TEST BANK for Davis's Drug Guide for Nurses 15th Edition by April Hazard Vallerand & Cynthia A. Sano by StudyGuide

TEST BANK FOR Davis's Drug Guide for Nurses 15th Edition By April Hazard Vallerand, Cynthia A. Sanoski Drug Guide Test Bank 1 Multiple Choice Identify the choice that best completes the statement or answers the question.

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1. The nurse is providing care for a patient scheduled to take Precose (acarbose) 25 mg three times daily with meals. The patient reports feeling sweaty, weak, and tremulous. Which of the following actions by the nurse is best? a. Reassure the patient that these are common side effects with the medication. b. Call the pharmacy to report an adverse drug reaction. c. Check the patient’s blood glucose level. d. Determine if the patient has a history of anemia.

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2. While responding to a rapid response called on the cardiac step-down unit, the nurse from intensive care observes the unit nurse massaging a patient’s neck and instructing the patient to bear down. Which of the following medications will most likely be used if the patient’s pulse does not return to normal? a. Adenocard (adenosine) b. Adrenaline (epinephrine) c. Tenormin (atenolol) d. Saphris (asenapine)

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3. The nurse is instructing the parent of a 6-year-old patient recently started on a ProAir HFA (albuterol) inhaler for exercise-induced asthma. The nurse recognizes that further teaching is necessary by which of the following client statements?

a. “He may feel like his heart is racing after he takes his inhaler.” b. “He can use the inhaler as many times during football practice as he needs it.” c. “He should avoid cola and other caffeinated drinks since they may increase his heart rate.” d. “He should take two puffs about 15 minutes before gym class.” ____

4. While providing care for an adolescent patient newly prescribed Elavil (amitriptyline), the nurse should be most concerned by which of the following patient statements? a. “My mouth seems really dry and I’m thirsty all the time.” b. “I take a nap most afternoons now because I feel sleepy sometimes.” c. “I’m not sure why we should even bother anymore; everything seems so pointless.” d. “I drink a cup of coffee most days with breakfast.”

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5. The nurse is caring for a patient with otitis media who reports an allergy to penicillin. Orders are received for ampicillin 500 mg every 8 hr. Which of the following actions by the nurse is best? a. Provide the medication as ordered. b. Call the pharmacist to request a substitution. c. Ask the patient if he or she has taken ampicillin in the past. d. Hold the medication.

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6. While caring for a patient in hospice who is actively dying, the nurse notes moderate respiratory distress, copious oral secretion, and a frequent moist cough. Which of the following prn medications would most promote comfort for the patient? a. Morphine (morphine sulfate) 2 mg IV bolus b. Atro-Pen (atropine) 0.4 mg IV bolus c. Ativan (lorazepam) 0.5 mg IV bolus d. Benadryl (diphenhydramine) 25 mg IV bolus

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7. The nurse is counseling a patient started on Zithromax (azithromycin) for the treatment of an upper respiratory infection. The nurse recognizes that teaching has been effective by which of the following patient statements? a. “The med pack will have five pills, one for each of the next 5 days.” b. “If I don’t feel better next week, I can get a refill from the pharmacist.” c. “I only need to take one pill, but my symptoms may not clear for 3 days.” d. “I can take this medication safely even though I’m allergic to erythromycin.”

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8. The home-care nurse is preparing to see a patient being treated for diabetic foot ulcerations with Regranex (becaplermin). Which of the following instructions will the nurse include in the patient teaching? a. “Apply the wound gel three times daily to promote healing.” b. “Store the gel in the refrigerator.” c. “Complete healing is expected within 3 days.” d. “After applying the wound gel, cover with a transparent adhesive dressing.”

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9. The nurse is tracking patient symptoms related to acute alcohol intoxication and withdrawal. Which of the following medications would the nurse expect to provide in the management of these symptoms? a. Plavix (clopidogrel) b. Zyban (bupropion) c. Prilosec (omeprazole) d. Tranxene (clorazepate)

____ 10. The nurse prepares to provide Colcrys (colchicine) to a patient. The nurse should assess which of the following prior to administration of the medication? a. Blood pressure b. Complete blood count c. Triglyceride level d. Oxygen saturation

____ 11. The nurse is transcribing new orders for a patient with multiple sclerosis. Amrix (cyclobenzaprine) 10 mg orally three times daily has been ordered. Which of the following would require an immediate intervention by the nurse? a. The patient has a noted allergy to acetaminophen. b. The patient has a family history of breast cancer. c. The patient is currently taking Nardil (phenelzine). d. The patient is diabetic. ____ 12. The nurse is preparing to provide medications for a patient newly admitted with a cerebral vascular accident who reportedly had difficulty swallowing pills during the previous shift. The nurse plans to crush the patient’s medications and provide them in applesauce. Which of the following medications will require an alternative form of administration? a. Aspirin 81 mg daily b. Enablex (darifenacin-XR) 15 mg daily c. Claritin (loratadine) 10 mg daily d. CalCarb (calcium carbonate) 500 mg daily ____ 13. The nurse receives a call from a patient who recently began taking Zyrtec (cetirizine) 5 mg daily. The patient reports that her mouth frequently feels dry. Which of the following responses by the nurse is best? a. “Dry mouth is a common side effect of Zyrtec. Rinse your mouth frequently, and try using sugarless chewing gum or candy for relief.” b. “You may be taking too strong of a dose. You should take half a pill each day to reduce the risk of side effects.” c. “You might be having an allergic reaction to the medication. Are you able to come to the doctor’s office today?” d. “It is important that you take the medication with a full meal and drink at least 12 glasses of water each day.” ____ 14. The nurse is caring for a patient who takes Dexedrine (dextroamphetamine). The nurse should be most concerned by which of the following patient statements? Copyright © 2017 F. A. Davis Company

a. “I seem to be able to focus better and I’m less distracted now.” b. “I’ve been having some trouble falling asleep at night lately.” c. “I started taking St. John’s wort this week to help with my depression.” d. “I forgot to take my medication in the morning last week so I took it at lunch time.” ____ 15. The nurse receives orders to begin Cardura (doxazosin) 1 mg daily with the first dose to start today. Which of the following assessments is the highest priority within the first 2 to 4 hr after provision? a. Urinary output b. Respiratory rate c. Pain relief d. Orthostatic hypotension ____ 16. The nurse is providing care for a patient who returned from surgery 4 hr earlier. The patient reports adequate pain control with the use of patient-controlled analgesia but states she is having significant nausea. Which of the following medications should the nurse provide? a. Inapsine (droperidol) 2.5 mg IV b. Benadryl (diphenhydramine) 25 mg IV c. Morphine (morphine sulfate) 2 mg IV d. Colace 100 mg po ____ 17. The nurse is counseling a patient with diabetes, hypertension, and chronic obstructive pulmonary disease on his medications. To verify patient understanding of his medications, the nurse states, “You are taking Cymbalta (duloxetine) 60 mg once a day; do you know why you take that medication?” The nurse determines the patient has a good understanding of his medications if which of the following responses is given? a. “I take that one to keep my blood sugar under control.” b. “I don’t know honey, is that my little blue pill?” c. “That helps with the pain in my feet.” d. “I think that is to lower my blood pressure.” Copyright © 2017 F. A. Davis Company

____ 18. While providing care for patients on a neuroscience unit, which of the following medications should the nurse provide first? a. Dantrium (dantrolene) 1 mg/kg IV to a patient with malignant hyperthermia b. Norpramin (desipramine) 100 mg orally to a patient admitted with syncope c. Enablex (darifenacin) 15 mg orally to a patient admitted for cerebrovascular accident d. Cymbalta (duloxetine) 20 mg to a patient with diabetes ____ 19. The nurse is caring for a patient with a history of Parkinson disease who recently started taking Comtan (entacapone). The nurse notes the patient’s urine has a brownish-orange discoloration. Which of the following actions should the nurse take next? a. Notify the physician. b. Determine the patient’s current weight. c. Ask the patient what he or she ate for breakfast. d. Note the assessment finding in the chart. ____ 20. A young woman reports to the emergency department with frank vaginal bleeding and a stated history of being 10 wk pregnant. Ultrasound confirms an incomplete miscarriage, and the woman is scheduled for a dilatation and curettage. Which of the following medications should the nurse anticipate being provided after the surgical procedure? a. Rheumatrex (methotrexate) b. Methergine (methylergonovine) c. Magnesium sulfate d. Terbutaline ____ 21. The nurse is assisting in the discharge of a patient with a peripherally inserted central catheter (PICC) who will receive antibiotic therapy with Invanz (ertapenem) at home under the direction of a home health-care agency. The nurse recognizes that teaching has been effective by which of the following client statements? a. “The nurses will come out every 6 hours to provide the IV antibiotic.” Copyright © 2017 F. A. Davis Company

b. “If the dressing over the PICC line pulls back, the nurse will change it the next day.” c. “I will have to get the antibiotic once a day, usually for 2 weeks.” d. “Since I’m not allergic to penicillin, I won’t be allergic to this medication.” ____ 22. A nursing faculty is observing a student nurse prepare and provide morning medications including Nexium (esomeprazole) to a patient with a nasogastric (NG) tube. The nurse should intervene if which of the following is noted? a. The student asks the patient to state his name and birth date prior to preparing the medication. b. The student opens the pellet and mixes the granules with 50 mL of water. c. The student uses a 60 mL cath-tipped syringe to instill the medication into the NG tube. d. The student unclamped the NG tube immediately after instilling the medication and initiates continuous tube feeding. ____ 23. The nurse caring for patients on a gynecological surgery unit would monitor which of the following women most closely for evidence of a deep vein thrombosis? a. A 64-year-old patient taking Ascol (mesalamine) who has a history of ulcerative colitis. b. A 47-year-old patient admitted for lumpectomy with a family history of breast cancer. c. A 58-year-old patient taking Estrace (estradiol) with a 42-pack-per-year history of smoking. d. A 61-year-old patient who had a bladder-sling procedure whose platelet count is 167,000 cells/mm3. ____ 24. A student nurse is taking care of patients on a medical unit and receives new orders for Lunesta (eszopiclone) 2 mg orally each evening. In transcribing this order, the student should take which of the following actions? a. Schedule the medication routinely at 6 p.m. Copyright © 2017 F. A. Davis Company

b. Schedule the medication 1 hr prior to the evening meal. c. Call the pharmacy to ask what time the medication should be given. d. Schedule the medication at bedtime. ____ 25. While reviewing medications to be provided by a student nurse, the instructor notes a patient is scheduled to take Famvir (famciclovir) 500 mg orally every 8 hr. The instructor suspects the patient most likely has which of the following diagnoses? a. Methicillin-resistant Staphylococcus aureus (MRSA) infection b. Hepatic encephalopathy c. Herpes zoster d. Bacterial pneumonia ____ 26. A nurse working in hospice is providing care for a patient reporting increased instances of pain. Which of the following factors would indicate the patient is a good candidate for Fentanyl buccal/transmucosal (ACTIQ) therapy? a. The patient reports breakthrough pain 8 out of 10. b. The patient currently takes greater than 60 mg of oral morphine scheduled around the clock per day. c. The patient has pancreatic cancer. d. The patient has an allergy to hydromorphone. ____ 27. While working with a patient who takes Dalmane (flurazepam), the nurse should be most concerned by which of the following patient statements? a. “I usually take the medication at 10 P.M.” b. “I have to take it every night or I won’t get any sleep.” c. “I work out at the gym three to four times per week.” d. “I stopped drinking coffee at dinner now.”

____ 28. The nurse caring for a patient who takes Simponi (golimumab) recognizes this as a relatively new agent in the class of monoclonal antibodies. In addition to their usefulness in the treatment of some tumor types, these agents play a role in the treatment of which of the following disease states? a. Viral hepatitis b. Rheumatoid arthritis c. Pancreatitis d. Multiple sclerosis

____ 29. The nurse providing therapy with Simponi (golimumab) recognizes the patient must be meticulously screened for which of the following? a. A history of active or latent tuberculosis b. The presence of orthostatic hypotension c. Risk factors associated with acute respiratory distress syndrome d. A history of poorly controlled diabetes mellitus ____ 30. The nurse is caring for a patient receiving treatment for viral pneumonia. The nurse notes the patient has a persistent cough that is interfering with the patient’s ability to sleep. Which of the following medications should the nurse provide? a. Ativan (lorazepam) 1 mg orally prn b. Guiatuss (guaifenesin) 200 mg every 4 hr prn c. Tylenol (acetaminophen) 325 mg orally prn d. Kytril (granisetron) 2 mg orally prn ____ 31. A nurse on the cardiac unit is providing care to a 67-year-old patient who has recently been started on BiDil (hydralazine/isosorbide dinitrate) 1 tablet orally three times daily. The patient informs the nurse that he has a headache and rates his headache pain as 4 on a scale of 1–10. Which of the following actions by the nurse is best? a. Hold all future doses of BiDil and notify the pharmacy that the patient is allergic to the medication. Copyright © 2017 F. A. Davis Company

b. Determine the patient’s oxygen saturation and call the physician. c. Inform the patient this is a common side effect and provide Tylenol (acetaminophen) prn as ordered. d. Provide earphones and teach the patient to use distraction techniques. ____ 32. A nursing student is preparing to join a college expedition in the tropics. Which of the following medications is most likely to be included in the medical preparation for this trip? a. Keppra (levetiracetam) b. Remicade (infliximab) c. Namenda (memantine) d. Plaquenil (hydroxychloroquine) ____ 33. The nurse is providing discharge instructions to a patient taking Boniva (ibandronate). The nurse should intervene if the client makes which of the following statements? a. “I usually walk 2 miles a day.” b. “I take that every morning when I get up and can’t eat for an hour.” c. “I realized at lunch time that I’d forgotten to take it once last week, so I just skipped the dose.” d. “I always take that with my morning coffee.” ____ 34. A nurse caring for a patient who takes Tofranil (imipramine) 150 mg orally at bedtime would be most concerned by which of the following observations? a. The patient’s urine has a blue-green tinge. b. The patient reports fuzzy vision and difficulty seeing. c. The patient reports feeling dizzy when getting out of bed. d. The patient reports she has gained 2 pounds in the last 3 weeks. ____ 35. A patient with asthma has multiple inhalants prescribed including Ventolin (albuterol), Pulmicort Flexhaler (budesonide), and Atrovent (ipratropium). The nurse verifies teaching is effective if which of the following is observed? a. The patient takes the Atrovent (ipratropium) inhaler first Copyright © 2017 F. A. Davis Company

b. The patient waits 1 min between each medication c. The patient rinses her mouth after using the inhalers d. The patient reports using ipratropium when experiencing severe, acute bronchospasms ____ 36. The nurse is caring for a patient recently started on Seroquel (quetiapine). Which assessment finding would indicate that treatment was effective? a. BP = 178/82 b. Patient denies hearing voices in his head. c. Urine output was 350 mL in 8 hr. d. Patient reported pain was a 2 on a 1–10 scale.

____ 37. The nurse is providing care for a patient diagnosed with candidiasis. The nurse expects the medication record to include which of the following medications? a. Lamictal (lamotrigine) b. Trandate (labetalol) c. Toradol (ketorolac) d. Nizoral (ketoconazole)

____ 38. The nurse is caring for a patient on the operative day for a laparoscopic-assisted vaginal hysterectomy. The patient complains of pain and the nurse notes orders for Toradol (ketorolac) 30 mg intravenously every 6 hr as needed for pain. Which of the following actions should the nurse take? a. Mix the ketorolac with 10 mL sterile normal saline prior to administration. b. Check the patient’s magnesium level prior to administration. c. Draw up the medication and administer in the nearest IV port over 30–60 seconds. d. Check to determine if the patient has an allergy to morphine.

____ 39. The nurse is caring for a patient admitted with hepatic encephalopathy who is receiving Constilac (lactulose). The nurse should be prepared to assist the patient in managing which of the following side effects? a. Headache b. Somnolence c. Muscle aches d. Frequent loose stools

____ 40. The nurse is caring for a patient who reports taking Prevacid (lansoprazole) 15 mg orally each day. The nurse expects the pharmacy to substitute which of the following medications during hospitalization? a. Prilosec (omeprazole) b. Zofran (ondansetron) c. Carafate (sucralfate) d. Tums (calcium carbonate)

____ 41. The nurse is caring for a patient experiencing dysphagia and weight loss due to oral mucositis. Which of the following should be the nurse’s highest priority? a. Instruct the patient to use hydrogen-peroxide-based mouthwash three times daily. b. Provide Xylocaine (viscous lidocaine) topically prior to meals. c. Encourage normal saline rinses each morning. d. Order a puree diet.

____ 42. The nurse is caring for a pediatric patient who needs to have an IV line started. The nurse plans to provide EMLA cream (lidocaine/prilocaine) to the patient’s arm. Which of the following actions should the nurse take? a. Rub the cream onto a 2-inch surface of the arm 15 min prior to the procedure. b. Rub the cream onto a 6-inch surface of the arm 30–45 min prior to the procedure. Copyright © 2017 F. A. Davis Company

c. Place a thick layer of cream under an occlusive dressing on a 2-inch site 1 hr prior to the procedure. d. Place a thin layer of cream under an occlusive dressing on a 6-inch site 20 min prior to the procedure.

____ 43. The nurse is caring for a patient admitted from an extended care facility who has developed a moist, productive cough. A chest x ray was ordered and new orders for Zyvox (linezolid) 600 mg IV every 12 hr has been received. Which of the following orders should the nurse also complete prior to providing the first dose of medication? a. Daily weight b. Sputum culture and sensitivity c. Complete blood count (CBC) d. Chemistry profile

____ 44. The nurse is caring for a patient who is to receive 1 mg of Ativan (lorazepam) intravenously as conscious sedation prior to a bedside procedure. Which of the following actions should the nurse take? a. Infuse the medication using an insulin syringe directly into the nearest Y port of the IV. b. Dilute the medication with 10 mL of Lactated Ringer’s solution prior to administration. c. Administer the medication over at least 1 min. d. Monitor the patient for hypertension immediately following administration.

____ 45. The nurse is working with a client who is undergoing a bowel prep prior to a scheduled colonoscopy. Which of the following medications should the nurse expect to provide? a. Magnesium chloride sustained-release tablets 535 mg/each, 2 tablets b. Magnesium citrate oral solution, 300 mL bottle Copyright © 2017 F. A. Davis Company

c. Magnesium hydroxide chewable tablets, 300 mg d. Magnesium sulfate 1 g intravenously

____ 46. The nurse is caring for a patient in the intensive care unit. The patient is receiving Osmitrol (mannitol) 0.5 g/kg infused over 60 min. Which of the following would indicate an effective response to the treatment? a. Urine output is 50 mL over the next hour. b. White blood cell count is 6.4 cells/mm3. c. Patient oxygen status is 89% on 3 L of oxygen. d. Patient’s blood pressure is 148/42.

____ 47. The nurse is caring for a patient admitted with chronic pain who has been receiving meperidine 100 mg orally every 3–4 hr as needed for pain for the past 4 days. Which of the following actions is the highest priority in the patient’s care? a. Monitor the patient for irritability or seizure activity. b. Determine when the patient last moved his bowels. c. Ask the patient if he is experiencing insomnia. d. Check the patient’s labs to determine triglyceride levels.

____ 48. The nurse recognizes that Apriso (mesalamine) would most likely be included in the plan of care for which of the following patients? a. A 52-year-old patient with chronic obstructive pulmonary disease (COPD). b. A 49-year-old patient with acute cholelithiasis. c. A 37-year-old patient with ruptured ectopic pregnancy. d. A 27-year-old patient with ulcerative colitis.

____ 49. The nurse is caring for a patient who has been receiving chemotherapy for the past 4 months. The patient takes Reglan (metoclopramide) 10 mg every 4 hr as needed for nausea and vomiting. The nurse should be most concerned with which of the following patient statements? a. “I’m losing my balance a lot and I noticed my hands are shaky.” b. “I’ve lost 5 pounds in the past month.” c. “I’m not sure what I’m going to do when I don’t have to come in here all of the time.” d. “My kids are really struggling with the fact that I just don’t have any energy anymore.”

____ 50. The nurse is caring for a patient who reports long-term use of nonsteroidal anti-inflammatory agents for the treatment of osteoarthritis. Which of the following medications would the nurse also expect as part of the patient’s treatment plan? a. Cytotec (misoprostol) b. Lopressor (metoprolol) c. Flagyl (metronidazole) d. Remeron (mirtazapine)

____ 51. The nurse is counseling the parent of a 14-year-old patient with asthma who is to initiate maintenance therapy with Singulair (montelukast). Which of the following should the nurse include in the teaching? a. “This medication can be helpful in acute asthmatic attacks.” b. “Monitor your child for any behavior that indicates depression or suicidal thoughts.” c. “If your child is not experiencing any asthma symptoms, she will not need to take the medication that day.” d. “Now that your child is taking this medication, she will not need her other asthma medications.”

____ 52. The student nurse is participating in discharge teaching for the parents of a 2-year-old patient diagnosed with impetigo who have been given a prescription for Bactroban (mupirocin). The student understands that this medication is provided in which of the following forms? a. As an oral pill b. As a rectal suppository c. As a topical ointment d. As a liquid suspension

____ 53. The nurse is caring for a patient who has been started on Corgard (nadolol). Which of the following assessment findings would be most concerning to the nurse? a. A fasting blood sugar of 92 g/dL b. A blood pressure of 116/70 mm Hg c. Noted jugular vein distension d. A resting pulse of 64 bpm

____ 54. The nurse is caring for a patient who has been on multiple antibiotics for the treatment of pneumonia. The patient reports having a sore throat. The nurse notes a white coating on the patient’s tongue as well as redness to the lips and gums. The nurse would most likely contact the physician to request which of the following? a. Pamelor (nortriptyline) 25 mg capsules three times daily b. Nimodipine 30 mg capsules every 4 hr c. Zyprexa (olanzapine) 5 mg tablet daily d. Nilstat (nystatin) 400,000 unit lozenge four times daily

____ 55. A nurse working in the chemotherapy outpatient department is providing antiemetic therapy using Zofran (ondansetron). The ordered dose is 32 mg. Which of the following actions should the nurse take to optimize the efficacy of the medication? Copyright © 2017 F. A. Davis Company

a. Provide the dose as an intramuscular injection 10 min prior to starting chemotherapy. b. Provide the dose undiluted intravenously over 2 min just prior to starting chemotherapy. c. Provide the dose diluted in 50 mL of D5W infused intravenously over 15 min at least 30 min prior to starting chemotherapy. d. Provide the dose diluted in 50 mL of 0.9 NaCl infused intravenously over 5 min, 60 min prior to starting chemotherapy.

____ 56. A nurse in an outpatient clinic receives a call from a patient who reports having had symptoms of the flu for the past 4 days. The patient is seeking an appointment with the physician and wants, “the medication that treats the flu [Tamiflu (oseltamivir)].” Which of the following responses by the nurse is best? a. “Tamiflu is only helpful for those who have had symptoms for 2 days or less.” b. “Did you receive the flu shot this season?” c. “What is your current temperature?” d. “Do you have an allergy to eggs?”

____ 57. The student nurse is caring for a patient who currently takes Ditropan XL (oxybutynin). The student should include which of the following statements in the patient’s teaching? a. “This medication will help reduce your pain.” b. “Some people who take this develop ringing in their ears.” c. “This medication helps you control your bladder.” d. “Some people complain of night sweats with this medication.”

____ 58. While reviewing a patient’s medications for the day, the nurse notes the patient is prescribed Creon (pancrelipase) three times daily. Which of the following actions by the nurse is best? a. Provide the medication 30 min after the patient’s meals. Copyright © 2017 F. A. Davis Company

b. Provide the medication immediately before or with the patient’s meals. c. Provide the medication at least 60 min before the patient’s meals. d. Provide the medication evenly spaced throughout the day with no correlation with meals.

____ 59. The nurse receives a call from a client who recently started taking Paxil (paroxetine). The parent reports the child has lost 6 pounds in the past 10 days. Which of the following statements by the nurse is best? a. “Are you able to come into the clinic today?” b. “That’s great news, the treatment must be working.” c. “Weight loss is expected with this medication, so there is no reason for concern.” d. “Has your child had any vomiting?”

____ 60. The nurse is caring for a patient who needs emergency surgery. The patient’s history includes daily use of Coumadin (warfarin). Which of the following medications should the nurse anticipate being ordered? a. Dilantin (phenytoin) b. Vitamin K (phytonadione) c. Luminal (phenobarbital) d. Protamine sulfate

____ 61. The nurse receives a call from a patient who recently started taking Actos (pioglitazone) 15 mg every morning. The patient states, “I forgot to take it for the past 2 days. What should I do?” Which of the following is the best response by the nurse? a. “Simply take the medication as planned today.” b. “Take two today and then one a day from this point forward.” c. “You will need to come in and have some blood drawn.” d. “Are you experiencing any pain today?” Copyright © 2017 F. A. Davis Company

____ 62. The nurse is caring for a patient in the intensive care unit with an NG tube to low intermittent suction after bowel surgery. Morning lab results include the following: Na + = 136 mEq, K+ = 3.3 mEq, Cl– = 100 mEq, Ca++ = 10 mg/dL. The patient has scheduled medications, which include potassium bicarbonate/potassium chloride 40 mEq via NG and Lasix (furosemide) 20 mg intravenous push daily. Which of the following actions should the nurse take next? a. Evaluate the patient’s telemetry reading. b. Hold the patient’s daily dose of potassium chloride. c. Assess the amount and color of the NG output over the past 2 hr. d. Provide the patient’s scheduled Lasix (furosemide).

____ 63. The nurse is providing care for a patient who is being considered for treatment with Actonel (risedronate). Prior to initiating therapy, the nurse should evaluate the results from which of the following diagnostic tests? a. Echocardiogram b. Pulmonary function tests c. Fasting blood sugar d. Bone density study

____ 64. The nurse is caring for a patient who takes Avandia (rosiglitazone) 4 mg daily. The nurse should be most concerned by which of the following assessment findings? a. Random glucose = 142 mg/dL b. Urine output is 200 mL in the past 4 hr c. Inspiratory crackles noted on auscultation d. Apical pulse = 72 bpm

____ 65. The nurse is providing Serevent Diskus (salmeterol) to a patient on the medical unit who has a long-term history of chronic obstructive pulmonary disease. The nurse would intervene if which of the following were observed? a. The patient did not attach a spacer prior to inspiration. b. The patient closes the device after inhalation without washing the mouthpiece. c. The patient held the diskus level in a horizontal position. d. The patient exhaled into the diskus device.

____ 66. The nurse is providing care for a patient who is taking Senokot (sennoside) two tablets orally each day. Which of the following actions by the nurse will most promote effective treatment with this planned medication? a. Give the medication with breakfast at 8 a.m. b. Give the medication with a full glass of water. c. Determine the patient’s resting pulse rate prior to provision. d. Assess the patient’s level of consciousness 2 hr after provision.

____ 67. While providing care for a patient who takes Januvia (sitagliptin), the nurse should be most concerned by which of the following findings? a. Patient reports persistent abdominal pain that radiates to the back b. Patient reports having a headache c. Hemoglobin A1C = 5% d. Patient takes Glucophage (metformin) concurrently

____ 68. While talking to a teen who stopped taking Sumycin (tetracycline) a couple of weeks ago, the nurse learns the teenager has been having diarrhea and abdominal cramping for the past few days. Which of the following responses by the nurse is best? a. “Does anyone else in your family have the flu?” b. “Did you get a flu vaccine this year?” Copyright © 2017 F. A. Davis Company

c. “How much water are you drinking each day?” d. “You need to contact your physician right away. This could be a serious complication of your medication.”

____ 69. The nurse is preparing to provide routine morning medications, which include Synthroid (levothyroxine). Which of the following assessments should be done prior to administration? a. Apical pulse rate b. Serum sodium level c. Deep tendon reflexes d. Pupils’ response to light

____ 70. A nurse working in a physician’s office is collecting history information from a patient who reports experiencing erectile dysfunction and is seeking treatment with Levitra (vardenafil). This medication would be contraindicated if the patient is currently taking which of the following? a. Vitamin B12 (cyanocobalamin) b. Nitro-Dur (nitroglycerin patch) c. Chantix (varenicline) d. Effexor (venlafaxine)

____ 71. While working on a medical unit, the nurse answers a call light for a woman who asks to take her Ambien (zolpidem) 10 mg orally as ordered before going to sleep. After providing the medication, which of the following actions should the nurse take next? a. Instruct the patient to drink at least two full glasses of water in the next 30 min. b. Instruct the patient to wear her slippers if she gets up during the night. c. Raise the patient’s bed side rail. d. Document the medication provision in the patient’s chart.

____ 72. While caring for a patient on post op day 1 after a total abdominal hysterectomy, the patient reports a pain level of 4 on a 1–10 scale. The nurse provides two tablets of Vicodin (hydrocodone/acetaminophen 5 mg/325 mg) orally along with the patient’s other morning medications, which include Isordil (isosorbide) 10 mg and Lasix (furosemide) 20 mg orally at 9 a.m. Which of the following instructions should the nurse provide to the nursing assistant regarding the patient’s activity? a. “Have her sit at the side of the bed for a minute before walking as she may be dizzy.” b. “She should only take a short walk right now since she just ate her breakfast.” c. “Wait to walk her until after lunch so her pain is better.” d. “Let’s not walk her today since she seems rather tired.”

____ 73. The nurse would be most concerned about ototoxicity for which of the following patients? a. A 51-year-old patient receiving ciprofloxacin b. A 29-year-old patient receiving gentamycin c. A 37-year-old patient receiving cefazolin d. A 70-year-old patient receiving clindamycin

____ 74. Prior to the administration of Humira (adalimumab) the nurse should assess which of the following laboratory values? a. Blood glucose b. White blood cell count c. Red blood cell count d. Hemoglobin and hematocrit

c. Atrial fibrillation d. Prophylaxis for artificial heart valve

____ 76. The nurse immediately notifies the doctor of a reaction to Lyrica (pregabalin) based on which of the following assessments? a. Petechiae on legs and back b. Poor appetite c. Increased heart rate d. Vomiting

____ 77. Which of the following actions should the nurse perform to administer Reclast (zoledronic acid)? a. Instruct the patient to look up and gently pull down on the eyelid. b. Select a syringe that will provide deep tissue insertion using a Z track method. c. Carefully peel back wrapper with extra caution not to touch the medication. d. Assess patency of the intravenous site.

____ 78. A public health nurse is administering the first dose of Gardasil (human papillomavirus quadrivalent vaccine) to a teenage girl. What action should the nurse take following the administration of this medication? a. Schedule an appointment for an additional dose in 4 weeks. b. Schedule an appointment for an additional dose in 8 weeks. c. Schedule an appointment for a second dose in 1 month and a third dose in 5 months. d. Schedule an appointment for a second dose in 2 months and a third dose in 6 months.

____ 79. Mr. Jacobs, who started taking Lipitor (atorvastatin) 8 weeks ago, returns for a follow-up visit. He is angry because there has been no improvement in his cholesterol level. How should the nurse respond to his concern? a. This medication helps to control but does not cure elevated serum cholesterol levels. b. Continue to take the medication as you have been and you should see results within 3 months. c. It must be taken in conjunction with an antihypertensive to get the most beneficial response. d. Did you eat something for breakfast this morning that would have caused the test result to be elevated?

____ 80. How is Abilify (aripiprazole) prescribed? a. As an add-on treatment along with antidepressant medications b. To minimize side effects associated with antidepressant medications c. As an add-on treatment for those with schizophrenia d. To minimize the side effects associated with medications for schizophrenia

____ 81. Which of the following should be communicated to a patient who is being prescribed Advair Diskus (fluticasone and salmeterol)? a. Open capsule and mix with water or juice. b. Rinse mouth with water after each use. c. Use a spacer device. d. Shake medication container prior to administration.

b. Relieve corneal pressure c. Decrease bacterial growth associated with use of contact lenses d. Facilitate increased growth of eyelashes

____ 83. Which of the following assessments would indicate that dopamine is effective? a. Increased blood pressure, peripheral circulation, and urine output b. Decreased respiratory rate and increased oxygen saturation c. Increased mental awareness, peripheral circulation, and respiratory rate d. Decreased blood pressure, increased urine output, and increased respiratory rate

____ 84. A woman with severe rheumatoid arthritis is starting Simponi (golimumab). Which of the following tests should be performed prior to starting this medication? a. CT scan b. x ray c. D-Dimer d. Tuberculin skin test

____ 85. A 7-year-old patient is to receive intravenous Lanoxin (digoxin). The apical rate is 66. What should the nurse do? a. Administer Lanoxin as ordered. b. Give fluid bolus and administer Lanoxin in 1 hr. c. Hold Lanoxin and notify the doctor. d. Hold Lanoxin and take apical rate again in 2 hr.

b. Potassium gluconate c. Potassium iodide d. Potassium

____ 87. When starting a patient on Synthroid (levothyroxine), which of the following requires close monitoring? a. Neurological status b. Heart rate and rhythm c. Respiratory rate and depth d. Urinary output

____ 88. Which is the preferred route for administration of Vitamin B 12 (cyanocobalamin)? a. Sublingual b. Intravenous c. Intramuscular d. Dermal patch

____ 89. Which of the following examples should be provided as food to include with dietary intake when taking Lasix (furosemide)? a. Cauliflower, cabbage, and yogurt b. Macaroni and cheese, deli meat, and buttermilk c. Clams, oysters, and broccoli d. Potatoes, milk, and prune juice

____ 90. A 58-year-old woman with a history of cardiac arrhythmias visits her health-care provider with complaints of sunburn on her arm while riding in a car. What should the health-care provider suspect? Copyright © 2017 F. A. Davis Company

a. Allergic reaction related to cardizem b. Photosensitivity related to amiodarone c. Dermatitis related to verapamil d. Hypersensitivity related to sotalol

____ 91. What times should be indicated for the administration of Maalox? a. 6 a.m., 10 a.m., 3 p.m., 7 p.m. b. 7 a.m., 11 a.m., 4 p.m., 8 p.m. c. 8 a.m., 12 p.m., 5 p.m., 9 p.m. d. 9 a.m., 1 p.m., 7 p.m., 11 p.m.

____ 92. Namenda (memantine) should be used cautiously in those with an impaired: a. Cognitive status b. Cardiac status c. Renal status d. Liver status

____ 93. What is Niacin indicated for? a. The treatment of inflammatory response b. As an adjunctive therapy for hyperlipidemia c. The treatment of thrush d. To prevent migraine headaches

____ 94. A 52-year-old patient is going home with NitroMist. How should the patient be taught to take this medication? a. Shake canister, spray in mouth, and rinse with glass of water 5 min after administration. Copyright © 2017 F. A. Davis Company

b. Roll canister between hands and spray on tongue. c. Inhale as the medication is being sprayed into the mouth. d. Lift the tongue and spray under the tongue.

____ 95. A 62-year-old male is started on Revatio (sildenafil) for treatment of pulmonary arterial hypertension. What is a side effect of this medication? a. Male erection b. Metallic taste in mouth c. Tinnitus d. Color of urine may turn orange

____ 96. An overdose of Starlix (nateglinide) would present with which symptom? a. Hypertension b. Hypotension c. Hyperglycemia d. Hypoglycemia

____ 97. Which laboratory value should be monitored during pharmacological therapy of Januvia (sitagliptin)? a. CBC b. Hemoglobin A1C c. Phosphorus levels d. Thiamine levels

c. An inability to stand on his or her own d. A respiratory rate greater than 24 breaths/min

____ 99. A patient was started on Fragmin (dalteparin). Which of the following assessment findings should cause concern? a. Nosebleed b. Low urine output c. Fever d. Ecchymosis on the abdomen

____100. Ciprofloxacin, Levaquin, and Avelox fall under which drug classification? a. Aminoglycosides b. Carbapenems c. Macrolides d. Fluoroquinolones

____101. As the nurse prepares to administer Ziagen, which of the following would indicate the medication is effective? a. Decreased creatinine clearance and increased BUN b. Increased creatinine clearance and decreased BUN c. Decreased viral load and increased CD4 cell count d. Increased viral load and decreased CD4 cell count

d. Jogging

____103. What is the proper action to prepare for the administration of Pulmicort Respules? a. Attach medication to a spacer. b. Place medication in a nebulizer equipped with a mouthpiece or face mask. c. Rotate diskus unit to proper dose prior to dispensing medication. d. Shake medication vigorously to mix medication.

____104. What should the nurse communicate to the patient when teaching the proper technique for administration of two simultaneous doses of beclomethasone? a. Allow at least 1 min between inhalations. b. Allow at least 5 min between inhalations. c. Take second dose immediately following the first dose. d. Rinse mouth between doses.

____105. What is the proper administration when an inhaled corticosteroid and a bronchodilator are scheduled for the same time frame? a. Take the corticosteroid, allow 1 min to elapse, and then take the bronchodilator. b. Take bronchodilator, allow 1 min to elapse, and then take the corticosteroid. c. Take the corticosteroid, allow 5 min to elapse, and then take the bronchodilator. d. Take bronchodilator, allow 5 min to elapse, and then take the corticosteroid.

____106. The nurse on the hospice unit receives an order to administer fentanyl via a transmucosal route. Which of the following actions will the nurse take? a. Place under the tongue and allow to dissolve. b. Place between the cheek and lower gum moving it back and forth from one side to another. Copyright © 2017 F. A. Davis Company

c. Place between the cheek and gum and allow to dissolve. d. Rub on tongue, instruct patient to move tongue in the mouth and then swallow.

____107. Intramuscular iron dextran should be administered in which site? a. Deltoid b. Dorsogluteal c. Ventrogluteal d. Vastus lateralis

____108. Which of the following laboratory values requires the closest monitoring with isoniazid therapy? a. CBC b. AST and ALT c. BUN and Cr d. HbA1c and glucose

____109. When taking Lunesta (eszopiclone), the following instructions should be followed. a. Take at the same time every morning. b. Take 1 hr before meals. c. Take with food. d. Take immediately before going to bed.

____111. Which drug is used in the treatment of scurvy? a. Ascorbic acid b. Polyethylene glycol c. Kava-kava d. Valerian

____112. For chondroitin to be effective it should be taken: a. As needed b. Once a week c. Once a month d. For an extended period of time

____113. Mrs. Lawson, a 2nd-grade teacher, tells the school nurse that she has started taking echinacea so that she will not get sick this school year. What is the nurse’s best response? a. “That is terrific. I think you will notice a big difference in how you feel.” b. “Echinacea should only be taken when you feel symptoms of a cold starting.” c. “It is best to get a therapeutic level of echinacea before being exposed to sick children.” d. “Are you taking vitamin C as well, because echinacea needs to be taken in conjunction with vitamin C?”

____114. A young man with an allergy to sulfa was recently diagnosed with ulcerative colitis. What medication is he likely to receive? a. Bactrim b. Dipentum c. Glyburide Copyright © 2017 F. A. Davis Company

d. Sulfasalazine

____115. The nurse is counseling a 55-year-old woman who is to begin taking Fosamax (alendronate) to prevent osteoporosis. Which of the following instructions by the nurse is best? a. Instruct the patient to take each dose with breakfast. b. Instruct the patient to take each dose on an empty stomach. c. Instruct the patient to take each dose with orange juice. d. Instruct the patient to take each dose just prior to bedtime.

____116. A 26-year-old female prescribed Axert (almotriptan) for use with migraine headache attacks, calls the nurse, stating, “I took a home pregnancy test last week and I know I’m pregnant but I haven’t seen the doctor yet. I have a terrible migraine starting and I don’t know what I should do.” Which of the following statements by the nurse is best? a. “When was your last menstrual cycle?” b. “It is usually safe to take medications early in a pregnancy.” c. “What other migraine treatments have worked in the past?” d. “You should not take Axert if you think you are pregnant.”

____117. The nurse is caring for a 72-year-old woman admitted for a cerebral vascular accident who has dysphasia with orders to follow a diet of pureed foods. The patient takes Xanax (alprazolam) 0.5 mg TID. Which of the following actions by the nurse is best? a. Crush the medication and administer it in pudding. b. Hold the medication. c. Contact the physician. d. Give the medication with a small sip of water.

____118. The nurse is caring for a patient receiving AlternaGEL (aluminum hydroxide) every 2 hr while awake for the treatment of a peptic ulcer. For which of the following side effects should the nurse monitor? a. Constipation b. Headache c. Insomnia d. Sedation

____119. While admitting a client with a history of osteoporosis, the nurse notes a physician’s order reading, “Acetaminophen extra strength (500 mg), two tabs every 8 hr as needed for pain.” Which of the following actions by the nurse is best? a. Call the physician to question the total daily dose. b. Call the pharmacy to verify that this is a safe dose. c. Transcribe the order as written. d. Schedule the pain medication TID to maximize pain control.

