Solifenacin is an antispasmodic, pentosan polysulfate sodium is a bladder protectant, and alfuzosin is used in the treatment of benign prostatic hyperplasia (BPH).

25. Urinary tract infections (UTIs) in children do occur. If a child has repeated UTIs, what would be important to assess for? (Select all that apply.) A)

Obstruction

Sexual abuse

Drinking apple juice

Bubble baths

Drinking too much water

Ans:

A, B, D Feedback: Some children, because of congenital problems or in-dwelling catheters, require other urinary tract agents such as urinary tract analgesics or antispasmodics. A child with repeated UTIs should be evaluated for potential sexual abuse. Children need to be

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instructed in proper hygiene and should not be given bubble baths if UTIs occur. Repeated UTIs can be related to drinking alkaline juices such as orange or grapefruit, but not apple. Children should be encouraged to drink a lot of water. Drinking too much water would not cause repeated infections. 26. A 77-year-old man has been placed on alfuzosin (Uroxatral) for his benign prostatic hyperplasia (BPH). The nurse explains to the patient that because of the medication he is taking, it will be necessary to monitor for what? (Select all that apply.) A)

Pulse pressure

Intraocular pressure

Fluid intake

Blood pressure

Bladder emptying

Ans:

B, D, E Feedback: Special precautions to monitor cardiac function, intraocular pressure, blood pressure, and bladder emptying need to be taken when using alpha-adrenergic blockers with these patients. It would not be necessary to monitor pulse pressure or fluid intake in this patient.

27. A 72-year-old man is being treated with doxazosin (Cardura) for his BPH. What nursing diagnosis would be important to include in this patients plan of care? A)

Sexual dysfunction

Chronic pain

Disturbed sensory perception

Risk of impaired urinary elimination

Ans:

A Feedback: Nursing diagnoses related to drug therapy might include sexual dysfunction related to drug effects, acute pain related to headache, central nervous system (CNS) effects, and GI effects of the drug, risk for injury related to blockage of alpha receptors, and deficient knowledge regarding drug therapy. The nursing diagnosis of risk of impaired urinary elimination would not be appropriate because the effect of the drug is to improve urinary elimination issues.

28. You are preparing a plan of care for a 78-year-old female patient who has been hospitalized with a recurrent urinary tract infection (UTI). What would be important to assess for before administering a urinary tract antispasmodic? (Select all that apply.)

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Allergy to eggs

Glaucoma

Pyloric obstruction

Dumping syndrome

Duodenal obstruction

Ans:

B, C, E Feedback: Assess for contraindications or cautions: any history of allergy to these drugs to prevent hypersensitivity reactions; pyloric or duodenal obstruction; or other GI lesions or obstructions of the lower urinary tract, which could be dangerously exacerbated by these drugs; glaucoma, which could increase intraocular pressure due to blockage of the parasympathetic nervous system; and current status of pregnancy or lactation, which would require cautious use. It would not be necessary to assess this patient for an allergy to eggs or dumping syndrome.

29. What would be an appropriate nursing intervention for a patient on a urinary tract antispasmodic? A)

Monitor for patient use of hot showers.

Advise patient about change in color of sclera.

Offer sugarless hard candy.

Teach proper personal hygiene.

Ans:

C Feedback: Offer frequent sips of water or use of sugarless hard candy to alleviate dry mouth because antispasmodics have anticholinergic effects that cause dry mouth. The use of hot water for showers will not cause the patient any danger. Urinary antispasmodics do not cause changes in the sclera. This patient has an issue with bladder spasms and not a urinary tract infection.

30. The nurse is providing health teaching to a patient who is taking methenamine (Hiprex). What instruction would be most important to include for the patient taking Hiprex? A)

Drink citrus juice with the medication to acidify the urine.

Take sodium bicarbonate with the medication to make the urine alkaline.

Limit your fluid intake to 8 ounce per day.

While you are taking this drug, limit your intake of foods high in sodium.

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Ans:

A Feedback: Urinary tract anti-infectives act specifically within the urinary tract to destroy bacteria, either through a direct antibiotic effect or through acidification of the urine. Therefore, the nurse would not instruct the patient to take sodium bicarbonate, limit fluid intake, or limit their intake of foods high in sodium.

31. The nurse is caring for a patient who is beginning treatment for benign prostatic hyperplasia and knows that this patient may be treated with which classification of drugs? (Select all that apply.) A)

Urinary anti-infectives

Urinary antispasmodics

Alpha-adrenergic blockers

Testosterone production blockers

Urinary analgesics

Ans:

C, D Feedback: Alpha-adrenergic blockers and testosterone production blockers are drugs used in the treatment of benign prostatic hyperplasia. Urinary anti-infectives are used to treat urinary tract infections. Urinary antispasmodics are used to treat bladder spasms and urinary analgesics are used in the treatment of pain associated with urinary tract infections.

32. The nurse is caring for a patient with a bladder infection. What symptoms are most common with this type of infection? (Select all that apply.) A)

Frequency

Urgency

Dysuria

Flank pain

Temperature elevation over 102F

Ans:

A, B, C Feedback: Patients with bladder infection most commonly experience urinary frequency, urgency, and burning on urination (dysuria). Patients with pyelonephritis also experience flank pain and temperature elevation.

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33. A patient with interstitial cystitis has just begun to take pentosan polysulfate sodium (Elmiron). The nurse would notify the physician if the patient exhibited which symptom(s). (Select all that apply.) A)

Petechiae

Anorexia

Decreased blood pressure

Blood in the urine

Headache

Ans:

A, C, D Feedback: Adverse effects associated with pentosan use include bleeding that may progress to hemorrhage (related to the drugs heparin effects), headache, alopecia, and GI disturbances. It would be necessary to notify the physician if the patient showed any signs of bleeding. Anorexia and headaches are not associated with this drug.

34. The nurse is providing discharge instructions to a patient who is taking pentosan polysulfate sodium (Elmiron). Which statement by the patient indicates a need for further instruction? A)

I will make sure and take this medication with my breakfast.

I will call the doctor if I start to have any unusual bruises.

This drug I am taking may cause me to lose hair.

I will take acetaminophen if I develop a headache.

Ans:

A Feedback: Pentosan polysulfate sodium should be taken on an empty stomach, either 1 hour before or 2 hours after meals. The patient should call the physician at the first sign of bleeding. Alopecia and headache may occur with this medication.

35. A patient with benign prostatic hyperplasia has been self-treating with an herbal called saw palmetto. The nurse would know which drug is contraindicated in this patient? A)

Tamsulosin (Flomax)

Finasteride (Proscar)

Alfuzosin (Uroxatral)

Terazosin (Hytrin)

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Ans:

B Feedback: Saw palmetto is an herbal therapy that has been used very successfully for the relief of symptoms associated with benign prostatic hyperplasia (BPH). Patients with BPH should be cautioned not to combine saw palmetto with finasteride because serious toxicity can occur. There is no contraindication in the use of tamsulosin, alfuzosin, and terazosin, which are alpha-adrenergic blockers. Finasteride is a testosterone blocking agent.

Chapter 33: Drugs for Anemia 1. The nurse is caring for a patient in end-stage renal failure and anemia. What is the cause of this patients anemia? A)

Low serum iron levels

Low erythropoietin levels

Inadequate oxygenation of tissue

Lack of B12 and folic acid intake

Ans:

B Feedback: Anemia can occur if erythropoietin levels are low. This is seen in association with renal failure, when the kidneys are no longer able to produce erythropoietin. Low iron levels, hypoxia, and vitamin deficiency are not likely to be the primary cause of anemia in a patient with kidney failure.

2. A 2-year-old child weighing 32 pounds is to take ferrous sulfate (Feosol) 6 mg/kg/d PO. How many milligram will the child receive per dose? A)

47 mg

67 mg

87 mg

107 mg

Ans:

C Feedback: The nurse will administer 87 mg per dose. The childs weight is first converted to kilograms by dividing 32 by 2.2, or 32/2.2 = 14.5 kg. Next, calculate the dose by multiplying weight times mg/kg/d or 14.5 6 = 87 mg.

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3. A nurse caring for a 28-year-old woman with renal failure is to start the patient on epoetin alfa therapy for iron replacement. What will the nurse assess before initiating therapy? A)

Weight

Last menstrual period

Intake and output (I & O) for a 24-hour period

Blood type

Ans:

B Feedback: The use of epoetin alfa is not recommended during pregnancy or lactation because of potential adverse effects to the fetus or baby. It is important to determine that the patient is not pregnant before drug therapy has started so the nurse would assess when the patient last menstruated. The patients weight, I & O, and blood type are not important factors in determining whether the drug can be used.

4. The nurse improves patient compliance with the drug regimen of epoetin alfa by providing what? A)

An appointment card for each drug administration day

A calendar to mark the days of the week the drug is to be administered

A referral for community transportation

The telephone number of the pharmacy where the medication can be purchased

Ans:

B Feedback: The nurse should provide the patient with a calendar with the days the drug is to be administered marked clearly to remind her when the dose is due. The patient can be taught to self-administer the drug so there is no need for an appointment or arranging transportation. The patient can use her choice of pharmacy and would not need the telephone number.

5. A patient who has anemia and a severe GI absorption disorder has been ordered iron dextran (INFeD). What is the most appropriate nursing diagnosis for the patient related to the administration of this drug? A)

Acute pain related to drug administration

Deficient knowledge regarding drug therapy

Risk for injury related to CNS effects

Disturbed body image related to drug staining of teeth

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Ans:

A Feedback: Iron dextran is a parenteral form of iron. It is given intramuscularly and must be given by the Z-track method. It can be very painful. Certainly, deficient knowledge and risk for injury are appropriate diagnoses for this patient but would not be related to the administration of the drug. Because this medication is not given orally, tooth staining would not be a concern.

6. A 22-year-old woman who has severe dysmenorrhea has been prescribed ferrous gluconate (Fergon) to treat iron deficiency anemia. What is it important for the nurse to instruct the patient to avoid when taking the drug? A)

Eggs

Chocolate

Pork

Whole wheat

Ans:

A Feedback: Iron is not absorbed if taken with antacids, eggs, milk, coffee, or tea. These substances should not be administered concurrently. Chocolate, pork, and whole wheat do not produce drugfood interactions when consumed with an iron supplement.

7. The nurse develops a care plan for a patient who has been prescribed a folic acid derivative that includes what priority nursing diagnosis? A)

Deficient knowledge regarding drug therapy

Monitor possibility of hypersensitivity reactions

Acute pain related to injection or nasal irritation

Risk for fluid volume imbalance related to cardiovascular effects

Ans:

D Feedback: Nursing diagnoses related to drug therapy might include: Risk for fluid volume imbalance related to cardiovascular effects. Deficient knowledge and acute pain might apply to this patient, but the priority nursing diagnosis this patient, but the priority nursing diagnosis for this patient is the risk for fluid imbalance related to cardiovascular effects. Monitoring for hypersensitivity is not a nursing diagnosis.

8. Before administering an iron preparation, what should the nurse assess? A)

Red blood cell count (RBC)

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Hematocrit and hemoglobin

Aspartate aminotransferase levels

Serum creatinine levels

Ans:

B Feedback: Hematocrit and hemoglobin levels should be assessed before administration because the drug will be evaluated for effectiveness by the response of these levels to drug treatment. These levels are also used to determine dosage. Counting RBCs would indicate the number of blood cells per cubic millimeter but not iron or oxygen content. Aspartate aminotransferase levels are associated with liver function and serum creatinine levels are associated with renal function.

9. What ordered dosage for epoetin alfa (Procrit) could the nurse administer without needing to question the order? A)

0.45 mcg/kg IV once per week

1 mg/d IM

100 mg/d PO

150 units/kg subcutaneously three times per week

Ans:

D Feedback: An appropriate dosage of epoetin alfa is 50 to 100 units/kg IV or subcutaneously, 3 days a week. Darbepoetin alfa can be administered by IV or subcutaneously once a week, and the usual dose is 0.45 mcg/kg. Folic acid (Folvite) is administered orally, IM, subcutaneously or IV; the usual dosage is 1 mg. The usual dose of ferrous sulfate is 100 to 200 mg/d PO.

10. After assessing the patient receiving erythropoietin drug therapy, the nurse suspects what finding is an adverse effect of erythropoietin drug therapy? A)

Constipation

Hypotension

Edema

Depression

Ans:

C Feedback:

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Potential adverse effects of an erythropoietin are edema, nausea, vomiting, chest pain, diarrhea, and hypertension. Options A, B, and D are not associated with these drugs. 11. A 62-year-old female patient is started on vitamin B12 for pernicious anemia. When the nurse develops the plan of care, what expected outcome will the nurse include? A)

Decreased bleeding

Increased hemoglobin

Decreased joint pain

Less fatigue

Ans:

B Feedback: Vitamin B12 is essential for normal functioning of red blood cells (RBCs) so the drug would be evaluated as successful in treating the disorder if the patients hemoglobin and RBC count increased after administration. Expected outcomes do not include decreased bleeding, decreased joint pain, or less fatigue.

12. A 50-year-old patient with pernicious anemia asks why she cant just take a vitamin B12 pill instead of getting an injection. What is the nurses best response to her question? A)

Pernicious anemia is caused by the bodys inability to absorb vitamin B12.

Oral ingestion of vitamin B12 irritates the GI tract and bleeding could occur.

Pernicious anemia alters mucous membrane lining of the bowel and impairs absorption.

With severe deficiencies like yours, oral vitamin B12 does not work fast enough.

Ans:

A Feedback: Vitamin B12 cannot be taken orally, because one problem with pernicious anemia is an inability by the patient to absorb vitamin B12 due to low levels of intrinsic factor. Other options are incorrect.

13. The nurse instructs a patient taking oral iron preparations about which potential adverse effect? A)

Clay-colored stools

Hypotension

Constipation

Frequent flatus

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Ans:

C Feedback: The most common adverse effects associated with oral iron supplements are related to direct GI irritation (e.g., GI upset, anorexia, nausea, vomiting, diarrhea, dark stools, and constipation). Oral iron supplements do not cause hypotension, clay-colored stools, or frequent flatus.

14. When providing patient teaching for a 30-year-old primigravida diagnosed with sickle cell anemia, but not currently in crisis, the priority teaching point is what? A)

Avoidance of infection

Constipation prevention

Control of pain

Iron-rich foods

Ans:

A Feedback: Severe, acute episodes of sickling with blood vessel occlusion may be associated with acute infections and the bodys reactions to the immune and inflammatory responses. Avoidance of infection is, then, a priority teaching point. Pain would be a concern only if the patient is in crisis. Constipation prevention and iron-rich foods would not be the priority at this time.

15. What drugs might the nurse administer that have been developed to stimulate erythropoiesis? (Select all that apply.) A)

Levoleucovorin

Hydroxocobalamin

Darbepoetin alfa

Methoxy polyethylene glycol-epoetin beta

Epoetin alfa

Ans:

C, D, E Feedback: Patients who are no longer able to produce enough erythropoietin in the kidneys may benefit from treatment with exogenous erythropoietin (EPO), which is available as the drugs epoetin alfa (Epogen, Procrit), darbepoetin alfa (Aranesp), and methoxy polyethylene glycol-epoetin beta (Mircera). Both darbepoetin alfa and methoxy polyethylene glycol-epoetin beta are approved to treat anemias associated with chronic

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renal failure, including patients receiving dialysis. Levoleucovorin and hydroxocobalamin are not erythropoiesis-stimulating agents. 16. What anemia does the nurse classify as a type of hemolytic anemia? A)

Iron deficiency anemia

Megaloblastic anemia

Pernicious anemia

Sickle cell anemia

Ans:

D Feedback: Another type of anemia is hemolytic anemia, which involves a lysing of red blood cells because of genetic factors or from exposure to toxins. Sickle cell anemia is a type of hemolytic anemia. Iron deficiency and megaloblastic anemias are different classifications of anemia.

17. What medication does the nurse administer to treat anemia associated with chronic renal failure? A)

Methoxy polyethylene glycol-epoetin beta

Ferrous sulfate exsiccated

Levoleucovorin

Hydroxyurea

Ans:

A Feedback: Both darbepoetin alfa and methoxy polyethylene glycol-epoetin beta are approved to treat forms of anemia associated with chronic renal failure, including in patients receiving dialysis. Ferrous sulfate exsiccated is used to treat iron deficiency. Levoleucovorin is administered to diminish toxicity and counteract the effects of impaired methotrexate elimination and of inadvertent overdose of folic acid antagonists after high-dose methotrexate therapy for osteosarcoma. Hydroxyurea is used to reduce the frequency of painful sickle cell crises and to decrease the need for blood transfusions in adults with sickle cell anemia.

18. The nurse is caring for a patient diagnosed with pernicious anemia and anticipates this patient will require supplemental what? A)

Iron

Vitamin B12

Erythropoietin

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Oxygen

Ans:

B Feedback: Pernicious anemia occurs when the gastric mucosa cannot produce intrinsic factor and vitamin B12 cannot be absorbed. Other options are incorrect.

19. When providing patient teaching the nurse warns the patient to avoid what triggers of an episode of sickling? (Select all that apply.) A)

Acute infections

Immune response

Exposure to heat

Inflammatory responses

Metabolic alkalosis

Ans:

A, B, D Feedback: Severe, acute episodes of sickling with occluded blood vessels may be associated with acute infections and the bodys reactions to the immune and inflammatory responses. Exposure to heat and metabolic alkalosis are not considered triggers.

20. The nurse teaches hemodialysis patients that anemia occurs because damaged kidneys fail to produce what? A)

Erythropoietin

Renin

Angiotensin

Urine

Ans:

A Feedback: People with chronic renal failure are often anemic because their kidneys are unable to produce erythropoietin. The production of renin and angiotensin impact the patients blood pressure. Anemia is not caused by lack of urine production.

21. A patient has been prescribed epoetin alfa. The nurse determines the drug is contraindicated as a result of what finding in the patient history? A)

Asthma

Irritable bowel syndrome

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Hypertension

Shortness of breath

Ans:

C Feedback: Erythropoiesis-stimulating agents are contraindicated in the presence of uncontrolled hypertension because of the risk of worsening hypertension when red blood cell counts increase and the pressure within the vascular system also increases. There is no contraindication to the use of erythropoiesis-stimulating agents for patients with asthma, irritable bowel syndrome, or shortness of breath.

22. An older adult patient, diagnosed with pernicious anemia, asks the nurse what causes this disorder. The nurses best response is that there is a lack of intrinsic factor secreted needed for absorption of vitamin B12 where? A)

Large bowel

Lower esophagus

Stomach

Small bowel

Ans:

D Feedback: Intrinsic factor, also secreted by the gastric mucosa, combines with dietary vitamin B12 so that the vitamin can be absorbed in the ileum, located in the small bowel. Other options are incorrect.

23. What genetic carrier screening would be appropriate for an African American couple planning to begin a family? A)

Renal failure

Sickle cell anemia

Iron deficiency anemia

Vitamin B12 deficiency

Ans:

B Feedback: Sickle cell anemia is a chronic hemolytic anemia that occurs most commonly in people of African descent, so it would be appropriate to have genetic screening to determine the risk associated with having children. The other answers are incorrect because they are not associated with people of African descent.

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24. The nurse is caring for a child who is prescribed supplemental iron therapy in liquid form. What is the priority parent teaching to be provided by the nurse? A)

The iron should be taken through a straw.

Positive results from treatment will be seen in 1 to 2 weeks.

Results will be evaluated through the childs appearance.

Dosages are determined by serum iron levels.

Ans:

A Feedback: Iron doses for replacement therapy are determined by age. If a liquid solution is being used, the child should drink it through a straw to avoid staining the teeth. Periodic blood counts should be performed; it may take 4 to 6 months of oral therapy to reverse an iron deficiency. Remember that iron can be toxic to children, so that iron supplements should be kept out of their reach and administration monitored.

25. The nurse admits a 26-year-old patient with sickle cell anemia. What drug does the nurse anticipate administering? A)

Hydroxyurea

Methoxy polyethylene glycol-epoetin beta

Vitamin B12

Leucovorin

Ans:

A Feedback: Indications for use of hydroxyurea include reducing the frequency of painful crises and the need for blood transfusions in adult patients with sickle cell anemia. Other options would not be used to treat a patient with sickle cell anemia.

26. The nurse admits a child to the pediatric unit who has an abnormally high serum iron level. What chelating agent will be appropriate to treat this child? A)

Calcium disodium edetate

Deferoxamine

Dimercaprol

Succimer

Ans:

B Feedback:

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Deferoxamine is given IM, IV, or subcutaneously to treat elevated iron levels. Calcium disodium edetate and succimer are used to treat elevated lead levels. Dimercaprol treats arsenic, gold, and mercury poisoning. 27. The nurse is caring for a patient who just received a cancer diagnosis. The patient tells the nurse, I saw the commercials on TV and I want to start taking Procrit immediately so I dont get tired from chemotherapy. What is the nurses best response? A)

Procrit is only effective if you develop anemia from chemotherapy that is caused by low levels of erythropoietin.

Before the doctor will order this drug, you will need to be found to have anemia so we will draw some blood for lab work while youre here.

Chemotherapy causes anemia and only when that happens will it be appropriate to prescribe Procrit for you.

The doctor may order Procrit for you when it is appropriate, but now is not the appropriate time for you to take this drug.

Ans:

A Feedback: There is a risk of decreasing normal levels of erythropoietin if epoetin alfa (Procrit), or any of this classification of drug (erythropoiesis-stimulating agents), is given to patients who have normal renal functioning and adequate levels of erythropoietin. The patient should be taught that the drug will only be prescribed if he develops anemia due to inadequate erythropoietin. Although it is true the doctor may prescribe the drug when it is appropriate, this answer does not explain why it is inappropriate to prescribe it now. Anemia alone is not sufficient cause for prescribing Procrit and not all chemotherapy results in anemia.

28. What drug used to treat anemia might the nurse administer as an antineoplastic drug because it is cytotoxic? A)

Epoetin alfa

Ferrous sulfate

Hydroxocobalamin

Hydroxyurea

Ans:

D Feedback: Hydroxyurea is a cytotoxic antineoplastic drug that is also used to treat leukemia, ovarian cancer, and melanoma. The other options would not serve this purpose.

29. The nurse is caring for a patient diagnosed with a megaloblastic anemia and administers what drug?

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Folic acid

Hydroxyurea

Ferrous sulfate

Epoetin alfa

Ans:

A Feedback: Folic acid and vitamin B12 are given as replacement therapy for dietary deficiencies, as replacement in high-demand conditions such as pregnancy and lactation, and to treat megaloblastic anemia. Hydroxyurea is used to treat sickle cell anemia. Ferrous sulfate is indicated for the treatment of iron deficiency anemia. Epoetin alfa is administered to treat anemias caused by inadequate erythropoietin production, such as in renal failure.

30. The nurse is preparing the patient prescribed hydroxocobalamin for discharge and teaches the patient to be alert for what adverse effects? (Select all that apply.) A)

Itching

Peripheral edema

Hypotension

Heart failure

Constipation

Ans:

A, B, D Feedback: Hydroxocobalamin has been associated with itching, rash, and signs of excessive vitamin B12levels, which can also include peripheral edema and heart failure. Hypotension and constipation are not adverse effects of hydroxocobalamin therapy.

31. The patient has taken epoetin alfa (Epogen) with good results for several months. On this visit, the nurse analyzes the patients lab results and finds indications of severe anemia and cytopenias. What order will the nurse anticipate receiving? A)

Increase the dosage of Epogen.

Change the patient to another erythropoiesis-stimulating agent.

Discontinue Epogen.

Begin administering Epogen IV instead of subcutaneously.

Ans:

C Feedback:

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In patients treated with Epogen or any drug in this class who develop severe anemia after improvement, the drug should be stopped and should not be changed to another drug in the class because it is likely due to patients development of neutralizing antibodies. Increasing the dosage will not help and changing the route of administration will not reverse the process after antibodies have formed. 32. The patient receiving epoetin alfa (Procrit) asks the nurse why it has to be administered IV because he read that it could be self-administered subcutaneously. What is the nurses best response? A)

Giving the drug IV reduces risk of a potentially serious response to the drug.

Giving the drug by the IV route makes it begin working sooner.

Only patients with renal disease can receive the drug subcutaneously.

It is all determined by physician preference and this doctor prefers the IV route.

Ans:

A Feedback: It is now recommended that patients receive Procrit and other drugs in this classification intravenously rather than subcutaneously because this reduces the risk of antibody production that can result from severe anemia. This decision is not based on speed of onset, diagnosis, or physician preference.

33. The nurse is administering an erythropoiesis-stimulating agent to a patient with renal failure and anemia. What is the maximum hemoglobin level the nurse would want to assess when reviewing this patients lab results? A)

8 g/dL

10 g/dL

12 g/dL

14 g/dL

Ans:

C Feedback: In recent years, the Food and Drug Administration alerted providers to the importance of a target hemoglobin of no more than 12 g/dL when using erythropoiesis-stimulating agents. As a result, other options are either too low or too high.

34. For what purpose would the nurse administer postoperative epoetin alfa to the patient who is a Jehovahs Witness? A)

Reduce the need for allogenic blood transfusion

Treatment of anemia associated with chronic renal failure

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Treatment of HIV infection

To prevent the need for chemotherapy

Ans:

A Feedback: Jehovahs Witnesses often refuse allogenic blood transfusions because of their religious beliefs. Indications for the use of epoetin alfa include treatment of anemia associated with chronic renal failure, related to treatment of HIV infection or to chemotherapy in cancer patients, to reduce the need for allogenic blood transfusions in surgical patients. There is no indication in this question that the patient has chronic renal failure, HIV, or need for chemotherapy.

35. For what purpose might the nurse administer folic acid to the patient? (Select all that apply.) A)

Nutritional deficiency

Megaloblastic anemia

Pregnancy or preparation for pregnancy

Sickle cell anemia

Renal failure

Ans:

A, B, C Feedback: Folic acid is indicated for the treatment of megaloblastic anemia caused by sprue and to replace a nutritional deficiency. It is also given to women who are, or plan to become, pregnant to reduce the risk of a neural tube disorder in the fetus. It is not indicated for the treatment of sickle cell anemia or renal failure.

Chapter 34: Drugs for Dermatologic Disorders MULTIPLE CHOICE 1.A client is diagnosed with acne. The client expresses concern to the nurse that he has not yet been placed on medication. The nurse explains to the client that the initial nonpharmacologic approach for treating acne vulgaris includes: a.application of large doses of vitamin A. b.application of large doses of vitamin C. c. cleansing of the skin gently several times a day. d.vigorously scrubbing skin in the morning and at bedtime.

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ANS: C Gentle cleansing is one of the chief nonpharmacologic treatments of acne. DIF:Cognitive Level: ApplicationREF:dm. 748 TOP:Nursing Process: Intervention MSC:CONTENT CATEGORY: Health Promotion and Maintenance 2. The client has been placed on tetracycline (Sumycin) for acne control. In planning a dosage

schedule, the nurse anticipates that the client will be taking: a.low doses over a period of months. b.low doses for 3 to 4 weeks. c.high doses for 10 days to 2 weeks. d.high doses for at least 1 year. ANS: A The most effective course of tetracycline dosage is low doses of the drug over a period of months. DIF:Cognitive Level: ApplicationREF:pp. 748-749 TOP:Nursing Process: Analysis MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies 3. Photosensitivity is a major complication of tetracycline (Sumycin). In providing client

teaching, the nurse should suggest that the client

while on the medication.

a.avoid direct sunlight b.wear a hat and long sleeves in the sun c.use a tanning bed only with supervision d.use a suntan lotion with a high SPF ANS: A

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To avoid photosensitivity, the client should avoid direct sunlight while she is taking the medication. DIF:Cognitive Level: ApplicationREF:pp. 748-749 TOP:Nursing Process: Intervention/Teaching MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies 4. The client is being treated extensively with silver nitrate cream. The nurse plans to closely

monitor the clients level of: a.calcium. b.sodium. c. potassium. d.magnesium. ANS: C Extensive use of silver nitrate can lead to hypokalemia. DIF:Cognitive Level: ApplicationREF:dm. 757 TOP:Nursing Process: Analysis MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies 5. Upon assessment of the burned client, the nurse notes that the client is exhibiting mottled,

blistered skin and is complaining of intense pain. These findings are congruent with which degree of burn injury? a. First b.Second c. Third d.Fourth ANS: B

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Second-degree burns are characterized by mottled, blistered skin, and the client is typically in intense pain. DIF:Cognitive Level: ApplicationREF:dm. 756 TOP:Nursing Process: Analysis MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies 6. Methoxsalen (Oxsoralen) is a drug used for the treatment of psoriasis. Clients using this agent

should not be in direct sunlight for which reason? a.Skin could become lightened or blanched. b.Psoriasis would spread. c. Exposed skin would burn or blister. d.Skin would become sensitive to light. ANS: C Methoxsalen (Oxsoralen) will produce burning or blistering of the skin if the area is exposed to direct sunlight. DIF:Cognitive Level: ApplicationREF:pp. 750-752 TOP:Nursing Process: Planning MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies 7.A client enters the healthcare providers office with complaints of verruca vulgaris (warts). What is the most accurate instructional point to include in a client teaching session? a.Warts can become malignant after 1 to 2 years and thus must be monitored closely. b.The only effective means of wart removal is by surgical excision. c. Drug therapy to remove a common wart may include systemic side effects. d.Electrodesiccation can be used to eradicate the common warts. ANS: D

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Electrodesiccation, along with freezing and surgical excision, can be used to treat the common wart. DIF:Cognitive Level: ApplicationREF:pp. 752-753 TOP:Nursing Process: Analysis MSC: CONTENT CATEGORY: Physiological Integrity: Pathophysiology 8. Contact dermatitis may be caused by chemical or plant irritation. What nonpharmacologic

measure may aid in alleviating the problem? a. Determining causative agent b.Cleansing the skin area immediately c. Wearing protective gloves or clothing d.Applying a sterile dressing over the involved area ANS: B Cleansing is one of the chief methods to decrease the irritation that has been caused by contact dermatitis. DIF:Cognitive Level: ApplicationREF:dm. 754 TOP:Nursing Process: Analysis MSC:CONTENT CATEGORY: Health Promotion and Maintenance 9. The client is being treated with clobetasol propionate (Clobex). In scheduling the clients next

appointment with the primary care provider, the nurse recognizes that the clients lesions need to be reassessed in

weeks.

a.2 b.4 c.6 d.8 ANS: A

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The lesions should be reassessed after 2 weeks of treatment with the medication. DIF:Cognitive Level: ApplicationREF:pp. 750-752 TOP:Nursing Process: Planning MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies 10. The client is being treated with etretinate (Tegison, Soriatane). She has been using the

medication for 6 weeks and is concerned because she has not seen an improvement in her symptoms. The most accurate response from the nurse is that it may be

months for the

client to notice an improvement in her symptoms. a.2 b.8 c.4 d.6 ANS: D Treatment with etretinate may take up to 6 months to produce a change in the clients symptoms. DIF:Cognitive Level: ApplicationREF:pp. 750-752 TOP:Nursing Process: Intervention/Teaching MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies 11. The nurse plans to monitor a client with second-degree burns for which adverse reaction to

mafenide acetate (Sulfamylon)? a.Increased intraocular pressure b.Urinary retention c.Fluid retention d.Superinfection ANS: D

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Adverse reactions to mafenide acetate (Sulfamylon) include superinfection, respiratory alkalosis, blistering, and metabolic acidosis. DIF:Cognitive Level: ApplicationREF:dm. 757 TOP:Nursing Process: Planning MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies 12. Silver sulfadiazine (Silvadene) is used for the treatment of second- and third-degree burns.

The highest priority nursing intervention related to this drug is to monitor for: a. crystalluria. b.dehydration. c. headaches. d.hypertension. ANS: A Extended use of silver sulfadiazine may lead to crystalluria. DIF:Cognitive Level: ApplicationREF:dm. 757 TOP:Nursing Process: Analysis MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies 13.A client is ordered to receive isotretinoin. What is a priority diagnostic test for the nurse to complete before beginning therapy? a.Blood glucose level b.Pregnancy test c. Serum electrolytes d.Complete blood count ANS: B

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Isotretinoin is highly teratogenic and includes strict guidelines related to ensuring safe use. Female clients who are sexually active will be asked to take a pregnancy test.

Chapter 35: Drugs for Bone Disorders 1. The nurse is teaching a class on muscular coordination and explains it is the movement of what electrolyte that contributes to the process of muscle contraction and relaxation? A)

Calcium

Chloride

Magnesium

Hydrogen

Ans:

A Feedback: Calcium is released from the sarcoplasmic reticulum, which leads to the binding of calcium with troponintropomyosin. This leads to contraction of the muscle fiber. The calcium pump then moves calcium back into the sarcoplasmic reticulum, which leads to relaxation of muscle fiber. Chloride, magnesium, and hydrogen are not involved in this process.

2. A mother brings her 9-year-old son to the clinic for a routine check up. The 9-year-old boy has cerebral palsy and is very spastic. The mother asks the nurse what causes the spasticity in her son. What is the nurses best response? A)

Your sons spasticity is caused by injury to the muscle tissue.

Your sons spasticity is caused by deficiency of a neurotransmitter called serotonin.

Your sons spasticity is caused by damaged sensory neurons.

Your sons spasticity is caused by damaged motor neurons.

Ans:

D Feedback: Muscle spasticity is the result of damage to neurons within the central nervous system (CNS) rather than injury to peripheral structures such as the musculoskeletal system. Serotonin is not involved in the process of muscle contraction and relaxation. Although acetylcholine is released and increases muscle cell membrane permeability to sodium, which eventually leads to the release of calcium, this process does play a vital part in muscle contraction and relaxation.

