Test Bank For Understanding Pharmacology Essentials for Medication Safety 1st Edition, Workman

Test Bank For Understanding Pharmacology Essentials for Medication Safety 1st Edition, Workman YOU CAN FIND MORE QUESTIONS AND ANSWERS, just go HERE

MULTIPLE CHOICE Chapter 01: Drug Actions and Body Responses 1. How are intrinsic drugs different from extrinsic drugs? a. Intrinsic drugs are made by the body, whereas extrinsic drugs are made outside the body. b. Intrinsic drugs are administered by the parenteral route, whereas extrinsic drugs are administered by the oral route. c. Extrinsic drugs can only be applied to the skin or mucous membranes, whereas intrinsic drugs are taken internally. d. Extrinsic drugs require a prescription for administration, whereas intrinsic drugs are available over the counter.

2. How are the terms drug and medication different in the health care environment? a. Medications must be prescribed, whereas drugs are available over the counter. b. Medications are used to treat health problems, whereas drugs can be abused. c. Drugs are always illegal, whereas medications are legal. d. There is no difference between these two terms.

3. Which patient response indicates a drug’s therapeutic response? a. Ankle swelling b. Bone strengthening c. Constipation d. Dizziness 4. Which type of drug name is used mainly by drug developers and manufacturers, and not by prescribers? a. Generic name b. Brand or trade name c. Chemical name d. Proprietary name 5. What major consideration allows a drug to be available over the counter rather than by prescription? a. Side effects are not induced by the drug. b. Over-the-counter drugs must cost less than prescription drugs. c. The drug is so mild that no federal regulations are needed. d. The drug is safe when the directions for dosage and scheduling are followed.

6. Why must the nurse always ask a patient about his or her use of any herbal supplements or botanicals? a. Many states do not have regulations about herbal supplements or botanicals.

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b. These substances are illegal and the nurse must report patients’ use of them. c. Patients who use botanicals seldom take their prescribed drugs. d. These substances can interact with a prescribed drug.

7. In the United States, which group is responsible for enforcing established standards for drug manufacturing? a. United States Pharmacopeia b. National Institutes of Health c. Food and Drug Administration d. Association of Pharmaceutical Manufacturers 8. How are the effects of naturally occurring testosterone changed when a patient is taking a drug that is a testosterone agonist? a. Effects are increased b. Effects are decreased c. Effects are eliminated d. Effects are unchanged 9. Which statement about agonist and antagonist drugs is true? a. The target tissues for these types of drugs are invading bacteria and viruses. b. Both agonist and antagonist drugs must interact with receptors to produce their intended responses. c. Antagonist drugs produce only intended responses and agonist drugs produce both intended responses and side effects. d. These types of drugs are less likely to cause allergic responses than drugs that are neither agonists nor antagonists.

10. Which statement about drug side effects is true? a. All drugs have side effects. b. Severe side effects are all considered allergic responses. c. All patients taking a specific drug experience the same side effects. d. Any patient experiencing a drug side effect must stop taking the drug immediately.

Chapter 02: Safely Preparing and Giving Drugs 1. What is the best way for the nurse to make sure that the right patient is receiving a prescribed drug when the patient is alert and oriented? a. Ask the patient to state his or her name. b. Check the patient’s wrist band. c. Look at the patient’s chart. d. Have the patient state his or her name and birth date.

2. When is it acceptable for the nurse to take a verbal order from the prescriber before giving a drug to a patient? a. During the night shift when the prescriber is not at the hospital b. In an emergency situation such as a cardiac arrest c. When a patient is experiencing severe pain d. At any time it is necessary 3. The nurse is giving morning medications to a patient who refuses to take an oral dose of docusate (Colace). What is the nurse’s best response? a. “Your prescriber ordered that you must take this drug twice a day.” b. “Docusate will soften your bowel movements so that you do not strain.” c. “This drug will help prevent constipation while you are on bed rest.” d. “Can you tell me why you do not want to take the docusate?”

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4. What is the most important role of the nurse in preventing drug errors? a. Always checking the patient’s diagnosis before giving a drug b. Always following the “six rights” of drug administration c. Being the one defense for detecting and preventing drug errors d. Being most likely to detect a drug error that has occurred 5. The prescriber orders atenolol (Tenormin) 25 mg to be given orally once a day to control a patient’s high blood pressure. The nurse takes the patient’s vital signs and finds that the blood pressure is 128/80 mm Hg and the heart rate is 60 beats per minute. What does the nurse do first before giving this drug? a. Check the order for prescriber limitations on when the drug should be given. b. Notify the prescriber and ask if the drug should be given. c. Reassess the blood pressure and heart rate in 30 minutes. d. Give the drug exactly as prescribed.

6. A patient is prescribed omeprazole (Prilosec) 60 mg once a day orally. The patient is having difficulty with swallowing and has a feeding tube in place. What is the nurse’s best action? a. Open the capsule and mix the contents with water, then give the drug through the feeding tube. b. Raise the head of the bed 90 degrees and mix the capsule in applesauce for easier swallowing. c. Contact the prescriber and pharmacist about using another drug or another form of the drug. d. Hold the tube feeding for at least 30 minutes before giving the drug.

7. For which route of parenteral drug administration does the nurse use a 3/8-inch 25-gauge needle? a. Intracardiac b. Subcutaneous c. Intramuscular d. Intravenous 8. A patient with severe postoperative pain is ordered to receive morphine 2 mg intravenously. The patient asks the nurse if the drug could be taken by mouth instead. What is the nurse’s best response? a. “Giving the drug intravenously will give you faster pain relief.” b. “I will call your prescriber and ask if the order can be changed.” c. “Your surgeon wants you to receive the drug intravenously.” d. “We can substitute the intravenous drug with an oral drug.”

9. A patient is to receive nitroglycerin ointment, 1 inch STAT, for elevated blood pressure. What must the nurse do before giving this drug? a. Shave the hair off the patient’s chest. b. Place the patient on a heart monitor. c. Put on a pair of disposable gloves. d. Measure the dose directly on the patient’s skin.

10. A sublingual drug is administered by placing the drug in what part of the body? a. Between the cheek and the upper jaw b. Under the tongue c. In the nose d. In the eyes Chapter 03: Teaching Patients About Drug Therapy 1. Which is the best indication of learning? a. Always using information appropriately b. Acquiring new knowledge that results in a persistent change of behavior c. Consistently making good grades on tests taken during school or college d. Identifying important health promotion information to teach patients and families

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2. Why is it important for the nurse to assess a patient’s religion when planning interventions for pain? a. Most patients believe that God administers or relieves pain. b. Artificial pain relief measures are discouraged by most non-Christian religions. c. The use of religious practices may enhance a patient’s response to drug therapy for pain. d. Providing prompt and effective pain relief measures can increase a patient’s faith in God or other deity figure.

3. The nurse is interviewing a patient. Which action by the nurse indicates active listening? a. Asking interview questions while starting an IV b. Correcting the patient’s use of the word “free bleeder” for hemophilia c. Asking the spouse to verify the patient’s responses to family history questions d. Restating what the patient said to ensure the nurse understands what the patient meant 4. The nurse is preparing to teach a patient about a newly prescribed drug therapy. What time is best for improving teaching effectiveness? a. During lunch so that the patient is not too hungry to learn b. After the patient wakes up from a nap and no visitors are present c. Right after the health care provider has told the patient that the health problem cannot be cured d. When the patient’s spouse and three adult children are present so that the family can reinforce the teaching 5. A patient from another culture does not look at the nurse’s face while answering questions about health and medication history. What is the nurse’s best action? a. Ask the patient whether a family member could serve as an interpreter. b. Speak in a louder tone to get the patient’s attention. c. Have the patient sit in a chair rather than in the bed. d. Proceed with the interview.

