TEST BANK for Pharmacology Clear and Simple A Guide to Drug Classifications and Dosage Calculations

Pharmacology Clear and Simple A Guide to Drug Classifications and Dosage Calculations 3rd Edition Watkins Test Bank Chapter 1. History of Pharmacology Multiple Choice Identify the choice that best completes the statement or answers the question.

1. While caring for a client who is taking furosemide (Lasix), the nurse recognizes dietary teaching has

been effective if the patient includes which of the following foods in his daily menus?

A. Broccoli and kiwi B. Oranges and sweet potatoes C. Kale and cucumbers D. Bananas and melon 2. A client newly diagnosed with diabetes tells the nurse, “I can’t take any insulin made from pigs or

cows.” Which of the following responses by the nurse is best?

A. “Most insulin comes from animal sources, but I’m sure alternative options are

available.”

B. “Medications that are derived from animals are typically less expensive than

synthetic medications, but synthetic insulin is commonly available.”

C. “Most insulin is synthetic now to help reduce the risk of disease transmission.”

D. “The animals aren’t hurt in the production of medications, so you don’t need to

worry.”

3. While providing medications to clients on the cardiac unit, the nurse anticipates that hydralazine

hydrochloride and isosorbide dinitrate (BiDil) would most likely be prescribed for which of the following clients?

A. A 48-year-old Caucasian male diagnosed with atrial fibrillation B. A 55-year-old African American female diagnosed with hypertension C. A 63-year-old Caucasian female diagnosed with sick sinus syndrome D. A 64-year-old African American male diagnosed with heart failure 4. While caring for a patient scheduled for knee replacement surgery, the nurse provides cefazolin

(Ancef) as ordered 30 minutes pre-operatively. The nurse knows that teaching has been effective by which of the following client statements?

A. “The antibiotic is given as a prophylactic to help reduce the risk of infection after surgery.”

B. “This is a palliative medication to help ease the pain from surgery.”

C. “This medication will replace vitamins and minerals that may be lost due to bleeding during surgery.”

D. “This medication will help the surgeon identify areas of bone destruction due to arthritis.”

5. While caring for a patient with a history of hypothyroidism, the nurse expects which of the following

medications to be included in the patient’s medication list?

A. Levothyroxine sodium (Synthroid) B. Estrogen (Estradiol) C. Iodine 131 D. Carbimazole (Methimazole)

6. The nurse is receiving a shift-to-shift report on a medical unit and is informed that a 55-year-old

patient with a history of vomiting is scheduled for a diagnostic radiograph of the upper gastrointestinal tract. Which of the following statements would the nurse include in the client’s teaching?

A. “You will need to drink a large amount of prep to clear out your system before the test.”

B. “It is important that you be given a prophylactic medication to prevent aspiration during the test.”

C. “You will be asked to drink a barium contrast about 30 minutes before the test to help highlight any digestive problems.”

D. “You will be given a sedative to help make you sleepy during the testing procedure.”

7. A student nurse is providing care for a 29-year-old patient with advanced cervical cancer who was

recently admitted with metastatic disease. While reviewing the patient’s medication list, the student would categorize which of the following medications as palliative in nature?

A. Cisplatin (Platinol) 50 mg IV weekly to start day 8 B. Sorafenib (Nexavar) 200 mg orally twice daily for 7 days C. Ondansetron (Zofran) 4 mg IV prior to chemotherapy D. Morphine sulfate (Roxanol) 5 mg po every 4 hours as needed for pain 8. A woman experiencing menopausal symptoms asks the nurse about conjugated estrogen (Premarin).

Which of the following statements by the individual indicates an understanding of the medication’s origin?

A. “I’m against animal cruelty, so I don’t want to take anything made from animal flesh.”

B. “I was told the medication is actually derived from the urine of pregnant horses.”

C. “Because I’m Jewish, I can’t take the medication since it comes from pigs.”

D. “I think harvesting medicines from cows seems rather odd.”

9. The nurse working in a diagnostic center is responsible for verifying client allergies prior to testing.

A 47-year-old woman reports being allergic to iodine, and thus is unable to have which test?

A. Computerized axial tomography (CAT) scan B. Magnetic resonance imaging (MRI) C. Colonoscopy D. Thyroid scan Multiple Response Identify one or more choices that best complete the statement or answer the question.

1. While working with patients in home care, a nurse becomes interested in additional ways to support

patient healing and comfort. Which of the following is recognized as an alternative therapy? (Select all that apply.)

A. Acupuncture B. Aromatherapy C. Therapeutic touch D. Stem cell treatment

E. Vegetarianism F. Acupressure

Chapter 1. History of Pharmacology Answer Section MULTIPLE CHOICE 1. ANS: B PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Diuretic KEY: Application MSC: NCLEX Category: Basic Care and Comfort NOT: See Minerals (p. 7): Diuretic drugs such as furosemide (Lasix) cause the body to lose excess water through the kidneys, and potassium, a vital mineral is also excreted with the water. Potassium is contained in sweet potatoes, bananas, and oranges.

2. ANS: C PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Anti-diabetic medication KEY: Analysis MSC: NCLEX Category: Pharmacological Therapies NOT: See Synthetic Medications (p. 8): Insulin can be obtained from pigs or cows, but a synthetic source is most commonly used. This change occurred because of concern over the possible transmission of diseases from animals to humans. Synthetic medications are usually more inexpensive because they are mass produced.

3. ANS: D PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Combination drug (diuretic/nitrate) KEY: Analysis MSC: NCLEX Category: Pharmacologic and Parenteral Therapy NOT: See Synthetic medications (p. 8). BiDil is a combination of two generic drugs and is used to treat African American patients with heart failure.

4. ANS: A PTS: 1 DIF: Easy TOP: Therapeutic Classification: Antibiotics KEY: Analysis MSC: NCLEX Category: Pharmacological Therapies NOT: See Categorizing Medications (p. 8): Prophylactic medications are given to prevent problems such as antibiotics given before surgery to prevent infection. Example of cefazolin is listed in Table 1.2.

5. ANS: A

Difficulty Level: Easy PTS: 1 DIF: Easy TOP: Therapeutic Classification: Replacement hormones KEY: Knowledge MSC: NCLEX Category: Pharmacological Therapies NOT: See Categorizing Medications (p. 9): Replacement drugs are given to replace missing substances.

Levothyroxine sodium (Synthroid) is a drug that replaces missing thyroid hormone. Estrogen may be given to women once they enter menopause. Iodine 131 is a radioactive medication used to help diagnose thyroid abnormalities. Carbimazole is used to inhibit the production of thyroid hormone to treat hyperthyroidism.

6. ANS: C PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Diagnostic contrast KEY: Analysis MSC: NCLEX Category: Reduction of Risk Potential NOT: See Categorizing Medications (p. 8): Some drugs help diagnose a disease such as barium that patients swallow to help highlight digestive problems on radiograph.

7. ANS: D PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Narcotics KEY: Analysis MSC: NCLEX Category: Pharmacological Therapies NOT: See Categorizing Medications (p. 8): Palliative drugs, such as pain relievers, do not cure disease, but they make patients more comfortable. Morphine is listed as an example in Table 1.2. Cisplatin is an antineoplastic agent and sorafenib is a biologic agent; both are designed to treat the cancer (destructive medications), while ondansetron is given in a prophylactic measure to prevent nausea and vomiting related to the chemotherapy.

8. ANS: B PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Hormonal therapy KEY: Analysis MSC: NCLEX Category: Pharmacological Therapies NOT: See Sources of Drugs (p. 6): Cows and pigs are good sources of hormone replacements, but conjugated estrogen (Premarin) comes from a pregnant mare’s urine.

9. ANS: D PTS: 1 DIF: Moderate TOP: Therapeutic Classification: NA KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Toxins (p. 7): Radioactive iodine in small doses can help pinpoint problems in a patient’s thyroid.

Because the client is allergic to iodine, she should not have this test.

MULTIPLE RESPONSE 1. ANS: A, B, D, F PTS: 1 DIF: Easy TOP: Therapeutic Classification: NA KEY: Knowledge MSC: NCLEX Category: Basic Care and Comfort NOT: See Pharmacology in the 21st century (p. 5): Alternative therapies now seem to have a place in the healing of patients. For example, aromatherapy involves the use of fragrant oils in baths; acupressure originates from an ancient Chinese art. Along similar lines is acupuncture; therapeutic touch involves the use of hand movements to stimulate circulation and healing. Stem cell research is considered mainstream medical treatment. Dietary manipulation may promote health but is not a recognized alternative therapy.

Chapter 2. Basics of Pharmacology Multiple Choice Identify the choice that best completes the statement or answers the question.

1. The nurse is preparing to apply valacyclovir (Valtrex) ointment to the shingles lesions located across

a client’s left side and lower back. Which of the following actions should the nurse take first?