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3. A nurse is providing discharge teaching for a patient who will be going home on cyclobenzaprine (Flexeril) prescribed for his acute musculoskeletal pain. The nurse will stress that the patient should avoid what? A)

Drinking alcohol

Taking antiemetics

Taking antihistamines

Taking antibiotics

Ans:

A Feedback: Taking cyclobenzaprine with alcohol can cause an increase in central nervous system depression. The nurse should stress that this combination should be avoided due to possible injury or severe body system depression that could lead to coma or death. No significant concerns exist with the use of antiemetics, antihistamines, or antibiotics with this drug.

4. The nurse provides patient teaching about chlorzoxazone (Paraflex) in preparation for the patients discharge to home. The nurse evaluates the patient understands potential adverse effects when the patient makes what statement? A)

This drug can cause diarrhea.

My urine may turn orange to purple red while taking this drug.

My skin may turn yellow but that will go away when I stop taking the drug.

After I take a pill it will take 2 to 3 hours before I feel the effects.

Ans:

B Feedback: The patient indicates an understanding of adverse effects of this drug by stating that his urine may be discolored while using the drug. Chlorzoxazone may discolor the urine, which will turn orange to purple-red when metabolized and excreted. Patients should be warned about this effect to prevent any fears of blood in the urine. Chlorzoxazone usually causes constipation, not diarrhea. The onset of action is usually within an hour after the drug has been taken. Yellow discoloration of the skin would indicate liver damage or dysfunction, which should be reported immediately.

5. The nurse admits a child diagnosed with tetanus. What medication will the nurse expect to administer? A)

Methocarbamol (Robaxin)

Baclofen (Lioresal)

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Dantrolene (Dantrium)

Diphenhydramine (Benadryl)

Ans:

A Feedback: Methocarbamol is the drug of choice if a child needs to be treated for tetanus. Baclofen and dantrolene are not recommended for use with children. Diphenhydramine is not indicated for treatment of tetanus.

6. A 20-year-old female patient has been diagnosed with multiple sclerosis. What drug will most likely be prescribed? A)

Baclofen (Lioresal)

Cyclobenzaprine (Flexeril)

Metaxalone (Skelaxin)

Orphenadrine (Banflex)

Ans:

A Feedback: Baclofen is used for treatment of muscle spasticity associated with neuromuscular diseases such as multiple sclerosis. Cyclobenzaprine, metaxalone, and orphenadrine are used for relief of discomfort associated with painful, acute musculoskeletal conditions.

7. The nurse is caring for four patients. Which patient would have the highest risk for hepatotoxicity from dantrolene (Dantrium)? A)

An 87-year-old man who is taking a cardiac glycosideh

A 32-year-old man who is taking an antipsychotic drug

A 65-year-old woman who is on hormone replacement therapy

A 48-year-old woman who is taking an antihypertensive agent

Ans:

C Feedback: If dantrolene is combined with estrogen, the incidence of hepatocellular toxicity is increased. This combination should be avoided. Nothing indicates that patients taking a cardiac glycoside, an antipsychotic drug, and an antihypertensive would have serious adverse effects when combined with dantrolene therapy.

8. The nurse alerts the patient to what adverse effect of tizanidine (Zanaflex) that could cause injury?

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Constipation

Dry mouth

Fatigue

Hypotension

Ans:

D Feedback: Tizanidine has been associated with hypotension, which could be a safety risk especially if the patient is also taking an antihypertensive drug. Constipation, dry mouth, and fatigue are common adverse effects that do not pose a safety risk.

9. A young woman attends a Botox Party and is injected with botulinum toxin type A to decrease frown lines between her eyebrows. Later that evening the patient is admitted to the emergency department and is hysterical, because she cannot move her eyebrows. The nurse explains that that toxin causes what? A)

The toxin causes muscle death, which smoothes wrinkles in the area.

The toxin causes muscle paralysis, preventing movement and relieving wrinkles.

The drug is a toxin to nerves in the area.

The drug is a permanent muscle relaxant and the muscles will never move again.

Ans:

B Feedback: Botulinum toxin types A and B bind directly to the receptor sites of motor nerve terminals and inhibit the release of acetylcholine, leading to local muscle paralysis. These two drugs are injected locally and used to paralyze or prevent the contractions of specific muscle groups. The action smoothes wrinkles in the area, but does not cause muscle death. The effect is temporary and does not cause nerve death. The other options are false statements.

10. A patient has stepped on a rusty nail and is exhibiting signs of muscle rigidity and contractions. The patients wife called the emergency department (ED) and the triage nurse told her to bring him in. The ED nurse will have which drug available for administration when the patient arrives? A)

Carisoprodol (Soma)

Cyclobenzaprine (Flexeril)

Metaxalone (Skelaxin)

Methocarbamol (Robaxin)

Ans:

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Feedback: The patient is exhibiting signs of tetanus and methocarbamol (Robaxin) is indicated for treatment. Carisoprodol, cyclobenzaprine, and metaxalone are not used to treat tetanus. 11. The nurse assesses a newly admitted patient and finds the muscle tone in his left leg has sustained muscle contraction. How will the nurse document this finding? A)

Tonus

Flaccid

Atonic

Spastic

Ans:

D Feedback: Muscle spasticity is defined as a sustained muscle contraction. Soft and flabby muscle tone is defined as atonic. A limp muscle without tone is described as flaccid. The state of readiness, known as muscle tone (tonus), is produced by the maintenance of some of the muscle fibers in a contracted state.

12. A patient comes to the clinic to receive a Botox injection in her forehead. The patient has adult acne across her forehead. What is the nurses priority action? A)

Hold the injection and consult the health care provider.

Cleanse the area well with an antibacterial soap.

Apply a topical antibiotic after administering the Botox.

Provide patient information about post-Botox injection care.

Ans:

A Feedback: Botulinum toxins should not be injected into any area with an active infection because of the risk of exacerbation of the infection. As a result, the nurse would hold the injection and consult with the physician, with the expectation the medication would be held until the acne resolved. Cleansing the area well, applying a topical antibiotic, and providing information about postinjection care would not resolve the problem and are not indicated.

13. The patient presents to the emergency department with muscle spasms in the back. What types of injury would the nurse recognize can result in muscle spasm? (Select all that apply.) A)

Overstretching a muscle

Wrenching a joint

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Tearing a tendon or ligament

Breaking a bone

Exercising too vigorously.

Ans:

A, B, C Feedback: Muscle spasms often result from injury to the musculoskeletal system (e.g., overstretching a muscle, wrenching a joint, tearing a tendon or ligament). These injuries can cause violent and painful involuntary muscle contractions. Breaking a bone or exercising would not cause muscle spasms unless one of the other options was involved.

14. The nurse is giving discharge instructions to a patient who just had Botox A injections around her eyes. What adverse effects would the nurse include in her discharge instructions? (Select all that apply.) A)

Respiratory infections

Flu-like syndrome

Droopy eyelids

Cough

Diarrhea

Ans:

A, B, C Feedback: Adverse effects associated with use of botulinum toxin type A for cosmetic purposes include headache, respiratory infections, flu-like syndrome, and droopy eyelids in severe cases. Adverse effects do not include cough or diarrhea.

15. A patient with severe spasticity sees his physician. The physician orders dantrolene. In what circumstances is the drug dantrolene contraindicated? A)

Spasticity that contributes to upright position

Spasticity that involves both legs

Spasticity that involves the arm and the leg on the same side

Spasticity that contributes to mobility

Ans:

A Feedback: Dantrolene is contraindicated in the presence of any known allergy to the drug. It is also contraindicated in the following conditions: spasticity that contributes to locomotion,

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upright position, or increased function, which would be lost if that spasticity was blocked; active hepatic disease, which might interfere with metabolism of the drug and because of known liver toxicity; and lactation because the drug may cross into breast milk and cause adverse effects in the infant. The other options would not contraindicate the medication. 16. Which muscle relaxant was found to be embryotoxic in animal studies? A)

Carisoprodol (Soma)

Botulinum toxin A (Botox)

Cyclobenzaprine (Flexeril)

Dantrolene (Dantrium)

Ans:

D Feedback: Dantrolene crosses the placenta and was found to be embryotoxic in animal studies. Botulinum toxin A, carisoprodol, and cyclobenzaprine are not known to be embryotoxic.

17. When spinal reflexes involve synapses with interneurons within the spinal cord, what physiological adjustments are made? A)

Coordinate movement and position

Adjust response and recovery

Adjust to upright position

Coordinate balance

Ans:

A Feedback: Other spinal reflexes may involve synapses with interneurons within the spinal cord, which adjust movement and response based on information from higher brain centers to coordinate movement and position. Spinal reflexes do not adjust response and recovery, adjust the body to the upright position, or coordinate balance.

18. What are the simplest nerve pathways in the body? A)

Arc reflexes

Spinal reflexes

Afferent nerve reflexes

Spindle gamma loop

Ans:

B Feedback:

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The spinal reflexes are the simplest nerve pathways that monitor movement and posture. Arc reflexes and afferent nerve reflexes are distracters for this question. Spindle gamma loops respond to stretch receptors. 19. The anatomy and physiology instructor is discussing reflex systems with the prenursing class. What system would the instructor say causes a muscle fiber contraction that relieves the stretch? A)

Arch reflex system

Spinal reflex system

Spindle gamma loop system

Stretch receptor system

Ans:

C Feedback: A spindle gamma loop system responds to stretch receptors or spindles on muscle fibers to cause a muscle fiber contraction that relieves the stretch. In this system, nerves from stretch receptors form a synapse with gamma nerves in the spinal cord, which send an impulse to the stretched muscle fibers to stimulate their contraction. These reflexes are responsible for maintaining muscle tone and keeping an upright position against the pull of gravity and are important in helping venous return when the contracting muscle fibers massage veins to help move the blood toward the heart. The arch reflex system and the stretch receptor system are distracters for this question. The spinal reflex system is not the reflex systems that respond to stretch receptors in the body.

20. A 3-year-old girl with a diagnosis of spasticity caused by cerebral palsy has been admitted to the unit. The physician has ordered dantrolene to see if it relieves the spasticity in the childs arms and hands. The nurse would schedule this child for what routine screenings? A)

Central nervous system and gastrointestinal (GI) function

Respiratory and cardiovascular (CV) function

Growth and development

Renal and hepatic function

Ans:

A Feedback: Children prescribed dantrolene should be routinely and regularly screened for central nervous system and gastrointestinal (including hepatic) toxicity. Growth and development should be routinely screened in all children. Renal, respiratory, and CV screening is not indicated.

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21. A patient is admitted to the unit with central spasticity after a terrible motor vehicle accident. The doctor places an intrathecal delivery pump. What medication can be administered via this route to treat the central spasticity? A)

Baclofen (Lioresal)

Cyclobenzaprine (Flexeril)

Dantrolene (Dantrium)

Carisoprodol (Soma)

Ans:

A Feedback: Baclofen is available in oral and intrathecal forms and can be administered via a delivery pump for the treatment of central spasticity. Flexeril, dantrolene, and Soma are not administered intrathecally.

22. Baclofen is a prototype drug for the centrally acting skeletal muscle relaxants. What adverse effects do drugs in this class have? (Select all that apply.) A)

Coronary artery disease

Hypotension

Urinary frequency

Dizziness

Bone marrow suppression

Ans:

B, C, D Feedback: Adverse effects include transient drowsiness, dizziness, weakness, fatigue, constipation, headache, insomnia, hypotension, nausea, and urinary frequency. Bone marrow suppression and coronary artery disease are not associated with therapy involving these drugs.

23. When caring for a patient taking dantrolene, what adverse effects would the nurse monitor for? (Select all that apply.) A)

Bradycardia

Hepatitis

Urinary retention

Fatigue

Rash

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Ans:

B, D, E Feedback: Adverse effects of dantrolene include drowsiness, dizziness, weakness, fatigue, diarrhea, hepatitis, myalgia, tachycardia, transient blood pressure changes, rash, and urinary frequency. Adverse effects of dantrolene do not include bradycardia or urinary retention.

24. The nurse is caring for a patient who is having a pump placed to deliver intrathecal baclofen and another patient who will receive dantrolene as a muscle relaxant. What nursing diagnosis would be appropriate for both care plans? (Select all that apply.) A)

Acute pain related to GI effects of drug

Risk for injury related to central nervous system (CNS) effects

Disturbed body image related to muscle pain

Disturbed thought processes related to CNS effects

Deficient knowledge related to procedure

Ans:

A, B, D Feedback: Acute pain related to GI effects of drug, risk for injury related to CNS effects, and disturbed thought processes related to CNS effects all apply to both patients. Disturbed body image may apply to the patient having the pump placed, but this is not related to muscle pain. Only the patient having the pump placed would need information related to the procedure.

25. The nurse is caring for a patient who is being discharged home from the rehabilitation unit. Baclofen will be discontinued and the patient will begin taking carisoprodol as an outpatient. What is the nurses primary consideration about discontinuing administration of baclofen? A)

Taper drug over 72 hours to reduce dependence on the drug.

Alternate doses of baclofen and soma over 10 days to prevent drug withdrawal.

Taper drug slowly over 1 to 2 weeks to prevent psychoses and hallucinations.

Start carisoprodol immediately while continuing baclofen at full dose to establish carisoprodol level.

Ans:

C Feedback: If using baclofen, taper drug slowly over 1 to 2 weeks to prevent the development of psychoses and hallucinations. Giving both drugs at once would risk toxicity and serious adverse effects and would never be done.

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26. The nurse is caring for a patient receiving intrathecal baclofen via pump while participating in rigorous rehabilitation therapy. What is the nurses priority to monitor related to adverse effects of this drug? A)

Blood pressure

Pulse pressure

Spasticity

Respiratory status

Ans:

D Feedback: The priority to monitor is respiratory status. One of the primary adverse effects of this drug is central nervous system (CNS) depression. If the patient receives too much medication, or reaches toxic levels, respiratory rate will decline as the result of excessive CNS depression and the drug dosage will either be adjusted downward or the drug may be held until the patients respirations improve. Monitoring other vital signs including blood pressure and pulse is indicated but is not the priority.

27. A patient has been diagnosed with multiple sclerosis and experiences spasticity in several muscle groups. What drug would the nurse anticipate will be ordered as the drug of choice to manage spasticity associated with neuromuscular diseases? A)

Dantrolene (Dantrium)

Baclofen (Lioresal)

Carisoprodol (Soma)

Botulinum toxin type B (Myobloc)

Ans:

A Feedback: Dantrolene directly affects peripheral muscle contraction, and has become important in the management of spasticity associated with neuromuscular diseases. Baclofen, carisoprodol, and botulinum toxin type B are not the drugs of choice for management of spasticity in neuromuscular disease.

28. The nurse is caring for a patient taking dantrolene. How would the nurse assess the therapeutic effects of this drug? A)

Observe the patient when emotionally stressed to assess for exacerbation of spasticity.

Discontinue the drug for 2 to 4 days and assess for exacerbation of spasticity.

Measure the amount of spasticity before and after administration of medication.

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Collect a thorough history to ask the patient any improvement has been noticed.

Ans:

B Feedback: Periodically discontinue drug for 2 to 4 days to monitor therapeutic effectiveness. A clinical impression of exacerbation of spasticity indicates a positive therapeutic effect and justifies continued use of the drug. It would not be ethical to stress the patient, there is no known measurement of spasticity, and the patient may not be able to relate how much improvement was felt because it is unlikely all spasticity will be eliminated.

29. What drug would the nurse expect to administer to the patient experiencing malignant hyperthermia? A)

Orphenadrine

Metaxalone

Chlorzoxazone

Dantrolene

Ans:

D Feedback: Indications for dantrolene include control of clinical spasticity resulting from upper motor neuron disorders; preoperatively to prevent or attenuate the development of malignant hyperthermia in susceptible patients; IV for management of fulminant malignant hyperthermia. The other drugs are not indicated for treatment of malignant hyperthermia.

30. What part of the brain does the nurse recognize the patient is using when making precise, intentional movements? A)

Pyramidal tract

Substantia nigra

Brocas area

Extrapyramidal tract

Ans:

A Feedback: Upper-level controls of muscle activity include the pyramidal tract in the cerebellum, which regulates precise intentional muscle movement, and the extrapyramidal tract in the cerebellum and basal ganglia, which coordinates crude movements related to unconscious muscle activity. Brocas area has to do with speech, not movement. The substantia nigra does not control muscle movement.

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31. The patient reports pain caused by muscle spasms in his back. The nurse assesses the patient as being very anxious and notes how the anxiety results in tensing of muscles. What medication would be most effective in treating this patient? A)

Baclofen (Lioresal)

Botulinum toxin type B (Myobloc)

Dantrolene (Dantrium)

Diazepam (Valium)

Ans:

D Feedback: Adults complaining of muscle spasm pain that may be related to anxiety often respond very effectively to diazepam, which is a muscle relaxant and anxiolytic. Although many drugs, including baclofen, will treat the muscle spasm, diazepam also reduces anxiety. Dantrolene would be better indicated for spasticity than for spasm and botulinum toxin type B is not prescribed for either anxiety or muscle spasm.

32. What is the drug of choice for an older adult or a patient with hepatic or renal impairment? A)

Baclofen

Carisoprodol

Chlorzoxazone

Cyclobenzaprine

Ans:

B Feedback: Carisoprodol is the centrally acting skeletal muscle relaxant of choice for older patients and for those with hepatic or renal impairment. Although the other options may be prescribed, older adults are more likely to experience the adverse effects associated with the drug.

33. After administering a centrally acting skeletal muscle relaxant, what other independent nursing measures might the nurse implement to relieve pain and reduce spasm? A)

Rest of the affected muscle

Application of cold

Physical therapy

Order of a nonsteroidal anti-inflammatory drug

Ans:

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Feedback: Other measures in addition to drugs should be used to alleviate muscle spasm and pain. The nurse can independently encourage rest of the affected muscle and provide heat applications to increase blood flow to the area to remove the pain-causing chemicals. 34. The nurse is caring for a patient with an infusing IV who is allowed noting by mouth due to a paralytic ileus. What centrally acting medication could the nurse administer to this patient? A)

Chlorzoxazone (Paraflex)

Carisoprodol (Soma)

Cyclobenzaprine (Flexeril)

Orphenadrine (Banflex)

Ans:

D Feedback: Only orphenadrine (Banflex) of these options can be given parenterally, either IV or intramuscularly. The other options are available for oral use only.

35. What is the maximum daily dose of cyclobenzaprine (Flexeril) the nurse can administer? A)

20 mg

30 mg

40 mg

60 mg

Ans:

D Feedback: The normal daily dosage of cyclobenzaprine is 10 mg taken orally t.i.d., and it can be increased to a maximum of 60 mg per day.

Chapter 36: Anti-inflammatory, Antipyretic, and Analgesic Agents MULTIPLE CHOICE 1. A nursing student asks the nurse to explain the role of cyclooxygenase-2 (COX-2) and its role in inflammation. The nurse will explain that COX-2 a. converts arachidonic acid into a chemical mediator for inflammation. b. directly causes vasodilation and increased capillary permeability.

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c. irritates the gastric mucosa to cause gastrointestinal upset. d. releases prostaglandins, which cause inflammation and pain in tissues. ANS: A COX-2 is an enzyme that converts arachidonic acid into prostaglandins and their products, and this synthesis causes pain and inflammation. They do not act directly to cause inflammation. COX-1 irritates the gastric mucosa. COX-2 synthesizes but does not release prostaglandins. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: dm 337 TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 2. A nursing student asks how nonsteroidal antiinflammatory drugs (NSAIDs) work to suppress inflammation and reduce pain. The nurse will explain that NSAIDs a. exert direct actions to cause relaxation of smooth muscle. b. inhibit cyclooxygenase that is necessary for prostaglandin synthesis. c. interfere with neuronal pathways associated with prostaglandin action. d. suppress prostaglandin activity by blocking tissue receptor sites. ANS: B NSAIDs act by inhibiting COX-1 and COX-2 to help block prostaglandin synthesis. They do not have direct action on tissues, nor do they interfere with chemical receptor sites or neuronal pathways. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: dm 337 TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 3. A patient is taking ibuprofen 400 mg every 4 hours to treat moderate arthritis pain and reports that it is less effective than before. What action will the nurse take? a. Counsel the patient to discuss a prescription NSAID with the provider. b. Recommend adding aspirin to increase the antiinflammatory effect. c. Suggest asking the provider about a short course of corticosteroids. d. Tell the patient to increase the dose to 800 mg every 4 hours. ANS: A The patient should discuss another NSAID with the provider if tolerance has developed to the

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over-the-counter NSAID. Patients should not take aspirin with NSAIDs because of the increased risk of bleeding and gastrointestinal upset. Steroids are not the drugs of choice for arthritis because of their side effects and are not used unless inflammation is severe. A prescription NSAID would be used prior to starting corticosteroids. Increasing the dose will increase side effects but may not increase desired effects. The maximum dose per day is 2400 mg, which would most likely be exceeded when increasing the dose to 800 mg every 4 hours. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 337 TOP: NURSING PROCESS: Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 4. A patient who is taking aspirin for arthritis pain asks the nurse why it also causes gastrointestinal upset. The nurse understands that this is because aspirin a. increases gastrointestinal secretions. b. increases hypersensitivity reactions. c. inhibits both COX-1 and COX-2. d. is an acidic compound. ANS: C Aspirin is a COX-1 and COX-2 inhibitor. COX-1 protects the stomach lining, so when it is inhibited, gastric upset occurs. Aspirin does not increase gastrointestinal secretions or hypersensitivity reactions. It is a weak acid. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: dm 337 TOP: NURSING PROCESS: N/A MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 5. A patient is taking aspirin to help prevent myocardial infarction and is experiencing moderate gastrointestinal upset. The nurse will contact the patients provider to discuss changing from aspirin to which drug? a. A COX-2 inhibitor b. Celecoxib (Celebrex) c. Enteric-coated aspirin d. Nabumetone (Relafen) ANS: C

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Aspirin is used to inhibit platelet aggregation to prevent cardiovascular accident and myocardial infarction. Patients taking aspirin for this purpose would not benefit from COX-2 inhibitors, since the COX-1 enzyme is responsible for inhibiting platelet aggregation. The patient should take enteric-coated aspirin to lessen the gastrointestinal distress. Celecoxib and nabumetone are both COX-2 inhibitors. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 339 TOP: NURSING PROCESS: Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 6. A patient who is 7 months pregnant and who has arthritis asks the nurse if she can take aspirin for pain. The nurse will tell her not to take aspirin for which reason? a. It can result in adverse effects on her fetus. b. It causes an increased risk of Reyes syndrome. c. It increases hemorrhage risk. d. It will cause increased gastrointestinal distress. ANS: A Patients should not take aspirin during the third trimester of pregnancy because it can cause premature closure of the ductus arteriosus in the fetus. It does not increase her risk of Reyes syndrome. Aspirin taken within a week of delivery will increase the risk of bleeding. It can cause gastrointestinal distress, but this is not the reason for caution. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 340 TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 7. The nurse is performing a health history on a patient who has arthritis. The patient reports tinnitus. Suspecting a drug adverse effect, the nurse will ask the patient about which medication? a. Aspirin (Bayer) b. Acetaminophen (Tylenol) c. Anakinra (Kineret) d. Prednisone (Deltasone) ANS: A

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Aspirin causes tinnitus at low toxicity levels. The nurse should question the patient about this medication. The other medications do not have this side effect. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 342 TOP: NURSING PROCESS: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 8. The nurse is teaching a patient about using high-dose aspirin to treat arthritis. What information will the nurse include when teaching this patient? a. A normal serum aspirin level is between 30 and 40 mg/dL. b. You may need to stop taking this drug a week prior to surgery. c. You will need to monitor aspirin levels if you are also taking warfarin. d. Your stools may become dark, but this is a harmless side effect. ANS: B Aspirin should be discontinued prior to surgery to avoid prolonged bleeding time. A normal serum level is 15 to 30 mg/dL. Patients taking warfarin and aspirin will have increased amounts of warfarin, so the INR will need to be monitored. Tarry stools are a symptom of gastrointestinal bleeding and should be reported. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 342 TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 9. A patient who takes high-dose aspirin to treat rheumatoid arthritis has a serum salicylate level of 35 mg/dL. The nurse will perform which action? a. Assess the patient for tinnitus. b. Monitor the patient for signs of Reyes syndrome. c. Notify the provider of severe aspirin toxicity. d. Request an order for an increased aspirin dose. ANS: A Mild toxicity occurs at levels above 30 mg/dL, so the nurse should assess for signs of toxicity, such as tinnitus. This level will not increase the risk for Reyes syndrome. Severe toxicity occurs at levels greater than 50 mg/dL. The dose should not be increased.

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DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 342 TOP: NURSING PROCESS: Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 10. The nurse provides teaching for a patient who will begin taking indomethacin (Inderal) to treat rheumatoid arthritis. Which statement by the patient indicates a need for further teaching? a. I should limit sodium intake while taking this drug. b. I should take indomethacin on an empty stomach. c. I will need to check my blood pressure frequently. d. I will take the medication twice daily. ANS: B Indomethacin is very irritating to the stomach and should be taken with food. It can cause sodium retention and elevated blood pressure, so patients should limit sodium intake. The medication is taken twice daily. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 342 TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 11. The nurse is caring for a postpartum woman who is refusing opioid analgesics but is rating her pain as a 7 or 8 on a 10-point pain scale. The nurse will contact the provider to request an order for which analgesic medication? a. Diclofenac sodium (Voltaren) b. Ketoprofen (Orudis) c. Ketorolac (Toradol) d. Naproxyn (Naprosyn) ANS: C Ketorolac is the first injectable NSAID and has shown analgesic efficacy equal or superior to that of opioid analgesics. The other NSAIDs listed are not used for postoperative pain. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 342 TOP: NURSING PROCESS: Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

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12. A patient who has osteoarthritis with mild to moderate pain asks the nurse about taking overthe-counter ibuprofen (Motrin). What will the nurse tell this patient? a. It may take several weeks to achieve therapeutic effects. b. Unlike aspirin, there is no increased risk of bleeding with ibuprofen. c. Take ibuprofen twice daily for maximum analgesic benefit. d. Combine ibuprofen with acetaminophen for best effect. ANS: A OTC NSAIDs can be effective for mild to moderate arthritis pain, but the effects may not appear for several weeks. NSAIDs carry a risk for bleeding. Ibuprofen is taken every 4 hours or QID. Ibuprofen should not be combined with aspirin or acetaminophen. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 343 TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 13. The nurse is caring for a patient who has been taking an NSAID for 4 weeks for osteoarthritis. The patient reports decreased pain, but the nurse notes continued swelling of the affected joints. The nurse will perform which action? a. Assess the patient for drug-seeking behaviors. b. Notify the provider that the drug is not effective. c. Reassure the patient that swelling will decrease eventually. d. Remind the patient that this drug is given for pain only. ANS: B This medication is effective for both pain and swelling. After 4 weeks, there should be some decrease in swelling, so the nurse should report that this medication is ineffective. There is no indication that this patient is seeking an opioid analgesic. The drug should be effective within several weeks. NSAIDs are given for pain and swelling. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 337 TOP: NURSING PROCESS: Evaluation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 14. The nurse is discussing celecoxib (Celebrex) with a patient who will use the drug to treat dysmenorrhea. What information will the nurse include in teaching?

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a. Do not take the medication during the first 2 days of your period. b. The initial dose will be twice the amount of subsequent doses. c. Take this medication with food to minimize gastrointestinal upset. d. Take the drug on a regular basis to prevent dysmenorrhea. ANS: B The initial dose of Celebrex is twice that of subsequent doses. The medication should not be taken just before a period. It does not need to be taken with food. It is taken as needed. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 345 TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 15. The nurse is caring for a patient who has rheumatoid arthritis and who is receiving infliximab (Remicade) IV every 8 weeks. Which laboratory test will the nurse anticipate that this patient will need? a. Calcium level b. Complete blood count c. Electrolytes d. Potassium ANS: B Infliximab is an immunomodulator and can cause agranulocytosis, so patients should have regular CBC evaluation. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 347 TOP: NURSING PROCESS: Planning MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 16. The nurse is teaching a patient about taking colchicine to treat gout. What information will the nurse include when teaching this patient about this drug? a. Avoid all alcohol except beer. b. Include salmon in the diet. c. Increase fluid intake. d. Take on an empty stomach. ANS: C

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The patient who is taking colchicine should increase fluid intake to promote uric acid excretion and prevent renal calculi. Foods rich in purine should be avoided, including beer, and some sea foods, such as salmon. Gastric irritation is a common problem, so colchicine should be taken with food. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 348 TOP: NURSING PROCESS: Planning/Nursing Intervention: Patient Teaching MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 17. Which antigout medication is used to treat chronic tophaceous gout? a. Allopurinol (Zyloprim) b. Colchicine c. Probenecid (Benemid) d. Sulfinpyrazone (Anturane) ANS: A Allopurinol inhibits the biosynthesis of uric acid and is used long-term to manage chronic gout. Colchicine does not inhibit uric acid synthesis or promote uric acid secretion and is not used for chronic gout. Probenecid can be used for chronic gout but is not the first choice. Sulfinpyrazone has many serious side effects. DIF: COGNITIVE LEVEL: Remembering (Knowledge) REF: dm 348 TOP: NURSING PROCESS: Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 18. The nurse is assessing a patient who has gout who will begin taking allopurinol (Zyloprim). The nurse reviews the patients medical record and will be concerned about which laboratory result? a. Elevated BUN and creatinine b. Increased serum uric acid c. Slight increase in the white blood count d. Increased serum glucose ANS: A Antigout drugs are excreted via the kidneys, so patients should have adequate renal function.

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DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 348 TOP: NURSING PROCESS: Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 19. The nurse provides teaching for a patient who will begin taking allopurinol. Which statement by the patient indicates understanding of the teaching? a. I should increase my vitamin C intake. b. I will get yearly eye exams. c. I will increase my protein intake. d. I will limit fluids to prevent edema. ANS: B Patients taking allopurinol can have visual changes with prolonged use and should have yearly eye exams. It is not necessary to increase vitamin C. Protein can increase purine intake, which is not recommended. Patients should consume extra fluids. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 348 TOP: NURSING PROCESS: Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies MULTIPLE RESPONSE 1. Which are characteristic signs of inflammation? (Select all that apply.) a. Edema b. Erythema c. Heat d. Numbness e. Pallor f. Paresthesia ANS: A, B, C Edema, erythema, and heat are signs of inflammation. The other three are signs of neurocirculatory compromise. DIF: COGNITIVE LEVEL: Remembering (Knowledge) REF: dm 337 TOP: NURSING PROCESS: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

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Test Bank MULTIPLE CHOICE 1. A nursing student asks the nurse to explain the role of cyclooxygenase-2 (COX-2) and its role in inflammation. The nurse will explain that COX-2 a. converts arachidonic acid into a chemical mediator for inflammation. b. directly causes vasodilation and increased capillary permeability. c. irritates the gastric mucosa to cause gastrointestinal upset. d. releases prostaglandins, which cause inflammation and pain in tissues. ANS: A COX-2 is an enzyme that converts arachidonic acid into prostaglandins and their products, and this synthesis causes pain and inflammation. They do not act directly to cause inflammation. COX-1 irritates the gastric mucosa. COX-2 synthesizes but does not release prostaglandins. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: dm 337 TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 2. A nursing student asks how nonsteroidal antiinflammatory drugs (NSAIDs) work to suppress inflammation and reduce pain. The nurse will explain that NSAIDs a. exert direct actions to cause relaxation of smooth muscle. b. inhibit cyclooxygenase that is necessary for prostaglandin synthesis. c. interfere with neuronal pathways associated with prostaglandin action. d. suppress prostaglandin activity by blocking tissue receptor sites. ANS: B NSAIDs act by inhibiting COX-1 and COX-2 to help block prostaglandin synthesis. They do not have direct action on tissues, nor do they interfere with chemical receptor sites or neuronal pathways. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: dm 337 TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

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3. A patient is taking ibuprofen 400 mg every 4 hours to treat moderate arthritis pain and reports that it is less effective than before. What action will the nurse take? a. Counsel the patient to discuss a prescription NSAID with the provider. b. Recommend adding aspirin to increase the antiinflammatory effect. c. Suggest asking the provider about a short course of corticosteroids. d. Tell the patient to increase the dose to 800 mg every 4 hours. ANS: A The patient should discuss another NSAID with the provider if tolerance has developed to the over-the-counter NSAID. Patients should not take aspirin with NSAIDs because of the increased risk of bleeding and gastrointestinal upset. Steroids are not the drugs of choice for arthritis because of their side effects and are not used unless inflammation is severe. A prescription NSAID would be used prior to starting corticosteroids. Increasing the dose will increase side effects but may not increase desired effects. The maximum dose per day is 2400 mg, which would most likely be exceeded when increasing the dose to 800 mg every 4 hours. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 337 TOP: NURSING PROCESS: Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 4. A patient who is taking aspirin for arthritis pain asks the nurse why it also causes gastrointestinal upset. The nurse understands that this is because aspirin a. increases gastrointestinal secretions. b. increases hypersensitivity reactions. c. inhibits both COX-1 and COX-2. d. is an acidic compound. ANS: C Aspirin is a COX-1 and COX-2 inhibitor. COX-1 protects the stomach lining, so when it is inhibited, gastric upset occurs. Aspirin does not increase gastrointestinal secretions or hypersensitivity reactions. It is a weak acid. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: dm 337 TOP: NURSING PROCESS: N/A MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

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5. A patient is taking aspirin to help prevent myocardial infarction and is experiencing moderate gastrointestinal upset. The nurse will contact the patients provider to discuss changing from aspirin to which drug? a. A COX-2 inhibitor b. Celecoxib (Celebrex) c. Enteric-coated aspirin d. Nabumetone (Relafen) ANS: C Aspirin is used to inhibit platelet aggregation to prevent cardiovascular accident and myocardial infarction. Patients taking aspirin for this purpose would not benefit from COX-2 inhibitors, since the COX-1 enzyme is responsible for inhibiting platelet aggregation. The patient should take enteric-coated aspirin to lessen the gastrointestinal distress. Celecoxib and nabumetone are both COX-2 inhibitors. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 339 TOP: NURSING PROCESS: Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 6. A patient who is 7 months pregnant and who has arthritis asks the nurse if she can take aspirin for pain. The nurse will tell her not to take aspirin for which reason? a. It can result in adverse effects on her fetus. b. It causes an increased risk of Reyes syndrome. c. It increases hemorrhage risk. d. It will cause increased gastrointestinal distress. ANS: A Patients should not take aspirin during the third trimester of pregnancy because it can cause premature closure of the ductus arteriosus in the fetus. It does not increase her risk of Reyes syndrome. Aspirin taken within a week of delivery will increase the risk of bleeding. It can cause gastrointestinal distress, but this is not the reason for caution. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 340 TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

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7. The nurse is performing a health history on a patient who has arthritis. The patient reports tinnitus. Suspecting a drug adverse effect, the nurse will ask the patient about which medication? a. Aspirin (Bayer) b. Acetaminophen (Tylenol) c. Anakinra (Kineret) d. Prednisone (Deltasone) ANS: A Aspirin causes tinnitus at low toxicity levels. The nurse should question the patient about this medication. The other medications do not have this side effect. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 342 TOP: NURSING PROCESS: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 8. The nurse is teaching a patient about using high-dose aspirin to treat arthritis. What information will the nurse include when teaching this patient? a. A normal serum aspirin level is between 30 and 40 mg/dL. b. You may need to stop taking this drug a week prior to surgery. c. You will need to monitor aspirin levels if you are also taking warfarin. d. Your stools may become dark, but this is a harmless side effect. ANS: B Aspirin should be discontinued prior to surgery to avoid prolonged bleeding time. A normal serum level is 15 to 30 mg/dL. Patients taking warfarin and aspirin will have increased amounts of warfarin, so the INR will need to be monitored. Tarry stools are a symptom of gastrointestinal bleeding and should be reported. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 342 TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 9. A patient who takes high-dose aspirin to treat rheumatoid arthritis has a serum salicylate level of 35 mg/dL. The nurse will perform which action? a. Assess the patient for tinnitus. b. Monitor the patient for signs of Reyes syndrome.