6. While assisting a pregnant Mexican-American woman to dress, the nurse asks about a brass key pinned to the patient’s underwear. The patient says that wearing the brass key protects her unborn baby if a solar eclipse occurs. What is the nurse’s best response? a. “An additional way to protect your baby is by taking your vitamins.” b. “Does your religion require you to wear this brass key during pregnancy?” c. “Just how does wearing a brass key protect your baby during a solar eclipse?” d. “Your baby would be better protected by keeping all your prenatal appointments.”

7. Which information noted by the nurse during a patient interview is considered part of cultural assessment? a. The patient’s personal appearance and clothing are neat and clean. b. The patient is considerably overweight for his or her height and age. c. The skin tone and eye coloring of all family members is very similar. d. The wife looks to her husband to answer questions about her health.

8. A patient who is a Jehovah’s Witness is scheduled for routine surgery and expresses concern about the possibility of receiving blood products, an act condemned by the patient’s religion. What is the nurse’s best response? a. “You should allow the health care professionals to do whatever is needed to save your life.” b. “Transfusions are not routine and now there are good alternatives to transfusions if you should lose an excessive amount of blood.” c. “If you are worried about contamination, the blood supply in this country is tested thoroughly and is the safest in the world.” d. “I will have the hospital chaplain come and explain to you that the Bible says there really is nothing

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unacceptable about a blood transfusion.”

9. Which patient action indicates learning in the psychomotor domain? a. Assembling a drug inhaler b. Looking up drug side effects on a computer c. Ensuring that the prescription is refilled on time d. Asking whether a drug dose should be skipped when vomiting occurs 10. Which statement by the nurse is more likely to motivate a patient to adhere to a drug therapy regimen for hypertension? a. “Your doctor prescribed this drug and your doctor knows what is best for your health.” b. “If you do not take this drug you are at greater risk to die of stroke or heart attack within the next 10 years.” c. “As an artist, your eyes are important, and taking this drug daily helps prevent eye damage from high blood pressure.” d. “If you are not taking this drug because you are too poor to afford it, I can call a social worker so you can get financial aid.”

Chapter 04: Medical Systems of Weights and Measures 1. A mother reports that her child has a temperature of 105.2° Fahrenheit. What Centigrade temperature will the nurse report to the child’s physician? a. 36.7° b. 38.7° c. 40.7° d. 42.7° 2. The prescriber tells a patient to call if a temperature higher than 39° Centigrade develops. The patient asks the nurse what this temperature is in Fahrenheit. What is the nurse’s response? a. 99.2° b. 100.2° c. 101.2° d. 102.2° 3. Why does the nurse teach a patient to use a small medication cup to measure a liquid drug rather than a tableware teaspoon? a. A child may learn to think that all tableware teaspoons contain drugs. b. Teaspoons are more likely to spill and waste drug than a medication cup. c. Medication cups measure liquids more accurately than tableware teaspoons. d. Medication cups are less likely to change the taste of the drug than tableware teaspoons.

4. An infant is to receive 6 mg of a liquid drug that is available in the strength of 10 mg/mL. How many drops (gtt) of this drug does the nurse administer to the infant? a. 3 b. 6 c. 9 d. 12 5. The nurse is mixing a dry drug in a vial with 1 ounce of the accompanying diluting fluid (diluent).

How many milliliters does the nurse add to the dry drug in the vial? a. 15 b. 30 c. 45 d. 60

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6. What technique does the nurse use when measuring a liquid drug in a medicine cup to ensure an accurate dose? a. Holding the cup at eye level while pouring the drug b. Holding the cup below eye level while pouring the drug c. Holding the cup above eye level while pouring the drug d. Using a syringe to draw up the drug and then placing it in the medicine cup 7. A patient is prescribed 500 mg of amoxicillin (Amoxil). The amoxicillin on hand is . How many milliliters does the nurse administer for this patient? a. 10 b. 25 c. 50 d. 100 8. Which drug amount is the greatest? a. 5 g b. 50 mg c. 500 mg d. 5000 mcg 9. What is the weight in kilograms for a patient who weighs 185 lb? a. 407.1 b. 203.5 c. 92.5 d. 84.1 10. A newborn infant weights 1.982 kg. What is this infant’s weight in pounds? a. 9.2 b. 4.36 c. 2.92 d. 0.9 Chapter 05: Mathematics Review and Introduction to Dosage Calculation 1. What is the most important consideration when using a calculator for drug dosages? a. Always check the answers with a pharmacist. b. Ensure the numbers are entered in the correct order. c. Work the problem by hand and then check all work using the computer. d. Calculate the answer with the computer and then check the answer by working the problem by hand.

2. What specific safety technique is always used when calculating an insulin dose? a. Use a calculator and never calculate the dose by hand. b. Calculate the dose by hand and never use a calculator. c. Have another health care professional check the dose. d. Wear sterile gloves to administer the calculated dose.

3. What is the best definition of a fraction? a. Part of a whole number obtained by dividing one number by a larger number b. The answer obtained when one number divided another number is always an even number c. The smallest unit or part of a number that can be obtained by dividing one number by itself d. The dividing point between whole numbers and parts of numbers in a system based on units of ten 4. In the equation 2X = , which element is the numerator? a. 2 b. 4

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c. 6 d. X 5. Which fraction represents the whole number 10?

6. Which number is expressed as a proper fraction?

7. Which fraction accurately represents the mixed number 6 5/8?

8. Which fraction is expressed as its lowest common denominator?

9. What is the lowest common denominator for the fraction series of 10/15, 9/27, 10/30, 34/51? a. 3 b. 5 c. 6 d. 10 Chapter 06: Dosage Calculation of Intravenous Solutions and Drugs 1. What is the most important advantage for intravenous (IV) infusion of drugs? a. Anyone can administer IV drugs. b. The drug reaches the bloodstream immediately. c. Drugs given intravenously cost less than drugs given orally. d. The patient is not required to be alert to swallow the drug.

2. How does the “drop factor” affect IV infusions? a. Fluid with a larger drop factor infuses more slowly than fluid with a smaller drop factor. b. Smaller drop factors occur with smaller needles (or cannulas) and larger drop factors occur with larger needles. c. The smaller the drop factor, the fewer the number of drops needed to administer 1 mL of infusion fluid. d. The larger the drop factor, the fewer the number of drops needed to administer 1 mL of infusion fluid.

3. A patient is to receive 1000 mL intravenously of dextrose 5% in lactated Ringer’s solution in 8 hours.

When the nurse checks the intravenous (IV) bag after 2 hours, 700 mL remain in the bag. How many milliliters have already infused? a. 100 b. 300 c. 700 d. 1000 4. A patient is to receive 125 mL of intravenous fluid per hour and the drop factor is 10 gtt per mL. The nurse counts the 15-second drip rate to be 8 gtt per minute. What is the nurse’s best action? a. Nothing, the IV flow rate is correct. b. Turn the rate down to 5 gtt/15 seconds. c. Turn the rate up to 11 gtt/15 seconds. d. Turn the rate up to 15 gtt/15 seconds.

5. How is extravasation different from infiltration? a. Infiltration occurs in the hand, whereas extravasation occurs in the arm. b. Both conditions lead to swelling, but extravasation causes tissue damage. c. Infiltration is swelling accompanied by pain, whereas extravasation is not painful. d. Extravasation causes phlebitis along with tissue swelling, whereas infiltration causes fluid overload along with swelling.

6. An IV infusion order for a patient reads “1000 mL dextrose 5% in normal saline intravenously, immediately.” What additional information does the nurse ask the prescriber to provide? a. Drip rate

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b. Drop factor c. Duration d. Start time 7. Which precaution is most important for the nurse to teach a patient who is receiving intravenous (IV) drug therapy? a. “Turn on your call light if the IV machine starts to beep for any reason.” b. “Do not use the arm that has the IV running in it for any reason whatsoever.” c. “Call me immediately if you start to feel any pain or burning in the arm with the IV.” d. “If you think the IV is running too slowly, just push the up-arrow button on the machine once or twice.”