A. Place the patient in a supine position.

B. Determine when the rash was first noted.

C. Ensure that the skin is clean and dry.

D. Take the patient’s vital signs.

2. The nurse is providing care for a client at 32 weeks’ gestation who started low-molecular heparin

injections after developing a deep vein thrombosis. The client asks the nurse, “Why do I have to take a shot? Why can’t I take the blood clot medicine that my dad takes orally?” Which of the following responses by the nurse is best?

A. “Anything that is fat-soluble, including warfarin (Coumadin), is able to cross the placental barrier. Heparin is not fat-soluble so it doesn’t cross the barrier well.”

B. “The placenta is easily crossed by anything you take by mouth while you are pregnant, but not by things absorbed in other ways.”

C. “Only water-soluble substances such as vitamins can cross the placental barrier, so you could take either medication, but heparin is cheaper.”

D. “They are the same medication, but the shot is absorbed faster than the pill so the doctor wants you to take daily shots.”

3. The nurse is providing care to a client with HIV who has been prescribed fosamprenavir (Lexiva).

Which of the following statements by the client indicates that further teaching is necessary?

A. “The metabolites of this medication may be excreted in active form.”

B. “I’m glad my kidneys work so well; otherwise the medication wouldn’t work.”

C. “This drug actually has to be broken down by my body to fight the virus.”

D. “Isn’t it fascinating that my liver has to metabolize the drug for it to work?”

4. The nurse is working with a client who was recently started on insulin therapy. The client’s young

daughter asks, “Why do you have to give her a shot? Why can’t you just give her a pill?” Which of the following responses by the nurse is best?

A. “Our bodies make insulin normally, so it is a liquid medication.”

B. “We do have diabetic medications in pill form. I’m not sure why the doctor ordered it this way for your mom.”

C. “Insulin is manufactured and given this way so it absorbs more rapidly into the body.”

D. “The acid in your mother’s stomach would destroy this medication, so it can’t be swallowed.”

5. The nurse is providing care for a 48-year-old male on the surgical unit. Gentamicin (Garamycin) 2

mg/kg every 8 hours has been started. The nurse would be most concerned by which of the following findings?

A. Blood levels have been ordered every 24 hours

B. The patient’s EGFR = 40 mL/min C. The patient’s hemoglobin = 11.8 g/dL D. The patient’s WBC = 14,000 c/mm3 6. A 16-year-old client comes to the urgent care clinic with symptoms of tonsillitis. The client tells the

nurse she takes tetracycline (Doxycycline) daily for the treatment of acne. The nurse would be most concerned if the health care provider prescribed which of the following?

A. Amoxicillin clavulanate (Augmentin) B. Cefdinir (Omnicef) C. Cefixime (Suprax) D. Ciprofloxacin (Cipro) 7. The nurse is providing care for a client experiencing muscle spasms. The physician has ordered

cyclobenzaprine (Flexeril). The nurse would inform the client to anticipate which of the following side effects?

A. Hypocalcemia and hypotension B. Dizziness and drowsiness C. Nausea and headache D. Flaccidity and urinary retention 8. While caring for clients on the medical unit, the nurse would see which of the following clients first?

A. A 28-year-old patient with HIV who has a temperature of 99.2°F B. A 54-year-old patient with diverticulitis whose diet was just advanced to solid food C. A 61-year-old patient who takes ibuprofen for arthritis complaining of severe

stomach pain D. A 37-year-old patient with a kidney stone who is due for pain medication in 20

minutes 9. While preparing to provide a patient admitted to the hospital for a laparoscopic hysterectomy the

prescribed dose of ibuprofen (Motrin) 800 mg orally, which of the following actions would take highest priority?

A. Determine if the client has eaten within the past hour.

B. Assess the client’s vaginal discharge.

C. Help the client ambulate in the hall.

D. Evaluate the client’s most recent renal panel labs.

10. The nurse is providing care for clients on the orthopedic unit. Which of the following assessment

findings is most concerning to the nurse?

A. A client who takes lisinopril (Zestril) and is complaining of limited range of

motion after shoulder surgery B. A client with a fractured pelvis who takes warfarin sodium (Coumadin) and reports

having a black tarry stool during the night C. A client 2 days post-op for knee replacement who takes

hydrocodone/acetaminophen (Vicodin) and refused to have labs drawn this morning D. A client 4 days after hip replacement surgery taking omeprazole (Prilosec) who ordered spinach for dinner

11. While working in the neonatal intensive care unit, the nurse notes an infant’s oxygen saturation has

been 98% for the past 4 hours. The infant has been receiving oxygen at 4 L. Which of the following actions by the nurse is best?

A. Turn the oxygen level down to 3 L and monitor closely to reduce the risk of eye damage.

B. Leave the oxygen level at its current rate to reduce the risk of lung damage.

C. Turn the oxygen level down to 2 L and monitor closely to evaluate the infant’s readiness for transfer out of the ICU. D. Leave the oxygen level at its current rate and inform the parents the baby will need supplemental oxygen at home.

Multiple Response Identify one or more choices that best complete the statement or answer the question.

1. While providing oral medications, the nurse recognizes which of the following is true regarding the

absorption rate of a medication? (Select all that apply.)

A. The drug’s level of fat solubility should be high to ensure absorption.

B. A medication will be more readily absorbed if it has a high pH. C. A drug will be more readily absorbed if it is acidic in nature.

D. Absorption will be more rapid if it is provided in liquid form.

E. Absorption is slower in the presence of food.

F. A lozenge should be chewed to release the maximum amount of medication.

2. While caring for multiple clients on the medical/surgical unit, the nurse would monitor which of the

following individuals for potential liver toxicity? (Select all that apply.)

A. A 14-year-old patient taking atomoxetine (Strattera) who has a history of ADHD B. A 44-year-old patient admitted for pneumonia who has been taking acetaminophen

(Tylenol) C. A 63-year-old patient with a history of atrial fibrillation who has an irregular apical pulse D. A 19-year-old patient with a history of alcohol abuse admitted for a tonsillectomy E. A 71-year-old patient with a history of tuberculosis who took isoniazid (Laniazid) F. A 15-year-old patient who took multiple aspirin as part of a suicide attempt 3. While working in the gastrointestinal diagnostic clinic, the nurse identifies which of the following

individuals as at high risk for developing a gastric ulcer? (Select all that apply.)

A. A 41-year-old patient with a family history of Crohn’s disease B. A 54-year-old patient who reports smoking 1.5 packs of cigarettes/day for the past

40 years C. A 29-year-old patient taking misoprostol (Cytotec) D. A 16-year-old patient with a 6-month history of bulimia E. A 44-year-old patient who reports taking ibuprofen (Advil) daily for low back pain 4. While providing medications to clients in the long-term care facility, which of the following actions

would the nurse use to prevent gastrointestinal side effects? (Select all that apply.)

A. Give clients yogurt to prevent diarrhea.

B. Increase client intake of fiber to reduce gastric motility.

C. Provide milk or food with some medications to reduce the occurrence of nausea.

D. Improve absorption of the medication by giving it at night with a large snack.

E. Prevent constipation by providing fiber laxatives.

Chapter 2. Basics of Pharmacology Answer Section MULTIPLE CHOICE 1. ANS: C PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Medication Provision; antivirals KEY: Analysis MSC: NCLEX Category: Pharmacological Therapies NOT: See Absorption (p. 15). When administering an ointment for a rash, make sure the skin is clean and dry.

2. ANS: A PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Anticoagulant therapy KEY: Analysis MSC: NCLEX Category: Pharmacological Therapies NOT: See Distribution (p. 16): The blood-placental barrier helps to filter drugs and other substances passing from mother to fetus. Most lipid-soluble drugs readily cross this barrier but water-soluble drugs do not.

Warfarin (Coumadin) is fat-soluble and crosses the placental barrier while heparin does not. They are not the same medication and cost is not part of the therapeutic decision.

3. ANS: B PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Medication Administration; antivirals KEY: Analysis MSC: NCLEX Category: Pharmacological Therapies NOT: See Metabolism (p. 16): The liver does most of the work of drug metabolism. In some instances, a drug is administered in its inactive form to become activated through metabolism. This category of drugs is known as prodrugs. An example of a prodrug is fosamprenavir (Lexiva).

4. ANS: D PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Antidiabetics KEY: Analysis MSC: NCLEX Category: Pharmacological Therapies NOT: See Metabolism (p. 16): Insulin given by mouth is virtually useless; stomach acid breaks down insulin to an inactive form before it can be absorbed into the bloodstream. Oral diabetic medications are not forms of insulin; they stimulate the pancreas to release insulin.