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c. Notify the provider of severe aspirin toxicity. d. Request an order for an increased aspirin dose. ANS: A Mild toxicity occurs at levels above 30 mg/dL, so the nurse should assess for signs of toxicity, such as tinnitus. This level will not increase the risk for Reyes syndrome. Severe toxicity occurs at levels greater than 50 mg/dL. The dose should not be increased. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 342 TOP: NURSING PROCESS: Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 10. The nurse provides teaching for a patient who will begin taking indomethacin (Inderal) to treat rheumatoid arthritis. Which statement by the patient indicates a need for further teaching? a. I should limit sodium intake while taking this drug. b. I should take indomethacin on an empty stomach. c. I will need to check my blood pressure frequently. d. I will take the medication twice daily. ANS: B Indomethacin is very irritating to the stomach and should be taken with food. It can cause sodium retention and elevated blood pressure, so patients should limit sodium intake. The medication is taken twice daily. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 342 TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 11. The nurse is caring for a postpartum woman who is refusing opioid analgesics but is rating her pain as a 7 or 8 on a 10-point pain scale. The nurse will contact the provider to request an order for which analgesic medication? a. Diclofenac sodium (Voltaren) b. Ketoprofen (Orudis) c. Ketorolac (Toradol) d. Naproxyn (Naprosyn) ANS: C

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Ketorolac is the first injectable NSAID and has shown analgesic efficacy equal or superior to that of opioid analgesics. The other NSAIDs listed are not used for postoperative pain. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 342 TOP: NURSING PROCESS: Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 12. A patient who has osteoarthritis with mild to moderate pain asks the nurse about taking overthe-counter ibuprofen (Motrin). What will the nurse tell this patient? a. It may take several weeks to achieve therapeutic effects. b. Unlike aspirin, there is no increased risk of bleeding with ibuprofen. c. Take ibuprofen twice daily for maximum analgesic benefit. d. Combine ibuprofen with acetaminophen for best effect. ANS: A OTC NSAIDs can be effective for mild to moderate arthritis pain, but the effects may not appear for several weeks. NSAIDs carry a risk for bleeding. Ibuprofen is taken every 4 hours or QID. Ibuprofen should not be combined with aspirin or acetaminophen. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 343 TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 13. The nurse is caring for a patient who has been taking an NSAID for 4 weeks for osteoarthritis. The patient reports decreased pain, but the nurse notes continued swelling of the affected joints. The nurse will perform which action? a. Assess the patient for drug-seeking behaviors. b. Notify the provider that the drug is not effective. c. Reassure the patient that swelling will decrease eventually. d. Remind the patient that this drug is given for pain only. ANS: B This medication is effective for both pain and swelling. After 4 weeks, there should be some decrease in swelling, so the nurse should report that this medication is ineffective. There is no indication that this patient is seeking an opioid analgesic. The drug should be effective within several weeks. NSAIDs are given for pain and swelling.

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DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 337 TOP: NURSING PROCESS: Evaluation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 14. The nurse is discussing celecoxib (Celebrex) with a patient who will use the drug to treat dysmenorrhea. What information will the nurse include in teaching? a. Do not take the medication during the first 2 days of your period. b. The initial dose will be twice the amount of subsequent doses. c. Take this medication with food to minimize gastrointestinal upset. d. Take the drug on a regular basis to prevent dysmenorrhea. ANS: B The initial dose of Celebrex is twice that of subsequent doses. The medication should not be taken just before a period. It does not need to be taken with food. It is taken as needed. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 345 TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 15. The nurse is caring for a patient who has rheumatoid arthritis and who is receiving infliximab (Remicade) IV every 8 weeks. Which laboratory test will the nurse anticipate that this patient will need? a. Calcium level b. Complete blood count c. Electrolytes d. Potassium ANS: B Infliximab is an immunomodulator and can cause agranulocytosis, so patients should have regular CBC evaluation. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 347 TOP: NURSING PROCESS: Planning MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 16. The nurse is teaching a patient about taking colchicine to treat gout. What information will the nurse include when teaching this patient about this drug?

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a. Avoid all alcohol except beer. b. Include salmon in the diet. c. Increase fluid intake. d. Take on an empty stomach. ANS: C The patient who is taking colchicine should increase fluid intake to promote uric acid excretion and prevent renal calculi. Foods rich in purine should be avoided, including beer, and some sea foods, such as salmon. Gastric irritation is a common problem, so colchicine should be taken with food. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 348 TOP: NURSING PROCESS: Planning/Nursing Intervention: Patient Teaching MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 17. Which antigout medication is used to treat chronic tophaceous gout? a. Allopurinol (Zyloprim) b. Colchicine c. Probenecid (Benemid) d. Sulfinpyrazone (Anturane) ANS: A Allopurinol inhibits the biosynthesis of uric acid and is used long-term to manage chronic gout. Colchicine does not inhibit uric acid synthesis or promote uric acid secretion and is not used for chronic gout. Probenecid can be used for chronic gout but is not the first choice. Sulfinpyrazone has many serious side effects. DIF: COGNITIVE LEVEL: Remembering (Knowledge) REF: dm 348 TOP: NURSING PROCESS: Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 18. The nurse is assessing a patient who has gout who will begin taking allopurinol (Zyloprim). The nurse reviews the patients medical record and will be concerned about which laboratory result? a. Elevated BUN and creatinine b. Increased serum uric acid

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c. Slight increase in the white blood count d. Increased serum glucose ANS: A Antigout drugs are excreted via the kidneys, so patients should have adequate renal function. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 348 TOP: NURSING PROCESS: Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 19. The nurse provides teaching for a patient who will begin taking allopurinol. Which statement by the patient indicates understanding of the teaching? a. I should increase my vitamin C intake. b. I will get yearly eye exams. c. I will increase my protein intake. d. I will limit fluids to prevent edema. ANS: B Patients taking allopurinol can have visual changes with prolonged use and should have yearly eye exams. It is not necessary to increase vitamin C. Protein can increase purine intake, which is not recommended. Patients should consume extra fluids. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 348 TOP: NURSING PROCESS: Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies MULTIPLE RESPONSE 1. Which are characteristic signs of inflammation? (Select all that apply.) a. Edema b. Erythema c. Heat d. Numbness e. Pallor f. Paresthesia ANS: A, B, C

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Edema, erythema, and heat are signs of inflammation. The other three are signs of neurocirculatory compromise.

Chapter 37: Principles of Antimicrobial Therapy 1. A patient asks the nurse how an anti-infective produces a therapeutic effect. What key point will the nurse explain to this patient? A)

Drugs used to treat infections date back to the 17th century.

All anti-infectives work in the same way to destroy organisms.

Selective toxicity determines the appropriate drug dosage needed.

The goal of anti-infectives is to interfere with normal functioning of the organism.

Ans:

D Feedback: The goal of anti-infectives is to interfere with the normal function of the invading organism to prevent it from reproducing and to cause cell death without affecting host cells. Each class of anti-infectives works in a different way, but all have the same goal. Because bacteria cells have a slightly different composition than human cells, the bacteria are destroyed without interfering with the host. The first drugs used to treat systemic infections were developed in the early 20th century. The term selective toxicity refers to the ability to affect certain proteins or enzyme systems that are used by infecting organisms, but not by human cells.

2. The nursing student learns about anti-infectives in class and demonstrates the need to study more when making what statement about how anti-infectives work? A)

Some anti-infectives interfere with biosynthesis of the pathogens cell wall.

Some anti-infectives prevent the cells of the organism from using essential substances.

Many anti-infectives interfere with the steps involved in protein synthesis.

Some anti-infectives interfere with ribonucleic acid (RNA) synthesis in the cell leading to cell death.

Ans:

D Feedback: Some anti-infectives interfere with deoxyribonucleic acid (DNA) synthesis, not RNA synthesis, in the cell, leading to inability to divide and causing cell death. The fluoroquinolones work in this way. The other three options are correct and would not indicate the need for further study time. Penicillins interfere with biosynthesis of the cell

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wall, sulfonamides prevent organisms from using substances essential to their growth and development, whereas aminoglycosides, macrolides, and chloramphenicol interfere with protein synthesis. 3. The nurse administers a drug to treat Neisseria gonorrhoeae that works on no other bacteria. How would the nurse describe this drug? A)

Broad spectrum

Narrow spectrum

Bactericidal

Bacteriostatic

Ans:

B Feedback: Without knowing the name of the antibiotic and how it works to treat N. gonorrhoeae, the only thing that can be said is that it is a narrow-spectrum anti-infective because it only treats one specific organism. Broad-spectrum anti-infectives treat multiple organisms. The name of the drug and how it works would need to be known to determine whether it is bacteriocidal or bacteriostatic.

4. The nurse has provided patient teaching for a patient who will be discharged to home on an anti-infective. What statement made by the patient indicates the nurse needs to provide additional teaching concerning the use of anti-infectives? A)

Antibiotics will not help me when I have a viral infection.

A bacterial culture will be done before antibiotics are prescribed for me.

I could develop diarrhea as a result of taking an antibiotic.

I will stop taking the antibiotic as soon as I feel better.

Ans:

D Feedback: Compliance with anti-infective therapy is a concern. Patients tend to stop taking the drugs when they begin to feel better. A nurse should instruct the patient to take the entire course of prescribed drug to ensure a sufficient period to rid the body of pathogens and to help prevent the development of resistance. Antibiotics are not prescribed for viral infections. It is important that cultures be performed before antibiotics are prescribed to determine what organism is causing the infection so that the correct drug is prescribed. Diarrhea is the most common adverse effect from anti-infectives.

5. The nurse attends a class on preventing resistance to anti-infectives and learns that the critical concept in preventing the development of resistant strains of microbes is what? A)

Exposure of pathogens to an antimicrobial agent without cellular death

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Drug dosages that are below a therapeutic level

The duration of drug use

Frequency of drug ingestion

Ans:

C Feedback: Exposure of pathogens to an antimicrobial agent without cellular death leads to the development of resistance so it is important to limit the use of these agents to treat pathogens with a known sensitivity to the drug being used. Drug dosages are also important in preventing the development of resistance. However, the duration of drug use is critical to ensure that microbes are completely eliminated and not given the chance to grow and develop resistant strains. It is hard to convince patients that they must always complete the entire course of antimicrobial agents when they begin to feel better, because stopping early favors the emergence of drug-resistant strains.

6. The pathophysiology class is learning how microorganisms develop resistance to antiinfective drugs. What is one way the nursing students would learn that microorganisms develop resistance to anti-infective drugs? A)

By rearranging their deoxyribonucleic acid (DNA) to produce membranes that are permeable to the drug

By producing an enzyme that stimulates the drug

By changing the cellular membrane to allow the drug entry into the cell

By altering binding sites on the membrane or ribosomes so that the drug cannot enter the cell

Ans:

D Feedback: Microorganisms have developed resistance by changing cellular permeability to prevent the drug from entering the cell by altering binding sites on the membranes or on ribosomes so the drug can no longer be accepted and by producing enzymes that deactivate the drug. Microorganisms have not been found to be able to rearrange their DNA to change their membrane structure.

7. The nurse, writing a care plan for a patient on an aminoglycoside, includes what intervention to reduce the accumulation of the drug in the kidney? A)

Avoid caffeine intake.

Increase fluids.

Decrease activity.

Increase consumption of fruits and vegetables.

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Ans:

B Feedback: To prevent the accumulation of anti-infective drugs in the kidneys, which can damage the kidney, patients taking anti-infective drugs should be well hydrated. Decreasing the dosage will likely reduce the therapeutic action and increase risk of resistance. There is no evidence of association between caffeine intake and drug accumulation in the kidney. Decreasing activity and increasing fruits and vegetables in the diet would not be effective in decreasing drug accumulation.

8. When conducting patient teaching about using antibiotic medications, what is it critical for the nurse to include to help stop the development of resistant strains of microorganisms? A)

Antibiotics should be used quickly to treat colds and other viral infections before the invading organism has a chance to multiply.

Antibiotic dosage should be reduced and used for shorter periods of time to reduce unnecessary exposure to the drug.

Prescriptions for antibiotics should be readily available so they can be filled as soon as patients suspect they have an infection.

It is very important to take the full course of an antibiotic as prescribed and not save remaining drugs for future infections.

Ans:

D Feedback: Teaching patients to take the full course of their antibiotic as prescribed can help to decrease the number of drug-resistant strains. Antibiotics should only be used to treat bacterial infections that have been cultured to identify the antibiotic sensitivity and then patients should be instructed to use the antibiotic for the prescribed course, which will help to eliminate drug-resistant strains. Reducing dosage and time intervals increases the chance for drug resistance because anti-infectives are most effective when taken exactly as indicated.

9. A patient is told that he or she will have to undergo extensive dental surgery. The dentist prescribes a course of antibiotic therapy before beginning the procedures and continuing for 5 days after the procedure. What is this is an example of? A)

Chemotherapy

Curative treatment

Prophylaxis

Synergism

Ans:

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Feedback: In a situation where an infection is likely to occur, antibiotics can be used to prevent it. This is called prophylaxis. Synergism is using two antibiotics at the same time to improve their effectiveness. Chemotherapy is the use of drugs to destroy abnormal cells, usually cancer cells. Curative treatment involves treating an actual infection to promote a cure. 10. A patient is receiving meropenem (Merrem IV). What drug-related reaction will the nurse assess for? A)

Gastrointestinal toxicity

Hepatic toxicity

Nephrotoxicity

Neurotoxicity

Ans:

A Feedback: This drug has been associated with potentially fatal pseudomembranous colitis, which affects the gastrointestinal tract. This drug is not associated with liver, kidney, or nerve toxicity.

11. A patient is admitted to the unit and the nurse assesses whether he or she is at increased risk for infection when what factors are determined? (Select all that apply.) A)

Malnutrition

Hypertension

Suppression of immune system

Advanced age

Decreased amylase levels

Ans:

A, C, D Feedback: Factors that suppress the host defense mechanisms include malnutrition, suppression of immune system, and advanced age. Hypertension does not predispose a person to infection neither does a decreased amylase level.

12. The nurse is caring for a patient receiving penicillin. The nurse knows this type of antibiotic works by what mechanism? A)

Inhibiting growth and development of the organism

Inhibiting protein synthesis

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Inhibiting cell wall biosynthesis

Stimulating bacterial reproduction

Ans:

C Feedback: Some anti-infectives interfere with biosynthesis of the bacterial cell wall. Because bacterial cells have a slightly different composition than human cells, this is an effective way to destroy the bacteria without interfering with the host (see Box 8.2). The penicillins work in this way. The sulfonamides inhibit growth and development of the organisms cells. Aminoglycosides, macrolides, and chloramphenicol interfere with protein synthesis. Fluoroquinolones interfere with synthesis of deoxyribonucleic acid, resulting in the inability to reproduce.

13. A nurse collects a culture sample of infected tissue. What does the result of testing the culture contribute to the patients care? A)

Identifies the specific organism causing the infection

Pinpoints the exact site of the infection

Identifies individualized patient factors contributing to infection

Describes the length of time the patient has experienced infection

Ans:

A Feedback: A culture is collected to identify the causative organism of an infection. It can help with determining the site of infection in some cases if the infection is limited only to the site where the culture is collected. It does not individualize patient factors contributing to infection. These must be determined through assessment. It cannot indicate how long the patient has had the infection, which is often determined by the white blood cell count and differential.

14. A patient calls the clinic to talk to the nurse. The patient states that he or she saw the physician last week and was prescribed penicillin for a strep throat. The patient goes on to say that they feel so much better they stopped taking the drug today, even though there are a few pills left. What is the nurses best response? A)

Okay, thank you for letting me know. I will document in your medical record that the treatment was effective.

It is important that you take all the medication so all the germs are killed. Otherwise they could come right back and be even stronger.

What you have described is the halo effect of the drug, making you feel better when you are still infected. Youll feel sick again when the drug is out of your system.

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You will need to come to the clinic and be evaluated by your physician to make sure the infection is really gone.

Ans:

B Feedback: The duration of drug use is critical to ensure that the microbes are completely, not partially, eliminated and are not given the chance to grow and develop resistant strains. The nurse must explain the importance of taking all of the prescribed medication and should not agree with the patient. This is not related to a halo effect and the patient may feel well until drug levels decrease rather than being completely eliminated from the body. The patient does not need to be seen if the infection is responding to treatment, but they must take the rest of the antibiotic.

15. When administering anti-infectives to patients, the nurse is aware of the risk for what potentially fatal adverse effect? A)

Gastrointestinal toxicity

Eighth cranial nerve damage

Anaphylaxis

Toxic effects on the kidney

Ans:

C Feedback: Anaphylaxis is an acute, systemic allergic response to a substance that can be fatal if medical intervention does not occur almost immediately because the airway closes due to tissue edema making it impossible to breathe. Gastrointestinal toxicity, hearing loss due to eighth cranial nerve damage and, toxic effects to the kidney are all adverse effects that may be seen with some anti-infectives. Although these adverse effects can be serious, they are not usually fatal.

16. A group of nursing students are giving a report on the emergence of drug-resistant microbial agents. What could the students cite as a good way to minimize the emergence of drug-resistant microbial agents? (Select all that apply.) A)

Avoid the use of broad-spectrum antibacterial drugs when treating trivial or viral infections.

Use narrow-spectrum agents if they are thought to be effective.

Do not use vancomycin unnecessarily.

Antibiotics are best started before the culture and sensitivity report returns.

Administer the smallest effective dosage available.

Ans:

A, B, C

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Feedback: Exposure to an antimicrobial agent leads to the development of resistance, so it is important to limit the use of antimicrobial agents to the treatment of specific pathogens known to be sensitive to the drug being used. Drug dosage is important in preventing the development of resistance. Doses should be high enough and the duration of drug therapy should be long enough to eradicate even slightly resistant microorganisms. It is best to wait until cultures return before initiating antibiotics when possible, but patients with severe infections may be started on broad -spectrum antibiotics while waiting for culture results. 17. The home care nurse is taking care of a patient on IV vancomycin for cellulitis of the left calf. How would the nurse explain how microorganisms develop resistance to antiinfective medications? A)

Microorganisms can alter the blood supply to the infection.

Microorganisms can stop the cell from reproducing.

Microorganisms produce a chemical that acts as an antagonist to the drug.

Microorganisms change their cell membrane to make it look like the drug.

Ans:

C Feedback: Microorganisms develop resistance in a number of ways, including the following: changing cellular permeability to prevent the drug from entering the cell or altering transport systems to exclude the drug from active transport into the cell; altering binding sites on the membranes or ribosomes, which then no longer accept the drug; and producing a chemical that acts as an antagonist to the drug. Microorganisms do not alter the blood supply to the infection, stop a cell from reproducing, or change the appearance of the cell membrane.

18. Overuse of anti-infective agents is known to contribute to the onset of superinfections in the body. What is a causative agent of a superinfection? A)

Escherichia coli

Probenecid

Protozoans

Pseudomonas

Ans:

D Feedback: Common superinfections include vaginal or gastrointestinal yeast infections, which are associated with antibiotic therapy, and infections caused by Proteus and Pseudomonas throughout the body, which are a result of broad-spectrum antibiotic use. Probenicid is a

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medication, not a causative organism. Protozoa and E. coli do not usually cause superinfections. 19. The pharmacology instructor is explaining combination drugs to the nursing class. The instructor tells the students that a combination of anti-infective agents may be used for several reasons. What is one of them? A)

Some drugs are synergistic.

Increased likelihood of killing the microorganisms

Requires larger doses of the drugs

Absorption of drugs increased

Ans:

A Feedback: Some drugs are synergistic, which means that they are more powerful when given in combination. The health care provider may be encouraged to use a smaller dosage of each drug, leading to fewer adverse effects, but still having a therapeutic impact on the pathogen. Many microbial infections are caused by more than one organism; each pathogen may react to a different anti-infective agent. Combination drugs do not have a better chance at killing the microorganism and they do not increase the absorption of the drugs.

20. Bactericidal agents do not prevent compounds fight infection and destroy microorganisms by inhibiting what? A)

Protein synthesis

Deoxyribonucleic acid (DNA) replication

Cell wall synthesis

Leukocytes

Ans:

A Feedback: Some anti-infectives are so active against the infective microorganisms that they actually cause the death of the cells they affect. These drugs are said to be bactericidal. Bactericidal action inhibits protein synthesis. Bacteriocidal agents do not prevent DNA replication , do not inhibit cell wall synthesis, and do not impact leukocytes.

21. The nurse is caring for a child who weighs 30 kg. The physician orders gentamicin (Garamycin) tid. The recommended dosage range is 6 to 7.5 mg/kg/day. Why is it important to give a dosage within this recommended range? (Select all that apply.) A)

To avoid toxic effects

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To protect other patients

To reduce the risk of drug-resistant organisms

To eradicate the bacteria

To promote lactic acid removal

Ans:

A, B, C, D Feedback: By administering the correct dosage, you avoid overdosage and reduce the risk of toxic effects. The correct dosage reduces the risk of creating drug-resistant organisms; it also protects both the patient and the other patients who might be susceptible to the drugresistant organisms as well. The proper dosage is needed to eradicate the bacteria. Lactic acid removal is not related to the proper dosage and is a distracter for this question.

22. The nurse is administering an anti-infective to a pediatric patient. What will the nurse assess for related to adverse effects in this patient? A)

Cardiovascular function and perfusion

Hydration and nutritional status

Liver and pancreatic function

Rest and sleep status

Ans:

B Feedback: Because children can have increased susceptibility to the gastrointestinal and nervous system effects of anti-infectives, monitor hydration and nutritional status carefully. Patients should be encouraged to drink fluids. Cardiovascular, hepatic, and pancreatic function are not at greater risk in children. Rest and sleep status are important but are not impacted by anti-infectives.

23. A parasitic infection is suspected. What type of culture is the nurse likely to collect? A)

Blood

Urine

Stool

Sputum

Ans:

C Feedback:

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When investigators search for parasitic sources of infection, the stool is examined for ova and parasites. Blood, urine, and sputum are unlikely to reflect signs of parasitic infection. 24. The nurse is caring for a patient receiving IV aminoglycosides for an intractable infection in his or her leg. What would it be important for the nurse to monitor this patient for? A)

Visual disturbances

Liver dysfunction

Serum glucose levels

Renal dysfunction

Ans:

D Feedback: When patients are taking aminoglycosides, it is important they be monitored closely for any sign of renal dysfunction. Aminoglycosides do not generally cause visual disturbances, liver dysfunction, or altered serum glucose levels.

25. The nurse collects the past medical history of a patient new to the clinic. The patient states he or she is allergic to penicillin. What would the nurse question next? (Select all that apply.) A)

What signs and symptoms were displayed with the reaction?

What treatment was required to control the allergic reaction?

How was the medication administered?

How many dosages were administered before the reaction occurred?

Had the medication ever been prescribed before the time when the reaction occurred?

Ans:

A, D, E Feedback: It is important to determine what the allergic reaction was and when the patient experienced it (e.g., after first use of drug, after years of use). If she had been prescribed this medication before with no reaction and then had a reaction the next time it was prescribed, this would be important information to know. Some patients report having a drug allergy, but closer investigation indicates that their reaction actually constituted an anticipated effect or a known adverse effect to the drug. It would not necessarily be important to find out what was done to stop the reaction or who the caregiver was at the time of the reaction or what type of allergic reaction it was.

26. A patient comes to the clinic to talk with the nurse about planned overseas travel. The patient tells the nurse that he or she is planning a trip to an area of the world where

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malaria is common. He wants to know how to prevent contracting the disease. What should the nurse respond? A)

We can ask the physician to give you some anti-infectives in case you get malaria.

We can ask the physician for some anti-infectives for you to take prophylactically.

Dont worry, if you get malaria they have some good doctors where you are going.

If you get malaria, you can always be treated on the way home.

Ans:

B Feedback: Some anti-infectives are used as a means of prophylaxis when patients expect to be in situations that will expose them to a known pathogen, such as travel to an area where malaria is endemic, or undergoing oral or invasive gastrointestinal surgery in a person who is susceptible to subacute bacterial endocarditis. After the patient contracts malaria, it is much harder to treat so he would not start the medication or obtain treatment after being infected.

27. The nurse is caring for a patient who is receiving a broad-spectrum anti-infective agents. The nurse would assess the patient for what common adverse effect of broad spectrum anti-infective agents? A)

Destruction of pathogens

Decrease in infection

Destruction of the normal flora

Decrease in inflammation

Ans:

C Feedback: One offshoot of the use of anti-infectives, especially broad-spectrum anti-infectives, is destruction of the normal flora resulting in superinfections. Destruction of pathogens is the therapeutic effect and not an adverse effect resulting in a decrease in infection. Inflammation is reduced by resolution of infection.

28. Selective toxicity, or the ability to affect certain proteins or enzyme systems in the infecting organism, is a much sought-after quality in an anti-infective agent. How many anti-infective agents have this quality? A)

75%

50%

25%

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Ans:

D Feedback: Although anti-infective agents target foreign organisms infecting the body of a human host, they do not possess selective toxicity, which is the ability to affect certain proteins or enzyme systems used by the infecting organism but not by human cells. Because all living cells are somewhat similar, however, no anti-infective drug has yet been developed that does not affect the host. Therefore Options A, B, and C are incorrect.

29. The nursing instructor teaches the students about selective toxicity when one of the students asks, What happens when a drug doesnt have selective toxicity? What is the instructors best response? A)

Healthy cells are damaged.

All pathogens are destroyed in the body.

Reduced enzymes are produced.

Protein malnutrition

Ans:

A Feedback: When a drug does not display selective toxicity, healthy cells are damaged because the drug does not specifically target only the pathogen. Anti-infectives work by a variety of different means so one drug is not likely to kill every type of pathogen in the body. Selective toxicity does not impact enzyme production or cause protein malnutrition.

30. The nursing instructor is talking with the students about anti-infective medication and explains that drugs that are very selective in their actions are said to be what? A)

Broad spectrum

Narrow spectrum

Bactericidal

Bacteriostatic

Ans:

B Feedback: Some anti-infectives are so selective in their action that they are effective against only a few, or possibly only one, microorganism with a very specific metabolic pathway or enzyme. These drugs are said to have a narrow spectrum of activity. They are not called broad spectrum, which applies to a drug with little selectivity; bactericidal, which is a substance that causes death of bacteria; or bacteriostatic, which prevents replication of a bacterium.

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31. The nurse administers polymyxin B to a patient with a gram-negative bacterial infection. What symptoms would cause the nurse to suspect drug fever, hold the medication, and call the health care provider immediately? (Select all that apply.) A)

Fever

Dizziness

Ataxia

Increased activity

Reduced urine output

Ans:

A, B, C, E Feedback: The actions of polymyxin B on cell membranes means it can be toxic to the human host, leading to nephrotoxicity, neurotoxicity (e.g., facial flushing, dizziness, ataxia, paresthesias, drowsiness), and drug-related fever and rash. This drug is reserved for infections that do not respond to less toxic drugs; the nurse needs to be alert for serious reactions and hold the drug until notifying the provider.

32. The charge nurse, working on a pediatric unit, sees an order was written to administer chloramphenicol (Chloromycetin) to one of the children assigned to a new graduate nurse. The charge nurse would make sure the new graduate was familiar with what possible adverse effects of this medication? (Select all that apply.) A)

Gray syndrome

Bone marrow depression

Aplastic anemia

Liver failure

Hearing loss

Ans:

A, B, C Feedback: Chloramphenicol (Chloromycetin), an older antibiotic, prevents bacterial cell division in susceptible bacteria. Because of the potential toxic effects of this drug, its use is limited to serious infections for which no other antibiotic is effective. Chloramphenicol produces a gray syndrome in neonates and premature babies, which is characterized by abdominal distention, pallid cyanosis, vasomotor collapse, irregular respirations, and even death. In addition, the drug may cause bone marrow depression, including aplastic anemia that can result in death. Liver failure and hearing loss are not usually associated with this drug.

33. The patient in the clinic receives a prescription for an anti-infective to treat a urinary tract infection. The patient asks the nurse, Would you ask the doctor to give me refills on this

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prescription? I get a urinary tract infection almost once a year it seems and Id like to have a refill I can store for the next time so I dont have to come back to the clinic. What is the nurses priority response? A)

Sure, Id be glad to ask. How many refills would you like to have?

Most medications, if not used, should be discarded after a year so it is better to get a new prescription next year when you need it.

This antibiotic doesnt destroy every pathogen that could cause a urinary tract infection so it is better to get the right antibiotic next time.

Saving antibiotics for another time and self-diagnosing when antibiotics are needed lead to resistant organisms that no longer respond to drugs.

Ans:

D Feedback: Option A is incorrect because the patient should not be given refills to use indiscriminately. The remaining options are all important teaching points for this patient, but the priority is teaching this patient about drug-resistant organisms and how they can be prevented, as well as what happens if an infection results from a resistant organism.

34. The nurse admits a patient with septicemia (i.e., infection in the bloodstream). The patient denies any allergies and the doctor has ordered cefuroxime based on blood culture results that report the active pathogen is susceptible to this drug. The patient asks what antibiotic was ordered, and when the nurse says cefuroxime, the patient says, Call my doctor and tell him I want vancomycin because Ive been reading about drug-resistant bacteria and I dont want to take any chances. What is the nurses best response? A)

Vancomycin is a powerful drug with many adverse effects and it is reserved for when no other drug will work against the infection.

There are some resistant infections that require vancomycin so you are right to prefer a stronger antibiotic.

I appreciate your concern but your doctor ordered the right medication for you so dont worry about it.

You cant believe anything you read on the Internet because most of it is just someones opinion and not fact.

Ans:

A Feedback: The patient is right in saying that vancomycin is effective against drug-resistant bacteria but needs help to understand that he or she does not have a resistant infection as indicated by the culture and sensitivity and that use of such a powerful drug when it is not needed increases risk of developing a vancomycin-resistant infection. It is never right to tell a patient not to worry because they have every right to participate in his or her own care

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and should not be patronized. Although some information on the Internet may not be accurate, it would be incorrect to say it is all just someones opinion and not fact, especially given that the patients information is accurate. 35. The mother brings her 18-month-old toddler to the pediatrician because the child has a fever and has been tugging on his or her left ear. Examination of the tympanic membrane confirms an ear infection and the toddler also has a cold with nasal congestion, rhinorrhea, and a cough. The provider tells the mother to apply heat and gives her a prescription for an otic anesthetic to make the ear more comfortable until the infection resolves. The mother is not happy and says she wants a prescription for an antibiotic. What important teaching points will the nurse include in the teaching plan? (Select all that apply.) A)

Ear infections that accompany viral respiratory infections do not respond to antibiotics.

Habitual use of antibiotics for viral infections contribute to development of resistant strains.

Adverse effects from antibiotics in children can cause diarrhea and dehydration.

Antibiotics will only be prescribed if a culture indicates the presence of bacteria in the ear.

The pediatrician knows more than the mother and she should trust what she is being told.

Ans:

A, B, C Feedback: When the child has a viral respiratory infection, the organism involved in ear infections is usually viral as well. As a result, antibiotics will have no effect on the infection that will resolve independently and only comfort care is indicated. Habitual use of antibiotics for viral infections contributes to the development of resistant strains of bacteria and the adverse effects can make the child more uncomfortable causing diarrhea and dehydration. Cultures of ear fluid are almost never done because it would be an invasive procedure to remove fluid from the middle ear. It is never right for the nurse to patronize the mother, who has every right to advocate for her child, and it is more important she understand why the antibiotic is not being prescribed than telling her the pediatrician knows more.