8. While examining a patient’s peripheral intravenous (IV) site, the nurse observes a red streak along the length of the vein. On palpation, the vein feels hard and cordlike. What is the nurse’s best action? a. Check for a blood return and notify the prescriber. b. Discontinue the infusion and remove the IV needle. c. Apply ice packs to the vein and continue the infusion. d. Change the IV fluid to normal saline and redress the site.

9. Which problem is a major disadvantage of an intravenous (IV) pump? a. The alarms are so sensitive that nurses tend to ignore them when they sound frequently. b. Patients and families can override the automatic features and reset the infusion rate. c. It can “run away” and cause a patient to experience fluid overload. d. It can continue to push fluid into the tissue when infiltration occurs.

10. The intravenous (IV) site of a patient who has been receiving IV therapy for 2 days is red and has a small amount of pus oozing from around the needle. What is the nurse’s best action? a. Document the finding as an expected response to long-term IV therapy as the only action. b. Immediately notify the prescriber to get an order to discontinue the IV therapy. c. Use an iodine solution to clean the site and replace the dressing. d. Discontinue the IV therapy and notify the prescriber.

Chapter 07: Drugs for Pain and Sleep Problems 1. Which is the best clinical definition of pain? a. A state of extreme physical distress or discomfort b. A condition of sensation caused by tissue damage c. A cognitive awareness of a change in comfort d. Whatever the patient says it is 2. Which statement by a patient indicates the need for more teaching about pain and pain control? a. “If my pain interferes with my usual activities, I will take medication for it.” b. “There is no reason for me to take drugs for pain; after all, you can’t cure old age.” c. “I don’t mind taking pain drugs for my sprained ankle because I know it won’t hurt this way forever.” d. “I will take enough pain medication to make me comfortable without making me too sleepy.”

3. Which statement about pain is true? a. Each patient perceives a painful event differently. b. Patients who cannot describe their pain do not really have pain. c. It is not necessary to assess for pain in patients who are sleeping. d. Infants and young children feel pain less intensely than adults do.

4. A patient who is paralyzed from the waist down as a result of an injury that completely severed the spinal cord has an open wound on the right heel. Why is this patient unaware of any pain caused from this wound?

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a. The nociceptors in the heel are no longer stimulated when injury occurs. b. The patient has become completely desensitized to this type of chronic pain. c. The severed spinal cord prevents the sensation of pain from reaching the brain. d. The spinal cord injury results in chronic pain that can mask any acute pain sensation.

5. A patient with arthritis of the left knee reports pain extending from the knee half-way down the lower leg. What type of pain is this patient perceiving? a. Localized b. Referred c. Radiating d. Phantom 6. Pain is considered to be the “fifth vital sign.” How does this principle affect nursing care? a. It ensures that pain assessment occurs on a regular basis for all patients. b. It helps nurses understand that experiencing pain can change heart rate and respiratory rate. c. It helps nurses to ensure that vital organ function is adequate before administering drugs to reduce pain. d. It encourages nurses to assess two parameters during patient contact to improve time management.

7. What is the best way for the nurse to determine a patient’s need for pain medication on the second day after an abdominal laparotomy? a. Check when the patient last received medication for pain. b. Assess the patient’s facial expression and vital signs. c. Consider the patient’s age and ethnicity. d. Ask the patient to rate his or her pain.

8. Which event or condition is most likely to result in chronic pain? a. Severe headache associated with a spinal tap b. Insertion of a needle for intravenous (IV) therapy c. Hip replacement surgery d. Osteoarthritis 9. How do morphine and other opioid pain medications relieve a patient’s pain? a. They reduce tissue damage and alter the physical problems causing the pain. b. They bind to opioid receptors in the central nervous system and alter the perception of pain. c. They inhibit the generation of impulses along sensory nerve tracts and alter pain transmission. d. They redirect substance P release from nociceptors and alter the amount of neurotransmitters reaching the brain.

10. After surgery, a patient expresses to the nurse the fear of becoming addicted to the opioid analgesic that has been prescribed for pain. What is the nurse’s best response? a. “Opioid-based drugs are not addictive.” b. “Have you or anyone in your family ever been addicted to drugs?” c. “When opioid drugs are taken for acute pain, they are rarely addictive.” d. “If you take the medication no more frequently than every 4 hours, it is not possible for you to become addicted.”

Chapter 08: Anti-Inflammatory Drugs 1. Why is inflammation considered a nonspecific body response? a. Inflammation is the basis for almost every type of chronic disease. b. Infection by bacteria or viruses is always a part of inflammation. c. The same tissue responses occur regardless of the type of triggering event. d. The discomfort associated with inflammation can be reduced by over-the-counter drugs.

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2. Which symptoms of inflammation are caused by leakage of blood plasma into the tissues at the site of injury or invasion? a. Increased production and migration of leukocytes b. Phagocytosis and fever c. Warmth and redness d. Swelling and pain 3. When is an inflammatory response a health problem rather than a helpful protection? a. When a patient’s immune system is suppressed b. When infection accompanies inflammation c. When inflammation is prolonged d. When pain is experienced 4. A patient is prescribed an oral corticosteroid for a chronic inflammatory health problem. Which precaution is most important for the nurse to teach? a. “Never stop taking this drug without consulting your prescriber.” b. “Avoid crowds and people who are ill.” c. “Be sure to take this drug with food.” d. “Reduce your salt intake.”

5. Which statement about stage I of the inflammatory process is true? a. Vascular changes occur, including dilation of blood vessels and capillary leak. b. White blood cells (WBCs) secrete chemicals that trigger resolution of pain and swelling. c. The body prepares to replace scar tissue with healthy tissue to maintain function. d. An exudate called pus is formed and white blood cell levels are four to five times above normal.

6. Why are corticosteroid drugs usually prescribed for a short period of time? a. The inflammatory process cannot be controlled with less powerful drugs. b. Inhalation of corticosteroid drugs causes irreversible damage to the lungs. c. These drugs work less effectively when given over an extended period. d. Corticosteroids have many adverse effects and side effects.

7. A patient who has been taking 30 mg of prednisone daily for the last 10 days reports crying more often and then suddenly getting angry at small issues. What is the nurse’s best action? a. Document the patient’s response as the only action. b. Hold the next dose and notify the prescriber immediately. c. Reassure the patient that this is an expected drug response. d. Suggest that the patient see a counselor or attend an anger management class.

8. A patient who has been prescribed long-term low-dose prednisone to control inflammation reports concern about the changes in her appearance caused by the drug. What is the nurse’s best response? a. “This often happens when a person takes this drug. You now have Cushing’s disease.” b. “When you stop taking this drug, the changes will disappear, but it may take a while.” c. “You can make use of different styles of clothes to minimize changes in appearance.” d. “Changes in your diet and an exercise program will eliminate these changes while you are on this drug.”

9. A patient is prescribed topical hydrocortisone 0.1% for skin inflammation. What does the nurse teach the patient for applying this drug? a. “Use a thick layer of drug just to the area that needs treatment.” b. “Apply a thin layer to the affected area and to the skin near the area.” c. “Apply a thick layer over and 1 inch around the affected area.” d. “Use as thin a layer as possible just to the area that needs treatment.”

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10. The nurse is providing care to an older adult patient who has been prescribed a topical corticosteroid.

Which assessment is most important for the nurse to perform? a. Skin assessment b. Intake and output c. Cognition or mental status d. Urinary tract infection Chapter 09: Anti-Infectives: Antibacterial Drugs 1. Why is it important to avoid killing off normal flora with antibacterial drugs? a. Normal flora can help provide protection against the development of pathogenic infections. b. Normal flora result in opportunistic infections while other bacteria result in pathogenic infections. c. When normal flora are not present, the immune system is suppressed, increasing the risk for infection. d. When normal flora are not present, the immune system is overactive, increasing the risk for autoimmune diseases.