5. ANS: B PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Antibiotics KEY: Analysis MSC: NCLEX Category: Pharmacological Therapies NOT: See Issues Affecting the Drug Cycle (p. 17): Gentamicin is known to be both nephrotoxic (toxic to the kidneys) and ototoxic (toxic to the ears). Thus, kidney function and hearing would be monitored closely. The EGFR is the best measurement of kidney function. Normal value is >60 mL/min. While the client’s hemoglobin is low, the kidney function is more concerning. An elevated WBC count is expected in the presence of an infection, which is the reason antibiotic therapy is provided. Routine blood levels to monitor drug dosage is expected to help prevent toxicity.

6. ANS: A PTS: 1 DIF: Hard TOP: Therapeutic Classification: Antibiotics KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Issues Affecting Drug Cycle (p. 18): Antagonist drugs do the opposite by rendering another drug less powerful. The antibiotic tetracycline becomes ineffective when it is taken with penicillin. Amoxicillin clavulanate is a penicillin derivative.

7. ANS: B PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Muscle relaxants KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See The Importance of Side Effects (p. 18): Muscle relaxants such as Flexeril cause dizziness and drowsiness in addition to their intended actions.

8. ANS: C PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Anti-inflammatory agents KEY: Analysis MSC: NCLEX Category: Pharmacological Therapies NOT: See Side Effects (p. 19): Clients who take nonsteroidal anti-inflammatory medications on a long-term basis run the risk of developing ulcers. This client is the most unstable and should be seen first.

9. ANS: D PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Anti-inflammatory agents KEY: Analysis MSC: NCLEX Category: Pharmacological Therapies NOT: See Side Effects (p. 19): If kidney damage or impairment is suspected, BUN levels may be monitored to evaluate kidney function. Clients taking anti-inflammatory agents are at increased risk of kidney damage because these drugs are primarily metabolized through the kidneys instead of the liver.

10. ANS: B PTS: 1 DIF: Hard TOP: Therapeutic Classification: Anticoagulants KEY: Analysis MSC: NCLEX Category: Pharmacological Therapies NOT: See Side Effects (p. 19): Any patient taking an anticoagulant such as Coumadin to decrease clotting should be carefully monitored for signs of bleeding, including dark tarry stools. Coumadin levels should be monitored to ensure the drug level is therapeutic but not toxic.

11. ANS: A PTS: 1 DIF: Moderate TOP: Therapeutic Classification: NA KEY: Analysis MSC: NCLEX Category: Pharmacological Therapies NOT: See Side Effects (p. 19): A serious problem is the use of oxygen in premature infants. At high doses, oxygen is very damaging to the eyes. For this reason, oxygen is now used at the lowest therapeutic dose possible for all age groups. This oxygen saturation level is very good, has been stable for 4 hours, and thus a trial on lower concentrations is warranted. Transfer out of ICU will depend on additional factors. Long-term use of oxygen can’t be determined at this time.

MULTIPLE RESPONSE 1. ANS: A, C, D, E PTS: 1 DIF: Hard TOP: Therapeutic Classification: NA KEY: Analysis MSC: NCLEX Category: Pharmacological Therapies NOT: See Absorption (p. 15): The more soluble a medication is in fat or lipids, the more easily it is absorbed through the stomach. Medications with a low (acidic) pH are easily absorbed in the stomach. Liquid medications act faster than pills. A large amount of food slows absorption. If a patient sucks on a lozenge, more medication is released in the mouth than if the lozenge is chewed or swallowed.

2. ANS: B, D, E, F PTS: 1 DIF: Hard TOP: Therapeutic Classification: Medication Administration KEY: Analysis MSC: NCLEX Category: Pharmacological Therapies NOT: See Side Effects (p. 18): Alcohol, acetaminophen, isoniazid, and aspirin can cause liver damage.

3. ANS: B, E PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Anti-inflammatory agents KEY: Analysis MSC: NCLEX Category: Pharmacological Therapies NOT: See Side Effects (p. 19): The synthetic prostaglandin misoprostol (Cytotec) may be given to prevent the development of ulcers. Clients taking anti-inflammatory agents such as ibuprofen are at increased risk for ulcer formation. These patients are also urged to stop smoking to reduce the risk of ulcers.

4. ANS: A, C, E PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Medication Administration KEY: Analysis MSC: NCLEX Category: Pharmacological Therapies NOT: See Side Effects (p. 19): Side effects are managed on an individual basis. Some medications require ingestion with milk or food. For certain drugs, adding yogurt to the diet is suggested to prevent diarrhea, and other drugs may require the addition of a high-fiber laxative to the diet to prevent constipation. Fiber will increase GI motility. The presence of food slows absorption rates.

Chapter 3. Patient Safety in Medication Administration Multiple Choice Identify the choice that best completes the statement or answers the question.

1. The student nurse is preparing to provide medications to a client scheduled to receive lisinopril

(Zestril) 10 mg PO daily and ofloxacin (Floxin) 2 drops o.s. three times daily. Which of the following actions by the student is best?

A. Provide the lisinopril by mouth and the ofloxacin into the right ear.

B. Provide the lisinopril into the right ear and the ofloxacin into the right eye.

C. Provide the lisinopril into the left ear and the ofloxacin orally.

D. Provide the lisinopril orally and the ofloxacin into the left eye.

2. When providing medications from floor stock to a client on the Alzheimer’s unit of a long-term-care

facility, the nurse demonstrates the principle of right drug by which of the following?

A. Checks the label before taking the medication out of the cabinet, checks the label

before pouring the medication, checks the label before placing the bottle back in the cabinet B. Checks the label before taking the medication out of the cabinet, checks the label before pouring the medication, checks the label before leaving the medication room C. Checks the label after removing the bottle from the cabinet, checks the label after pouring the dose of medication, checks the label before closing the cabinet door D. Checks the label while removing the bottle from the cabinet, checks the label after pouring the dose of medication, checks the label while replacing the bottle in the cabinet 3. The nurse is preparing to discharge a client originally admitted for community-acquired pneumonia

who has a discharge prescription for cefditoren (Spectracef). Which of the following instructions would the nurse include in the discharge teaching?

A. “Be sure to take the medication until your cough is gone.”

B. “It is important that you take the medication with meals.”

C. “Taking the medication at set time intervals will help blood levels stay constant.”

D. “Keeping the medication on the counter top will help you remember to take it.”

4. While working in an urgent care center, the nurse assists in the care of a client with allergic rhinitis

who has been given a prescription for beclomethasone nasal spray (Beconase), 2 sprays in each nostril 2 to 4 times daily. The nurse would provide further instruction to which of the following client statements?

A. “This will help my nose to not run so constantly.”

B. “I should spray this in each nostril whenever my nose starts to drip.”

C. “I can use this before I go to work, midday, and again at bedtime.”

D. “This medication is a mild steroid and will reduce swelling and irritation of my nasal passages.”

5. The nurse is conducting a home visit for a 43-year-old client. The client, who has three children

under the age of 12, is 3 days post-mastectomy. The nurse would be most concerned by which of the following?

A. The client has a calendar for appointments and a list with physician contact information by the phone.

B. The client keeps her medications in a daily pill box that sits on the kitchen windowsill.

C. The client reports that it was too uncomfortable to wear the temporary prosthesis she had been given.

D. The children are participating in a support group for family members of people with cancer.

6. The nurse is providing medications to a client with a gastrostomy tube. Diclofenac (Cambia) has

been ordered. Prior to administration, the nurse should take which of the following actions?

A. Ensure that the medication comes as a liquid preparation.

B. Obtain a 3-mL syringe and needle with a safety device.

C. Document the medication provision.

D. Ask the client to state her name and room number.

7. A nurse on the pediatric unit is preparing to pass medications for a 10-year-old client with

exacerbation of asthma. Amphetamine (Adderall) and fluticasone (Advair) are scheduled. The nurse must be aware of which of the following?

A. Adderall and Advair should not be given at the same time.

B. Adderall is used to reduce bronchospasms.

C. Advair must be given with food.

D. Adderall and Advair each have look-alike/sound-alike medications.

8. A nurse working in the GI clinic is performing pre-op phone calls. The nurse calls a client who is

scheduled for a colonoscopy to inform the client of the following orders, “Begin clear liquid diet 24 hours prior to the exam; take magnesium citrate (Citroma) 1 bottle PO 12 hours prior to the exam and another 8 hours prior to the exam; remain NPO for 6 hours prior to the study.” The test is scheduled the next day at 2 p.m. The nurse would instruct the patient to: A. “Only have liquids to drink at this point until the test. Use the enema prep at 2 a.m. and then again at 6 a.m. You can’t have anything to eat or drink after waking in the morning.”

B. “Start a clear liquid diet today at 2 p.m. Drink a bottle of prep at 2 a.m. and another at 6 a.m., and then don’t eat or drink anything after 8 a.m.”

C. “Don’t eat anything solid starting with lunch today. Give yourself an enema with the prep at 6 a.m. and again at noon, and don’t have anything to eat or drink after 8 a.m.”

D. “Start a clear liquid diet with dinner today. Drink the prep 12 hours and 8 hours before your test at 2 p.m. tomorrow, and be sure not to eat anything solid after you get up in the morning.”