Chapter 38: Cell Wall Inhibitors 1. A 32-year-old female patient is admitted to the floor with a superinfection. Her orders read tigecycline (Tygacil) 100 mg IV followed by 50 mg IV every 12 hours infused over 30 to 60 minutes for 5 days. What would be important for the nurse to educate this patient about? A)

Analgesics

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Antihistamines

Contraceptives

Decongestants

Ans:

C Feedback: Many antibiotics interfere with the effectiveness of oral contraceptives and unplanned pregnancies can occur. Women should be advised to use a barrier form of contraceptives when taking this drug. No known serious drugdrug interactions involve analgesics, antihistamines, or decongestants.

2. A patient with a gram-negative infection is being treated with an aminoglycoside. What system should the nurse expect to monitor closely while the patient is taking this medication? A)

Respiratory system

Ophthalmic system

Renal system

Musculoskeletal system

Ans:

C Feedback: Renal function should be tested daily because aminoglycosides depend on the kidney for excretion and if the glomerular filtration rate (GFR) is abnormal it may be toxic to the kidney. The results of the renal function testing could change the daily dosage. Aminoglycosides do not usually adversely affect respiratory, hepatic, or musculoskeletal function, although baseline data concerning these systems is always needed.

3. How would the nurse describe selective toxicity? A)

Selective toxicity interferes with a biochemical reaction common to many different organisms.

Selective toxicity will decrease invading bacteria by interfering with the pathogens ability to reproduce.

Selective toxicity will eliminate bacteria by interrupting protein synthesis and damaging the pathogens cell wall.

Selective toxicity is the ability of the drug to kill foreign cells without causing harm to ones own body cells.

Ans:

D Feedback:

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The choice of antibiotics in a clinical situation is determined by assessing which drug will affect the causative organism and lead to the fewest adverse effects. Selective toxicity is the ability of the drug to kill foreign cells without causing harm to the human body cells. How the antibiotic works to kill bacteria varies by drug type and may reduce the ability to reproduce, damage the cell wall, or interfere with a biochemical reaction, but this is a description of how the antibiotic works and does not describe selective toxicity 4. A local bioterrorism medical team is learning about germ warfare. The team is instructed that a fluoroquinolone may be used to prevent an outbreak of anthrax infection. What fluoroquinolone would the nurse be most likely to administer for this purpose? A)

Ciprofloxacin (Cipro)

Gemifloxacin (Factive)

Norfloxacin (Noroxin)

Sparfloxacin (Zagam)

Ans:

A Feedback: Ciprofloxacin (Cipro) is the most widely used fluoroquinolone and is indicated for the prevention of anthrax infection. Gemifloxacin and sparfloxacin are most useful in treating acute episodes of chronic bronchitis and community-acquired pneumonia. Norfloxacin is recommended only for certain types of urinary tract infections.

5. A clinic nurse is caring for a 66-pound child who has acute otitis media. The physician has ordered ceftibuten (Cedax) 9 mg/kg per day PO for 10 days. The drug comes in an oral suspension of 90 mg/5 mL. How many mL will the nurse administer? A)

5 mL

10 mL

15 mL

20 mL

Ans:

C Feedback: First, using the formula: 2.2 lb/1 kg = 66 lb/X kg, determine the childs weight in kg (66/2.2 = 30 kg). Next, determine the desired dose by using the formula: amount of prescribed drug times weight in kg (9 mg/kg times 30 kg = 270 mg). To determine the volume of medication to administer, use the formula: amount of drug available/volume available = amount of drug prescribed/volume to administer (90 mg/5 mL = 270 mg/X mL, 90mg/(X) = 1,350 mg/mL, X = 15 mL).

6. A 78-year-old woman, who lives alone and is forgetful, is being seen by her home health nurse. In reviewing the patients medication, the nurse discovers that the patient is taking

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Azithromycin (Zithromax) for urethritis. Why would this be a good choice of antibiotics for this patient? A)

The half-life of the drug is 3 to 7 hours.

It is taken only once a day.

It has very few adverse effects.

It can be given without consideration to drugdrug interactions.

Ans:

B Feedback: Given that the patient is forgetful and lives alone, a daily dose would likely promote improved compliance. Azithromycin can be administered once daily because the half-life is 68 hours. Azithromycin is associated with GI adverse effects and can cause pseudomembranous colitis; neurological symptoms can occur as well. Azithromycin (Zithromax) may adversely interact with cardiac glycosides, oral anticoagulants, theophyllines, carbamazepine, and corticosteroids to name a few agents.

7. A 12-year-old patient with a complicated skin infection has been admitted to the pediatric unit. The physician has ordered Ertapenem (Invanz). What is the nursing priority? A)

Transcribe the order to the medication administration record (MAR).

Perform hand hygiene before preparing the medication.

Assess the patients renal and hepatic functions.

Question the order by calling the physician who prescribed it.

Ans:

D Feedback: The nurse should call the physician and question the order Because this drug is not recommended for children younger than 18 years of age. Following clarification of the order, the drug would be transcribed and listed in the MAR. The nurse would then wash her hands before preparing the drug for administration. Assessment of renal and hepatic function is good practice before administering any medication but is not the nursing priority.

8. A 22-year-old female is diagnosed with mycobacterial tuberculosis. The physician orders rifampin (Rifadin) 600 mg PO daily. What should the nurse question the patient about? A)

Her diet

Sun exposure

Type of exercise she does

Use of contact lenses

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Ans:

D Feedback: Some antimycobacterial drugs can cause discoloration of body fluids. The orange tinged discoloration can cause permanent stain to contact lenses. The patient should avoid wearing them while on the antimycobacterial therapy. With antimycobacterial drugs there is not a concern is warranted about photosensitivity or exercise. However, due to the GI adverse effects, the nurse may want to discuss an appropriate diet if the patient experiences GI upset after beginning treatment.

9. The nurse is providing discharge teaching to a patient who is being sent home on oral tetracycline (Sumycin). What instructions should the nurse include? A)

Take the medication only once a day.

Check pulse rate and hold the drug if lower than 60 beats per minute (bpm).

Take the drug on an empty stomach.

Take the medication with 2 ounces of water.

Ans:

C Feedback: Tetracycline should be taken on an empty stomach 1 hour before or 2 hours after meals with a full 8 ounces of water to ensure full absorption. Tetracycline is usually taken at least once every 12 hours. Checking the pulse and holding the dose if below 60 bpm is an action specific to the use of cardiac glycosides.

10. A 28-year-old patient has been prescribed penicillin for the first time. What nursing diagnosis would be most appropriate for this patient? A)

Acute pain related to gastrointestinal (GI) effects of the drug

Deficient knowledge regarding drug therapy

Imbalance nutrition: less than body requirements related to multiple GI effects of the drug

Constipation

Ans:

B Feedback: Because this is the first time the patient has taken penicillin, she is likely to have limited knowledge about the drug. She may not understand the importance of taking the medication as ordered to increase effectiveness of the drug or to report adverse effects. because the patient has not started the drug yet, there is no way to know what adverse effects, if any, she will experience. Only if she develops acute pain related to GI effects of

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the drug would this be appropriate. If GI symptoms develop it may lead to imbalanced nutrition, but that remains to be seen. No indication about constipation exists. 11. The pharmacology instructor is discussing antimicrobials with the nursing class. What would the instructor tell the students about the mechanism of action of antimicrobials? (Select all that apply). A)

Preventing cell division

Causing cell death

Inhibiting cell wall synthesis

Causing leakage of cell wall allowing fluid to leak in

Inhibiting synthesis of ribonucleic acid (RNA)

Ans:

A, B, C Feedback: Sites of cellular action of carbapenems, ketolides, lincosamides, aztreonam, penicillins, sulfonamides, tetracyclines, and antimycobacterials. Carbapenems, ketolides, and lincosamides change protein function and prevent cell division or cause cell death. Aztreonam alters cell membranes to allow leakage of intracellular substances and causes cell death; it does not cause leakage of fluid into the cell. Penicillins prevent bacteria from building their cells during division. Sulfonamides inhibit folic acid synthesis for RNA and deoxyribonucleic acid production but does not inhibit RNA synthesis

12. The nurse is preparing to contact the physician for an antibiotic order for the patients infection. What information will the nurse be prepared to provide for the physician to choose the proper antibiotic? A)

First day of infection symptoms

Culture and sensitivity test results

The patients intake and output for past 2 days

Results of complete blood count with differential

Ans:

B Feedback: Antibiotics are best selected based on culture results that identify the type of organism causing the infection and sensitivity testing that shows what antibiotics are most effective in eliminating the bacteria. First day of symptoms of infection is likely already known if culture and sensitivity testing has been performed. Although measurement of intake and output is one indicator of renal function, a bloodureanitrogen test and assessment of creatinine levels would be better ways of assessing renal function, which will be used to determine dose of medication but not for selection of the correct antibiotic. The white

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blood cell count and differential would indicate the possibility of an infection but are not needed in choosing the proper antibiotic. 13. A nursing student asks the pharmacology instructor for ways to minimize the emergence of drug-resistant microbial agents. What would be an appropriate response by the instructor? (Select all that apply.) A)

Avoid the use of broad-spectrum antibacterial drugs when treating trivial or viral infections.

Use narrow-spectrum agents if they are thought to be effective.

Do not use vancomycin unnecessarily.

Prescribe antibiotics when the patient believes they are warranted.

Start the antibiotics, do culture and sensitivity tests, and provide patient education.

Ans:

A, B, C Feedback: To prevent or contain the growing threat of drug-resistant strains of bacteria, it is very important to use antibiotics cautiously, to complete the full course of an antibiotic prescription, and to avoid saving antibiotics for self-medication in the future. You would not give antibiotics every time the patient wants them, nor would you do a culture and sensitivity test after starting antibiotics. Therefore, Options D and E are incorrect.

14. A student asks the pharmacology instructor if there is a way to increase the benefits and decrease the risks of antibiotic therapy. What would be an appropriate response by the instructor? A)

Taking drugs not prescribed for the particular illness tends to maximize risks and minimize benefits.

Never use antibiotics in combination with other prescriptions or in combination with other antibiotics.

Maximize antibiotic drug therapy by administering the full dose when the patient has a fever.

Use antibiotics cautiously and teach patients to complete the full course of an antibiotic prescription.

Ans:

D Feedback: To prevent or contain the growing threat of drug-resistant strains of bacteria, it is very important to use antibiotics cautiously, to complete the full course of an antibiotic prescription, and to avoid saving antibiotics for self-medication in the future. A patient and family teaching program should address these issues, as well as the proper dosing procedure for the drug (even if the patient feels better) and the importance of keeping a

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record of any reactions to antibiotics. Thus, taking drugs not prescribed for the particular illness tends to maximize risks and minimize benefits. Also, if the infection is viral, antibacterial drugs are ineffective and should not be used. 15. What is the priority reason for the nurse to consider questioning an order for tetracycline in a child younger than 8 years of age? A)

Children younger than 8 years of age cannot take tetracyclines.

Weight-bearing joints have been impaired in young animals given the drugs.

Tetracyclines can damage developing teeth and bone in children younger than 8 years of age.

Liver and kidney function may be damaged when it is given to children under 8 years of age.

Ans:

C Feedback: Use tetracyclines with caution in children younger than 8 years of age because they can potentially damage developing bones and teeth. Although the drug does not cause damage to liver and kidneys, it may be contraindicated in patients with hepatic or renal dysfunction because it is concentrated in the bile and excreted in the urine. Fluoroquinolones, not tetracyclines, are generally contraindicated for use in children (i.e., those younger than 18 years of age) because weight-bearing joints have been impaired in young animals given the drugs. Clindamycin (Dalacin C) warrants monitoring hepatic and renal function when it is given to neonates and infants. Trimethoprimsulfamethoxazole (Nu-Cotrimox) is used in children, although children younger than 2 months of age have not been evaluated. Children under 8 years of age can take tetracycline, but it should be used with caution.

16. After administering an antibiotic, the nurse assesses the patient for what common, potentially serious, adverse effect? A)

Rash

Pain

Constipation

Hypopnea

Ans:

A Feedback: Examine skin for any rash or lesions, examine injection sites for abscess formation, and note respiratory statusincluding rate, depth, and adventitious sounds to provide a baseline for indications of an allergic or adverse response to the drug. Report nausea, vomiting, diarrhea, rash, recurrence of symptoms for which the antibiotic drug was prescribed, or

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signs of new infection (e.g., fever, cough, sore mouth, drainage). These problems may indicate adverse effects of the drug, lack of therapeutic response to the drug, or another infection. Pain, constipation, and hypopnea are not common adverse effects of antibiotic drugs. 17. The nurse is caring for a 62-year-old patient who is receiving IV gentamicin (Garamycin). The patient complains of difficulty hearing. What should the nurse do? A)

Hold the dose and notify the physician immediately.

Administer the dose and speak in a louder voice when talking to the patient.

Administer the dose and report this information to the oncoming nurse.

Administer the dose and document the finding in the nurses notes.

Ans:

A Feedback: Aminoglycosides are contraindicated in the following conditions: known allergy to any of the aminoglycosides; renal or hepatic disease that could be exacerbated by toxic aminoglycoside effects and that could interfere with drug metabolism and excretion, leading to higher toxicity; preexisting hearing loss, which could be intensified by toxic drug-related adverse effects on the auditory nerve. Ototoxicity should be reported and the drug should be stopped. You would not administer the dose and then call the physician, administer the dose and report information to oncoming nurse, or administer the dose and document the finding in the nurses notes because each additional dose administered could potentially worsen hearing loss.

18. The nurse is providing patient teaching before discharging a patient home. The patient is taking ciprofloxacin (Cipro). What would the nurse teach this patient is the best way to prevent crystalluria caused by ciprofloxacin (Cipro)? A)

Eliminate red meat and seafood from the diet.

Encourage at least 2 liters of fluid per day.

Avoid caffeine and alcohol.

Spend time in the sun each day to optimize vitamin D levels.

Ans:

B Feedback: Provide the following patient teaching: Avoid driving or operating dangerous machinery because dizziness, lethargy, and ataxia may occur; try to drink a lot of fluids and maintain nutrition (very important), even though nausea, vomiting, and diarrhea may occur. There is no need to eliminate red meat, seafood, caffeine, or alcohol from the diet, although alcohol may increase the risk of GI irritation. Patients should be taught to avoid the sun due to possible photosensitivity.

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19. The nurse is caring for a child weighing 30 kg. The physician orders gentamicin (Garamycin) 100 mg tid for the patient. The recommended dosage range is 6 to 7.5 mg/kg/day. What action should the nurse take? A)

Administer the medication and assess hearing frequently.

Question the physician about the frequency of administration.

Question the physician about the dosage of the medication.

Administer the medication and assess renal function frequently.

Ans:

C Feedback: The dosage is outside the recommended dosage range at 10 mg/kg/day so the nurse should question the dosage before administering the medication. It is appropriate to administer gentamicin tid to pediatric patients so there would be no need to question frequency of dosage. The drug should not be administered until the correct dosage is ordered so there is no need to assess hearing or renal function.

20. The nurse is caring for a patient with a gram-positive infection. What antibiotic would be most effective in treating this infection? A)

Cefaclor (Ceclor)

Cefoxitin (generic)

Cefotaxime (Claforan)

Cefazolin (Zolicef)

Ans:

A Feedback: First-generation cephalosporins are largely effective against gram-positive bacteria and include cefadroxil (generic), cefazolin (Zolicef), and cephalexin (Keflex). Second-and third-generation cephalosporins are less effective against gram-positive bacteria. Cefoxitin (generic) is a second-generation cephalosporin and cefotaxime (Claforan) and cefazolin (Zolicef) are third-generation cephalosporins.

21. What severe reaction would the nurse assess for if it were necessary to administer trimethoprim/sulfamethoxazole (TMP/SMX) to an older adult? A)

Diarrhea

Bone marrow depression

Vomiting

Decreased gastrointestinal (GI) motility

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Ans:

B Feedback: TMP/SMX is associated with an increased risk of severe adverse effects in patients with reduced liver and kidney function. Because kidney function is known to decline as a natural part of aging, older adults would be at more increased risk of severe reactions and would require more careful monitoring. Severe skin reactions and bone marrow depression are the most frequently reported severe reactions. Diarrhea and vomiting are possible adverse effects of most medications but are not examples of severe reactions, although they would require proper intervention to prevent dehydration. GI motility is more likely to increase than to decrease.

22. What medication would the nurse question if ordered for a pediatric patient? A)

Amikacin

Cefazolin

Streptomycin

Levofloxacin

Ans:

D Feedback: Fluoroquinolones are contraindicated in patients who are younger than 18 years of age. Levofloxacin is the only fluoroquinolone among the answer options and is contraindicated for pediatric patients under age 18.

23. The nurse is caring for a patient who is receiving an aminoglycoside. What would be a priority assessment on this patient? A)

Respiratory function

Vision

Cardiac function

Liver function

Ans:

A Feedback: Aminoglycosides come with a black box warning alerting health care professionals to the serious risk of ototoxicity and nephrotoxicity. Central nervous system effects include ototoxicity, possibly leading to irreversible deafness; vestibular paralysis resulting from drug effects on the auditory nerve; confusion; depression; disorientation; and numbness, tingling, and weakness related to drug-related adverse effects on other nerves. Visual alterations are not usually reported in relation to this drug. Respiratory function and liver function are not usually impacted by this drug.

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24. The nurse provides discharge teaching for a patient who will receive a prescription for cefaclor (Ceclor). What important information will the nurse provide this patient? A)

Avoid alcohol until 72 hours after stopping this medication.

Genital itching will go away after the drug is discontinued.

Monitor for yellowing of the skin or eyes and call the doctor if it occurs.

Avoid grapefruit juice when taking this medication to prevent adverse effects.

Ans:

A Feedback: Patients should be taught to avoid alcohol for up to 72 hours after discontinuing cefaclor (Ceclor) to prevent a disulfiram-like reaction that results in unpleasant symptoms such as flushing, throbbing headache, nausea and vomiting, chest pain, palpitations, dyspnea, syncope, vertigo, blurred vision, and in extreme reactions, cardiovascular collapse, convulsions, or even death. Genital itching in women indicates the possibility of a superinfection and the patient should see her health care provider. Liver damage, indicated by jaundice, is not a likely adverse effect with this drug. There is no need to avoid grapefruit juice.

25. The nurse is teaching the patient about amoxicillin prior to discharge and includes what important teaching point? A)

Blackening of the tongue may occur but will subside when the drug is discontinued.

Even if it seems like the infection is not improving, the drug is still working.

Yeast infections are unlikely to occur with this medication because it is narrow spectrum.

Appearance of a rash is common and does not indicate an allergic reaction.

Ans:

A Feedback: One of the adverse effects of ampicillin is blackening of the tongue but the discoloration goes away after stopping the drug. If it is accompanied by swelling, the patient should be instructed to call the prescribing health care provider immediately. Many penicillinresistant pathogens exist, so if the infection does not seem to be responding to the drug, the patient should notify the health care provider because a different antibiotic may be required. Yeast infections are very likely after taking ampicillin because it is a broadspectrum antibiotic. Appearance of a rash should be evaluated by a health care professional because allergic reactions to this class of antibiotic are very common.

26. What drug administered by the nurse belongs to the group of Carbapenems? A)

Primaxin

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Gemifloxacin

Demeclocycline

Cefuroxime

Ans:

A Feedback: The group consists of three drugs: imipenem-cilastatin (Primaxin), meropenem (Merrem), and ertapenem (Invanz). Gemifloxacin is a Fluoroquinolones, Cefuroxime is a secondgeneration cephalosporin, and demeclocycline is a tetracycline.

27. An intensive care unit nurse is caring for a patient taking kanamycin. What is the nurses priority action? A)

Giving the drug for no longer than 7 days

Assessing liver function daily

Contacting the ordering physician

Monitoring renal function daily

Ans:

D Feedback: The potential for nephrotoxicity and ototoxicity with amikacin is very high, so the drug is used only as long as absolutely necessary and should not be administered for longer than 7 to 10 days because of its potentially toxic adverse effects, which include renal damage, bone marrow depression, and gastrointestinal (GI) complications. The nurse cannot stop administering the drug after 7 days if the doctor orders it to be given longer but the nurse could question the order and promote change to another antibiotic if necessary. Monitoring renal function is the priority action when this drug is administered and the provider should be notified if signs of renal failure occur. Liver function is not usually impacted by this drug, although a patient with preexisting liver alterations may require a change in dosage to prevent toxicity. There is no indication of a need to contact the health care provider.

28. The clinic nurse is providing health teaching to a patient who has been prescribed doxycycline (Doxycin). What is a priority teaching point for this patient? A)

Stay out of the sun.

Avoid sexual activity.

Take an antacid with the drug if nausea occurs.

Chew the tablets completely before swallowing.

Ans:

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Feedback: Encourage the patient to apply sunscreen and wear protective clothing if sun exposure cannot be avoided to protect exposed skin from rashes and sunburn associated with photosensitivity reactions. If the patient is a woman the nurse may advise the patient to use barrier methods of contraceptives (if she is taking oral contraceptives) due to the drugdrug interaction but the patient would not be told to avoid sexual activity. Antacid therapy and chewing the tablets would be inaccurate information. 29. The mother of a 5-year-old asks the nurse why it seems amoxicillin is always prescribed when her child needs an antibiotic. What is the priority rationale the nurse should give the mother? A)

It is better absorbed.

It is less costly.

It has a less frequent dosing schedule.

It tastes better in oral form.

Ans:

A Feedback: Most penicillins are rapidly absorbed from the GI tract, reaching peak levels in 1 hour. Although amoxicillin is less expensive, that fact has far less impact on choosing the proper antibiotic than the effectiveness of the drug. Most oral antibiotics for children are available in pleasant tasting syrups so taste would not be a factor. Ampicillin is often given up to 4 times a day so it actually has a frequent dosing schedule.

30. When discussing cephalosporins with the nursing class, the pharmacology instructor explains that this classification of drug is primarily excreted through which organ? A)

Lung

Liver

Kidney

Skin

Ans:

C Feedback: The cephalosporins are primarily metabolized in the liver and excreted in urine. These drugs cross the placenta and enter breast milk. They are not excreted through the lungs, liver, or skin.

31. The nurse is caring for a patient receiving an antimycobacterial who reports dizziness, headache, and drowsiness. What is the priority nursing diagnosis?

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Imbalanced nutrition: less than body requirements

Disturbed sensory perception (kinesthetic) related to central nervous system (CNS) effects of the drug

Acute pain related to gastrointestinal (GI) effects of the drug

Deficient knowledge regarding drug therapy

Ans:

B Feedback: The priority concern for this patient right now is the disturbed sensory perception related to the CNS effects of the drug. Acute Pain could also be used but it would be related to CNS effects, not GI effects. There is no indication of imbalanced nutrition or deficient knowledge in the question.

32. The patient is admitted to the acute care facility with acute septicemia and has orders to receive gentamicin and ampicillin IV. The nurse is performing an admission assessment that includes a complete nursing history. What information provided by the patient would indicate the need to consult the health care provider before administering the ordered medication? A)

Takes furosemide (Lasix), a potent diuretic, daily

Had prostate surgery 3 months ago

History of hypothyroidism

Allergic to peanuts and peanut products

Ans:

A Feedback: Aminoglycosides should be avoided if the patient takes a potent diuretic because of the increased risk of ototoxicity, nephrotoxicity, and neurotoxicity. Learning the patient takes a potent diuretic would indicate the need to consult with the health care provider before administering gentamicin. Prostate surgery, hypothyroidism, and an allergy to peanuts would not preclude administration of these medications and would not indicate a need to consult with the provider.

33. When the nurse cares for a patient receiving an antibiotic, what instructions will the nurse provide no matter what medication is prescribed? (Select all that apply.) A)

Drink plenty of fluids to avoid kidney damage.

Take all medications as prescribed until all of the medication is gone.

Report difficulty breathing, severe headache, or changes in urine output.

Take antibiotic with food to avoid gastrointestinal (GI) upset.

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Take safety precautions such as changing position slowly.

Ans:

A, B, C Feedback: The patient taking any antibiotic needs to drink plenty of fluids to avoid kidney damage and improve excretion of the metabolized drug; take all medications as prescribed until all of the medication is gone to avoid developing a resistant strain of bacteria; and report any difficulty breathing, severe headache, or changes in urine output because these are primary manifestations of serious adverse effects. Although some antibiotics need to be taken with food, others may be best taken on an empty stomach so this does not apply to all antibiotics. Not all antibiotics are associated with central nervous system (CNS) toxicity so taking safety precautions need only be included in patient teaching if they are taking a drug associated with CNS adverse effects.

34. The nurse is admitting a 12-year-old girl to the acute care facility and notices discolored secondary teeth. The mother says she doesnt know why the teeth are discolored because the child is very good about brushing and flossing and sees the dentist regularly. What question would the nurse ask? A)

Has she ever received tetracycline?

Has she ever received gentamicin?

Has she ever received ampicillin?

Has she ever received cephalexin?

Ans:

A Feedback: 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.

35. The nurse is caring for a female patient whose tests confirm she is 10 weeks pregnant and has contracted tuberculosis. The health care provider orders a combination of antimycobacterials. What combination of drugs would the nurse identify as safest for this pregnant patient? A)

Isoniazid, ethambutol, and rifampin

Rifabutin, streptomycin, and rifampin

Capreomycin, cycloserine, and ethionamide

Dapsone, ethambutol, and cycloserine

Ans:

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Feedback: The antituberculosis drugs are always used in combination to affect the bacteria at various cellular stages and first-line drugs are always the first choice, using second-line drugs only when the patient is unable to take the first-line medications. Because this patient is pregnant, the safest choices would be isoniazid, ethambutol, and rifampin but no drug is administered during pregnancy unless the benefit outweighs the risk. The other drug choices would be less safe and would not be used unless the safer drugs were contraindicated. Chapter 39: Protein Synthesis Inhibitors 1. Which is a characteristic that distinguishes sulfonamides from other drugs used to treat bacterial infection? a. Sulfonamides are bactericidal. b. Sulfonamides are derived from biologic substances. c. Sulfonamides have antifungal and antiviral properties. d. Sulfonamides increase bacterial synthesis of folic acid. ANS: B Sulfonamides are bacteriostatic, not bactericidal. They are not derived from biologic substances. They are not antifungals or antivirals. They act by decreasing bacterial synthesis of folic acid. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: dm 429 TOP: NURSING PROCESS: N/A MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 2. The nurse is counseling a patient who will begin taking a sulfonamide drug to treat a urinary tract infection. What information will the nurse include in teaching? a. Drink several quarts of water daily. b. If stomach upset occurs, take an antacid. c. Limit sun exposure to no more than 1 hour each day. d. Sore throat is a common, harmless side effect. ANS: A Patients should drink several quarts of water daily while taking sulfonamides to prevent crystalluria. Patients should not take antacids with sulfonamides. Patients should not go out into the sun. Sore throat should be reported. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 430 TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 3. A female patient who is taking trimethoprim-sulfamethoxazole (TMP-SMZ) (Bactrim, Septra) to treat a urinary tract infection reports vaginal itching and discharge. The nurse will perform which action? a. Ask the patient if she might be pregnant. b. Reassure the patient that this is a normal side effect. c. Report a possible superinfection to the provider. d. Suspect that the patient is having a hematologic reaction.

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ANS: C Superinfection can occur with a secondary infection. Vaginal itching and discharge is a sign of superinfection. This is not symptomatic of pregnancy. These are not common side effects and do not indicate a hematologic reaction. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 432 TOP: NURSING PROCESS: Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 4. A patient who will begin taking trimethoprim-sulfamethoxazole (TMP-SMX) asks the nurse why the combination drug is necessary. The nurse will explain that the combination is used to a. broaden the antibacterial spectrum. b. decrease bacterial resistance. c. improve the taste. d. minimize toxic effects. ANS: B The combination drug is used to decrease bacterial resistance to sulfonamides. It does not broaden the spectrum, improve the taste, or decrease toxicity. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 429 TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 5. The nurse is preparing to administer trimethoprim-sulfamethoxazole (TMP-SMX) to a patient who is being treated for a urinary tract infection. The nurse learns that the patient has type 2 diabetes mellitus and takes a sulfonylurea oral antidiabetic drug. The nurse will monitor this patient closely for which effect? a. Headaches b. Hypertension c. Hypoglycemia d. Superinfection ANS: C Taking oral antidiabetic agents (sulfonylurea) with sulfonamides increases the hypoglycemic effect. Sulfonylureas do not increase the incidence of headaches, hypertension, or superinfection when taken with sulfonamides. Examples of antidiabetic sulfonylurea medications are glipizide, glimepride, glyburide, tolaamide, and tolbutamide. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: dm 431 TOP: NURSING PROCESS: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 6. The nurse is preparing to give a dose of trimethoprim-sulfamethoxazole (TMP-SMX) and learns that the patient takes warfarin (Coumadin). The nurse will request an order for a. a decreased dose of TMP-SMX. b. a different antibiotic. c. an increased dose of warfarin. d. coagulation studies. ANS: D Sulfonamides can increase the anticoagulant effects of warfarin. The nurse should request INR

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levels. An increased dose of warfarin would likely lead to toxicity and to undesirable anticoagulation. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 432 TOP: NURSING PROCESS: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 7. A patient who is taking trimethoprim-sulfamethoxazole (TMP-SMX) calls to report developing an all-over rash. The nurse will instruct the patient to perform which action? a. Increase fluid intake. b. Take diphenhydramine. c. Stop taking TMP-SMX immediately. d. Continue taking the medication. ANS: C A rash can indicate a serious drug reaction. Patients should stop taking the drug immediately and notify the provider. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 431 TOP: NURSING PROCESS: Evaluation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 8. The nurse is caring for a patient who is receiving sulfadiazine. The nurse knows that this patients daily fluid intake should be at least which amount? a. 1000 mL/day b. 1200 mL/day c. 2000 mL/day d. 2400 mL/day ANS: C To prevent crystalluria, patients should consume at least 2000 mL/day. DIF: COGNITIVE LEVEL: Remembering (Knowledge) REF: dm 432 TOP: NURSING PROCESS: Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 9. A patient taking trimethoprim-sulfamethoxazole (TMP-SMX) to treat a urinary tract infection complains of a sore throat. The nurse will contact the provider to request an order for which laboratory test(s)? a. Complete blood count with differential b. Throat culture c. Urinalysis d. Coagulation studies ANS: A A sore throat can indicate a life-threatening anemia, so a complete blood count with differential should be ordered. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 432 TOP: NURSING PROCESS: Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

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10. The nurse is caring for a patient who is ordered to receive PO trimethoprimsulfamethoxazole (TMP-SMX) 160/800 QID to treat a urinary tract infection caused by E. coli. The nurse will contact the provider to clarify the correct a. dose. b. drug. c. frequency. d. route. ANS: C TMP-SMX is taken twice daily. This is the correct dose, drug, and route to treat this condition. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 431 TOP: NURSING PROCESS: Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 11. The nurse is preparing to give trimethoprim-sulfamethoxazole (TMP-SMX) to a patient and notes a petechial rash on the patients extremities. The nurse will perform which action? a. Hold the dose and notify the provider. b. Request an order for a blood glucose level. c. Request an order for a BUN and creatinine level. d. Request an order for diphenhydramine (Benadryl). ANS: A A petechial rash can indicate a severe adverse reaction and should be reported. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 432 TOP: NURSING PROCESS: Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 12. The nurse is caring for a patient who is taking trimethoprim-sulfamethoxazole (TMP-SMX). The nurse learns that the patient takes an angiotension-converting enzyme (ACE) inhibitor. To monitor for drug interactions, the nurse will request an order for which laboratory test(s)? a. A complete blood count b. BUN and creatinine c. Electrolytes d. Glucose ANS: C TMP-SMX can result in hyperkalemia when taken with an ACE inhibitor. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 431 TOP: NURSING PROCESS: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 13. A child who weighs 10 kg will begin taking oral trimethoprim-sulfamethoxazole (TMPSMX). The liquid preparation contains 40 mg of TMP and 200 mg of SMX per 5 mL. The nurse determines that the childs dose should be 8 mg of TMP and 40 mg of SMX/kg/day divided into two doses. Which order for this child is correct? a. 5 mL PO BID b. 5 mL PO daily c. 10 mL PO BID d. 10 mL PO daily

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ANS: A This child should receive (10 kg 8 mg) 80 mg of TMP and (10 kg 40 mg) 400 mL of SMX per day. When divided into two doses, the correct dose is 40 mg TMP and 200 mg SMX, or 5 mL per dose. Chapter 40: Quinolones, Folic Acid Antagonists, and Urinary Tract Antiseptics MULTIPLE CHOICE 1. A patient allergic to penicillin is being evaluated for a gram-negative infection. Which antimicrobial drug class would the health care provider be cautious in prescribing because of a possible cross sensitivity and/or allergic reaction? a. Cephalosporins b. Aminoglycosides c. Sulfonamides d. Quinolones ANS: A Cephalosporins may be used with caution as alternatives when patients are allergic to the penicillins, but cephalosporins are chemically similar in structure to penicillins and may produce a cross sensitivity and/or allergic reaction. Aminoglycosides, sulfonamides, and quinolones do not tend to produce cross sensitivities. DIF: Cognitive Level: Comprehension REF: dm. 736 OBJ: 7 | 8 TOP: Nursing Process Step: Implementation MSC: NCLEX Client Needs Category: Physiological Integrity 2. The health care provider has prescribed penicillin and probenecid for a patient with a sexually transmitted disease. What is the purpose of combining these medications? a. To accelerate the excretion of the penicillin

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b. To inhibit the absorption of penicillin to allow the drug to remain in the transport phase c. To inhibit the excretion of the penicillin d. To reduce toxic effects associated with penicillin ANS: C The combination therapy of penicillin and probenecid allows the penicillin to remain in the body longer, which enhances drug availability and action. The combination may be used advantageously in treating serious or resistant infections. Probenecid inhibits the excretion of penicillin, slows down the excretion of penicillin, and does not affect absorption or toxic effects. DIF: Cognitive Level: Comprehension REF: dm. 730 OBJ: 6 TOP: Nursing Process Step: Implementation MSC: NCLEX Client Needs Category: Physiological Integrity 3. An older adult who has septicemia is receiving IV aminoglycoside therapy. Which symptom is most important for the nurse to monitor? a. Bone marrow suppression b. Ototoxicity c. Gastrointestinal (GI) distress d. Photosensitivity ANS: B Eighth cranial nerve damage can result from aminoglycoside therapy. Patients should be monitored during therapy and after therapy has been discontinued for signs and symptoms of ototoxicity, including dizziness, tinnitus, and progressive hearing loss. Aminoglycosides do not produce bone marrow depression; this is characteristic of treatment with chloramphenicol. Aminoglycosides do not typically produce GI distress. Aminogylcosides do not produce photosensitivity; this is characteristic of treatment with glycylcyclines.