____120. The nurse is caring for a patient with a long history of asthma. Which of the following medications should the nurse question? a. Inderal (propanolol) b. Proventil (albuterol) c. Serevent (salmeterol) d. Pulmacort (budesonide)

____121. The nurse is counseling a patient who is to start taking Norvasc (amlodipine) for hypertension. The nurse recognizes that further teaching is required by which of the following statements? a. “I need to call the doctor if my pulse is less than 50 beats in a minute.” b. “I’ll get up slowly since I may be a little dizzy if I get up too fast.” c. “It is important that I take this medication on an empty stomach.” Copyright © 2017 F. A. Davis Company

d. “I need to check with the doctor before taking any new over-the-counter cold medicines.”

____122. The nurse is providing care to a 9-year-old boy admitted with a broken tibia. The child takes Adderall XR 20 mg/day. The physician has prescribed Meperidine 25 mg IM every 4 hr as needed for pain. Which of the following actions by the nurse is best? a. Give the Meperidine if the child complains of pain. b. Hold the Meperidine and contact the physician. c. Notify the charge nurse. d. Hold the Adderall.

____123. While providing peri-care for a patient receiving multiple intravenous antibiotics, the nurse notes that the patient’s groin folds and peri-area are red, inflamed, and excoriated and that whitish discharge is noted from the vagina. When contacting the physician to report the patient’s condition, which of the following medications would the nurse anticipate being ordered? a. Neomycin ointment b. Monistat cream c. Calamine lotion d. Hydrocortisone cream

____124. A client calls the nurse at 2 p.m. stating, “I forgot to take my Tenormin (atenolol) at 8 a.m. like I usually do. Should I take it now?” Which of the following responses by the nurse is best? a. “It would be best to simply take two pills tomorrow.” b. “No, too much time has gone by so just skip that dose.” c. “Yes, it is important to take the medication each day.” d. “Why did you forget to take it today?”

____125. While reviewing medications for a patient with multiple sclerosis, the student nurse recognizes that Lioresal (baclofen) is given for which the following symptoms? a. Depression b. Anxiety c. Muscle spasticity d. Headache

____126. The nurse is caring for a patient with ulcerative colitis. New orders are received for Anaflex (salsalate) orally TID. The nurse recognizes the patient cannot received this drug due to an allergy to which of the following? a. Meperidine b. Sulfa c. Penicillin d. Aspirin

____127. The nurse is caring for a patient with bronchitis and prepares to provide Tessalon pearls (benzonatate) as ordered. The patient states, “I don’t think I’ve had this before. What is it for?” Which of the following responses by the nurse is best? a. “This helps thin the mucus so it is easier for you to cough it up.” b. “It is a cough suppressant and will help reduce your coughing.” c. “This helps dilate the small airways in your lungs to help you breathe.” d. “It is a muscle relaxer so you can rest more comfortably.”

____128. While counseling a patient who takes Colace (bisacodyl) for constipation, the nurse recognizes that further teaching is required by which of the following statements? a. “I try not to take it very often, but when I need it, it sure helps.” b. “If I take it at night, I can usually have a bowel movement in the morning.” c. “They told me it was important not to strain when I move my bowels.” Copyright © 2017 F. A. Davis Company

d. “I usually drink about three cups of water or coffee every day; I don’t like milk or juice.”

____129. A neighbor reports giving her 3-year-old daughter Pepto Bismol (bismuth subsalicylate) for diarrhea stools for the past 2 days. Which of the following statements by the nurse is the highest priority? a. “Has your child had a fever during this illness?” b. “Is the diarrhea better now?” c. “Has she had diarrhea before?” d. “What does she think of the taste of that stuff?”

____130. The nurse is providing care to a patient with congestive heart failure who is taking Digoxin (lanoxin) and bumetanide. Which of the following statements indicates teaching has been effective? a. “I need to restrict my intake of salt and potassium while I’m on these medications.” b. “The bumetanide can increase my risk of digoxin overdose, so I should call the doctor if I have any nausea, vomiting, confusion, or muscle cramps.” c. “I need to hold both medications if the top number of my blood pressure is less than 140.” d. “These medications help my heart beat faster so I won’t feel so tired all the time.”

____131. The nurse is assisting in the care of a 28-year-old woman who has been seen by a psychologist for depression. The woman is interested in starting treatment with Wellbutrin (bupropion). Which of the following factors would indicate this plan should be questioned? a. The patient smokes a pack of cigarettes each day. b. The patient is currently taking birth control pills. c. The patient has a history of hypertension Copyright © 2017 F. A. Davis Company

d. The patient has a history of seizures.

____132. The nurse is counseling a patient who will begin taking Buspar (buspirone). Which of the following statements indicates further teaching is required? a. “I might feel dizzy or sleepy with this medication.” b. “I shouldn’t drive until I know how I’m going to respond to this medication.” c. “It’s all right to take most over-the-counter medications and things with this medication.” d. “I should avoid alcohol or other medications that depress my nervous system.”

____133. The nurse is providing care for a patient who received Busulfex (busulfan) 2 weeks ago for chronic myelogenous leukemia (CML). Which of the following lab results would be most concerning to the nurse? a. Ca++ = 5.1 mg/dL b. Glucose = 98 c. LDH = 120 IU/L d. Platelets = 84,000/mm3

____134. The nurse is providing care for a woman who is in labor and is requesting something for pain. The order reads, “Stadol (butorphanol) 2 mg every 4 hr as needed.” Which of the following assessments should the nurse complete prior to providing the medication? a. Cervical dilation b. Respiratory rate c. Contraction rate d. Capillary refill

____135. The nurse is caring for a patient diagnosed with hypocalcaemia related to cancer. Which of the following medications would the nurse anticipate being ordered? a. Rolaids (calcium carbonate) b. Miacalcin (calcitonin) c. Capsin (capsaicin) d. Norvasc (nifedipine)

____136. A 38-year-old woman asks the nurse, “Can I just use Tums (calcium carbonate) to help prevent osteoporosis?” Which of the following responses by the nurse is best? a. “Tums are really an antacid, so there isn’t any research to support their use that way.” b. “You can use them that way, but they aren’t very effective.” c. “Did your doctor tell you to start taking a calcium supplement?” d. “It is safe to use them as a calcium supplement, but make sure you’re getting enough vitamin D as well.”

____137. The nurse recognizes that which of the following medications ordered for a patient may help reduce skeletal muscle spasms? a. Tagamet (cimetidine) b. Reglan (metoclopromide) c. Soma (carisoprodol) d. Tegretol (carbamazepine)

____138. The nurse is preparing to pass morning medications, including newly prescribed Coreg (carvedilol), for a patient admitted with an acute myocardial infarction and congestive heart failure. Which of the following actions should the nurse take first? a. Check to make sure the medication has been delivered from pharmacy. b. Take the patient’s blood pressure. Copyright © 2017 F. A. Davis Company

c. Monitor the patient’s respiratory rate and rhythm. d. Determine the patient’s level of pain.

____139. The nurse is caring for a patient with rheumatoid arthritis who takes Celebrex (celecoxib). The patient is on a pureed diet, and the nurse from the previous shift reported some difficulty with oral pills. Which of the following actions by the nurse is best? a. Hold the medication. b. Call the pharmacy to obtain a substitute medication that comes in liquid form. c. Call the physician to request a different pain medication. d. Open the capsule and sprinkle granules on applesauce.

____140. The nurse caring for a patient taking Zyrtec (cetirizine) recognizes the treatment plan is effective by which of the following statements? a. “I don’t feel nearly as tired as I used to feel.” b. “I am able to sleep at least 6 or 7 hr every night now.” c. “My eyes itch less and I’m not sneezing as often.” d. “My heartburn has essentially gone away.”

____141. A nurse caring for a patient who recently started taking Pletal (cilostazol) recognizes the further need for teaching by which of the following statements? a. “I’m able to walk three blocks a day now instead of one.” b. “I take the medication with breakfast every day.” c. “I’ve given up grapefruit juice and grapefruits entirely.” d. “I’ve stopped smoking all together.”

a. A 42-year-old patient with a history of depression b. A 22-year-old patient with a history of schizophrenia c. A 37-year-old patient taking MAO inhibitors d. A 55-year-old patient with a history of alcoholism

____143. The nurse is taking a medication history over the phone for a patient scheduled for knee replacement in 3 days. Which of the following medications, if reported by the patient, should be reported to the surgeon? a. Zantac (ranitidine) b. Proventil (albuterol) c. Lotrimin (clortrimazole) d. Klonopin (clonazepam)

____144. The nurse is providing care for a patient taking Plavix (clopidogrel). Which of the following laboratory results would be most important for the nurse to evaluate? a. Urine-specific gravity b. Albumin c. Bleeding time d. Potassium

____145. The nurse is caring for a patient admitted with suspected overdose with Codeine. Which of the following medications would the nurse anticipate being ordered? a. Pamelor (nortriptyline) b. Narcan (naloxone) c. Naprosyn (naproxen) d. Nicobid (niacin)

____146. A patient undergoing chemotherapy for breast cancer tells the nurse, “I feel so tired I can barely do anything. Even getting out of bed makes me dizzy.” After laboratory results are obtained, which of the following medications would most likely help relieve these symptoms? a. Aranesp (darbepoetin) b. Neupogen (filgrastim) c. Kytril (granisetron) d. Plavix (clopidrogel)

____147. The nurse is caring for a patient who just received parenteral Valium (diazepam). Which of the following nursing actions is best? a. Monitor patient’s serum calcium levels for the next 12 hr. b. Ensure fluid intake of 3,000 mL over the next 24 hr. c. Place patient on bed rest and monitor vital signs closely. d. Call for a hypothermia blanket to prevent rigors.

____148. The nurse is caring for a 56-year-old patient with a history of atrial fibrillation who takes Lanoxin (digoxin) 0.5 mg/day. Which of the following assessments should cause the nurse to hold the patient’s dose? a. BP = 112/70 mmHg b. Lung sounds with fine bibasilar crackles c. Urine output = 300 mL in 3 hr d. P = 58 bpm

____149. A nurse working with a patient who started taking Bentyl (dicyclomine) recognizes that patient further teaching is necessary by which of the following statements? a. “I’ll call the doctor immediately if I have any eye pain or sensitivity to light.” b. “I won’t have any restrictions on my driving or other activities if I take this drug.” c. “I will get up slowly since this medication may make me dizzy.” Copyright © 2017 F. A. Davis Company

d. “People who take this medication sweat less, so it is important not to get overheated.”

____150. The nurse receives a call from the parent of an 8-year-old boy who is home sick from school with a headache, sinus congestion, and a cough. The parent asks, “Can I give him some Benadryl to help him breathe easier?” Which of the following statements by the nurse is best? a. “How long has your child been ill?” b. “It should be fine if he weighs more than 50 pounds.” c. “What other over-the-counter medications have you given him?” d. “That might make him sleepy, so it is best to give it at night.”

____151. The nurse is caring for a patient admitted with diarrhea for the past 3 days. Stool cultures are negative, and the physician orders Lomotil, two tablets orally now and one tablet after each loose stool OR every 3–4 hr as needed. Which of the following parameters would the nurse expect to accompany the order? a. “Do not exceed 8 tablets per day.” b. “Do not exceed 4 doses per day.” c. “Do not give for more than 2 days.” d. No parameters are necessary.

____152. The nurse is providing care for a patient who received surgical intervention for mitral valve prolapse. The patient is taking Persantine (dipyridamole) 75 mg po TID. The nurse recognizes the medication is effective by which of the following patient outcomes? a. Patient reports chest pain is less after receiving the medication. b. Patient remains free from deep vein thrombosis throughout hospital stay. c. Patient’s heart rhythm is regular without ectopic beats for 48 hr postprocedure. d. Patient’s lung sounds remain clear without evidence of fluid overload throughout hospital stay. Copyright © 2017 F. A. Davis Company

____153. The nurse is providing care for a patient admitted after an acute myocardial infarction. Which of the following medications should the nurse anticipate to be part of the patient’s treatment plan? a. Anzemet (dolasetron) b. Sinequan (doxepin) c. Aricept (donepezil) d. Colace (docusate)

____154. A nurse in the labor and delivery unit is caring for a patient who is receiving Marcaine (bupivicaine) epidural anesthesia. Which of the following symptoms would be recognized as indicative of systemic toxicity? a. BP drops from 112/74 to 106/68. b. Patient complains, “I can’t feel the baby moving anymore.” c. Patient reports, “I can hear ringing in my ears.” d. Respiratory rate drops from 22 to 16 respirations per minute.

____155. While counseling a patient receiving Inspra (eplerenone) for hypertension, the nurse recognizes the need for further teaching by which of the following statements? a. “I’ll follow a cardiac diet to help lower my blood pressure.” b. “It is important that I stop smoking to reduce my risk of a heart attack.” c. “I can use salt substitutes if I want more seasoning.” d. “It is important to check my blood pressure at home at least once a week.”

____156. A nurse working on the postpartum unit is caring for a woman who had a spontaneous delivery of a 9 lb, 6 oz baby 6 hr earlier. The nurse notes the patient has soaked four peri-pads and that her uterine fundus is boggy. Which of the following medications does the nurse anticipate being ordered? Copyright © 2017 F. A. Davis Company

a. Pitocin (oxytocin) b. Methylergonovine (methergine) c. Brethine (terbutaline) d. Magnesium sulfate (magnesium sulfate)

____157. The nurse is working with a patient who has elevated triglyceride levels despite dietary changes. The physician has ordered Tri-Lipix (fenofibric acid) 135 mg per day. Which of the following statements should the nurse include in the teaching? a. “Since I take Coumadin, I’ll need to have my bleeding labs checked more frequently for a while.” b. “This will be much easier than following all of those dietary restrictions; I know how hard that can be.” c. “This medicine will really help you lose weight, just be sure you’re drinking enough water.” d. “This medicine sometimes causes stomach pain and fatty, clay-colored stools, so if I experience that, I shouldn’t worry.”

____158. A nurse working in hospice is providing care for a patient recently started on a transdermal fentanyl patch. Which of the following statements, made by the patient’s caretaker, indicates further teaching is required? a. “I can wash right over the patch, and it won’t come off.” b. “I should change the patch every 3 days.” c. “I put the first patch on him this morning at 8 a.m., so he shouldn’t need any more pain medicine today.” d. “The medicine can cause constipation, so it is important to give him the stool softener and increase fluid if possible.”

____159. The nurse is providing a follow-up phone call to a patient who recently started taking Allegra (fexofenadine). Which of the following statements by the patient would indicate the medication has been effective? a. “My arthritis is much better; I can even write letters again.” b. “My nose isn’t running and itchy all the time now.” c. “I don’t have to get up to go to the bathroom in the middle of the night anymore.” d. “I’m sleeping a lot better, and I don’t have any headaches anymore.”

____160. The nurse is caring for a patient with colorectal cancer who has been receiving continuous infusion chemotherapy at home. The patient complains of mouth sores and difficulty swallowing. Upon exam, the homecare nurse notes a whitish coating on the tongue and mucosal breakdown on the inner cheeks and lips. The nurse informs the patient, “The sores in your mouth are caused by the chemotherapy, but it looks like you may also have a secondary yeast infection in your mouth and throat. I will call the doctor so you can be seen right away.” The nurse recognizes which of the following medications will most likely be ordered to treat the esophageal candidiasis once the patient is seen by a physician? a. Ditropan (oxybutynin) b. Fosamax (alendronate) c. 5-FU (fluorouracil) d. Diflucan (fluconazole)

____161. The nurse is talking to a friend who recently revealed that she is 6 weeks pregnant. The woman says, “The doctor told me to take prenatal vitamins that have folic acid in them; what is that for?” Which of the following is the best response by the nurse? a. “Folic acid helps prevent miscarriage.” b. “Folic acid boosts your immune system.” c. “Folic acid actually helps fetal development.” d. “Folic acid reduces the amount of nausea caused by prenatal vitamins.”

____162. The nurse is providing care for a 12-year-old child whose order reads, “Ciprofloxin 15 mg/kg po q 12 hr.” The child weighs 88 pounds (40 kg). What dose of Ciprofloxin should be provided? a. 500 mg tablet every 12 hr b. 500 mg tablet and a 100 mg tablet every 12 hr c. 750 mg tablet every 12 hr d. Two 500 mg tablets every 12 hr

____163. While providing care to a 68-year-old man taking Lopid (gemfibrozil), the nurse recognizes that which of the following assessments indicates the medication and treatment plan are effective? a. The patient has lost 4 pounds this month. b. The patient’s HDL drops from 55 mg/dL to 49 mg/dL. c. The patient’s cholesterol drops from 265 mg/dL to 238 mg/dL. d. The patient’s LDL is 175 mg/dL.

____164. The nurse is providing care for a 54-year-old woman with insulin-dependent diabetes. The woman is pale, diaphoretic, groggy, and difficulty to arouse. Her blood glucose result is 49. Which of the following actions should the nurse take next? a. Notify the physician. b. Encourage the patient to drink orange juice with a teaspoon of added sugar. c. Request a stat lab blood draw and await results. d. Provide 1 mg IV glucagon per protocol.

____165. A nurse working in an outpatient psychiatric clinic is assessing a 39-year-old patient with a history of schizophrenia who started taking Haldol (haloperidol) 3 mg po TID last week. Which of the following should be reported to the physician immediately? a. The patient is smacking his lips and chewing while the nurse is asking questions. b. The patient says, “I heard the angels talking again last night.” Copyright © 2017 F. A. Davis Company

c. The patient reports he is staying at a homeless shelter downtown. d. The patient tells the nurse he forgot to bring in his pills but that he needs more.

____166. The nurse is caring for an 82-year-old woman with superior vena cava syndrome due to a clot formed around the patient’s implanted port. The patient is on a heparin drip at 12 units/hr. Which of the following laboratory values will be used to titrate the infusion rate? a. Hemoglobin (Hgb) b. Platelet count (Plt) c. Partial thromboplastin time (aPTT) d. Clotting time

____167. The nurse is asked by the parent of a 13-year-old girl, “How does the new cervical cancer vaccine work?” Which of the following statements by the nurse is best? a. “It is a series of three vaccinations over a 6-month period of time designed to prevent cervical cancer and genital warts caused by a virus we call human papilloma virus (HPV).” b. “Gardasil helps reduce sexually transmitted diseases and female cancers by stimulating an immune response to the herpes virus.” c. “Your daughter would get a single shot to help prevent cervical, ovarian, and vaginal cancer.” d. “You should really ask the doctor about the vaccination because it is still controversial.”

____168. A nurse caring for a patient with a history of diabetes mellitus notes that his prebreakfast blood glucose is 268. The nurse understands the patient most likely has sliding scale insulin using which of the following? a. Novolog Mix 70/30 b. Humulin R Copyright © 2017 F. A. Davis Company

c. Humulin N d. Lantus

____169. While checking orders for a patient newly admitted with abdominal pain and suspected pancreatitis, the nurse notes the following order, “Meperidine 50–100 mg IM q 3–4 hr prn for pain.” Which of the following medications currently taken by the patient would cause the nurse to contact the physician? a. Isordil (isosorbide) 20 mg po q 6 hr b. Trandate (labetalol) 100 mg BID c. Nardil (phenelzine) 15 mg po TID d. Indocin (indomethacin) 25 mg po QID

____170. The nurse contacts a patient whose physician has ordered Feosol (carbonyl iron) 60 mg BID after routine lab work revealed mild iron-deficiency anemia. Which of the following statements would be included in the patient teaching? a. “Since you are taking an iron supplement, you should reduce the amount of iron in your diet to prevent overdose.” b. “The iron may make your stool a dark green or black color; this is nothing to worry about.” c. “It is alright to take both doses together if you prefer.” d. “Iron is fairly harmless, so there is little concern if you take extra when you are on your menstrual cycle.”

____171. The nurse is assisting in the care of a patient complaining of severe pruritis. Which of the following medications does the nurse anticipate being available on an as-needed basis for the patient? a. Toradol (ketorolac) b. Atarax (hydroxyzine) Copyright © 2017 F. A. Davis Company

c. Dilaudid (hydromorphone) d. Hycodan (hydrocodone)

____172. The nurse is caring for a patient being treated for tuberculosis who is taking INH (isoniazid). Which of the following statements indicates the need for further teaching? a. “I know I need to take this medication for at least 6 months.” b. “I need to call the doctor if I notice any yellow color to my skin or eyes.” c. “I’ll have to have regular checkups and eye exams to monitor for side effects.” d. “I should limit my alcohol intake to no more than 3 beers a day while I’m taking this medicine.”

____173. The nurse is providing care for a patient with hepatic encephalopathy who is receiving lactulose via a nasogastric tube QID. Which of the following indicates the patient is responding appropriately to the medication? a. The patient’s serum ammonia level returns to normal limits. b. The patient’s potassium level returns to normal limits. c. The patient’s blood alcohol level returns to normal limits. d. The patient’s serum calcium level returns to normal limits.

Multiple Response Identify one or more choices that best complete the statement or answer the question. ____174. As part of a new treatment regimen for migraine headaches, an 18-year-old girl is prescribed Axert (almotriptan). The nurse should include which of the following statements in the patient teaching? Select all that apply. a. “You will take this medication daily to help prevent the onset of migraines.” b. “You should avoid alcohol when you are taking this medication.” c. “You can take this medication every 2–4 hr as needed for up to eight doses per Copyright © 2017 F. A. Davis Company

day.” d. “Take the medication as soon as you notice the onset of a migraine headache.” e. “Avoid taking over-the-counter medications that have not been prescribed by your doctor while taking this medication.” f. “If taking this medication causes any pain or tightness in your chest, you should notify the physician immediately.”

____175. The nurse is providing care for a patient who has new orders to start Pacerone (amiodarone) po 400 mg BID. Which of the following orders should the nurse anticipate? Select all that apply. a. Monitor vital signs every 4 hr. b. Telemetry monitoring. c. Liver function tests every morning for the next 3 days. d. Initiate seizure precautions. e. Notify physician of visual changes. f. Do not serve grapefruit juice.

____176. A nurse from the medical unit is floated to the cardiology floor. While preparing to provide morning medications, the nurse realizes many patients are taking Zebeta (bisoprolol) and knows the drug must be given cautiously or in reduced doses to which of the following patients? Select all that apply. a. A 56-year-old patient with a history of pulmonary disease. b. A 68-year-old patient with a history of gastroesophogeal reflux disease. c. A 71-year-old patient with chronic renal failure. d. A 66-year-old patient with elevated liver enzymes. e. A 59-year-old patient with a history of diverticulitis. f. A 74-year-old patient with a history of Alzheimer’s disease.

____177. A nurse caring for a patient who is to initiate therapy with Zostrix (capsaicin) would include which of thefollowing statements in thepatient teaching? Select all that apply. a. “This medication is used to treat local skin infections.” b. “Apply themedication topically 3–4 times daily.” c. “Keep theointment away from theeyes or any open skin areas.” d. “Rub thecream into theaffected area well so little or no cream is left on thesurface.” e. “The medication helps reduce thepain associated with arthritis.” f. “Capsaicin is taken in pill form on an empty stomach once daily.”

____178. While providing initial chemotherapy teaching for a patient who is scheduled to receive Platinol (cisplatin) for metastatic ovarian cancer, thenurse recognizes that teaching has been effective by which of thefollowing client statements? Select all that apply. a. “This medication is usually taken as a pill every day for a week.” b. “You will need to check my lab values each time I’m due for chemotherapy to make sure I can safely take each scheduled treatment.” c. “It is very important that I continue to take themedication that prevents nausea and vomiting consistently throughout my day of treatment.” d. “Aside from nausea, this medication has few other side effects.” e. “I may have nausea or loss of appetite for up to a week after taking this medication.” f. “I will come into an infusion center to get my chemotherapy in an IV.”

____179. Which of thefollowing would cause thenurse to suspect that a patient taking Lexapro (escitalopram) may be developing serotonin syndrome? Select all that apply. a. Pulse = 122 bpm b. Patient reports seeing blue spiders on thewall. c. Patient’s blood glucose = 93 g/dL. d. Patient complains of nausea and diarrhea. Copyright © 2017 F. A. Davis Company

e. White blood cell count = 5,500 cell/mm3. f. Urinary output = 600 mL in 8 hr.

____180. The nurse is caring for a patient taking Nexium (esomeprazole). thenurse knows teaching has been effective by which of thefollowing statements? Select all that apply. a. “I should take this pill with my meals.” b. “This medication helps reduce therelease of stomach acid and reduces my reflux.” c. “I should not chew or crush thepellets.” d. “If I miss a dose, it should be skipped for theday.” e. “I’ve eliminated alcohol from my diet completely.” f. “I can keep taking Advil for my arthritis pain.”

____181. While providing care for a patient who receives Lasix (furosemide) 20 mg IV push twice daily, thenurse would include which of thefollowing in theplan of care? Select all that apply. a. Change thepatient’s incontinence brief 30–60 min after medication administration. b. Check patient’s platelet count prior to medication administration. c. Schedule thefirst dose at 11 a.m. and thesecond dose at 11 p.m. d. Provide thedose undiluted. e. Give themedication over 30 seconds f. Institute high fall risk protocol interventions.

____182. While reviewing a patient’s medication list, thenurse notes thepatient takes Neurontin (gabapentin) 300 mg three times daily. thenurse recognizes this medication has multiple indications and is used both on and off label for various reasons including which of thefollowing? Select all that apply. a. Adjunct treatment of partial seizures b. Prevention of migraine headaches c. Treatment of diabetic peripheral neuropathy Copyright © 2017 F. A. Davis Company

d. Treatment of postherpetic neuralgia e. Treatment for insomnia f. Reduction of increased intracranial pressure

____183. The nursing instructor is reviewing theadministration of Levemir (insulin-detemir) via injectable pen. theinstructor would be most concerned by which of thefollowing statements by thestudent? Select all that apply. a. “I have to rotate thepen a few times before I set thedose.” b. “I need a special needle so I make sure to get theinsulin into muscle tissue.” c. “It is important to rotate sites to prevent tissue damage.” d. “The expiration date is not important on single-patient administration devices.” e. “This medication is usually given once a day with dinner or at bedtime.” f. “I should store this pen in therefrigerator once I provide thedose.”

____184. The nurse is caring for a patient who is to start taking Carbolith (lithium) 300 mg three times daily. Which of thefollowing statements should be included in thepatient teaching? Select all that apply. a. “You will need to have blood levels checked frequently for thefirst few months of treatment.” b. “You should report any muscle twitches or change in coordination since those could be symptoms of too much medication in your system.” c. “This medication will help level out your mood.” d. “Please make sure you limit your fluid intake to three glasses of liquid per day.” e. “Avoid dairy products while you are taking this medication.” f. “You must have a baseline electromyelogram before you start this medication.”

____185. While admitting a patient to themedical unit at 9:30 a.m. for an acute episode of Crohn’s disease, thenurse learns thepatient typically takes Imodium (loperamide) 2 mg four times each day. thenurse recognizes that further patient teaching is needed by which of thefollowing statements? Select all that apply. a. “That is themedicine that helps control my diarrhea.” b. “I have to be careful about loperamide when I’m taking my narcotic pain medication.” c. “I didn’t take my loperamide this morning so I’d like to take two when it is due at 11 a.m.” d. “I usually drink one or two beers a day.” e. “I’m always sure to drink at least 10 glasses of water or juice each day.” f. “I chew a lot of sugarless gum.”

____186. While providing discharge instructions for a patient who is taking Naprosyn (naproxen) for rheumatoid arthritis, thenurse would include which of thefollowing statements? Select all that apply. a. “You should limit your alcohol consumption to a maximum of one glass per day.” b. “Please notify your physician if you notice your stools become dark or tarry in appearance.” c. “Extended release tablets can be broken into smaller pieces to make it easier to swallow.” d. “You should not take any over-the-counter products that contain aspirin while you are taking this medication.” e. “Consult your doctor before taking anything that contains Tylenol.” f. “Ringing in theears is a potential side effect of this medication, so don’t worry if that happens.”

____187. While caring for a client who chose to start taking Niacin (vitamin B 3) rather than a statin agent, thenurse determines that thetreatment has been effective by which of thefollowing findings? Select all that apply. a. Serum triglyceride = 136 mg/dL b. Protein = 7.2 g/dL c. Prothrombin time = 12 sec d. Total cholesterol = 168 mg/dL e. Random glucose = 108 g/dL f. Glycosylated hemoglobin (A1C) = 4.4%

____188. The nurse is counseling a patient who wants to start using Nicorette (nicotine gum). Which of thefollowing statements indicates that teaching has been effective? Select all that apply. a. “Since I used to smoke about 12 cigarettes a day, I will use the2 mg gum.” b. “I should not chew more than five pieces per day.” c. “I should start out chewing one piece of gum every 1 or 2 hr.” d. “I will gradually decrease theamount of gum I chew over about 10 weeks.” e. “The gum comes in a number of flavors so I can have variety.” f. “There are no side effects to thegum, so I can use more if I need it.”

____189. The nurse is counseling a patient who is newly prescribed Lyrica (pregabalin). Which of thefollowing statements should be included in thepatient’s teaching? Select all that apply. a. “This medication may increase depression or suicidal thoughts, so be sure to notify your physician if this occurs.” b. “The medication is used to reduce thepain associated with diabetic neuropathy.” c. “Do not stop using this medication quickly.” d. “Weight loss and decreased interest in food may be experienced with this medication.” e. “Call thedoctor right away if you have muscle pain or weakness.” f. “You must take this medication with your meals to avoid severe gastric irritation.” Copyright © 2017 F. A. Davis Company

____190. A nurse working in thepsychiatric unit receives report for a new patient being admitted with symptoms of depressive disorder and possible schizophrenia. thenurse knows thetreatment regimen may include which of thefollowing medications? Select all that apply. a. Apo-Quinidine (quinidine) b. Seroquel (quetiapine) c. Amaryl (glimepiride) d. Risperdal (risperidone) e. Restoril (temazepam) f. Spiriva (tiotropium)

____191. While planning care for a patient who takes Requip (ropinirole), thenurse would develop which of thefollowing nursing diagnoses? Select all that apply. a. Impaired gas exchange related to chronic obstructive pulmonary disease b. Decreased cardiac output related to heart failure c. Impaired physical mobility related to Parkinson disease d. Risk for injury related to fall risk e. Risk for fluid volume deficit related to diuresis f. Ineffective coping related to depression.

____192. Prior to administering Lovaza, what laboratory values should be obtained? Select all that apply. a. Na+ b. K+ c. HDL d. LDL e. Triglycerides f. LFT

____193. A patient in thehospital is going to receive her first dose of Reclast (zoledronic acid) prior to being discharged from thehospital. Which of thefollowing actions are required of thenurse? Select all that apply. a. Keep patient NPO for 1 hr after thefirst dose is given. b. Encourage high fluid intake within a few hours prior to theadministration of Reclast. c. Assess patency of intravenous line. d. Select a syringe that will provide deep tissue injection. e. Provide patient with written instruction for follow-up dose in 2 months. f. Tell patient to notify thehealth-care provider if he or she has muscle spasms or cramps.

____194. Which laboratory values should be monitored for a person receiving Heparin? Select all that apply. a. CBC b. WBC c. PT d. aPTT e. Platelet count f. D-Dimer

____195. An oral dose of zinc sulfate is being prescribed for a patient in thewound clinic. Patient education should emphasize that thefollowing products should not be taken with zinc sulfate because they will decrease absorption. Select all that apply. a. Caffeine products b. Bran c. Dairy products d. Seafood Copyright © 2017 F. A. Davis Company

____196. Which of thefollowing laboratory values must be closely monitored when taking amiodarone? Select all that apply. a. Liver function tests b. Thyroid level c. Electrolytes d. Chest x-ray e. Pulmonary function tests

____197. When administering bisacodyl, which of thefollowing implications should thenurse consider? Select all that apply. a. Increase fluid intake up to 2,000 mL/day. b. Administer with food. c. Dilute with normal saline prior to administration. d. Assess fluid and electrolyte status. e. If giving rectally, encourage retention of enema for 15–30 min.

____198. After theadministration of rifampin, what should be included in patient education? Select all that apply. a. Take dose at thesame time daily. b. Avoid use of soft contact while taking rifampin. c. If taking oral contraceptives, an alternate form should be used. d. Keep medication refrigerated until time of use. e. Notify patient that bodily fluids such as sweat, urine, saliva, and feces may turn reddish-orange in color.

____199. A person taking Questran should restrict intake of foods high in which of thefollowing components? Select all that apply. a. Sugar b. Fat c. Carbohydrates d. Cholesterol e. Potassium f. Sodium

____200. Which of thefollowing assessments should cause concern for a patient who is receiving Vancomycin? Select all that apply. a. Black, furry growth on thetongue b. Tinnitus c. Vertigo d. Yellow sclera e. Pink-tinged urine

____201. The nurse is providing education for an immunosuppressed patient with recurrent oral herpes simplex lesions (cold sores) who is being treated with topical acyclovir ointment. Which of thefollowing statements would be included in thenurse’s teaching? Select all that apply. a. “Apply theointment every 3 hr each day for 7 days.” b. “Other topical ointments should be avoided as they may cause thelesions to spread or worsen.” c. “This medication should cure thelesions and recurrence is rare.” d. “You should wear a glove when applying theointment to prevent spreading.” e. “You cannot eat or drink for 2 hr after application.” f. “There are no activity restrictions while you are taking this medication.”

____202. A nurse working in theintensive care unit would expect albumin as part of thetreatment plan for which of thefollowing patients? Select all that apply. a. A 33-year-old patient with profound plastic anemia b. A 55-year-old patient with second- and third-degree burns to 40% of his body c. A 29-year-old patient with rectal bleeding d. A 71-year-old patient with lung cancer and congestive heart failure e. A 68-year-old patient with symptoms of septic shock f. A 37-year-old patient with end-stage liver disease

____203. The nurse is providing care for a patient with recurrent lymphocytic leukemia who is receiving weekly treatment with Campath (alemtuzumab). Which of thefollowing lab results would thenurse be expected to monitor prior to initiating therapy? Select all that apply. a. Prothrombin time (PTT) b. Urine-specific gravity c. White blood cell count (WBC) d. Platelet count e. CD-8 count f. Red blood cell count (RBC)

____204. The nurse is caring for a patient receiving intravenous antibiotic therapy with tobramycin 100 mg every 8 hr. Which of thefollowing nursing actions are appropriate for this medication? Select all that apply. a. Mixed IVPB solutions are stable at room temperature for 24 hr. b. IVPB doses should be administered over 30–60 min. c. Monitor thepatient for signs of tinnitus, dizziness, or hearing loss. d. Monitor renal function before and during therapy. e. May mix or infuse simultaneously with other antibiotics. f. Monitor for symptoms of a super infection.

____205. A nurse providing hypertension screening and education recognizes which of thefollowing medications as an ACE inhibitor? Select all that apply. a. Tenormin (atenolol) b. Capoten (captopril) c. Vasotec (enalopril) d. Teveten (eprosartan) e. Lotensin (benazepril) f. Atacand (candesartan)

____206. The nurse is teaching a patient with prostate cancer about theplanned treatment of Casodex (bicalutamide) and Goserelin (an LHRH analog). Which of thefollowing statements should be included in thepatient teaching? Select all that apply. a. “Diarrhea is common, so it is important to increase fluid intake.” b. “You may experience hot flashes while taking these medications.” c. “The doctor will follow CA-125 levels periodically to monitor thetumor’s response to themedications.” d. “You may experience hair loss while taking Casodex.” e. “These medications block theeffects of testosterone in your body and keep theprostate cancer from growing.” f. “You must take this medication first thing in themorning while sitting upright and wait for at least an hour before eating anything.”

____207. The nurse is providing care for a 59-year-old patient with a long-term history of asthma for an acute exacerbation. theclient is started on an infusion of aminophylline. Which of thefollowing orders would thenurse expect to be written? a. Place on telemetry and monitor patient for reports of chest pain. b. Theophylline levels every 6 hr x4. c. O2 to keep saturation greater than 93%. Copyright © 2017 F. A. Davis Company

d. Strict I/O. e. NG to intermittent suction. f. Pleurovac to 20 cm water seal.

____208. Which of thefollowing lab values must be monitored during therapy with Tegretol CR (carbamazepine)? Select all that apply. a. Uric acid level b. Hemoglobin c. Creatinine d. Alkaline phosphatase e. Platelet count f. Serum iron

____209. The nurse is preparing to provide thefirst dose of Maxipime (cefepime) 1 gm in 50 mL D5W via intravenous piggyback to a patient diagnosed with febrile neutropenia. Place thefollowing steps in theappropriate order: a. Set rate at 100 mL/hr. b. Verify right drug, dose, and time. c. Observe for symptoms of anaphylaxis. d. Discontinue theinfusion. e. Verify correct patient using two identifiers. f. Begin infusion.

____210. A nurse assisting in thecare of an elderly patient who received PO Librium (chlordiazepoxide) in thetreatment of acute alcohol intoxication would include which of thefollowing in theplan of care? Select all that apply. a. Place patient in leather restraints. b. Institute seizure precautions. Copyright © 2017 F. A. Davis Company

c. Assess for tremors. d. Administer higher doses in morning. e. Institute fall precautions. f. Administer after meals or with milk.

____211. Which of thefollowing medications can be used to prevent or treat nausea and vomiting? Select all that apply. a. Thorazine (chlorpromazine) b. Zofran (ondansetron) c. Adrenalne (epinephrine) d. Reglan (metoclopramide) e. Amend (aprepitant) f. Catapres (clonodine)

____212. The nurse providing patient education about Questran (cholestyramine) would include which of thefollowing statements in theeducation? Select all that apply. a. “Diarrhea may occur.” b. “This medication should be taken before meals.” c. “It can be mixed with water, milk, juice, or another noncarbonated beverage.” d. “It is still important to follow a low-fat, low-cholesterol diet.” e. “Notify thephysician if your stool becomes frothy or foul smelling.” f. “This medication may cause dry mouth or a rapid heart rate; that is normal.”

____213. The nurse is preparing to provide Norvasc (amlodipine) to a 69-year-old patient with a history of multifocal premature ventricular contractions (PVCs). His cardiac monitor has shown normal sinus rhythm with rare PVCs for thepast 24 hr. Which of thefollowing assessment findings would cause thenurse to withhold themedication? Select all that apply. a. Blood pressure = 86/50 Copyright © 2017 F. A. Davis Company

b. Blood pressure = 112/68 c. Pulse = 88 bpm d. Pulse = 48 bpm e. Monitor shows normal sinus rhythm f. Monitor shows three PVCs in past 24 hr

____214. Which of thefollowing are classified as potassium-sparing diuretics? Select all that apply. a. Lasix (furosemide) b. Aldactone (spirinolactone) c. Dyrenium (triamterene) d. Diuril (chlorothiazide) e. Midamor (amiloride) f. Microzide (hydrochlorothiazide)

____215. A nurse working with patients in an HIV clinic recognizes thefollowing medications as antivirals that may be included in patient medication regimens. Select all that apply. a. Famvir (famciclovir) b. Emtriva (emtricitabine) c. Sustiva (efavirenz) d. Lodine (etodolac) e. Afinitor (everolimus) f. Enbrel (etanercept)

____216. The nurse is counseling a patient who has been given a prescription for Prozac (fluoxetine). Which of thefollowing statements should thenurse include in thepatient’s teaching? Select all that apply. a. “The medicine can cause some dizziness, so you should change position slowly.” b. “Sugarless gum or candy may help thefeeling of dry mouth that some patient’s Copyright © 2017 F. A. Davis Company

experience with this medicine.” c. “Most likely you will notice a huge change in your mood immediately.” d. “You may experience a decrease in your sex drive while on this medication.” e. “It is important to wear protective clothing and sunscreen since thedrug can cause increased sensitivity to thesun.” f. “This medicine should always be taken on an empty stomach.”