9. While working in a surgical clinic, the nurse notes orders that read, “.25 mg digoxin (Lanoxin) IV

now.” Which action by the nurse is best?

A. Give .25 mg of digoxin intravenously.

B. Give 25 mg of digoxin as an injection into the skin.

C. Contact the physician for clarification of the order.

D. Give .25 mL of digoxin as an intramuscular injection.

10. A client being seen in the outpatient clinic has been given a new prescription for tetracycline

(Doxycycline) orally each day. The client reported current medications include a multivitamin with calcium, St. John’s Wort, and omeprazole (Prilosec). The nurse would provide additional teaching for which client statement?

A. “I should try to take the medication at roughly the same time each day.”

B. “I can take this medication with my other morning meds.”

C. “I should take this medication at least an hour before or 2 hours after I eat.”

D. “Drinking extra water is important when taking this medication.”

11. The nurse receives a phone call from an elderly woman who states that her husband has recently

started taking atorvastatin (Lipitor) and is complaining of having sore muscles. Which response by the nurse is best?

A. “Does your husband smoke cigarettes?”

B. “What type of exercise is your husband doing?”

C. “Does your husband have a history of heart disease?”

D. “Your husband should be seen in the clinic today for some tests.”

12. A nurse from the adult medical unit is pulled to the geriatric unit. The nurse notes many of the

common medications provided are in lower doses than typically prescribed. What action by the nurse is the highest priority?

A. Notify the charge nurse that clients may have received inappropriate medication dosages.

B. Call the nursing supervisor to investigate the nurse’s concerns.

C. Don’t worry about the discrepancy since this is not the nurse’s unit.

D. Evaluate the lab values of each client to determine liver and kidney function.

13. While working on a geriatric unit, the nurse would be most concerned by which of these findings?

A. An 81-year-old client is scheduled to take 12 pills at 9 a.m.

B. A 72-year-old client given a sleeping pill the night before seems confused.

C. A 69-year-old client with a deep vein thrombosis has an order for an anticoagulant.

D. A 74-year-old client with diabetes has a fasting glucose result of 88 g/dL. 14. The nurse notes that an elderly client admitted with metastatic cancer has a low serum protein level.

Which action by the nurse is best?

A. No action is required because the patient is terminal.

B. Increase the frequency of vital sign monitoring.

C. Determine the most recent complete blood count (CBC) results.

D. Increase awareness and assessment of potential medication side effects.

15. Shortly after providing a new sleeping pill to a client on the medical unit, the nurse answers the

client’s call light. Which of the following findings would indicate to the nurse that the client is experiencing an anaphylactic reaction to the medication?

A. The client’s respiratory rate is 28 and slightly labored.

B. The client complains of continued wakefulness and agitation.

C. The client states that she feels nauseated and has a headache.

D. The client reports feeling hot and has a rash across her chest.

16. A nurse working at the poison control center receives a call from a young woman babysitting for a 4-

year-old child who reportedly swallowed some of the parent’s medication. Which statement by the nurse is best?

A. “I’m calling emergency personnel for you now.”

B. “What do the pills look like?”

C. “Have the child drink a glass of milk.”

D. “What is the name of the pills?”

17. The nurse is preparing to provide medications to a client in a double room. The client’s roommate

has multiple visitors present. Which of the following actions would the nurse take first?

A. Identify the action and side effect of each medication as it is provided.

B. Pull the client’s bedside curtain and talk in subdued tones.

C. Ask the client to state his name and birth date to verify identity.

D. Determine what questions the client has about his medications.

Multiple Response Identify one or more choices that best complete the statement or answer the question.

1. While providing medications in the clinical lab, a student would perform actions related to safe

administration that include which of the following? (Select all that apply.)

A. Right medication B. Right dose C. Right time D. Right room E. Right patient F. Right route 2. While supervising a student nurse providing morning medications to clients in the long-term-care

facility, the nurse would intervene if the student was observed performing which of the following actions? (Select all that apply.)

A. The student checks the patient’s arm band to verify identity.

B. The student verifies the medication order.

C. The student scans the medication with the computer scanner.

D. The student checks the medication’s expiration date.

E. The student prepares a medication scheduled for 1800.

F. The student asks the client to state his first name prior to giving the medication.

3. A female nursing student is 18 weeks pregnant while attending her pharmacology class. Which of

the following facts related to fetal effects of medications will the student recognize as true? (Select all that apply.)

A. Category A drugs are known to have minimal risk to the fetus.

B. Category C drugs are known to cause severe risk to the fetus in human trials.

C. Drugs that are classified as teratogenic are not able to cross the placental barrier.

D. Category X drugs have not been studied in pregnant women.

E. Category B drugs have slight risk to the fetus; both animal and human studies have

been done.

4. A nurse is working with a group of male veterans participating in a smoking-cessation program. The

nurse recognizes that which of the following statements related to medications in these clients is true? (Select all that apply.)

A. An increased number of medications will have teratogenic effects in this population.

B. Medications are likely to be absorbed and distributed more rapidly.

C. This population has a decreased lipase secretion.

D. These clients may need larger doses of liver-metabolized drugs.

E. Drugs will be metabolized more slowly by this population.

5. A nurse working in the emergency room is preparing for the admission of a 34-year-old client with a

drug overdose. Which of the following equipment and/or orders will the nurse anticipate?

A. Telemetry monitoring B. Blood transfusion C. Activated charcoal D. Dialysis machine E. Nasogastric tube and 60-mL syringe for lavage F. Contrast for magnetic resonance imaging (MRI) testing 6. A nurse working on the orthopedic unit is providing discharge instructions for a client with a

fractured femur. When explaining the client’s narcotic pain medication, the nurse would include which statement? (Select all that apply.)

A. “This medication may make you sleepy, so you can’t drive while taking it.”

B. “Narcotics can cause constipation, so be sure to drink extra fluid and eat a highfiber diet.”

C. “Many patients who take this feel dizzy or light-headed, so you must be careful of falls, especially at night.”

D. “Only take the number of pills prescribed per day. Taking more can be dangerous.”

E. “You can take this medication as many times as needed for pain control.”

7. An RN is working to support clinical trials in clients with cancer. Which of the following would be

an anticipated part of this role? (Select all that apply.)

A. Educating the clients about the treatment, side effects, and alternative therapies B. Ensuring that informed consent to participate is obtained C. Documenting client and family understanding related to the trial D. Providing payment to the client for participation in the trial E. Ordering medications from the pharmacy based on clients’ height and weight Matching

Place the following steps of medication administration for an ordered medication in the correct order.

A. Ask the client to state his/her name and birth date.

B. Open the medication packaging.

C. Verify the medication and dose.

D. Scan the medication with the computer scanner.

1. First 2. Second 3. Third

4.

Fourth

Chapter 3. Patient Safety in Medication Administration Answer Section MULTIPLE CHOICE 1. ANS: D PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Medication Administration KEY: Analysis MSC: NCLEX Category: Pharmacological Therapies NOT: See Table 3.2 (p. 29): PO is by mouth (orally) and o.s. is left eye.

2. ANS: A PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Medication Administration KEY: Analysis MSC: NCLEX Category: Pharmacological Therapies NOT: See Patient Rights for Safety (p. 26): Check the label before you take the bottle from the shelf, check the label before you pour the drug out, check the label before you put the bottle back on the shelf.

3. ANS: C PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Antibiotics KEY: Analysis MSC: NCLEX Category: Pharmacological Therapies NOT: See Patient Rights for Safety (p. 26): Some medications, such as antibiotics need to be given a standard number of hours apart around the clock to maintain a consistent blood level. Most antibiotics work best when taken on an empty stomach (p. 31). Store medications safely locked away.

4. ANS: B PTS: 1 DIF: Easy TOP: Therapeutic Classification: Inhaled Steroids KEY: Analysis MSC: NCLEX Category: Pharmacological Therapies NOT: See Patient Rights for Safety (p. 26): Emphasize that patients need to adhere to the exact prescription and avoid self-medication.

5. ANS: B PTS: 1 DIF: Moderate TOP: Therapeutic Classification: NA KEY: Analysis MSC: NCLEX Category: Pharmacological Therapies NOT: See Fast Tip 3.1 (p. 27): Store medications safely no matter what age others are in the household.

Discomfort at the surgical incision site should be investigated to ensure that no infection is present, but tenderness 3 days after surgery is still expected and may interfere with prosthetic use.

6. ANS: A PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Anti-inflammatory agents KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: Patient Rights for Safety (p. 27): A liquid formulation may be necessary if the drug must be given through a feeding tube. A needle should not be necessary for g-tube administration. Documentation should not occur until after the medication is given. Clients should be asked to state name and birth date for proper identification.