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DIF: Cognitive Level: Application REF: dm. 729 OBJ: 7 | 8 TOP: Nursing Process Step: Assessment MSC: NCLEX Client Needs Category: Physiological Integrity 4. On what is the selection of an antimicrobial agent based? a. Sensitivity of the microorganism to the drug b. Half life of the medication c. Therapeutic levels of the drug d. Bioavailability of the drug ANS: A The selection of the antimicrobial agent must be based on the sensitivity of the pathogen and the possible toxicity to the patient. The half life of the drug is not a concern with selection in comparison to sensitivity. Therapeutic levels of the drug are not criteria for selection. Bioavailability is a lesser concern than sensitivity. DIF: Cognitive Level: Comprehension REF: dm. 727 OBJ: 6 TOP: Nursing Process Step: Evaluation MSC: NCLEX Client Needs Category: Safe, Effective Care Environment 5. A patient is scheduled to take tetracycline and aluminum hydroxide (Amphojel) at the same time. When will the nurse administer the medications to achieve the optimal effects? a. Both medications together b. Amphojel 30 minutes before tetracycline c. Tetracycline with orange juice d. Tetracycline 1 hour before Amphojel ANS: D

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For optimal effectiveness, tetracyclines should be administered 1 hour before or 2 hours after ingesting antacids, milk, or other dairy products, or products containing calcium, aluminum, magnesium, or iron. Taking the drugs this closely together will most likely inhibit absorption of the antibiotic. Tetracycline does not tend to interact with orange juice, but the beverage may be contraindicated in a patient who needs to take antacids. DIF: Cognitive Level: Application REF: pp. 750-751 OBJ: 7 | 8 TOP: Nursing Process Step: Implementation MSC: NCLEX Client Needs Category: Safe, Effective Care Environment 6. Which conditions may occur with the administration of broad spectrum antibiotics over an extended period of time? a. Cross sensitivity b. Immunosuppression c. Secondary infection d. Immunity ANS: C Secondary infections, such as oral thrush, genital and anal pruritus, and vaginitis, can occur with prolonged use of broad spectrum antibiotics. Secondary infections result when normal flora are eliminated, which causes disease producing microorganisms to multiply. Cross sensitivities develop during repeat exposures, not over a prolonged period. Immunosuppression does not develop over a prolonged interval of administration. Immunity is not produced by exposure to antibiotics. DIF: Cognitive Level: Knowledge REF: pp. 729-730 OBJ: 7 TOP: Nursing Process Step: Evaluation MSC: NCLEX Client Needs Category: Safe, Effective Care Environment

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7. A patient is admitted with glomerulonephritis. IV gentamicin therapy is started after cultures indicate gram negative bacilli in the blood. The patient also receives IV furosemide (Lasix). The nurse will monitor for signs and symptoms of toxicity related to which organ? a. Kidneys b. Pancreas c. Liver d. Brain ANS: A The results of urinalysis and kidney function tests should be closely monitored when a patient is on aminoglycoside therapy. Patients also receiving cephalosporins, enflurane, methoxyflurane, vancomycin, and diuretics, when combined with aminoglycosides, have a greater potential for nephrotoxicity. The pancreas is not vulnerable to damage from aminogylcosides. Bone marrow suppression is a result of toxicity from treatment with chloramphenicol. Central nervous system toxicities may result from toxic effects of treatment with aminoglycosides, but are not related to interactions between the antibiotic and diuretics. DIF: Cognitive Level: Comprehension REF: dm. 731 OBJ: 7 TOP: Nursing Process Step: Evaluation MSC: NCLEX Client Needs Category: Health Promotion and Maintenance 8. Which drug is the cornerstone of treatment for prophylaxis and treatment of tuberculosis (TB)? a. Amphotericin B (Abelcet) b. Streptomycin (Streptomycin) c. Isoniazid (Nydrazid) d. Acyclovir (Zovirax) ANS: C

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Isoniazid has been the mainstay for years in the treatment and prevention of TB. The mechanism of action of isoniazid is not fully known. Isoniazid appears to disrupt the Mycobacterium tuberculosis cell wall and inhibit replication. Amphotericin B is used in the treatment of fungal infections. Streptomycin is an aminoglycoside used to treat bacterial infections. Acyclovir is used in the treatment of viral infections associated with herpes simplex virus. DIF: Cognitive Level: Comprehension REF: dm. 752 OBJ: 6 TOP: Nursing Process Step: Evaluation MSC: NCLEX Client Needs Category: Health Promotion and Maintenance 9. A patient indicates during the nursing assessment that he is currently taking zidovudine (Retrovir). For which condition is the patient being treated? a. Influenza A b. HIV infection c. TB d. Herpes simplex ANS: B Zidovudine (Retrovir) is an antiviral agent that is effective in certain patients with HIV 1 infection. Zidovudine inhibits viral replication, reduces the risk and severity of opportunistic infections, and improves immune status. Zidovudine is not used to treat influenza, TB, or herpes infections. DIF: Cognitive Level: Knowledge REF: dm. 787 OBJ: 6 TOP: Nursing Process Step: Evaluation MSC: NCLEX Client Needs Category: Health Promotion and Maintenance 10. Which drug is incompatible with heparin? a. Gentamicin

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b. Ampicillin (Unasyn) c. Ticarcillin (Timentin) d. Ciprofloxacin (Cipro) ANS: A Gentamicin is incompatible with heparin. Ampicillin, ticarcillin, and ciprofloxacin are compatible with heparin. DIF: Cognitive Level: Knowledge REF: pp. 733-734 OBJ: 7 | 8 TOP: Nursing Process Step: Planning MSC: NCLEX Client Needs Category: Physiological Integrity 11. What adverse effect may manifest as dizziness, tinnitus, and progressive hearing loss? a. Ear infection b. Drug allergy c. Ototoxicity d. Idiosyncratic reaction ANS: C Damage to the eighth cranial nerve (ototoxicity) can occur from drug therapy, particularly from aminoglycosides. This may initially be manifested by dizziness, tinnitus, and progressive hearing loss. Ear infection is not an adverse effect of drug therapy. Drug allergy is not manifested by hearing loss. Idiosyncratic reaction to a medication is an unusual, unpredictable response specific to a particular person. Unlike allergy, it can occur on first exposure to the medication; unlike an adverse effect, it only affects very few individuals, possibly with a genetic or metabolic abnormality. DIF: Cognitive Level: Comprehension REF: dm. 729 | dm. 733 OBJ: 7 TOP: Nursing Process Step: Evaluation

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MSC: NCLEX Client Needs Category: Physiological Integrity 12. The nurse will monitor patients on cephalosporins and loop diuretics for which adverse effect? a. Hepatic toxicity b. Ototoxicity c. Nephrotoxicity d. Splenotoxicity ANS: C Patients receiving cephalosporins, aminoglycosides, polymyxin B, vancomycin, and loop diuretics concurrently should be assessed for signs of nephrotoxicity. Urinalysis and kidney function tests should be monitored for abnormal results. Cephalosporins are unlikely to cause liver toxicity, ototoxicity, or spleen toxicity. DIF: Cognitive Level: Comprehension REF: dm. 731 | dm. 733 OBJ: 7 TOP: Nursing Process Step: Evaluation MSC: NCLEX Client Needs Category: Physiological Integrity 13. The nurse is caring for a patient being treated with an antimicrobial agent for the diagnosis of a sexually transmitted infection. Which statement made by the patient shows a need for further education? a. I will use a barrier method when having sexual intercourse during therapy. b. I will increase fluid intake to 2000 to 3000 mL/day. c. I will increase protein in my diet. d. I will rest frequently. ANS: A

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Patients should be instructed to refrain from sexual intercourse during therapy for sexually transmitted infections. Fluids should be increased to 2000 to 3000 mL/day, protein should be increased, and adequate rest should be encouraged. DIF: Cognitive Level: Analysis REF: dm. 731 OBJ: 4 TOP: Nursing Process Step: Assessment MSC: NCLEX Client Needs Category: Health Promotion and Maintenance 14. Which patient can safely be treated with a fluoroquinolone medication? a. A 40 year old on steroid therapy b. A 15 year old with a sore throat c. A 70 year old with a gait abnormality d. A 30 year old with a fractured tibia ANS: D Fluoroquinolones are safe to prescribe for a 30 year old with a fractured tibia. Fluoroquinolones should not be prescribed for patients taking corticosteroids, patients younger than 18 years, or patients older than 60 years. DIF: Cognitive Level: Analysis REF: dm. 746 OBJ: 6 TOP: Nursing Process Step: Assessment MSC: NCLEX Client Needs Category: Safe, Effective Care Environment; Physiological Integrity MULTIPLE RESPONSE 15. An older adult with a history of asthma, rhinitis, and no known drug allergies has been admitted to receive IV antimicrobial therapy for bronchitis. The patient has received the oral form of the antimicrobial agent in the past. Which factors increase the risk for an allergic reaction? (Select all that apply.)

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a. Medical history of asthma b. The patients age c. IV antimicrobial therapy d. Medical history of rhinitis e. Subsequent use of the same antimicrobial therapy ANS: A, D, E Patients with a history of asthma, allergies, or rhinitis should be closely monitored for possible allergic reaction. Subsequent use of the same antimicrobial therapy may only pose a risk if a reaction occurred with the first administration of the drug; in this case, repeat exposures to a previously sensitized substance can be fatal. Older adults, because of physiologic changes of aging, require close observation for therapeutic response and drug toxicity, but not necessarily for allergic reaction. The route of administration does not increase the risk of an allergic reaction. DIF: Cognitive Level: Application REF: dm. 730 OBJ: 7 TOP: Nursing Process Step: Assessment MSC: NCLEX Client Needs Category: Physiological Integrity 16. A patient has been receiving home health care and IV antimicrobial therapy for osteomyelitis (infection of the bone) of the lower right leg for the past 4 weeks. What will the nurse assess to evaluate the effectiveness of the antimicrobial agent? (Select all that apply.) a. Pain of the right leg b. Patient temperature c. Presence of edema, redness, or swelling in the right lower leg d. Culture and sensitivity parameters at the drug completion e. Complete blood count (CBC) and sedimentation rate laboratory values ANS: A, B, C, E

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Ongoing evaluation of treatment effectiveness includes assessing for pain of the affected leg, monitoring the patients temperature, observing the affected extremity for decreased signs of infection (including reduced swelling, wound discharge, and redness), and monitoring the CBC and sedimentation rate through regular laboratory data. Culture and sensitivity testing should be completed before therapy to determine the most effective drug for therapy. DIF: Cognitive Level: Application REF: dm. 730 OBJ: 1 TOP: Nursing Process Step: Evaluation MSC: NCLEX Client Needs Category: Physiological Integrity 17. Which drugs may reach toxic blood levels if administered with macrolide antibiotics? (Select all that apply.) a. Benzodiazepines b. Digoxin c. NSAIDs d. HMG CoA reductase inhibitors e. Diuretics f. Theophylline ANS: A, B, D, F Macrolide antibiotics may inhibit the metabolism of benzodiazepines, digoxin, HMG CoA reductase inhibitors, and theophylline, causing accumulation and potential toxicity. NSAIDs and diuretics are not inhibited by macrolide antibiotics. DIF: Cognitive Level: Comprehension REF: dm. 741 OBJ: 7 | 8 TOP: Nursing Process Step: Implementation MSC: NCLEX Client Needs Category: Physiological Integrity

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18. The nurse is planning to administer ertapenem IV to a patient in the intensive care unit. When preparing this medication, the nurse will consider reconstituting it with: (Select all that apply.) a. water. b. bacteriostatic water. c. 0.9% sodium chloride. d. 0.45% dextrose. e. 1% lidocaine. ANS: A, B, C Ertapenem for IV use should be reconstituted with water for injection, bacteriostatic water for injection, or 0.9% sodium chloride (normal saline) for injection. Ertapenem should not be reconstituted with dextrose solutions or 1% lidocaine injection.

Chapter 41: Antimycobacterial Drugs MULTIPLE CHOICE 1. The nurse is caring for a patient who is receiving an intravenous antibiotic. The nurse notes that the provider has ordered serum drug peak and trough levels. The nurse understands that these tests are necessary for which type of drugs? a. Drugs with a broad spectrum b. Drugs with a narrow spectrum c. Drugs with a broad therapeutic index d. Drugs with a narrow therapeutic index ANS: D Medications with a narrow therapeutic index have a limited range between the therapeutic dose and a toxic dose. It is important to monitor these medications closely by evaluating regular serum peak and trough levels. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: dm 401 TOP: NURSING PROCESS: Evaluation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 2. The nurse is caring for a patient who is receiving an intravenous antibiotic. The patient has a serum drug trough of 1.5 mcg/mL. The normal trough for this drug is 1.7 mcg/mL to 2.2 mcg/mL. What will the nurse expect the patient to experience? a. Inadequate drug effects b. Increased risk for superinfection

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c. Minimal adverse effects d. Slowed onset of action ANS: A Low peak levels may indicate that the medication is below the therapeutic level. They do not indicate altered risk for superinfection, a decrease in adverse effects, or a slowed onset of action. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: dm 401 TOP: NURSING PROCESS: Analysis/Evaluation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 3. The nurse is teaching a nursing student about the minimal effective concentration (MEC) of antibiotics. Which statement by the nursing student indicates understanding of this concept? a. A serum drug level greater than the MEC ensures that the drug is bacteriostatic. b. A serum drug level greater than the MEC broadens the spectrum of the drug. c. A serum drug level greater than the MEC helps eradicate bacterial infections. d. A serum drug level greater than the MEC increases the therapeutic index. ANS: C The MEC is the minimum amount of drug needed to halt the growth of a microorganism. A level greater than the MEC helps eradicate infections. Drugs at or above the MEC are usually bactericidal, not bacteriostatic. Raising the drug level does not usually broaden the spectrum or increase the therapeutic index of a drug. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: dm 401 TOP: NURSING PROCESS: N/A MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 4. The nurse is caring for a patient who has recurrent urinary tract infections. The patients current infection is not responding to an antibiotic that has been used successfully several times in the past. The nurse understands that this is most likely due to a. acquired bacterial resistance. b. cross-resistance. c. inherent bacterial resistance. d. transferred resistance. ANS: A Acquired resistance occurs when an organism has been exposed to the antibacterial drug. Crossresistance occurs when an organism that is resistant to one drug is also resistant to another. Inherent resistance occurs without previous exposure to the drug. Transferred resistance occurs when the resistant genes of one organism are passed to another organism. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: dm 402 TOP: NURSING PROCESS: Evaluation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 5. The nurse is preparing to administer amoxicillin (Amoxil) to a patient and learns that the patient previously experienced a rash when taking penicillin. Which action will the nurse take? a. Administer the amoxicillin and have epinephrine available. b. Ask the provider to order an antihistamine. c. Contact the provider to discuss using a different antibiotic. d. Request an order for a beta-lactamase resistant drug.

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ANS: C Patients who have previously experienced manifestations of allergy to a penicillin should not use penicillins again unless necessary. The nurse should contact the provider to discuss using another antibiotic from a different class. Epinephrine and antihistamines are useful when patients are experiencing allergic reactions, depending on severity. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 407 TOP: NURSING PROCESS: Planning MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 6. The nurse is preparing to administer an antibiotic to a patient who has been receiving the antibiotic for 2 days after a culture was obtained. The nurse notes increased erythema and swelling, and the patient has a persistent high fever of 39 C. What is the nurses next action? a. Administer the antibiotic as ordered. b. Contact the provider to request another culture. c. Discuss the need to add a second antibiotic with the provider. d. Review the sensitivity results from the patients culture. ANS: D The sensitivity results from the patients culture will reveal whether the organism is sensitive or resistant to a particular antibiotic. The patient is not responding to the antibiotic being given, so the antibiotic should be held and the provider notified. Another culture is not indicated. Antibiotics should be added only when indicated by the sensitivity. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 408 TOP: NURSING PROCESS: Evaluation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 7. The nurse is preparing to administer the first dose of an antibiotic to a patient admitted for a urinary tract infection. Which action is most important prior to administering the antibiotic? a. Administering a small test dose to determine whether hypersensitivity exists b. Having epinephrine available in the event of a severe hypersensitivity reaction c. Monitoring baseline vital signs, including temperature and blood pressure d. Obtaining a specimen for culture and sensitivity ANS: D To obtain the most accurate culture, the specimen should be obtained before antibiotic therapy begins. It is important to obtain cultures when possible in order to correctly identify the organism and help determine which antibiotic will be most effective. Administering test doses to determine hypersensitivity is sometimes done when there is a strong suspicion of allergy when a particular antibiotic is needed. Epinephrine is kept close at hand when there is a strong suspicion of allergy. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 408 TOP: NURSING PROCESS: Planning MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 8. A patient is admitted to the hospital for treatment of pneumonia after complaining of high fever and shortness of breath. The patient was not able to produce sputum for a culture. The nurse will expect the patients provider to order a. a broad-spectrum antibiotic. b. a narrow-spectrum antibiotic.

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c. multiple antibiotics. d. the pneumococcal vaccine. ANS: A Broad-spectrum antibiotics are frequently used to treat infections when the offending organism has not been identified by culture and sensitivity (C&S). Narrow-spectrum antibiotics are usually effective against one type of organism and are used when the C&S indicates sensitivity to that antibiotic. The use of multiple antibiotics, unless indicated by C&S, can increase resistance. The pneumococcal vaccine is used to prevent, not treat, an infection. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 403 TOP: NURSING PROCESS: Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 9. The nurse is teaching a patient who will be discharged home from the hospital to take amoxicillin (Amoxil) twice daily for 10 days. Which statement by the nurse is correct? a. Discontinue the antibiotic when your temperature returns to normal and your symptoms have improved. b. If diarrhea occurs, stop taking the drug immediately and contact your provider. c. Stop taking the drug and notify your provider if you develop a rash while taking this drug. d. You may save any unused antibiotic to use if your symptoms recur. ANS: C Patients who develop signs of allergy, such as rash, should notify their provider before continuing medication therapy. Patients should be counseled to continue taking their antibiotics until completion of the prescribed regimen even when they feel well. Diarrhea is an adverse effect but does not warrant cessation of the drug. Before deciding to stop taking a medication due to a side effect, encourage the patient to contact the provider first. Patients should discard any unused antibiotic. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 407 TOP: NURSING PROCESS: Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 10. The nurse is preparing to administer the first dose of intravenous ceftriaxone (Rocephin) to a patient. When reviewing the patients chart, the nurse notes that the patient previously experienced a rash when taking amoxicillin. What is the nurses next action? a. Administer the drug and observe closely for hypersensitivity reactions. b. Ask the provider whether a cephalosporin from a different generation may be used. c. Contact the provider to report drug hypersensitivity. d. Notify the provider and suggest an oral cephalosporin. ANS: A A small percentage of patients who are allergic to penicillin could also be allergic to a cephalosporin product. Patients should be monitored closely after receiving a cephalosporin if they are allergic to penicillin. There is no difference in hypersensitivity potential between different generations or method of delivery of cephalosporins. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 410 TOP: NURSING PROCESS: Assessment/Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

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11. The nurse is preparing to give a dose of a cephalosporin medication to a patient who has been receiving the antibiotic for 2 weeks. The nurse notes ulcers on the patients tongue and buccal mucosa. Which action will the nurse take? a. Hold the drug and notify the provider. b. Obtain an order to culture the oral lesions. c. Gather emergency equipment to prepare for anaphylaxis. d. Report a possible superinfection side effect of the cephalosporin. ANS: D The patients symptoms may indicate a superinfection and should be reported to the physician so it can be treated; however, the drug does not need to be held. It is not necessary to culture the lesions. The symptoms do not indicate impending anaphylaxis. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 408 TOP: NURSING PROCESS: Evaluation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 12. The nurse is providing teaching to a patient who will begin taking a cephalosporin to treat an infection. Which statement by the patient indicates a need for further teaching? a. I may stop taking the medication if my symptoms clear up. b. I should eat yogurt while taking this medication. c. I should stop taking the drug and call my provider if I develop a rash. d. I will not consume alcohol while taking this medication. ANS: A Patients should take all of an antibiotic regimen even after symptoms clear to ensure complete treatment of the infection. Patients are often advised to eat yogurt or drink buttermilk to prevent superinfection. A rash is a sign of hypersensitivity, and patients should be counseled to stop taking the drug and notify the provider if this occurs. Alcohol consumption may cause adverse effects and should be avoided by patients while they are taking cephalosporins. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 403 TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 13. The nurse is caring for a patient who takes low-dose erythromycin as a prophylactic medication. The patient will begin taking cefaclor for treatment of an acute infection. The nurse should discuss this with the provider because taking both of these medications simultaneously can cause which effect? a. Decreased effectiveness of cefaclor. b. Increased effectiveness of cefaclor. c. Decreased effectiveness of erythromycin. d. Increased effectiveness of erythromycin. ANS: A The interaction of cefaclor and erythromycin will produce a decrease in the action of the cefaclor. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: dm 409 TOP: NURSING PROCESS: Planning MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

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14. A patient is receiving high doses of a cephalosporin. Which laboratory values will this patients nurse monitor closely? a. Blood urea nitrogen (BUN), serum creatinine, and liver function tests b. Complete blood count and electrolytes c. Serum calcium and magnesium d. Serum glucose and lipids ANS: A Cefazolin will produce an increase in the patients BUN, creatinine, AST, ALT, ALP, LDH, and bilirubin. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: dm 409 TOP: NURSING PROCESS: Planning MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 15. A patient will begin taking amoxicillin. The nurse should instruct the patient to avoid which foods? a. Green leafy vegetables b. Beef and other red meat c. Coffee, tea, and colas d. Acidic fruits and juices ANS: D Acidic fruits and juices should be avoided while the client is being treated with amoxicillin because amoxicillin can be irritating to the stomach. Stomach irritation will be increased with the ingestion of citrus and acidic foods. Amoxicillin may also be less effective when taken with acidic fruit or juice. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 405 TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 16. The patient will begin taking penicillin G procaine (Wycillin).The nurse notes that the solution is milky in color. What action will the nurse take? a. Call the pharmacist and report the milky color. b. Add normal saline to dilute the medication. c. Call the physician and report the milky appearance. d. Administer the medication as ordered by the physician. ANS: D Penicillin G procaine (Wycillin) has a milky appearance; therefore, the appearance should not concern the nurse. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 406 TOP: NURSING PROCESS: Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies MULTIPLE RESPONSE 1. Which actions can contribute to bacterial resistance to antibiotics? (Select all that apply.) a. Frequent use of antibiotics b. Giving large doses of antibiotics

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c. Skipping doses d. Taking a full course of antibiotics e. Treating viral infections with antibiotics ANS: A, C, E Frequent use of antibiotics increases the exposure of bacteria to an antibiotic and results in acquired resistance. Skipping doses of an antibiotic can lead to incomplete treatment of an infection, and the remaining bacteria may develop acquired resistance. Treating viral infections with antibiotics is unnecessary and may cause acquired resistance to develop from unneeded exposure to a drug. Infections adequately treated with an antibiotic do not result in resistance. Chapter 42: Antifungal Drugs MULTIPLE CHOICE 1. Which person should be treated with prophylactic antitubercular medication? a. A child who attends the same school with a child who has tuberculosis b. A nurse who is working in a hospital c. An individual who is HIV-positive with a negative TB skin test d. A patient who has close contact with someone who has tuberculosis ANS: D Personal contact with a person having a diagnosis of tuberculosis is required to indicate prophylactic treatment with antitubercular therapy. Attending the same school does not necessarily mean close contact occurs. Health care professionals do not need prophylactic treatment. HIV-positive individuals with negative TB skin tests do not need prophylaxis. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 437 TOP: NURSING PROCESS: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 2. A patient who has chronic liver disease reports contact with a person who has tuberculosis (TB). The nurse will counsel this patient to contact the provider to discuss a. a chest x-ray. b. a TB skin test. c. liver function tests (LFTs). d. prophylactic antitubercular drugs. ANS: B Patients who have exposure to TB should have a TB skin test. A chest x-ray is performed if the skin test is positive. LFTs do not need to be done simply because of TB exposure. This patient is not a candidate for antitubercular drug prophylaxis. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: dm 437 TOP: NURSING PROCESS: Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 3. A patient who has tuberculosis asks the nurse why three drugs are used to treat this disease. The nurse will explain that multi-drug therapy is used to reduce the likelihood of a. disease relapse.

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b. drug hypersensitivity reactions. c. drug resistance. d. drug adverse effects. ANS: C Without multi-drug therapy, patients easily develop resistance to antitubercular drugs. Using more than one antitubercular drug does not prevent relapse, hypersensitivity reactions, or adverse effects. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: dm 437 TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 4. A patient is being treated with isoniazid (INH), rifampin, and pyrazinamide in phase I of treatment for tuberculosis. The organism develops resistance to isoniazid. Which drug will the nurse anticipate the provider will order to replace the isoniazid? a. Ciprofloxacin (Cipro) b. Ethambutol (Myambutol) c. Kanamycin d. Streptomycin sulfate ANS: B If there is bacterial resistance to isoniazid, the first phase may be changed to ethambutol, rifampin, and pyrazinamide. Ciprofloxacin, kanamycin, and streptomycin are not generally firstline antitubercular drugs. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 437 TOP: NURSING PROCESS: Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 5. The nurse is caring for a patient who is diagnosed with tuberculosis. The patient tells the nurse that the provider plans to order a prophylactic antitubercular drug for family members and asks which drug will be ordered. The nurse will expect the provider to order which drug? a. Isoniazid (INH) b. Pyrazinamide c. Rifampin (Rifadin) d. Streptomycin ANS: A INH is the drug of choice for prophylactic treatment of patients who have had close contact with a patient who has tuberculosis. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: dm 437 TOP: NURSING PROCESS: Planning MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 6. The nurse caring for a patient who has tuberculosis and who is taking isoniazid, rifampin, and streptomycin reviews the medical record and notes the patients sputum cultures reveal resistance to streptomycin. The nurse will anticipate that the provider will take which action? a. Add ethambutol (Myambutol). b. Change the streptomycin to clarithromycin. c. Change the streptomycin to kanamycin.

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d. Order renal function tests. ANS: C The patients current regimen is first-phase treatment. If resistance to streptomycin develops, the provider can change to kanamycin or to ciprofloxacin. Ethambutol is added if there is resistance to isoniazid. Clarithromycin is used during phase II. Renal function tests are not indicated. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 437 TOP: NURSING PROCESS: Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 7. A patient who is taking isoniazid (INH) as part of a two-drug tuberculosis treatment regimen reports tingling of the fingers and toes. The nurse will recommend discussing which treatment with the provider? a. Adding pyrazinamide b. Changing to ethambutol c. Increasing oral fluid intake d. Taking pyridoxine (B6) ANS: D Peripheral neuropathy is an adverse reaction to INH, so pyridoxine is usually given to prevent this. It is not necessary to change medications. Increasing fluids will not help with this. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 437 TOP: NURSING PROCESS: Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 8. The nurse is teaching a patient about rifampin. Which statement by the patient indicates understanding of the teaching? a. I should not wear soft contact lenses while taking rifampin. b. I will need regular eye examinations while taking this drug. c. I will report orange urine to my provider immediately. d. I understand that renal toxicity is a common adverse effect. ANS: A Patients taking rifampin should be warned that urine, feces, saliva, sputum, sweat, and tears may turn a harmless red-orange color. Patients should not wear soft contact lenses to avoid permanent staining. Regular eye exams are necessary for patients who receive isoniazid and ethambutol. Orange urine is a harmless side effect and does not need to be reported. Renal toxicity is not common with rifampin. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 439 TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 9. A patient who has completed the first phase of a three-drug regimen for tuberculosis has a positive sputum acid-bacilli test. The nurse will tell the patient that a. drug resistance has probably occurred. b. it may be another month before this test is negative. c. the provider will change the pyrazinamide to ethambutol. d. there may be a need to remain in the first phase of therapy for several weeks. ANS: B

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The goal is for the patients sputum test to be negative 2 to 3 months after the therapy. The positive test does not indicate drug resistance. The provider will not change the drugs or keep the patient in the first phase longer than planned. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 440 TOP: NURSING PROCESS: Planning MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 10. The nurse is teaching a nursing student about the antifungal drug amphotericin B. Which statement by the student indicates a need for further teaching? a. Amphotericin B may be given intravenously or by mouth. b. Patients who take this drug should have potassium and magnesium levels assessed. c. Patients with renal disease should not take amphotericin B. d. This drug is used for severe systemic infections. ANS: A Amphotericin B is not absorbed from the gastrointestinal tract, so is not given by mouth. It can cause nephrotoxicity and electrolyte imbalance. It is highly toxic and is reserved for severe, systemic infections. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 442 TOP: NURSING PROCESS: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 11. A patient who has oral candidiasis will begin using nystatin suspension to treat the infection. What information will the nurse include when teaching this patient? a. Coat the buccal mucosa with the drug and then rinse your mouth. b. Gargle with the nystatin and then spit it out without swallowing. c. Mix the suspension with 4 ounces of water and then drink it. d. Swish the liquid in your mouth and then swallow after a few minutes. ANS: D Patients should be taught to swish the suspension in the mouth to coat the tongue and buccal mucosa and then swallow the medication. It should not be spit out, diluted with water, or swallowed with water. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 442 TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 12. A patient will begin taking streptomycin as part of the medication regimen to treat tuberculosis. Before administering this medication, the nurse will review which laboratory values in the patients medical record? a. Complete blood count (CBC) with differential white cell count b. Blood urea nitrogen (BUN) and creatinine c. Potassium and magnesium levels d. Serum fasting glucose ANS: B Streptomycin can cause significant renal toxicity.

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DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 444 TOP: NURSING PROCESS: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 13. The nurse is preparing to administer an intravenous polymyxin antibiotic. The patient reports dizziness along with numbness and tingling of the hands and feet. The nurse will perform which action? a. Administer the drug since these are harmless side effects. b. Hold the drug and notify the provider of these adverse reactions. c. Obtain an order for an oral form of this medication. d. Request an order for serum electrolytes. ANS: B Polymyxins can cause nephrotoxicity and neurotoxicity. This patient has signs of neurotoxicity, so the nurse should notify the provider. These effects are generally reversible when the drug is discontinued. It is not correct to administer the drug when these symptoms are present. Polymyxins are not absorbed orally. Serum electrolytes are not indicated. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 445 TOP: NURSING PROCESS: Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 14. A young adult female who is taking metronidazole (Flagyl) to treat trichomoniasis calls the nurse to report severe headache, flushing, palpitations, cramping, and nausea. What will the nurse do next? a. Ask about alcohol consumption. b. Reassure her that these are harmless side effects. c. Tell her that this signals a worsening of her infection. d. Tell her to go to the emergency department immediately. ANS: A Patients who are taking metronidazole can experience a disulfiram-like reaction when they drink alcohol. These are not harmless adverse effects or a sign of worsening of her infection. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 446 TOP: NURSING PROCESS: Evaluation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 15. A patient who is taking metronidazole (Flagyl) reports reddish-brown urine. Which action will the nurse take? a. Obtain an order for BUN and creatinine levels. b. Reassure the patient that this is a harmless effect. c. Request an order for a urinalysis. d. Test her urine for occult blood. ANS: B Reddish-brown urine is a harmless side effect of metronidazole and is not cause for concern. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 446 TOP: NURSING PROCESS: Evaluation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

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16. A patient is diagnosed with histoplasmosis and will begin taking ketoconazole. What information will the nurse include when teaching this patient about this medication? a. Take the medicine twice daily. b. Take the medication with food. c. You may consume small amounts of alcohol. d. You will not need lab tests while taking this drug. ANS: B Ketoconazole should be taken with food. It is administered once daily. Patients taking antifungals should not consume alcohol. Antifungals can cause liver and renal toxicity, so patients will need lab monitoring. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 441 TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 17. A patient who has AIDS is at risk to contract aspergillosis. The nurse will anticipate that which antifungal medication will be ordered prophylactically for this patient? a. Metronidazole (Flagyl) b. Micafungin (Mycamine) c. Posaconazole (Noxafil) d. Voriconazole (Vfend) ANS: C Posaconazole is given for prophylactic treatment of Aspergillus and Candida infections. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: dm 441 TOP: NURSING PROCESS: Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 18. A patient is diagnosed with tinea capitis. The provider will order which systemic antifungal medication for this patient? a. Anidulafungin (Eraxis) b. Fluconazole (Diflucan) c. Griseofulvin (Fulvicin) d. Ketoconazole (Nizoral) ANS: C Griseofulvin is used to treat tinea capitis. Anidulafungin is used to treat esophageal candidiasis, candidemia, and other Candida infections. Fluconazole is used to treat Candida infections and cryptococcal meningitis. Ketoconazole is used to treat Candida infections, histoplasmosis, blastomycosis, and other infections. DIF: COGNITIVE LEVEL: Remembering (Knowledge) REF: dm 442 TOP: NURSING PROCESS: Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 19. Which topical antifungal medication is used to treat vaginal candidiasis? a. Haloprogin (Halotex) b. Miconazole (Monistat) c. Oxiconazole (Oxistat) d. Terbenafine HCl (Lamisil)

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ANS: B Topical miconazole is used to treat vaginal candidiasis. DIF: COGNITIVE LEVEL: Remembering (Knowledge) REF: dm 444 TOP: NURSING PROCESS: Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 20. A patient who takes an oral sulfonylurea medication will begin taking fluconazole (Diflucan). The nurse will expect to monitor which lab values in this patient? a. Blood urea nitrogen (BUN) and creatinine b. Electrolytes c. Fluconazole levels d. Glucose ANS: D Patients taking sulfonylurea drugs may have altered serum glucose when taking antifungal medications. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 444 TOP: NURSING PROCESS: Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies MULTIPLE RESPONSE 1. A client is being treated for tuberculosis. Which medications are used to treat this condition? (Select all that apply.) a. Streptomycin sulfate b. Amoxicillin (Amoxil) c. Ethambutol (Myambutol) d. Gentamicin (Garamycin) e. Rifabutin (Mycobutin) f. Ethionamide (Trecator-SC) g. Pyrazinamide ANS: A, C, E, F, G Streptomycin sulfate, ethambutol (Myambutol), rifabutin (Mycobutin), ethionamide (TrecatorSC), and pyrazinamide are used to treat tuberculosis. The other medications are not used. Chapter 43: Antiprotozoal Drugs 1. The patient is having an acute malarial attack with chills and fever. The nurse knows chills and fever are caused by what? A)

Formation of sporozoites into the system

Rupture of red blood cells due to invasion of merozoites

Invasion of the tsetse fly into the central nervous system

Release of amastigotes into the blood vessels

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Ans:

B Feedback: The chills and fever associated with an acute malarial attack are caused by the rupture of red blood cells containing merozoites. These symptoms are related to the pyrogenic effects of the protozoa and the toxic effects of the red blood cell components on the system. The formation of sporozoites occurs in the stomach of the mosquito when the male and female gametocytes mate and produce a zygote. Invasion of the tsetse fly causes trypanosomiasis, which affects the central nervous system. The release of amastigotes occurs in leishmaniasis, which is caused by the sand fly and is part of a cyclic pattern that causes serious skin lesions.