____217. The nurse is caring for a patient who had a total hip replacement yesterday. Based on thepatient’s risk of developing deep vein thrombosis or pulmonary emboli, which of thefollowing would thenurse expect to find in thepatient’s plan of care? Select all that apply. a. Bilateral thigh-high sequential compression stockings b. Fragmin (dalteparin) 5,000 IU SQ every day c. Strict bed rest for 3 days d. Vital signs and pulse oximetry every 4 hr e. Lovenox (enoxaparin) 30 mg IV push—single dose now f. Aspirin 650 mg every 4 hr while awake

____218. The nurse is providing care for a patient who is to take Tagamet (cimetidine) 400 mg BID upon discharge. Which of thefollowing statements should thenurse include in thepatient’s teaching? Select all that apply. a. “The medication may make your stool black; this is normal.” b. “Smoking interferes with theaction of this medication, so it is important not to smoke after taking your last dose of theday.” c. “Do not take any over-the-counter medications with aspirin or nonsteroidal antiinflammatory agents without talking to your physician.” d. “You should take this medication first thing in themorning on an empty stomach.” e. “This medication may make you feel sleepy.” f. “This medication will improve your heartburn symptoms and help reduce stomach acid from irritating your esophagus.” Copyright © 2017 F. A. Davis Company

____219. While caring for elderly residents in a nursing home, thenurse recognizes theuse of Advil (ibuprofen) places these clients at increased risk for which of thefollowing? Select all that apply. a. Gastrointestinal bleeding b. Renal toxicity c. Hepatic toxicity d. Cerebrovascular accident e. Pulmonary embolism f. Peripheral vascular disease

____220. The nurse caring for a patient taking hydrochlorothiazide and Lanoxin (digoxin) instructs thepatient to notify thephysician with which of thefollowing symptoms? Select all that apply. a. Systolic blood pressure less than 150 b. Anorexia, nausea, and vomiting c. Muscle cramps d. Confusion e. Numbness and tingling in extremities f. Nocturia

____221. A patient with newly diagnosed type 2 diabetes has been instructed on administration of insulin, human inhalation (Afrezza). Which of thefollowing statements should be included in thepatient teaching? Select all that apply. a. Administer at beginning of each meal b. Do not take your Subcut insulin with Afrezza c. Use theAfrezza inhaler upside down d. Avoid smoking while taking inhaled insulin e. Monitor blood glucose every 6 hr f. Monitor your weight daily. Afrezza may cause weight loss. Copyright © 2017 F. A. Davis Company

Completion Complete each statement. 222. The nurse receives new orders to start clindamycin 25 mg/kg/day in four equal intravenous doses every 6 hr to a child who weighs 20 kg. thedose of medication thenurse should provide with each administration is ___________________mg. 223. The nurse is caring for a patient in theintensive care unit who is to be started on dopamine 1 mcg/kg/min. thepatient weighs 220 pounds. thedrip rate in mg/hr should be ____________________. 224. Prior to initiating continuous drip intravenous therapy with dopamine, thenurse checks theinfusion bag that lists 250 mg dopamine has been added to 250 mL of 0.9 NS. thenurse determines theconcentration, expressed as mg/mL, is ____________________. 225. A nurse working in theneonatal intensive care unit receives an order to provide Lasix (furosemide) 2 mg/kg orally now. theneonate weighs 2.5 kg, and themedication is available as a liquid with a concentration of 10 mg/mL. thecalculated dose thenurse will provide in mL is __________________ mL. 226. The nurse is caring for a patient who is to receive 40 mg of Lasix (furosemide) as an intravenous push. If therecommended administration time is 20 mg/min, thenurse will take ____________________ min to administer themedication. 227. The nurse is caring for a patient who reports taking 20 mg Adalat (nifedipine) three times daily. thehospital has 10 mg capsules. thepatient should take ____________________ capsules in a 24hr period.

228. A nurse in theintensive care unit is establishing a continuous infusion of Levophed (norepinephrine). thepharmacy has supplied 1,000 mL of D5NS with 4 mg of norepinephrine. In terms of mL/hr, therate thenurse should program into thepump to keep thepatient on a continuous infusion of 2 mcg/min is ____________________. 229. The nurse is caring for an infant who weighs 4.5 kg. Penicillin at 25,000 units/kg every 8 hr has been ordered. theamount of penicillin in each dose is ____________________ units. 230. The nurse is preparing to infuse Keflex (cephalexin) 1 g in 50 mL over 30 min. To infuse 50 mL of fluid over 30 min, thepump should be set at __________________mL/hr (= hourly rate). 231. A nurse passing medications at thenursing home is supposed to provide Cardizem (diltiazem) 90 mg po TID. thepharmacy stocks 60 mg tablets. thenurse should provide ____________________ tablets. 232. The nurse is passing medications for a patient whose medication administration record reads, “Neurontin (gabapentin) 300 mg po TID.” Gabapentin is provided by thepharmacy in 600 mg scored tablets. thenurse should provide ____________________ tablets with each dose. Matching Match theinstructions for using an inhaler in thefollowing section with thenumber they should occur in. a. Press down on theinhaler to release medication. b. Hold your breath for 10 sec. c. Shake theinhaler. d. Tilt your head back and breathe out slowly. e. Breathe in slowly through themouth. f. Connect theinhaler to a spacer/chamber.

____233. Step 1 ____234. Step 2 ____235. Step 3 ____236. Step 4 ____237. Step 5 ____238. Step 6 Other 239. Place thefollowing steps in proper sequence to provide 12 units NPH insulin and 4 units regular insulin. A. Draw up 12 units NPH insulin. B. Draw up 4 units regular insulin. C. Administer subcutaneous injection. D. Select and prep thesite. E. Mix NPH insulin vial by rotating briskly between hands. F. Verify order and current accu check result. 240. Place thefollowing steps in thecorrect order for thenurse to provide Prevacid (lansoprazole) 15 mg capsule qd through an NG tube. A. Flush NG tube with 20 mL water B. Check chest x-ray results to verify NG tube placement. C. Flush NG tube with additional 20 mL water or apple juice. D. Open capsule and mix contents with 40 mL apple juice. E. Inject medication mixture through theNG tube. F. Aspirate NG tube and check pH of aspirate. Copyright © 2017 F. A. Davis Company

Drug Guide Test Bank 1 Answer Section MULTIPLE CHOICE 1. ANS: C See Nursing Implications for acarbose: Observe thepatient for signs and symptoms of hypoglycemia. Acarbose alone does not cause hypoglycemia; however, other concurrently administered hypoglycemic agents may produce hypoglycemia, requiring treatment. Ignoring these symptoms would be dangerous, but it is not considered an adverse drug reaction requiring an official report. thepatient is experiencing symptoms of hypoglycemia not anemia. PTS: 1

DIF: Medium

REF: Drugguide.com

TOP: Therapeutic Classification: Antidiabetics

KEY: Cognitive Level: Analysis

2. ANS: A See adenosine Indications: Adenosine is used for theconversion of paroxysmal supraventricular tachycardia (PVST) to normal sinus rhythm when vagal maneuvers are unsuccessful. Epinephrine is a bronchodilator used in themanagement of reversible airway disease. Atenolol is a beta blocker used in themanagement of hypertension. Asenapine is an antipsychotic mood stabilizer used in theacute treatment of schizophrenia or manic/mixed episodes associated with bipolar I disorder. PTS: 1

DIF: Medium

REF: Page 113 | Page 496 | Page 194 | Page 188

TOP: Therapeutic Classification: Antiarrhythmics Application 3. ANS: B

KEY: Cognitive Level:

See Contraindications/Precautions, Interactions, and Dosage for albuterol. Excess inhaler use may lead to tolerance and paradoxical bronchospasm. Use with caffeine-containing herbs (cola nut, guarana, tea, coffee) increases stimulant effect. Two inhalations every 4–6 hr or two inhalations 15 min prior to exercise). Tachycardia is an expected side effect with this medication. PTS: 1

DIF: Easy

REF: Page 120

TOP: Therapeutic Classification: Bronchodilators

KEY: Cognitive Level: Analysis

4. ANS: C See Contraindications/Precautions for amitriptyline: theuse of this medication may increase therisk of suicide attempt/ideation especially during dose early treatment or dose adjustment; risk may be greater in children or adolescents. Sedation is an expected side effect. Dry mouth is an expected side effect. There is no directive to avoid caffeine with this medication. PTS: 1

DIF: Medium

REF: Page 145

TOP: Therapeutic Classification: Antidepressants

KEY: Cognitive Level: Analysis

5. ANS: D See contraindications/precautions for ampicillin: Contraindicated in hypersensitivity to penicillin. This medication should be held due to thestated allergy to penicillin. PTS: 1

DIF: Easy

REF: Page 158

TOP: Therapeutic Classification: Antibiotics

KEY: Cognitive Level: Application

6. ANS: B See Action for atropine: Low doses decrease sweating, salivation, and respiratory secretions. Morphine is used for pain control. Lorazepam is used for anxiety. Benadryl is used for itching. PTS: 1

DIF: Medium

REF: Page 198

7. ANS: A See Route/Dosage for azithromycin: 500 mg on 1st day, then 250 mg/day for 4 more days. Instruct thepatent to notify health-care professional if symptoms do not improve. Teach thepatient to take medication as directed and to finish thedrug completely. Azithromycin is contraindicated in patients with an allergy to erythromycin. PTS: 1

DIF: Easy

REF: Page 203

TOP: Therapeutic Classification: Antibiotics

KEY: Cognitive Level: Analysis

8. ANS: B See Implementation for becaplermin: Calculated amount is applied as a thin layer and covered with a moist saline dressing for 12 hr; dressing is removed, ulcer rinsed, and redressed with moist dressing without becaplermin for rest of day. Process is repeated daily. Store gel in refrigerator; do not freeze. If ulcer does not decrease in size by 30% within 10 wk, continuation of therapy should be reassessed. Cover with a moist saline dressing for 12 hr. Then, remove dressing, rinse ulcer, and redress with moist dressing without becaplermin for rest of day. PTS: 1

DIF: Hard

REF: Page 211

TOP: Therapeutic Classification: Therapeutic wound | Therapeutic Classification: Ulcer | Therapeutic Classification: Decubiti healing agents

KEY: Cognitive Level: Analysis

9. ANS: D See Indications for clorazepate: Clorazepate is used in themanagement of simple partial seizures, anxiety disorder, symptoms of anxiety, and acute alcohol withdrawal. Clopidogrel is an antiplatelet agent. Bupropion is an antidepressant. Omeprazole is an antiulcer agent. PTS: 1

DIF: Medium

REF: Drugguide.com

TOP: Therapeutic Classification: Anticonvulsants Application

KEY: Cognitive Level:

10. ANS: B See Nursing Implications/assessment for colchicine: In patients receiving prolonged therapy, monitor baseline and periodic CBC; may cause decreased platelet count, leukopenia, aplastic anemia, and agranulocytosis. No alteration in theblood pressure, triglyceride, or oxygenation is expected. PTS: 1

DIF: Hard

REF: Page 338

TOP: Therapeutic Classification: Antigout

KEY: Cognitive Level:

Application 11. ANS: C See Contraindications/Precautions for cyclobenzaprine: Should not be used within 14 days of MAO inhibitor therapy. Phenelzine is an MAO inhibitor. theother factors will not impact thesafe provision of cyclobenzaprine. PTS: 1

DIF: Hard

REF: Page 368 | Drugguide.com

TOP: Therapeutic Classification: Skeletal muscle relaxants KEY: Cognitive Level: Analysis 12. ANS: B See Implementation/Nursing Implications for Enablex: Extended-release tablets must be swallowed whole; do not break or crush. Doing so can result in theimmediate release of thefull dose. Enablex (darifenacin-XR) is a urinary tract antispasmodic. PTS: 1

DIF: Easy

KEY: Cognitive Level: Application 13. ANS: A

REF: Page 394

TOP: Therapeutic Classification: N/A

See Patient/Family Teaching for cetirizine: Advise patient that good oral hygiene, frequent rinsing of themouth with water, and sugarless gum or candy may minimize dry mouth. It is outside thenursing scope of practice to alter dosage of a medication. Dry mouth is not a symptom of an allergic reaction and thepatient does not need to be seen by a physician—if dry mouth persists beyond 2 wk, thepatient should notify a dentist. themedication can be taken without regard to food. PTS: 1

DIF: Medium

REF: Page 308

TOP: Therapeutic Classification: Allergy | Therapeutic Classification: Cold and cough remedies | Therapeutic Classification: Antihistamines

KEY: Cognitive Level: Analysis

14. ANS: C See Interactions for dextroamphetamine: St. John’s wort may increase serious side effects; concurrent use is not recommended. Dextroamphetamine is used in thetreatment of ADHD, so improved focus is a desired effect. Insomnia is commonly seen and thepatient should be instructed to take themedication at least 6 hr prior to bedtime. themedication is generally given 1–2 times each day, and missed doses should be taken as soon as remembered up to 6 hr prior to bedtime. PTS: 1

DIF: Medium

REF: Drugguide.com

TOP: Therapeutic Classification: Central nervous system stimulants KEY: Cognitive Level: Analysis 15. ANS: D See Nursing Implications for doxazosin: Assess for first-dose orthostatic hypotension and syncope. themedication can be used in thetreatment of benign prostatic hyperplasia, but orthostatic hypotension is a bigger concern and should be thefirst concern. No effect on therespiratory rate or pain is anticipated. PTS: 1

DIF: Easy

REF: Page 459

KEY: Cognitive Level: Application

See Indications for droperidol: Used to produce tranquilization and as an adjunct to general and regional anesthesia; useful in decreasing postoperative or postprocedure nausea and vomiting. Benadryl is an antihistamine used to treat itching. Morphine sulfate is a narcotic used to treat pain. Colace is a stool softener. PTS: 1

DIF: Medium

REF: Drugguide.com

TOP: Therapeutic Classification: Sedative/hypnotics

KEY: Cognitive Level: Application

17. ANS: C See Indications for duloxetine: Duloxetine is used for major depressive disorder, diabetic peripheral neuropathic pain, generalized anxiety disorder and fibromyalgia. Patient education and verification of his or her understanding regarding medication use and purpose is an important component of health care. PTS: 1

DIF: Medium

REF: Page 473

TOP: Therapeutic Classification: Antidepressants

KEY: Cognitive Level: Analysis

18. ANS: A See Indications for dantrolene: Emergency treatment of malignant hyperthermia, which can cause seizures. This is an emergency situation and must be thenurse’s highest priority. Desipramine is an antidepressant. It is not a priority. Darifenacin is used to treat overactive bladder spasms. It is not a priority. Duloxetine is an antidepressant. It is not a priority. PTS: 1

DIF: Hard

REF: Page 387 | Page 404 | Page 394 | Page 473

TOP: Therapeutic Classification: Skeletal muscle relaxants KEY: Cognitive Level: Analysis 19. ANS: D See Adverse Reactions/Side Effects GU for entacapone: This is a normal finding for patients taking entacapone. There is no need to take a specific action, and theassessments listed will not help determine thepresence of other side effects or concerns.

PTS: 1

DIF: Hard

REF: Page 490

TOP: Therapeutic Classification: Antiparkinsonian agents

KEY: Cognitive Level: Analysis

20. ANS: B See indications for methylergonovine: Prevention and treatment of postpartum or postabortion hemorrhage caused by uterine atony or involution. Methotrexate is a neoplastic agent that has been used to induce chemical abortion. Magnesium sulfate is given in thetreatment of preeclampsia. Terbutaline is used off label to reduce uterine contraction in theprevention of preterm labor. PTS: 1

DIF: Medium

REF: Page 824

TOP: Therapeutic Classification: Oxytocics

KEY: Cognitive Level: Application

21. ANS: C See Route/Dosage and Nursing Implications for ertapenem: Ertapenem dosage is 1 g daily for up to 14 days (IV). thedressing on a PICC line must remain occlusive to prevent infection—if thedressing should pull back, thehome-care nurse should be notified immediately. Ertapenem is given once daily. Persons with a negative history of penicillin sensitivity may still have an allergic response. PTS: 1

DIF: Medium

REF: Page 511

TOP: Therapeutic Classification: Anti-infectives

KEY: Cognitive Level: Analysis

22. ANS: D See Nursing Implications/Implementation for esomeprazole: theNG must be flushed after medication provision, and tube feeding should be held for at least 1 hr. Verifying patient identity with two unique identifiers is thecorrect way to ensure safe medication administration. For patients with an NG tube, delayed-release capsules can be opened and intact granules emptied into a 60 mL syringe and mixed with 50 mL of water. After administering, flush syringe with additional water. Provide at least 1 hr before meals. theNG tube must be flushed after medication provision, and tube feeding should be held for at least 1 hr. PTS: 1

DIF: Medium

REF: Pages 520–521

TOP: Therapeutic Classification: Antiulcer agents

KEY: Cognitive Level: Analysis

23. ANS: C See Adverse Reactions/Side effects for estradiol: CV risk for MI and thromboembolism; smoking increases risk of adverse CV reactions. Mesalamine is a GI anti-inflammatory agent used in thetreatment of ulcerative colitis and does not increase risk of thromboembolism. theplatelet count is normal and although all surgical patients have an increased risk for thromboembolism, thepatient taking estradiol is at higher risk. PTS: 1

DIF: Medium

REF: Page 522

TOP: Therapeutic Classification: Hormones

KEY: Cognitive Level: Analysis

24. ANS: D See Route/Dosage for eszopiclone: 2 mg immediately before bedtime. PTS: 1

DIF: Easy

REF: Page 528

TOP: Therapeutic Classification: Sedative/hypnotics

KEY: Cognitive Level: Application

25. ANS: C See Indications for famciclovir: Famciclovir is given for acute herpes zoster infection (shingles). PTS: 1

DIF: Easy

REF: Page 543

TOP: Therapeutic Classification: Antivirals

KEY: Cognitive Level: Analysis

26. ANS: B See Indications and Implementation for Fentanyl buccal/transmucosal: Used in themanagement of breakthrough pain in cancer patients already receiving and tolerant to around-the-clock opioid therapy for persistent cancer pain (60 mg/day of oral morphine or equivalent). thepatient’s ranking of pain, cancer diagnosis, and allergy to hydromorphone do not necessarily indicate that buccal fentanyl is an appropriate therapy.

PTS: 1

DIF: Hard

REF: Pages 555–557

TOP: Therapeutic Classification: Opioid analgesics

KEY: Cognitive Level: Analysis

27. ANS: B See flurazepam Patient/Family Teaching: Advise patient to take medication as prescribed (at bedtime). Teach sleep hygiene techniques (dark room, quiet, bedtime ritual, limit daytime napping, avoid nicotine and caffeine). Prolonged use may lead to psychological or physical dependence. PTS: 1

DIF: Easy

REF: Drugguide.com

TOP: Therapeutic Classification: Sedative/hypnotics

KEY: Cognitive Level: Analysis

28. ANS: B See Indications for golimumab: Golimumab is used in thetreatment of moderately to severely active rheumatoid arthritis (with methotrexate), treatment of active psoriatic arthritis (alone or with methotrexate), and treatment of active ankylosing spondylitis. PTS: 1

DIF: Medium

REF: Page 616

TOP: Therapeutic Classification: Antirheumatics

KEY: Cognitive Level:

Knowledge 29. ANS: A See Contraindications/Precautions, Nursing Implication/Assessment for golimumab: Use cautiously in patient with history of latent or active tuberculosis, when adequate treatment cannot be confirmed, antitubercular therapy should be considered. An increased risk of hypotension is not associated with this medication. An increased risk of ARDS is not associated with this medication. An increased risk of uncontrolled blood glucose levels is not associated with this medication. PTS: 1

DIF: Hard

REF: Page 616

KEY: Cognitive Level: Analysis

See Indications for guaifenesin: Guaifenesin is used for cough associated with viral upper respiratory tract infections. Lorazepam is a sedative. Acetaminophen is an analgesic. Granisetron is an antiemetic. PTS: 1

DIF: Medium

REF: Page 622

TOP: Therapeutic Classification: Allergy, cold

KEY: Cognitive Level:

Application 31. ANS: C See Patient/Family Teaching for hydralazine/isosorbide dinitrate: Inform thepatient that headache is a common side effect that should decrease with continuing therapy. Aspirin or acetaminophen may be ordered to treat headache. Notify thehealth-care provider if headache is persistent or severe. Do not later dose to avoid headache. Valid assessment would include vital signs and neurological examination because themedication is used in thetreatment of heart failure; however, headache is not a symptom of allergic reaction, and there is no immediate need to notify thephysician. Distraction techniques may be helpful but will not be thehighest priority. PTS: 1

DIF: Hard

REF: Page 648

TOP: Therapeutic Classification: Vasodilators

KEY: Cognitive Level: Analysis

32. ANS: D See indications for hydroxychloroquine. It is an antimalarial agent used in thesuppression/chemoprophylaxis of malaria, which is common in tropical areas. See indications for levetiracetam. It is an anti-seizure medication. See indications for infliximab. It is a monoclonal antibody used as an antirheumatic. See indications for memantine. It is an anti-Alzheimer’s agent. PTS: 1

DIF: Medium

REF: Page 761 | Page 681 | Page 807 | Page 655

KEY: Cognitive Level:

See Implementation for Ibandronate: Ibandronate should be taken with 6–8 oz of plain water (mineral water, orange juice, coffee, and other beverages decrease absorption) 60 min before beverages or food. Encourage patient to participate in regular exercise. Instruct patient on theimportance of taking as directed, first thing in themorning, 60 min before other medications, beverages, or food. If a dose is missed, skip dose and resume thenext morning. PTS: 1

DIF: Medium

REF: Page 661

TOP: Therapeutic Classification: Bone resorption inhibitors KEY: Cognitive Level: Analysis 34. ANS: B See Patient/Family Teaching for imipramine: Instruct thepatient to notify health-care professional if visual changes occur. Inform patient that periodic glaucoma testing may be needed during long-term therapy. Alert patient that urine may turn blue-green in color. Caution patient to change positions slowly to minimize orthostatic hypotension. Inform patient of need to monitor dietary intake, as possible increase in appetite may lead to undesired weight gain. PTS: 1

DIF: Medium

REF: Page 677

TOP: Therapeutic Classification: Antidepressants

KEY: Cognitive Level: Analysis

35. ANS: C See Nursing Implications and Patient/Family Teaching for albuterol: Advise patient that rinsing mouth after using inhaler, good oral hygiene, and sugarless gum or candy may minimize dry mouth. When ipratropium is administered concurrently with other inhalation medications, administer adrenergic bronchodilators (albuterol) first, followed by ipratropium, then corticosteroids. Wait 5 min between medications. Albuterol is theinhaler of choice with acute bronchospasm because theonset of action of ipratropium is too slow for patients in acute distress. PTS: 1

DIF: Medium

REF: Pages 121–122

See Evaluation/Desired Outcomes for quetiapine: Decrease in positive symptoms (delusions, hallucinations) of schizophrenia. PTS: 1

DIF: Medium

REF: Page 1065

TOP: Therapeutic Classification: Antipsychotics

KEY: Cognitive Level: Analysis

37. ANS: D See Indications for ketoconazole: Ketoconazole is indicated in thetreatment of candidiasis. See Indications for lamotrigine. It is an anticonvulsant. See Indications for labetalol. It is an anti-anginal beta blocker. See Indications for ketorolac. It is a nonsteroidal anti-inflammatory analgesic. PTS: 1

DIF: Hard

REF: Page 742 | Page 735 | Page 730 | Page 175

TOP: Therapeutic Classification: Antifungals

KEY: Cognitive Level: Application

38. ANS: C See IV administration for Ketorolac: Administer undiluted. Ketorolac may alter BUN, serum lipoproteins, potassium, triglycerides, and uric acid levels, but no effect on magnesium is expected. Allergy to morphine is not a contraindication for theuse of ketorolac. PTS: 1

DIF: Medium

REF: Page 732

TOP: Therapeutic Classification: Nonopioid analgesics

KEY: Cognitive Level: Application

39. ANS: D See Side Effects for lactulose: Belching, cramps, distention, flatulence, diarrhea, and hyperglycemia. PTS: 1

DIF: Medium

REF: Page 735

TOP: Therapeutic Classification: Laxatives 40. ANS: A

KEY: Cognitive Level: Application

See Action for lansoprazole, omeprazole, ondansetron, and calcium carbonate. While each of themedications may be used in thetreatment of gastric ulcer, theaction of lansoprazole and omeprazole are similar; both are proton pump inhibitors, and therefore substitution based on availability per hospital pharmacy registry is possible. PTS: 1

DIF: Easy

REF: Page 931 | Page 933 | Page 1145 | Page 258

TOP: Therapeutic Classification: Antiulcer

KEY: Cognitive Level: Analysis

41. ANS: B See Indications for lidocaine: Local infiltration/mucosal/topical anesthetic. Mouth rinses containing hydrogen peroxide help prevent infection but will not relieve thepain associated with oral mucositis. Normal saline rinses should be recommended frequently (every 2–4 hr) to keep themouth clean but will not help reduce pain with meals. Puree diet may be helpful but will not address thepatient’s report of pain. PTS: 1

DIF: Medium

REF: Page 767

TOP: Therapeutic Classification: Therapeutic analgesics

KEY: Cognitive Level: Application

42. ANS: C See Implementation for lidocaine/prilocaine: Apply the2.5 g tube of cream (one-half of the5 g tube) to each 2-inch by 2-inch area of skin in a thick layer. Cover so there is a thick layer of cream under theocclusive dressing. Do not spread out or rub in thecream. It must be applied at least 1 hr before thestart of theprocedure. PTS: 1

DIF: Medium

REF: Page 771

TOP: Therapeutic Classification: Anesthetics

KEY: Cognitive Level: Analysis

43. ANS: B See Nursing Implications for linezolid: Obtain specimens for culture and sensitivity prior to initiating therapy.

PTS: 1

DIF: Easy

REF: Page 775

TOP: Therapeutic Classification: Anti-infectives

KEY: Cognitive Level:

Application 44. ANS: C See IV Administration for lorazepam: Administer at a rate not to exceed 2 mg/min or 0.05 mg/kg over 2–5 min. themedication should be diluted and insulin syringes are reserved for insulin and are generally not used to provide IV medication. Dilute immediately before use with an equal amount of sterile water for injection, D5W or 0.9NS for injection. Rapid administration may result in apnea, hypotension, bradycardia, or cardiac arrest—hypertension is not expected. PTS: 1

DIF: Medium

REF: Page 787

TOP: Therapeutic Classification: Anesthetic adjunct

KEY: Cognitive Level: Analysis

45. ANS: B See Indications for Magnesium citrate oral solution: Bowel evacuant in preparation for surgical/radiographic procedures. Magnesium citrate oral solution is used as a bowel prep. Sustained-release tablets will not aid in theevacuation of bowel contents. Chewable tablets are used as electrolyte replacement or as an antacid. IV provision is used for electrolyte replacement. PTS: 1

DIF: Easy

REF: Page 794

TOP: Therapeutic Classification: Mineral and electrolyte replacement KEY: Cognitive Level: Application 46. ANS: A

See Indications and Evaluation for mannitol: Mannitol is used in thetreatment of acute oliguric renal failure, edema, and increased intracranial or intra-ocular pressure. Urine output of at least 30–50 mL/hr or an increase in urine output in accordance with parameters set by physician should be seen. Mannitol will have no effect on theWBC. Oxygenation may improve if intracranial pressure or fluid overload is effecting oxygenation, but this saturation is below normal and not indicative of effective treatment. Wide pulse pressures are indicative of increased intracranial pressure that should improve with mannitol treatment. PTS: 1

DIF: Hard

REF: Pages 797–799

TOP: Therapeutic Classification: Diuretics

KEY: Cognitive Level: Analysis

47. ANS: A See Nursing Implications for Meperidine: Monitor patients on chronic or high-dose therapy for CNS stimulation (restlessness, irritability, or seizures) due to accumulation of normeperidine metabolite. Risk of toxicity increases with doses greater than 600 mg/24 hr. Constipation is a concern for thepatient but is not thehighest priority. Insomnia is not expected because meperidine causes sedation. Triglyceride levels are not affected by meperidine. PTS: 1

DIF: Medium

REF: Page 809

TOP: Therapeutic Classification: Opioid analgesics

KEY: Cognitive Level: Analysis

48. ANS: D See Indications for mesalamine: Mesalamine is used for inflammatory bowel disease including ulcerative colitis, proctitis, and proctosigmoiditis. PTS: 1

DIF: Medium

REF: Page 813

TOP: Therapeutic Classification: Gastrointestinal anti-inflammatories KEY: Cognitive Level: Analysis 49. ANS: A

See Nursing Implications for metoclopramide: Assess patient for extrapyramidal side effects— difficulty speaking or swallowing, loss of balance, pill rolling, mask-like face, shuffling gait, rigidity, tremors, and dystonic reactions. Weight loss is concerning but not thehighest priority. Psychosocial concerns are important but are not thehighest priority. Psychosocial concerns are important but are not thehighest priority. PTS: 1

DIF: Medium

REF: Pages 836–837

TOP: Therapeutic Classification: Antiemetics

KEY: Cognitive Level: Analysis

50. ANS: A See Indications for misoprostol. Misoprostol is used in theprevention of gastric mucosal injury from NSAIDs in high-risk patients. See Indications for metoprolol. Metoprolol is a beta blocker. See Indications for metronidazole. Metronidazole is an anti-infective. See Indications for mirtazapine. Mirtazapine is an antidepressant. PTS: 1

DIF: Hard

REF: Page 857 | Page 839 | Page 842 | Page 855

TOP: Therapeutic Classification: Antiulcer agents

KEY: Cognitive Level: Analysis

51. ANS: B See Nursing Implications and Patient/Family Teaching for montelukast: Monitor closely for changes in behavior that could indicate theemergence or worsening of depression or suicidal thoughts. Montelukast is not to be used to treat acute asthmatic attacks. Take medication daily even if not experiencing symptoms of asthma. Instruct patient not to discontinue or reduce other asthma medications without consulting a health-care professional. PTS: 1

DIF: Medium

REF: Page 865

TOP: Therapeutic Classification: Allergy | Therapeutic Classification: Cold | Therapeutic Classification: Cough remedies 52. ANS: C

KEY: Cognitive Level: Analysis

See Availability for Bactroban: Ointment or cream. Impetigo is a skin infection characterized by honey-colored crusts often involving thenose or around theoral mucosa; treatment is topical. PTS: 1

DIF: Medium

REF: Page 870

TOP: Therapeutic Classification: Anti-infectives

KEY: Cognitive Level:

Application 53. ANS: C See Nursing Implications for nadolol: Assess patient routinely for evidence of fluid overload (including jugular vein distention). thefasting blood sugar is within accepted normal limits. Blood pressure is of a normal finding. Pulse is of a normal finding. PTS: 1

DIF: Medium

REF: Pages 877–878

TOP: Therapeutic Classification: Antianginals

KEY: Cognitive Level: Analysis

54. ANS: D See Indications, Dosage, and Availability for nystatin. Nystatin is used for local treatment of oropharyngeal candidiasis and can be taken as an oral suspension or as a lozenge. See Indications, Dosage, and Availability for nortriptyline. Nortriptyline is an antidepressant. See Indications, Dosage, and Availability for nimodipine. Nimodipine is a calcium channel blocker. See Indications, Dosage and Availability for olanzapine. Olanzapine is an antipsychotic. PTS: 1

DIF: Medium

REF: Page 916 | Page 914 | Pages 902–903 | Page 919

TOP: Therapeutic Classification: Antifungals

KEY: Cognitive Level: Application

55. ANS: C See Route/Dosage and IV administration for ondansetron: Prevention of chemotherapy-induced nausea/vomiting can be given as a single 32 mg dose 30 min prior to chemotherapy. Ondansetron can be diluted in D5W and 0.9 NaCl. PTS: 1

DIF: Medium

REF: Pages 933–934

TOP: Therapeutic Classification: Antiemetics

KEY: Cognitive Level: Application

56. ANS: A See Indications for oseltamivir: Oseltamivir is used in thetreatment of uncomplicated acute illness due to influenza infection in adults and children who have had symptoms for  2 days. Flu shot, current temperature, and egg allergy are not contraindications for Tamiflu. PTS: 1

DIF: Medium

REF: Page 936

TOP: Therapeutic Classification: Antivirals

KEY: Cognitive Level: Analysis

57. ANS: C See Indications for oxybutynin: Oxybutynin is used for urinary symptoms that may be associated with neurogenic bladder including frequent urination, urgency, nocturia, urge incontinence. theside effect profile does not include ringing in theears or night sweats. PTS: 1

DIF: Medium

REF: Page 944

TOP: Therapeutic Classification: Urinary tract antispasmodics

KEY: Cognitive Level: Analysis

58. ANS: B See Route/Dosage for Creon: One to three capsules before or with meals. PTS: 1

DIF: Medium

REF: Page 968

TOP: Therapeutic Classification: Digestive agents

KEY: Cognitive Level: Application

59. ANS: A See Nursing Implications for Paxil: Paxil is an antianxiety/antidepressant. It is important to monitor appetite and nutritional intake, weigh weekly, and notify health-care professional of continued weight loss. PTS: 1

DIF: Medium

REF: Pages 976–977

KEY: Cognitive Level: Analysis

60. ANS: B See Indications for Vitamin K: Phytonadione (vitamin K) is theantidote to oral anticoagulants. Phenytoin is an anticonvulsant. Phenobarbital is an anticonvulsant. Protamine sulfate is theantidote to heparin. PTS: 1

DIF: Easy

REF: Page 1015 | Page 1280

TOP: Therapeutic Classification: Antidotes

KEY: Cognitive Level: Application

61. ANS: A See Patient/Family Teaching for Actos: Instruct thepatient to take themedication as directed. If thedose for 1 day is missed, do not double thedose thenext day. Pioglitazone improves sensitivity to insulin and is used in thecontrol of diabetes. Pain is not a side effect or theindication for treatment so assessing pain is not pertinent to thestated problem. PTS: 1

DIF: Medium

REF: Pages 1019–1020

TOP: Therapeutic Classification: Antidiabetics

KEY: Cognitive Level: Analysis

62. ANS: A See Evaluation/Desired Outcomes and Nursing Implications for Potassium bicarbonate/potassium chloride: Potassium bicarbonate/potassium chloride is used to prevent or correct serum potassium depletion. thepatient’s serum potassium is low, and this places thepatient at risk for cardiac arrhythmias. themedication should be given. While theNG output is important, it is not thehighest priority. While thescheduled furosemide dose is important, it is not thehighest priority. PTS: 1

DIF: Medium

REF: Pages 1029–1030

TOP: Therapeutic Classification: Mineral and electrolyte replacement KEY: Cognitive Level: Analysis 63. ANS: D

See Nursing Implications for Actonel: Assess patient via bone density study for low bone mass before and periodically during therapy. PTS: 1

DIF: Medium

REF: Pages 1092–1093

TOP: Therapeutic Classification: Bone resorption inhibitors KEY: Cognitive Level: Application 64. ANS: C See Nursing Implications for rosiglitazone: Assess patient for edema and sings of CHF (dyspnea, rales/crackles, peripheral edema, weight gain, jugular venous distention). Rosiglitazone is used in thetreatment of diabetes mellitus, so an elevated serum glucose of 142 mg/dL is expected. Urine output is within normal limits. Apical pulse is within normal limits. PTS: 1

DIF: Medium

REF: Drugguide.com

TOP: Therapeutic Classification: Antidiabetics

KEY: Cognitive Level: Analysis

65. ANS: D See Patient/Family Teaching for salmeterol: Instruct patient using powder for inhalation never to exhale into diskus device and to always hold thedevice in a level, horizontal position. themouthpiece should be kept dry; never wash. PTS: 1

DIF: Medium

REF: Page 1114

TOP: Therapeutic Classification: Bronchodilators

KEY: Cognitive Level: Analysis

66. ANS: B See Implementation sennoside: Take with a full glass of water. Administer medication at bedtime for evacuation 6–12 hr later. Administer on an empty stomach for more rapid results. Determining resting pulse is not necessary or related to themedications action or side effects. Determining level of consciousness is not necessary or related to themedication’s action or side effects. PTS: 1

DIF: Medium

REF: Page 1123

KEY: Cognitive Level: Analysis

67. ANS: A See Nursing Implications for sitagliptin: Monitor for signs of pancreatitis (nausea, vomiting, anorexia, persistent severe abdominal pain, sometimes radiating to theback). Sitagliptin is used to improve glycemic control in type 2 diabetes. Headache is a recognized side effect and is not thehighest priority. Sitagliptin can be taken as monotherapy or in combination with metformin and a thiazolidinedione and/or a sulfonylurea. thehemoglobin A1C is normal. PTS: 1

DIF: Medium

REF: Page 1138

TOP: Therapeutic Classification: Antidiabetics

KEY: Cognitive Level: Analysis

68. ANS: D See Nursing Implications for tetracycline: Monitor bowel function. Diarrhea, abdominal cramping, fever, and bloody stools should be reported to thehealth-care professional promptly as a sign of pseudomembranous colitis. It may begin up to several weeks following cessation of therapy. PTS: 1

DIF: Medium

REF: Pages 1186–1187

TOP: Therapeutic Classification: Anti-infectives

KEY: Cognitive Level: Analysis

69. ANS: A See Nursing Implications for levothyroxine: Assess apical pulse and blood pressure prior to and periodically during therapy. Assess for tachyarrhythmias and chest pain. PTS: 1

DIF: Medium

REF: Page 766

TOP: Therapeutic Classification: Hormones

KEY: Cognitive Level: Application

70. ANS: B See Interactions for vardenafil: Concurrent use of nitrates may cause serious life-threatening hypotension and is contraindicated. Concurrent use of Class IA antiarrhythmics (such as quinidine or procainamide) or Class III antiarrhythmics (such as amiodarone or sotalol) increase risk of serious arrhythmias and should be avoided. Copyright © 2017 F. A. Davis Company

PTS: 1

DIF: Hard

REF: Page 1246

TOP: Therapeutic Classification: Erectile dysfunction agents

KEY: Cognitive Level:

Application 71. ANS: C See Nursing Implications/Implementation for zolpidem: Protect patient from injury; raise bed side rails. Assist with ambulation. Increasing fluid intake is not necessary and will increase risk of falls due to nocturnal urination. thepatient should not get up without assistance in thehospital environment. Documentation is not thehighest priority. PTS: 1

DIF: Medium

REF: Pages 1295–1296

TOP: Therapeutic Classification: Sedative/hypnotics

KEY: Cognitive Level: Analysis

72. ANS: A See Adverse Reactions/Side Effects for hydrocodone, isosorbide, and furosemide: May cause confusion, dizziness, sedation; dizziness, hypotension; hypotension. Orthostatic hypotension is a common concern for patients receiving these medications. There is no correlation between thepatient’s breakfast and a need to take a short walk. Pain relief will be optimal approximately 1 hr after theadministration of theVicodin and will begin to fade within 3–4 hr. It is important to walk postoperative patients if at all possible to prevent theformation of thromboembolism. PTS: 1

DIF: Medium

REF: Page 649 | Page 721 | Page 598

TOP: Therapeutic Classification: Opioid analgesics

KEY: Cognitive Level: Analysis

73. ANS: B See Adverse Reactions/Side Effects for Aminoglycosides: Ototoxicity is a side effect associated with aminoglycosides including gentamycin. theother anti-infective agents are not associated with ototoxicity. PTS: 1

DIF: Medium

REF: Page 138

TOP: Therapeutic Classification: Anti-infectives

KEY: Cognitive Level: Analysis

74. ANS: B See Nursing Implications for Adalimumab: Adalimumab prevents and alters theaction of tumor necrosis factor. This drug is used in thetreatment of severe rheumatoid arthritis. Adverse side effects include therisk for serious infections. thenurse should monitor for early signs and symptoms of infection. PTS: 1

DIF: Easy

REF: Page 112

TOP: Drug: Humira (adalimumab)

KEY: Cognitive Level: Analysis 75. ANS: C See Indications for dabigatran: Dabigatran is an anticoagulant that is approved for thetreatment of atrial xfibrillation. It lowers therisk of blood clot development. PTS: 1

DIF: Easy

REF: Page 379

TOP: Drug: Pradaxa (dabigatran)

KEY: Cognitive Level: Knowledge 76. ANS: A See Adverse Reactions/Side Effects for pregabalin: An adverse reaction to pregabalin is thrombocytopenia, which would cause petechiae. Poor appetite, increased heart rate and vomiting are not adverse reactions to pregabalin PTS: 1

DIF: Hard

REF: Page 1026

TOP: Drug: Lyrica (pregabalin)

KEY: Cognitive Level: Analysis 77. ANS: D See Implementation for zoledronic acid: Zoledronic acid is a bone resorption inhibitor that is administered intravenously as a single infusion over at least 15 min. PTS: 1

DIF: Medium

REF: Page 1292

TOP: Drug: Reclast (zoledronic acid)

KEY: Cognitive Level: Application 78. ANS: D See Route/Dosage for Gardasil: Gardasil is a vaccine to protect against HPV. Gardasil is given in a series of three injections. After thefirst dose is administered, thesecond dose should be administered 2 months later. thelast dose is given 6 months after thefirst dose. PTS: 1

DIF: Easy

REF: Page 644

TOP: Drug: Gardasil (human papillomavirus quadrivalent vaccine, recombinant) KEY: Cognitive Level: Synthesis 79. ANS: A See Indications and Nursing Implications for atrovastatin: Atorvastatin is given to help manage cholesterol levels but when taken alone it will not cure elevated serum cholesterol levels. thenurse should ask Mr. Jacobs about his dietary history. To lower serum cholesterol levels a diet low in fat, cholesterol, carbohydrates, and alcohol should be consumed in conjunction with taking Lipitor. PTS: 1

DIF: Hard

TOP: Drug: Lipitor (atorvastatin)

REF: Pages 643–644 KEY: Cognitive Level: Synthesis

80. ANS: A See Indications/Nursing Implications for aripiprazole: Aripiprazole is used as an add-on medication when an antidepressant alone is not effective. If antidepressants have been used for at least 6 weeks and symptoms of major depressive disorder exist, aripiprazole can be added in addition to an antidepressant. PTS: 1

DIF: Medium

KEY: Cognitive Level: Knowledge 81. ANS: B

REF: Page 185

TOP: Drug: Abilify (aripiprazole)

See Indications and Patient/Family Teaching for Advair Diskus (fluticasone and salmeterol): Advair Diskus is an anti-inflammatory and long-acting bronchodilator used for COPD, chronic bronchitis, and emphysema. Advair Diskus is an inhalation cased medication that carries a side effect of thrush in themouth; therefore, themouth should be rinsed with water after each use. Advair requires theperson to puncture thecapsule in a sealed container prior to inhalation. PTS: 1

DIF: Medium

REF: Pages 351–355 | Page 1114

TOP: Drug: Advair (fluticasone and salmeterol)

KEY: Cognitive Level:

Application 82. ANS: A See Indications for Restasis: Restasis is an ophthalmic emulsion used to increase tear production and provide temporary relief for those with chronic dry eye syndrome. PTS: 1

DIF: Easy

TOP: Drug: Restasis (cyclosporine)

REF: Page 1401 (ophthalmic medications) KEY: Cognitive Level: Comprehension

83. ANS: A See Indications and Evaluation/Desired Outcomes for dopamine: Dopamine is a vasopressor agent used to treat shock that does not respond to fluid replacement. A desired outcome of dopamine is increased blood pressure, cardiac output, and urine output. PTS: 1

DIF: Easy

TOP: Drug: Dopamine (Intropin)

REF: Pages 455–456 KEY: Cognitive Level: Synthesis

84. ANS: D See Nursing Implications/Implementation for golimumab : A tuberculin skin test should be administered prior to theadministration of golimumab. There is serious risk for thedevelopment of tuberculosis while taking this medication. If a test indicates thepresence of latent tuberculosis, treatment must be initiated prior to initiation of golimumab.