7. ANS: D PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Amphetamine mixtures KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Medication Administration Table 3.1 (p. 28): Adderall and Advair each have other drugs with look-alike/sound-alike names. Adderall is used to treat ADHD symptoms. Advair is provided in diskus/inhalation format for clients with asthma and food is not a factor in its provision. These two medications can be given at the same time.

8. ANS: B PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Laxatives KEY: Analysis MSC: NCLEX Category: Pharmacological Therapies NOT: See Table 3.2: NPO means nothing by mouth; PO means orally. Giving specific directions/instructions,

9.

10.

11.

12.

13.

14.

15.

16.

including times for prep, will help ensure that clients understand and follow the correct procedure for medication administration.

ANS: C PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Amionoglycocides KEY: Analysis MSC: NCLEX Category: Pharmacological Therapies NOT: See Table 3.2 and 3.3: IV means intravenous (into a vein), but without a zero in front of the decimal point, this order should be clarified.

ANS: B PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Antibiotics KEY: Analysis MSC: NCLEX Category: Pharmacological Therapies NOT: See Factors Affecting Medication Administration (p. 31): Administering tetracycline with calcium prevents the absorption of the antibiotic. Most antibiotics work best when taken on an empty stomach. Many antibiotics can cause diarrhea, so drinking extra fluids is important.

ANS: D PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Lipid lowering agents KEY: Analysis MSC: NCLEX Category: Pharmacological Therapies NOT: See Age, gender and culture (p. 31): Toxic drug levels can be found in elderly patients, even with normal doses. The aging process alters liver and kidney function and leads to accumulation of medications.

Atorvastatin can cause muscle breakdown, a condition that is worsened in the presence of kidney or liver disease, so it will be important to have the client evaluated and have laboratory testing done.

ANS: D PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Medication administration KEY: Analysis MSC: NCLEX Category: Dosage Calculations NOT: See Age, gender and culture (p. 31): The aging process alters liver and kidney function and leads to accumulation of medications. Because of these factors, doses may need to be adjusted for elderly patients.

ANS: B PTS: 1 DIF: Moderate TOP: Therapeutic Classification: NA KEY: Analysis MSC: NCLEX Category: Coordinated Care NOT: See Age, gender and culture (p. 31): Of special concern are sedative-hypnotics. These medications are commonly associated with adverse drug events and can worsen agitation and exacerbate dementia. Another concern for geriatric patients is polypharmacy, but this is not the highest priority in this scenario.

Anticoagulant medication is an appropriate treatment for deep vein thrombosis. A reading of 88 g/dL is a normal fasting blood glucose.

ANS: D PTS: 1 DIF: Moderate TOP: Therapeutic Classification: NA KEY: Application MSC: NCLEX Category: Physiological Adaptation NOT: See Patients with Organ Dysfunction (p. 34): Decreased serum protein levels can alter the capacity of a drug to bond. More unbound medication is therefore available and this can lead to side effects. Serum protein levels may indirectly impact blood volume and therefore blood pressure, but this is not the highest priority.

Recent CBC results may be indirectly affected by low serum protein levels, but this is not the highest priority for this scenario.

ANS: A PTS: 1 DIF: Moderate TOP: Therapeutic Classification: NA KEY: Analysis MSC: NCLEX Category: Pharmacological Therapies NOT: See Patient Emergencies (p. 36): A severe allergic reaction is called anaphylaxis. Patients experiencing anaphylaxis have difficulty breathing and may have other symptoms such as itching, wheezing, anxiety, and light-headedness.

ANS: A PTS: 1 DIF: Moderate TOP: Therapeutic Classification: NA KEY: Analysis MSC: NCLEX Category: Safety and Infection Control NOT: See Patient Emergencies (p. 36): If you receive a call from a patient who has ingested a toxic substance, call 911. This child needs immediate medical attention, which should take priority over other actions or assessment. Learning more about the medications will be helpful and milk may be appropriate to reduce acidity, but the priority is to have emergency personnel respond first.

17. ANS: B PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Medication Administration KEY: Analysis MSC: NCLEX Category: Pharmacological Therapies NOT: See Patient Consent (p. 35): Patients have the right to receive medications in a quiet, private place. The first action in this scenario is to attempt to provide client privacy by pulling the bedside curtain and speaking in subdued tones.

MULTIPLE RESPONSE 1. ANS: A, B, C, E, F PTS: 1 DIF: Easy TOP: Therapeutic Classification: Medication Administration KEY: Knowledge MSC: NCLEX Category: Pharmacological Therapies NOT: See Patient Rights for Safety (p. 26) The seven right of medication administration include right patient, right drug, right dose, right time, right route, right technique, and right documentation.

2. ANS: E, F PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Medication administration KEY: Analysis MSC: NCLEX Category: Pharmacological Therapies NOT: See Patient Rights for Safety (p. 26) The seven rights of medication administration include right patient, right drug, right dose, right time, right route, right technique, and right documentation. Before you administer any medication, make sure that you have the right patient by asking the individual to state his or her full name and birth date. Verify that you have the correct medication for the patient. In a hospital, scanning a bar code to double-check a medication with a computer system may help reduce medication errors.

1800 is 6 p.m.; this is not a morning medication and would not be provided at this time. Both first and last name and birthdate should be stated prior to provision of medications.

3. ANS: A, E PTS: 1 DIF: Hard TOP: Therapeutic Classification: NA KEY: Knowledge MSC: NCLEX Category: Pharmacological Therapies NOT: See Pregnancy and Table 3.5 (p. 33): Category A medications have the lowest risk. Category B medications have slight risk, with animal studies showing no risk or, if risk is noted, human studies have shown no risk. Category C medications have moderate risk based on animal studies, and controlled studies have not been done on women. Category X medications have the highest risk as studies have shown significant risk. Teratogenic drugs cross the placental barrier and cause deformities.

4. ANS: B, D PTS: 1 DIF: Hard TOP: Therapeutic Classification: NA KEY: Knowledge MSC: NCLEX Category: Pharmacological Therapies NOT: See Age, gender and culture (p. 32–33): Medications are absorbed and distributed in the body more quickly in men than in women. Smoking cigarettes induces liver enzymes to metabolize drugs more rapidly, so clients may need larger doses of liver-metabolized drugs. Teratogenic effects are related to fetal development and will not impact male clients. Lipase secretion is decreased in infants as compared with adults.

5. ANS: A, C, E PTS: 1 DIF: Moderate TOP: Therapeutic Classification: NA KEY: Application MSC: NCLEX Category: Physiological Adaptation NOT: See Patient Emergencies (p. 36): Actions will depend on the type of toxin but may include administration of activated charcoal, lavage (pumping of the patient’s stomach), and monitoring the patient for changes in vital signs, including heart rate (telemetry). Blood transfusion, dialysis, and MRI testing is not immediately anticipated and would only be ordered if the client was experiencing bleeding, kidney failure, or symptoms of a stroke, respectively.

6. ANS: A, B, C, D PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Narcotics KEY: Analysis MSC: NCLEX Category: Pharmacological Therapies NOT: See Protecting the Patient: Ethical and Safety Considerations (p. 34): It is your responsibility as a health professional to educate the patient about the risks associated with taking more than the prescribed dose.

7. ANS: A, B, C PTS: 1 DIF: Hard TOP: Therapeutic Classification: NA KEY: Application MSC: NCLEX Category: Coordinated Care NOT: See Patient consent (p. 35): A patient who is taking an experimental drug has the right to informed consent, which includes understanding the treatment and its effects, alternative treatments, and possible outcome if the treatment is declined. It is essential to document informed consent. Clients are generally not paid to participate in clinical trials. RNs are not able to order medications.

MATCHING 1. ANS: A PTS: 1 DIF: Easy TOP: Therapeutic Classification: Medication Administration KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Patient Rights for Safety (p. 26): Before you administer any medication, make sure that you have the right patient by asking the individual to state his or her full name and birth date. Verify that you have the correct medication for the patient. In a hospital, scanning bar codes to double-check a medication with a computer system may help reduce medication errors.

2. ANS: D PTS: 1 DIF: Easy TOP: Therapeutic Classification: Medication Administration KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Patient Rights for Safety (p. 26): Before you administer any medication, make sure that you have the right patient by asking the individual to state his or her full name and birth date. Verify that you have the correct medication for the patient. In a hospital, scanning bar codes to double-check a medication with a computer system may help reduce medication errors.

3. ANS: B PTS: 1 DIF: Easy TOP: Therapeutic Classification: Medication Administration KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Patient Rights for Safety (p. 26): Before you administer any medication, make sure that you have the right patient by asking the individual to state his or her full name and birth date. Verify that you have the correct medication for the patient. In a hospital, scanning bar codes to double-check a medication with a computer system may help reduce medication errors.

4. ANS: C PTS: 1 DIF: Easy TOP: Therapeutic Classification: Medication Administration KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Patient Rights for Safety (p. 26): Before you administer any medication, make sure that you have the right patient by asking the individual to state his or her full name and birth date. Verify that you have the correct medication for the patient. In a hospital, scanning bar codes to double-check a medication with a computer system may help reduce medication errors.