2. Which type of bacteria cause infection when a patient’s immune system is impaired? a. Pathogenic b. Nonpathogenic c. Gram negative d. Opportunistic 3. How are bactericidal drugs different from bacteriostatic drugs? a. Bacteriostatic drugs are more likely to cause an allergic response than bactericidal drugs. b. Bacteriostatic drugs work only on bacteria, whereas bactericidal drugs are effective against other types of organisms. c. Bactericidal drug actions result in killing the bacteria, whereas bacteriostatic drugs only slow bacterial growth. d. Bactericidal drugs require assistance from the patient’s immune system to be effective, whereas bacteriostatic drugs are effective even when function is poor.

4. A patient has a bacterial infection, but the causative organism is not known. Which type of antibacterial drug will most likely be prescribed? a. Narrow-spectrum b. Limited-spectrum c. Extended-spectrum d. Broad-spectrum 5. The nurse is teaching a patient in whom a wound infection developed after surgery about antibiotic therapy. Which statement made by the patient indicates a correct understanding of the therapy? a. “If my temperature is normal for 3 days in a row, the infection is gone and I can stop taking the drug.” b. “If my temperature goes above 100° for 2 days, I should double the dose of the drug.” c. “Even if I feel completely well, I should take the drug exactly as prescribed until it is gone.” d. “I should notify my prescriber to change the medication if I develop diarrhea while taking this drug.”

6. A patient with a respiratory bacterial infection asks why a sputum sample is being collected before starting antibacterial drug therapy. What is the nurse’s best response? a. “Drug therapy for lung infections works better when less sputum is present.” b. “A sputum sample will help us determine what drug will work best against your infection.” c. “The lab will be able to determine which drug will treat your infection without harming your normal tissues.” d. “The dosage of your antibacterial drug is determined by the organism that is causing your infection.”

7. A patient receiving antibiotics for 3 days reports a skin rash over the chest, back, and arms. What is

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the nurse’s first action? a. Ask the patient whether he or she has ever developed a rash while taking another drug. b. Reassure the patient that many people have this expected reaction to antibiotic therapy. c. Ask the patient whether the rash itches, burns, or causes other types of discomfort. d. Document the report as the only action.

8. A patient who has been on antibiotic therapy for 3 weeks has a cottage cheese–like coating on the teeth, gums, and roof of the mouth. What is the nurse’s best action? a. Take a specimen and send it to the laboratory for culture. b. Hold the dose and notify the prescriber immediately. c. Document this expected finding as the only response. d. Assist the patient to perform frequent mouth care.

9. What is the most important nursing action when a patient is first started on an intravenous (IV) antibacterial drug? a. Check the IV site every 4 hours for redness around the site and the presence of cordlike veins. b. Check the drip rate every hour to ensure that the proper blood drug level is maintained. c. Assess the patient’s pulse, blood pressure, and respiratory effect every 15 minutes. d. Assess the patient’s white blood cell count daily to determine drug effectiveness.

10. A patient experiences facial angioedema after receiving a dose of a new antibacterial drug. Which assessment does the nurse perform first? a. Airway adequacy b. Peripheral lung sounds c. Rate and depth of respirations d. Symmetry of respiratory movement Chapter 10: Anti-Infectives: Antiviral Drugs 1. How are viral infections different from bacterial infections? a. Bacterial infections can be spread from one person to another, whereas viral infections cannot be spread directly. b. Bacterial infections can be cured by treatment with some anti-infective drugs, whereas viral infections are not cured by anti-infective therapy. c. Viruses only cause disease in a person who is immunocompromised, whereas bacteria can cause disease even among immunocompetent people. d. Viruses are the less mature form of a bacterium, so there is essentially no difference between viral infections and bacterial infections.

2. What is the purpose of antiviral drug therapy? a. To make the patient immune to infection by viruses b. To reduce infection by killing the virus causing disease c. To reduce illness duration by controlling viral reproduction d. To prevent opportunistic infections in immunosuppressed patients 3. What is the most important precaution the nurse must teach a patient who is prescribed any antiviral drug? a. “Take the drug exactly as prescribed and for as long as prescribed.” b. “Never take any antibacterial drugs while you are on antiviral therapy.” c. “Drink at least 3 L of water daily for the entire time you are taking this drug.” d. “Avoid unnecessary exposure to this drug by stopping it when you have no symptoms for 24 hours.”

4. A patient is prescribed intravenous (IV) acyclovir (Zovirax). Which question is most important for the nurse to ask before giving the first dose of this drug?

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a. “Do you have a hearing problem or any trouble with your ears?” b. “Do you take medications for seizures?” c. “Are you allergic to sulfa drugs?” d. “Have you ever had asthma?”

5. What is the most important precaution for the nurse to teach a patient who is prescribed oral valacyclovir (Valtrex)? a. “Avoid coffee and other caffeinated beverages.” b. “Wear long sleeves and a hat when going outdoors.” c. “Take this drug 1 hour before or 4 hours after eating a full meal.” d. “Drink at least 3 L of water daily for the entire time you are taking this drug.”

6. A patient who has been prescribed amantadine (Symmetrel) has all of the following health problems.

For which problem does the nurse contact the prescriber before giving the first dose? a. Asthma b. Influenza c. Glaucoma d. Diabetes mellitus 7. A 2-year-old patient with respiratory syncytial virus is prescribed aerosolized ribavirin (Virazole).

Which visitor does the nurse ensure is not in the patient’s room during the aerosol treatments? a. 10-year-old brother b. 81-year-old grandmother c. 32-year-old pregnant mother d. 36-year-old father who has diabetes 8. A patient who is taking interferon is also prescribed ribavirin (Virazole). Which laboratory blood test result for this patient does the nurse report immediately to the prescriber? a. Red blood cells (RBCs) 2.2 million/mm3 b. White blood cells (WBCs) 6000/mm3 c. Sodium 134 mEq/L d. International normalized ratio (INR) 1.6 9. Which precaution about zanamivir (Relenza) therapy does the nurse teach a patient who also uses a bronchodilator for asthma control? a. “Drink at least 3 L of water daily while using this drug.” b. “Use the bronchodilator 15 minutes before taking the zanamivir.” c. “Avoid taking the zanamivir within 2 hours of using the bronchodilator.” d. “Take your pulse daily while on this drug because when taken with a bronchodilator heart rhythm problems are common.”

10. How are retroviruses different from common viruses? a. Retroviruses respond to antibacterial drugs but common viruses do not. b. Retroviruses have a greater efficiency of infection than common viruses. c. Common viral infections can be cured while retroviral infections can only be controlled. d. Common viruses can infect anyone whereas retroviruses can only cause infection in an immunosuppressed host.

Chapter 11: Anti-Infectives: Antitubercular and Antifungal Drugs 1. A patient received a tuberculosis skin test injection of purified protein derivative (PPD) 72 hours ago.

Which assessment finding of the test site does the nurse interpret as a positive reaction? a. The injected area has a blister-like swelling about 2 mm high and 2 mm in diameter. b. The injection site is puffy and soft with pus oozing from the needle hole.

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c. The skin is red and very hard for 12 mm around the injection site. d. There is a large bruise surrounding the injection site.

2. A patient with which findings requires drug therapy for active tuberculosis (TB)? a. Negative TB skin test and chest x-ray but who has productive cough, fever, and shortness of breath b. Positive TB skin test, productive cough, and a cavitation on chest x-ray c. Positive TB skin test and a TB scar on chest x-ray d. Positive TB skin test as the only symptom 3. How long is the minimum course of drug therapy for an immunocompetent patient with active tuberculosis? a. 7 to 10 days b. 6 weeks c. 6 months d. 2 years 4. A patient with active tuberculosis who has been taking isoniazid (INH, Nydrazid) and rifampin (RIF, Rifadin) reports having urine that is an orange color. What is the nurse’s best action? a. Obtain a specimen for culture and test the urine for occult blood. b. Reassure the patient that this is a normal drug side effect. c. Hold the dose and contact the prescriber. d. Document the report as the only action.