PTS: 1

DIF: Medium

REF: Page 617

TOP: Drug: Simponi (golimumab)

KEY: Cognitive Level: Synthesis 85. ANS: C See Nursing Implications for digoxin: Digoxin should be held if an apical pulse is less than 70 beats per minute in a child. thehealth-care provider should be notified. PTS: 1

DIF: Easy

TOP: Drug: Lanoxin (digoxin)

REF: Pages 425–426 KEY: Cognitive Level: Application

86. ANS: C See Nursing Implications for Potassium Iodide: Thyroid crisis is a severe hyperthyroid response. thetherapeutic effect of potassium iodide is to slow therelease and synthesis of thyroid hormones. PTS: 1

DIF: Medium

REF: Pages 705–706

TOP: Drug: Potassium Iodide (iodine, iodide)

KEY: Cognitive Level: Comprehension

87. ANS: B See Indications for levothyroxine: Levothyroxine is a thyroid supplement for thetreatment of hypothyroidism. It is necessary to monitor theheart rate and rhythm, blood pressure, and chest pain. These symptoms are associated with hyperthyroidism, indicating that thepatient is overdosed or has a toxic level of levothyroxine. PTS: 1

DIF: Easy

REF: Page 766

TOP: Drug: Synthroid (levothyroxine)

KEY: Cognitive Level: Application 88. ANS: C See Route/Dosage for cyanocobalamin: Cyanocobalamin is a vitamin B 12 preparation used in thetreatment of pernicious anemia. thepreferred route of administration is monthly intramuscular injection.

PTS: 1

DIF: Easy

REF: Page 1269

TOP: Drug: Vitamin B12 (cyanocobalamin)

KEY: Cognitive Level: Comprehension

89. ANS: D See Indications for furosemide: Furosemide is a diuretic that will decrease potassium levels. A diet high in potassium is needed to replace potassium that is lost. Cauliflower, cabbage, and yogurt are high in vitamin K. Macaroni and cheese, deli meat, and buttermilk are high in sodium. Clams, oysters, and broccoli are high in calcium. Potatoes, milk, and prune juice have high potassium levels. PTS: 1

DIF: Medium

TOP: Drug: Lasix (furosemide)

REF: Page 598 | Appendix J KEY: Cognitive Level: Synthesis

90. ANS: B See Indications and Adverse Reactions/Side Effects for amiodarone: Amiodarone is used to treat ventricular arrhythmias. A common side effect of amiodarone is photosensitivity that can occur through window glass and thin clothing. PTS: 1

DIF: Medium

TOP: Drug: Cordarone (amiodarone)

REF: Pages 142–143 KEY: Cognitive Level: Analysis

91. ANS: D See Route/Dosage for Maalox: Maalox is an antacid and should be given 1–3 hr after meals and at bedtime. This medication should not be given at thesame time as other medications are being taken. PTS: 1

DIF: Easy

KEY: Cognitive Level: Synthesis 92. ANS: C

REF: Page 793

TOP: Drug: Maalox

See Indications and Contraindications/Precautions for memantine: Memantine is an anti-Alzheimer’s agent. Its therapeutic effect is to decrease symptoms of dementia. Memantine is metabolized through tubular reabsorption and excreted by thekidneys. This drug should be used cautiously in those with renal impairment, urinary tract infections, or those with renal tubular necrosis. PTS: 1

DIF: Easy

REF: Page 807

TOP: Drug: Namenda (memantine)

KEY: Cognitive Level: Synthesis 93. ANS: B See Indications for Niacin: Also known as vitamin B3, Niacin is required for lipid metabolism, glycogenolysis, and tissue repair. thetherapeutic effect of niacin is to decrease blood lipids. PTS: 1

DIF: Medium

TOP: Drug: Niaspan (niacin)

REF: Pages 891–892 KEY: Cognitive Level: Analysis

94. ANS: D See Nursing Implications/Implementation for NitroMist: can be applied as a spray under thetongue or on thetongue. PTS: 1

DIF: Medium

REF: Page 907

TOP: Drug: NitroMist (nitroglycerine translingual spray)

KEY: Cognitive Level: Application

95. ANS: A See Indications, Action, and Patient Family Teaching for Revatio: a form of sildenafil, a vasodilator for thetreatment of pulmonary arterial hypertension or as an erectile dysfunction agent. thepatient must know to notify a health-care provider if an erection occurs that lasts for more than 4 hr. PTS: 1

DIF: Medium

REF: Page 1128

TOP: Drug: Revatio (sildenafil)

See Indications, Adverse Reactions and assessment for nateglinide: Nateglinide is an antidiabetic agent intended to lower blood glucose. Too much of this medication or sensitivity to themedication could cause hypoglycemia. Symptoms such as weakness, dizziness, tachycardia, tremors, and anxiety would indicate hypoglycemia. PTS: 1

DIF: Easy

TOP: Drug: Starlix (nateglinide)

REF: Drugguide.com KEY: Cognitive Level: Comprehension

97. ANS: B See Indications and Nursing Implications for Januvia: an antidiabetic agent for those with type 2 diabetes. A hemoglobin A1C provides a 3-month window of glycemic control. PTS: 1

DIF: Medium

REF: Page 1136

TOP: Drug: Januvia (sitagliptin)

KEY: Cognitive Level: Application 98. ANS: A See Nursing Implications for Percodan: should not be given to people with bleeding tendencies because it is a combination drug made of oxycodone and aspirin. PTS: 1

DIF: Medium

REF: Page 946 | Page 1111

TOP: Drug: Percodan (oxycodone and aspirin)

KEY: Cognitive Level: Application

99. ANS: A See Indications, Nursing implications/Assessment and Implementation for dalteparin: Dalteparin is an anticoagulant in theform of a low molecular weight heparin. It is administered in theabdomen and may cause ecchymosis or inflammation around theinjection site. Bleeding gums, nosebleeds, hematuria, black tarry stools, or unusual bleeding may indicate an adverse reaction. Dalteparin can be injected into theabdomen, and ecchymosis around theabdomen is common. PTS: 1

DIF: Hard

REF: Pages 632–635 KEY: Cognitive Level: Analysis

100. ANS: D See class of fluoroquinolones: These drugs fall under thecategory of fluoroquinolones, which are used in thetreatment of bacterial infection by inhibiting bacterial synthesis. PTS: 1

DIF: Easy

REF: Page 574

TOP: Drug: Fluoroquinolones

KEY: Cognitive Level: Comprehension 101. ANS: C See Indications and Nursing Implications/Lab, Evaluation/Desired Outcomes for abacavir: Abacavir is an antiretroviral used in combination with other drugs to manage HIV infection. thetherapeutic action of abacavir is to slow theprogression of HIV infection. theeffectiveness of abacavir can be determined by a decreased viral load and an increased CD4 cell count. PTS: 1

DIF: Easy

REF: Pages 95–96 TOP: Drug: Ziagen (abacavir)

KEY: Cognitive Level: Analysis 102. ANS: B See Indications, and Patient Family Teaching for Clonidine: Clonidine is an antihypertensive. People taking clonidine should avoid activities that require sudden change in body positions because of risk for orthostatic hypotension. Squat thrusts require a person to go from an upright erect position to a squat with thelegs extended and return to an upright position in a fluid motion. PTS: 1

DIF: Medium

REF: Page 330

TOP: Drug: Catapres (clonidine)

KEY: Cognitive Level: Synthesis 103. ANS: B See Nursing Implications and Patient Family Teaching for Pulmicort Respules: Pulmicort Respules are administered through a nebulizer. Wash face after use of face mask. PTS: 1

DIF: Medium

REF: Page 352

TOP: Drug: Pulmicort Respules (budesonide)

KEY: Cognitive Level: Comprehension

104. ANS: A See Implementation for Corticosteroids (nasal)/beclomethasone: Beclomethasone is an inhaled corticosteroid used for those with asthma. Inhaled doses of corticosteroids should be spaced by at least 1 min. PTS: 1

DIF: Medium

TOP: Drug: Beclomethasone

REF: Page 351 | Appendix D KEY: Cognitive Level: Application

105. ANS: D See Patient/Family Teaching for corticosteroids inhalation route: When taking inhaled corticosteroids and bronchodilators, thebronchodilator should be administered first. Allow 5 min to elapse and then administer thecorticosteroid. PTS: 1

DIF: Medium

REF: Page 351

TOP: Drug: Corticosteroids and Bronchodilators

KEY: Cognitive Level:

Application 106. ANS: B See Nursing Implications/Patient Family Teaching for transmucosal fentanyl: theadministration of transmucosal fentanyl, available as Actiq, should be placed between thecheek and lower gum moving it from one side to another using thehandle of theapplicator. themedication is consumed by sucking on theapplicator over a period of 15 min or longer. thepatient should not chew or swallow themedication. PTS: 1

DIF: Medium

TOP: Drug: Sublimaze (fentanyl) 107. ANS: C

REF: Pages 557–558 KEY: Cognitive Level: Application

See Implementation for Iron dextran: Iron dextran is administered via intramuscular injection and should be given into theventrogluteal site because it may permanently stain theskin. It should be injected deeply into thetissue using a Z track method. To decrease thestaining of subcutaneous tissue, theneedle should be changed between withdrawal of themedication prior to injection. thedorsogluteal site is not recommended because of risk for sciatic nerve injury. PTS: 1

DIF: Easy

TOP: Drug: Iron dextran

REF: Pages 716–717 KEY: Cognitive Level: Analysis

108. ANS: B See Nursing Implications/Assessment/labs for isoniazid: AST and ALT are associated with liver function tests. Isoniazid is an antitubercular medication used for thetreatment and prevention of tuberculosis. This medication is primarily metabolized and excreted by theliver. Isoniazid should be used cautiously in those with liver disease or chronic alcoholism. Liver function tests must be evaluated prior to and monthly throughout therapy for drug-induced hepatitis. PTS: 1

DIF: Medium

REF: Page 720

TOP: Drug: INH (isoniazid)

KEY: Cognitive Level: Synthesis 109. ANS: D See Indications and Nursing Implications/Implemention for Lunesta: given for thetreatment of insomnia. Because of its rapid onset, Lunesta should be taken immediately before going to bed and during a time frame that allows for at least 8 hr of sleep. To maximize effectiveness, Lunesta should not be taken with a high-fat or heavy meal. PTS: 1

DIF: Easy

REF: Page 528

TOP: Drug: Lunesta (eszopiclone)

KEY: Cognitive Level: Comprehension 110. ANS: D See Nursing Implications/Assessment for Vancomycin: theeighth cranial nerve must be monitored during use of Vancomycin because of risk for permanent hearing loss. Copyright © 2017 F. A. Davis Company

PTS: 1

DIF: Medium

REF: Page 1242

TOP: Drug: Vancomycin

KEY: Cognitive Level: Synthesis 111. ANS: A See Indications for Ascorbic acid (Vitamin C). Ascorbic Acid is administered as a nutritional supplement and in thetreatment of vitamin C deficiency as seen with scurvy. PTS: 1

DIF: Medium

TOP: Drug: Ascorbic acid

REF: Drugguide.com KEY: Cognitive Level: Application

112. ANS: D See Patient/Family Teaching for Chondroitin: Chondroitin helps to build bone cartilage and is often taken in conjunction with glucosamine. In order for chondroitin to be effective, it should be taken consistently for an extended period of time. PTS: 1

DIF: Medium

TOP: Drug: Chondroitin

REF: Drugguide.com KEY: Cognitive Level: Comprehension

113. ANS: B Echinacea is an herbal supplement used to ward off theseverity of bacterial and viral infections by stimulating theimmune system. It should be taken only when thesymptoms of a cold appear. It should not be taken as a preventative and should not be used for more than 10–14 days. Using echinacea for more than 8 weeks may generate an overstimulation of theimmune system and cause immunosuppression. PTS: 1

DIF: Easy

KEY: Cognitive Level: Synthesis 114. ANS: B

REF: Page 1331

TOP: Drug: Echinacea

See Indications and action for Dipentum (olsalazine): Dipentum is used in thetreatment of ulcerative colitis for those who have an allergy to sulfa. Sulfasalazine is frequently thedrug of choice for thetreatment of ulcerative colitis but cannot be used in this scenario because of theallergy to sulfa. PTS: 1

DIF: Medium

REF: Page 925

TOP: Drug: Dipentum (olsalazine)

KEY: Cognitive Level: Application 115. ANS: B See Patient/Family Teaching for alendronate. themedication should be taken first thing in themorning, 30 min before any other medications, beverages, or food. Waiting longer than 30 min will improve absorption. Alendronate should be taken with 6–8 oz of plain water (mineral water, orange juice, coffee, and other beverages decrease absorption). PTS: 1

DIF: Medium

REF: Page 123

TOP: Therapeutic Classification: Bone resorption inhibitors KEY: Cognitive Level: Application 116. ANS: D See Patient/Family Teaching for almotriptan. A female patient should not use almotriptan if she is pregnant, suspects she is pregnant, plans to become pregnant, or is breastfeeding. PTS: 1

DIF: Medium

REF: Page 129

TOP: Therapeutic Classification: Vascular headache suppressants KEY: Cognitive Level: Analysis 117. ANS: A See Implementation for alprazolam. Tablets may be crushed and taken with food or fluids if patient has difficulty swallowing. PTS: 1

DIF: Medium

REF: Page 131

TOP: Therapeutic Classification: Antianxiety agents

KEY: Cognitive Level: Application

118. ANS: A See Adverse Reactions/Side effects for aluminum hydroxide. Constipation is themost common side effect with this medication. PTS: 1

DIF: Medium

REF: Page 132

TOP: Therapeutic Classification: Antiulcer

KEY: Cognitive Level: Application

119. ANS: C See Route/Dosage for acetaminophen. This order should be transcribed as written. Since it is a safe daily dose, there is no reason to question the safety of the order unless hepatic or renal insufficiency is suspected. Nurses cannot alter physician’s orders, and since this is written as a prn order, it cannot be scheduled TID. PO (adults and children greater than 12 yrs): 325–650 mg q 4–6 hr or 1 g 3–4 times daily or 1,300 mg q 8 hr (not to exceed 4 g or 2.5 g/24 hr in patients with hepatic/renal impairment). PTS: 1

DIF: Medium

REF: Page 101

TOP: Therapeutic Classification: Antipyretics

KEY: Cognitive Level: Analysis

120. ANS: A See Contraindications propanolol. Beta blockers (olol) are contraindicated in the presence of pulmonary disease including asthma due to the potential interaction with beta receptors in the pulmonary tissue. PTS: 1

DIF: Medium

REF: Page 1049

TOP: Therapeutic Classification: Antiarrhythmics/Antihypertensives KEY: Cognitive Level: Analysis 121. ANS: C

See Implementation and Patient/Family Teaching for amlodipine. Norvasc may be administered without regard to meals. Caution patient to change positions slowly to minimize orthostatic hypotension. Instruct patient to contact health-care professional if heart rate is less than 50 bpm. Instruct patient to avoid concurrent use of alcohol or OTC medications, especially cold preparations, without consulting a health-care professional. PTS: 1

DIF: Medium

REF: Page 148

TOP: Therapeutic Classification: Antihypertensives

KEY: Cognitive Level: Analysis

122. ANS: B See Interactions for amphetamine mixtures. The Meperidine must be held since use of Adderall XR with MAO inhibitors or Meperidine can result in hypertensive crisis. PTS: 1

DIF: Easy

REF: Page 153

TOP: Therapeutic Classification: Central nervous system stimulants KEY: Cognitive Level: Analysis 123. ANS: B See Indications for Antifungals vaginal: Monistat (miconazole) is given for the treatment of vulvovaginal candidiasis, and the patient is both at risk for and has signs of a yeast infection. PTS: 1

DIF: Medium

REF: Page 177

TOP: Therapeutic Classification: Antifungals

KEY: Cognitive Level: Analysis

124. ANS: C See Patient/Family Teaching for atenolol. Atenolol should be taken as directed at the same time each day, even if feeling well; do not skip or double up on missed doses. Take missed doses as soon as possible up to 8 hr before next dose. Abrupt withdrawal may cause life-threatening arrhythmias, hypertension, or myocardial ischemia. Atenolol is typically given in daily doses. It is not important to determine why the patient forgot the missed dose.

PTS: 1

DIF: Medium

REF: Pages 195–196

TOP: Therapeutic Classification: Antihypertensives

KEY: Cognitive Level: Analysis

125. ANS: C See Indications for baclofen. Baclofen is used in the treatment of reversible spasticity due to multiple sclerosis or spinal cord lesions. PTS: 1

DIF: Easy

REF: Page 209

TOP: Therapeutic Classification: Skeletal muscle relaxants KEY: Cognitive Level: Knowledge 126. ANS: D See Contraindications/Precautions for salicylates. Anaflex is a salicylate that is contraindicated in patients with hypersensitivity to aspirin, tartrazine (FDC yellow dye #5), or other salicylates. Patients should be assessed for allergy to salicylates. PTS: 1

DIF: Hard

REF: Page 1111

TOP: Therapeutic Classification: Salicylates

KEY: Cognitive Level: Application

127. ANS: B See Action for benzonatate: Tessalon anesthetizes cough or stretch receptors in vagal nerve afferent fibers found in lungs, pleura, and respiratory passages. It may also decrease transmission of the cough reflex centrally. Therapeutic Effects: Decrease in cough. PTS: 1

DIF: Medium

REF: Drugguide.com

TOP: Therapeutic Classification: Allergy, cold, and cough remedies KEY: Cognitive Level: Comprehension 128. ANS: D

See Patient/Family Teaching for bisacodyl. It is important for clients to consume 1,500–2,000 mL of fluid each day. One cup is 240 mL, so this patient is not drinking sufficient quantities of fluid. The use of laxatives should be limited. Colace may be administered at bedtime for morning results. Instruct patients with cardiac disease to avoid straining during bowel movements. PTS: 1

DIF: Medium

REF: Page 221

TOP: Therapeutic Classification: Laxatives

KEY: Cognitive Level: Analysis

129. ANS: A See Patient/Family Teaching for bismuth subsalicylates. It is important to determine if the child has a febrile illness since this product contains aspirin and it has been associated with Reye syndrome. Individuals with diarrhea need to notify a health-care professional if diarrhea lasts more than 2 days or is accompanied by a fever. It will be important to determine if the child is improving, but that is not the highest priority. Determining if the child has had diarrhea in the past will not clarify the current concern, nor is the child’s preference for the medication important. PTS: 1

DIF: Hard

REF: Page 222

TOP: Therapeutic Classification: Antidiarrheals

KEY: Cognitive Level:

Application 130. ANS: B See Nursing Implications for bumetanide. Assess patients receiving digoxin for anorexia, nausea, vomiting, muscle cramps, paresthesia, and confusion  risk of digoxin toxicity due to the potassiumdepleting effect of diuretic. Potassium supplements or potassium-sparing diuretics may be used concurrently to prevent hypokalemia. Patients taking lanoxin need to monitor pulse rate. The medications are given to improve cardiac output and reduce fluid overload; they are not intended to make the heart beat faster. PTS: 1

DIF: Medium

REF: Page 235

131. ANS: D See Contraindications/Precautions for bupropion. Extreme caution should be exercised in patients with a history of seizures. Wellbutrin can be used for smoking cessation, so there are no precautions necessary due to smoking. No contraindication for birth control pills or antihypertensives is listed. PTS: 1

DIF: Hard

REF: Page 242

TOP: Therapeutic Classification: Antidepressants

KEY: Cognitive Level: Analysis

132. ANS: C See Patient/Family Teaching for buspirone. Advise patient to consult a health-care professional before taking OTC medications or herbal products with this drug. It may cause dizziness or drowsiness. Caution patient to avoid driving or other activities requiring alertness until response to the medication is known. Advise patient to avoid concurrent use of alcohol or other CNS depressants. PTS: 1

DIF: Medium

REF: Page 247

TOP: Therapeutic Classification: Antianxiety agents KEY: Cognitive Level: Analysis | Cognitive Level: Application 133. ANS: D See Nursing Implications for busulfan. High Alert: Monitor for bone marrow depression. Assess for bleeding (bleeding gums, bruising, petechiae, guaiac stools, urine, or emesis). Institute thrombocytopenia precautions if platelet count is less than 150,000/mm 3. The nonhematological values are within normal limits. PTS: 1

DIF: Medium

REF: Page 248

TOP: Therapeutic Classification: Antineoplastic agents 134. ANS: B

KEY: Cognitive Level: Analysis

See Nursing Implications for butorphanol. Assess blood pressure, pulse, and respirations before and periodically during administration. If respiratory rate is less than 10 breaths/min, assess level of sedation. PTS: 1

DIF: Medium

REF: Drugguide.com

TOP: Therapeutic Classification: Opioid analgesics

KEY: Cognitive Level: Application

135. ANS: B See Implications for calcitonin. Miacalcin is used as adjunct therapy in the treatment of hypocalcemia. PTS: 1

DIF: Medium

REF: Page 256

TOP: Therapeutic Classification: Hypocalcemics

KEY: Cognitive Level:

Application 136. ANS: D See Patient/Family Teaching for Calcium Salts. Calcium carbonate is indicated for calcium supplementation, but patients should be instructed to get sufficient amounts of vitamin D in their diet. PTS: 1

DIF: Medium

REF: Page 261

TOP: Therapeutic Classification: Mineral and electrolyte supplements KEY: Cognitive Level: Analysis 137. ANS: C See Indications for carisoprodol. Adjunct to rest and physical therapy in the treatment of muscle spasm associated with acute painful musculoskeletal conditions. PTS: 1

DIF: Medium

REF: Page 277

TOP: Therapeutic Classification: Skeletal muscle relaxants KEY: Cognitive Level: Knowledge

138. ANS: B See Nursing Implications for carvedilol. Coreg is an antihypertensive. The nurse must monitor patient pulse and blood pressure frequently during dose adjustments. PTS: 1

DIF: Medium

REF: Pages 279–280

TOP: Therapeutic Classification: Antihypertensives

KEY: Cognitive Level: Application

139. ANS: D See Implementation for celecoxib. Capsules may be opened and sprinkled on applesauce. PTS: 1

DIF: Easy

REF: Page 290

TOP: Therapeutic Classification: Antirheumatics; nonsteroidal anti-inflammatory agents KEY: Cognitive Level: Application 140. ANS: C See Evaluation for cetirizine. Patients taking Zyrtec expect to receive relief from seasonal allergy symptoms. PTS: 1

DIF: Medium

REF: Page 308

TOP: Therapeutic Classification: Allergy, cold, and cough remedies KEY: Cognitive Level: Analysis 141. ANS: B See Nursing Implications for chilostazol. Pletal is given to reduce the symptoms of intermittent claudication and improve walking endurance. It is taken on an empty stomach, 1 hr before or 2 hr after meals and should not be taken with grapefruit juice to avoid increased cilostazol levels. PTS: 1

DIF: Medium

REF: Page 314

KEY: Cognitive Level: Analysis

See Indications for citalopram. Celexa is used in the treatment of depression. It may cause serious, potentially fatal reactions when used with MAO inhibitors and should be used cautiously with other centrally acting drugs including alcohol. PTS: 1

DIF: Medium

REF: Page 318

TOP: Therapeutic Classification: Antidepressants

KEY: Cognitive Level:

Application 143. ANS: D Feedback: See Patient/Family Education for clonazepam. Klonopin is an anticonvulsant that cannot be stopped abruptly. It is important to notify health-care professionals of medication regimen prior to treatment or surgery. PTS: 1

DIF: Medium

REF: Pages 325–326

TOP: Therapeutic Classification: Anticonvulsants

KEY: Cognitive Level:

Comprehension 144. ANS: C See Nursing Assessment for clopidogrel. Plavix is an antiplatelet medication, so it is important to monitor bleeding time throughout therapy. PTS: 1

DIF: Medium

REF: Page 331

TOP: Therapeutic Classification: Antiplatelets KEY: Cognitive Level: Comprehension | Cognitive Level: Application 145. ANS: B See Indications for naloxone, and/or Nursing Implications/Toxicity Overdose for Codeine. Codeine is a narcotic, and Narcan is an antidote for narcotic overdose. PTS: 1

DIF: Medium

REF: Page 336

KEY: Cognitive Level: Application

146. ANS: A See Indications for darbepoetin, filgrastim, granisetron, and clopidrogel. The patient is exhibiting symptoms associated with anemia, which is common with chemotherapy. Aranesp is one of the erythroid colony–stimulating factors designed to stimulate production of red blood cells and improve symptoms associated with chemotherapy-induced anemia. PTS: 1

DIF: Medium

REF: Page 391 | Page 563 | Page 620 | Page 330

TOP: Therapeutic Classification: Antianemics

KEY: Cognitive Level: Application

147. ANS: C See Nursing Implications for diazepam. Parenteral therapy with Valium may alter vital signs or cause sedation, increasing the patient’s risk for falls. Patient should be kept on bed rest and observed for at least 3 hr following parenteral administration. Valium will not alter serum calcium levels, induce dieresis, or alter core temperature. PTS: 1

DIF: Hard

REF: Pages 417–418

TOP: Therapeutic Classification: Antianxiety, anticonvulsants, sedatives, and skeletal muscle relaxants KEY: Cognitive Level: Application 148. ANS: D See Nursing Assessment for digoxin. Monitor apical pulse for 1 full min before administering. Withhold dose and notify physician if pulse rate is less than 60 bpm in an adult. PTS: 1

DIF: Easy

REF: Page 425

TOP: Therapeutic Classification: Antiarrhythmics Application 149. ANS: B

KEY: Cognitive Level:

See Patient/Family Teaching for dicyclomine. Advise patient to notify a health-care professional immediately if eye pain or increased sensitivity to light occurs. Medication may cause drowsiness and blurred vision. Caution patient to avoid driving or other activities requiring alertness until response to the medication is known. Advise patient receiving dicyclomine to make position changes slowly to minimize the effects of drug-induced orthostatic hypotension. Caution patient to avoid extremes of temperature. This medication decreases the ability to sweat and may increase the risk of heat stroke. PTS: 1

DIF: Medium

REF: Pages 423–424

TOP: Therapeutic Classification: Antispasmodics

KEY: Cognitive Level:

Application 150. ANS: C See Patient/Family Teaching on diphenhydramine. Benadryl has many uses and can be safely given to children, but it is found in numerous OTC medications and risk of overdose may be present. Therefore, it is important to know what other medications the parent has given. Caution patient not to use oral OTC diphenhydramine products with any other product containing diphenhydramine. The other assessments are not as important, and ANS B misses the opportunity to assess for potential overdose. PTS: 1

DIF: Medium

REF: Pages 438–439

TOP: Therapeutic Classification: Allergy, cold, cough remedies, antihistamines, and antitussives KEY: Cognitive Level: Application 151. ANS: A See Dosage for diphenoxylate. PO (adults): 2 tablets initially, then 1 tablet after each loose stool, or every 3–4 hr as needed (not to exceed 8 tablets/day). PTS: 1

DIF: Medium

REF: Drugguide.com

KEY: Cognitive Level:

152. ANS: B See Indications for dipyridamole. Persantine is given to prevent thromboembolism in patients with prosthetic heart valves. PTS: 1

DIF: Hard

REF: Drugguide.com

TOP: Therapeutic Classification: Antiplatelet agents

KEY: Cognitive Level: Analysis

153. ANS: D See Indications for docusate. It is important to prevent additional strain on the heart during recovery. Docusate is used in the prevention constipation (in patients who should avoid straining, such as after a myocardial infarction or rectal surgery). Anzemet is an antiemetic used to prevent chemotherapyinduced nausea and vomiting, Sinequan is used in the treatment of depression, and Aricept is used to improve cognition and slow Alzheimer’s disease. PTS: 1

DIF: Medium

REF: Page 448 | Page 450 | Page 460 | Page 454

TOP: Therapeutic Classification: Laxatives

KEY: Cognitive Level: Application

154. ANS: C See Nursing Implications for Epidural local anesthetics, Systemic Toxicity: Assess for systemic toxicity each shift (circumoral tingling and numbness, ringing in ears, metallic taste, dizziness, blurred vision, tremors, slow speech, irritability, twitching, seizures, and cardiac dysrhythmias). Report to physician or other health-care professional. Mild hypotension is common. Respirations will most likely slow as pain is well controlled. PTS: 1

DIF: Medium

REF: Page 495

TOP: Therapeutic Classification: Epidural local anesthetics KEY: Cognitive Level: Application 155. ANS: C

See Patient/Family Teaching for eplerenone. Inform patient not to use potassium supplements, salt substitutes containing potassium, or other Rx or OTC medications without consulting a health-care professional. Encourage the patient to comply with additional interventions for hypertension (weight reduction, discontinuation of smoking, moderation of alcohol consumption, regular exercise, and stress management). Medication controls, but does not cure, hypertension. Instruct patient and family on correct technique for monitoring blood pressure. Advise them to monitor blood pressure at least weekly. PTS: 1

DIF: Medium

REF: Page 503

TOP: Therapeutic Classification: Antihypertensives

KEY: Cognitive Level: Analysis

156. ANS: B See Indications for Methylergonovine. Methylergonovine is used in the prevention and treatment of postpartum or postabortion hemorrhage caused by uterine atony or involution. PTS: 1

DIF: Medium

REF: Page 830

TOP: Therapeutic Classification: None assigned

KEY: Cognitive Level: Analysis

157. ANS: A See Nursing Implications for fenofibric acid. Patients taking anticoagulants concurrently should have prothrombin time and INR monitored frequently until levels stabilize. Patients must still follow a low-fat, low-cholesterol diet. The medication is not designed to cause weight loss. Assess patient for cholethiasis. If symptoms occur, gall bladder studies are indicated; fatty, clay-colored stools, and abdominal pain are symptoms of gall bladder dysfunction. PTS: 1

DIF: Medium

REF: Page 549

TOP: Therapeutic Classification: Lipid-lowering agents 158. ANS: C

KEY: Cognitive Level: Analysis

See Dosage and Nursing Implications for fentanyl transdermal. It is important to use supplemental doses of short-acting opioid analgesics to manage pain until relief is obtained with the transdermal system. The patch may be worn while bathing, showering, or swimming. Transdermal patches lasts 72 hr in most patients. Prevent constipation with increased intake of fluids and bulk as well as laxatives to minimize constipating effects. PTS: 1

DIF: Medium

REF: Pages 553–554

TOP: Therapeutic Classification: Opioid analgesics

KEY: Cognitive Level: Analysis

159. ANS: B See Evaluation/Desired Effects for fexofenadine. Allegra is designed to decrease in allergic symptoms. PTS: 1

DIF: Medium

REF: Page 562

TOP: Therapeutic Classification: Cold, cough, and allergy medications KEY: Cognitive Level: Analysis 160. ANS: D See Indications for fluconazole, oxybutynin, alendronate, and fluorouracil. Diflucan is used to treat fungal infections caused by susceptible organisms, including oropharyngeal or esophageal candidiasis. Ditropan is used in the management overactive bladder, and alendronate is a bisphosphonate used to decrease bone resorption. 5-FU is a chemotherapy agent commonly used in the treatment of colorectal cancer and causes stomatitis—it is most likely what the patient is receiving for his treatment, and it will need to be held at this time with probable dose reduction when treatment resumes. PTS: 1

DIF: Medium

REF: Page 569 | Page 944 | Page 122 | Page 581

TOP: Therapeutic Classification: Antifungals (systemic) 161. ANS: C

KEY: Cognitive Level: Application

See Indications for folic acid. Folic acid is given during pregnancy to promote normal fetal development. PTS: 1

DIF: Medium

REF: Page 588

TOP: Therapeutic Classification: Antianemics and vitamins KEY: Cognitive Level: Analysis 162. ANS: B See Route/Dosage and Availability for fluoroquinolones. Ciprofloxin dosage for a child is 10–15 mg/kg q 12 hr (not to exceed 750 mg/dose). Tablets are available as 100 mg, 250 mg, 500 mg, and 750 mg. The child’s order is 15 mg/kg, and the child weighs 40 kg; 15 mg/kg x 40 kg = 600 mg per dose. PTS: 1

DIF: Medium

REF: Pages 576–577

TOP: Therapeutic Classification: Antibiotics

KEY: Cognitive Level: Application

163. ANS: C See Evaluation for gemfibrozil. Lopid is given to decrease serum triglyceride and cholesterol levels and to improve HDL to total cholesterol ratios. Weight loss may be seen with low-fat, lowcholesterol dietary restrictions but is not wholly reflective of the medication’s efficacy. With HDL (good) cholesterol, higher levels are better. Low HDL cholesterol (less than 40 mg/dL for men, less than 50 mg/dL for women) puts one at higher risk for heart disease. An LDL between 160 and 189 mg/dL is considered high and indicates increased risk for heart disease. PTS: 1

DIF: Hard

REF: Page 611

TOP: Therapeutic Classification: Lipid-lowering agents 164. ANS: D

KEY: Cognitive Level: Analysis

See Indications for glucagon. Glucagon is used in the acute management of severe hypoglycemia with the administration of glucose is not feasible. Because this patient is groggy, it would be dangerous to provide oral fluids. Use of bedside finger stick blood glucose determination methods is recommended for rapid results. Follow-up lab results may be ordered to validate finger stick values, but do not delay treatment while awaiting lab results, as this could result in neurological injury or death. PTS: 1

DIF: Easy

REF: Pages 611–612

TOP: Therapeutic Classification: Hormones

KEY: Cognitive Level: Application

165. ANS: A See Nursing Assessment for haloperidol. Monitor for tardive dyskinesia (uncontrolled rhythmic movement of mouth, face, and extremities; lip smacking or puckering; puffing of cheeks; uncontrolled chewing; rapid or worm-like movements of tongue; and excessive eye blinking). Report these immediately, as they may be irreversible. Hallucinations are a positive sign of schizophrenia and may be seen despite medication since it may require several weeks of therapy to obtain desired effects. Individuals with psychiatric disorders may be homeless; since this patient has housing, this is not the priority. It is important to monitor compliance with the medication schedule and prevent hoarding of pills, but this is not the priority. PTS: 1

DIF: Medium

REF: Page 628

TOP: Therapeutic Classification: Antipsychotics

KEY: Cognitive Level:

Application 166. ANS: C See Nursing Assessment/Lab Test Considerations for heparin. During continuous administration, monitor aPTT levels every 4 hr during early therapy. PTS: 1

DIF: Easy

REF: Page 631

KEY: Cognitive Level:

167. ANS: A See Route/Dosage and Indications for the HPV Vaccine. It is given via three 0.5 ml doses at 0, 2, and 6 months. The vaccine is designed to prevent squamous cell cervical cancer, other cervical and vaginal neoplasias, and genital warts related to the HPV. Gardasil will not prevent other sexually transmitted diseases or other “female” cancers such as ovarian, uterine, or breast cancer, and it is not associated with the herpes virus. Three doses (shots) are required for the series. The nurse should be able to answer this parent’s questions, and teaching is considered a nursing function. PTS: 1

DIF: Medium

REF: Page 644

TOP: Therapeutic Classification: Vaccines

KEY: Cognitive Level:

Application 168. ANS: B See Pharmacokinetics for Insulin Regular. Humulin R is short-acting insulin with an onset of action of 30–60 min when given subcutaneously. Novolog 70/30 is mixed insulin with both short- and long-acting insulins. Humulin N is an intermediate-acting insulin. Lantus is a long-acting insulin. PTS: 1

DIF: Easy

REF: Page 692

TOP: Therapeutic Classification:

Insulins KEY: Cognitive Level: Comprehension 169. ANS: C See Interactions for meperidine. Do not use in patients receiving MAO inhibitors or procarbazine (may cause fatal reaction—contraindicated within 14–21 days of MAO inhibitor therapy). PTS: 1

DIF: Hard

REF: Page 808 | Drugguide.com

See Patient/Family Teaching for Iron Supplements. Advise patient that stools may become dark green or black and that this change is harmless. Instruct patient to follow a diet high in iron. Encourage patient to comply with medication regimen. Take missed doses as soon as remembered within 12 hr; otherwise, return to regular dosing schedule. Do not double doses. Discuss with parents the risk of children overdosing on iron. PTS: 1

DIF: Easy

REF: Page 717

TOP: Therapeutic Classification: Antianemics

KEY: Cognitive Level: Application

171. ANS: B See Indications for hydroxyzine. Atarax is an antiprurutic, Toradol is a nonsteroidal antiinflammatory, Dilaudid is an opioid analgesic, and Hycodan is an analgesic, antitussive. PTS: 1

DIF: Hard

REF: Page 657

TOP: Therapeutic Classification: Antihistamines

KEY: Cognitive Level:

Application 172. ANS: D See Patient/Family Teaching for isoniazid. Caution patient to avoid the use of alcohol during this therapy, as this may increase the risk of hepatotoxicity. Emphasize the importance of continuing therapy even after symptoms have subsided. Therapy may be continued for 6 months to 2 years. Advise patient to notify health-care professional promptly if signs and symptoms of hepatitis (yellow eyes and skin, nausea, vomiting, anorexia, dark urine, unusual tiredness, or weakness) or peripheral neuritis (numbness, tingling, or paresthesia) occur. Emphasize the importance of regular follow-up physical and ophthalmological exams to monitor progress and to check for side effects. PTS: 1

DIF: Medium

REF: Pages 720–721

TOP: Therapeutic Classification: Antituberculars 173. ANS: A

KEY: Cognitive Level: Analysis

See Action of lactulose. It lowers the pH of the colon, which inhibits the diffusion of ammonia from the colon into the blood, thereby reducing blood ammonia levels. PTS: 1

DIF: Medium

REF: Page 739

TOP: Therapeutic Classification: Laxatives

KEY: Cognitive Level: Analysis

MULTIPLE RESPONSE 174. ANS: B, D, E, F See Nursing Implications for almotriptan. Instruct the patient to administer almotriptan as soon as symptoms of a migraine attack appear, but it may be administered any time during an attack. If migraine symptoms return, a second dose may be used. Allow at least 2 hr between doses, and do not use more than 2 doses in any 24-hr period. Advise patients to notify health-care professional prior to next dose of almotriptan if pain or tightness in the chest occurs during use. Advise patient to avoid alcohol, which aggravates headaches, during almotriptan use. Advise patient to consult a health-care professional before taking other prescriptions or OTC or herbal products concurrently. PTS: 1

DIF: Medium

REF: Pages 128–129

TOP: Therapeutic Classification: Vascular headache suppressants KEY: Cognitive Level: Analysis 175. ANS: A, B, C, E, F See Adverse Reactions, Nursing Implications, and Patient/Family Teaching for amiodarone: Seizures are not an identified adverse reaction to amiodarone, so seizure precautions are not necessary. The ECG should be monitored continuously, and the nurse should assess for signs of pulmonary toxicity and monitor blood pressure frequently. Ophthalmic examinations should be performed before and regularly during therapy and whenever visual changes occur. Advise patient to avoid drinking grapefruit juice during therapy. PTS: 1

DIF: Hard

REF: Pages 142–145

KEY: Cognitive Level: Analysis

176. ANS: A, C, D See Contraindications/Precautions for bisoprolol: Use cautiously in renal impairment (dosage reduction recommended), hepatic impairment (dosage reduction recommended), pulmonary disease (including asthma; beta1 selectivity may be lost at higher doses; avoid use if possible), diabetes mellitus (may mask signs of hypoglycemia), and thyrotoxicosis (may mask symptoms). There is no contraindication for gastroesophageal reflux, diverticulitis, or Alzheimer’s disease. PTS: 1