Chapter 4. Regulations Multiple Choice Identify the choice that best completes the statement or answers the question.

1. While shopping for an over-the-counter cough suppressant, the nurse identifies the medication will

be classified as: A. A Schedule I medication B. A Schedule III medication C. A Schedule V medication D. Nonscheduled medication 2. Nurses are protected from unnecessary job-related risks due to the regulations set by: A. Food and Drug Administration (FDA) B. Drug Enforcement Administration (DEA) C. Occupational Safety and Health Administration (OSHA) D. Joint Commission on Accreditation of Healthcare Organizations (JCAHO) 3. The nurse provides a client admitted with gastroesophageal reflux a dose of intravenous

pantoprazole (Protonix). Fifteen minutes later, the client calls for help and is gasping for breath.

Emergency measures are instituted and the client is transferred to the intensive care unit. Which action should be included in the nurse’s follow-up activities?

A. Notify the nursing supervisor that the client experienced a common side effect to the drug.

B. Identify the episode as an adverse reaction and ensure it is reported to the FDA. C. Call the hospital administrator to report an act of medication fraud.

D. Contact the local news channel to arrange an investigation.

4. A client with advanced colorectal cancer is going to start taking long-acting morphine sulfate (MS

Contin). Which of the following statements by the nurse is best?

A. “I will call the prescription into your local pharmacy.”

B. “You are only allowed to have one refill on this medication before you have to see

the doctor again.”

C. “This is considered a Schedule IV medication, so there are strict guidelines we must follow.”

D. “I am faxing the prescription to the pharmacy, but you must also take this written prescription with you to pick it up.”

5. A client with a compressed disc in the lumbar region takes Vicodin every 6 hours for pain control.

He tells the nurse, “This pain medication just doesn’t seem to be working anymore.” Which response by the nurse is best?

A. “Are you taking the medication with a full glass of water?”

B. “You may be developing a tolerance to the medication.”

C. “We will have to draw some lab work to see if your stomach is digesting the medication correctly.”

D. “How did you rank your pain on a 0–10 scale with your original injury?”

6. A co-worker tearfully confides that she is struggling with a growing dependence on sleeping

medication and other drugs to maintain her work schedule on the night shift. Which action by the nurse is best?

A. Refer the co-worker to the employee assistance program.

B. Encourage the co-worker to switch to herbal remedies.

C. Suggest the co-worker try to get a daytime position.

D. Ask if the co-worker needs help with childcare.

Multiple Response Identify one or more choices that best complete the statement or answer the question.

1. A student nurse is reminded to follow OSHA guidelines when providing care to clients in the

hospital. Which of the following actions will the student take to comply with this direction? (Select all that apply.)

A. Wear a uniform that identifies the student’s status B. Wear gloves when providing a client bath C. Hand washing before providing client care D. Needle disposal in an identified “sharps” container E. Wear a face mask when caring for a client with heart failure 2. A clinical trial nurse is helping to register a patient to a phase II double-blind trial comparing a new

medication to a placebo. Which of the following would the nurse include in the patient teaching?

(Select all that apply.)

A. “Neither you, the doctor, or I will know if you are getting the real medication or not.”

B. “A computer will randomly determine which people get the actual study drug.”

C. “This trial is designed to determine if a benefit is found when using the drug.”

D. “Less than 100 people will be participating in this study.”

E. “The results of the study will not be known for at least 5 years.”

3. A nurse working with a client who is experiencing withdrawal from a medication would track which

of the following symptoms? (Select all that apply.)

A. Tremors B. Pin-point pupils C. Hallucinations D. Low blood pressure E. Emotional distress F. Feelings of euphoria 4. The nurse manager on a surgical unit suspects one of the nurses may be dealing with a substance

abuse problem. Which of the following symptoms would support this suspicion? (Select all that apply.)

A. The individual’s uniform is frequently wrinkled or disheveled.

B. The individual has called in sick three times in the past month.

C. The individual has made two medication errors in the past week.

D. The individual is irritable and withdrawn.

E. The individual was seen crying in the medication room after a patient death.

F. The individual has lost an estimated 10 pounds in the past 8 weeks.

Chapter 4. Regulations Answer Section MULTIPLE CHOICE 1. ANS: C PTS: 1 DIF: Moderate TOP: Therapeutic Classification: NA KEY: Comprehension MSC: NCLEX Category: Pharmacological Therapies NOT: See Table 4.4 (p. 45) and Table 4.7 (p. 57): Schedule I medications have high abuse potential.

Schedule III medications have lower abuse potential with moderate to low dependence risk. Schedule V medications have even lower abuse potential and include over-the-counter cough suppressants.

2. ANS: C PTS: 1 DIF: Easy TOP: Therapeutic Classification: NA KEY: Knowledge MSC: NCLEX Category: Pharmacological Therapies NOT: See Modern Regulating Agencies (p. 46): OSHA is a branch of the Department of Labor that helps ensure all workers are not exposed to unnecessary job-related risks.

3. ANS: B PTS: 1 DIF: Moderate TOP: Therapeutic Classification: GERD agents KEY: Analysis MSC: NCLEX Category: Safety and Infection Control NOT: See Food and Drug Administration (p. 47): A side effect that can cause severe harm or death is commonly called an adverse reaction. An example is airway swelling. It is your responsibility as an allied health professional to report an adverse reaction to a medication to the FDA’s MedWatch.

4. ANS: D PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Narcotics KEY: Analysis MSC: NCLEX Category: Psychosocial Integrity NOT: See Drug Control (p. 57): Morphine is a Schedule II medication. An office assistant cannot call in the prescription, and no refills are permitted. The office staff may fax the prescription to the pharmacy, but the clients must also give a handwritten prescription to the pharmacist to receive the medication.

5. ANS: B PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Narcotics KEY: Analysis MSC: NCLEX Category: Psychosocial Integrity NOT: See Substance Abuse (p. 59): Requiring greater amounts of a drug occurs when clients develop a tolerance to the medication. The amount of water consumed will not contribute to drug efficacy. Kidney or liver dysfunction may contribute to drug metabolism, but lab results are not typically used to determine digestion of a medication. The level of pain associated with the original injury is not helpful to the current situation.

6. ANS: A PTS: 1 DIF: Moderate TOP: Therapeutic Classification: NA KEY: Application MSC: NCLEX Category: Coordinated Care NOT: See Treating Substance Abuse (p. 60): Follow your facility’s protocol on referral of impaired employees for substance abuse treatment. Many employers have employee assistance programs or support groups organized through the human resource department.

MULTIPLE RESPONSE 1. ANS: B, C, D PTS: 1 DIF: Moderate TOP: Therapeutic Classification: NA KEY: Analysis MSC: NCLEX Category: Safety and Infection Control NOT: See Modern Regulating Agencies (p. 46): OSHA regulations for protecting yourself on the job include hand washing before any patient is handled. Medications should not be touched without wearing gloves.

Gloves should be worn during client care in case of exposure to blood or body fluids. Sharp objects should be disposed of in a specialized sharps disposal container. Face masks are part of additional precautions when providing care for clients with a respiratory infection - a client with heart failure is not considered infectious.

2. ANS: A, B, C PTS: 1 DIF: Hard TOP: Therapeutic Classification: NA KEY: Analysis MSC: NCLEX Category: Pharmacological Therapies NOT: See Clinical Trials (p. 51-52) and Table 4.6: Clinical trials are studies performed after testing is done in a laboratory. During the study the effect of the active drug is compared to a placebo (an inactive substance).

Most studies are double-blind, meaning neither the participant nor the clinicians know who is receiving the active drug. Phase II clinical trials involve hundreds of patients and are designed to see whether a drug works as desired. Phase II trials last several months to 2 years.

3. ANS: A, C, E PTS: 1 DIF: Moderate TOP: Therapeutic Classification: NA KEY: Knowledge MSC: NCLEX Category: Psychosocial Integrity NOT: See Substance Abuse (p. 59): Patients who stop taking a medication may experience symptoms of withdrawal, such as tremors, emotional distress, and hallucinations.

4. ANS: A, B, C, D, F PTS: 1 DIF: Moderate TOP: Therapeutic Classification: NA KEY: Application MSC: NCLEX Category: Psychosocial Integrity NOT: See Box 4.3 (p. 61): Signs of possible substance abuse include: being late or absent frequently due to illness, irritable and defensive or withdrawn behavior, frequent mistakes, changes in appearance such as weight change, and poor or deteriorated hygiene.

Chapter 5. Prescriptions and Labels Multiple Choice Identify the choice that best completes the statement or answers the question.