2. The nurse is caring for a patient of Greek descent who plans to travel to an area of the world in which malaria is endemic. What should this patient be tested for before administering antimalarial medications? A)

Tay-Sachs disease

Glucose-6-phosphate dehydrogenase (G6PD) deficiency

Plasmodium

Penicillin allergy

Ans:

B Feedback: Patients of Mediterranean descent, including Greeks, are more likely to have a G6PD deficiency. When patients with this deficiency take primaquine, chloroquine, or quinine, an acute hemolytic crisis may occur. Patients of Mediterranean descent should be tested for G6PD deficiency before any antimalarial drugs are prescribed. Tay-Sachs disease is a disorder seen in those of middle-eastern descent that causes death of the child by age 5. Plasmodium is the genus strain that causes malaria. Penicillin allergy has no connection to this situation.

3. The nurse is caring for a patient who is being treated with quinine (Qualaquin) for drugresistant malaria. The nurse will monitor the patient for cinchonism that will present with what manifestations? A)

Diarrhea, nausea, and fever

Yellowing of the sclera and skin

Tremors and ataxia

Vomiting, tinnitus, and vertigo

Ans:

D Feedback:

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Patients with cinchonism or quinine toxicity may complain of tinnitus, headache, dizziness, nausea, fever, tremors, and visual disturbances. Diarrhea, yellowing of the sclera or skin, and ataxia are not associated with cinchonism. 4. Patients receiving chloroquine (Aralen Phosphate) for malaria prophylaxis should receive patient teaching from the nurse, which includes instructions to receive what regularly? A)

Cardiovascular studies

Eye exams

Immunizations

Pulmonary studies

Ans:

B Feedback: Chloroquine is associated with visual disturbances and a patient receiving this drug should receive regular ophthalmic exams. Heart and lung toxicity is not associated with chloroquine use. Immunizations are not associated with chloroquine use.

5. A 28-year-old woman is planning to be part of a mission team going to Central Africa. She will take mefloquine (Lariam) once a week, beginning 1 week before traveling to Africa until 4 weeks after leaving Africa. What precaution will the nurse teach this patient is needed? A)

Avoid excessive weight gain.

Have regular cancer screening.

Use contraceptives to avoid pregnancy.

Stop the medication if diabetes is diagnosed.

Ans:

C Feedback: Mefloquine is teratogenic and should be avoided during pregnancy. The nurse will want to determine whether a possibility exists that the patient is pregnant and warn about the need to avoid pregnancy for 2 months after completing therapy. Avoiding weight gain and having regular cancer screenings are good preventive care but not associated with mefloquine. This medication is not contraindicated in patients with diabetes.

6. The nurse is writing a plan of care for a patient receiving antimalarial drug therapy. What nursing diagnosis would be appropriate for this patient if common adverse effects were indicated? A)

Disturbed sensory perception (visual) related to central nervous system effects

Imbalanced nutrition: more than body requirements

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Constipation

Ineffective breathing pattern

Ans:

A Feedback: Visual disturbances, including blindness related to retinal damage from the drug, may occur. Patients usually have gastrointestinal (GI) upset including diarrhea, not constipation, which could produce loss of weight and not an increase. Respiratory disturbances are not associated with antimalarial agents.

7. During a lecture on intestinal parasites, the students learn that what is the most commonly diagnosed intestinal parasite infection in the United States? A)

Amebiasis

Giardiasis

Leishmaniasis

Trichomoniasis

Ans:

B Feedback: The most commonly diagnosed intestinal parasite in the United States is Giardiasis. It is transmitted through contaminated water or food. Amebiasis is found in the United States but is not the most common. Leishmaniasis is transmitted through sand flies, which are not common in the United States. Trichomoniasis is a flagellated protozoan and most often is seen in the vagina and is spread during sexual intercourse by men who have no signs and symptoms of infection, it is not the most commonly diagnosed.

8. A patient has been diagnosed with trichomoniasis. Before beginning tinidazole (Tindamax) therapy, what should the nurse question the patient about? A)

Working conditions

Use of alcohol

Recent visit to a beach or desert

Possibly having AIDS

Ans:

B Feedback: Tinidazole is prescribed for trichomoniasis, which is transmitted during sexual intercourse. The drug should not be used when there is a history of alcohol use. Alcohol use could interfere with the drugs metabolism in the liver and cause toxicity and patients should be warned to avoid consuming all alcoholic beverages while taking this

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medication. There is no need to question about working conditions unless transmission involved environmental contamination of food and water, which is not indicated by the question. A recent visit to a beach or desert would be indicated if the patient was diagnosed with leishmaniasis and questioning the patient concerning AIDS would be indicated if the patient had a diagnosis of Pneumocystis carinii pneumonia and would not involve trichomonas. 9. The nurse is caring for a patient with acquired immunodeficiency syndrome (AIDS) who has been diagnosed with Pneumocystis jiroveci pneumonia. The patient is taking multiple oral agents to treat AIDS. What would be the drug of choice for this patient? A)

Nitazoxanide (Alinia)

Chloroquine

Metronidazole

Pentamidine

Ans:

D Feedback: Pentamidine is available as an inhalation product for the direct treatment of dm. jiroveci in patients with AIDS. Because the patient is already taking multiple oral drugs, inhaler administration would be the best choice. Nitazoxanide, chloroquine, and metronidazole are not effective against dm. jiroveci pneumonia.

10. A patient with giardiasis is being treated with metronidazole. What comment by the patient would indicate that the nurse needs to provide further teaching? A)

I can continue to work delivering pizza because the disease is not contagious.

I will not lose my hair during drug therapy.

I know I will experience diarrhea during this time.

I shouldnt experience irregular menstrual periods.

Ans:

A Feedback: Although giardiasis is not contagious, the patient should be encouraged not to drive or operate heavy equipment until the effects of the drug can be assessed because metronidazole can lead to central nervous system adverse effects, including dizziness and lack of coordination. The drug may also cause diarrhea. Loss of hair and irregular menstrual periods are not associated with this drug, so these statements would be correct and would not indicate the need for further teaching.

11. During treatment of amebiasis with chloroquine (Aralen Phosphate), the nurse assesses the patient for what adverse effects?

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Diarrhea

Weight gain

Hypertension

Seizures

Ans:

A Feedback: With amebicides, observe for anorexia, nausea, vomiting, epigastric burning, and diarrhea that can lead to malnutrition and significant weight loss, which the nurse assesses for with each visit to intervene before significant malnutrition occurs. Weight gain, hypertension, or seizures are not associated adverse effects.

12. The clinic nurse provides teaching for a patient prescribed pyrimethamine (Daraprim) to prevent malaria and instructs on the need to notify the prescriber immediately if what signs and symptoms occur? A)

Diarrhea, fatigue, weight loss, and anemia

Irritation, rash, or inflammation

Headache, nausea, or constipation

Anorexia, nausea, or vomiting

Ans:

A Feedback: If signs of folate deficiency develop, pyrimethamine will need to be discontinued so the prescriber needs to be notified immediately. Folate deficiency presents with diarrhea, fatigue, weight loss, and anemia. The other signs and symptoms would need to be reported if significant and/or long-lasting.

13. The mother of a 6-month-old infant comes to the clinic. The mother is diagnosed with a protozoal infection. What would be a priority for the nurse to assess for? A)

Whether she is breast-feeding

Whether she has a support network

Whether she has money to pay for the medication

Whether she eats a protein-rich diet

Ans:

A Feedback:

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Assess for lactation because antiprotozoal drugs could enter the breast milk and be toxic to the infant. The other options are part of a complete nursing history but do not specifically relate to treatment for a protozoal infection. 14. A patient is prescribed mefloquine (Lariam) for malaria prophylaxis. When should the nurse instruct mefloquine be started? A)

1 week prior to entering an endemic area

1 to 2 days prior to entering an endemic area

On arrival to an endemic area

When mosquitoes are present

Ans:

A Feedback: Lariam should be taken 1 week prior to entering a malarial area. Therefore, options B, C, and D are incorrect.

15. What statements made by the 36-year-old patient leads the nurse to believe that he or she has understood the teaching regarding metronidazole (Flagyl)? A)

I will refrain from operating heavy machinery while I am taking this medication.

I will avoid foods high in vitamin C.

I will not drink alcohol while I am taking this medication.

I will contact my physician if I have a cold.

Ans:

C Feedback: Patients should avoid all forms of alcohol while taking metronidazole. Patients do not need to avoid operating heavy machinery,and foods high in vitamin C, and will not contact the physician if they have colds.

16. The emergency room nurse admits a patient suspected of having giardiasis. What symptoms would the nurse expect the patient to present with? A)

Voluminous soft unformed stool

Frothy voluminous pale stool

Pale and mucous-filled stool

Frothy tan stool

Ans:

C Feedback:

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Diarrhea, rotten-egg-smelling stool, and pale and mucous-filled stool are commonly seen. Diarrhea is often accompanied by epigastric distress, weight loss, and malnutrition as a result of the invasion of the mucosa. Therefore, options A, B, and D are incorrect. 17. A 91-year-old man is being treated for Pneumocystis carinii pneumonia with pentamidine (NebuPent). What should the nurse measure when assessing this patient for adverse effects of the medication? A)

Liver function tests

Serum potassium

Daily blood pressure

Blood urea nitrogen (BUN) and creatinine

Ans:

A Feedback: Patients receiving antiprotozoal agents should be monitored regularly to detect any serious adverse effects. Liver function tests are of particular importance to determine the appropriateness of therapy and to monitor for toxicity. Serum potassium, BUN, and creatinine would indicate kidney damage, which is not normally a risk with this drug. Blood pressure is not indicated for this medication but is an early indicator of health deterioration and is usually included in all provisions of care.

18. What is the priority teaching point to be provided by the nurse to a patient being treated for trichomoniasis to prevent reinfection? A)

Meats should be fully cooked before eaten.

Sexual partners should be treated.

Wash hands before eating.

Purify all drinking water when camping.

Ans:

B Feedback: Trichomoniasis is usually spread during sexual intercourse and men often have no symptoms. Women present with red, inflamed vaginal mucosa, itching, burning, and a yellowish green discharge. Women should be taught the importance of having their partners tested and treated simultaneously to prevent reinfection. The other options are healthy lifestyle choices but are not the primary means of preventing reinfection.

19. How does the nurse teach the patient to take chloroquine (Aralen Phosphate)? A)

On an empty stomach

With 8 ounces of water

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With meals

With orange juice followed by 8 ounces of water

Ans:

C Feedback: Chloroquine should be taken with meals to reduce gastrointestinal (GI) upset; small frequent meals may also reduce negative GI effects. Taking medications, any medication, with adequate amounts of water is always good practice but not specific to this medication. There is no indication that ingestion of orange juice makes any practical difference.

20. The nurse, learning about malaria, discovers that the transmission of malaria occurs when what is injected into the human body by the infected mosquito? A)

Sporozoites

Gametocytes

Schizonts

Merozoites

Ans:

A Feedback: Gametocytes are sucked with the blood from an infected person by the mosquito. The gametocytes mate in the stomach of the mosquito and produce a zygote that goes through several phases before forming sporozoites (spore animals) that make their way to the mosquitos salivary glands. The next person who is bitten by that mosquito is injected with thousands of sporozoites. Schizonts are the primary tissue organisms resulting from asexual cell division and reproduction after the sporozoites are introduced into the body. Merozoites are then formed from the primary schizonts.

21. The nurse is caring for a patient who is taking antimalarial medications. The nurse teaches the patient about the medication and explains the need to report what signs and symptoms immediately because of its association with a serious adverse effect? A)

Loss of appetite

Loss of hair

Loss of vision

Loss of sensation

Ans:

C Feedback:

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Report blurring of vision, which could indicate retinal damage; loss of hearing or ringing in the ears, which could indicate central nervous system toxicity; and fever or worsening of condition, which could indicate a drug-resistant strain or noneffective therapy. Loss of appetite is such a common result of the gastrointestinal (GI) effects of the drug that the nurse should provide anticipatory guidance to teach the patient how to maintain adequate nutrition, but the patient does not need to report this unless it becomes serious or unmanageable. Loss of sensation is not a typical adverse effect the nurse would anticipate and teach about. 22. The nurse is caring for a patient who just returned from a trip to South America and was infected by the protozoan Trypanosoma cruzi. What will the nurse assess for in this patient? A)

Serious lesions in the skin

Sleeping sickness

Severe cardiomyopathy

Yellowish green vaginal discharge

Ans:

C Feedback: Chagas disease, which is caused by T. cruzi, is passed to humans by the common house fly. This protozoan results in a severe cardiomyopathy that accounts for numerous deaths and disabilities in certain regions. Sleeping sickness results from T. brucei gambiense; leishmaniasis produces serious lesions in the skin, and trichomoniasis produces a yellowish green discharge.

23. A patient with malaria is taking primaquine. What would indicate to the nurse caring for this patient that the patient has cinchonism? A)

Diarrhea

Abdominal cramping

Tan, frothy stool

Vertigo

Ans:

D Feedback: Cinchonism (nausea, vomiting, tinnitus, and vertigo) may occur with high levels of primaquine. Symptoms of cinchonism do not include diarrhea, abdominal cramping, or tan, frothy stool.

24. A patient has been prescribed an antimalarial as prophylaxis for the disease. What assessment finding would the nurse recognize as indicating the patient has a common adverse effect?

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Dyspepsia

Hematemesis

Tarry stool

Tachycardia

Ans:

A Feedback: Nausea, vomiting, dyspepsia, and anorexia are associated with direct effects of the antimalarial medications on the GI tract and the effects on central nervous system control of vomiting caused by the products of cell death and protein changes. Adverse effects from antimalarial drugs do not usually include hematemesis, tarry stool, or tachycardia.

25. A patient presents at the emergency department complaining of sudden onset of high fever and swelling and reddening of the limbs. Assessment shows severe hypotension. The nurse taking the patients history notes that the patient has recently returned to the United States from the African continent. The patient is admitted to the intensive care unit (ICU) suspected of having malaria caused by what protozoan? A)

Plasmodium ovale

Plasmodium falciparum

Plasmodium vivax

Plasmodium malariae

Ans:

B Feedback: dm. falciparum is considered to be the most dangerous type of protozoan. Infection with this protozoan results in an acute, rapidly fulminating form of the disease with high fever, severe hypotension, swelling and reddening of the limbs, loss of red blood cells, and even death. The other options are pathogens that cause milder forms of the disease and dm. ovale is rarely encountered.

26. Pyrimethamine (Daraprim) has been ordered for the patient as prophylactic treatment of malaria. The nurse recognizes the action of this drug prevents relapse of the disease by acting on what? A)

Changing the metabolic pathways for reproduction

Disrupting the mitochondria of the plasmodium

Blocking the use of folic acid

Increasing the acidity of plasmodial food vacuoles

Ans:

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Feedback: Pyrimethamine is used in combination with agents that act more rapidly to suppress malaria; it acts by blockings the use of folic acid in protein synthesis by the plasmodium, eventually leading to inability to reproduce and cell death. Chloroquine changes the metabolic pathways for reproduction of the plasmodium and is toxic to parasites that absorb it. Primaquine disrupts the mitochondria of the plasmodium. Mefloquine increases the acidity of plasmodial food vacuoles causing cell rupture and death. 27. A patient, recently returned from a vacation in the tropics, is diagnosed with leishmaniasis. The patient asks the nurse how he or shes got this disease. What is the nurses best response? A)

You got this disease from a mosquito bite.

You got this disease from unsanitary drinking water.

You got this disease from eating unsanitary food.

You got this disease from the bites of sand flies.

Ans:

D Feedback: Leishmaniasis is a disease caused by a protozoan that is passed from sand flies to humans. Therefore, options A, C, and D are incorrect.

28. The patient, newly diagnosed with African sleeping sickness, asked what caused the disease. What is the nurses best response? A)

Trypanosoma brucei gambiense

Giardia lamblia

Promastigote

Trypanosoma cruzi

Ans:

A Feedback: African sleeping sickness, which is caused by Trypanosoma brucei gambiense, is transmitted by the tsetse fly. After the pathogenic organism has lived and grown in human blood, it eventually invades the central nervous system, leading to acute inflammation resulting in lethargy, prolonged sleep, and even death. G. lamblia causes giardiasis; T. cruzi causes Chagas disease. A promastigote is a flagellated protozoan that causes leishmaniasis.

29. The patient, a physician returning from a trip to the tropics, is prescribed chloroquine and asks the nurse how it works. What is the nurses best response?

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Blocks the plasmodiums ability to synthesize ribonucleic acid

Changes the metabolic pathways necessary for the reproduction of the plasmodium

Interrupts the cell wall preventing entry of nutrients into the plasmodium

It is alkaline and decreases the ability of the parasite to synthesize deoxyribonucleic acid (DNA).

Ans:

B Feedback: Chloroquine is currently the mainstay of antimalarial therapy. This drug enters human red blood cells and changes the metabolic pathways necessary for the reproduction of the plasmodium (see Figure 12.1). In addition, this agent is directly toxic to parasites that absorb it, it is acidic, and it decreases the ability of the parasite to synthesize DNA, leading to a blockage of reproduction.

30. What antimalarial medication is used as a radical cure of Plasmodium vivax malaria? A)

Chloroquine

Mefloquine

Pyrimethamine

Primaquine

Ans:

D Feedback: Primaquine (generic) is the only drug indicated for the prevention of relapses of dm. vivax and dm. malariae infections and a radical cure of dm. vivax malaria. It may be given in combination with other drugs that interrupt the cell cycle at other stages. None of the other options are indicated for this use.

31. The nurse, working in a pediatric clinic, admits a patient who will be traveling to a country where malaria is endemic. What is the safest treatment for this child? A)

No prophylaxis is administered because of the severity of adverse effects.

Call the Centers for Disease Control and Prevention (CDC) or local health department for the safest possible treatment.

Administer extremely small doses of chloroquine.

Any antimalarials in appropriate dosages can be administered.

Ans:

B Feedback:

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Although dosages for prophylaxis have been calculated to treat malaria in children, many drugs have not been proven to be safe and efficient in that population and extreme caution is needed .If a child needs to travel to an area with endemic protozoal infections, the CDC or local health department should be consulted about the safest possible preventive measures. As a result, the other options are incorrect. 32. What statement, if made by the nurse, would be correct? A)

Malaria can live without a host and be contracted from drinking standing water.

Any mosquito can carry the plasmodium that transmits malaria.

A major problem with controlling malaria is the mosquito that is resistant to insecticide.

Widespread efforts at mosquito control have never been helpful.

Ans:

C Feedback: Widespread efforts at mosquito control have been successful, with fewer cases of malaria being reported each year. However, the rise of insecticide-resistant mosquitoes has allowed malaria to continue to flourish, increasing the incidence of the disease. Malaria requires a host to live, whether it is human or mosquito. Only the female Anopheles mosquito harbors the protozoal parasite and carries it to humans.

33. The nurse is caring for a patient diagnosed with amebiasis caused by Entamoeba histolytica that resulted in the patient having amebic dysentery. What questions might the nurse ask in an attempt to discover how the patient came in contact with the organism? (Select all that apply.) A)

Have you traveled outside the country recently?

Have you been swimming in a lake or pond recently?

Have you been eating fresh fruits or vegetables without washing them first?

Have you been bitten by a mosquito?

Have you had unprotected sex recently?

Ans:

A, B, C Feedback: The disease is transmitted while the protozoan is in the cystic stage in fecal matter, from which it can enter water and soil. It can be passed to other humans who drink this water or eat food that has been grown in this ground. It is not passed by a mosquito or from sexual activity.

34. The nurse explains that the drugs metronidazole (Flagyl) or tinidazole (Tindamax) can be administered to treat what protozoan infections? (Select all that apply.)

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Trichomoniasis

Giardiasis

Amebiasis

Pneumocystis carinii pneumonia

Cryptosporidium parvum

Ans:

A, B, C Feedback: Metronidazole or tinidazole are effective treatments for trichomoniasis, giardiasis, and amebiasis. They are not effective for P carinii pneumonia or C. parvum.

35. How does the nurse adapt the plan of care when caring for an older adult receiving an antiprotozoal agent? A)

Patients should be monitored more closely for toxic adverse effects.

The drug dosage should be lowered for all older adults.

Antiprotozoal agents should not be administered to older adults.

Female patients of appropriate age should be advised to use barrier contraceptives.

Ans:

A Feedback: Older patients may be more susceptible to the adverse effects associated with these drugs. They should be monitored closely. Dosage should only be lowered if the patient has hepatic dysfunction or if hepatic dysfunction is anticipated. Antiprotozoal agents can be administered to older adults with caution when the benefit outweighs the risk. It is not necessary for older adult women to use barrier methods of contraceptives because they are no longer of childbearing age.

Chapter 44: Anthelmintic Drugs 1. A public health nurse is speaking to parents of first graders. When discussing worm infection, the nurse will explain that the most common type found in U.S. school-aged children is what? A)

Pinworms

Roundworms

Threadworms

Whipworms

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Ans:

A Feedback: The most common worm infection encountered in U.S. school-aged children is pinworms. These worms are endogenous to the area and easily spread. Roundworms, whipworms, and threadworms are not as common.

2. A mother of a 3-year-old child brings her child to the clinic. The child is diagnosed with pinworms. What drug would be the best choice for the patient? A)

Pyrantel (Pin-Rid)

Ivermectin (Stromectol)

Mebendazole (Vermox)

Albendazole (Albenza)

Ans:

C Feedback: Mebendazole is the most commonly used anthelmintic for pinworms because it is available in a chewable tablet. This is a good choice for the 3-year-old patient. Pyrantel is also prescribed for pinworms but is not available in a chewable form. Ivermectin is prescribed for treatment of threadworm disease and albendazole is given to treat active lesions caused by pork tapeworm and cystic disease of the liver, lungs, and peritoneum caused by dog tapeworm.

3. A nurse is teaching a young mother about administering pyrantel (Pin-Rid, others) to her 5-year-old child. What will the nurse emphasize about how the agent is given? A)

In 3 doses as a 1-day treatment

In a morning dose and an evening dose for 3 days

B.I.D. for 10 days

Give only once

Ans:

D Feedback: Pyrantel is administered orally as a single dose. Albendazole is prescribed for hydatid disease and is given twice a day for 8 to 30 days of treatment. Mebendazole is used in the treatment of diseases caused by pinworms, roundworms, whipworms, and hookworms and is given in a morning and evening dose for 3 days. Praziquantel is used to treat schistosomes and is taken in three doses as a 1-day treatment.

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4. A patient has been diagnosed with roundworms and is to be treated with albendazole. A priority nursing assessment of this patient would be to determine if the patient is taking what? A)

Cimetidine (Tagamet)

Pioglitazone (Actos)

Alprazolam (Xanax)

Loperamide (Imodium)

Ans:

A Feedback: The adverse effects of albendazole, which are already severe, may increase if the drug is combined with dexamethasone, praziquantel, or cimetidine. These combinations should be avoided if at all possible; if they are necessary, patients should be monitored closely for the occurrence of adverse effects. Pioglitazone is an oral antidiabetic agent that could be taken with albendazole. Loperamide is an antidiarrheal drug that may be used for treatment of diarrhea as a result of the mebendazole and pyrantel. Alprazolam should not be a concern.

5. What would be a priority nursing action related to the care of a patient taking albendazole (Albenza)? A)

Check blood pressure, pulse, and respirations

Weigh the patient

Monitor renal function

Encourage small, frequent meals

Ans:

C Feedback: It is important that the patients kidney function be monitored because a serious adverse effect of this drug is renal failure. Even though vital signs, weight, and nutrition are important and should be monitored, if the patient exhibits any signs of renal failure the drug should be stopped immediately.

6. The nurse is caring for an adult patient receiving a prescription for an anthelmintic drug. What is a possible nursing diagnosis for this patient? A)

Constipation

Disturbed body image

Acute confusion

Imbalanced nutrition: More than body requirements

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Ans:

B Feedback: A potential nursing diagnosis for the patient would be disturbed body image related to diagnosis and treatment. There is a stigma associated with having helminthic infections. Treatment can cause diarrhea, loss of hair, and pruritus, which could be noticed by others and further impact the patients body image. Usually these drugs do not cause constipation; they have not been linked to confusion.

7. A nurse is teaching a patient who has been diagnosed with trichinosis. The nurse will include in the discussion that trichinosis is caused by roundworms having what effect? A)

Disruption of the hosts normal cellular functions causing cell death and resulting in disease

Invasion of body tissues seriously damages lymphatic tissue, lungs, the central nervous system, heart, and liver

Exposure to the delicate mucous membranes of the anus and colon producing local irritation

Easily passed from one individual to another resulting in rapid spreading within a work place

Ans:

B Feedback: Trichinosis is a disease caused by the ingestion of the encysted larvae of the roundworm from undercooked pork. These worms exist outside the intestinal tract and can seriously damage the tissues they invade. The worms do not spread rapidly through a large group of people unless they have all eaten the undercooked pork. They do not enter cells to alter human cellular function.

8. When instructing a patient about the therapeutic effectiveness of an anthelmintic drug, the nurse would be sure to include what? A)

Any person exposed to the patient should also be treated.

The drugs should never be taken with food.

The infected person should be isolated.

Strict hygiene measures are important in eradicating the worm.

Ans:

D Feedback: When treating a patient with an anthelmintic drug, the patient should be instructed to follow strict hand washing and hygiene measures as an adjunct in eradicating the worm. Isolation is not necessary and prophylactic treatment is not effective with worms.

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Anthelmintics are often taken with food to decrease the gastrointestinal (GI) adverse effects. 9. The nurse is caring for a patient diagnosed with hookworms. The patient is receiving mebendazole (Vermox). What would the nurse expect to see in this patient? A)

Increased bilirubin

Decreased hematocrit and hemoglobin

Increased aspartate transaminase levels

Decreased blood sugar

Ans:

B Feedback: Hookworms can cause anemia and fluid and electrolyte imbalances because of the amount of blood that is sucked from the walls of the intestine. A decreased hematocrit and hemoglobin would indicate anemia and is often found in patients with hookworm. Bilirubin and aspartate transaminase indicate liver function. Because mebendazole is not absorbed systemically, adverse effects are limited to abdominal effects such as discomfort, diarrhea, or pain so this drug would not impact bilirubin or aspartate transaminase levels. Neither the disease nor drug should decrease blood sugar.

10. A patient is taking an anthelmintic that is absorbed systemically. What adverse effect should the nurse inform the patient might be experienced? A)

Abdominal discomfort

Diarrhea

Loss of hair

Pain

Ans:

C Feedback: Anthelmintics that are absorbed systemically could cause headache, dizziness, fever, shaking, chills, malaise, pruritus, and loss of hair. Mebendazole and pyrantel are anthelmintics that are not generally absorbed systemically and may cause abdominal discomfort, diarrhea, and pain.

11. A mother brings her child to the clinic where the child is diagnosed with hookworms. The mother asks how the child got hookworms. What would the nurse tell the mother is the route of entry for hookworm? A)

Inhalation

Contact with skin

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Ingestion of undercooked foods

Blood-borne exposure

Ans:

B Feedback: The larvae penetrate the skin and then enter the blood and within about a week, reach the intestine. Inhalation, ingestion, and blood-borne exposure are incorrect.

12. A patient is diagnosed with an ascaris infection. The patient asks what the best way is to prevent ascaris infections. What is the nurses best response? A)

Wash hands before eating.

Do not share hairbrushes or hats.

Wash fresh fruits and vegetables before eating.

Avoid heavily populated areas.

Ans:

C Feedback: Ascaris infection occurs where sanitation is poor. Eggs in the soil are ingested with vegetables or other improperly washed foods containing the worm. The patients may be unaware until a worm in their stool is seen or the patient becomes quite ill. Teaching patients the importance of washing fresh fruit and vegetables will help them reduce risk of infection. Washing hands, avoiding sharing hairbrushes or hats, and being aware in populated areas will reduce the risk of other infections but do not relate to ascaris.

13. What is an appropriate nursing diagnosis for a patient with tapeworm? A)

Imbalanced nutrition: less than body requirements

Chronic pain

Constipation

Impaired mobility

Ans:

A Feedback: Tapeworm affects the bodys ability to absorb food products and weight loss and malnutrition often follow unless treatment is received promptly. As a result, the best nursing diagnosis is imbalanced nutrition: less than body requirements. Patients with tapeworm are often symptom-free but may experience some abdominal discomfort and distention as well as weight loss so they do not have chronic pain, constipation, or impaired mobility.

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14. Why is it important for a nurse to inquire about any foreign travel of a patient with a suspected lymphatic or hematologic disorder? A)

To determine the varied sexual history of the patient, if any

To determine the potential exposure to infectious agents

To determine whether the patient has had any blood transfusions

To determine whether the patient adopted any specific dietary habits

Ans:

B Feedback: Knowledge of recent travel can help the nurse to pinpoint potential exposure to helminths, parasites, or other infection exposure common in the area visited. The nurse should specifically ask about foreign travel to countries where malaria or parasitic roundworms are common. Sexual history, dietary habits, or any blood transfusions that the patient may have had before would not be adequately explored by questioning travel history.

15. What helmintic infestation occurs in tropical areas and is carried by snails? A)

Schistosomiasis

Platyhelminths

Trichinosis

Filariasis

Ans:

A Feedback: Schistosomiasis is a common problem in many tropical areas where the snail that is necessary in the life cycle of the fluke lives. Trichinosis is caused by eating undercooked pork and can occur in any part of the world. Filariasis and platyhelminths are not restricted to tropical areas.

16. The nursing instructor is discussing helmintic infections with the nursing students. How would the instructor explain the action of anthelmintic drugs? A)

Destroy the nervous system of the invading worm

Act on metabolic pathways that are present in the invading worm

Interfere in the reproductive cycle of the invading worm

Cause fatal mutations in the deoxyribonucleic acid of the invading worm

Ans:

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Feedback: The anthelmintic drugs act on metabolic pathways that are present in the invading worm, but that are absent or significantly different in the human host. Other options are incorrect descriptions of how anthelmintic drugs work. 17. What anthelmintics would the nurse expect will be readily absorbed from the gastrointestinal (GI) tract? (Select all that apply.) A)

Mebendazole

Pyrantel

Albendazole

Praziquantel

Ivermectin

Ans:

D, E Feedback: Praziquantel and ivermectin are readily absorbed from the GI tract. Mebendazole, pyrantel, and albendazole are not.

18. A mother brings her 18-month-old son into the clinic. The child is diagnosed with pinworms. Which anthelmintic would the nurse expect to be prescribed? A)

Pyrantel

Mebendazole

Ivermectin

Praziquantel

Ans:

B Feedback: Mebendazole is available in the form of a chewable tablet that would be preferable for a young child. Because little of the drug is absorbed systemically, it is safe for children and has few adverse effects, thus making it safer to administer to a child. Pyrantel is not approved for children younger than 2 years old. Ivermectin and praziquantel effects are systemic and would a greater number of adverse effects.

19. The nurse is caring for a 26-year-old patient diagnosed with roundworms who is prescribed pyrantel. What adverse effect would the nurse teach the patient about? A)

Vomiting

Itching

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Diarrhea

Constipation

Ans:

C Feedback: Mebendazole and pyrantel, which are not absorbed systemically, may cause abdominal discomfort, diarrhea, or pain, but have very few other effects and are well-tolerated. Therefore options A, B, and D are incorrect.