DIF: Hard

REF: Page 223

TOP: Therapeutic Classification: Antihypertensives

KEY: Cognitive Level: Analysis

177. ANS: B, C, D, E See Indications, Contraindications, and Nursing Implications for capsaicin: Capsaicin offers temporary management of pain due to rheumatoid arthritis and osteoarthritis and treatment of pain associated with postherpetic neuralgia or diabetic neuropathy. It is not for use near eyes or on open or broken skin. Topical: Apply to affected areas 3–4 times daily. Rub cream into affected area well so that little or no cream is left on the surface. PTS: 1

DIF: Medium

REF: Pages 266–267

TOP: Therapeutic Classification: Nonopioid analgesics

KEY: Cognitive Level: Analysis

178. ANS: B, C, E, F See Nursing Implications for cisplatin: Severe and protracted nausea and vomiting usually occur 1–4 hr after a dose; vomiting may last for 24 hr. Administer parenteral antiemetic agents 30–45 min before therapy and routinely around the clock for the next 24 hr. Nausea and anorexia may persist for up to 1 week. Monitor CBC with differential and platelet count before and routinely throughout therapy. Additional side effects occur including bone marrow suppression, ototoxicity, neurotoxicity, and renal compromise. The medication is given as an intravenous infusion. PTS: 1

DIF: Medium

REF: Pages 316–317

KEY: Cognitive Level: Analysis

179. ANS: A, B, D See Nursing Implications for escitalopram. Assess for serotonin syndrome (mental changes [agitation, hallucinations, and coma], autonomic instability [tachycardia, labile blood pressure, and hyperthermia], neuromuscular aberrations [hyperreflexia and incoordination], and/or GI symptoms [nausea, vomiting, and diarrhea]), especially in patients taking other serotonergic drugs (SSRIs, SNRIs, or triptans). PTS: 1

DIF: Hard

REF: Pages 516–517

TOP: Therapeutic Classification: Antidepressants

KEY: Cognitive Level: Analysis

180. ANS: B, C, E See Nursing Implications for esomeprazole: Esomeprazole is an antiulcer agent that prevents the final transport of hydrogen ions into the gastric lumen. It is given at least 1 hr before meals. Capsules should be swallowed whole; do not crush or chew pellets. Advise patients to avoid alcohol, products containing aspirin or NSAIDs, and foods that cause an increase in GI irritation. PTS: 1

DIF: Medium

REF: Pages 520–521

TOP: Therapeutic Classification: Antiulcer agents

KEY: Cognitive Level: Analysis

181. ANS: A, D, F See Action and Nursing Implications for furosemide. Furosemide half-life is 30–60 min, and urine production is expected. Electrolytes and renal and hepatic function should be monitored, but there is no expected effect on platelet level. If administering twice daily, give the last dose no later than 5 p.m. to minimize disruption of sleep cycle. Lasix can be given undiluted in a concentration of 10 mg/mL up to 20 mg/min. Elderly individuals are at higher risk for falls when taking diuretics. PTS: 1

DIF: Medium

REF: Pages 598–599

KEY: Cognitive Level: Analysis

See Indications for gabapentin: Partial seizures (adjunct treatment) and postherpetic neuralgia. Unlabeled uses: neuropathic pain, prevention of migraine headaches, bipolar disorder, anxiety, diabetic peripheral neuropathy. PTS: 1

DIF: Medium

REF: Page 601

TOP: Therapeutic Classification: Analgesic adjunct, therapeutic anticonvulsants KEY: Cognitive Level: Analysis 183. ANS: B, D, F See Implementation for Insulins (Long-Acting): Prior to withdrawing dose, rotate vial between palms to ensure uniform solution; do not shake. Insulin is provided subcutaneously. Rotate injection sites. After initial use, cartridges may be stored in a cool place for 42 days; expiration dates should be noted. Administer daily with evening meal or at bedtime. Do not store in-use cartridges and prefilled syringes in refrigerator. PTS: 1

DIF: Medium

REF: Page 696

TOP: Therapeutic Classification: Antidiabetics

KEY: Cognitive Level: Analysis

184. ANS: A, B, C See Indications, Assessment, and Patient Teaching for Lithium: Monitor serum lithium levels twice weekly during initiation of therapy. Assess patient for signs and symptoms of lithium toxicity (vomiting, diarrhea, slurred speech, decreased coordination, muscle weakness, or twitching). Lithium is used in the treatment of manic episodes of manic depressive illness. Advise patients to drink at least 2,000–3,000 mL of fluid each day, avoiding coffee, tea, and cola due to the inherent diuretic property of the medication. Those with cardiovascular disease or over 40 years old should have a baseline ECG, but an EMG is not needed. PTS: 1

DIF: Hard

REF: Page 778

KEY: Cognitive Level: Analysis

See Indications and Interactions for loperamide: Loperamide is used in the adjunctive treatment of acute diarrhea. Interactions include increased CNS depression with other CNS depressants. Patient/Family Teaching: Do not take missed doses and do not double doses. Avoid using alcohol and other CNS depressants concurrently. Administer with clear fluids to help prevent dehydration. Frequent mouth rinses, good oral hygiene, and sugarless gum may relieve dry mouth. PTS: 1

DIF: Medium

REF: Pages 781–782

TOP: Therapeutic Classification: Antidiarrheals

KEY: Cognitive Level: Analysis

186. ANS: A, B, D, E See Patient/Family Teaching and Nursing Implications for naproxen. Caution patient to avoid the concurrent use of alcohol, aspirin, acetaminophen, or other OTC medications without consulting the health-care professional. Use of naproxen with three or more glasses of alcohol per day may increase risk of GI bleeding. Advise patient to consult the physician if rash, itching, visual disturbances, tinnitus, weight gain, edema, black stools, persistent headache, or influenza-like syndrome (chills, fever, muscle aches, and pain) occur. PTS: 1

DIF: Hard

REF: Pages 885–886

TOP: Therapeutic Classification: Nonopioid analgesics

KEY: Cognitive Level: Analysis

187. ANS: A, D See Evaluation/Desired Outcomes for Niacin. Niacin leads to a decrease in serum cholesterol and triglyceride levels. All listed levels are within normal limits, but Niacin is taken to reduce lipid levels. PTS: 1

DIF: Hard

REF: Page 894

TOP: Therapeutic Classification: Lipid-lowering agents 188. ANS: A, C, D, E

KEY: Cognitive Level: Analysis

See Route/Dosage for nicotine gum: If a patient smokes less than 25 cigarettes per day, they should start with the 2 mg gum. Patients should chew one piece of gum every 1–2 hr for 6 wk, then one piece of gum every 2–4 hr for 2 wk, then one piece of gum every 4–8 hr for 2 wk, and then discontinue. They should not exceed 24 pieces of gum/day. Chewing gum is available in cinnamon, mint, orange, and fruit chill flavors. Multiple side effects exist. PTS: 1

DIF: Medium

REF: Page 897

TOP: Therapeutic Classification: Smoking deterrents

KEY: Cognitive Level: Analysis

189. ANS: A, B, C, E See Indications and Patient/Family Teaching and Implementation for pregabalin: Pregabalin is used in the treatment of diabetic neuropathy. Do not discontinue abruptly. Instruct patient to promptly report unexplained muscle pain, tenderness, or weakness. Advise patient and family to notify their health-care professional if thoughts about suicide or dying, new or worse depression, or anxiety occur. Weight gain and edema are potential side effects. The medication can be taken without regard to food. PTS: 1

DIF: Hard

REF: Pages 1035–1036

TOP: Therapeutic Classification: Analgesics

KEY: Cognitive Level: Analysis

190. ANS: B, D See Indications for each medication listed. Quetiapine is used in schizophrenia and depressive episodes with bipolar disorder. Risperidone is used for schizophrenia in adults and adolescents ages 13–17. Quinidine is used to restore and maintain sinus rhythm in patients with atrial fibrillation. Temazepam is used in the short-term management of insomnia. Tiotropium is used in the long-term maintenance treatment of bronchospasm. PTS: 1

DIF: Hard

KEY: Cognitive Level: Analysis

191. ANS: C, D See Indication and Potential Nursing Diagnoses. Ropinirole is used in the management of signs and symptoms of idiopathic Parkinson disease. Impaired physical mobility and risk for injury are potential nursing diagnoses. PTS: 1

DIF: Medium

REF: Pages 1107–1108

TOP: Therapeutic Classification: Antiparkinson agents

KEY: Cognitive Level: Analysis

192. ANS: C, D, E See Indications and Nursing Implications/Labs for Lovaza: used to treat high triglyceride levels; that is, those greater than 500 mg/dL. High-density lipoproteins and triglycerides should be monitored to gauge effectiveness of the medication. Low-density lipoproteins may increase because of the medication and should be monitored during pharmacological treatment with Lovaza. PTS: 1

DIF: Medium

REF: Page 930

TOP: Therapeutic Classification: Lipid-lowering agents

KEY: Cognitive Level: Analysis

193. ANS: B, C, F See Indications, Nursing Implications, and Patient Family Teaching for Reclast: Reclast is prescribed to increase bone mass and is administered annually via intravenous infusion. Reclast is associated with serious side effects such as hypocalcemia and severe kidney problems. Those taking Reclast should notify their health-care provider immediately if they experience muscle spasms or muscle cramps because these are indicative of hypocalcemia. To decrease potential side effects on the kidney, it is recommended that at least two glasses of water should be consumed within the hours prior to the administration of Reclast. PTS: 1

DIF: Medium

REF: Pages 1290–1292

TOP: Therapeutic Classification: Bone resorption inhibitors KEY: Cognitive Level: Synthesis 194. ANS: A, D, E

See Nursing Implications/Lab Test Considerations for Heparin: The CBC includes a hemoglobin and hematocrit. The aPTT is activated partial thromboplastin time and should be 1.5–2.5 times the control level. A platelet count should be monitored to provide early identification of Heparininduced thrombocytopenia. PTS: 1

DIF: Medium

REF: Page 631

TOP: Therapeutic Classification: Anticoagulants

KEY: Cognitive Level: Analysis

195. ANS: A, B, C See Indications and Nursing Implications and Patient/Family Teaching for Zinc sulfate: Zinc is necessary for tissue repair and wound healing. Those with impaired wound healing may be prescribed zinc sulfate as a supplement to dietary intake. Zinc sulfate should be taken with food to decrease gastrointestinal irritation. However, zinc sulfate should not be taken with caffeine products, dairy products, and bran, as these will decrease the absorption of zinc. Seafood is a source of food that is high in zinc. PTS: 1

DIF: Medium

REF: Page 1286

TOP: Therapeutic Classification: Mineral supplements

KEY: Cognitive Level: Analysis

196. ANS: A, B, C, D, E See Nursing Implications/Lab Test Considerations, and Patient/Family Teaching for amiodarone: Liver and thyroid function tests need to be monitored before treatment and every 6 months after initiation of amiodarone because of the high risk for liver toxicity and thyroid dysfunction. May cause hypokalemia, hypocalcemia, and hypomagnesemia. A chest x-ray and pulmonary function tests need to be monitored every 3 to 6 months because of risk for pulmonary toxicity and acute respiratory distress syndrome. PTS: 1

DIF: Hard

REF: Pages 144–145

TOP: Drug: Cordarone (amiodarone) | Therapeutic Classification: Antiarrhythmics KEY: Cognitive Level: Synthesis

197. ANS: A, D, E See Indications and Nursing Implications, and Patient/Family Teaching for Bisacodyl: Bisacodyl is a laxative that will alter fluid and electrolyte transport, producing accumulation of fluid in the colon. Encourage fluid intake from 1,500–2,000 mL/day to prevent dehydration. Do not give oral dose with food. It is best to take bisacodyl on an empty stomach. If given rectally, lubricate the enema with water-soluble lubricant with insertion and encourage retention of enema for 15–30 min. PTS: 1

DIF: Easy

REF: Page 221

TOP: Therapeutic Classification: Laxatives

KEY: Cognitive Level: Application

198. ANS: A, B, C, E See Indications and Patient Family Teaching for Rifampin: used for the treatment and prevention of tuberculosis. It must be taken at the same time daily even when symptoms have subsided. People receiving this drug should know that soft contacts will be permanently discolored if worn while taking rifampin. In addition, saliva, tears, sweat, urine, feces, and sputum will change to a red-orange or red-brown color. The effectiveness of oral contraceptives may be decreased. The use of a nonhormonal form of contraceptives should be used while on rifampin. PTS: 1

DIF: Hard

REF: Pages 1088–1089

TOP: Therapeutic Classification: Antituberculars

KEY: Cognitive Level:

Synthesis 199. ANS: B, C, D See Indications and Nursing Implications, and Patient/Family Teaching for Questran: Questran is a lipid-lowering agent used in the treatment of hypercholesterolemia or to treat pruritis associated with increased bile acids. Questran should be taken in conjunction with a diet that will aid in lowering cholesterol and low-density lipoproteins. Foods that are high in fats, carbohydrates, and cholesterol should be avoided. PTS: 1

DIF: Easy

REF: Drugguide.com

KEY: Cognitive Level: Application

200. ANS: A, B, C, E See Adverse Reactions/Side Effects, and Nursing Implications/Assessment for Vancomycin: Black, furry growth on the tongue is associated with a superinfection and should be reported immediately. Tinnitus and vertigo are associated with ototoxicity. Pink-tinged urine may be a sign of nephrotoxicity. Yellow sclera does not occur as an adverse reaction or side effect of vancomycin. PTS: 1

DIF: Hard

REF: Pages 1241–1242

TOP: Therapeutic Classification: Anti-infectives

KEY: Cognitive Level:

Synthesis 201. ANS: A, B, D See Route/Dosage and Patient/Family Teaching for acyclovir: Instruct patient to apply ointment in sufficient quantity to cover all lesions every 3 hr, 6 times/day for 7 days. Additional use of OTC creams, lotions, and ointments may delay healing and may cause spreading of lesions. Use a finger cot or glove when applying to prevent inoculation of other areas or spread to other people. Inform patient that acyclovir is not a cure. The virus lies dormant in the ganglia, and acyclovir will not prevent the spread of infection to others. No eating or drinking restrictions are required. No sexual contact should be made while lesions are present. PTS: 1

DIF: Medium

REF: Pages 108–110

TOP: Therapeutic Classification: Antivirals

KEY: Cognitive Level: Analysis

202. ANS: B, C, E, F See Indications for albumin. These include expansion of plasma volume and maintenance of cardiac output in situations associated with fluid volume deficit, including shock, hemorrhage, and burns. Temporary replacement of albumin in diseases associated with low levels of plasma proteins, such as nephrotic syndrome or end-stage liver disease, results in relief or reduction of associated edema. Albumin is contraindicated in patients with allergic reactions to albumin, severe anemia, CHF, and normal or increased intravascular volume.

PTS: 1

DIF: Hard

REF: Drugguide.com

TOP: Therapeutic Classification: Volume Expanders

KEY: Cognitive Level: Application

203. ANS: C, D, F See Nursing Implications/Assessment for alemtuzumab. Lab Test Considerations: Obtain CBC and platelet counts weekly during therapy and more frequently if worsening anemia, neutropenia, or thrombocytopenia is observed. CD4 counts are assessed after treatment until recovery. PTS: 1

DIF: Medium

REF: Drugguide.com

TOP: Therapeutic Classification: Antineoplastics

KEY: Cognitive Level:

Application 204. ANS: A, B, C, D, F See Nursing Implications/IV Administration (tobramycin) for Aminoglycosides: IVPB mixtures are stable for 24 hr at room temperature. Infuse slowly over 30–60 min in both adult and pediatric patients. Evaluate the eighth cranial nerve function by audiometry before and throughout therapy. Hearing loss is usually in the high-frequency range. Prompt recognition and intervention are essential in preventing permanent damage. Also monitor for vestibular dysfunction (vertigo, ataxia, nausea, and vomiting). Monitor renal function by urinalysis, specific gravity, BUN, creatinine, and CCr before and during therapy. Manufacturer recommends administering separately; do not admix. Assess patient for signs of super infection. PTS: 1

DIF: Hard

REF: Pages 139–140

TOP: Therapeutic Classification: Anti-infectives

KEY: Cognitive Level:

Application 205. ANS: B, C, E See drug list for angiotensin-converting enzyme inhibitors. ACE inhibitors can be recognized by the ending “pril.” Atenolol is a beta blocker—recognized by the ending “olol.” Teveten and atacand are angiotensin II receptor antagonists—recognized by the ending “sartan.”

PTS: 1

DIF: Medium

REF: Page 164

TOP: Therapeutic Classification: Antihypertensives

KEY: Cognitive Level: Knowledge

206. ANS: A, B, D, E See Nursing Implications and Adverse Reactions/Side Effects for bicalutamide: Diarrhea and hot flashes are common with Casodex, and potential hair loss should be discussed. Casodex antagonizes the effects of androgen at the cellular level and is used to decrease the spread of prostate cancer. Prostate-specific antigen levels are followed to indicate tumor response. Casodex can be taken without regard to food. PTS: 1

DIF: Hard

REF: Pages 219–220

TOP: Therapeutic Classification: Antineoplastics

KEY: Cognitive Level:

Application 207. ANS: A, B, C, D See Nursing ImplicationsAssessment for Bronchodilators (Xanthines): Patients with a history of cardiovascular problems should be monitored for chest pain and ECG changes. Monitor drug levels routinely. Ensure that oxygen therapy is correctly instituted during acute asthma attacks. Monitor intake and output ratios for an increase in diuresis or fluid overload. PTS: 1

DIF: Hard

REF: Drugguide.com

TOP: Therapeutic Classification: Bronchodilators

KEY: Cognitive Level: Analysis

208. ANS: B, E, F See Nursing Implications/Lab Test Considerations for carbamazepine: Monitor CBC, including platelet count, reticulocyte count, and serum iron, weekly during the first 2 mo and yearly thereafter for evidence of potentially fatal blood cell abnormalities. Medication should be discontinued if bone marrow depression occurs. PTS: 1

DIF: Hard

REF: Page 270

KEY: Cognitive Level:

Knowledge 209. ANS: A, B, C, D, E, F See Nursing Implications for cefepime. Correct medication administration requires using the five rights—right medication, right dose, right time, right route, and right patient. The medication order (drug, dose, route, and time) should be verified when the nurse obtains the medication in preparation for provision. The right patient should be identified using two patient identifiers once the drug is verified. Maxipime should be infused over 30 min (100 mL/hr), and the patient should be monitored for signs of anaphylaxis. Finally the infusion can be discontinued upon completion. Verify right drug, dose, and time. Verify correct patient using two identifiers. Set IV pump rate at 100 mL/hr. Begin infusion. Observe for symptoms of anaphylaxis. Discontinue the infusion. PTS: 1

DIF: Hard

REF: Pages 283–284

TOP: Therapeutic Classification: Anti-infectives

KEY: Cognitive Level:

Application 210. ANS: B, C, E, F See Nursing Implications/Assessment for chlordiazepoxide: With alcohol withdrawal assess for tremors, agitation, delirium, and hallucinations. Protect patient from injury. Institute seizure precautions. Geri: Assess risk of falls and institute fall prevention strategies. Administer greater dose at bedtime to avoid daytime sedation. Patients should only be placed in restraints as a last resort— there are no indications restraints are needed in this scenario. Administer Librium after meals or with milk to minimize GI irritation. PTS: 1

DIF: Medium

REF: Drugguide.com

KEY: Cognitive Level: Comprehension

211. ANS: A, B, D, E See Classification for chlorpromazine, ondansetron, epinepherine, metoclopramide, aprepitant, and clonodine: Medications that prevent or treat nausea and vomiting are known as anti-emetics. PTS: 1

DIF: Medium

REF: Page 310 | Page 933 | Page 496 | Page 835 | Page 180 | Page 328 TOP: Therapeutic Classification: Antiemetics KEY: Cognitive Level: Knowledge | Cognitive Level: Comprehension 212. ANS: B, C, D, E See Patient/Family Teaching for cholestyramine: Instruct patient to take medication before meals. Mix cholestyramine with 4–6 oz water, milk, fruit juice, or other noncarbonated beverages. Shake vigorously. Slowly stir in a large glass. Rinse glass with small amount of additional beverage to ensure all medication is taken. Advise patient that this medication should be used in conjunction with dietary restrictions (fat, cholesterol, carbohydrates, and alcohol), exercise, and cessation of smoking. Explain that constipation may occur. Increase in fluids and bulk in diet, exercise, stool softeners, and laxatives may be required to minimize the constipating effects. Instruct patient to notify a health-care professional if constipation, nausea, flatulence, and heartburn persist or if stools become frothy and foul smelling. PTS: 1

DIF: Medium

REF: Drugguide.com

TOP: Therapeutic Classification: Lipid-lowering agents

KEY: Cognitive Level: Analysis

213. ANS: A, D See Nursing Implications for amlodipine: Norvasc is used in the management of hypertension, angina pectoris, and vasospastic angina. Monitor blood pressure and pulse before therapy, during dose titration, and periodically during therapy. Contraindicated in systolic blood pressure less than 90 mmHg. Instruct patient to contact health-care provider if heart rate is less than 50 bpm. PTS: 1

DIF: Medium

REF: Page 148

TOP: Therapeutic Classification: Antiarrhythmics KEY: Cognitive Level: Application | Cognitive Level: Analysis 214. ANS: B, C, E See Drug List/Classification for Diuretics (potassium sparing, thiazide) and furosemide: Aldactone, Dyrenium, and Midamor are all potassium-sparing diuretics. Furosemide is a loop diuretic and depletes potassium. Diuril and Microzide are thiazide diuretics and deplete potassium. PTS: 1

DIF: Medium

KEY: Cognitive Level:

Knowledge 215. ANS: A, B, C See Indications for famciclovir, emtricitabine, efavirenz, etodolac, etoposide, and etanercept. Famvir, Emtriva, and Sustiva are all antivirals or antiretrovirals used in the treatment of HIV or in the treatment of recurrent herpes simplex virus infection in patients with HIV. Etodolac and Enbrel are used in the treatment of arthritis. Afinitor is a chemotherapy agent. PTS: 1

DIF: Hard

KEY: Cognitive Level:

Knowledge 216. ANS: A, B, D, E See Patient/Family Teaching and Desired Effects for fluoxetine: Caution patient to change positions slowly to minimize dizziness. Inform patient that frequent mouth rinses, good oral hygiene, and sugarless gum or candy may minimize dry mouth. Inform patient that medication may cause decreased libido. Caution patient to wear protective clothing and use sunscreen to prevent photosensitivity reactions. May be administered with food to minimize GI irritation.

PTS: 1

DIF: Medium

REF: Page 585

TOP: Therapeutic Classification: Antidepressants

KEY: Cognitive Level: Analysis

217. ANS: A, B, D See Nursing Implications for Heparins (low molecular weight): Compression device stockings are routinely used in the prevention of DVT and PE postoperatively. Fragmin is dosed 5,000 IU evening before surgery, then once daily for 5–10 days. Patients are encouraged to increase activity unless contraindicated; most patients with hip replacement surgery are assisted out of bed on the first postop day. Intravenous push Lovenox is used in the treatment of acute ST segment MI, not as DVT prophylaxis. Instruct patient not to take aspirin or NSAIDs without consulting a health-care professional while on therapy since aspirin products will increase the risk of bleeding. PTS: 1

DIF: Medium

REF: Page 631

TOP: Therapeutic Classification: Anticoagulants

KEY: Cognitive Level:

Application 218. ANS: B, C, E, F See Patient/Family Education and Evaluation Desired Outcomes for Histamine H 2 Antagonists: Advise patient to report onset of black, tarry stools; fever; sore throat; diarrhea; dizziness; rash; confusion; or hallucinations to a health-care professional promptly. Inform patient that smoking interferes with the action of histamine antagonists. Encourage patient to quit smoking or at least not to smoke after last dose of the day. Administer with meals or immediately afterward and at bedtime to prolong effect. It may cause drowsiness or dizziness. Caution patient to avoid driving or other activities requiring alertness until response to the drug is known. Advise patient to avoid alcohol, products containing aspirin or NSAIDs, and foods that may cause an increase in GI irritation. Decreased symptoms of esophageal reflux and treatment of heartburn, acid indigestion, and sour stomach. PTS: 1

DIF: Medium

REF: Page 639

KEY: Cognitive Level:

219. ANS: A, B, C See Nursing Implications for ibuprofen. Geri: Higher risk for poor outcomes or death from GI bleeding. Age-related renal impairment increases risk of hepatic and renal toxicity. Assess for signs and symptoms of GI bleeding (tarry stools, lightheadedness, and hypotension), renal dysfunction (elevated BUN and creatinine levels and decreased urine output), and hepatic impairment (elevated liver enzymes and jaundice). PTS: 1

DIF: Medium

REF: Page 664

TOP: Therapeutic Classification: Antipyretics, antirheumatics, nonopioid analgesics, nonsteroidal anti-inflammatory agents

KEY: Cognitive Level: Knowledge

220. ANS: B, C, D, E See Nursing Implications for Diuretics (thiazide) and Lanoxin: Assess patient, especially if taking digoxin, for anorexia, nausea, vomiting, muscle cramps, paresthesia, and confusion; report signs of electrolyte imbalance. Patients taking digoxin have an increased risk of digitalis toxicity due to the potassium-depleting effect of the diuretic. Hydrochlorothiazide is an antihypertensive/diuretic; systolic BP less than 150 is a desired effect; nocturia may be present when the patient is taking a diuretic. PTS: 1

DIF: Medium

REF: Page 426 | Page 442

TOP: Therapeutic Classification: Antihypertensives and Antirrhythmics KEY: Cognitive Level: Application 221. ANS: A, D, E See Nursing Implications, and Patient/Family Teaching for Insulin, Human Inhalation (Afrezza): Afrezza should be administered at the beginning of each meal. It must be used in combination with subcut long-acting insulin. The inhaler must be level while in use. Patients should not smoke while using Afrezza. Monitor blood glucose every 6 hr. Afrezza may cause weight gain. PTS: 1

DIF: Medium

REF: Pages 686–687

TOP: Therapeutic Classification: Insulins

KEY: Cognitive Level:

Application COMPLETION 222. ANS: 125 PTS: 1

DIF: Medium

REF: Page 324

TOP: Therapeutic Classification: Anti-infectives

KEY: Cognitive Level:

Application 223. ANS: 6 PTS: 1

DIF: Hard

REF: Page 455

TOP: Therapeutic Classification: Inotropics

KEY: Cognitive Level: Application

224. ANS: 1 PTS: 1

DIF: Easy

REF: Page 455

TOP: Therapeutic Classification: Inotropics

KEY: Cognitive Level: Application

225. ANS: 0.5 PTS: 1

DIF: Medium

REF: Page 598

TOP: Therapeutic Classification: Diuretics

KEY: Cognitive Level:

Application 226. ANS: 2 PTS: 1

DIF: Easy

REF: Page 598

KEY: Cognitive Level:

Application 227. ANS: 6 PTS: 1

DIF: Easy

REF: Page 898

TOP: Therapeutic Classification: Antianginals

KEY: Cognitive Level: Application

228. ANS: 30 mL/hr PTS: 1

DIF: Medium

REF: Page 911

TOP: Therapeutic Classification: Vasopressors

KEY: Cognitive Level:

Application 229. ANS: 112,500 PTS: 1

DIF: Medium

REF: Page 989

TOP: Therapeutic Classification: Antibiotics

KEY: Cognitive Level: Application

230. ANS: 100 100 (mL/hr) See IV Administration for cephalosporin first generation. To infuse 50 mL of fluid over 30 min, the pump should be set at 100 mL/hr (= hourly rate). PTS: 1

DIF: Medium

REF: Page 291

KEY: Cognitive Level:

See Route/Dosage for diltiazem. The patient’s dose is 90 mg and 60 mg tablets are available, so the nurse must give 1.5 tablets. PTS: 1

DIF: Easy

REF: Page 427

TOP: Therapeutic Classification: Antianginals, antihypertensives, antiarrhythmics KEY: Cognitive Level: Application 232. ANS: 0.5 See Dosage and Availability for gabapentin. Typical dose is 300 mg three times daily initially. Titration may be continued until desired (range is 900–1,800 mg/day in three divided doses; 600 mg and 800 mg tablets are scored and can be broken to administer a half-tablet). If a half-tablet is used, administer other half at the next dose. Discard half-tablets not used within several days. A 300-mg ordered dose for this patient is one-half of an available 600 mg tablet. PTS: 1

DIF: Easy

REF: Page 601

TOP: Therapeutic Classification: Analgesic analogs, therapeutic anticonvulsants, mood stabilizers KEY: Cognitive Level: Application MATCHING 233. ANS: C

PTS: 1

DIF: Medium

TOP: Therapeutic Classification: Respiratory inhalants 234. ANS: F

PTS: 1

DIF: Medium

TOP: Therapeutic Classification: Respiratory inhalants 235. ANS: D

PTS: 1

DIF: Medium

TOP: Therapeutic Classification: Respiratory inhalants 236. ANS: A

PTS: 1

DIF: Medium

REF: Appendix D KEY: Cognitive Level: Application REF: Appendix D KEY: Cognitive Level: Application REF: Appendix D KEY: Cognitive Level: Application REF: Appendix D

TOP: Therapeutic Classification: Respiratory inhalants 237. ANS: E

PTS: 1

DIF: Medium

TOP: Therapeutic Classification: Respiratory inhalants 238. ANS: B

PTS: 1

DIF: Medium

TOP: Therapeutic Classification: Respiratory inhalants

KEY: Cognitive Level: Application REF: Appendix D KEY: Cognitive Level: Application REF: Appendix D KEY: Cognitive Level: Application

SEQUENCING 239. ANS: F, E, B, A, D, C See Implementation Insulin Intermediate-acting. It is important with all medication administration that the order be verified. The current blood sugar result should be determined for safety to prevent hypoglycemia. Roll intermediate-acting insulin vial between palms to mix, rather than shaking (may cause inaccurate dose). Completing this step before drawing up any insulin will decrease the need to recap the needle between vials. When mixing insulins, draw regular insulin, insulin aspart, insulin glulisine, or insulin lispro into syringe first to avoid contamination of regular insulin vial. The site should be selected and prepped prior to administration PTS: 1

DIF: Medium

Insulins KEY: Cognitive Level: Application 240. ANS: B, F, A, D, E, C

REF: Page 691

TOP: Therapeutic Classification:

See Implementation for lansoprazole. Prior to giving anything into an NG tube, placement must be verified via chest x ray. Prior to medication administration, exact placement should be checked by aspirating stomach contents and checking the pH of the aspirate; flush the NG tube with water after this procedure. For patients with an NG tube getting Prevacid, capsules may be opened and intact granules may be mixed in 40 mL of apple, cranberry, grape, orange, pineapple, prune, or V8 vegetable juice and injected through the NG tube into stomach. Flush NG tube with additional apple juice or water to clear tube. PTS: 1

DIF: Medium

REF: Pages 746–747

TOP: Therapeutic Classification: Antiulcer

KEY: Cognitive Level: Analysis

Drug Guide Test Bank 2 Multiple Choice Identify the choice that best completes the statement or answers the question. ____ 1. A nurse is caring for a 14-year-old patient with epilepsy. The child takes phenytoin and started taking Lamictal (lamotrigine) 50 mg/day approximately 10 days ago. The child’s mother calls to report a newly noted rash across the girl’s face and arms. Which of the following statements by the nurse is best? a. “Did your daughter use a new soap?” b. “Has your daughter been exposed to poison ivy or other plant irritants?” c. “Do not give the Lamictal; your daughter will need to be seen by the doctor today.” d. “This is commonly seen with Lamictal. A mild soap and calamine lotion may reduce any itching.”

____ 2. The nurse receives a call from an 82-year-old patient with advanced prostate cancer who is being treated with Lupron (leuprolide) therapy. Which of the following statements requires immediate notification of the physician? a. “I’ve been having hot flashes lately, what should I do?” Copyright © 2017 F. A. Davis Company

b. “The pain in my bones seems worse since I started this medication.” c. “I forgot to get my shot 3 hours ago like I usually do, so I was going to take it now; is that okay?” d. “My legs feel numb and weak; is that normal with this medication?”

____ 3. The nurse is caring for a woman with metastatic breast cancer who was recently admitted with hypercalcemia. Which of the following medications does the nurse anticipate would be included in the treatment plan? a. Zometa (zoledronic acid) b. Oscal (calcium carbonate) c. Sandostatin (octreotide) d. Emend (aprepitant)

____ 4. The nurse is providing care for a 92-year-old patient who has a standing order for Ambien (zolpidem) prn for insomnia. When providing the medication for the patient as requested, which of the following actions by the nurse is best? a. Inform the patient the medication will work within 10 min. b. Ensure the patient is in bed, ready for sleep, and raise the bed side rails. c. Instruct the patient to eat some crackers to reduce stomach irritation caused by the medication. d. Suggest the patient take the medication routinely every night.

____ 5. The nurse is caring for a patient with multiple medications, including Sinemet (carbidopa/levodopa) QID. The nurse knows this medication is effective by which of the following signs or symptoms? a. The patient has fewer hand tremors. b. The patient’s apical pulse is regular. c. The patient has less edema in the ankles bilaterally. d. The patient’s cough is well controlled. Copyright © 2017 F. A. Davis Company

____ 6. While caring for a patient who is taking Imodium (loperamide), the nurse would be most concerned by which of the following symptoms? a. Patient reports abdominal cramping and loose stool. b. Patient complains of a headache and a sore throat. c. Pupils are equal, round, and reactive to direct and indirect light. d. Tenting across the clavicular region and decreased reflexes are noted.

____ 7. The nurse prepares to provide Zofran (ondansetron) in orally disintegrating form. Which of the following instructions should the nurse provide? a. “Simply suck on the pill like a lozenge, and it will dissolve over a few minutes.” b. “Place the tablet on your tongue; it will melt in seconds and then you can swallow.” c. “Take this with a full swallow of water.” d. “I will dissolve this in some water, and you can drink it in one sip.”

____ 8. The nurse is caring for a patient taking Xenical (orlistat). Which of the following symptoms would be most concerning to the nurse? a. Nausea and vomiting b. Orange-colored oil noted in stool c. Reports of fecal urgency d. Flatus with discharge

____ 9. The nurse is caring for a client who is to receive Trileptal (oxcarbazepine). The nurse recognizes this client most likely has a history of which of the following? a. Diabetes mellitus b. Depression Copyright © 2017 F. A. Davis Company

c. Seizures d. Hypothyroidism

____ 10. The nurse is caring for a patient receiving Aredia (pamidronate) for the treatment of Paget’s disease. Which of the following symptoms would be most concerning to the nurse? a. Anorexia b. Bone pain c. Constipation d. Muscle twitching

____ 11. A student nurse caring for a patient who is taking Creon (pancrelipase) would include which of the following statements when reviewing medications with the instructor? a. “This reduces inflammation of the pancreas seen with pancreatitis.” b. “This increases absorption of fats since the pancreas is not excreting normal enzymes.” c. “This is used to bind with proteins and reduce protein excretion in the urine.” d. “This helps relieve abdominal pain caused by liver damage in patients with a history of alcohol abuse.”

____ 12. Which of the following would cause the nurse to intervene for a patient taking Protonix (pantoprazole)? a. The client takes the medication an hour before breakfast. b. The client orders eggs and bacon for breakfast. c. The client drinks a glass of orange juice when taking the medication. d. The client chews the medication before swallowing.

____ 13. Which of the following lab values should be followed periodically for a patient taking Paxil (paroxetine)? a. Complete blood count b. Electrolytes c. Thyroxine d. Creatinine

____ 14. While caring for a patient who uses oral birth control pills and is taking PO (procaine penicillin G), which of the following instructions should the nurse include in the client teaching? a. “You should stop taking your birth control pills for at least 3 months since you have to take this medication.” b. “You will need to use a barrier method of birth control through this therapy and until your next menstrual cycle.” c. “The doctor will want to give you a hormone patch in addition to the birth control pills for the next 30 days.” d. “There is no need to alter your method of birth control while you are taking this medication.”

____ 15. The nurse is caring for a woman in labor who is given Talwin (pentazocine). Which of the following actions should the nurse take next? a. Elevate the side rails and instruct the patient to call before attempting to ambulate. b. Prepare for the placement of an internal monitoring device. c. Encourage the client to lie on her right side. d. Monitor the patient’s blood pressure every 15 min.

b. Beer c. Milk d. Coffee

____ 17. A student nurse caring for a client with a history of anxiety disorder would expect which of the following medications to be included in the patient’s treatment plan? a. Atarax (hydroxyzine) b. Antivert (meclizine) c. Ativan (lorazepam) d. Adalat (nifedipine)

____ 18. The nurse is caring for a patient who has an order for Osmitrol (mannitol) 1 g/kg to be infused over an hour. Which of the following actions should the nurse take prior to administering the medication? a. Assess deep tendon reflexes. b. Determine the blood pressure. c. Evaluate level of consciousness. d. Listen to bowel sounds.

____ 19. The nurse is caring for a patient who is NPO after midnight for a cardiac catheterization scheduled for 1 p.m. The patient normally receives Glucophage (metformin) 1,000 mg po BID, and the morning dose is due at 8:30 a.m. The patient’s blood glucose result was 115. Which of the following actions should the nurse take? a. Hold the medication. b. Give the medication with a glass of juice. c. Give the medication with a sip of water. d. Call the physician for direction.

____ 20. The nurse is caring for a patient with a known history of narcotic abuse. The patient is started on methadone 30 mg po daily during detoxification. Which of the following assessments would indicate the patient’s dose may need to be decreased? a. Chills b. Irritability c. Respirations = 8 per min d. Diaphoresis

____ 21. A nurse working on the postpartum floor is checking orders and notes the following, “Methergine (methylergonovine) 200 mcg po q 6 hr for 48 hr.” Which of the following nursing interventions should be added to the patient’s plan of care? a. Assess respiratory rate and rhythm q 2 hr. b. Monitor for signs of uterine atony or change in menstrual bleeding. c. Instruct patient to wear a tight-fitting bra and avoid facing the water during shower. d. Collect urine for protein dipstick every 4 hr.

____ 22. While preparing to discharge a patient who has started taking Lopressor (metoprolol) during their hospitalization, the nurse recognizes further teaching is necessary by which of the following statements: a. “I should take my pulse every day before taking this medication.” b. “I need to stay on a low-salt diet to help control my blood pressure.” c. “I’ll have to have my blood drawn frequently to monitor for toxic levels of this medication.” d. “I should contact the physician immediately if I notice any wheezing, difficulty breathing, or dizziness.”

____ 23. The nurse is providing care for a patient in hospice who has been converted to a continuous infusion of morphine for pain control via the use of a patient-controlled analgesia pump. The nurse recognizes that break-through pain should be handled in which of the following ways? a. No break-through pain is expected since the patient is on a continuous infusion of narcotic. b. Additional intravenous bolus doses can be given by the nurse every 15–30 min c. Additional predetermined bolus doses can be programmed to be available at patient request every 90 min. d. Oral morphine can be given in liquid form every 2 hr.

____ 24. A patient is admitted with suspected overdose of Prostigmin (neostigmine). Which of the following will be used as an antidote? a. Narcan b. Vitamin K c. Atropine d. Epinephrine

____ 25. The nurse is caring for an infant with oral thrush whose medications include Mycostatin (nystatin) suspension 5 mL QID. Which of the following actions should the nurse take? a. Dilute the medication in 30 mL of water and provide it to the infant in a bottle. b. Use a needleless syringe to gently squirt small amounts into the baby’s mouth. c. Dip a pacifier into the medication and allow the infant to suck on the pacifier; repeat until the dose is consumed. d. Use a cotton swab to paint the inside of the infant’s cheeks, gums, and tongue.

____ 26. The nurse is caring for a patient who recently started taking Compro (prochlorperazine) 10 mg po QID. Which of the following symptoms would cause the nurse to contact the physician immediately? Copyright © 2017 F. A. Davis Company

a. Temp = 104.5°F and new onset urinary incontinence. b. Pulse = 70 bpm and patient complains of constipation. c. Blood pressure = 126/64 mmHg and complaints of hiccups. d. Respirations = 18 per min and patient reports mild nausea.

____ 27. A hospice nurse is caring for a patient with end-stage stomach cancer who has a new order to be kept NPO. The patient complains of nausea and has a standard order for Promethacon (promethazine) for this complaint. Which of the following actions should the nurse take? a. Request intravenous dosing from pharmacy and start an IV. b. Call pharmacy to request an oral tablet, and allow the patient to take it with one sip of water. c. Obtain oral liquid preparation and add thick-it to reduce aspiration risk. d. Request and provide the medication in rectal suppository form.