5. A male patient who has been prescribed isoniazid (INH, Nydrazid) reports that his breasts have enlarged since starting therapy. What is the nurse’s best response? a. “This is common with isoniazid and will disappear after you stop drug therapy.” b. “Is the enlargement the same on both sides or is one breast larger than the other?” c. “If you are not having difficulty getting an erection, do not worry about this change.” d. “I will report this problem to your prescriber and see if it is possible for you to stop taking this drug.”

6. Which statement made by a patient indicates to the nurse the need for more teaching about first-line drug therapy for tuberculosis (TB)? a. “To prevent nausea and vomiting, I have been taking my drugs at night with a small snack.” b. “I have stopped taking all herbal supplements and stopped drinking beer until I finish this drug therapy.” c. “Now that my symptoms have disappeared after a month of drug therapy, I can no longer infect my family.” d. “Now that my symptoms have disappeared after a month of drug therapy, I can stop taking all of these drugs.”

7. What is the most important question the nurse must ask a patient before administering rifampin (RIF) intravenously? a. “Have you ever had gout?” b. “Are you allergic to sulfa drugs?” c. “Are you allergic to sulfite preservatives?” d. “Have you had any alcoholic beverages within the last month?”

8. A patient is prescribed 420 mg of rifampin to be added to 500 mL of dextrose 5% in water (D5W).

The vial contains rifampin 60 mg/mL. How many milliliters does the nurse add to the D5W? a. 0.16 b. 5 c. 7 d. 8

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9. A patient has been prescribed all four first-line drugs for tuberculosis (TB). Which laboratory blood value is most important for the nurse to report to the prescriber first? a. Red blood cells (RBCs) 2.2 million/mm3 b. International normalized ratio 1.6 c. White blood cells 6000/mm3 d. Sodium 134 mEq/L 10. Which administration technique does the nurse teach the family of a patient with memory problems for best adherence to first-line drug therapy for tuberculosis? a. Having one family member responsible for giving the drugs and watching the patient swallow them b. Setting up the patient’s drugs using a daily pill dispenser that has separate slots for each individual drug c. Asking the patient every night whether he or she has remembered to take all the drug doses that day d. Administering all the drugs together at the same time every day and ensuring that the patient drinks plenty of water Chapter 12: Drugs That Affect Urine Output 1. For which complication does the nurse remain alert when a patient is taking any type of diuretic? a. Loss of appetite b. Bladder spasms c. Hypertension d. Dehydration 2. A patient who has been taking a diuretic for the past 2 weeks now experiences all of the following changes. Which change indicates to the nurse that the diuretic is effective? a. Weight loss of 7 lb b. Heart rate increased from 72 to 80 beats per minute c. Respiratory rate decreased from 20 to 16 breaths per minute d. Morning blood glucose decreased from 142 mg/dL to 110 mg/dL 3. A patient prescribed a once-daily diuretic calls the office to report that yesterday’s drug dose was missed. What is the nurse’s best advice? a. “Take today’s dose now and restrict today’s fluid intake to 1 L.” b. “Take yesterday’s dose now and take today’s dose after another 6 hours.” c. “Take today’s dose now and maintain your normal intake of food and fluids.” d. “Skip today’s doses of all your medications and then begin everything fresh tomorrow.”

4. The nurse is teaching a patient about diuretic therapy. Which statement made by the patient indicates that more teaching is needed? a. “I am so thankful that my high blood pressure has been cured by this drug.” b. “I always try to drink just about the same amount of fluid that I urinate each day.” c. “I will call my health care provider if my heart rate is less than 60 beats per minute.” d. “I have been taking this drug early in the day so that I don’t have to get up during the night.”

5. A patient taking a thiazide diuretic has the following blood laboratory values for kidney function.

Which value does the nurse report to the prescriber immediately? a. Sodium 136 mEq/L b. Potassium 2.6 mEq/L c. Creatinine 0.9 mg/dL d. Blood urea nitrogen 6 mg/dL 6. Why does the nurse teach a patient who is prescribed a thiazide diuretic to change positions slowly? a. Moving rapidly from a standing position to a sitting position can raise blood pressure and increase the

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patient’s risk for a stroke. b. Moving rapidly from a standing position to a sitting position can cause excess body fluids to collect in the feet and ankles increasing the patient’s risk for edema. c. Moving rapidly from a sitting position to a standing position can put pressure on the bladder and increase the patient’s risk for incontinence. d. Moving rapidly from a sitting position to a standing position can cause blood pressure to drop and increase the patient’s risk for falling.

7. The nurse administers 20 mg of furosemide (Lasix) to a patient by the intravenous (IV) route. Which action is most important for the nurse to take? a. Give the drug slowly over at least 2 minutes. b. Check the patient carefully for symptoms of low blood glucose levels. c. Mix the drug with potassium chloride to prevent a rapid drop in serum potassium levels. d. Monitor the IV site after giving the drug because furosemide causes severe tissue damage if infiltration occurs.

8. Which side effect is associated only with loop diuretics? a. Dizziness b. Hearing loss c. Urinary frequency d. Increased sun sensitivity 9. Which diuretic may cause an adverse effect of a higher than normal serum potassium level? a. spironolactone (Aldactone) b. bumetanide (Bumex) c. chlorothiazide (Diuril) d. furosemide (Lasix) 10. A patient is prescribed spironolactone (Aldactone). Why does the nurse advise the patient to avoid the use of salt substitutes? a. They may cause the patient to be at risk for a high potassium level. b. They can increase the patient’s risk for hypertension. c. They may lead to hypokalemia. d. They can cause water retention.

Chapter 13: Drugs for Hypertension 1. A patient’s blood pressure is consistently around 138/88 mm Hg. What does this reading represent? a. Normal blood pressure b. Prehypertension c. Stage 1 hypertension d. Stage 2 hypertension 2. When hypertension is not treated, which health problem can result? a. Kidney damage b. Prostate enlargement c. Diabetes mellitus d. Seizures 3. What is the difference between primary hypertension and secondary hypertension? a. Secondary hypertension is not as severe as primary hypertension. b. Primary hypertension usually occurs at an earlier age than secondary hypertension. c. Secondary hypertension is caused by another health problem, whereas primary hypertension does not have a known cause.

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d. Primary hypertension can be treated with antihypertensive drugs, whereas secondary hypertension does not respond to drug therapy.

4. The nurse is teaching a patient about antihypertensive therapy. Which statement by the patient indicates the need for more teaching? a. “Now that my blood pressure is normal, I won’t need to take my medication anymore.” b. “When I take my blood pressure at home, I always try to take it at just about the same time every day.” c. “I check the labels on cans and other food packages to be sure they do not have too much sodium.” d. “I hope that by continuing to lose weight, I might not have to take medications to manage my high blood pressure.”

5. Which drug action is most likely to lower blood pressure? a. Increasing the effectiveness of heart pumping b. Relaxing (dilating) blood vessel smooth muscle c. Increasing the excretion of urine from the body d. Retaining the body’s concentration of potassium 6. Which action or precaution is most important for the nurse to perform before giving any type of drug for hypertension? a. Check the patient’s blood pressure. b. Ensure that the patient is in a sitting position. c. Check the patient’s pulse for regularity. d. Have the patient drink a full glass of water.

7. The nurse is checking a patient’s blood pressure before administering an antihypertensive, and gets a reading of 88/52 mm Hg. What is the nurse’s best action? a. Give the patient a cup of coffee and retake the blood pressure in 30 minutes. b. Document the finding as the only action and administer the drug as usual. c. Raise the side rails and apply oxygen by mask or nasal cannula. d. Hold the dose and notify the prescriber.

8. The nurse gives the first dose of an antihypertensive drug to a patient. Which instruction does the nurse give to the patient next? a. “Stay in bed and call for help if you need to get up for any reason.” b. “Urinate in a container so that we can keep track of your urine output.” c. “If you develop a headache, we can give you some acetaminophen (Tylenol).” d. “You may get up but only if you need to use the bathroom.”