20. The nurse is caring for a patient taking albendazole. When reviewing the patients medication history what drug would cause the nurse to question administering albendazole? A)

Propranolol

Fexofenadine

Furosemide

Dexamethasone

Ans:

D Feedback: The effects of albendazole, which are already severe, may increase if the drug is combined with dexamethasone, praziquantel, or cimetidine. These combinations should be avoided if at all possible; if they are necessary, patients should be monitored closely for occurrence of adverse effects. No contraindications are noted for propranolol, fexofenadine, or furosemide.

21. Why is a filariae infestation potentially fatal? A)

Worm-like embryos overwhelm the lymphatic system

Worm-like embryos invade the central nervous system (CNS)

Worm-like embryos destroy the gastric mucosa

Worm-like embryos hibernate in the brain

Ans:

A Feedback: Filariasis refers to infection of the blood and tissues of healthy individuals by worm embryos, which enter the body via insect bites. These thread-like embryos, or filariae, can overwhelm the lymphatic system and cause massive inflammatory reactions. While any system can be impacted due to the effect on the blood and lymphatic system, the filariae do not invade the CNS, gastric mucosa, or the brain specifically.

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22. The nurse is caring for a patient diagnosed with threadworm infestation. What is the nurses priority assessment related to common manifestations of this infestation? A)

Gastroenteritis

Pneumonia

Hematuria

Tarry stools

Ans:

B Feedback: Threadworm is a pervasive nematode that can send larvae into the lungs, liver, and central nervous system and can cause severe pneumonia or liver abscess. Threadworms do not cause gastroenteritis, hematuria, or tarry stools.

23. What infestation would the nurse suspect when the patient manifests with intestinal obstruction caused by the adult worms clogging the lumen of the intestine? A)

Platyhelminth

Trichinosis

Nematode

Cestode

Ans:

C Feedback: Nematode are roundworms such as the commonly encountered pinworm, whipworm, threadworm, Ascaris, or hookworm that cause a common helminthic infection in humans and can cause intestinal obstruction as the adult worms clog the intestinal lumen or severe pneumonia when the larvae migrate to the lungs and form a pulmonary infiltrate. Options A, B, and D are incorrect.

24. The nurse is caring for a 17-year-old girl who has just been diagnosed with a tapeworm. What is a priority nursing action for this patient? A)

Monitor hepatic and renal function before and periodically during treatment.

Provide small, frequent, nutritious meals if GI upset is severe.

Instruct the patient about the appropriate dosage regimen.

Offer support and encouragement.

Ans:

D Feedback:

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Frequently, patients have a very difficult time dealing with a diagnosis of worm infestation. It is very important for the nurse to understand the disease process and to explain the disease and treatment carefully to help the patient to cope with both the diagnosis and the treatment. Options A, B, and C are correct nursing interventions for this patient, but they are not the priority nursing intervention. 25. The nurse is counseling a patient who has been prescribed mebendazole for a worm infestation. What adverse effects would the nurse caution this patient about? A)

Fever

Constipation

Nausea

Hematuria

Ans:

A Feedback: Mebendazole is not absorbed systemically so it has few adverse effects. Adverse effects include transient abdominal pain, diarrhea, and fever. Adverse effects do not include constipation, nausea, or hematuria.

26. When teaching a class of her peers about use of the drug ivermectin, what would the nurse say is the primary route of excretion? A)

Urine

Feces

Sweat

Both urine and feces

Ans:

B Feedback: Ivermectin is readily absorbed from the gastrointestinal (GI) tract and reaches peak plasma levels in 4 hours. It is completely metabolized in the liver with a half-life of 16 hours and excretion is fecal. Options A, C, and D are incorrect.

27. Which anthelmintic medication is poorly absorbed from the gastrointestinal (GI) tract and primarily excreted in the urine? A)

Ivermectin

Praziquantel

Albendazole

Mebendazole

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Ans:

C Feedback: Albendazole is poorly absorbed from the GI tract, reaching peak plasma levels in about 5 hours. It is metabolized in the liver and primarily excreted in urine. Although praziquantel is excreted in the urine, it is rapidly absorbed from the GI tract. Mebendazole and ivermectin are excreted in feces.

28. The nurse is presenting at an educational event about pinworms at the local elementary school during an outbreak of the infestation. What suggestion would the nurse give the attendees to prevent a recurrence of the infestation? A)

Tell the children not to share combs and brushes.

Tell the children not to drink out of other peoples drinks.

Avoid pajamas in favor of night gowns.

Shower the children every morning.

Ans:

D Feedback: Some suggested hygiene measures that might help to control the infection include the following: Keep the childs nails cut short and hands well scrubbed, because reinfection results from the worms eggs being carried back to the mouth after becoming lodged under the fingernails when the child scratches the pruritic perianal area. Give the child a shower in the morning to wash away any ova deposited in the anal area during the night. Change and launder undergarments, bed linens, and pajamas every day. Open gowns, rather than pajamas with pants, would not be the best choice because this would allow for greater perianal scratching.

29. An adult presents at the clinic complaining of a cough, fever, abdominal distention, and pain. The patient is diagnosed with pneumonia and a helminth infection. What type of worm would the nurse suspect the patient has? A)

Ascaris

Platyhelminth

Hookworm

Schistosomiasis

Ans:

A Feedback: Ascaris manifestations include cough, fever, pulmonary infiltrates, abdominal distention, and pain. Platyhelminth is a flatworm that can live in the human intestine or can invade other human tissues causing malnutrition as the worm competes for the food eaten by the

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human. Hookworms attach to the small intestine leading to severe anemia, lethargy, fatigue, and weakness. Schistosomiasis presents with a rash and then symptoms of diarrhea and liver and brain inflammation. 30. A mother asks the nurse what to look for if her child has pinworms. What would be the nurses best response? A)

Hard stools full of worms

Perianal itching

Upset stomach

Bloody diarrhea

Ans:

B Feedback: Pinworms manifestation includes perianal itching, and occasionally, vaginal itching particularly at night when the pinworms are most active around the anal opening. Pinworms do not usually present in any other manner so the other options are incorrect.

31. A patient with hookworm infection states that he has a hard time following medication regimens. The nurse knows that what medication would be preferred for this patient? A)

Pyrantel (Antiminth)

Mebendazole (Vermox)

Ivermectin (Stromectol)

Albendazole (Albenza)

Ans:

A Feedback: Pyrantel can be administered as a single dose, which makes it a good choice for patients who have trouble remembering to take their medications, or have trouble following medication regimens. Mebendazole requires twice-daily dosing, which makes it less optimal for a patient who has trouble with medication regimens. Ivermectin is used to treat threadworm disease (strongyloidiasis) and river blindness (onchocerciasis). Albendazole is used to treat active lesions caused by pork tapeworm and cystic disease of the liver, lungs, and peritoneum caused by dog tapeworm.

32. What benefit would the nurse describe for treating pinworms and roundworms with a prescription for pyrantel instead of mebendazole? A)

Pyrantel needs only be taken once.

Mebendazole has many serious adverse effects.

Pyrantel is excreted in the feces.

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Pyrantel is safer for children younger than 2 years.

Ans:

A Feedback: Pyrantels big advantage is that it needs only be taken one time so it is a better choice for those who may not remember to take repeated doses. Mebendazole has very few side effects because very little of the medication is absorbed systemically so that is not a reason to prescribe pyrantel. Pyrantel is mostly excreted in the feces but some is also found in urine while mebendazole is only excreted in the feces so this does not benefit prescribing pyrantel. Pyrantel has not been established as safe for use in children under 2 years old.

33. What laboratory test will the nurse obtain to determine what type of helminth is infecting the patient? A)

Stool culture

Stool for ova and parasite

Renal function studies

Liver function studies

Ans:

B Feedback: The only test to specifically determine what helminth is involved is a stool culture for ova and parasite. A simple stool culture would not be likely to identify the helminth. Renal and liver function studies would indicate the functioning of these organ systems but would not identify the helminth.

34. What assessment findings would raise the nurses level of suspicion that the patient may be infected with cestodes? (Select all that apply.) A)

Abdominal discomfort and distention

Weight loss without dieting

Pneumonia

Heart failure

Encephalitis

Ans:

A, B Feedback: Cestodes enter the body as larvae that are found in undercooked meat or fish; they sometimes form worms that are several yards long, people with a tapeworm may experience some abdominal discomfort and distention, as well as weight loss, because the

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worm eats ingested nutrients. Trichinosis can result in fatal pneumonia, heart failure, and encephalitis if not treated early, but these symptoms would not be expected with cestode infection. 35. The nurse is caring for an 85-year-old woman diagnosed with a roundworm infection in addition to heart disease, chronic renal failure, and history of a stroke. The patient is prescribed mebendazole. What assessments will be of particular importance for this patient related to drug therapy? (Select all that apply.) A)

Hydration

Nutritional status

Liver function

Cognitive function

Respiratory function

Ans:

A, B, D Feedback: Mebendazole is a relatively safe drug with few adverse effects. However, infection by a helminth that impacts absorption of nutrients in a frail older woman could lead to significant dehydration and malnutrition so it would be of particular importance to assess this patient frequently and regularly. Respiratory function, liver function, and cognition would not be impacted by the helminth or the medication, but altered cognition could occur with malnutrition and/or dehydration.

Chapter 45: Antiviral Drugs MULTIPLE CHOICE 1. A patient calls the clinic in November to report a temperature of 103 F, headache, a nonproductive cough, and muscle aches. The patient reports feeling well earlier that day. The nurse will schedule the patient to see the provider and will expect the provider to order which medication? a. Amantadine HCl (Symmetrel) b. Influenza vaccine c. Rimantadine HCl (Flumadine) d. An over-the-counter drug for symptomatic treatment ANS: C Rimantadine is used for treatment of influenza. Amantadine is used primarily for prophylaxis, and this patient already has symptoms. The influenza vaccine may be given later to protect against other strains. Over-the-counter medications may be used as adjunct treatment. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 450 TOP: NURSING PROCESS: Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

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2. A nurse whose last flu vaccine was 1 year prior is exposed to the influenza A virus. The occupational health nurse will administer which medication? a. Acyclovir (Zovirax) b. Amantadine HCl (Symmetrel) c. Influenza vaccine d. Oseltamivir phosphate (Tamiflu) ANS: B The primary use for amantadine is prophylaxis against influenza A. Acyclovir is used to treat herpes virus. Oseltamivir phosphate (Tamiflu) is to be taken once flu symptoms appear. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 450 TOP: NURSING PROCESS: Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 3. A patient is diagnosed with influenza and will begin taking a neuraminidase inhibitor. The nurse knows that this drug is effective when taken within how many hours of onset of flu symptoms? a. 12 hours b. 24 hours c. 48 hours d. 72 hours ANS: C Neuraminidase inhibitors, such as zanamivir and oseltamivir, should be taken within 48 hours of onset of symptoms for best effect. DIF: COGNITIVE LEVEL: Remembering (Knowledge) REF: dm 450 TOP: NURSING PROCESS: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 4. The nurse receives an order to administer a purine nucleoside antiviral medication. The nurse understands that this medication treats which type of virus? a. Hepatitis virus b. Herpes virus c. HIV d. Influenza virus ANS: B Purine nucleosides, such as acyclovir, are used to treat herpes simplex viruses 1 and 2, herpes zoster virus, varicella-zoster virus, and cytomegalovirus. DIF: COGNITIVE LEVEL: Remembering (Knowledge) REF: dm 450 TOP: NURSING PROCESS: Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 5. The nurse is caring for an infant who has respiratory syncytial virus (RSV) and who will receive ribavirin. The nurse expects to administer this drug by which route? a. Inhalation b. Intramuscular c. Intravenous d. Oral

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ANS: A Ribavirin is given by inhalation to treat RSV. Oral ribavirin is used to treat hepatitis C, and intravenous ribavirin is used to treat hepatitis C and Lassa fever. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: dm 450 TOP: NURSING PROCESS: Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 6. The nurse receives the following order for a patient who is diagnosed with herpes zoster virus: PO acyclovir (Zovirax) 400 mg TID for 7 to 10 days. The nurse will contact the provider to clarify which part of the order? a. Dose and frequency b. Frequency and duration c. Drug and dose d. Drug and duration ANS: A Acyclovir is used for herpes zoster, but the dose should be 800 mg 5 times daily for 7 to 10 days. The nurse should clarify the dose and frequency. For herpes simplex, 400 mg 3 times daily is correct. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 451 TOP: NURSING PROCESS: Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 7. The nurse is teaching a patient who will receive acyclovir for a herpes virus infection. What information will the nurse include when teaching this patient? a. Blood cell counts should be monitored closely. b. Dizziness and confusion are harmless side effects. c. Increase fluid intake while taking this medication. d. Side effects are rare with this medication. ANS: C Patients taking acyclovir should increase fluid intake to maintain hydration. A complete blood count is not required. Dizziness and confusion should be reported to the provider. Antiviral medications have many side effects. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: dm 453 TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 8. A patient who has travelled to an area with prevalent malaria has chills, fever, and diaphoresis. The nurse recognizes this as which phase of malarial infection? a. Erythrocytic phase b. Incubation phase c. Prodromal phase d. Tissue phase ANS: A The erythrocytic phase of malarial infection occurs when the parasite invades the red blood cells and is characterized by chills, fever, and sweating.

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DIF: COGNITIVE LEVEL: Remembering (Knowledge) REF: dm 454 TOP: NURSING PROCESS: Assessment MSC: NCLEX: Physiological Integrity: Pathophysiology 9. A patient is preparing to travel to a country with prevalent malaria. To prevent contracting the disease, the provider has ordered chloroquine HCl (Aralen). The nurse will instruct the patient to take this drug according to which schedule? a. 500 mg weekly beginning 2 weeks prior to travel and continuing for 6 to 8 weeks after travel b. 1000 mg weekly beginning 2 weeks prior to travel and continuing for 6 to 8 weeks after travel c. 500 mg once followed by 500 mg per dose in 6 hours, 24 hours, and 48 hours d. 1000 mg once followed by 500 mg per dose in 6 hours, 24 hours, and 48 hours ANS: A For malaria prophylaxis, chloroquine is given 500 mg/dose weekly for 2 weeks prior to travel and then weekly until 6 to 8 weeks after exposure. The dosing schedule of 1000 mg once, followed by 500 mg in 6, 24, and 48 hours is used to treat acute malaria. DIF: COGNITIVE LEVEL: Remembering (Knowledge) REF: dm 455 TOP: NURSING PROCESS: Planning MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 10. A patient is taking chloroquine (Aralen) to treat acute malaria. Which statement by the patient indicates understanding of this medication? a. I should abstain from alcohol while taking this medication. b. I should report urine output less than 1000 mL/day. c. I should report visual changes immediately. d. I should take this drug on an empty stomach. ANS: C Patients taking chloroquine (Aralen) have a risk of visual injury related to side effects of blurred vision and should report visual changes to the provider. There is no restriction on alcohol. Patient should report urine output of less than 600 mL/day, and patients should take the drug with food. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 456 TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 11. A patient will take an anthelmintic medication and asks the nurse about side effects. The nurse will tell the patient that anthelmintic drugs a. can cause hepatic toxicity. b. cause orthostatic hypotension. c. commonly have gastrointestinal (GI) side effects. d. have many serious adverse reactions. ANS: C Anthelmintic drugs have many GI side effects, including anorexia, nausea, vomiting, diarrhea, and cramps. Adverse reactions do not occur frequently. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: dm 457 TOP: NURSING PROCESS: Planning MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

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12. A child is being treated for pinworms, and the parent asks the nurse how to prevent spreading this to other family members. What will the nurse tell the parent? a. Give your child baths every day. b. Obtain a daily stool specimen from your child. c. Wash your childs clothing in hot water. d. Your child should wash hands well after using the toilet. ANS: D To prevent the spread of pinworms, good hand washing after toileting is recommended. Patients should take showers, not baths. It is not necessary to get regular stool specimens or to wash clothing in hot water. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 458 TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 13. A patient who is taking acyclovir (Zovirax) to treat an oral HSV-1 infection asks the nurse why oral care is so important. The nurse will tell the patient that meticulous oral care helps to a. minimize transmission of disease. b. prevent gingival hyperplasia. c. reduce viral resistance to the drug. d. shorten the duration of drug therapy. ANS: B Good oral care can prevent gingival hyperplasia in patients with HSV-1. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: dm 453 TOP: NURSING PROCESS: Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 14. A child is diagnosed with pinworms. Which anthelmintic drug will the provider order for this child? a. Bithionol (Bitin) b. Diethylcarbamazine (Hetrazan) c. Mebendazole (Vermox) d. Praziquantel (Biltricide) ANS: C Mebendazole is used to treat pinworms. The other drugs treat other types of parasites. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 457 TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 15. The patient has been ordered treatment with rimantadine (Flumadine). The patient has renal impairment. The nurse anticipates what change to the dose of medication? a. Increased b. Decreased c. Unchanged d. Held ANS: B The dosage of the medication will be decreased when the patient has renal impairment.

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DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 450 TOP: NURSING PROCESS: Planning MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 16. The nurse is teaching a patient who is receiving chloroquine (Aralen) for malaria prophylaxis. Which statement by the patient indicates a need for further teaching? a. I may experience hair discoloration while taking this drug. b. I should not take this drug with lemon juice. c. I should use sunscreen while taking this drug. d. If I have gastrointestinal upset, I should take an antacid. ANS: D Patients should not take these drugs with antacids. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 455 TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies MULTIPLE RESPONSE 1. Which diseases are caused by herpes viruses? (Select all that apply.) a. Chicken pox b. Hepatitis c. Influenza d. Mononucleosis e. Shingles ANS: A, D, E Herpes viruses cause chicken pox, mononucleosis, and shingles. Chapter 46: Anticancer Drugs MULTIPLE CHOICE 1. A patient who has been instructed to use a liquid antacid medication to treat gastrointestinal upset asks the nurse about how to take this medication. What information will the nurse include when teaching this patient? a. Take a laxative if constipation occurs. b. Take 60 minutes after meals and at bedtime. c. Take with at least 8 ounces of water to improve absorption. d. Take with milk to improve effectiveness. ANS: B Since maximum acid secretion occurs after eating and at bedtime, antacids should be taken 1 to 3 hours after eating and at bedtime. Taking antacids before meals slows gastric emptying time and causes increased gastrointestinal (GI) secretions. Patients should not self-treat constipation or diarrhea. Patients should use 2 to 4 ounces of water when taking to ensure that the drug enters the stomach; more than that will increase GI secretions. Antacids should not be taken with milk or foods high in vitamin D.

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DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 698 TOP: NURSING PROCESS: Nursing Intervention: Teaching MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 2. A patient who has symptoms of peptic ulcer disease will undergo a test that requires drinking a liquid containing 13C urea and breathing into a container. The nurse will explain to the patient that this test is performed to a. assess the level of hydrochloric acid. b. detect H. pylori antibodies. c. measure the pH of gastric secretions. d. test for the presence of 13CO2. ANS: D When H. pylori is suspected, a noninvasive test is performed by administering 13C urea which, in the presence of H. pylori, will release 13CO2. The test does not measure the amount of HCl acid or the pH and does not detect H. pylori antibodies. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: dm 695 TOP: NURSING PROCESS: Assessment/Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 3. A patient is taking esomeprazole (Nexium) 15 mg per day to treat a duodenal ulcer. After 10 days of treatment, the patient reports that the pain has subsided. The nurse will counsel the patient to a. continue the medication for 4 more weeks. b. reduce the medication dose by half. c. stop taking the medication. d. take the medication every other day. ANS: A With treatment, ulcer pain may subside in 10 days, but the healing process may take 1 to 2 months. Patients should be counseled to take the drug for the length of time prescribed. Reducing the dose or taking less frequently is not indicated. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 695 TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 4. A patient with a peptic ulcer has been diagnosed with H. pylori. The provider has ordered lansoprazole (Prevacid), clarithromycin (Biaxin), and metronidazole (Flagyl). The patient asks the nurse why two antibiotics are needed. The nurse will explain that two antibiotics a. allow for less toxic dosing. b. combat bacterial resistance. c. have synergistic effects. d. improve acid suppression. ANS: B The use of two antibiotics when treating H. pylori peptic ulcer disease helps to combat bacterial resistance because H. pylori develops resistance rapidly. Giving two antibiotics, in this case, is not to reduce the dose or to cause synergistic effects. Antibiotics do not affect acid production.

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DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: dm 695 TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 5. A patient who takes propantheline bromine (Pro-Banthine) and omeprazole (Prilosec) for an ulcer will begin taking an antacid. The nurse will give which instruction to the patient regarding how to take the antacid? a. Take the antacid 2 hours after taking the propantheline. b. Take the antacid along with a meal. c. Take the antacid with milk. d. Take the antacid with the propantheline bromine. ANS: A Antacids can slow the absorption of anticholinergics and should be taken 2 hours after anticholinergic administration. Antacids should be given 1 to 3 hours after a meal and should not be given with dairy products. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 699 TOP: NURSING PROCESS: Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 6. Which antacid is likely to cause acid rebound? a. Aluminum hydroxide b. Calcium carbonate c. Magnesium hydroxide d. Magnesium trisilicate ANS: B While calcium carbonate is most effective in neutralizing acid, a significant amount can be systemically absorbed and can cause acid rebound. The other antacids do not have significant systemic absorption. DIF: COGNITIVE LEVEL: Remembering (Knowledge) REF: dm 699 TOP: NURSING PROCESS: Planning MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 7. An elderly patient reports using Maalox frequently to treat acid reflux. The nurse should notify the patients provider to request an order for which laboratory tests? a. Liver enzymes and serum calcium b. Liver enzymes and serum magnesium c. Renal function tests and serum calcium d. Renal function tests and serum magnesium ANS: D Maalox contains magnesium and carries a risk of hypermagnesemia, especially with decreased renal function. Older patients have an increased risk of poor renal function, so this patient should especially be evaluated for hypermagnesemia. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 698 TOP: NURSING PROCESS: Evaluation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

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8. The nurse is caring for a patient who has Zollinger-Ellison syndrome. Which medication order would the nurse question for this patient? a. Cimetadine (Tagamet) b. Pantoprazole (Protonix) c. Rabeprazole (Aciphex) d. Ranitidine (Zantac) ANS: A Cimetidine is not effective for treating Zollinger-Ellison syndrome. The other medications are used to treat Zollinger-Ellison syndrome. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: dm 700 TOP: NURSING PROCESS: Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 9. A patient who is diagnosed with peptic ulcer disease has been started on a regimen that includes ranitidine (Zantac) 300 mg daily at bedtime. The patient calls the clinic 1 week later to report no relief from discomfort. What action will the nurse take? a. Contact the provider to discuss changing to cimetidine (Tagamet). b. Notify the provider to discuss increasing the dose. c. Reassure the patient that the drug may take 1 to 2 weeks to be effective. d. Suggest that the patient split the medication into twice daily dosing. ANS: C Patients taking histamine2 blockers can expect abdominal pain to decrease after 1 to 2 weeks of drug therapy. Cimetidine is not as potent as ranitidine and interacts with many medications through the cytochrome P450 system. Three hundred milligrams is the maximum dose. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 700 TOP: NURSING PROCESS: Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 10. A male patient who has been taking a histamine2 blocker for several months reports decreased libido and breast swelling. What will the nurse do? a. Contact the provider to report possible drug toxicity. b. Reassure the patient that these symptoms will stop when the drug is discontinued. c. Request an order for serum hormone levels. d. Suggest that the patient see an endocrinologist. ANS: B Drug-induced impotence and gynecomastia are reversible drug side effects. These signs do not indicate drug toxicity. Serum hormone levels and endocrinology evaluation are not indicated. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 701 TOP: NURSING PROCESS: Evaluation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 11. A patient who has been taking ranitidine (Zantac) continues to have pain associated with peptic ulcer. A noninvasive breath test is negative. Which treatment does the nurse expect the provider to order for this patient? a. Adding an over-the-counter antacid to the patients drug regimen b. A dual drug therapy regimen

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c. Amoxicillin (Amoxil), clarithromycin (Biaxin), and omeprazole (Prilosec) d. Lansoprazole (Prevacid) instead of ranitidine ANS: D This patient does not have H. pylori ulcer disease, so dual and triple drug therapy with antibiotics is not indicated. Patients who fail treatment with a histamine2 blocker should be changed to a proton pump inhibitor (PPI) such as lansoprazole. PPIs tend to inhibit gastric acid secretion up to 90% greater than the histamine antagonists. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 695 TOP: NURSING PROCESS: Planning MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 12. A patient has been taking famotidine (Pepcid) 20 mg bid to treat an ulcer but continues to have pain. The provider has ordered lansoprazole (Prevacid) 15 mg per day. The patient asks why the new drug is necessary, since it is more expensive. The nurse will explain that lansoprazole a. can be used for long-term therapy. b. does not interact with other drugs. c. has fewer medication side effects. d. is more potent than famotidine. ANS: D Famotidine is a histamine2 (H2) blocker. When patients fail therapy with these agents, proton pump inhibitors, which can inhibit gastric acid secretion up to 90% greater than the H2 blockers, are used. Lansoprazole is not for long-term treatment and has drug interactions and drug side effects as do all other medications. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: dm 702 TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 13. The nurse is caring for a patient who will begin taking omeprazole (Prevacid) 20 mg per day for 4 to 8 weeks to treat gastroesophageal reflux disease esophagitis. The nurse learns that the patient takes digoxin. The nurse will contact the provider for orders to a. decrease the dose of omeprazole. b. increase the dose of digoxin. c. increase the omeprazole to 60 mg per day. d. monitor for digoxin toxicity. ANS: D Proton pump inhibitors can enhance the effects of digoxin, so patients should be monitored for digoxin toxicity. Changing the dose of either medication is not indicated prior to obtaining lab results that are positive for digoxin toxicity. DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 699 TOP: NURSING PROCESS: Assessment/Planning MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies 14. A patient reports experiencing flatulence and abdominal distension to the nurse. Which overthe-counter medication will the nurse recommend? a. Alka-Seltzer

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b. Maalox c. Mylicon d. Tums ANS: C Mylicon is a brand-name simethicone, which is an anti-gas agent. Maalox Gas contains simethicone, while regular Maalox does not. The other products do not contain simethicone. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: dm 697 TOP: NURSING PROCESS: Nursing Intervention MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies MULTIPLE RESPONSE 1. A patient who recently began having mild symptoms of GERD is reluctant to take medication. What measures will the nurse recommend to minimize this patients symptoms? (Select all that apply.) a. Avoiding hot, spicy foods b. Avoiding tobacco products c. Drinking a glass of red wine with dinner d. Eating a snack before bedtime e. Taking ibuprofen with food f. Using a small pillow for sleeping g. Wearing well-fitted clothing ANS: A, B, E Hot, spicy foods aggravate gastric upset, tobacco increases gastric secretions, and ibuprofen on an empty stomach increases gastric secretions, so patients should be taught to avoid these actions. Alcohol should be avoided since it increases gastric secretions. Eating at bedtime increases reflux, as does laying relatively flat to sleep, or wearing fitted clothing. Chapter 47: Immunosuppressants 1. A patient has been diagnosed with hairy cell leukemia. The patient is to begin taking interferon alfa 2b. What will the nurse include in her instructions to the patient concerning this drug? A)

Avoid drinking alcohol while taking the drug.

Continue to maintain maximal physical activity.

Increase fluid intake while taking the drug.

Treat constipation with over-the-counter laxatives.

Ans:

C Feedback: Interferon alfa 2b is metabolized in the kidney so adequate fluid intake is needed to promote metabolism and excretion of the drug as well as to minimize common adverse

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effects including dry skin and dizziness. Maintaining maximal physical activity is a good idea but has no relationship to the use of the drug. Fluids should be increased not decreased while taking the drug. Constipation is not an associated adverse effect of this medication. 2. The health care provider plans to inject an interferon directly into the patients wart. What interferon will the nurse prepare? A)

Interferon alfa 2a (Roferon-A)

Interferon alfacon 1 (Infergen)

Interferon alfa n3 (Alferon N)

Interferon beta 1a (Avonex)

Ans:

C Feedback: Interferon alf n3 is used for intralesional treatment of warts. Interferon alfa 2a is used in the treatment of leukemia. Interferon alfacon 1 is used in the treatment of chronic hepatitis C infection in adults. Interferon beta 1a is used to treat multiple sclerosis in adults.

3. A 30-year-old woman has been diagnosed with leukemia and will be using an immune modulator for treatment. What will be important to discuss with the patient when the nurse provides patient teaching about her treatment? A)

The need to continue oral contraceptives

The need to use barrier contraceptives while taking the drug

The need to avoid sexual intercourse while taking the drug

The importance of taking an aspirin daily to decrease the adverse effects of the drug

Ans:

B Feedback: A patient taking an immune modulator would be advised to use barrier contraceptives to prevent pregnancy. The interaction of the immune modulator and the oral contraceptive may interfere with the oral contraceptives ability to work properly. Asking patients to avoid sexual intercourse is not necessary if barrier methods are properly used. Daily aspirin would not decrease adverse effects of this drug.

4. The nurse has an order to administer oprelvekin (Neumega) to a patient for the first time. Before administering the drug, what allergy would the nurse want to specifically question the patient about? A)

Egg products

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Escherichia coliproduced products

Lactose intolerance

Penicillin

Ans:

B Feedback: The interleukins are produced using deoxyribonucleic acid technology and E. coli bacteria. Patients with known allergy to E. coli products should not receive oprelvekin. The allergies to penicillin, egg products, or lactose intolerance would not be of concern with this drug.

5. The physician has decided to prescribe T- and B-cell suppressors for a patient diagnosed with psoriasis. What drug will be ordered for this patient? A)

Alefacept (Amevive)

Azathioprine (Imuran)

Cyclosporine (Neoral)

Glatiramer acetate (Copaxone)

Ans:

A Feedback: Alefacept is prescribed for patients with severe chronic plaque psoriasis. Cyclosporine is used to suppress rejection in a variety of transplant situations. Azathioprine is used to treat patients with rheumatoid arthritis and in prevention of rejection in renal homotransplants. Tacrolimus is used for prevention of rejection after renal or liver transplantation.

6. A patient who is receiving an immune suppressant has been admitted to the unit. What would be a priority action by the nurse? A)

Monitor nutritional status.

Provide patient teaching regarding the drug.

Protect the patient from exposure to infection.

Provide support and comfort measures in relation to adverse effects of the drug.

Ans:

C Feedback: Patients taking immune suppressant drugs are more susceptible to infection because the patients normal body defenses will be diminished. As a result, the priority action by the nurse would to protect the patient from exposure to infection through room selection,

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good hand hygiene, and taking care to avoid exposure to sick staff members. Teaching will need to include avoiding crowded places and people with known infection and those working in soil. Nutritional status is important as are comfort and support measures and other instructions concerning the drug. However, protecting the patient from infection should be the priority action. 7. A nurse is discussing interferon alfa 2b with a patient. What will the nurse encourage the patient to do while taking this drug? A)

To avoid crowds

To increase salt intake

To decrease milk intake

To eat three meals a day

Ans:

A Feedback: Potential adverse effects in addition to the types of conditions interferon alfa 2b is prescribed to contribute to the need for the patient to take care to avoid people with infections so the patient should be taught to avoid crowds whenever possible. Adverse effects include dizziness, confusion, rash, dry skin, anorexia, nausea, bone marrow suppression, and flu-like syndrome. Salt, diet, and milk do not interfere with this drug.

8. A 70-year-old patient with acute myelocytic leukemia is receiving sargramostim (Leukine). What is a priority nursing action for this patient? A)

Providing a quiet environment

Increasing fluids

Providing comfort measures related to nausea

Encouraging appropriate dietary intake

Ans:

B Feedback: A common adverse effect of this drug is vomiting and diarrhea. Due to the patients age it would be important to keep him hydrated. Vomiting and diarrhea can cause dehydration quickly in the elderly. Providing a quiet environment and comfort measures for the nausea would be important but not as critical as increasing fluids. Diet is very important to this patient; however, usually this drug causes a loss of appetite. Therefore, increasing fluids would be extremely important to the patients nutritional status.

9. The nurse is caring for a patient in the immediate postoperative period following cardiac transplantation who is receiving mycophenolate (CellCept) twice a day IV. What will the nurse teach the patient regarding drug therapy? (Select all that apply.)

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The drug will be given orally as soon as possible.

Take the medication three times a day.

Avoid people with contagious diseases.

Ask a pharmacist about drugdrug interactions before taking any over-the-counter (OTC) drug.

Never miss a dose of medication.

Ans:

A, C, D, E Feedback: The nurse will explain that the IV medication will be changed to oral therapy when the patient is able to tolerate oral medications. The patient will take the medication twice a day, not three times a day. Care should be taken to never miss a dose. The patient should avoid other medications that are hepatotoxic or nephrotoxic due to a risk of increased toxicity so the patient should be taught to always consult a doctor or pharmacist before beginning an OTC drug. Patients who have immune suppression must be taught how to reduce risk of infection, including avoiding people with contagious diseases, such as colds or viruses.

10. The nurse administers aldesleukin to a patient diagnosed with renal cell carcinoma. When assessing the patient a few days later, what abnormal findings would the nurse attribute to the medication? (Select all that apply.) A)

Increased lymphocyte count

Increased red blood cell count

Increased platelet count

Irregular pulse rate

Increased blood pressure

Ans:

A, C, D Feedback: Aldesleukin activates human cellular immunity and inhibits tumor growth through increases in lymphocytes, platelets, and cytokines. Common adverse effects include hypotension, sinus tachycardia, arrhythmias, as well as pruritus, nausea, vomiting, diarrhea, anorexia, GI bleeding, bone marrow suppression, respiratory difficulties, fever, chills, pain, mental status changes, and dizziness. There is no impact on red blood cell count. It does not raise blood pressure.

11. While studying for a pharmacology test, a student asks his peers about interferons. What statement about interferons is accurate? A)

They stimulate B-lymphocyte activity.

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They interfere with multiplication of stem cells.