____ 28. To monitor the peak efficacy after providing oral Dilaudid (hydromorphone) Immediate Release for a patient reporting pain ranked 6 out of 10 on a numeric pain scale. The patient should report some relief in pain at the peak action of the drug. Which of the following reflects the peak action of Dilaudid Immediate Release? a. 15–30 min b. 30–90 min c. 1–2 hr d. Over 2 hr

____ 29. A nurse caring for a patient who’s prescribed Inderal (propranolol) is being tapered off over a 2-wk period. The nurse would include which of the following statements in the patient teaching? a. “I bet you’re glad to be getting off this medication since it is so expensive.” b. “Stopping this medication suddenly can be very dangerous, so it is important that you follow the taper schedule carefully.” Copyright © 2017 F. A. Davis Company

c. “Patients usually only take this drug for a 1–2 wk cycle before switching to another medication.” d. “By slowly weaning you from this drug, the risk of rebound headaches is reduced.”

____ 30. Which of the following would indicate to the nurse that treatment was effective in a patient being treated with propylthiouracil? a. Patient reports sleeping 12 hr a day. b. Fine tremors noted in both hands. c. Patient gains 2 pounds in 4 days. d. Pulse is 110 bpm.

____ 31. While caring for a patient with myasthenia gravis and a history of dysphasia who is taking Mestinon (pyridostigmine), the nurse recognizes the need for further teaching by which of the following statements? a. “I should set an alarm clock to make sure I take my medication on time.” b. “I may have trouble swallowing if I do not take my medication correctly.” c. “I will have to take this medication for a few months before my condition resolves.” d. “I should carry an identification card with my diagnosis and medication list at all times.”

____ 32. A client taking vitamin B6 (pyridoxine) calls the nurse at 3 p.m. to report she is at work and didn’t take the pill at breakfast. Which of the following statements by the nurse is best? a. “You should make arrangements to take the missed dose as soon as possible.” b. “Missing a single dose is not critical.” c. “Why didn’t you take the medication?” d. “How are you feeling right now?”

____ 33. The nurse is caring for a patient with tuberculosis who is on a diet with honey-thick liquids. Which action should the nurse take to administer the dose of Rifadin (rifampin)? a. Obtain the medication in liquid form. b. Give the pill with a small sip of water. c. Call the pharmacy to request a parenteral dose. d. Open the capsule onto a spoonful of applesauce.

____ 34. A nurse working at an adult care center for individuals with mental illness provides an individual with their dose of Risperdal (risperidone). The nurse should intervene if the client mixes the liquid medication with which of the following? a. Milk b. Cola c. Orange juice d. Water

____ 35. A nurse caring for an individual taking Avandia (rosiglitazone) monitors which of the following lab results to help evaluate treatment effectiveness? a. Glycosylated hemoglobin b. Serum calcium c. Serum iron d. Cardiac troponin

____ 36. The nurse observing a patient who uses a prescribed Serevent Diskus (salmeterol) recognizes that teaching has been effective if which of the following is observed? a. The patient shakes the diskus vigorously before taking a dose. b. The patient rinses the mouthpiece after administration. c. The patient keeps the diskus horizontal at all times throughout administration. Copyright © 2017 F. A. Davis Company

d. The patient exhales into the diskus before inhaling a dose of medication.

____ 37. A nurse caring for a patient with non-Hodgkin lymphoma prepares to provide Leukine (sargramostim). Which of the following will indicate successful response to the medication? a. Patient’s white blood cell count increases. b. Patient’s platelet count increases. c. Patient denies nausea or vomiting with chemotherapy. d. Patient’s hair does not fall out after chemotherapy.

____ 38. While in the recovery room, the nurse cares for a post-anesthesia patient who reports severe nausea. The nurse would most likely request an order for which of the following medications? a. Eldepryl (selegiline) b. Transderm-Scop (scopolamine) c. Januvia (sitagliptin) d. Cialis (tadalafil)

____ 39. An infant being treated for colic was prescribed Mylicon (simethicone) drops and has returned to the clinic for follow-up evaluation. Which of the following nursing action has the highest priority? a. Assessment of the infant’s startle reflex. b. Gentle palpation of the anterior fontanel. c. Inspection and auscultation of the abdomen. d. Measurement of the infant’s head circumference.

____ 40. At a follow-up appointment at the urologist’s office, the nurse is gathering data on a patient who takes VESIcare (solifenacin) for an overactive bladder. Which of the following statements would be most concerning to the nurse? a. I started taking an aerobics class twice a week. Copyright © 2017 F. A. Davis Company

b. I drink three cups of coffee each day. c. I smoke a half pack of cigarettes a day. d. A friend recommended St. John’s wort and I’ve been taking that for a few weeks now.

____ 41. The nurse is caring for a patient who takes Betapace (sotalol) 80 mg po BID. Prior to administering the dose, which of the following actions should the nurse take first? a. Assess respiratory rate and depth. b. Determine apical pulse rate and rhythm. c. Identify recent food intake. d. Check color and presence of pulses in lower extremities.

____ 42. While caring for a patient taking Carafate (sucralfate), the nurse recognizes the medication is effective by which of the following? a. Patient is able to pass formed stool daily. b. Patient has increased range of motion in the small joints of her hands. c. Patient reports decreased abdominal pain. d. Patient remains afebrile for 24 hr.

____ 43. While caring for a 31-year-old female client who is initiating therapy with Thalomid (thalidomide), the nurse recognizes the need for further teaching by which of the following statements. a. “I can’t start the medication until I’ve had a negative pregnancy test.” b. “I must have a pregnancy test every month for the first 3 months I take this medication.” c. “I must use two methods of birth control while I am taking this medication.” d. “I will not be able to donate blood while taking this medication.”

____ 44. While caring for an individual taking Demadex (torsemide) for hypertension, the nurse would be most concerned by which of the following assessments? a. Patient’s resting pulse is 68 bpm. b. Patient reports abdominal cramps and nausea. c. Patient has lost 2 pounds in one day. d. Patient eats two bananas for breakfast.

____ 45. The nurse is caring for an individual receiving intravenous Vancocin (vancomycin). Which of the following assessments is most important to prevent permanent complication? a. Serum vancomycin levels b. Visual acuity c. Gag reflex d. Deep tendon reflexes

____ 46. A nurse caring for an individual with diabetes insipidus who is taking Pressyn (vasopressin). Which of the following assessments would indicate treatment has been effective? a. Urine output is 800 mL at the end of an 8-hr shift. b. Urine specific gravity is 0.998. c. Patient has lost 2 pounds in 1 day. d. Mucous membranes are dry and sticky.

____ 47. The nurse recognizes which of the following individuals is at highest risk for developing orthostatic hypotension? a. A 53-year-old patient taking Tigasil (tigecycline). b. A 61-year-old patient taking Coumadin (warfarin). c. A 49-year-old patient taking Verazinc (zinc sulfate). d. A 64-year-old patient taking Calan (verapamil).

____ 48. The nurse recognizes that which of the following individuals will need to receive supplemental vitamin B12 injections? a. A 37-year-old patient with acute renal calculi. b. A 59-year-old patient with gastric resection for stomach cancer. c. A 24-year-old patient with sickle cell anemia. d. A 58-year-old patient with congestive heart failure.

____ 49. The nurse is counseling a patient who has been given a prescription for Imitrex (sumatriptan) for migraine headaches. Which of the following statements indicates teaching has been effective? a. “This medication will prevent migraine headaches.” b. “I can take this medication at any time during a migraine headache attack.” c. “I can repeat the medication in 15 minutes if I have not gotten relief from the first injection.” d. “I can use up to 4 doses in a 24-hour period.”

____ 50. Which of the following patients would most likely be taking Quinidine Gluconate (quinidine)? a. A 45-year-old patient with atrial fibrillation. b. A 59-year-old patient with pneumocystis carni pneumonia. c. A 68-year-old patient with gastroesophogeal reflux disease. d. A 33-year-old patient with acute pyelonephritis.

____ 51. An individual with a history of angina takes sublingual nitroglycerine to relieve chest pain ranked 6/10. Five min later, the chest pain is 4/10. What action should the nurse take next? a. Have a family member call 911. b. Tell the individual to take a warm shower. c. Instruct the individual to take another sublingual nitroglycerine tablet. d. Monitor the individual for an additional 10 min before taking any action. Copyright © 2017 F. A. Davis Company

____ 52. An individual with chronic schizophrenia who recently started taking Zyprexa (olanzapine) is smacking his lips, puffing his cheeks, and chewing. Which of the following statements by the nurse is best? a. “Don’t worry, this is commonly seen with advancing schizophrenia; you may need a higher dose of medication.” b. “These are symptoms seen in withdrawal from the medication; have you stopped taking your medication for some reason?” c. “These movements are a side effect of the medication; you should stop taking it.” d. “We see this a lot, it will go away after you’ve been on the medication for a month or so.”

Multiple Response Identify one or more choices that best complete the statement or answer the question. ____ 53. A nurse is counseling the parent of a 3-year-old child with chronic ear infections and fluid in the ears. The physician recommends Silfedrine Children’s (pseudoephedrine) as a decongestant. Which of the following statements indicate that teaching has been effective? Select all that apply. a. “The decongestant will help clear the fluid from his ears.” b. “I should give this medication at bedtime to help him sleep.” c. “I should call the doctor if I notice he is having any difficulty breathing.” d. “This medication will kill the bacteria causing the infection in his ears.” e. “Too much of this medication can alter his heart rate, so I need to keep it out of his reach.” f. “I should limit his fluid intake to help reduce the congestion in his ears.”

a. A 72-year-old patient who drinks prune juice on a daily basis and has a soft brown stool daily. b. A 61-year-old patient hospitalized for an anterior myocardial infarction. c. A 29-year-old patient with the flu who reports having diarrhea. d. A 57-year-old patient reporting increased difficulty with constipation since the onset of menopause. e. A 65-year-old patient who recently had a hemorrhoidectomy. f. An 84-year-old patient who reports walking 3 miles every day in the mall.

____ 55. A nurse working in the health department recognizes that the shingles vaccine (Zostavax) is contraindicated for which of the following individuals? Select all that apply. a. A 55-year-old patient with a history of atrial fibrillation b. A 49-year-old patient with HIV c. A 61-year-old patient with an upper respiratory infection; T = 101.4F d. A 33-year-old patient who is 6 wk pregnant e. A 42-year-old patient with an allergy to eggs f. A 51-year-old patient with a history of chronic obstructive pulmonary disease

____ 56. Which of the following would be included in the patient teaching for a client receiving Lithobid (lithium) therapy? Select all that apply. a. “This medication may cause dizziness or drowsiness so you should avoid driving until you know how the medication will affect you.” b. “It is important to reduce your fluid intake while taking this medication.” c. “Avoid drinking excessive amounts of coffee, tea, and colas while on this medication.” d. “Weight loss may occur with this medication, so you should try to eat at least 3,000 calories a day.” e. “Since you have a history of heart disease, you will need to have periodic electrocardiogram tests done.” Copyright © 2017 F. A. Davis Company

f. “Notify the physician immediately if you have any fainting or difficulty breathing while taking this medication.”

____ 57. Which of the following interventions would be helpful for a patient taking Claritin (loratadine) who complains of a dry mouth? Select all that apply. a. Frequent oral rinses with water b. Sugarless gum or candy c. Flossing twice daily d. Increased intake of caffeine e. Fluid intake of 1,000 mL/day f. Use of alcohol-based mouth wash

____ 58. The nurse is advising a client whose triglyceride levels remain elevated despite 3 mo of following a low-fat, low-cholesterol diet. The client is started on Lovaza (omega-3 acid ethyl esters). Which of the following statements would the nurse include in the teaching? Select all that apply. a. “You still need to follow a low-fat diet while you’re taking this medication.” b. “This medication may be taken with meals.” c. “Limiting cholesterol intake is not as critical as limiting intake of carbohydrates.” d. “Diabetes contributes to elevated triglyceride levels, so it is important to maintain good control or your diabetes.” e. “It is important to establish an exercise routine that works with diet and medication to help control your weight.” f. “You probably inherited this from one of your parents, so aside from medication, there isn’t much you can do.”

____ 59. While caring for a client who reports taking Prilosec (omeprazole), thenurse recognizes theneed for further teaching if theclient also reports taking which of thefollowing? Select all that apply. a. Tylenol for occasional headaches Copyright © 2017 F. A. Davis Company

b. Ibuprofen daily for arthritis c. Baby aspirin daily to prevent heart pain d. Maalox occasionally to reduce heartburn e. Flaxseed supplement to increase omega-3 intake f. Multi-vitamin with iron to promote health

____ 60. While caring for a client with a history of epilepsy, thenurse would expect which of thefollowing medications to be included in thepatient’s treatment plan? Select all that apply. a. Clinoril (sulindac) b. Dilantin (phenytoin) c. Solfoton (phenobarbital) d. Depakote (divalproex sodium) e. Relafen (nabumetone) f. Tegretol (carbamazepine)

____ 61. Which of thefollowing laboratory values will be closely monitored for a patient newly started on Pronestyl (procainamide) after cardioversion? Select all that apply. a. Mean corpuscular volume b. Triglycerides c. White blood cell count d. Platelet count e. Magnesium f. Protein

____ 62. In thetreatment of a postmenopausal woman with osteoporosis who has been prescribed Evista (raloxifene), which of thefollowing should be included in thepatient’s plan of care? Select all that apply. a. Daily weight-bearing exercises Copyright © 2017 F. A. Davis Company

b. Supplemental iron c. Education on smoking cessation d. Instruction to limit alcohol consumption e. Prolonged bed rest f. Dietary teaching to increase protein intake

____ 63. A neighbor says to thenurse, “My arthritis is getting worse in this cold weather; what can I take?” thenurse would base theresponse on theknowledge that which of thefollowing medications would provide both pain relief and help decrease inflammation associated with arthritis. Select all that apply. a. Bufferin (aspirin) b. Choline and magnesium salicylates c. Tylenol (acetaminophen) d. Advil (ibuprofen) e. Excedrin (ibuprofen) f. Cetafen (acetaminophen)

____ 64. An order for Restoril (temazepam) 30 mg po prn for sleep would be questioned for which of thefollowing patients? Select all that apply. a. A 42-year-old patient hospitalized with a broken femur b. A 29-year-old patient admitted with depression and attempted suicide c. A 51-year-old patient admitted with migraine headache d. A 33-year-old patient admitted with exacerbation of Crohn’s disease e. A 79-year-old patient admitted with a hip fracture f. A 48-year-old patient admitted with cirrhosis

65. The nurse is preparing to provide Namenda (memantine) in liquid form. theordered dose is 10 mg po BID. Liquid preparation is available in 2 mg/mL. thenurse should provide __________________ mL. 66. The nurse is caring for a patient receiving chemotherapy that includes ifosfamide 1.2 g/m 2 and mesna; 20% of themesna dose is to be given via IV at thesame time as theifosfamide; repeat 4 hr and 8 hr later. thepatient’s body surface area is 2 m2. thenurse anticipates that thepharmacy will supply a ____ mg dose of mesna.

Drug Guide Test Bank 2 Answer Section MULTIPLE CHOICE 1. ANS: C See Nursing Implications/Assessment for lamotrigine. Assess patient for skin rash frequently during therapy. Discontinue lamotrigine at first sign of rash; it may be life-threatening. Stevens-Johnson syndrome or toxic epidermal necrolysis may develop. therash usually occurs during theinitial 2–8 wk of therapy and is more frequent in patients taking multiple antiepileptic agents, especially valproic acid, and is much more frequent in patients <16 yr. PTS: 1

DIF: Medium

REF: Pages 759–760

TOP: Therapeutic Classification: Anticonvulsants

KEY: Cognitive Level:

Application 2. ANS: D See Patient/Family Teaching for leuprolide. Instruct patient to notify a health-care professional promptly if difficulty urinating, weakness, or numbness occurs. Advise patient that medication may cause hot flashes. Advise patient that bone pain may increase at initiation of therapy. This will resolve with time. Instruct patient to take medication exactly as directed. If a dose is missed, take as soon as remembered unless not remembered until next day. PTS: 1

DIF: Medium

REF: Page 752

TOP: Therapeutic Classification: Antineoplastics 3. ANS: A

KEY: Cognitive Level: Analysis

See Indications and Actions for zoledronic acid. Zometa is used in thetreatment of hypercalcemia of malignancy. It inhibits bone resorption by inhibiting increased osteoclast activity and skeletal calcium release induced by tumors. Therapeutic effects include decreased serum calcium. Oscal is a calcium supplement and should be avoided if thepatient’s serum calcium level is too high. Sandostatin is used in thetreatment of severe diarrhea including that caused by carcinoid tumors. Emend is used in thetreatment of nausea/vomiting during chemotherapy. PTS: 1

DIF: Medium

REF: Pages 1292–1293

TOP: Therapeutic Classification: Bone resorption inhibitors KEY: Cognitive Level: Application 4. ANS: B See Patient Teaching for zolpidem. Because of rapid onset, advise patient to go to bed immediately after taking zolpidem. Onset of action is 30 min or more and is increased in geriatric patients and patients with hepatic impairment. Do not administer with or immediately after a meal as food slows absorption. Due to thehabit-forming nature of this medication, it should not be used for more than 7– 10 days. PTS: 1

DIF: Medium

REF: Page 1296

TOP: Therapeutic Classification: Sedative/hypnotics

KEY: Cognitive Level: Application

5. ANS: A See Evaluation/Desired Effect for carbidopa/levodopa. Effects include resolution of parkinsonian signs and symptoms. Therapeutic effects usually become evident after 2–3 wk of therapy but may require up to 6 months. PTS: 1

DIF: Medium

REF: Page 273

TOP: Therapeutic Classification: Antiparkinson agents 6. ANS: D

KEY: Cognitive Level: Analysis

See Assessment for loperamide. Assess fluid and electrolyte balance and skin turgor for dehydration. Tenting is an indication of dehydration, and decreased deep tendon reflexes are indicative of hypokalemia. thepatient is taking Imodium, which is used in thetreatment of diarrhea, so symptoms of abdominal cramping and loose stool are expected. Viral symptoms are not thefirst priority and may be related to thecause of thediarrhea. PERRL is a normal finding. Diarrhea places thepatient at risk for dehydration and hypokalemia, so this is thefirst priority. PTS: 1

DIF: Hard

REF: Page 781

TOP: Therapeutic Classification: Antidiarrheals

KEY: Cognitive Level: Analysis

7. ANS: B See Implementation for ondansetron. Immediately place tablet on tongue; it will dissolve in seconds. Then swallow with saliva. PTS: 1

DIF: Easy

REF: Page 934

TOP: Therapeutic Classification: Antiemetics

KEY: Cognitive Level: Application

8. ANS: A See Side Effects for orlistat. Nausea and vomiting are not expected with this drug. Common GI side effects include fecal urgency, flatus with discharge, increased defecation, oily evacuation, oily spotting, and fecal incontinence. PTS: 1

DIF: Medium

REF: Drugguide.com

TOP: Therapeutic Classification: Weight control agents

KEY: Cognitive Level: Analysis

9. ANS: C See Indications for oxcarbazepine. Trileptal is used as monotherapy or adjunctive therapy of partial seizures in adults and children 4 years and older with epilepsy. PTS: 1

DIF: Medium

REF: Page 942

KEY: Cognitive Level:

Knowledge 10. ANS: D See Side effects and Assessment for pamidronate. Observe for evidence of hypocalcaemia (paresthesia, muscle twitching, laryngospasm, and Chvostek’s or Trousseau’s sign). PTS: 1

DIF: Medium

REF: Pages 965–966

TOP: Therapeutic Classification: Bone resorption inhibitors KEY: Cognitive Level: Application 11. ANS: B See Action/Therapeutic Effect for pancrelipase. Effects include increased digestion of fats, carbohydrates, and proteins in theGI tract. PTS: 1

DIF: Medium

REF: Page 967

TOP: Therapeutic Classification: Digestive agents

KEY: Cognitive Level: Application

12. ANS: D See Implementation for pantoprazole. Do not break, crush, or chew tablets. PTS: 1

DIF: Medium

REF: Page 973

TOP: Therapeutic Classification: Antiulcer agents

KEY: Cognitive Level:

Application 13. ANS: A See Assessment/Lab test considerations for paroxetine. Lab Test Considerations: Monitor CBC and differential periodically during therapy. Report leukopenia or anemia. PTS: 1

DIF: Hard

REF: Page 977

TOP: Therapeutic Classification: Antidepressants Knowledge

KEY: Cognitive Level:

14. ANS: B See Patient/Family Teaching for penicillin. Advise patient taking oral contraceptives to use an additional nonhormonal method of contraception during therapy with penicillin and until next menstrual period. PTS: 1

DIF: Medium

REF: Page 992

TOP: Therapeutic Classification: Anti-infectives

KEY: Cognitive Level:

Application 15. ANS: A See Patient/Family Teaching for pentazocine. Medication may cause drowsiness, dizziness, or hallucinations, particularly in geriatric patients. Advise patient to call for assistance when ambulating. PTS: 1

DIF: Medium

REF: Drugguide.com

TOP: Therapeutic Classification: Opioid analgesics

KEY: Cognitive Level: Application

16. ANS: B See Patient/Family Teaching for phenobarbital. Caution patient to avoid taking alcohol or other CNS depressants concurrently with this medication. PTS: 1

DIF: Medium

REF: Page 1005

TOP: Therapeutic Classification: Anticonvulsants

KEY: Cognitive Level:

Application 17. ANS: C See Indications for lorazepam. Ativan is an antianxiety agent. Atarax is provided for itching. Antivert is provided for vertigo. Adalat in provided for hypertension. PTS: 1

DIF: Medium

REF: Page 786

KEY: Cognitive Level: Application

18. ANS: B See Assessment for mannitol. Mannitol is a diuretic used in thetreatment of acute oliguric renal failure, edema, and increased intracranial or intraocular pressure. Monitor vital signs, urine output, CVP, and pulmonary artery pressures before and hourly throughout administration. PTS: 1

DIF: Medium

REF: Page 798

TOP: Therapeutic Classification: Diuretics

KEY: Cognitive Level:

Application 19. ANS: A See Implementation for metformin. Because thepatient is NPO, themedication should be held and blood sugars should be monitored frequently. Patients stabilized on a diabetic regimen who are exposed to stress, fever, trauma, infection, or surgery may require administration of insulin. Withhold metformin and reinstitute after resolution of acute episode. PTS: 1

DIF: Medium

REF: Page 818

TOP: Therapeutic Classification: Antidiabetics

KEY: Cognitive Level:

Application 20. ANS: D See Assessment for methadone. If respiratory rate is less than 10 breaths per min, assess level of sedation. Dose may need to be decreased by 25–50%. Chills, irritability, and diaphoresis are all symptoms of narcotic withdraw and may be expected during detoxification. PTS: 1

DIF: Easy

REF: Page 820

TOP: Therapeutic Classification: Opioid analgesics 21. ANS: B

KEY: Cognitive Level: Application

See Assessment for methylergonovine. Methergine is used in thetreatment of postpartum hemorrhage. Monitor blood pressure, heart rate, and uterine response frequently during medication administration. PTS: 1

DIF: Medium

REF: Page 830

TOP: Therapeutic Classification: Oxytocics

KEY: Cognitive Level: Application

22. ANS: C See Patient/Family Teaching for metoprolol. Blood levels are not followed for this medication. Teach patient and family how to check pulse daily and blood pressure biweekly and to report significant changes to a health-care professional. Reinforce theneed to continue additional therapies for hypertension (weight loss, sodium restriction, stress reduction, regular exercise, moderation of alcohol consumption, and smoking cessation). Advise patient to notify health-care professional if slow pulse, difficulty breathing, wheezing, cold hands and feet, dizziness, light-headedness, confusion, depression, rash, fever, sore throat, unusual bleeding, or bruising occurs. PTS: 1

DIF: Medium

REF: Pages 841–842

TOP: Therapeutic Classification: Antihypertensives; also Antianginals KEY: Cognitive Level: Analysis 23. ANS: B See Assessment for Morphine. Patients on a continuous infusion should have additional bolus doses provided every 15–30 min, as needed, for break-through pain. PTS: 1

DIF: Medium

REF: Pages 867–868

TOP: Therapeutic Classification: Opioid analgesics

KEY: Cognitive Level: Application

24. ANS: C See Assessment/Toxicity and Overdose for neostigmine. If an overdose occurs, atropine is theantidote.

PTS: 1

DIF: Medium

REF: Drugguide.com

TOP: Therapeutic Classification: Antimyasthenics

KEY: Cognitive Level: Knowledge

25. ANS: D See Implementation for nystatin. For neonates and infants, paint suspension into recesses of themouth. PTS: 1

DIF: Medium

REF: Page 916

TOP: Therapeutic Classification: Antifungals

KEY: Cognitive Level: Application

26. ANS: A See Assessment for prochlorperazine. Monitor for development of neuroleptic malignant syndrome (fever, respiratory distress, tachycardia, seizures, diaphoresis, hypertension or hypotension, pallor, tiredness, severe muscle stiffness, and loss of bladder control). Notify physician or other health-care professional immediately if these symptoms occur. Constipation is a known side effect with this medication, and thepulse is normal. Blood pressure is within normal limits and hiccups are not immediately concerning. Respirations are within normal parameters, and Compro is taken for nausea, so mild nausea may be expected. PTS: 1

DIF: Medium

REF: Page 1040

TOP: Therapeutic Classification: Antiemetics

KEY: Cognitive Level: Application

27. ANS: D See Routes/dosages for promethazine. Because thepatient has orders to be kept NPO, any oral preparation is contraindicated without an overriding order. Rectal dosing is available and can be used effectively, although it may be less reliable. This noninvasive route should be chosen over starting an IV. PTS: 1

DIF: Medium

REF: Pages 1044–1045

TOP: Therapeutic Classification: Antiemetics

KEY: Cognitive Level: Application

28. ANS: B See Pharmacokinetics for hydromorphone. thepeak action for this medication is 30–90 min. PTS: 1

DIF: Medium

REF: Page 653

TOP: Therapeutic Classification: Opioid analgesics

KEY: Cognitive Level: Comprehension

29. ANS: B See Assessment for propranolol. Abrupt withdrawal of propranolol may precipitate life-threatening arrhythmias, hypertension, or myocardial ischemia. Drug should be tapered off over a 2-wk period before discontinuation. Assess patient carefully during tapering and after medication is discontinued. Consider that patients taking propranolol for noncardiac indications may have undiagnosed cardiac disease. Abrupt discontinuation or withdrawal over too short a period of time (less than 9 days) should be avoided. While thecost of medications is important, it is not thehighest priority. PTS: 1

DIF: Medium

REF: Page 1050

TOP: Therapeutic Classification: Antianginals, antiarrhythmics (Class II), antihypertensives, and vascular headache suppressants

KEY:

Cognitive Level: Comprehension

30. ANS: C See Evaluation for propylthiouracil. PTU decreases theseverity of symptoms of hyperthyroidism (lowered pulse rate and weight gain). Symptoms of hyperthyroidism include tachycardia, palpitations, nervousness, insomnia, fever, diaphoresis, heat intolerance, tremors, weight loss, and diarrhea. Symptoms of hypothyroidism include intolerance to cold, constipation, dry skin, headache, listlessness, tiredness, or weakness. PTS: 1

DIF: Medium

REF: Page 1053

TOP: Therapeutic Classification: Antithyroids 31. ANS: C

KEY: Cognitive Level: Analysis

See Patient/Family Teaching for pyridostigmine. Patients with a history of dysphagia should have a nonelectric or battery-operated back-up alarm clock to remind them of exact dose time. Patients with dysphagia may not be able to swallow medication if thedose is not taken exactly on time. Taking dose late may result in myasthenic crisis. Taking dose early may result in cholinergic crisis. Patients with myasthenia gravis must continue this regimen as a life-long therapy. Advise patient to carry identification describing their disease and medication regimen at all times. PTS: 1

DIF: Hard

REF: Page 1060

TOP: Therapeutic Classification: Antimyasthenics

KEY: Cognitive Level: Analysis

32. ANS: B See Patient/Family Teaching for pyridoxine. Instruct patient to take medication as directed. If a dose is missed, it may be omitted because an extended period of time is required to become deficient in vitamin B6. PTS: 1

DIF: Medium

REF: Page 1061

TOP: Therapeutic Classification: Vitamins

KEY: Cognitive Level:

Application 33. ANS: D See Implementation for rifampin. Capsules may be opened and contents mixed with applesauce or jelly for patients with difficulty swallowing. While thepharmacist can compound a syrup for patients unable to swallow solids, this patient has difficulty swallowing liquids. If honey-thick liquids are ordered, nonthickened water should be avoided. Parenteral therapy is not required. PTS: 1

DIF: Medium

REF: Page 1088

TOP: Therapeutic Classification: Antitubercular agents

KEY: Cognitive Level: Application

PTS: 1

DIF: Hard

REF: Page 1095

TOP: Therapeutic Classification: Antipsychotics

KEY: Cognitive Level:

Application 35. ANS: A See Assessment/Lab test considerations for rosiglitazone. Monitor serum glucose and glycosylated hemoglobin periodically during therapy to evaluate effectiveness. PTS: 1

DIF: Medium

REF: Drugguide.com

TOP: Therapeutic Classification: Antidiabetics

KEY: Cognitive Level:

Application 36. ANS: C See Patient/Family Teaching for salmeterol. Instruct patient using powder for inhalation never to exhale into diskus device and always to hold device in a level horizontal position. Mouthpiece should be kept dry and should never be washed. PTS: 1

DIF: Medium

REF: Page 1114

TOP: Therapeutic Classification: Bronchodilators

KEY: Cognitive Level: Analysis

37. ANS: A See Action for sargramostim. Indications include accelerated recovery of bone marrow after autologous bone marrow transplantation, resulting in decreased risk of infection and other complications. PTS: 1

DIF: Medium

REF: Page 1107

TOP: Therapeutic Classification: Colony stimulating factors KEY: Cognitive Level: Application 38. ANS: B

See Indications for scopolamine. Scopolamine is used in themanagement of nausea and vomiting associated with opioid analgesia or general anesthesia/recovery from anesthesia. Carbex is used in themanagement of Parkinson disease. Januvia is used in themanagement of diabetes. Cialis is used for erectile dysfunction. PTS: 1

DIF: Medium

REF: Page 1119 | Page 1118 | Page 1136 | Page 1161

TOP: Therapeutic Classification: Antiemetics

KEY: Cognitive Level: Application

39. ANS: C See Assessment for simethicone. Assess patient for abdominal pain, distention, and bowel sounds prior to and periodically throughout course of therapy. PTS: 1

DIF: Medium

REF: Drugguide.com

TOP: Therapeutic Classification: Antiflatulents

KEY: Cognitive Level:

Application 40. ANS: D See Patient/Family Teaching for solifenacin. Advise patient to consult a health-care professional prior to taking Rx, OTC, or herbal products with solifenacin. Drug-Drug: Drugs that induce or inhibit theCYP3A4 enzyme system may significantly alter blood levels of solifenacin; ketoconazole  blood levels and risk of toxicity (do not exceed 5 mg/day). PTS: 1

DIF: Medium

REF: Pages 1142–1143

TOP: Therapeutic Classification: Urinary tract antispasmodics

KEY: Cognitive Level:

Application 41. ANS: B See Implementation for sotalol. Take apical pulse prior to administering. If less than 50 bpm or if arrhythmia occurs, withhold medication and notify physician or other health-care professional. PTS: 1

DIF: Medium

REF: Page 1144

TOP: Therapeutic Classification: Antiarrhythmics

KEY: Cognitive Level:

Application 42. ANS: C See Evaluation for sucralfate. Carafate is used in thetreatment of duodenal ulcers, and desired results include decrease in abdominal pain. PTS: 1

DIF: Medium

REF: Page 1146

TOP: Therapeutic Classification: Antiulcer

KEY: Cognitive Level: Analysis

43. ANS: B See Implementation for thalidomide. Pregnancy testing must occur weekly during first month of therapy. Due to teratogenic effects, thalidomide may be prescribed only by prescribers registered in theSystem for Thalidomide Education and Prescribing Safety (STEPS) program. Thalidomide is started within 24 hr of a negative pregnancy test with a sensitivity of at least 50 mIU/mL and then monthly thereafter in women with a regular menstrual cycle. For women of childbearing years, two methods of reliable contraception must be used unless complete abstinence is used. For women with irregular menses, pregnancy testing should occur every 2 wk. If pregnancy occurs, thalidomide should be discontinued immediately. Instruct patient not to donate blood and male patients not to donate sperm while taking thalidomide. PTS: 1

DIF: Medium

REF: Page 1190

TOP: Therapeutic Classification: Immunosuppressants

KEY: Cognitive Level: Application

44. ANS: B See Patient/Family Teaching for torsemide. Advise patient to contact a health-care professional immediately if muscle weakness, cramps, nausea, dizziness, numbness, or tingling of extremities occurs. Advise patient to contact a health-care professional if they gain more than 2–3 pounds per day. Instruct patient to consult a health-care professional regarding a diet high in potassium. PTS: 1

DIF: Medium

REF: Pages 1219–1220

TOP: Therapeutic Classification: Antihypertensives

KEY: Cognitive Level: Application

45. ANS: A See Assessment for vancomycin. Evaluate eighth cranial nerve function by audiometry and serum vancomycin levels prior to and throughout therapy in patients with borderline renal function or those older than 60 years of age. Prompt recognition and intervention are essential in preventing permanent damage. No alteration in vision or reflexes is anticipated with vancomycin. PTS: 1

DIF: Medium

REF: Page 1242

TOP: Therapeutic Classification: Anti-infectives

KEY: Cognitive Level:

Application 46. ANS: A See Evaluation for vasopressin. Desired outcome includes decrease in urine volume, relief of polydipsia, and increased urine osmolality in patients with central diabetes insipidus. Normal urine output is 60–100 cc/hr, so this value is within normal limits and indicates successful management of diabetes insipidus. Normal urine specific gravity is 1.010–1.030. Signs of dehydration indicate ongoing fluid loss associated with diabetes insipidus. PTS: 1

DIF: Hard

REF: Page 1250

TOP: Therapeutic Classification: Hormones

KEY: Cognitive Level: Analysis

47. ANS: D See Adverse Reactions/Side Effects for verapamil. Calan is an antihypertensive that can cause orthostatic hypotension. Tigasil is an anti-infective that causes sedation. Coumadin is an anticoagulant without noted CNS side effects. Verazinc is a mineral supplement without noted CNS side effects. PTS: 1

DIF: Medium

REF: Pages 1256–1257

TOP: Therapeutic Classification: Antihypertensives

KEY: Cognitive Level: Analysis

48. ANS: B See Implementation for vitamin B12 Preparation. Patients with small bowel disease, malabsorption syndrome, or gastric or ileal resections require parenteral administration. PTS: 1

DIF: Easy

REF: Page 1270

TOP: Therapeutic Classification: Vitamin supplements

KEY: Cognitive Level: Analysis

49. ANS: B See Patient/Family Teaching for sumatriptan. Instruct patient to administer sumatriptan as soon as symptoms of a migraine attack appear, but it may be administered at any time during an attack. Inform patient that sumatriptan should be used only during a migraine attack. It is meant to be used for relief of migraine attacks but not to prevent or reduce thenumber of attacks. If migraine symptoms return, a second injection may be used. Allow at least 1 hr between doses, and do not use more than two injections in any 24-hr period. PTS: 1

DIF: Medium

REF: Page 1152

TOP: Therapeutic Classification: Vascular headache suppressants KEY: Cognitive Level: Analysis 50. ANS: A See Indications for quinidine. They include restoration and maintenance of sinus rhythm in patients with atrial fibrillation or flutter, prevention of recurrent ventricular arrhythmias, and treatment of malaria. PTS: 1

DIF: Medium

REF: Drugguide.com

TOP: Therapeutic Classification: Antiarrhythmics 51. ANS: C

KEY: Cognitive Level: Analysis

See Patient/Family Teaching for nitroglycerin. For an acute anginal attack, advise patient to sit down and use medication at first sign of attack. Relief usually occurs within 5 min. Dose may be repeated if pain is not relieved in 5–10 min. Call health-care professional or go to nearest emergency room if anginal pain is not relieved by 3 tablets in 15 min. PTS: 1

DIF: Medium

REF: Page 908

TOP: Therapeutic Classification: Antianginal agents

KEY: Cognitive Level: Application

52. ANS: C See Assessment for olanzapine. Monitor for tardive dyskinesia (uncontrolled rhythmic movement of mouth, face, and extremities; lip smacking or puckering; puffing of cheeks; uncontrolled chewing; rapid or worm-like movements of tongue; and excessive blinking of eyes). Report immediately, as it may be irreversible. PTS: 1

DIF: Medium

REF: Pages 920–921

TOP: Therapeutic Classification: Antipsychotics

KEY: Cognitive Level:

Application MULTIPLE RESPONSE 53. ANS: A, C, E See Indications and Patient/Family Teaching and Assessment for pseudoephedrine. It is used to open obstructed eustachian tubes in chronic otic inflammation or infection; it does not kill bacteria. Instruct patient to notify a health-care professional if nervousness, slow or fast heart rate, breathing difficulties, hallucinations, or seizures occur because these symptoms may indicate overdose. Administer pseudoephedrine at least 2 hr before bedtime to minimize insomnia. Maintain fluid intake of 1,500–2,000 mL/day to decrease viscosity of secretions. PTS: 1

DIF: Medium

REF: Pages 1055–1056

54. ANS: B, D, E See Indications for psyllium. They include management of simple or chronic constipation, particularly if associated with a low-fiber diet. It is useful in situations in which straining should be avoided (after MI, rectal surgery, or prolonged bed rest). It is used in themanagement of chronic watery diarrhea. PTS: 1

DIF: Medium

REF: Page 1056

TOP: Therapeutic Classification: Laxatives

KEY: Cognitive Level: Analysis

55. ANS: B, C, D See Contraindications for theZoster Vaccine. It is contraindicated in a history of anaphylactic/anaphylactoid reactions to gelatin, neomycin; active infections; immunosuppression (including HIV); and pregnancy. There is no contraindication for chronic medical conditions that do not impart immunosuppression. Sensitivity to eggs is contraindicated for flu vaccine, but not for theshingles vaccine. PTS: 1

DIF: Hard

REF: Drugguide.com

TOP: Therapeutic Classification: Vaccines

KEY: Cognitive Level: Analysis

56. ANS: A, C, E, F See Patient/Family Teaching for lithium. Lithium may cause dizziness or drowsiness. Caution patient to avoid driving or other activities requiring alertness until response to medication is known. Advise patient to drink 2,000–3,000 mL fluid each day and eat a diet with consistent and moderate sodium intake. Excessive amounts of coffee, tea, and cola should be avoided because of diuretic effect. Advise patient that weight gain may occur. Review principles of a low-calorie diet. Explain to patients with cardiovascular disease or over 40 years of age theneed for ECG evaluation before and periodically during therapy. Patient should inform health-care professional if fainting, irregular pulse, or difficulty breathing occurs. PTS: 1

DIF: Hard

REF: Page 780

TOP: Therapeutic Classification: Mood stabilizers

KEY: Cognitive Level: Analysis

57. ANS: A, B See Patient/Family Teaching for loratadine. Advise patient that good oral hygiene, frequent rinsing of mouth with water, and sugarless gum or candy may minimize dry mouth. Patient should notify dentist if dry mouth persists longer than 2 wk. Flossing is not helpful in addressing dry mouth. Caffeine has a diuretic effect and will not be helpful. Normal recommended fluid intake is 1,500– 2,000 mL/day. Alcohol-based mouth rinse may increase a sensation of dryness. PTS: 1

DIF: Easy

REF: Page 785

TOP: Therapeutic Classification: Antihistamines

KEY: Cognitive Level:

Comprehension 58. ANS: A, B, D, E See Patient/Family Teaching for omega-3 acid ethyl esters. It may be administered with meals. Advise patient that this medication should be used in conjunction with diet restrictions (fat, cholesterol, carbohydrates, and alcohol), exercise, weight loss in overweight patients, and control of medical problems (such as diabetes mellitus and hypothyroidism) that may contribute to hypertriglyceridemia. PTS: 1

DIF: Hard

REF: Page 930

TOP: Therapeutic Classification: Lipid-lowering agents KEY: Cognitive Level: Comprehension | Cognitive Level: Application 59. ANS: B, C See Patient/Family Teaching for omeprazole. Advise patient to avoid alcohol, products containing aspirin or NSAIDs, and foods that may cause an increase in GI irritation. PTS: 1

DIF: Hard

REF: Page 932

KEY: Cognitive Level:

60. ANS: B, C, D, F See Indications for sulindec, phenytoin, phenobarbital, divalproex sodium, nabumetone and carbamazepine. Phenytoin, phenobarbital, divalproex sodium and carbamazepine are all used in thetreatment/prevention of tonic-clonic (grand mal) seizures and complex partial seizures. Sulindac and nabumetone are used in thetreatment of arthritis. PTS: 1

DIF: Hard

REF: Drugguide.com | Page 1009 | Page 1003 | Page 1238 | Page 268 TOP: Therapeutic Classification: Anticonvulsants

KEY: Cognitive Level:

Knowledge 61. ANS: C, D See Lab Considerations for procainamide. Monitor CBC every 2 wk during thefirst 3 mo of therapy. May cause  leukocyte, neutrophil, and platelet counts. Therapy may be discontinued if leucopenia occurs. Blood counts usually return to normal within 1 mo of discontinuation of therapy. Monitor ANA periodically during prolonged therapy or if symptoms of lupus-like reaction occur. Therapy is discontinued if a steady increase in ANA titer occurs. May cause  AST, ALT, alkaline phosphatase, LDH, and bilirubin, as well as a positive Coombs’ test result. PTS: 1

DIF: Hard

REF: Drugguide.com

TOP: Therapeutic Classification: Antiarrhythmics

KEY: Cognitive Level:

Knowledge 62. ANS: A, C, D See Patient/Family Teaching for raloxifene. Emphasize theimportance of regular weight-bearing exercise. Discuss theimportance of adequate calcium and vitamin D intake or supplementation; iron supplementation will not improve osteoporosis. Advise patient to discontinue smoking and alcohol consumption. Prolonged inactivity should be avoided due to increased risk of thrombosis. Dietary teaching should focus on increased/adequate intake of calcium and vitamin D.