9. A patient prescribed a thiazide diuretic for hypertension reports having cramps and feeling like the heart is skipping beats. What side effect of this drug does the nurse suspect? a. Dizziness b. Orthostatic hypotension c. Hypokalemia d. Dysrhythmia 10. A patient taking a thiazide diuretic has the following blood laboratory values for kidney function.

Which value does the nurse report to the prescriber immediately? a. Sodium 124 mEq/L b. Potassium 3.6 mEq/L c. Creatinine 0.9 mg/dL d. Blood urea nitrogen 16 mg/dL Chapter 14: Drugs for Heart Failure

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1. What is the most common cause of heart failure? a. Cardiomyopathy b. Hypertension c. Myocardial infarction d. Substance abuse 2. Why must the muscles of the left ventricle be the strongest ones in the heart? a. The mitral (bicuspid) valve is larger than the aortic valve. b. The left ventricle receives blood under high pressure from the pulmonary system. c. The pressure in the aorta is higher than the pressures elsewhere in the circulatory system. d. Blood in the left ventricle is oxygenated, making it thicker and harder to move than deoxygenated blood.

3. Which two factors are most likely to result in improved cardiac output? a. Greater preload; greater afterload b. Greater preload; reduced afterload c. Reduced preload; greater afterload d. Reduced preload; reduced afterload 4. Which symptom is commonly assessed by the nurse when a patient has left ventricular heart failure? a. Weight gain b. Swelling in the legs c. Jugular vein distention d. Crackles in the lungs 5. Which condition alerts the nurse to assess a patient for worsening heart failure? a. Blood pressure of 106/40 mm Hg b. Pounding headache c. Foul urine odor d. Ankle swelling 6. The nurse prepares to administer a drug for heart failure to a patient. Which assessment finding does the nurse report to the prescriber before administering the drug? a. Systolic blood pressure increase from 128 to 136 b. Urine output of 2100 mL in 24 hours c. Weight gain of 1 pound in 3 days d. Heart rate of 54 beats per minute 7. Which statement made by a patient with heart failure indicates that more teaching is needed about the prescribed drug therapy? a. “I always try to take my heart failure drugs at the same time each day.” b. “Now I am using a weekly pill dispenser to keep my drugs straight.” c. “Now that my heart failure is cured I can cut back the drugs I take.” d. “If I gain more than 3 pounds in a week I will call my doctor.”

8. A patient asks the nurse how a prescribed diuretic can help heart failure. What is the nurse’s best response? a. “Urinating more prevents heart failure from damaging your kidneys.” b. “Diuretics reduce blood pressure so your heart won’t have to work as hard.” c. “Taking a diuretic reduces salt levels so you don’t have to limit your intake of salty foods.” d. “The diuretic counteracts the side effects of the other drugs prescribed for your heart failure.”

9. A patient with heart failure asks the nurse why the antihypertensive drug enalopril (Vasotec) has been prescribed. What is the nurse’s best response?

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a. “Hypertension is the most common cause of heart failure.” b. “Lowering your blood pressure will allow your heart to pump more easily.” c. “This drug will decrease the amount of blood your heart has to pump, leading to less work for you heart.” d. “Enalopril will cause your heart to reestablish its normal electrical functions so that it works more effectively as a pump.”

10. A patient taking lisinopril (Zestril) for heart failure reports a nagging, nonproductive cough. What is the nurse’s best first action? a. Ask the patient whether he or she has received the annual influenza vaccination. b. Ask the patient how much the cough is interfering with sleep or other activities. c. Document the report as the only action. d. Notify the prescriber immediately.

Chapter 15: Antidysrhythmic Drugs 1. A patient’s heart rate is regular at 68 beats per minute. The electrocardiogram (ECG) tracing shows P waves before every QRS complex. What is the likely pacemaker of the heart? a. SA node b. AV node c. Bundle of His d. Purkinje fibers 2. A patient whose heart rate is 52 beats per minute reports feeling dizzy and light-headed. What is the nurse’s best first action? a. Start an IV line. b. Ask if the patient has experienced this before. c. Notify the prescriber immediately. d. Check the patient’s blood pressure.

3. A patient on a telemetry monitor reports feeling like the heart is skipping beats, and asks the nurse what could be causing this. What is the nurse’s best response? a. “Have you been exercising recently?” b. “Do you notice any other symptoms when your heart skips beats?” c. “You will have to tell your prescriber about this and ask him or her what is the cause.” d. “Let me first listen to your heart, measure your blood pressure, and check your heart monitor.”

4. A patient’s heart monitor shows ventricular fibrillation. What is the nurse’s best first action? a. Check the patient. b. Call a code. c. Begin CPR d. Defibrillate the patient.

5. A patient with an upper respiratory infection reports feeling like the heart is pounding. After checking that the patient is not having chest pain or difficulty breathing, what is the most important question the nurse must ask the patient? a. “How long have you had upper respiratory infection symptoms?” b. “Are you using any over-the-counter cold or cough drugs?” c. “Is this the first time you have felt like this?” d. “What exercise have you done today?”

6. A patient is prescribed digoxin. The patient’s apical heart rate is 58 beats per minute. What is the nurse’s best action? a. Give the drug as ordered.

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b. Document the finding because this is an expected effect of the drug. c. Recheck the heart rate and blood pressure after 30 minutes. d. Hold the drug and notify the prescriber.

7. A patient given atropine (Atropine Sulfate) intravenously as a one-time dose for bradycardia now reports a very dry mouth. What is the nurse’s best response? a. Notify the prescriber immediately. b. Document the report as the only action. c. Reassure the patient that this is a normal drug response. d. Offer the patient the opportunity to brush his or her teeth and rinse the mouth.

8. A 70-year-old patient who has been taking digoxin (Lanoxin) for 4 years has all of the following laboratory blood tests. For which test value does the nurse notify the prescriber immediately? a. Sodium (Na) 132 mEq/L b. Potassium (K) 2.1 mEq/L c. Blood urea nitrogen (BUN) 9 mg/dL d. International normalized ratio (INR) 1.5 9. Nausea, vomiting, and an irregular heart rate develop in a patient who takes oral digoxin every morning. What is the nurse’s best action? a. Give prescribed diphenhydramine (Phenergan) as needed. b. Check the patient’s cardiac monitor strip. c. Assess the apical pulse for a full minute. d. Check laboratory results for a digoxin level.

10. A patient who is prescribed oral quinidine (Quinaglute) for a tachydysrhythmia is on a cardiac monitor, which shows lengthening PR intervals. What is the nurse’s best action? a. Perform a 12-lead electrocardiogram (ECG). b. Send a serum potassium level to the laboratory. c. Document this as an expected action of the drug. d. Notify the prescriber immediately.

Chapter 16: Drugs for High Blood Lipids 1. Which statement about cholesterol is true? a. The one source of cholesterol is from the foods a person eats. b. Cholesterol always has harmful effects on a person’s body. c. Too much cholesterol leads to a deficit of bile acids that digest fat. d. It is a fatty, waxy material present in cell membranes of the body.

2. A patient has been prescribed an antihyperlipidemic drug. Which laboratory value does the nurse report to the prescriber? a. Total cholesterol 198 mg/dL b. Triglycerides 135 mg/dL c. Low density lipoprotein (LDL) 195 mg/dL d. High density lipoprotein (HDL) 60 mg/dL 3. A patient with high blood lipids asks the nurse why the lipid profile did not improve after 3 months following a low-fat diet. What is the nurse’s best response? a. “You may need to follow a no-fat diet to improve your lipid profile.” b. “You must follow a low-fat diet for at least 6 months to see improvement.” c. “You will definitely need to be prescribed a drug to see improvement.” d. “You may have a genetic factor that is causing your high blood lipid levels.”

4. Which statement by a patient who has been prescribed an antilipidemic drug indicates to the nurse the

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need for additional teaching? a. “Once my lipid profile levels are normal, I will no longer need to take the drug.” b. “Taking this drug will decrease my risk for having a heart attack.” c. “My goal is to increase my HDL cholesterol and decrease my LDL cholesterol.” d. “I will continue walking and watching the fat in my diet while I’m taking this drug.”