1. The nurse notes orders for lorazepam (Ativan) 1 mg PO qhs prn. Which action by the nurse is best?

A. Give the client 1 mg at noon each day.

B. Ask the client at bedtime if he/she would like to take an Ativan.

C. Schedule the Ativan daily with breakfast.

D. Instruct the client to ask for Ativan any time it is needed.

2. The following order is written for a 28-year-old client with asthma, “Budesonide nasal (Pulmicort) 2

sprays each nostril bid.” The nurse will instruct the client to take this medication: A. Once daily with two sprays in each nostril B. Once each evening with one spray in each nostril C. One spray in each nostril twice daily D. Two sprays in each nostril two times each day 3. A client with Alzheimer’s disease is started on donepezil (Aricept) 10 mg PO qhs. The nurse will

administer this medication at: A. 6 p.m.

B. 6 a.m.

C. 9 p.m.

D. 9 a.m.

4. A client with diabetes mellitus is ordered sliding scale insulin glulisine (Apidra) 2 to 10 units ac and

hs based on blood glucose results. The nurse will need to check the client’s blood sugar: A. Before each meal and at bedtime B. Fasting in the morning and again at bedtime C. Just before breakfast and again at dinner D. After each meal 5. A neighbor calls the nurse saying, “This bottle of infant acetaminophen (Tylenol) doesn’t have a

dropper; it has a little cup. How do I know how much to give to my 3-month-old daughter?” Which response by the nurse is best?

A. “How much did you give your three-year-old son when he was a baby?”

B. “Read the label on the back of the box to find the strength and recommended dosage.”

C. “Why do you need to give the baby Tylenol?”

D. “Tylenol is no longer given to infants or children.”

6. While caring for a client being sent home with a prescription for oxycodone and acetaminophen

(Percocet), the nurse must caution the client to avoid which of the following?

A. Eye drops or medications causing pupil constriction B. Alcoholic beverages and grapefruit juice C. Cold remedies and other products containing Tylenol D. Fiber laxatives and other stool softeners

7. An 18-year-old patient calls a physician’s office to request a refill for birth control pills. Which

response by the nurse is best?

A. “The physician must see you at least every 6 months to provide prescription

refills.”

B. “If you’ve been seen by the doctor in the last year, a prescription refill can be

called to your pharmacy.”

C. “All birth control medications require a hand-written prescription, so you will need

to pick this up at the desk at your convenience.”

D. “Are you sexually active?”

8. The nurse is providing care for a client who is taking dulasteride (Avodart) for benign prostatic

hypertrophy (BPH). The client’s prescription reads, “Take daily by mouth.” Thirty pills have been dispensed and the prescription allows for five refills. The nurse anticipates seeing the client again in: A. 1 month B. 3 months C. 6 months D. 1 year Multiple Response Identify one or more choices that best complete the statement or answer the question.

1. The nurse notes a prescription for eletriptan (Relpax) to be taken prn for migraine headaches. What

additional information would the nurse expect to see on the prescription bottle? (Select all that apply.)

A. Picture of the medication B. Drug dosage C. Physician DEA number D. Subscription information E. Client’s name and address F. Pharmacy contact information 2. A 34-year-old patient recovering from a motor vehicle accident is receiving physical therapy. The

client has been prescribed metaxalone (Skelaxin) 800 mg tablet qid. Which of following directions or warning labels would the nurse expect to see on the prescription label? (Select all that apply.)

A. Avoid alcoholic beverages when taking this medication B. Take four times each day C. Take three times a day with meals D. May cause drowsiness or dizziness E. Shake well

Chapter 5. Prescriptions and Labels Answer Section MULTIPLE CHOICE 1. ANS: B PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Antianxiety agents KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Medication Labels/Abbreviations (p. 70): PO means the medication is given orally; prn means it is given as needed/desired; qhs means given at bedtime.

2. ANS: D PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Asthma medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Medication Labels/Abbreviations (p. 70): Bid stands for twice daily. The prescription is written for 2 sprays in each nostril.

3. ANS: C PTS: 1 DIF: Easy TOP: Therapeutic Classification: Alzheimer’s agents KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Medication Labels/Abbreviations (p. 70): Qhs means at bedtime.

4. ANS: A PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Antidiabetic agents KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Medication Labels/Abbreviations (p. 70): Ac means before meals; hs means at bedtime.

5. ANS: B PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Pain medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Manufacturer Labels and Names (p. 73): Over-the-counter drugs also contain labels or instructions on drug use based on age and weight. Infant Tylenol concentration has recently been changed to match the pediatric dosing, but the product is still safely administered to infants and children.

6. ANS: C PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Narcotics KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Manufacturer Labels and Names (p. 73): Over-the-counter medications can interact negatively with prescription drugs. Some cold medications increase the action of sedatives so a person taking both would be sleepier than expected. Percocet is a narcotic. Alcoholic beverages should be avoided but there is no interaction with grapefruit juice. A daily limit of 3 grams of Tylenol is recommended so products containing additional Tylenol should be avoided.

7. ANS: B PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Hormonal therapy KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Medication Labels/Abbreviations (p. 69): A prescriber may refill a prescription without asking to see the patient again, especially if the patient has a chronic condition or is taking birth control pills.

8. ANS: C PTS: 1 DIF: Moderate TOP: Therapeutic Classification: BPH agents KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Inscription (p. 69): The medication is taken daily and an estimated 6-month supply has been provided (current script plus five refills).

MULTIPLE RESPONSE 1. ANS: B, D, E, F PTS: 1 DIF: Hard TOP: Therapeutic Classification: Antimigraine agents KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Medication Labels (p. 71): A pharmacy label will contain the pharmacy contact information, date filled, prescription number, client name, address, prescription directions including drug name, dose, and directions, subscription information including number of pills prescribed and refill information, and the physician’s name and contact information. The DEA number is required on the written, faxed, or phoned-in prescription, but is not necessarily printed on the prescription label. Pictures of the medication can be found in a physician’s desk reference but are not located on the prescription label.

2. ANS: A, B, D PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Muscle relaxants KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Medication Labels/Abbreviations (p. 70–71): Qid means four times each day. Metaxalone is a muscle relaxant that can cause drowsiness; clients should avoid alcoholic beverages. There is no need to shake tablets.

Chapter 6. Basic Review of Mathematics Problem 1. The nurse is caring for a client on peritoneal dialysis. During a dialysis session, 2,000 mL of

dialysate solution was infused and 1850 mL returned. The client consumed 1 cup of coffee, 120 mL of apple juice, and 1 bowl of oatmeal without milk. Calculate the client’s intake in mL. 2. While caring for a client on a 1,700-calorie diet restriction, the nurse notes the client has consumed

415 calories for breakfast. If 300 calories are allotted for beverages and snacks, how many calories remain for the client’s meals?

3. The nurse is caring for a client who takes lisinopril (Zestril) 10 mg tid. Discharge orders include a

prescription for a 30-day supply. How many pills will be in the bottle when the prescription is filled?

4. A young girl is started on 5 mg of paroxetine (Paxil) daily. The pharmacy provides 10-mg tablets.

How much will the nurse provide?

5. The nurse is providing ondansetron (Zofran) 4 mg as an intravenous injection. The pharmacy

provides ondansetron in 8 mg/2 mL vials. How much medication will the nurse draw up? Provide the answer in mL. 6. The nurse is caring for a client placed on a 2,000-calorie diet. If two snacks are responsible for 20%

of the caloric intake, how many calories can be consumed with each snack?

7. While assisting with meal planning for a client placed on an 1,800-calorie diet, the nurse plans for

meals to make up 80% of the calorie consumption and wants to make each meal equivalent. How many calories should the nurse plan for each of three meals?

8. A client consumes 1/2 cup grape juice, 2/3 of a 10 oz bowl of broth, 1/4 of a 4 oz bowl of gelatin,

and 1/3 a carton of milk, which holds 240 mL. Calculate the client’s intake in mL. 9. While working in the pediatric clinic, the nurse receives a call from a client trying to figure out how

much infant acetaminophen (Tylenol) to give to her child. The doctor has prescribed 45 mg every 4 hours. The medication is provided in 60 mg/5 mL concentration. How much medication (in mL) should the client provide per dose? (Round to the nearest mL)

The physician recommends a teenager start taking 600 mg ibuprofen (Advil) tid starting 2 days prior to her menstrual cycle and that she continue the medication for one week. The medication comes in 200-mg strength tablets. How many tablets will the client consume during the week?

10.

Chapter 6. Basic Review of Mathematics Answer Section PROBLEM 1. ANS:

510 mL PTS: 1 DIF: Moderate TOP: Therapeutic Classification: NA KEY: Application MSC: NCLEX Category: Basic Care and Comfort NOT: See Addition Calculations (p. 79–80): The client has 150 mL dialysate solution, 240 mL coffee, 120 mL juice. 150 + 240 + 120 is 510 mL. 2. ANS:

985 calories PTS: 1 DIF: Moderate TOP: Therapeutic Classification: NA KEY: Application MSC: NCLEX Category: Basic Care and Comfort NOT: See Subtraction Calculations (p. 80–81): 1,700 calories allowed each day, minus the calories for breakfast (415) and snacks (300) is written as: 1,700 – 715 and totals 985.