PTS: 1

DIF: Hard

REF: Page 1071

TOP: Therapeutic Classification: Bone resorption inhibitors KEY: Cognitive Level: Application 63. ANS: A, B, D, E See Indications for salicylates, ibuprofen, and acetaminophen. Aspirin, other salicylates, and ibuprofen have anti-inflammatory and pain-relieving properties. Acetaminophen has no significant anti-inflammatory property. PTS: 1

DIF: Medium

KEY: Cognitive Level: Application

64. ANS: B, E, F See Contraindications/Precautions for temazepam. Use cautiously when there is a pre-existing hepatic dysfunction or history of a suicide attempt or drug addiction. Elderly patients have increased sensitivity to benzodiazepines. It appears on Beers list and is associated with increased risk of falls ( dose required). PTS: 1

DIF: Hard

REF: Page 1170

TOP: Therapeutic Classification: Sedative/hypnotics

KEY: Cognitive Level: Analysis

COMPLETION 65. ANS: 5 5 mL See Dosage for memantine. With a dose of 10 mg due at this time and liquid preparation of 2 mg/mL, theprovided dose is 5 mL [10 mg ÷ 2 mg/mL = 5 mL]. PTS: 1

DIF: Easy

REF: Page 806

KEY: Cognitive Level: Knowledge

66. ANS: 48 48 mg See Dosage for mesna. To calculate a dose of mesna, thenurse must first calculate theifosfamide dose based on thepatient’s body surface area. If theBSA is 2 m 2, then theifosfamide dose is 2.4 g [1.2 g/m2  2 m2 = 4.8 g]. themesna dose is 20% of theifosfamide dose [0.20  4.8 g = 0.48 g] converted to mg [0.48 g  100 mg/g = 48 mg]. Dosage: Give a dose of mesna equal to 20% of theifosfamide dose at thesame time as ifosfamide and 4 and 8 hr after. Ifosfamide is given via IV (adults) 1.2 g/m2/day for 5 days; it should be coadministered with mesna. PTS: 1

DIF: Hard

REF: Page 667 | Page 815

TOP: Therapeutic Classification: Antidotes

KEY: Cognitive Level: Knowledge

Drug Guide Test Bank 3 Multiple Choice Identify thechoice that best completes thestatement or answers thequestion. ____ 1. The nurse is providing care for an 82-year-old client with glaucoma. Diamox (acetazolamide) 250 mg orally twice daily has been ordered as a new medication. thenurse would be most concerned by which of thefollowing? a. The client has a listed allergy to sulfonamides. b. The client has a history of rheumatoid arthritis. c. The client takes Cogentin (benztropine) daily. d. The client’s potassium is 3.6 mEq/dL.

____ 2. A 21-year-old client is brought to theemergency room with suspected overdose with Tylenol (acetaminophen). Which of thefollowing medications would thenurse expect to be ordered? a. Protamine sulfate b. Primaxin (imipenem) Copyright © 2017 F. A. Davis Company

c. Acetadote (acetylcysteine) d. Diabeta (glyburide)

____ 3. The nurse is providing care for a 64-year-old client on thetelemetry unit whose heart rate suddenly jumps to 144 bpm. Telemetry shows supraventricular tachycardia and theclient reports feeling a bit lightheaded and dizzy. thenurse attempts vagal stimulation without success and prepares to administer Adenocard (adenosine) 6 mg IV push. thenurse would expect which of thefollowing to occur? a. A gradual slowing of theheart rate over thenext 30 min with an end result of normal sinus rhythm and improved symptoms. b. Slowing of thetachycardia with an end rate between 100–120 bpm and improved dizziness within 5 min. c. Loss of consciousness for theclient in preparation for electric shock/cardioversion. d. A short period of heart block or asystole immediately after injection followed by conversion to normal sinus rhythm.

____ 4. The nurse is caring for a 34-year-old patient with a large hilar mass due to lymphoma. Chemotherapy is being provided and theclient also has orders for Zyloprim (allopurinol) 300 mg orally twice daily. When providing this medication, thenurse would include which of thefollowing statements in theclient teaching? a. “This medication will help prevent gout, which occurs when clients are given radiation therapy.” b. “Allopurinol binds to theuric acid being released by thedestroyed cancer cells and prevents it from damaging your kidneys.” c. “Chemotherapy agents can reduce thenumber of white blood cells, red blood cells, and platelets in your body; this medication helps protect those cells.” d. “This is part of thechemotherapy regimen since some chemo agents are given in your IV and others are given by mouth.”

____ 5. The nurse is providing Ethyol (amifostine) to a 51-year-old woman with ovarian cancer who is also receiving Cisplatin. Which of thefollowing nursing assessments during theinfusion is of thehighest priority? a. Monitor client blood sugar every hr. b. Monitor client’s respiratory rate every 30 min. c. Monitor client’s blood pressure every 5 min. d. Monitor client’s urine output every 4 hr.

____ 6. While preparing to give Fungizone (amphotericin B) to a client who is also receiving Dexasone (dexamethasone), thenurse recognizes theclient is at increased risk for which of thefollowing? a. Hypoglycemia b. Hyponatremia c. Hypocalcemia d. Hypokalemia

____ 7. A client with breast cancer is taking Arimidex (anastrozole). thenurse recognizes that teaching has been effective by which of thefollowing client statements? a. “If I miss a dose, I should take a double dose thenext day.” b. “I must take this medication on an empty stomach before going to bed each night.” c. “Oral chemotherapy generally has fewer side effects and is much safer.” d. “There is a risk of allergic reaction for this medication so I need to notify thedoctor right away if I have any swelling in my face, difficulty swallowing, or rashes.”

____ 8. A nurse is receiving shift-to-shift report for a client in theintensive care unit with multiple medical problems. theclient is receiving Argatroban infusion. thenurse recognizes this medication is ordered to address which of thefollowing health-care problems for theclient? a. Ventilator-associated pneumonia Copyright © 2017 F. A. Davis Company

b. Deep vein thrombosis c. Hypotension d. Urosepsis

____ 9. While providing care for a client who is to receive Abilify (aripiprazole), thenurse recognizes that theclient understands this medication by which of thefollowing statements? a. “This medication may cause me to have a dry mouth or lower my saliva production.” b. “This medication will reduce my nicotine cravings and help me quit smoking.” c. “I need to let thedoctor know right away if I have any thoughts of suicide or worsening depression.” d. “I need to be sure and drink at least 4 quarts of water each day while I’m taking this medication.”

____ 10. In reviewing new orders, thenurse notes Azactam (aztreonam) 1 gram IV every 8 hr has been ordered. Before initiating therapy, thenurse should assess for an allergy history to which of thefollowing? Select all that apply. a. Penicillins b. MAO inhibitors c. Antifungals d. Cephalosporins e. Nonsteroidal anti-inflammatory agents

____ 11. While caring for a client with Parkinson disease who has recently started taking Cogentin (benztropine), theclient reports, “My mouth seems so dry all thetime.” Which of thefollowing statements by thenurse is best? a. “Dry mouth is common with your new medications. You should rinse frequently and consider using hard sugarless candies or gum to help with thesymptom.” Copyright © 2017 F. A. Davis Company

b. “I wonder if your dose is too high; try taking half thepill twice a day instead of all at once and see if that helps.” c. “You should call your doctor and let them know about that—it could be a serious side effect of thenew medication.” d. “Have you noticed any fever or night sweats lately?”

____ 12. The nurse is providing instructions to a client who has started therapy with Subutex (buprenorphine) to assist with opioid withdrawal. thenurse instructs theclient to avoid which of thefollowing natural substances/herbs? Select all that apply. a. Kava-kava b. Valerian c. Garlic d. Ginger e. Chamomile f. Hops

____ 13. While providing care for an 84-year-old patient with Parkinson disease who is taking Sinemet (carbidopa/levodopa), thenurse notes abnormalities in theclient’s lab values. Which of thefollowing could be attributed to themedication? a. Platelet count—440,000 c/mm3 b. Hemoglobin—10.4 g/dL c. Albumin—3.2 g/dL d. B-type natriuretic peptide (BNP)—449 pg/mL

____ 14. While caring for a client taking Clozaril (clozapine), thenurse determines themedication is effective by which of thefollowing findings? a. Decreased swelling noted at thesite of cellulitis in theleft hand. b. Apical heart rate is regular at 72 bpm. Copyright © 2017 F. A. Davis Company

c. Client is cooperative; oriented to person, place, and time; and has no hallucinations or delusions. d. Breath sounds are clear throughout anterior, lateral, and posterior aspects.

____ 15. While caring for a client who is taking Sandimmune (cyclosporine) after a cardiac transplant, thenurse is aware that it is most important to monitor for which of thefollowing? a. Hypokalemia b. Hypotension c. Anorexia d. Nephrotoxicity

____ 16. A client admitted with atrial fibrillation would most likely be started on which of thefollowing medications to reduce therisk of embolization? a. Pradaxa (dabigatran) b. DDAVP (desmopressin) c. Effexor (venlafaxine) d. Flomax (tamsulosin)

____ 17. While caring for a client who is receiving Desferal (deferoxamine), thenurse notes theclient’s urine is reddish colored. Which of thefollowing conclusions should thenurse draw? a. There is a risk of hemolytic cystitis with this medication and thenext dose should be held. b. The client may be experiencing liver toxicity; thephysician should be contacted to request laboratory analysis be done. c. This is an expected and normal finding with themedication due to theexcretion of iron. d. The client may have a secondary urinary tract infection and a urinalysis should be sent. Copyright © 2017 F. A. Davis Company

____ 18. The nurse is providing care for a 41-year-old patient with a severe head injury following a motor vehicle accident. thenurse notes theclient’s urinary output for thepast four hr is 900 mL. Which of thefollowing medications would thenurse anticipate being ordered? a. DDAVP (desmopressin) b. Lasix (furosemide) c. Lopurin (allopurinol) d. Dexedrine (dextroamphetamine)

____ 19. While counseling a client taking Pristiq (desvenlafaxine), thenurse recognizes that further teaching is necessary based on which of thefollowing client statements? a. “I’ll be sure to let my doctor know if I have any thoughts of suicide.” b. “If I need something for pain, I should take aspirin, ibuprofen, or another nonsteroidal anti-inflammatory instead of Tylenol while I’m taking this medication.” c. “I shouldn’t drive a car for a few weeks since this medication can cause dizziness.” d. “I should avoid drinking alcohol while I’m taking this medication.”

____ 20. The nurse is preparing to give theinitial dose of Doribax (doripenem). Which of thefollowing nursing actions would thenurse do first? a. Determine if a culture of thewound or blood has been obtained. b. Monitor bowel function for abdominal cramping or diarrhea. c. Start dose of 500 mg IV and provide every 8 hr. d. Reconstitute thepowder for injection.

____ 21. The nurse is caring for a 68-year-old male who is taking Cardura (doxazosin). He denies any history of hypertension. thenurse recognizes this medication can also be used to treat which of thefollowing conditions? a. Psoriasis b. Gout c. Lymphoma d. Benign prostatic hypertrophy

____ 22. The nurse is providing Epogen (epoetin) subcutaneously to a client with chronic kidney disease. Which of thefollowing would indicate that thetherapy is effective? Select all that apply. a. The client’s hematocrit rises from 27.4 to 32.9%. b. The client’s serum creatinine falls from 5.6 mg/dL to 4.9 mg/dL. c. The client reports decreased fatigue and dyspnea. d. The client reports 500 mL of urine output in a 24-hr period. e. The client’s WBC = 7.4 u/L. f. The client has remained afebrile for 2 wk.

____ 23. The nurse is providing Tarceva (erlotinib) intravenously for a client who has small cell lung cancer. theclient begins to appear slightly short of breath, respiratory rate has gone from 14 breaths per min to 20 breaths per min and he has been coughing mildly for thepast 10 min. Which of thefollowing actions should thenurse take first? a. Listen to breath sounds to determine if theclient is experiencing fluid volume overload. b. Stop theinfusion since there is a risk of interstitial lung disease with this medication. c. Check theclient’s temperature to determine if he is developing pneumonia. d. Reassure theclient that a cough is normal as cancer cells are destroyed and continue to monitor closely.

____ 24. The nurse is talking to a neighbor who spent 3 days in thehospital on intravenous antibiotics including erythromycin theweek before. theindividual states, “I’ve had such bad diarrhea all night and it really isn’t any better today.” Which of thefollowing statements by thenurse is best? a. “Are you taking any oral antibiotics now?” b. “Antibiotics commonly cause diarrhea; be sure to drink plenty of fluids.” c. “Have you noticed any blood or pus in thestool?” d. “Is anyone else in thefamily experiencing thesame symptoms?”

____ 25. The nurse is reviewing thehome medication list for a client with identified hypercholesterolemia. theclient reports taking Zetia (ezetimibe) daily. thenurse understands this medication is designed to reduce theclient’s risk for which of thefollowing? a. Atherosclerosis b. Angina c. Deep vein thrombosis d. Gastric ulceration

____ 26. While investigating themedications taken by a client in thehospital, thestudent nurse understands that Plendil (felodipine) works to lower blood pressure by causing which of thefollowing physiologic changes? a. Dilatation of thevascular wall b. Blocking thetransport of calcium c. Inhibiting thebeta receptors on cell membranes d. Reducing theformation of ectopic beats

____ 27. A nurse caring for a client with chronic obstructive pulmonary disease notes therecent addition of a new inhaler, formoterol. thenurse knows this medication is designed to prevent which of thefollowing symptoms? Copyright © 2017 F. A. Davis Company

a. Mucous production b. Salivation c. Bleb formation d. Bronchospasm

____ 28. A client with Alzheimer is started on Razadyne (galantamine) 4 mg twice daily. thefamily has been told to return to thephysician’s office in 4 wk. Which of thefollowing statements by thenurse is best? a. “Sometimes a higher dose of this medication is needed to see improvement.” b. “You should notice improvement within a day or two.” c. “If you forget a dose one day, just have her take two thenext day.” d. “This medication can cause dizziness so be extra careful to avoid falls.”

____ 29. While observing in theoperating room, thestudent nurse notes a client was given Robinul (glycopyrrolate) pre-operatively as part of theanesthesia regimen. thestudent recognizes this medication will cause which of thefollowing? a. Decreased pain perception during theprocedure b. Reduced oral and respiratory secretions c. Neuromuscular blockage and paralysis d. Reduced consciousness and sedation

____ 30. While working in thepsychiatric hospital, thenurse provides Fanapt (iloperidone) 2 mg twice daily. Which of thefollowing assessments indicates themedication is effective? a. The client’s mood is stabilized. b. The client is able to sleep for 8 hr at night. c. The client denies hearing voices. d. The client’s weight is stabilized.

____ 31. The nurse is caring for a client newly admitted with pelvic inflammatory disease. An order for Primaxin (imipenem) 500 mg IV every 6 hr is noted. thenurse would be most concerned by which of thefollowing findings in theclient’s history? a. Use of an intrauterine device for birth control b. Family history of hypertension c. Order for morphine sulfate 2 mg IV every 4 hr as needed for pain d. History of seizures

____ 32. The nurse responds to a call light for a client with chronic obstructive pulmonary disease and finds theclient slightly dyspneic with a respiratory rate of 20 and wheezing noted in theanterior and posterior upper lung fields. thenurse knows theclient has orders for Arcapta (indacaterol) inhaler once daily, which is due in 1 hr. Which of thefollowing actions by thenurse is best? a. Provide theArcapta (indacaterol) inhaler at this time. b. Check theclient’s temperature. c. Determine if theclient has an order for other respiratory inhalers/treatment. d. Identify themost recent chest x-ray results.

____ 33. The nurse is providing care for a client with end stage renal disease who is receiving Fosrenol (lanthanum carbonate). thenurse recognizes this medication is effective by which of thefollowing laboratory values? a. Serum potassium = 3.7 mEq/L b. Hemoglobin = 10.2 g/dL c. Uric acid = 3.7 mg/dL d. Serum phosphate = 5.4 mg/dL

____ 34. While observing in theoncology clinic, a student nurse is reviewing chemotherapy orders for a client with advanced colorectal cancer. thenurse providing care explains theclient is to receive “high dose methotrexate with leucovorin rescue.” thestudent understands thefolinic acid (leucovorin calcium) is given for which of thefollowing reasons? a. As a catalyst to increase thenumber of cancer cells destroyed by themethotrexate. b. As an antidote to themethotrexate to reduce thedestruction of blood cells. c. As a second chemotherapeutic agent that will destroy cancer cells using a different mechanism. d. As a carrying agent to ensure delivery of themethotrexate into thecells.

____ 35. The student nurse reviews a list of medications a client takes at home. Xopenex (levalbuterol) is on thelist. thestudent expects this medication is provided in which of thefollowing ways? a. Orally b. Topically c. Rectally d. Metered dose inhaler

Multiple Response Identify one or more choices that best complete thestatement or answer thequestion. ____ 36. A student nurse is preparing to participate in a mission-trip to South Africa and is prescribed Plaquenil (hydroxychloroquine). Which of thefollowing side effects may be experienced by thestudent? Select all that apply. a. Rash b. Headache c. Ringing in theears d. Anorexia e. Diarrhea f. Hypertension Copyright © 2017 F. A. Davis Company

____ 37. As part of a new treatment regimen for hypothyroidism, a 48-year-old woman is prescribed Levoxyl (levothyroxine). thenurse should include which of thefollowing statements in theclient teaching? Select all that apply. a. “You should take this medication at roughly thesame time each day.” b. “Once you’ve been taking this medication for a few weeks, you should be cured and thedoctor will stop it.” c. “Let thedoctor know if you lose more than 2 pounds per week while taking this medication.” d. “Do not take this medication at thesame time as any other medications.” e. “Avoid eating beef or pork while taking this medication.” f. “Some clients experience headaches, nervousness, sweating, and palpitations while taking this medication.”

____ 38. The nurse is providing care for a client who has new orders to start Victoza (liraglutide) 0.6 mg subcutaneously each day. Which of thefollowing orders should thenurse anticipate? Select all that apply. a. Check blood sugar before meals and at bedtime. b. Teach client self-injection techniques. c. Conduct liver function tests every morning for thenext 3 days. d. Discontinue low molecular weight heparin. e. Notify physician of acute abdominal pain, nausea, or vomiting. f. Hold all aspirin products.

____ 39. A nurse from themedical unit is floated to thesurgical unit. While preparing to provide morning medications, thenurse realizes many clients are taking Demerol (meperidine) and knows thedrug must be given cautiously or in reduced doses to which of thefollowing clients? Select all that apply. a. A 42-year-old patient taking Nitro-Bid (nitroglycerine) Copyright © 2017 F. A. Davis Company

b. A 68-year-old patient taking Prozac (fluoxetine) c. A 74-year-old patient taking Matulane (procarbazine) d. A 66-year-old patient taking Dilantin (phenytoin) e. A 51-year-old patient taking Zovirax (acyclovir) f. A 76-year-old patient taking Synthroid (levothyroxine)

____ 40. A nurse caring for a client who is to initiate therapy with Merrem (meropenem) 500 mg intravenously every 12 hr would include which of thefollowing statements in theclient teaching? Select all that apply. a. “This medication is used to treat various infections.” b. “The dose is reduced since you have a history of renal impairment.” c. “Be sure to let us know if you develop any diarrhea.” d. “Since you have an allergy to penicillin, there is no risk of allergy to this medication.” e. “The medication can cause dizziness for some people so be sure to call for help when you need to get up out of bed.”

____ 41. Which of thefollowing would cause thenurse to suspect that a client taking Glucophage (metformin) may be developing lactic acidosis? Select all that apply. a. Client reports chills and muscle aches. b. Blood pressure = 98/54 mmHg. c. Client reports profound headache and ringing in theears. d. Client complains of dizziness and diarrhea. e. White blood cell count = 7,500 cell/mm3. f. Pupils are dilated and unresponsive to light.

____ 42. The nurse is caring for a client taking Skelaxin (metaxalone). The nurse knows teaching has been effective by which of the following statements? Select all that apply. Copyright © 2017 F. A. Davis Company

a. “I might be constipated while I’m on this medication.” b. “Most people who take this medication have fewer muscle spasms and less pain.” c. “This can cause dizziness, blurred vision, and sleepiness so I shouldn’t drive while I’m on it.” d. “I need to move slowly so I don’t faint.” e. “I can drink up to 2 beers per day safely while I’m on this medication.” f. “If I forget this medication, I can take it within one hour or skip that dose and remain on the schedule.”

____ 43. While providing care for a 45-year-old woman client who has been started on Tapazole (methimazole) 15 mg every 4 hr, the nurse would include which of the following in the plan of care? Select all that apply. a. Teach client self-injection techniques. b. Monitor for signs and symptoms of hyper- or hypothyroidism. c. Place client in protective isolation. d. Assess white blood cell and differential counts. e. Strain all urine. f. Monitor for signs or symptoms of bleeding.

____ 44. While reviewing a client’s medication list, the nurse notes the client takes Remeron (mirtazapine) 15 mg daily. The nurse recognizes this medication has multiple indications and is used both on and off label for various reasons including which of the following? Select all that apply. a. Major depressive disorder b. Schizophrenia c. Anorexia nervosa d. Panic disorder e. Generalized anxiety disorder f. Post-traumatic stress disorder

____ 45. While caring for a client receiving methyldopa for hypertension, the nurse recognizes elevations in which of the following labs may be caused by the medication? Select all that apply. a. Serum creatinine b. White blood cells c. Amylase d. Albumin e. Potassium f. Sodium

Completion Complete each statement. 46. A new order for Foscavir (foscarnet) 60 mg/kg IV every 8 hr has been noted. The patient weighs 50 kg. With a dilution required concentration of 12 mg/mL, what size IV bag will the nurse need to infuse this medication ___________________? 47. The nurse receives orders to begin Robaxin (methocarbamol) 4.5 grams per day in 3 equally divided doses. The medication is available in 500 mg tablets. How many pills will the nurse provide with each dose? __________ pills 48. The nurse is preparing to start therapy with IV Dobutrex (dobutamine). The pre-mixed solution has 250 mg in 250 mL. The orders read 5 mcg/kg/min and the client weighs 165 pounds. At what rate, expressed in mL/hr, should the infusion be started? (Round to the nearest tenths place.) ___________ mL/hr Short Answer

49. The nurse is caring for a 6-month-old patient receiving oral Moxatag (amoxicillin) 25 mg/kg/day divided into two doses and distributed as 50 mg/mL oral suspension. The child weighs 33 pounds. How much medication (in mL) will this nurse pour/provide each dose? Other 50. The nurse is preparing to provide a chemotherapy treatment for a client with non-small cell lung cancer. It is day 8 of the 28-day chemotherapy cycle and the client is scheduled to receive Gemzar (gemcitabine) IV. Match the following nursing actions in the correct order for provision. A. Infuse over 30 min. B. Identify absolute granulocyte and platelet counts. C. Monitor vital signs every 15 min. D. Obtain medication from pharmacy.

Drug Guide Test Bank 3 Answer Section MULTIPLE CHOICE 1. ANS: A See Contraindications/Precautions for acetazolamide. Hypersensitivity or cross-sensitivity with sulfonamides may occur. PTS: 1

DIF: Medium

REF: Page 103

TOP: Therapeutic Classification: Anticonvulsants, Antiglaucoma agents KEY: Cognitive Level: Application 2. ANS: C See Toxicity and overdose for acetaminophen and Indications for acetylcysteine: Acetylcysteine is the antidote for the management of potentially hepatotoxic overdose of acetaminophen. PTS: 1

DIF: Medium

REF: Page 102 | Page 105

TOP: Therapeutic Classification: Antidotes, mucolytic

KEY: Cognitive Level: Application

3. ANS: D See Nursing Implications adenosine: Monitor heart rate frequently (every 15–30 sec) and ECG continuously during therapy. Short transient periods of 1st, 2nd, or 3rd degree heart block or asystole may occur following injection; usually resolves quickly due to short duration of adenosine. Once conversion to normal sinus rhythm is achieved, transient arrhythmias may occur but generally last a few seconds. PTS: 1

DIF: Hard

REF: Page 114

KEY: Cognitive Level:

4. ANS: B See Indications for allopurinol: Treatment of secondary hyperuricemia, which may occur during treatment of tumors or leukemias. PTS: 1

DIF: Hard

REF: Page 126

TOP: Therapeutic Classification: Antigout, antihyperuremics

KEY: Cognitive Level: Analysis

5. ANS: C See Nursing Implications Assessment for amifostine. Monitor BP before and every 5 min during infusion. Discontinue antihypertensives 24 hr prior to the treatment. If significant hypotension requiring interruption of therapy occurs, place client in Trendelenburg position and administer an infusion of 0.9% NaCl using separate IV line. PTS: 1

DIF: Hard

REF: Page 135

TOP: Therapeutic Classification: Cytoprotective agents

KEY: Cognitive Level: Analysis

6. ANS: D See Interactions for amphotericin B with corticosteroids. Concurrent use with corticosteroids increases risk of hypokalemia. PTS: 1

DIF: Hard

REF: Page 156

TOP: Therapeutic Classification: Antifungals

KEY: Cognitive Level: Knowledge

7. ANS: D See Patient/Family Teaching for anastrozole. Inform client of potential for adverse reactions and advise client to notify health-care professional immediately if allergic reactions or chest pain occurs. PTS: 1

DIF: Easy

REF: Pages 163–164

TOP: Therapeutic Classification: Antineoplastics

KEY: Cognitive Level: Analysis

8. ANS: B See Indications for Argatroban. Prophylaxis or treatment of thrombosis in client with heparininduced thrombocytopenia. PTS: 1

DIF: Easy

REF: Page 183

TOP: Therapeutic Classification: Anticoagulations

KEY: Cognitive Level: Application

9. ANS: C See Patient Family Teaching for aripiprazole. Advise patient and family to notify health-care professional if thoughts about suicide or dying, attempts to commit suicide, new or worse depression, or new or worse anxiety occur. The medication can cause tardive dyskinesia or neuroleptic malignant syndrome but does not typically cause a dry mouth nor are increased fluids required. PTS: 1

DIF: Medium

REF: Pages 187–188

TOP: Therapeutic Classification: Antipsychotic, mood stabilizers KEY: Cognitive Level: Application 10. ANS: A D See Nursing Implications Assessment for aztreonam. Obtain a history before initiating therapy to determine previous use of and reaction to penicillins and cephalosporins. PTS: 1

DIF: Medium

REF: Page 207

TOP: Therapeutic Classification: Anti-infectives

KEY: Cognitive Level:

Knowledge 11. ANS: A See Patient/Family Teaching for benztropine. Instruct patient that frequent rinsing of mouth and good oral hygiene, and sugarless gum or candy may decrease dry mouth.

PTS: 1

DIF: Medium

REF: Page 217

TOP: Therapeutic Classification: Antiparkinson agents

KEY: Cognitive Level: Analysis

12. ANS: A B, E, F See Drug-Natural Products under Interactions for buprenorphine. Concomitant use of kava-kava, valerian, chamomile, or hops can increase CNS depression. PTS: 1

DIF: Hard

REF: Page 238

TOP: Therapeutic Classification: Opioid analgesics

KEY: Cognitive Level: Knowledge

13. ANS: B See Nursing Implications for carbidopa/levodopa. May cause decreased hemoglobin/hematocrit, agranulocytosis, hemolytic and nonhemolytic anemia, thrombocytopenia, leucopenia, and increased WBC. The listed platelet count is high, which is not expected with the drug, the hemoglobin is low and could be attributed to the drug, the protein value is low with no correlation to the drug, and the BNP is high with no correlation to the drug. PTS: 1

DIF: Hard

REF: Page 272

TOP: Therapeutic Classification: Anti-Parkinson agents

KEY: Cognitive Level: Analysis

14. ANS: C See Indications and Evaluation/Desired Outcomes for clozapine. Used in the treatment of schizophrenia. The medication will have no impact on infection, heart rate, or breath sounds but will help reduce psychotic behaviors. PTS: 1

DIF: Medium

REF: Pages 332–334

TOP: Therapeutic Classification: Antipsychotics 15. ANS: D

KEY: Cognitive Level: Analysis

See Adverse Reactions/Side Effects for cyclosporine: Can cause hyperkalemia and hypertension (not hypokalemia or hypotension) as well as anorexia and nephrotoxicity—the highest priority of those listed (anorexia and nephrotoxicity) is nephrotoxicity. PTS: 1

DIF: Hard

REF: Page 372

TOP: Therapeutic Classification: Immunosuppressants

KEY: Cognitive Level: Application

16. ANS: A See Indications for dabigatran: to reduce the risk of stroke/systemic embolization associated with nonvalvular atrial fibrillation. DDAVP is used in the treatment of diabetes insipidus. Venlafexine is an antidepressant and tamsulosin is an anti-adrenergic agent used for prostatic hyperplasia. PTS: 1

DIF: Hard

REF: Page 379

TOP: Therapeutic Classification: Anticoagulants

KEY: Cognitive Level:

Knowledge 17. ANS: C See Action and Adverse Reactions/Side Effects of deferoxamine. Chelates unbound iron, forming a water-soluble complex that is easily excreted by the kidneys; red urine is a frequent side effect. PTS: 1

DIF: Hard

REF: Page 400

TOP: Therapeutic Classification: Antidotes

KEY: Cognitive Level: Analysis

18. ANS: A See Indications for desmopressin: Treatment of central diabetes insipidus caused by deficiency of vasopressin. Diabetes insipidus, often seen in the presence of a head injury, result in profound dieresis. Treatment with diuretics (Lasix and Allopurinol) would be contraindicated. Dextroamphetamine is a CNS stimulant used in the treatment of ADHD and narcolepsy. PTS: 1

DIF: Medium

REF: Page 406

KEY: Cognitive Level: Analysis

19. ANS: B See Patient/Family Teaching for desvenlafaxine: Increased risk of bleeding with concomitant use of NSAIDs, aspirin, or other drugs that affect coagulation. Advise patient and family to look for suicidality. May cause dizziness or drowsiness. Caution patient to avoid driving until response to the drug is known. Caution patient to avoid taking alcohol or other CNS depressants. PTS: 1

DIF: Medium

REF: Pages 409–410

TOP: Therapeutic Classification: Antidepressants

KEY: Cognitive Level:

Application 20. ANS: A See Nursing Implications for doripenem. Obtain specimens for culture and sensitivity before initiating therapy. First dose may be given before receiving results. PTS: 1

DIF: Easy

REF: Page 457

TOP: Therapeutic Classification: Anti-infectives

KEY: Cognitive Level:

Application 21. ANS: D See Indications for doxazosin: Symptomatic benign prostatic hypertrophy. PTS: 1

DIF: Medium

REF: Page 458

TOP: Therapeutic Classification: Antihypertensives, peripherally acting antiadrenergics KEY: Cognitive Level: Knowledge 22. ANS: A C See Evaluation/Desired Outcomes for epoetin. Increase in hematocrit to 30–36% with improvement in symptoms of anemia in patients with chronic renal failure.

PTS: 1

DIF: Hard

REF: Page 506

TOP: Therapeutic Classification: Antianemics

KEY: Cognitive Level: Analysis

23. ANS: B See Nursing Implications for erlotinib. Assess respiratory status prior to and periodically during therapy. If dyspnea, cough, or fever occur, discontinue erlotinib, assess for interstitial lung disease, and institute treatment as needed. Treatment must be stopped as the first priority. PTS: 1

DIF: Hard

REF: Pages 510–511

TOP: Therapeutic Classification: Antineoplastics

KEY: Cognitive Level: Analysis

24. ANS: C See Nursing Implications for erythromycin. Monitor bowel function. Diarrhea, abdominal cramping, fever, and bloody stools should be reported promptly as a sign of pseudomembranous colitis. May begin up to several weeks following cessation of therapy. PTS: 1

DIF: Medium

REF: Page 514

TOP: Therapeutic Classification: Antibiotics

KEY: Cognitive Level: Analysis

25. ANS: A See Indications and Therapeutic Effects for ezetimibe. Lowers cholesterol, a known risk factor for atherosclerosis. PTS: 1

DIF: Easy

REF: Page 540

TOP: Therapeutic Classification: Lipid-lowering agents

KEY: Cognitive Level: Comprehension

26. ANS: B See Action for felodipine. Inhibits the transport of calcium into myocardial and vascular smooth muscle cells, resulting in inhibition of excitation-contraction coupling and subsequent contraction. PTS: 1

DIF: Easy

REF: Page 545

TOP: Therapeutic Classification: Antianginals; Calcium channel blockers KEY: Cognitive Level: Comprehension 27. ANS: D See Indications for formoterol: As concomitant therapy for the treatment of asthma and the prevention of bronchospasm. PTS: 1

DIF: Easy

REF: Page 591

TOP: Therapeutic Classification: Bronchodilators

KEY: Cognitive Level:

Knowledge 28. ANS: D See Patient/Family Teaching. Increased dosage may be needed but the risk of falls due to dizziness is a higher priority. Improvement may not been seen for weeks to months and doses should not be doubled. PTS: 1

DIF: Medium

REF: Page 604

TOP: Therapeutic Classification: Anti-Alzheimer's agents

KEY: Cognitive Level: Analysis

29. ANS: B See Indications for glycopyrrolate: Inhibits salivation and excessive respiratory secretions when given preoperatively. PTS: 1

DIF: Medium

REF: Page 613

TOP: Therapeutic Classification: Antispasmodics

KEY: Cognitive Level:

Comprehension 30. ANS: C See Action/Therapeutic Effects: Decreased symptoms of schizophrenia. PTS: 1

DIF: Medium

REF: Page 668

TOP: Therapeutic Classification: Antipsychotics

KEY: Cognitive Level:

Application 31. ANS: D See Contraindications/Precautions for imipenem/cilastatin. Previous history of seizure disorder— medication can cause seizures. PTS: 1

DIF: Easy

REF: Page 674

TOP: Therapeutic Classification: Anti-infectives

KEY: Cognitive Level:

Application 32. ANS: C See Nursing Implications: Consult health-care professional about alternative medications if severe bronchospasm is present; onset of action is too slow for client in acute distress. PTS: 1

DIF: Medium

REF: Pages 678–679

TOP: Therapeutic Classification: Bronchodilators

KEY: Cognitive Level: Analysis

33. ANS: D See Evaluation/Desired Outcome: Decrease in serum phosphate to below 6.0 mg/dL in clients with end stage renal disease. PTS: 1

DIF: Medium

REF: Page 747

TOP: Therapeutic Classification: Hypophosphatemics

KEY: Cognitive Level: Analysis

34. ANS: B See Indications of leucovorin calcium: Minimizes hematologic effects of high-dose methotrexate therapy. PTS: 1

DIF: Medium

REF: Page 755

KEY: Cognitive Level: Comprehension

35. ANS: D See Availability: Metered dose inhaler. PTS: 1

DIF: Easy

REF: Page 761

TOP: Therapeutic Classification: Bronchodilators

KEY: Cognitive Level:

Knowledge MULTIPLE RESPONSE 36. ANS: B, C, D, E See Adverse Reactions/Side Effects of hydroxychloroquine: Can cause headache, fatigue, hypotension (not hypertension), abdominal cramps, diarrhea, anorexia, alopecia, photosensitivity, and hyperpigmentation (not rash). PTS: 1

DIF: Hard

REF: Page 655

TOP: Therapeutic Classification: Antimalarials

KEY: Cognitive Level:

Knowledge 37. ANS: A, C, D, F See Patient/Family Teaching for levothyroxine. Instruct patient to take medication as directed at the same time each day. Explain the medication does not cure hypothyroidism; therapy is life-long. Advise patient to notify health care provider if headache, nervousness, diarrhea, excessive sweating, heat intolerance, weight loss of more than 2 pounds/wk, or any unusual symptoms occur. Caution patient to avoid taking other medications concurrently. PTS: 1

DIF: Medium

REF: Pages 766–767

TOP: Therapeutic Classification: Hormones 38. ANS: A, B, E

KEY: Cognitive Level: Analysis

See Indications, Availability, and Assessment for liraglutide: Used in the management of type 2 diabetes, provided as a subcutaneous injection with/without pre-filled pen, monitor for pancreatitis. No contraindication for heparin or aspirin products; no change in liver enzymes expected. PTS: 1

DIF: Medium

REF: Pages 776–777

TOP: Therapeutic Classification: Antidiabetics

KEY: Cognitive Level:

Application 39. ANS: C, D, E See Interactions Drug-Drug for meperidine: Do not use in clients receiving MAO inhibitors or procarbazine. Phenytoin increases metabolism and may decrease effects. Acyclovir may increase plasma concentrations. No listed interaction with nitroglycerine, fluoxetine, or levothyroxine. PTS: 1

DIF: Hard

REF: Page 808

TOP: Therapeutic Classification: Opioid analgesics

KEY: Cognitive Level: Application

40. ANS: A, B, C, E See Indications, Route/Dosage (Renal Impairment), and Patient/Family Teaching for meropenem. Treatment of intra-abdominal infections, bacterial meningitis, skin and skin structure infections, reduce dose to 500 mg every 12 hr CCr 10–25 mL/min, caution patient to notify health care provider with fever and diarrhea; may cause dizziness. PTS: 1

DIF: Medium

REF: Pages 811–812

TOP: Therapeutic Classification: Anti-infectives

KEY: Cognitive Level:

Application 41. ANS: A, B, D See Patient/Family Teaching for metformin. Explain to patient the risk of lactic acidosis. Symptoms include chills, diarrhea, dizziness, low BP, muscle pain, sleepiness, slow heartbeat or pulse, dyspnea, or weakness.