5. How do antihyperlipidemic drugs from the statin class lower “bad” cholesterol levels? a. They act as a filter in the blood to trap bad cholesterol and allow white blood cells to destroy it. b. They block the absorption of dietary fats through the walls of the intestinal tract. c. They bind to cholesterol in the intestinal tract and promote its excretion in stool. d. They decrease normal liver production of cholesterol.

6. Which laboratory finding does the nurse report to the prescriber before giving any antihyperlipidemic drug? a. Aspartate aminotransferase 41 IU/L b. Alanine aminotransferase 24 IU/L c. Alkaline phosphatase 130 IU/L d. Gamma-glutamyltransferase 50 IU/L 7. A patient prescribed atorvastatin (Lipitor) reports all of the following problems or changes since starting this drug. Which problem or change does the nurse report to the prescriber? a. Abdominal cramps and bloating b. Muscle aches and weakness c. Urinating more at night d. Loss of taste for sweets 8. A patient who is prescribed atorvastatin (Lipitor) reports experiencing some muscle pain and weakness. What is the nurse’s best action? a. Administer ordered acetaminophen (Tylenol) as needed. b. Document the finding as the only action. c. Reassure the patient that this is an expected side effect. d. Hold the drug and notify the prescriber.

9. A patient who has been prescribed lovastatin (Mevacor) asks the nurse why all urine must be saved for intake and output measurements. What is the nurse’s best response? a. “All patients on this unit have orders for strict intake and output measurements.” b. “Intake and output measurements are important indicators of how well your kidneys are functioning.” c. “A side effect of this drug can be blockage of urine flow through the kidneys and decreased urine output.” d. “Sometimes this drug can cause the kidneys to make extra urine resulting in increased urine output and dehydration.”

10. A patient who is prescribed simvastatin (Zocor) asks the nurse why liver function tests must be drawn every 6 months. What is the nurse’s best response? a. “They are important because early liver problems do not cause symptoms.” b. “They help your prescriber decide what your dose of simvastatin should be.” c. “They tell your prescriber how well your body is responding to the therapy.” d. “They indicate how much cholesterol is being produced by your liver.”

Chapter 17: Drugs That Affect Blood Clotting 1. How are anticoagulant drugs and thrombolytic drugs different? a. There is no difference; they both have the same actions. b. Anticoagulants prevent clots from forming whereas thrombolytics can dissolve clots that have already

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formed. c. Thrombolytics must be administered intravenously while all anticoagulants are administered as oral agents. d. Anticoagulants prevent clots by actually thinning the blood whereas thrombolytics reduce platelet aggregation and do not affect blood thickness.

2. Which blood component forms the initial plug that helps stop bleeding? a. Fibrin b. Platelets c. Neutrophils d. Eosinophils 3. Which condition occurs as a result of a thrombus developing in a coronary artery? a. Cerebrovascular accident b. Deep vein thrombosis c. Pulmonary embolus d. Myocardial infarction 4. A patient asks the nurse why an anticoagulant has been prescribed. What is the nurse’s best response? a. “It will dissolve any clots in your blood vessels.” b. “It will prevent any new clots from forming.” c. “It will prevent a clot from migrating.” d. “It will thin your blood.”

5. A patient prescribed an anticoagulant long-term engages in all of the following activities. Which activity does the nurse teach the patient to avoid? a. Golfing b. Bowling c. Jumping rope d. Walking 2 miles daily 6. A patient in the emergency department developed stroke symptoms one hour ago. Which type of drug will the nurse expect to administer to resolve this problem? a. Thrombolytic b. Thrombin inhibitor c. Antiplatelet drug d. Clotting factor synthesis inhibitor 7. Which action does the nurse avoid after administering a thrombolytic drug? a. Administering IV drugs b. Using electric razors c. Providing a soft toothbrush d. Giving an intramuscular injection 8. A patient who has been prescribed continuous intravenous (IV) heparin asks the nurse why being weighed is necessary. What is the nurse’s best response? a. “All patients are weighed upon admission to the hospital.” b. “IV heparin has been known to cause weight gain.” c. “The initial IV bolus of heparin is prescribed based on your weight.” d. “The rate of the heparin infusion is based on your weight.”

9. The aPTT of a patient who is prescribed continuous intravenous (IV) heparin is two times the control value. What is the nurse’s best action? a. Increase the IV rate as ordered.

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b. Decrease the IV rate as ordered. c. Leave the rate unchanged. d. Stop the infusion and notify the prescriber.

10. A patient is being discharged on enoxaparin (Lovenox). Which statement does the nurse include in the discharge teaching plan? a. “An advantage of this drug is that labs do not need to be drawn to guide therapy.” b. “Follow-up lab work must be drawn every 2 to 6 months.” c. “Enoxaparin is given intramuscularly twice a day.” d. “The purpose of this drug is to dissolve clots.”

Chapter 18: Drugs for Asthma and Other Respiratory Problems 1. How are asthma and chronic obstructive pulmonary disease (COPD) different? a. COPD is a genetic disease whereas asthma is largely caused by allergies. b. Breathing problems with asthma are reversible but those with COPD are permanent. c. Asthma is a disease of children and younger adults whereas COPD is found only in older adults. d. Breathing problems with COPD can lead to death, whereas those with asthma are not severe enough to be fatal.

2. Which statement about the pathology of asthma is true? a. Breath sounds are normal between attacks. b. Mucous plugs are the major cause of airway obstruction. c. Eventually the alveoli are destroyed and gas exchange is limited. d. During an attack, arterial oxygen levels and carbon dioxide levels are decreased.

3. A patient has been medicated during an asthma attack. Which assessment finding indicates to the nurse that the therapy is ineffective? a. Trachea is at the midline. b. Oxygen saturation is 96%. c. Respiratory rate is 22 breaths per minute d. Peak expiratory flow is 40% below expected value 4. A patient with asthma is prescribed albuterol (Proventil) as needed and salmeterol (Serevent) every 12 hours. When the patient asks the nurse why two inhaler drugs are needed, what is the nurse’s best response? a. “Albuterol opens your airways and salmeterol decreases the inflammation.” b. “I will check with the prescriber to determine whether you can just use one drug.” c. “Albuterol is a rescue drug to stop asthma attacks and salmeterol prevents attacks.” d. “Salmeterol helps you breathe better and albuterol opens alveoli for gas exchange.”

5. A patient newly diagnosed with chronic obstructive pulmonary disease (COPD) is prescribed inhaled pirbuterol (Maxair) every 6 hours. The nurse instructs the patient to take additional drug doses during which specific times or conditions? a. At bedtime b. When feeling especially nervous c. When feeling especially breathless d. If the peak expiratory flow rate is 80% or greater than his or her personal best 6. A patient reaches for the salmeterol (Serevent) inhaler with the onset of an asthma attack. What is the nurse’s best instruction to the patient? a. Use the albuterol (Proventil) inhaler instead. b. Wait at least one full minute between puffs. c. Attach the spacer to the inhaler before using it.

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d. Take a deep breath, hold it for 15 seconds, and then exhale before using the inhaler.

7. A patient with chronic obstructive pulmonary disease (COPD) who is prescribed a short-acting inhaled beta2 agonist reports hating the inhaler and asks why the drug can’t be taken as a pill. What is the nurse’s best response? a. “Inhaled drugs work more slowly.” b. “Inhaled drugs have no side effects.” c. “Oral drugs are usually more expensive.” d. “Oral drugs have more systemic side effects.”

8. A patient with asthma asks why he must take regularly scheduled systemic drugs when he can stop several asthma attacks each day within a few minutes of their onset by using a short-acting beta agonist inhaler. What is the nurse’s best response? a. “Frequent asthma attacks, even if they are halted relatively quickly, damage the bronchial tissues over time.” b. “If asthma attacks are uncontrolled they lead to the eventual development of lung cancer and emphysema.” c. “Using only short-acting beta agonists will lead to drug resistance and then the drug won’t work when you need it.” d. “Inhaled beta agonist drugs only treat the constriction aspects of asthma and do not help the inflammatory aspects of the disease.”