They stimulate growth and differentiation of lymphoid cells into lymphocytes.

They interfere with the ability of viruses in infected cells to replicate.

Ans:

D Feedback: Interferons are substances naturally produced and released by human cells that have been invaded by viruses. They may also be released from cells in response to other stimuli, such as cytotoxic T-cell activity. Interferons do not stimulate B-lymphocyte activity, interfere with multiplication of stem cells, nor do they stimulate growth and differentiation of lymphoid cells into lymphocytes.

12. How do immune suppressants work when ordered for a patient who has had an organ transplant? A)

Blocking normal effects of the immune system

Stimulating immune system to fight off infection

Working with corticosteroids to enhance healing

Working with corticosteroids to promote suppressor cells

Ans:

A Feedback: Immune suppressants are used to block the normal effects of the immune system in cases of organ transplantation (in which nonself-cells are transplanted into the body and destroyed by the immune reaction) and in autoimmune disorders (in which the bodys defenses recognize self-cells as foreign and work to destroy them) in some cancers. Options B, C, and D are distracters for this question.

13. A patient has just been told that her cancer has metastasized to her right kidney. An interferon (Aldesleukin) has been prescribed to treat this metastasis. The patient asks why this interferon is ordered. What is the nurses best response? A)

Aldesleukin has been shown to protect autologous tumor cells.

Aldesleukin has been shown to inhibit tumor growth.

Aldesleukin has been shown to enhance allogeneic stem-cell transplantation.

Aldesleukin has been shown to have a direct proliferative effect on renal tumors.

Ans:

B Feedback:

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Aldesleukin is prescribed for metastatic renal cell carcinoma in adults and treatment of metastatic melanomas (orphan drug use) working by activating human cellular immunity and inhibiting tumor growth through increases in lymphocytes, platelets, and cytokines. Aldesleukin does not protect autologous tumor cells, enhance allogeneic stem-cell transplantation, or have a direct proliferative effect on renal tumors. 14. The nurse admits a patient who was newly diagnosed with Kaposis sarcoma to the unit. The physician has ordered an IV infusion of an interferon. What drug would be appropriate? A)

Interferon beta1a

Interferon gamma 1b

Interferon alfa 2b

Peginterferon alfa 2b

Ans:

C Feedback: Interferon alfa 2b indications include hairy cell leukemia, melanoma, AIDS-related Kaposis sarcoma, chronic hepatitis B and C infection, intralesional treatment of condyloma acuminatum in patients 18 years of age or older. No other interferons are indicated for treatment of Kaposis sarcoma.

15. The pharmacology instructor is talking about interferon. The instructor explains that agents, such as interferons, have more than one biologic function. What are the functions of interferons? (Select all that apply.) A)

Antibacterial

Antiviral

Immunomodulatory

Antiproliferative

Anticancer

Ans:

B, C, D Feedback: Interferons act to prevent virus particles from replicating inside the cells. They also stimulate interferon receptor sites on noninvaded cells to produce antiviral proteins, which prevent viruses from entering the cell. In addition, interferons have been found to inhibit tumor growth and replication, to stimulate cytotoxic T-cell activity, and to enhance the inflammatory response. Options A and E are incorrect.

16. The nursing class is studying monoclonal antibodies. What monoclonal antibody reacts to human T cells, disabling them and acting as an immune suppressor?

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Adalimumab

Cetuximab

Rituximab

Muromonab-CD3

Ans:

D Feedback: Muromonab-CD3, the first monoclonal antibody approved for use, is a T-cellspecific antibody, that is available as an IV agent. It reacts as an antibody to human T cells, disabling the T cells, acting as an immune suppressor. Adalimumab is an antibody specific for human tumor necrosis factor. Cetuximab is an antibody specific to epidermal growth factor receptor sites. Rituximab is an antibody specific to sites on activated B lymphocytes.

17. What monoclonal antibody is used to prevent respiratory syncytial virus (RSV) in high risk children? A)

Palivizumab

Natalizumab

Belimumab

Eculizumab

Ans:

A Feedback: Palivizumab is specific to the antigenic site on respiratory syncytial virus (RSV); it inactivates that virus. It is used to prevent RSV disease in high-risk children. Natalizumab is an antibody specific to surface receptors on all leukocytes except neutrophils. Belimumab is a specific inhibitor of B-lymphocyte stimulator that inhibits the survival of B-lymphocytes and their differentiation into immune-globulin producing cells. Eculizumab binds to complement proteins and prevents the formation of the complement complex.

18. The nurse is caring for a patient with an allograft transplant. The physician orders a monoclonal antibody to prevent rejection of the transplant. What monoclonal antibody would the nurse expect to be ordered? A)

Alemtuzumab

Daclizumab

Erlotinib

Omalizumab

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Ans:

B Feedback: Daclizumab is specific to interleukin-2 receptor sites on activated T lymphocytes; it reacts with those sites and blocks cellular response to allograft transplants. Alemtuzumab is an antibody specific for lymphocyte receptor sites used to treat chronic lymphocytic leukemia patients who have been treated with alkylating agents and have been failed by fludarabine therapy. Erlotinib is effective against specific malignant receptor sites. Omalizumab is an antibody to immunoglobulin E, an important factor in allergic reactions.

19. The pharmacology instructor is explaining interleukins to the class. What would be the best definition of interleukins? A)

They are substances naturally produced and released by human cells that have been invaded by viruses.

They block the inflammatory reaction and decrease initial damage to cells.

They are chemicals used to communicate between leukocytes and stimulate immunity.

They attach to specific receptor sites and respond to very specific situations.

Ans:

C Feedback: Interleukins are chemicals produced by T cells to communicate between leukocytes and stimulate cellular immunity and inhibit tumor growth. Immune suppressants block the inflammatory reaction and decrease initial damage to cells. Interferons are naturally produced and released by human cells that have been invaded by viruses. Monoclonal antibodies attach to specific receptor sites and respond to very specific situations.

20. The nurse is caring for a female patient, aged 62, who has been admitted for treatment of metastatic melanoma. What agent would the nurse anticipate the physician is likely to order? A)

Aldesleukin

Interferon alfa 2b

Cyclosporine

Ipilimumab

Ans:

D Feedback: Ipilimumab is a human cytotoxic T-cell antigen-4 blocking antibody. By blocking this site, T cells are activated and proliferate at a faster rate. It is used to treat patients with

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unresectable or metastatic melanoma. Aldesleukin is an interleukin, used for metastatic renal cell carcinoma in adults; a treatment of metastatic melanomas. Interferon alfa 2b is indicated for hairy cell leukemia, melanoma, AIDS-related Kaposis sarcoma, chronic hepatitis B and C infections, intralesional treatment of condyloma acuminatum in patients 18 years of age or older. Cyclosporine is a T and B cell suppressor and is indicated for prophylaxis for organ rejection in kidney, liver, and heart transplants (used with corticosteroids); treatment of chronic rejection in patients previously treated with other immunosuppressants; treatment of rheumatoid arthritis; and recalcitrant psoriasis. 21. While studying the T- and B-cell immune suppressors, the nursing students learn that the most commonly used immune suppressant is what? A)

Cyclosporine (Sandimmune)

Azathioprine (Imuran)

Pimecrolimus (Elidel)

Glatiramer (Copaxone)

Ans:

A Feedback: Several T- and B-cell immune suppressors are available for use. Of the numerous agents available, cyclosporine is the most commonly used immune suppressant. Options B, C, and D are all T- and B-cell immune suppressors, they are simply not the most commonly prescribed.

22. What interleukin receptor antagonist would the nurse anticipate is most likely to be ordered for a patient, 25 years old, who has not responded to traditional antirheumatic drugs? A)

Natalizumab (Tysabri)

Anakinra (Kineret)

Eculizumab (Soliris)

Adalimumab (Humira)

Ans:

B Feedback: Anakinra is used to reduce the signs and symptoms of moderately to severely active rheumatoid arthritis in patients 18 years of age and older who have not responded to the traditional antirheumatic drugs. Options A, C, and D are monoclonal antibodies, therefore they are incorrect answers.

23. A patient with chronic hepatitis C has been prescribed peginterferon alfa 2b (PEGINTRON). By what route would the nurse administer this drug?

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Subcutaneously (SQ)

Intramuscularly (IM)

Intralesionally (IL)

Orally

Ans:

A Feedback: PEG-INTRON, like many of the interferons, is administered subcutaneously. Avonex is given intramuscularly. Interferon alfa n3 is given intralesionally. There are no interferons given orally.

24. The patient has arrived in the short stay unit for an infusion of tositumomab with 131 tositumomab (Bexxar). Before beginning the infusion, the nurse assesses the patients vital signs and finds the patient has a temperature of 101.5F, What is the nurses priority action? A)

Holding the infusion until patient is afebrile

Notifying the physician

Starting the infusion and inform the physician

Treating the fever before beginning the therapy

Ans:

D Feedback: Monoclonal antibodies should be used cautiously with fever (treat the fever before beginning therapy). This makes Options A, B, and C incorrect.

25. A 72-year-old male patient has arrived at the outpatient unit to receive an infusion of alemtuzumab (Compath). The patient tells the nurse this is the second time his chronic lymphocytic leukemia has relapsed and the second time he will receive this drug because he failed alemtuzumab therapy after being treated with an alkylating agent. What is the priority nursing action? A)

Calling the physician and questioning the order

Washing your hands

Beginning an intravenous infusion

Canceling the infusion

Ans:

A Feedback:

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Monoclonal antibodies should be used cautiously in patients who have had previous administration of the monoclonal antibody (serious hypersensitivity reactions can occur with repeat administration). The nursing priority would be to question the order because the patient has already received alemtuzumab (Compath) previously and if the order is verified, this patient should be monitored very carefully, perhaps starting to infuse more slowly until the patients reaction can be determined. Only after questioning the order and having it verified would the nurse perform hand hygiene and begin the infusion. 26. The nurse is writing a plan of care for a patient receiving immune suppressants for leukemia. What would be an appropriate nursing diagnosis for this patient? A)

Anxiety related to diagnosis and drug therapy

Acute pain related to central nervous system (CNS), gastrointestinal (GI), and flulike effects

Risk for infection related to immune stimulation

Imbalanced nutrition: More than body requirements

Ans:

B Feedback: Nursing diagnoses related to drug therapy might include: Acute pain related to CNS, GI, and flu-like effects. Anxiety related to diagnosis and drug therapy is a nursing diagnosis for a patient on an immune stimulant. There is no risk for infection related to immune stimulation unless an adverse effect occurs. Imbalanced nutrition would be less than body requirements due to flu-like symptoms resulting in diminished appetite.

27. The nurse is preparing a patient to receive immunosuppressant drugs on an outpatient basis. What is the priority for the nurse to arrange for this patient in the home environment? A)

A caregiver who is skilled in cardiopulmonary resuscitation (CPR)

A caregiver who will provide adequate nutrition

Supportive care and comfort measures

Arrange for a home care nurse to administer injections

Ans:

C Feedback: Arrange for supportive care and comfort measures for flu-like symptoms (rest, environmental control, acetaminophen) to decrease patient discomfort and increase therapeutic compliance. Patients may also need support and comfort measures related to diagnosis and drug therapy. Although knowledge of CPR and providing appropriate nutrition are always positive actions, they are not related to administration of immunosuppressants. The patient or caregiver can be taught to administer injections

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unless the medication is to be given IV, in which case the patient would go to an infusion center. 28. The nurse is caring for a patient who has a diagnosis of chronic hepatitis B infection and has been prescribed an immune stimulant. After teaching the patient about the treatment plan, how might the nurse evaluate the effectiveness of teaching? A)

The patient can state where to go to get the medication.

The patient can state who will administer the medication.

The patient can state what positive effects to watch for.

The patient can state specific measures to avoid adverse effects.

Ans:

D Feedback: The nurse would evaluate that the teaching plan was successful if the patient can name drug, dosage, adverse effects to watch for, and specific measures to avoid adverse effects. Knowing where to get the medication, who will administer it, and the positive effects to watch for would not be an adequate assessment of the teaching plan.

29. The patient underwent an allograft renal transplant 48 hours earlier and is showing signs of rejection. What drug would the nurse expect the physician to order? A)

Muromonab

Anakinra

Mycophenolate

Sirolimus

Ans:

A Feedback: Muromonab is indicated for the treatment of acute allograft rejection in patients undergoing renal transplantation. It also is indicated for the treatment of steroid-resistant acute allograft rejection in those receiving heart or liver transplants. Anakinra, mycophenolate, and sirolimus are useful for preventing renal or liver transplant rejection.

30. The nurse, working with a nursing student, is caring for a patient who is to receive interleukins. The student nurse asks you what happens physiologically when a patient receives interleukins. What is the nurses best response? A)

It really helps the patient!

The patient has increases in the number of natural killer cells.

The patient has decreased cytokine activity.

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The patient gets really sick from flu-like symptoms and then they get better.

Ans:

B Feedback: When interleukins are administered, there are increases in the numbers of natural killer cells and lymphocytes, in cytokine activity, and in the number of circulating platelets. Options A, C, and D are incorrect.

31. The nurse is caring for a child requiring cyclosporine to prevent rejection. Cyclosporine is given to adults using a dosage of 15 mg/kg. The nurse calculates the childs dosage is 20 mg/kg. What is the nurses priority action? A)

Administer the drug.

Hold the dose and question the ordering provider.

Complete an incident report if this dosage has already been given before.

Notify the nursing supervisor of the medication error.

Ans:

A Feedback: The nurse would administer the medication as ordered because doses larger than those given to adults are often needed when cyclosporine is administered to children. This is not an error so the nurse would not hold the drug, question the provider, complete an incident report, or notify the nursing supervisor.

32. When caring for older adults receiving immune modulators, what are the nurses priorities of care? (Select all that apply.) A)

Assess carefully for infection.

Obtain baseline liver function studies and monitor follow-up studies.

Determine dosage based on renal and liver function.

Minimize teaching to avoid causing confusion.

Encourage the family to visit often, especially young children.

Ans:

A, B, C Feedback: Older patients may be more susceptible to the effects of the immune modulators, partly because the aging immune system is less efficient and less responsive. These patients need to be monitored closely for infection, GI, renal, hepatic, and central nervous system effects. Baseline renal and liver function tests can help to determine whether a decreased dosage will be needed before beginning therapy. Because these patients are more susceptible to infection, they need to receive extensive teaching, not less teaching, about

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ways to avoid infection and injury. Contact with young children and large groups of people increase the risk of infection. 33. The nurse teaches the female patient receiving immune modulating drugs about the need to use barrier contraceptives. The patient says, I hate using barrier contraceptives. Why cant I just take oral contraceptives? What is the nurses best response? A)

Effects of oral contraceptives may be altered by liver changes or changes in immune response.

Oral contraceptives increase the action of immune modulating drugs so dosage needs to be reduced.

Immune modulators make oral contraceptives ineffective because of hormonal impact of drugs.

Oral contraceptives are acceptable if barrier contraceptives are distasteful, but only high-estrogen pills can be used.

Ans:

A Feedback: The use of barrier contraceptives is advised because the effects of oral contraceptives may be altered by liver changes or by changes in the bodys immune response, potentially resulting in unexpected pregnancy. The other options conflict with this information and are incorrect.

34. The nurse is caring for a young adult woman taking immune modulating medications who has been advised to use barrier contraceptives but she wants to start her family. What information can the nurse provide about these drugs to help this patient with her decisionmaking? A)

Discuss the desire to start a family with the provider so risk can be minimized.

Immune modulating drugs will need to be discontinued if pregnancy occurs.

Immune modulating drugs have been proven to be highly teratogenic.

Pregnancy is not an option when taking immune modulating drugs but adoption is an option.

Ans:

A Feedback: If a patient taking immune modulators becomes pregnant or decides that she wants to become pregnant, she should discuss this with her health care provider and review the risks associated with use of the drug or drugs being taken. Monoclonal antibodies should be used with caution during pregnancy and lactation. Because results of long-term studies of most of these drugs are not yet available, it may be prudent to advise patients taking these drugs to avoid pregnancy if possible. Immune modulating drugs do not need to be

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discontinued, but the safest drug should be prescribed. Most immune modulating drugs have not been studied and there is not enough information to know whether they are teratogenic. The nurse cannot tell a patient that pregnancy is not an option. 35. The nurse is caring for a patient diagnosed with rheumatoid arthritis (RA) who recently underwent a liver transplant. What immunosuppressant could this patient be prescribed that would treat both diagnoses? A)

Anakinra (Kineret)

Adalimumab (Humira)

Sirolimus (Rapamune)

Cyclosporine (Sandimmune)

Ans:

A Feedback: Anakinra is used to prevent rejection after kidney or liver transplantation and also reduces signs and symptoms of RA in patients who have had inadequate response to other drugs. Adalimumab would be effective for the patients RA but would not prevent rejection of the transplanted liver. Sirolimus is used to prevent rejection of kidney transplants but would not be effective for either of the patients diagnoses. Cyclosporine would be appropriate to prevent liver rejection but would not treat RA.

Chapter 48: Clinical Toxicology MULTIPLE CHOICE 1. What is the primary purpose of the nursing assessment? a. Identifying underlying pathologic conditions b. Assisting the physician in identifying medical conditions c. Determining the patients mental status d. Exploring patient responses to health problems ANS: D A nursing assessment is done to identify the patients response to health problems. During the nursing assessment phase, a comprehensive information base is developed through a physical examination, nursing history, medication history, and professional observation. Identifying underlying pathologic conditions and assisting the physician in identifying medical conditions is

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not part of the nursing process. Determining the patients mental status is one part of the nursing assessment, but it is not the primary purpose. DIF: Cognitive Level: Comprehension REF: dm. 36 OBJ: 1 | 3 TOP: Nursing Process Step: Assessment MSC: NCLEX Client Needs Category: Health Promotion and Maintenance 2. What is the basis of the NANDA I taxonomy? a. Functional health patterns b. Human response patterns c. Basic human needs d. Pathophysiologic needs ANS: B The NANDA I taxonomy identifies human response patterns. Functional components of health patterns are limited to activity, fluid volume, nutrition, self care, and sensory perception. Basic human needs comprise less than merely health patterns. Pathophysiologic needs are not part of the scope of NANDA I. DIF: Cognitive Level: Knowledge REF: pp. 37-38 OBJ: 5 TOP: Nursing Process Step: Diagnosis MSC: NCLEX Client Needs Category: Physiological Integrity 3. Which task is included in the assessment step of the nursing process? a. Establishing patient goals/outcomes b. Implementing the nursing care plan (NCP) c. Measuring goal/outcome achievement d. Collecting and communicating data

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ANS: D Data are collected and communicated in the assessment phase of the nursing process. Establishing goals is the function of planning. Implementing the NCP is the function of implementation. Measuring outcome achievement is the function of evaluation. DIF: Cognitive Level: Comprehension REF: dm. 36 OBJ: 2 | 3 TOP: Nursing Process Step: Assessment MSC: NCLEX Client Needs Category: Health Promotion and Maintenance 4. Which statement regarding nursing diagnoses is accurate? a. Nursing diagnoses remain the same for as long as the disease is present. b. Nursing diagnoses are written to identify disease states. c. Nursing diagnoses describe patient problems that nurses treat. d. Nursing diagnoses identify causes related to illness. ANS: C Diagnostic statements identify problems a nurse is independently able to treat within the scope of professional practice. Nursing diagnoses vary with the changing condition of the patient. The response patterns are unique to the patient and are not disease specific. Nursing diagnoses describe the patients human response pattern. DIF: Cognitive Level: Comprehension REF: pp. 37-38 OBJ: 5 TOP: Nursing Process Step: Diagnosis MSC: NCLEX Client Needs Category: Physiological Integrity 5. What do the classification systems NIC and NOC provide? a. Individualized data banks of treatments related to disease processes b. Standardized language for reporting and analyzing nursing care delivery

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c. A measure for cost containment within medical institutions d. Specialized interventions for rare diseases ANS: B Nursing classification systems such as NIC and NOC are designed to provide a standardized language for reporting and analyzing nursing care delivery that is individualized for each patient. Standardized terminology assists practitioners in the implementation of the five phases of the nursing process. Classification systems are not related to disease process and are not used for financial purposes. Classification systems include interventions for all health conditions. DIF: Cognitive Level: Knowledge REF: dm. 34 OBJ: 11 TOP: Nursing Process Step: Implementation MSC: NCLEX Client Needs Category: Safe, Effective Care Environment 6. Which type of nursing diagnosis will be written when the patient exhibits factors that makes him or her susceptible to the development of a problem? a. Actual diagnosis b. Risk diagnosis c. Possible diagnosis d. Wellness diagnosis ANS: B When patients have the potential or risk for a problem to develop, a risk diagnosis is written. These diagnoses are two part statements such as Risk for falls related to unsteady gait. An actual diagnosis consists of a NANDA diagnostic label, contributing factor (if known), and defining characteristics such as signs and symptoms. A possible nursing diagnosis identifies a problem that may occur, but the assembled data are insufficient to confirm it. A wellness diagnosis applies to individuals for whom an enhanced level of wellness is possible. DIF: Cognitive Level: Comprehension REF: dm. 38 OBJ: 5

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TOP: Nursing Process Step: Diagnosis MSC: NCLEX Client Needs Category: Physiological Integrity 7. Which outcome statement identified by the nurse is written correctly? a. After surgery, patient will express acceptance of loss of breast. b. Patient will die with dignity. c. At the end of the shift, the nurse will determine whether the patient is more comfortable. d. Within the next 8 hours, urine output will be greater than 30 mL/hr. ANS: D The statement, Within the next 8 hours, urine output will be greater than 30 mL/hr is patient oriented, realistic, and measurable, and has an appropriate time frame. DIF: Cognitive Level: Application REF: dm. 42 OBJ: 11 TOP: Nursing Process Step: Evaluation MSC: NCLEX Client Needs Category: Safe, Effective Care Environment 8. Which is an example of an interdependent nursing action? a. Assess lung sounds every 4 hours. b. Educate the patient about the prescribed medication. c. Administer Demerol 50 mg intramuscularly (IM) every 4 hours PRN. d. Encourage the patient to express feelings. ANS: C Administer Demerol 50 mg IM every 4 hours PRN requires the nurse to follow the parameters of the order, yet use nursing judgment to determine how often the medication is to be administered; therefore, it is an interdependent nursing action. Assessing lung sounds, educating the patient

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about medication, and encouraging the patient to express feelings are independent nursing actions. DIF: Cognitive Level: Application REF: dm. 45 OBJ: 12 TOP: Nursing Process Step: Implementation MSC: NCLEX Client Needs Category: Safe, Effective Care Environment 9. What is the nurses primary source of information when obtaining a patient history? a. The physician b. The patient record c. The family d. The patient ANS: D The focus of the nursing process is the patient. Although family members contribute to the nursing history, this information is secondhand. It is important that the nurse continue to assess patient data for validation of this information. The physician is not to be relied on to provide information about a complete patient history. The patient record reflects only recorded past information and not current input that may be relevant. The family may provide information about a patient history if the patient is unable to provide it, but the information is subject to interpretation by someone other than the patient. DIF: Cognitive Level: Knowledge REF: dm. 43 OBJ: 13 TOP: Nursing Process Step: Assessment MSC: NCLEX Client Needs Category: Safe, Effective Care Environment 10. An obese patient did not meet the goal of by the end of the second week, is able to follow a 1500 calorie diet. What will the nurse and the patient reassess? a. Patients weight

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b. Patients understanding of the 1500 calorie diet c. Nurses feelings about obese patients d. Health care agencys ability to provide the prescribed diet ANS: B When goals are not met, the nurse must reassess the patients understanding of the interventions and commitment to reaching the identified goal. All phases of the nursing process are ongoing as the nurse continues to evaluate, assess, and readjust interventions as indicated to facilitate patient achievement of outcomes. The patient may have followed the diet but not lost any weight. The nurses feelings should not be a factor in the assessment. The agencys ability to provide the prescribed diet should have been determined before implementation of the plan. DIF: Cognitive Level: Analysis REF: pp. 42-43 OBJ: 12 TOP: Nursing Process Step: Evaluation MSC: NCLEX Client Needs Category: Safe, Effective Care Environment 11. What is the priority nursing diagnosis for an older adult with diabetes who is hospitalized for pneumonia? a. Deficient knowledge related to lack of information about diabetic medication b. Risk for falls related to weakness c. Impaired gas exchange related to decreased pulmonary ventilation d. Imbalanced nutrition: more than body requirements related to obesity ANS: C Airway is the first priority in a needs assessment (ABCs = airway, breathing, circulation). Medication, weakness, and nutrition are less of a priority than the patients respiratory status. DIF: Cognitive Level: Analysis REF: pp. 37-38 OBJ: 9 TOP: Nursing Process Step: Assessment

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MSC: NCLEX Client Needs Category: Physiological Integrity 12. What is a critical care pathway? a. A nursing care plan for a patient in a critical care unit b. A standardized care plan derived from best practice patterns c. A care plan that has been critiqued by a quality improvement officer d. A care plan based on measurable goals and outcomes ANS: B A critical care pathway is a standardized care plan derived from best practice patterns, enabling the nurse to develop a treatment plan that sequences detailed clinical interventions to be performed over a projected amount of time for a specific case type of disease process. A nursing care plan for a patient in a critical care unit is not a critical care pathway. A care plan that has been critiqued by a quality improvement officer is not a critical care pathway. All good care plans are based on measurable goals and outcomes. DIF: Cognitive Level: Knowledge REF: dm. 40 OBJ: 7 TOP: Nursing Process Step: Planning MSC: NCLEX Client Needs Category: Physiological Integrity 13. When a nursing diagnosis statement is written, who or what directs the nurse to identify appropriate nursing interventions? a. Other nurses on staff who have experience with the diagnoses b. The patient and family who have an interest in the outcome c. The etiologies of the problems identified in the nursing diagnoses d. The medical staff who have more expertise than the nurses ANS: C

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Nursing actions are suggested by the etiologies of the problems identified in the nursing diagnoses and are used to implement plans. Nursing actions are not suggested by other nurses, the patient and family, or by the medical staff. DIF: Cognitive Level: Comprehension REF: dm. 42 OBJ: 12 TOP: Nursing Process Step: Planning MSC: NCLEX Client Needs Category: Physiological Integrity 14. A patient is experiencing adverse effects of a medication. Which information obtained by the nurse is subjective? a. Cough b. Edema c. Nausea d. Tachycardia ANS: C Nausea is a symptom for which only the person experiencing it can provide the information. Cough is heard by the nurse. Edema is measured and seen by the nurse. Tachycardia is assessed by the nurse. DIF: Cognitive Level: Application REF: dm. 43 OBJ: 13 TOP: Nursing Process Step: Assessment MSC: NCLEX Client Needs Category: Physiological Integrity 15. The nurse has determined that the pain medication given to a patient an hour ago has been effective. The nurse is using which step of the nursing process? a. Evaluation b. Intervention

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c. Nursing diagnosis d. Planning ANS: A The nurse has used evaluation to assess the response to the administered medication. Intervention is the administration of the medication or teaching about the medication in this situation. This situation is not an example of making a nursing diagnosis. Planning is developing goal statements and prioritizing patient problems. DIF: Cognitive Level: Application REF: pp. 42-43 OBJ: 15 TOP: Nursing Process Step: Evaluation MSC: NCLEX Client Needs Category: Physiological Integrity 16. Prior to the administration of a nephrotoxic drug, the nurse determines that the kidney lab data are within normal range. Which step of the nursing process is being used? a. Assessment b. Nursing diagnosis c. Planning d. Evaluation ANS: A The nurse is collecting information about renal function through lab data; this is baseline assessment data. This action is not an example of the development of a nursing diagnosis. Planning is developing goal statements and prioritizing patient problems. Evaluation determines if goals have been met. DIF: Cognitive Level: Application REF: dm. 36 OBJ: 2 TOP: Nursing Process Step: Assessment MSC: NCLEX Client Needs Category: Physiological Integrity

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17. Which statement best describes the planning phase of the nursing process? a. Administer insulin subcutaneously (subcut) in the abdominal area. b. Patient is at high risk for falls related to hypotension. c. The patient will state the expected adverse effects of medication by the end of the teaching session. d. Itching has resolved; medication given is effective. ANS: C The patient will state the expected adverse effects of medication by the end of the teaching session is an example of a goal statement that is developed in the planning phase. Administration of insulin subcut is an example of the implementation phase. Noting a high risk for falls related to hypotension is an example of the second phase or nursing diagnosis. Stating that the medication given is effective is an example of the evaluation phase. DIF: Cognitive Level: Application REF: dm. 39 OBJ: 2 | 7 TOP: Nursing Process Step: Planning MSC: NCLEX Client Needs Category: Physiological Integrity 18. The nurse is prioritizing care of a pediatric patient diagnosed with cystic fibrosis. Which nursing diagnosis would the nurse consider the highest priority? a. Risk for altered nutrition: less than body related to decreased appetite b. Altered breathing pattern related to thickened mucus secretions c. Knowledge deficit related to disease process d. Impaired skin integrity related to decreased mobility ANS: B Altered breathing pattern would be the highest priority because the physiologic need of oxygenation is required for total body function. Risk for altered nutrition, knowledge deficit, and impaired skin integrity would not be of higher priority than oxygenation.

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DIF: Cognitive Level: Analysis REF: dm. 40 OBJ: 9 TOP: Nursing Process Step: Diagnosis MSC: NCLEX Client Needs Category: Physiological Integrity MULTIPLE RESPONSE 19. Which statement(s) regarding critical pathways is/are true? (Select all that apply.) a. Efficient for specific diseases or case types b. The same as medical plans c. Standardized and enhanced quality care d. Evaluated less frequently than care plans e. Enhanced communication for a variety of health care providers ANS: A, C, E Critical pathways are standardized care plans that detail clinical interventions to be performed over a projected time frame for a specific disease or case type. Physician interventions are included in the pathways. Critical pathways enhance the quality of care and require evaluation and modification on an ongoing basis. Critical pathways assist as a communication system for all health care providers. Medical plans are distinct to physicians. Critical pathways should be evaluated as needed to achieve desired outcomes. DIF: Cognitive Level: Comprehension REF: dm. 40 OBJ: 7 | 8 TOP: Nursing Process Step: Planning MSC: NCLEX Client Needs Category: Safe, Effective Care Environment 20. In which way(s) is nursing diagnosis different from a medical diagnosis? (Select all that apply.) a. Statement of the patients alterations in structure and functions

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b. Description of the patients ability to function in relation to impairment c. Tend to remain the same throughout the course of illness or recovery from injury d. Varies depending on patients state of recovery e. Based on research done by nurses f. Conditions can be accurately identified by nursing assessment methods ANS: B, D, E, F Nursing diagnoses, as exemplified by the NANDA I taxonomy, are statements about the patients ability to function in relation to an illness or injury, vary with the patients state of recovery, are based on research done by nurses, and can be determined based on nursing assessment methods. Nursing diagnoses do not include statements of the patients alterations in structure and function and do not remain the same throughout the course of illness or recovery from injury. DIF: Cognitive Level: Comprehension REF: pp. 37-38 OBJ: 6 TOP: Nursing Process Step: Assessment MSC: NCLEX Client Needs Category: Physiological Integrity 21. The nurse is participating in the planning phase of the nursing process for a new admission to a long term care facility. When formulating a plan to meet the patients needs, the nurse will take which action(s)? (Select all that apply.) a. Formulate nursing interventions. b. Collect data. c. Make a clinical judgment about the patient. d. Set priorities. e. Develop measurable goals. ANS: A, D, E Planning is the third phase of the five step nursing process. Once the patient has been assessed and problems have been diagnosed, plans should be formulated to meet the patients needs.

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Planning usually encompasses four phases: (1) priority setting, (2) development of measurable goal and outcome statements, (3) formulation of nursing interventions, and (4) formulation of anticipated therapeutic outcomes that can be used to evaluate the patients status. Collecting data is part of the assessment phase of the nursing process. Making a clinical judgment about the patient takes place during the diagnosis phase. DIF: Cognitive Level: Application REF: dm. 39 OBJ: 7 | 8 TOP: Nursing Process Step: Planning MSC: NCLEX Client Needs Category: Physiological Integrity 22. The nurse is preparing a patients prescribed medications. In order to ensure patient safety, the nurse will perform which intervention(s)? (Select all that apply.) a. Select the correct supplies. b. Administer the medication by the correct route. c. Use room number to identify correct patient. d. Educate patient regarding medications prescribed. e. Document in chart all aspects of medication administration. ANS: A, B, D, E The nurse prepares prescribed medications using procedures to ensure patient safety, including selecting correct supplies, administering medication by the correct route, educating patients regarding medications prescribed, and documenting in chart all aspects of medication administration. To improve the accuracy of patient identification, it is now recommended that two patient identifiers, neither of which is the room number, be used when administering medications. Best practice would be to look at the patients name band for identity and to request that the patient state his or her name and birth date. DIF: Cognitive Level: Application REF: dm. 45 OBJ: 13 | 14 TOP: Nursing Process Step: Implementation

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MSC: NCLEX Client Needs Category: Safe, Effective Care Environment OTHER 23. Rank the patient needs according to Maslows hierarchy, beginning with the lowest level need to the highest level need. (Enter your answer with a comma and space between each lettered option as follows: A, B, C, D, E.) A. A patient would like to write a book. B. A patient becomes frightened when no one answers the call light during the night. C. A pediatric patient is worrying that school friends will forget him. D. A patient needs to be repositioned in bed. E. A chronically ill patient states that he feels worthless because he is unable to support his family. ANS: D, B, C, E, A The needs should be addressed in the following order: The patients need for repositioning represents a basic need for comfort; the patients alarm when the call light is not answered represents fear for safety; the patients worry about his school friends forgetting him represents a threat to sense of love and belonging; the patients feeling of worthlessness represents threatened self esteem; and the patients desire to write a book is related to self actualization.

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