PTS: 1

DIF: Hard

REF: Pages 818–819

TOP: Therapeutic Classification: Antidiabetics

KEY: Cognitive Level: Analysis

42. ANS: B, C, D, F See Patient/Family Teaching for metaxalone: Used for muscle spasm. Medication may cause dizziness, drowsiness, and blurred vision. Advise patient to avoid driving and other activities requiring alertness. Instruct patient to make position changes slowly to minimize orthostatic hypotension. Instruct patient to take medication as directed, take missed doses within 1 hr, if not, and return to regular dosing schedule. Advise patient to avoid concurrent use of alcohol and other CNS depressants. Does not usually cause constipation. PTS: 1

DIF: Medium

REF: Page 817

TOP: Therapeutic Classification: Skeletal muscle relaxants KEY: Cognitive Level: Application 43. ANS: B, D See Nursing Implications for methimazole: Monitor response for symptoms of hyperthyroidism; assess for development of hypothyroidism. Monitor WBC and differential counts periodically during therapy. Medication is provided orally, no effect on urine or formation of kidney stones, does not require protective isolation or cause bleeding. PTS: 1

DIF: Hard

REF: Page 822

TOP: Therapeutic Classification: Antithyroid agents

KEY: Cognitive Level: Application

44. ANS: A, D, E, F See Indications for mirtazapine: Major depressive disorder. Unlabeled use: panic disorder, generalized anxiety disorder, post-traumatic stress disorder. PTS: 1

DIF: Hard

REF: Page 855

TOP: Therapeutic Classification: Antidepressants Application

KEY: Cognitive Level:

45. ANS: A, E, F See Nursing Implications for methyldopa: May cause increase in BUN, serum creatinine, potassium, sodium, prolactin, uric acid, AST, ALT, alkaline phosphatase, and bilirubin concentration. PTS: 1

DIF: Medium

REF: Pages 828–829

TOP: Therapeutic Classification: Antihypertensives

KEY: Cognitive Level: Application

COMPLETION 46. ANS: 250 mL 250 mL IV bag See Implementation/IV Administration for foscarnet: Drug calculation: 60 mg x 50 kg = 3,000 mg. 3,000 mg divided by 12 mg = 250. The nurse will need a 250 mL IV bag. PTS: 1

DIF: Easy

REF: Page 592

TOP: Therapeutic Classification: Antivirals

KEY: Cognitive Level: Application

47. ANS: 3 Dose calculation: 4.5 grams divided by 3 is 1.5 grams per dose. 1.5 grams x 1,000 mg/g divided by 500 mg/tablet = 3 tablets PTS: 1

DIF: Easy

REF: Page 823

TOP: Therapeutic Classification: Skeletal muscle relaxants KEY: Cognitive Level: Application 48. ANS: 22.5

See Route/Dosage and Availability for dobutamine. Drug calculation involves converting client’s weight to kg [165 divided by 2.2 = 75 kg] followed by calculation of the dose [5 mcg  75 kg = 375 mcg/min] followed by dose conversion to mg [375 divided by 1,000 = 0.375 mg/min] followed by calculation for an hourly rate [0.375  60 = 22.5 mg/hr] since the solution has 1 mg/mL, the final conversion does not change the rate [22.5  1 = 22.5 mL/hr]. PTS: 1

DIF: Hard

REF: Pages 443–444

TOP: Therapeutic Classification: Inotropics

KEY: Cognitive Level: Knowledge

SHORT ANSWER 49. ANS: 3.75 mL = 3.8 mL See Availability for amoxicillin and perform drug calculation. 2.2 pounds = 1 kg so weight conversion is 33 pounds divided by 2.2 = 15 kg. Calculate daily drug dose by multiplying 25 mg/kg and 15 = 375 mg. Divide by 2 for single dose = 187.5. Since medication comes 50 mg/mL, divide by 50 to calculate oral amount in each dose = 3.75 mL PTS: 1

DIF: Hard

REF: Page 149

TOP: Therapeutic Classification: Antibiotics

KEY: Cognitive Level: Analysis

SEQUENCING 50. ANS: B, D, A, C See Nursing Implications/labs for gemcitabine: Dose guidelines are based on CBC results, so this must be determined first. Administer over 30 min—longer infusions have a greater incidence of toxicity. Monitor vital signs before and frequently during therapy. PTS: 1

DIF: Easy

REF: Pages 608–609

TOP: Therapeutic Classification: Antineoplastics

KEY: Cognitive Level: Analysis

Drug Guide Test Bank 4 Multiple Choice Identify the choice that best completes the statement or answers the question. ____ 1. The nurse works in a pediatric psychiatry unit. Ritalin (methylphenidate) 5 mg three times daily is commonly prescribed for many of the clients. The nurse recognizes this drug needs to be used cautiously in which of the following children? a. An 8-year-old patient with a history of cardiovascular disease b. A 12-year-old patient with a history of scoliosis c. A 6-year-old patient who takes Singulair (montelukast) daily d. A 7-year-old patient with a history of sickle cell anemia ____ 2. A 71-year-old client was newly prescribed Zaroxolyn (metolazone). The nurse recognizes the drug has been effective by which of the following assessments? a. White blood cell count = 5,500 cells/mm3 b. Client reports sleeping 8 hr per night c. BP = 132/74 d. Client denies hallucinations

____ 3. The nurse is providing care for a 64-year-old client being prepped for a colonoscopy who is given midazolam. The nurse would expect to see which of the following responses? a. Decrease in oral secretions b. Increased heart rate c. Decrease in abdominal cramping d. Increased drowsiness

____ 4. The nurse is providing milrinone to a 71-year-old woman with heart failure. Which of the following nursing assessments during the infusion is of the highest priority? a. Monitor client’s blood sugar every 4 hr. b. Monitor client’s sedation level hourly. c. Monitor client’s telemetry continuously. d. Monitor client’s urine output every 4 hr.

____ 5. While preparing to give morning medications, Remeron (mirtazapine) was newly ordered for the patient to begin this morning. The nurse would immediately call the physician to question this order if which of the following medications was included in the patient’s list of home medications? a. Enteric coated aspirin b. Lasix (furosemide) c. Digoxin (lanoxin) d. Nardil (phenelzine)

____ 6. A nurse is receiving a shift-to-shift report for a client with multiple medical problems. The client is receiving Relafen (nabumetone). The nurse recognizes this medication is ordered to address which of the following health-care problems for the client? a. Benign prostatic hypertrophy b. Rheumatoid arthritis c. Venous-thrombosis embolic prophylaxis d. Urinary tract infection

____ 7. While providing care for a client who is to receive Amerge (naratriptan), the nurse recognizes that the client understands this medication by which of the following statements? a. “If my migraine headache doesn’t go away, I can repeat the dose within 30 minutes.” b. “This medication will typically make me very sleepy after I take it.” Copyright © 2017 F. A. Davis Company

c. “I need to let the doctor know right away if I have any chest pain or tightness after taking this medication.” d. “I need to be sure and take a laxative when I take this medication.”

____ 8. In reviewing new orders, the nurse notes Starlix (nateglinide) 120 mg three times daily before meals has been ordered. Before initiating therapy, the nurse should assess for which of the following? a. Blood sugar b. Respiratory rate c. Level of consciousness d. Creatinine clearance

____ 9. While caring for a client with hypertension who has recently started taking Bystolic (nebivolol), the client reports, “This medication seems to give me a headache.” Which of the following statements by the nurse is best? a. “Headaches are common with your new medications. You should continue to take the medication to help control your blood pressure.” b. “That’s too bad. You could try taking half a pill twice a day.” c. “You should call your doctor and let them know about that—it could be a serious side effect of the new medication.” d. “Have you noticed any muscle twitching or facial numbness?”

____ 10. The nurse is providing instructions to a client who has started therapy with Cardene (nicardipine). The nurse instructs the client to avoid which of the following foods? a. Kiwi b. Grapefruit juice c. Garlic d. Ginger

____ 11. While caring for a client who is taking Dipentum (olsalazine) for ulcerative colitis, the nurse is aware that it is most important to determine if the patient has an allergy to which of the following? a. Penicillins or cephalosporins b. NSAIDs or opioids c. Beta blockers or nitrosoureas d. Sulfonamides or salicylates

____ 12. A client admitted with neutropenia would most likely be started on which of the following medications to promote neutrophil differentiation? a. Neumega (oprelvekin) b. Neulasta (pegfilgrastim) c. Neurontin (gabapentin) d. Procardia (nifedipine)

____ 13. While caring for a client who is receiving Serax (oxazepam), the nurse notes the client is drowsy and slightly confused upon waking. Which of the following conclusions should the nurse draw? a. The client may be experiencing symptoms of a stroke and the physician should be contacted immediately. b. The client may be experiencing hypersensitivity and the drug should be held. c. This is an expected and normal finding with the medication and the patient should be monitored for safety concerns. d. The client may have underlying psychiatric disorders and should be assessed for the presence of hallucinations.

____ 14. The nurse is providing care for a 31-year-old patient with a history of seizures. Which of the following medications would the nurse anticipate is part of the patient’s home medication regimen? a. Trileptal (oxcarbazepine) Copyright © 2017 F. A. Davis Company

b. Trental (pentoxifylline) c. Zyloprim (allopurinol) d. Dexedrine (dextroamphetamine)

____ 15. While counseling a client taking Kepivance (palifermin), the nurse recognizes that further teaching is necessary based on which of the following client statements? a. “I’ll be sure to let my doctor know if I develop a rash or any tongue discolorations.” b. “As long as I’m taking this, I won’t get any side effects from my chemotherapy.” c. “This medication helps prevent the mouth sores that were so bad with my last chemotherapy treatment.” d. “I have to get this medication in an IV 3 days before and 3 days after my chemotherapy.”

____ 16. The nurse caring for clients in the psychiatric unit provides Invega (paliperidone) to one of the clients. The nurse recognizes this medication is effective by which of the following observations? a. The client’s weight is stable for 3 days. b. The client reports the voices in his head have stopped talking to him. c. The client stops pacing the halls and ringing his hands. d. The client is able to focus on completing a puzzle in the day room.

____ 17. The nurse is preparing to give an initial dose of Aloxi (palonosetron) as ordered prior to starting chemotherapy for breast cancer. Which of the following nursing actions is of the highest priority? a. Infuse the medication undiluted 30 min prior to planned chemotherapy. b. Monitor symptoms of nausea or vomiting. c. Provide the client with written materials on the chemotherapy agents being used. d. Determine the client’s typical food intake.

____ 18. The nurse is caring for a 58-year-old male who has been prescribed Neulasta (pegfilgrastim). The nurse recognizes provision of this medication is based on which of the following lab results? a. Hmg = 11.7 g/dL b. CPK = 25 mcg/L c. Platelets = 114,000 cells/mm3 d. WBC = 2.3 cells/mm3

____ 19. The nurse is providing care for an elderly woman with a urinary tract infection. The nurse understands the patient is receiving Pyridium (phenazopyridine) for which of the following reasons? a. To reduce the frequency and severity of bladder spasms. b. To provide local anesthetic effects to the bladder mucosa. c. To kill E. coli bacteria commonly associated with urinary tract infection. d. To promote diuresis and subsequently prevent stone formation.

____ 20. The nurse is reviewing the home medication list for a client with a history of head and neck cancer who has been receiving radiation therapy. The client reports taking PO Salagen (pilocarpine) three times daily. The nurse understands this medication is designed to help treat which of the following? a. Xerostomia b. Nausea c. Metastatic disease d. Taste changes

____ 21. While investigating the medications taken by a client in the hospital, the student nurse understands that Zosyn (piperacillin/tazobactam) has an extended spectrum compared to other penicillins for which of the following reasons? a. Neither drug is able to cross the placenta well. b. Tazobactam inhibits an enzyme that destroys penicillins. Copyright © 2017 F. A. Davis Company

c. The half-life of the combined drugs is over 6 hr. d. Pipercillin is highly metabolized with less than 10% excreted in an unchanged form.

____ 22. A new order for K-Phos (potassium phosphate) 250 mg four times daily has been noted. When preparing to administer the medication, which of the following actions will the nurse take? a. Provide the tablets orally at least 2 hr before meals. b. Provide the tablets orally directly after meals. c. Dissolve the tablets in a full glass of water and let stand for 2–5 min to ensure it is fully dissolved. d. Provide medication simultaneously with antacid to reduce stomach irritation.

____ 23. A client with Parkinson disease is started on Mirapex (pramipexole) 0.125 mg three times daily. The family has been told to return to the physician’s office in 4 wk. Which of the following statements by the nurse is best? a. “This medication may cause insomnia, so you may want to take melatonin to help you sleep.” b. “You can break the extended release tablet up to make it easier to swallow.” c. “If you forget to take the extended release tablet in the morning, just take it at bedtime.” d. “Be sure to let the physician know if you notice any confusion or hallucinations.”

____ 24. While preparing to pass medications on a medical unit, the student nurse notes a client is scheduled to receive Minipress (prazosin). The student recognizes this medication will cause which of the following? a. Decreased gastric acid production b. Reduced oral and respiratory secretions c. Dilatation of arteries and veins Copyright © 2017 F. A. Davis Company

d. Increased cardiac preload and afterload

____ 25. While working in the oncology clinic, the nurse provides Matulane (procarbazine) for a patient with Hodgkin disease. Which of the following medications could potentially cause deep coma and/or death if given concurrently? a. Advil (ibuprofen) b. Lanoxin (digoxin) c. Demerol (meperidine) d. Carafate (sulcrafate)

____ 26. The nurse is caring for a client who was newly prescribed Crinone (progesterone). The nurse would provide additional education in response to which of the following client statements? a. “I should stop taking this medication if I suspect I may be pregnant.” b. “If I have spotting or a change in my bleeding pattern, I should call the physician.” c. “I should use sunscreen and protective clothing to reduce the chance of irritation.” d. “This medication is designed to halt ovulation.”

____ 27. The nurse is providing medications for a male patient who has been taking Tebrazid (pyrazinamide) 30 mg/kg daily. The nurse notes the patient’s AST = 45 units/L. Which of the following actions by the nurse is best? a. Provide the pyrazinamide at this time. b. Check the client’s total protein level. c. Hold the medication and call the physician regarding dosage. d. Contact the pharmacy and ask them to split the dose.

____ 28. The nurse is providing care for a client who is receiving Aciphex (rabeprazole). The nurse recognizes this medication is effective by which of the following assessment findings? Copyright © 2017 F. A. Davis Company

a. Patient voids 250 mL urine and reports feeling reduced bladder spasms. b. Patient denies abdominal pain or heartburn. c. Patient reports improvement in itching. d. Patient’s white blood cell count is less than 10,000/mm 3.

____ 29. While working on the medical unit, the nurse is notified that one of the patients has requested a sleeping pill. A new order has been received for Rozerem (ramelteon) 8 mg orally 30 min prior to sleep. The nurse will monitor most closely for which of the following potential adverse reactions? a. Dizziness b. Angioedema c. Nausea d. Hallucinations

____ 30. The student nurse reviews a list of medications a client takes at home. Prandin (repaglinide) is on the list. The student expects this medication is provided in which of the following ways? a. Topically b. Rectally c. Orally d. Subcutaneously

____ 31. While preparing to provide morning medications, a new nurse realizes many clients are taking Viagra (sildenafil) and knows the drug must be given cautiously or in reduced doses to which of the following clients? a. A 52-year-old patient with a history of coronary artery disease b. A 68-year-old patient with a history of benign prostatic hypertrophy c. A 64-year-old patient admitted with cellulitis d. A 56-year-old patient admitted for knee replacement surgery

____ 32. A nurse caring for a client who is to initiate therapy with Amaryl (glimepiride) 1 mg once daily would include which of the following statements in the client teaching? a. “This medication is used to treat infections.” b. “You should take this in the evening on an empty stomach for optimal effectiveness.” c. “You can continue to eat or drink whatever you like, including alcohol, while taking this medication.” d. “Please notify me if you have any feelings of low blood sugar such as sweating, dizziness, or tremors.”

____ 33. Which of the following would allow the nurse to determine that a client taking Flomax (tamsulosin) was achieving clinical benefit from the medication? a. Client’s white blood cell count = 10,500/mm 3. b. Client blood pressure = 142/88 mmHg. c. Client reports decreased nocturia. d. Family reports noting improved cooperation and cohesive thought patterns.

Multiple Response Identify one or more choices that best complete the statement or answer the question. ____ 34. The nurse is caring for a 44-year-old patient with fibromyalgia. Savella (milnacipran) has been prescribed. Which of the following statements would be included in the client teaching? Select all that apply. a. “This medication can cause dizziness so move slowly and call for assistance if you feel dizzy.” b. “One side effect of this medication is headaches; let me know if you experience that.” c. “This can be constipating, so I suggest increasing your fluid and fiber intake.” Copyright © 2017 F. A. Davis Company

d. “We will be monitoring your blood pressure and heart rate more frequently since this medication can cause an increase in blood pressure.” e. “There are minimal risks for fetal harm with this medication so you don’t need to worry.”

____ 35. A diabetic patient treated with a sulfonylurea has been ordered a beta blocker for hypertension. The nurse is aware that beta blockers taken with sulfonylureas may mask the signs and symptoms of hypoglycemia. The nurse recognizes which of the following medications is included in the class of sulfonylureas? Select all that apply. a. Januvia (sitagliptin) b. Amaryl (glimepiride) c. Diabeta (glyburide) d. Glucophage (metformin) e. Glucotrol (glipizide)

____ 36. The nurse is providing care for a client receiving Pentam 300 (pentamidine). The nurse should monitor for which of the following complications associated with this medication? Select all that apply. a. Steven-Johnson syndrome b. Severe hypotension c. Respiratory arrest d. Cardiac arrhythmia e. Hypoglycemia f. Hemolytic anemia

____ 37. The physician has ordered GoLytely (polyethylene glycol/electrolyte) for an 82-year-old patient. Which of the following actions will be included in the nurse’s plan of care? Select all that apply. a. Add powdered fruit punch to the prep before serving. Copyright © 2017 F. A. Davis Company

b. Instruct the patient to restrict their food intake to clear liquids during the prep. c. Encourage the client to drink the fluid over a 2–3 hr period of time. d. Shake vigorously after reconstituting with tap water. e. Assess client hydration status prior to and throughout the prep. f. Initiate the prep 1 hr prior to the procedure.

____ 38. A student nurse is preparing to provide Lyrica (pregabalin). Which of the following side effects should be monitored by the students? Select all that apply. a. Rash b. Suicidal thoughts c. Decreased serum potassium d. Weight gain e. Dry mouth f. Hypertension

____ 39. As part of a new treatment regimen for Alzheimer, a 78-year-old woman is prescribed Exelon (rivastigmine). The nurse should include which of the following statements in the client teaching? Select all that apply. a. “This medication can be given in transdermal patch form that is changed every 24 hours.” b. “Revastigmine can cause dizziness so it is important to use caution until your body adjusts to it.” c. “Let the doctor know if you have nausea, vomiting, anorexia, or weight loss.” d. “You should notice an improvement in your memory and thinking within a few days.” e. “The oral form of this medication should be taken on an empty stomach.” f. “Some clients experience headaches, weakness, and diarrhea with this medication.”

____ 40. The nurse is providing care for a client who has new orders to start Renagel (sevelamer) 800 mg with each meal. Which of the following orders should the nurse anticipate? Select all that apply. a. Serum calcium and phosphorous in the morning. b. Teach client self-injection techniques. c. Administer with meals. d. Do not give other medications less than 1 hr before or 3 hr after sevelamer. e. Low protein, renal diet.

____ 41. The nurse is overseeing medication provision by a student nurse for a client taking Vitamin B-1 (thiamine). The nurse knows the student has a solid understanding of this medication by which of the following statements? Select all that apply. a. “The patient may have some diarrhea while taking this medication.” b. “Many people who take this medication have a history of alcohol use.” c. “This medication helps prevent Wernicke’s encephalopathy.” d. “Sometimes thiamine is given in IV form.” e. “This medication helps prevent bone loss.” f. “We typically get thiamine from foods such as whole grains, pork, and fresh vegetables.”

____ 42. While providing care for a 35-year-old client who has been started on (Topiramate) Topamax 25 mg twice daily, the nurse would include which of the following in the plan of care? Select all that apply. a. Ensure patient drinks 2,000–3,000 mL of fluid to prevent kidney stone formation. b. Monitor for signs and symptoms of hyper- or hypokalemia. c. Initiate seizure precautions. d. Monitor for suicidal thoughts or depression. e. Place patient in contact isolation. f. Place patient on telemetry monitoring.

____ 43. While reviewing a client’s medication list, the nurse notes the client takes Oleptro (trazodone) 50 mg three times daily. The nurse recognizes this medication has multiple indications and is used both on and off label for various reasons including which of the following? Select all that apply. a. Insomnia b. Chronic pain syndromes c. Appetite stimulation d. Major depression e. Migraine headaches f. Diabetic neuropathy

____ 44. While caring for a client receiving Ultram (tramadol) for moderate pain control, the nurse recognizes increased CNS depression can occur if this medication is given concurrently with which of the following? Select all that apply. a. Antineoplastic agents b. Antihistamines c. Opioid analgesics d. Anticoagulants e. Sedative/hypnotics f. Bisphosphonates

Completion Complete each statement. 45. While providing care for a client in the intensive care unit, the nurse is preparing to initiate therapy with Nitropress (nitroprusside). Orders are to start the infusion at 0.3 mcg/kg/min. The client weighs 154 pounds. The IV fluid has been sent with 50 mg in 250 mL D5W. Calculate the rate of medication in mL/hr. ______________ mL/hr

Other 46. The nurse is caring for a woman in active labor. IV Nubain (nalbuphine) 10 mg every 4 hr as needed has been ordered. Prioritize the following nursing actions in the correct order to depict safe administration. A. Administer slowly over 3–5 min. B. Explain therapeutic value of the medication. C. Assess respiratory rate and pain control in 30 min D. Assess location and intensity of the pain. E. Advise client to call for assistance with ambulation. 47. While working in the intensive care unit, the nurse is preparing to initiate an IV infusion of Levophed (norepinepherine) ordered at 1 mcg/min. Prioritize the following steps in the correct order of infusion. A. Titrate as ordered to maintain SBP between 80–100 mm Hg. B. Have second nurse verify order and dose calculations. C. Calculate rate of IV solutions and pump settings. D. Obtain IV solutions from pharmacy. E. Monitor Urinary output. 48. The nurse is preparing to provide Fleet Enema (phosphate/biphosphate). Prioritize the following steps in correct order for this procedure. A. Gently squeeze until the bottle is empty. B. Assist the client onto the left side with knees flexed. C. Discontinue with resistance or abdominal cramping. D. Insert prelubricated tip about 2 in. into the rectum. E. Perform hand hygiene and don clean gloves. 49. The nurse is preparing to provide a Symlin (pramlintide) to a client with diabetes. Prioritize the following nursing actions in the correct order for provision. Copyright © 2017 F. A. Davis Company

A. Adjust insulin dose. B. Assess recent blood glucose data. C. Inject pramlintide and insulin separately. D. Provide meal immediately. 50. The nurse receives orders to use Cathflo Activase (alteplase) 2 mg/2 mL for a patient with an occluded venous access devise. Prioritize the following nursing actions in correct order for alteplase usage. A. Withdraw 2.2 mL sterile water and inject into Cathflo vial. B. Instill 2 mL of solution into occluded catheter. C. Gently swirl vial to dissolve powder. D. Irrigate catheter with 0.9% NaCl. E. Allow 30 min of dwell time. F. Attempt to aspirate blood, withdrawing 5 mL for discard.

Drug Guide Test Bank 4 Answer Section MULTIPLE CHOICE 1. ANS: A See Contraindications/Precautions for methylphenidate: Sudden death has occurred in children with structural cardiac abnormalities or other cardiovascular disease. PTS: 1

DIF: Medium

REF: Pages 832–833

TOP: Therapeutic Classification: Central nervous system stimulants KEY: Cognitive Level: Application 2. ANS: C See Evaluation for metolazone: Decrease in BP and edema, increase in urine output. PTS: 1

DIF: Medium

REF: Page 839

TOP: Therapeutic Classification: Antihypertensives, diuretics

KEY: Cognitive Level:

Application 3. ANS: D See Nursing Implications for midazolam: Pre-procedural sedation. PTS: 1

DIF: Medium

REF: Pages 847–848

TOP: Therapeutic Classification: Antianxiety agents; sedative/hypnotics KEY: Cognitive Level: Application 4. ANS: C See Nursing Implications Assessment for milrinone: Monitor ECG continuously during infusion. Arrhythmias are common and may be life threatening. Copyright © 2017 F. A. Davis Company

PTS: 1

DIF: Hard

REF: Page 853

TOP: Therapeutic Classification: Inotropics

KEY: Cognitive Level: Analysis

5. ANS: D See Interactions for mirtazapine: Concurrent use with MAO inhibitors can cause hypertension, seizures, and death. PTS: 1

DIF: Hard

REF: Page 856

TOP: Therapeutic Classification: Antifungals

KEY: Cognitive Level: Analysis

6. ANS: B See Indications for nabumetone: Symptomatic management of rheumatoid arthritis. PTS: 1

DIF: Medium

REF: Drugguide.com

TOP: Therapeutic Classification: Antirheumatics

KEY: Cognitive Level:

Application 7. ANS: C See Patient Family Teaching for naratriptan: Advise patient and family to notify health-care professional prior to next dose of naratriptan if pain or tightness in the chest occurs during use. Dose may be repeated in 4 hr if response is inadequate. Medication does not cause sedation or constipation. PTS: 1

DIF: Medium

REF: Pages 888–889

TOP: Therapeutic Classification: Vascular headache suppressants KEY: Cognitive Level: Analysis 8. ANS: A See Nursing Implications Assessment for nateglinide: Monitor serum glucose.

PTS: 1

DIF: Medium

REF: Drugguide.com

TOP: Therapeutic Classification: Antidiabetics

KEY: Cognitive Level:

Application 9. ANS: A See Adverse Reactions/Side Effects for nebivolol: Can cause dizziness, fatigue, and headache. PTS: 1

DIF: Medium

REF: Page 889

TOP: Therapeutic Classification: Antihypertensive; beta blockers KEY: Cognitive Level: Analysis 10. ANS: B See Drug-Natural Products under Interactions for nicardipine: Grapefruit and grapefruit juice increases serum levels and effect. PTS: 1

DIF: Easy

REF: Page 894

TOP: Therapeutic Classification: Antianginals

KEY: Cognitive Level: Knowledge

11. ANS: D See Nursing Implications/Assessment for olsalazine: Assess patient for allergy to sulfonamides and salicylates. Patients allergic to sulfasalazine may take mesalamine or olsalazine without difficulty, but therapy should be discontinued if rash or fever occurs. PTS: 1

DIF: Hard

REF: Page 925

TOP: Therapeutic Classification: Gastrointestinal anti-inflammatories KEY: Cognitive Level: Application 12. ANS: B See Indications for pegfilgrastim: Decreases incidence of infection in patients with nonmyeloid malignancies receiving myelosuppressive antineoplastics associated with a high risk febrile neutropenia. Copyright © 2017 F. A. Davis Company

PTS: 1

DIF: Medium

REF: Page 981

TOP: Therapeutic Classification: Colony stimulating factors KEY: Cognitive Level: Knowledge 13. ANS: C See Action and Adverse Reactions/Side Effects of oxazepam: Management of anxiety. Depresses CNS. Common side effects include dizziness, and drowsiness, confusion, and impaired memory may occur. PTS: 1

DIF: Medium

REF: Page 941

TOP: Therapeutic Classification: Antianxiety

KEY: Cognitive Level: Analysis

14. ANS: A See Indications for oxcarbazepine: Monotherapy or adjunctive therapy of partial seizures in adults and children. Pentoxifylline is used to treat leg cramps associated with intermittent claudication. Allopurinol is a diuretic. Dextroamphetamine is a CNS stimulant used in the treatment of ADHD and narcolepsy. PTS: 1

DIF: Hard

REF: Page 942

TOP: Therapeutic Classification: Anticonvulsants

KEY: Cognitive Level:

Knowledge 15. ANS: B See Indications, Side Effects and Patient/Family Teaching for palifermin: To decrease incidence/duration of severe oral mucositis associated with myelotoxic therapy. Advise patient to notify health-care professional if rash, erythema, edema, pruritus, or tongue discoloration occur. Provided IV 3 days prior to and 3 days after chemotherapy. PTS: 1

DIF: Medium

REF: Pages 960–961

TOP: Therapeutic Classification: Cytoprotective agents

KEY: Cognitive Level: Analysis

16. ANS: B See Indication for paliperidone: Acute and maintenance treatment of schizophrenia. Clients with schizophrenia often have auditory hallucinations. Stable weight is associated with eating disorders. Pacing and ringing of hands is more indicative of mania. Increased focus and attention may be related to depression or ADHD. PTS: 1

DIF: Medium

REF: Page 961

TOP: Therapeutic Classification: Antipsychotics

KEY: Cognitive Level: Analysis

17. ANS: A See Nursing Implications and Implementation for palonosetron: Prevention of acute and delayed nausea and vomiting caused by initial or repeat courses of moderate or highly emetogenic chemotherapy. Administer dose undiluted 30 min prior to chemotherapy. Symptoms of nausea and vomiting will be associated with chemotherapy provision, which is timed after the provision of palonosetron. Written material provision is not time sensitive. Typical food intake will not impact timing or provision of the drug. PTS: 1

DIF: Medium

REF: Pages 964–965

TOP: Therapeutic Classification: Antiemetics

KEY: Cognitive Level: Application

18. ANS: D See Indications for pegfilgrastim. To decrease incidence of infection in patients with nonmyeloid malignancies receiving myelosuppressive antineoplastics. The WBC count will be effected by the medication and the listed value is very low. The Hmg is slightly low; the CPK and platelet counts are normal. PTS: 1

DIF: Medium

REF: Page 981

TOP: Therapeutic Classification: Colony stimulating factors KEY: Cognitive Level: Analysis 19. ANS: B

See Action for phenazopyridine: Acts locally on the urinary tract mucosa to produce analgesic or local anesthetic effects. PTS: 1

DIF: Medium

REF: Page 1002

TOP: Therapeutic Classification: Nonopioid analgesics

KEY: Cognitive Level: Comprehension

20. ANS: A See Indications for pilocarpine: Management of xerostomia, which may occur as a consequence of radiation therapy. PTS: 1

DIF: Easy

REF: Page 1017

TOP: Therapeutic Classification: Cholinergics

KEY: Cognitive Level: Comprehension

21. ANS: B See Action and Pharmacokinetics for piperacillin/tazobactam: Pipercillin binds to bacterial cell wall membrane causing cell death. Spectrum is extended. Tazobactam inhibits beta-lactamase, an enzyme that can destroy penicillins. The drugs are widely distributed. Half-life is 0.7–1.2 hr and cross the placenta at low concentrations. 68 and 80% respectively are excreted unchanged by the kidneys. PTS: 1

DIF: Hard

REF: Page 1020

TOP: Therapeutic Classification: Anti-infectives

KEY: Cognitive Level:

Comprehension 22. ANS: C See Implementation for potassium phosphate: Tablets should be dissolved in a full glass of water. Allow mixture to stand for 2–5 min. Medication should be administered after meals. Do not administer simultaneously with antacids. PTS: 1

DIF: Medium

REF: Page 1027

23. ANS: D See Nursing Implications and Patient/Family Teaching for pramipexole: Drowsiness is a common side effect of the medication. Extended release tablets should be swallowed whole. If extended release tablets are missed, skip dose and take next regular scheduled dose. The medication can cause hallucinations and confusion—the health-care provider should be notified. PTS: 1

DIF: Medium

REF: Pages 1031–1032

TOP: Therapeutic Classification: Anti-Parkinson agents

KEY: Cognitive Level: Analysis

24. ANS: C See Action for prazosin: Dilates both arteries and veins by blocking postsynaptic alpha-adrenergic receptors; decreased cardiac preload and afterload. PTS: 1

DIF: Medium

REF: Page 1034

TOP: Therapeutic Classification: Antihypertensives

KEY: Cognitive Level: Comprehension

25. ANS: C See Interactions Drug-Drug for procarbazine: Deep coma and death may result from concurrent use of opioid analgesics; avoid meperidine. PTS: 1

DIF: Medium

REF: Pages 1037–1038

TOP: Therapeutic Classification: Antineoplastics Knowledge 26. ANS: D

KEY: Cognitive Level:

See Patient/Family Teaching and Therapeutic Effect for progesterone: Instruct patient to notify health-care professional if change in vaginal bleeding pattern or spotting occurs. Instruct patient to stop taking medication and notify health-care professional if pregnancy is suspected. Caution patient to use sunscreen and protective clothing to prevent photosensitivity reactions. Medication restores hormonal balance with control of uterine bleeding and supports successful outcome in assisted reproduction. PTS: 1

DIF: Medium

REF: Pages 1042–1043

TOP: Therapeutic Classification: Hormones

KEY: Cognitive Level: Analysis

27. ANS: C See Nursing Implications for pyrazinamide: Evaluate hepatic function before and every 2–4 wk during therapy. Patients with impaired liver function should receive pyrazinamide therapy only if crucial to treatment. Normal AST for males is 14–20 units/L. PTS: 1

DIF: Medium

REF: Page 1058

TOP: Therapeutic Classification: Antituberculars

KEY: Cognitive Level: Analysis

28. ANS: B See Evaluation/Desired Outcome for rabeprazole: Decrease in abdominal pain or prevention of gastric irritation. PTS: 1

DIF: Hard

REF: Page 1070

TOP: Therapeutic Classification: Antiulcer agents

KEY: Cognitive Level: Analysis

29. ANS: B See Patient/Family Teaching and Adverse Reactions for ramelteon: Advise patient to notify healthcare professional immediately if anaphylaxis or angioedema occurs—may occur as early as the first time the product is taken. Dizziness, nausea, and hallucinations can occur but are not as high a priority.

PTS: 1

DIF: Medium

REF: Pages 1073–1074

TOP: Therapeutic Classification: Sedative/hypnotics

KEY: Cognitive Level: Application

30. ANS: C See Route/Dosage for repaglinide: Orally 0.5–4 mg taken before meals. PTS: 1

DIF: Easy

REF: Drugguide.com

TOP: Therapeutic Classification: Antidiabetics

KEY: Cognitive Level:

Knowledge 31. ANS: A See Contraindications for Viagra (sildenafil): Use cautiously in serious underlying cardiovascular disease including history of MI, stroke, arrhythmia, cardiac failure, or coronary artery disease. PTS: 1

DIF: Medium

REF: Pages 1127–1128

TOP: Therapeutic Classification: Erectile dysfunction agents

KEY: Cognitive Level:

Application 32. ANS: D See Indications, Implementation and Patient/Family Teaching for sulfonylureas: Control of blood glucose in type 2 diabetes mellitus. May be administered once in the morning with breakfast or divided into 2 doses. Concurrent use of alcohol may cause a disulfiram-like reaction. Observe for signs/symptoms of hypoglycemia (sweating, hunger, weakness, dizziness, tremor, tachycardia, anxiety). PTS: 1

DIF: Medium

REF: Pages 1148–1150

TOP: Therapeutic Classification: Antidiabetics

KEY: Cognitive Level: Analysis

PTS: 1

DIF: Medium

REF: Page 1164

TOP: Therapeutic Classification: Alpha-blockers

KEY: Cognitive Level: Analysis

MULTIPLE RESPONSE 34. ANS: A, B, C, D See Adverse Reactions/Side Effects for milnacipran: Dizziness, headache, insomnia, hypertension, tachycardia, constipation, dry mouth, nausea, vomiting, hot flushes, hyperhidrosis, serotonin syndrome, neuroleptic malignant syndrome, elevated liver enzymes. PTS: 1

DIF: Hard

REF: Pages 851–852

TOP: Therapeutic Classification: Antifibromyalgia agents

KEY: Cognitive Level: Analysis

35. ANS: B, C, E See Drug List and Interactions for sulfonylureas: Sulfonylureas taken with beta blockers may mask the signs and symptoms of hypoglycemia. Januvia and Glucophage are also antidiabetic drugs but do not negatively interact with beta blockers. PTS: 1

DIF: Medium

REF: Page 1148

TOP: Therapeutic Classification: Antidiabetics

KEY: Cognitive Level:

Knowledge 36. ANS: A, B, D, E See Nursing Implications for pentamidine: May cause Stevens-Johnson syndrome. Sudden, severe hypotension may occur following a single dose. Assess patient for signs of hypoglycemia. Fatalities due to cardiac arrhythmias, tachycardia, and cardiotoxicity have been reported. PTS: 1

DIF: Hard

REF: Pages 995–996

KEY: Cognitive Level:

37. ANS: B, C, D, E See Implementation for polyethylene glycol: Do not add extra flavorings or additional ingredients. Patient should avoid solid food 1–2 hr prior to administration and be allowed only clear liquids after administration. Solution may be reconstituted with tap—shake vigorously until powder is dissolved. May be administered the morning of the exam as long as 4 hr is allotted for proper prep. Patient should be adequately hydrated prior to, during, and after the administration. PTS: 1

DIF: Medium

REF: Page 1024

TOP: Therapeutic Classification: Laxatives

KEY: Cognitive Level: Application

38. ANS: B, D, E See Adverse Reactions/Side Effects for pregabalin: Can cause suicidal thoughts, dizziness, drowsiness, edema, dry mouth, weight gain, decreased platelet count, constipation, abdominal pain, blurred vision (not rash, decreased potassium, or hypertension). PTS: 1

DIF: Hard

REF: Pages 1035–1036

TOP: Therapeutic Classification: Analgesics

KEY: Cognitive Level: Knowledge

39. ANS: A, B, C, F See Patient/Family Teaching and Adverse Reactions for rivastigmine: Each 24 hr, remove old patch; rotate sites. Caution patient and caregiver that rivastigmine may cause dizziness. Advise patient and caregiver to notify health-care professional if nausea, vomiting, anorexia, or weight loss occurs. Inform patient and caregivers that improvements in cognitive function may take weeks to months and that the degenerative process is not reversed. Administer oral form in the morning and evening with food. Headache, weakness, and diarrhea are all potential side effects. PTS: 1

DIF: Hard

REF: Pages 1103–1104

KEY: Cognitive Level: Analysis

See Nursing Implications and Patient/Family Teaching for sevelamer: Monitor serum phosphorous, calcium, bicarbonate, and chloride levels periodically during therapy. Provided in oral form only. Administer with meals and adhere to prescribed diet. Sevelamer is used to help reduce phosphate levels in patients with end-stage renal disease. Caution patient to space concurrent medications at least 1 hr before or 3 hr after sevelamer. PTS: 1

DIF: Hard

REF: Pages 1126–1127

TOP: Therapeutic Classification: Electrolyte modifiers

KEY: Cognitive Level: Application

41. ANS: B, C, D, F See Indication, Adverse Reactions, and Patient/Family Teaching for thiamine: Used for prevention of Wernicke’s encephalopathy and as a dietary supplement in patients with GI disease, alcoholism, or cirrhosis. GI side effects include GI bleeding and nausea, not diarrhea. It can be given orally, IM, or IV. Foods high in thiamine include cereals, meats (especially pork), and fresh vegetables. It does not alter bone loss. PTS: 1

DIF: Medium

REF: Pages 1191–1192

TOP: Therapeutic Classification: Vitamins

KEY: Cognitive Level: Analysis

42. ANS: A, C, D See Indications, Adverse Reactions, and Nursing Implications for topiramate: Used for seizures. Advise patient to maintain fluid intake of 2,000–3,000 mL of fluid to prevent formation of kidney stones. Monitor closely for suicidal thoughts or depression. No significant risk for alteration in potassium levels, infection, or arrhythmias. PTS: 1

DIF: Hard

REF: Pages 1213–1216

TOP: Therapeutic Classification: Anticonvulsants Application 43. ANS: A, B, D, F

KEY: Cognitive Level:

See Indications for trazodone: Major depression. Unlabeled use: Insomnia, chronic pain syndromes including diabetic neuropathy, and anxiety. PTS: 1

DIF: Hard

REF: Page 1224

TOP: Therapeutic Classification: Antidepressants

KEY: Cognitive Level:

Application 44. ANS: B, C, E See Interactions for tramadol: Increased risk of CNS depression when used concurrently with other CNS depressants including alcohol, antihistamines, sedative/hypnotics, opioid analgesics, anesthetics, or psychotropic agents. PTS: 1

DIF: Medium

REF: Pages 1220–1221

TOP: Therapeutic Classification: Analgesics

KEY: Cognitive Level: Application

COMPLETION 45. ANS: 6.3 Drug calculation: Multiple 50 mg by 1,000 mcg/mg and divide by 250 mL = 200 mcg/ml to determine solution concentration. Divide 154 lbs by 2.2 = 70 kg to determine client weight. Multiply 0.3 mcg by 70 kg = 21 mcg/min to determine dose. Multiply 21 mcg/min  60 min/hr  1 mL/200 mcg = 6.3 mL/hr. PTS: 1

DIF: Hard

REF: Page 908

KEY: Cognitive Level: Application

2: B 3: A 4: E 5: C See Nursing Implications, Implementation, and Patient/Family Teaching for nalbuphine: Assess type, location, and intensity of pain before administration. Explain therapeutic value before administration. Administer slowly over 3–5 min. May cause drowsiness or dizziness—advise patient to call for assistance. Assess pain control 30 min after IV administration. PTS: 1

DIF: Easy

REF: Pages 880–882

TOP: Therapeutic Classification: Opioid analgesics

KEY: Cognitive Level: Analysis

47. ANS: 1: D 2: C 3: B 4: A 5: E See Dosage and Nursing Implications for norepinephrine: 1 mcg/min initially followed by maintenance of 2–12 mcg/min titrated by BP response. Vasoactive medications are inherently dangerous. The infusion solution must be available to program the pump. Have a second practitioner independently check original order, dose calculation, and infusion pump. Monitor urinary output and notify health-care professional if it decreases to less than 30 mL/hr. PTS: 1

DIF: Medium

REF: Pages 911–912

KEY: Cognitive Level: Analysis

2: B 3: D 4: A 5: C See Implementation for phosphate/biphosphate: Hand hygiene should be done prior to any procedure that involves direct patient contact. Position the patient on left side with knees slightly flexed. Insert prelubricated tip about 2 in. into rectum aiming toward the umbilicus. Gently squeeze bottle until empty. Discontinue if resistance is met. PTS: 1

DIF: Easy

REF: Page 1014

TOP: Therapeutic Classification: Laxatives

KEY: Cognitive Level: Application

49. ANS: 1: B 2: A 3: C 4: D See Indications and Implementation for pramlintide: Assess hemoglobin A1C and recent blood glucose data. Adjust dose of insulin to optimize glycemic control. Administer pramlintide and insulin separately immediately prior to a major meal. PTS: 1

DIF: Easy

REF: Drugguide.com

KEY: Cognitive Level: Analysis

5: F 6: D See Implementation for Cathflo Activase. Withdraw 2.2 mL sterile water and inject into Cathflo vial; Gently swirl vial to dissolve powder; Instill 2 mL of solution into occluded catheter; Allow 30 minutes of dwell time; Attempt to aspirate blood, withdrawing 5 mL to discard; Irrigate catheter with 0.95 Na Cl PTS: 1

DIF: Easy

REF: Pages 1192–1194

TOP: Therapeutic Classification: Thrombolytic agents

KEY: Cognitive Level: Application