9. A patient is prescribed a dry powder inhaler (DPI) for chronic obstructive pulmonary disease (COPD). Which statement made by the patient indicates to the nurse that more instruction is needed? a. “I won’t exhale into the inhaler.” b. “The inhaler will be kept in the drawer of my bedroom dresser.” c. “I will wash the inhaler mouthpiece daily with soap and water.” d. “I’ll inhale twice as hard through this inhaler as I do with my aerosol inhaler.”

10. A patient receiving aminophylline (Theophylline) by continuous IV infusion for a severe asthma attack asks why a blood sample must be drawn. What is the nurse’s best response? a. “The blood level of this drug that causes dangerous side effects is close to the level needed to help open the airways.” b. “The blood test helps us evaluate how well the drug is working to open your airways and improve your oxygen intake.” c. “The blood test helps determine how much of this drug you are making naturally and how much we are giving you.” d. This blood tests assesses whether you are developing an allergy to this drug.”

Chapter 19: Drugs for Nausea, Vomiting, Diarrhea, and Constipation 1. Which statement about normal bowel function is true? a. Bowel movements should occur once a day every day. b. Frequency of bowel movements is more important than their consistency. c. Bowel movements are very simple processes. d. Bowel movements should be soft and easily pass out of the bowel.

2. Which statement about the vomiting reflex is accurate? a. The vomiting process consists of four phases. b. Retching precedes vomiting in the process. c. Nausea usually occurs prior to vomiting. d. Vomiting may be a reflex or a voluntary action.

3. The nurse is instructing a patient on how to prevent constipation. Which point does the nurse plan to

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include in the teaching plan? a. “Be sure to eat a diet that is low in fiber.” b. “Use a laxative on a daily basis to prevent constipation.” c. “Physical inactivity will not affect your bowel function.” d. “You should drink plenty of fluids every day to prevent constipation.”

4. The nurse is instructing a patient about how to help prevent the spread of diarrhea. Which point does the nurse include in the teaching plan? a. “When travelling internationally it is best to drink bottled water with ice cubes.” b. “Be sure to wash your hands after using the bathroom or changing diapers.” c. “Always wear clean gloves when handling raw meat or poultry.” d. “Cut down on your fluid intake to decrease the number of diarrhea episodes.”

5. A patient receiving chemotherapy and prescribed ondansetron (Zofran) asks the nurse why the drug is given before meals. What is the nurse’s best response? a. “Ondansetron is given 30 minutes before your meals to prevent nausea.” b. “The purpose of this drug is to move food rapidly through your GI tract.” c. “This drug works by preventing nausea caused by morphine given for your pain.” d. “If this drug were given after your meals, the food would interfere with its absorption.”

6. A patient prescribed metoclopramide (Reglan) reports having difficulty sleeping, difficulty concentrating, tiredness, and feeling hopeless. What is the nurse’s best action? a. Instruct the patient that these are expected side effects of the drug. b. Document these findings as the only action. c. Check the patient’s chart history of depression. d. Hold the drug and notify the prescriber.

7. A patient prescribed metoclopramide (Reglan) tells the nurse that his abdomen is making gurgling sounds. What is the nurse’s best action? a. Instruct the patient that this is an expected effect of the drug. b. Document this finding as the only action. c. Hold the drug and notify the prescriber. d. Give the drug and notify the prescriber.

8. A 10-year-old child is prescribed cyclizine (Marezine) 25 mg orally for motion sickness. The drug is available as a 50 mg tablet. How many tablets does the nurse instruct the parent to give the child? a. One fourth b. One half c. Two d. Four 9. The spouse of a patient who is prescribed promethazine (Phenergan) as part of her antiemetic therapy with chemotherapy reports that after the last dose the patient did not remember the drive home. What is the nurse’s best action? a. Thank the spouse for reporting the problem, and document the adverse drug reaction. b. Hold the dose of promethazine for this round of chemotherapy until the patient is seen by the prescriber. c. Reassure the patient and spouse that this is a normal response to the drug and that the patient should not drive home. d. Perform a mini-mental status exam and assess the patient’s pupillary reflexes before administering the promethazine.

10. What is the most important assessment question for the nurse to ask a patient before administering

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intravenous metoclopramide (Reglan)? a. “Are you being treated for depression?” b. “Is your type 1 diabetes well controlled?” c. “Do you have a gastric or duodenal ulcer?” d. “Are you taking aspirin or any aspirin-containing products?”

Chapter 20: Drugs for Gastric Ulcers and Reflux 1. Which protective mechanism by the stomach protects it from stomach acids and the formation of gastric ulcers? a. Buffers such as bicarbonate neutralize stomach acids. b. The stomach secretes a thick gel-like mucus to coat itself. c. Acid secretion is decreased when food is not present in the stomach. d. Stomach secretions such as lipase digest foods and protect the stomach.

2. Why does the backward flow of stomach contents into the esophagus cause tissue damage? a. No digestive processes occur in the esophagus. b. The esophagus does not have the thick gel-like mucus to protect it from acid. c. The esophagus secretes only bicarbonate, which is not strong enough to neutralize stomach acids. d. The esophagus cannot expand with extra volume, and the excessive stretching damages the muscle layer.

3. Which factor is the cause of most peptic ulcers? a. Excessive production of stomach acids b. Lifestyle factors such as stress and spicy foods c. Infection with Helicobacter pylori bacteria d. Excessive use of drugs such as nonsteroidal anti-inflammatory drugs (NSAIDs) 4. Which symptoms are associated with gastric ulcers? a. Constant bloating and diarrhea b. Shortness of breath in any position c. Burning pain that is relieved by eating d. Burning pain that is relieved by abstaining from food 5. A patient with a history of GI ulcers reports feeling new onset burning, gnawing stomach pain. What is the nurse’s best action? a. Assess the patient’s abdomen for the presence of active bowel sounds. b. Administer the already ordered as-needed dose of liquid antacid. c. Offer the patient food to buffer excess stomach acid. d. Notify the prescriber immediately.

6. A patient who is prescribed sucralfate asks the nurse how this drug will help treat his gastric ulcer.

What is the nurse’s best response? a. “Sucralfate decreases secretion of gastric acids to help your ulcer heal.” b. “Sucralfate completely blocks the secretion of gastric acids so your ulcer can heal.” c. “Sucralfate treats the infection with H. pylori that is the major cause of gastric ulcers.” d. “Sucralfate forms a thick coating to cover the ulcer, protect from further damage, and allow healing.”

7. How do histamine (H2) blockers help heal gastric ulcers? a. They promote cell division. b. They neutralize acids that are present in the stomach. c. They decrease the amount of acid secreted by stomach cells. d. They increase the rate that stomach contents move into the intestinal tract.

8. The nurse is preparing an older adult patient who has been prescribed famotidine (Pepcid) for

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discharge. Which common side effect should the nurse instruct the patient’s family to watch for? a. Confusion b. Anxiety c. Depression d. Psychosis 9. A patient who has been taking nizatidine (Axid) for the last month has all of the following blood laboratory results. Which result does the nurse report to the prescriber as soon as possible? a. International normalized ratio (INR) of 0.9 b. Red blood cell count of 2 million/mm3 c. White blood cell count of 8000/mm3 d. Platelet count of 150,000/mm3 10. A patient with gastroesophageal reflux disease is prescribed ranitidine (Zantac). Which statement by the patient indicates to the nurse a need for additional teaching? a. “If I need to use ranitidine for more than 2 weeks, I will notify my prescriber.” b. “I will look into a smoking cessation program when I go home.” c. “I will take the ranitidine first thing in the morning so that its effect will last all day and night.” d. “I will not drive until I know how the ranitidine affects me.”

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