3. ANS:

90 pills PTS: 1 DIF: Easy TOP: Therapeutic Classification: Antihypertensive KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Multiplication Calculations (p. 81): Tid means three times per day, so the client will take 3 pills per day for 30 days (3 x 30), totaling 90 pills.

4. ANS:

1/2 pill PTS: 1 DIF: Easy TOP: Therapeutic Classification: Antidepressants KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Adding Fractions (p. 87): Sometimes a patient is required to take partial tablets. The dose is onehalf (5 divided by 10) the available pill, so 1/2 pill is given.

5. ANS:

1 mL PTS: 1 DIF: Easy TOP: Therapeutic Classification: Antiemetics KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Solving for Unknown (p. 99): The ordered dose is 4 mg. The medication is provided in 8-mg vials.

The dose is half of the available vial (4 divided by 8) so half the vial will be given. Because there are 2 mL in each vial, half the vial is (1/2 multiplied by 2), which equals 1 mL. 6. ANS:

200 calories PTS: 1

DIF: Easy

TOP: Therapeutic Classification: NA

KEY: Application MSC: NCLEX Category: Basic Care and Comfort NOT: See Percentages (p. 95): 20% of 2,000 calories is 400 calories (0.2 x 2000), divided by 2 results in 200 calories per snack.

7. ANS:

480 calories PTS: 1 DIF: Moderate TOP: Therapeutic Classification: NA KEY: Application MSC: NCLEX Category: Basic Care and Comfort NOT: See Percentages (p. 95): 80% of the 1,800 calorie intake is 1,440 calories (0.8 x 1,800). 1,440 is divided equally between three meals (1,440/3) for 480 calories per meal.

8. ANS:

430 mL PTS: 1 DIF: Moderate TOP: Therapeutic Classification: NA KEY: Application MSC: NCLEX Category: Basic Care and Comfort NOT: See Fractions (p. 87): 1/2 cup is 120 mL, 2/3 of 10 oz (300 mL) is 200 mL, 1/4 of 4 oz (120 mL) is 30 mL, 1/3 of 240 mL is 80 mL. 120 + 200 + 30 + 80 is 430.

9. ANS:

4 mL PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Medication Administration KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Fractions (p. 87): 60 mg in 5 mL is equivalent to 12 mg per mL. 45 mg divided by 12 mg/mL is 3.75 mL, which is rounded to 4 mL. 10. ANS:

63 tablets PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Medication Administration KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Multiplication Calculations (p. 81): A 600-mg dose requires 3 pills per dose (600 mg/200 mg per pill). Tid means the client takes three doses per day, which is 9 pills per day (3 pills x 3 doses per day). One week of medication is 7 days x 9 pills per day, or 63 pills total for the week.

Chapter 7. Measurement Systems Completion Complete each statement.

1. The nurse is providing care for a newborn that weighs 8 lb 8 oz. The physician has ordered

medications based on a kg weight. How much does the infant weigh in kg? Round to the nearest whole number.

2. While working in the pediatric clinic, the nurse weighs a 5-year-old child as 20.5 kg. The mother

asks, “How much is that in pounds?” Provide the child’s weight to the nearest whole pound.

3. While removing the dinner tray from a client’s room, the nurse notes the client drank 1 cup of water,

6 oz of beef broth, 4 oz of gelatin, 120 mL of juice and 1 2-oz popsicle. What would the nurse record for intake in mL? 4. While attempting to track the intake of an elderly client, the nurse asks the client to identify what the

client drank that day. The client reports, “I had a small cup of tea, a juice glass full of juice, and 2 cups of milk.” The nurse would record how many oz for this client’s intake?

5. While preparing to dispense a dose of liquid medication for a client with a gastrostomy tube, the

nurse notes the ordered dose is 15 mL. How many cc will the nurse draw into the cath-tipped syringe when dispensing the medication?

6. The physician has ordered a child’s antibiotic dose as 5 mg/kg. The child weighs 14 kg. The

antibiotic is provided in a vial with 10 mg/mL. How many mL of antibiotic will be dispensed?

Round to the nearest whole number.

7. The nurse is mixing diluent with a powdered medication. The package directions instruct the nurse

to mix 3 mL of sterile water to achieve a concentration of 4 mg/mL. The client’s dose is 6 mg. How many mL will the nurse withdraw to provide to the client? Round to the nearest tenth.

8. A client is ordered 25 mg of diphenhydramine (Benadryl) by intramuscular injection. The

medication is supplied in a 1-mL vial with 50 mg dosage. How much will the nurse inject?

9. The nurse is preparing to provide sliding scale insulin coverage to a client with diabetes. The client’s

blood sugar is 240 g/dL. The sliding scale indicates the client should receive 8 units of insulin. The insulin is provided in a multi-dose vial with a concentration of 100 units/10 mL. How many mL of insulin will the nurse provide?

The nurse is caring for a client who is to receive cefoperazone (Cefodbid) 1.5 g in 100 mL normal saline intravenously over 30 minutes. The nurse begins the infusion and a little while later the client calls to report itching so the nurse stops the infusion. The pump reading has recorded 44 mL infused. Approximately how much medication (in mg) did the client receive?

10.

Chapter 7. Measurement Systems Answer Section COMPLETION 1. ANS: 4 kg PTS: 1 DIF: Easy TOP: Therapeutic Classification: Medication Administration KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Measurement System (p. 109): 1 kg equals 2.2 lb; 1 lb equals 0.45 kg; 1 lb equals 16 oz. The infant weights 8 lb, 8 oz. 8oz is one-half pound, so 8.5 lb x 0.45 equals 3.825 or 4 kg.

2. ANS: 45 lb PTS: 1 KEY: Application 3. ANS: 720 mL

DIF: Easy TOP: Therapeutic Classification: NA MSC: NCLEX Category: Pharmacological Therapies

PTS: 1 DIF: Moderate TOP: Therapeutic Classification: NA KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Household System (p. 112): 8 oz equals 1 cup equals 240 mL. 1 cup of water is 240 mL, 6 oz beef broth is 180 mL, 4 oz of gelatin is 120 mL, 120 mL of juice, and 2 oz of popsicle is 60 mL. Add 240 + 180 + 120 + 120 + 30 for a total of 720 mL. 4. ANS: 26 oz PTS: 1 DIF: Easy TOP: Therapeutic Classification: NA KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Household System (p. 110): A teacup is 6 oz, the juice glass is 4 oz, the 2 cups of milk are 16 oz, so 6 + 4 + 16 equals 26 oz.

5. ANS: 15 cc PTS: 1 DIF: Easy TOP: Therapeutic Classification: Medication Administration KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Metric System (p. 112–113): 1 cubic centimeter (cc) equals 1 mL of fluid.

6. ANS: 7 mL PTS: 1 DIF: Easy TOP: Therapeutic Classification: Medication Administration KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Household and Metric System (p. 110, 115): 14 kg multiplied by 5 mg/kg equals 70 mg. 70 mg divided by 10 mg/mL equals 7 mL. 7. ANS: 1.5 mL PTS: 1 DIF: Easy TOP: Therapeutic Classification: Medication Administration KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Metric System (p. 117): The dose of 6 mg is divided by 4 mg/mL for a total of 1.5 mL.

8. ANS: 0.5 mL PTS: 1 DIF: Easy TOP: Therapeutic Classification: Medication Administration KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Metric System (p. 115): The 25-mg dose is one half of the supplied dose, so 0.5 mL will be injected.

9. ANS: 0.8 mL PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Medication Administration KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Metric System (p. 117): 100 units in 10 mL is equivalent to 10 units per mL. The client is to receive 8 units of insulin coverage. 8 units divided by 10 units/mL equals 0.8 mL. 10. ANS: 660 mg PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Medication Administration KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Metric System (p. 117): 1.5 g in 100 mL is equivalent to 1,500 mg in 100 mL or 15 mg in 1 mL. 44 mL of medication has infused. 44 times 15 equals 660 mg.

Chapter 8. Dosage Calculations Multiple Choice Identify the choice that best completes the statement or answers the question.

1. The nurse provides a client with 20 mL of megestrol acetate (Megace 40 mg/mL strength) and the

client reports, “I usually take one teaspoon of the long-acting formulation; are you sure this is the right stuff?” The nurse checks with the pharmacy and learns 5 mL of megestrol extended release (Megace ES 125 mg/mL) is equivalent to 800 mg of Megace. Which response by the nurse is best?

A. “You are right; you should only take 5 mL of this medication.”

B. “The two doses are equal since we don’t carry the long-acting medication.”

C. “You should be taking 20 mL of medication at home as well.”

D. “We will hold the medication at this time and verify the order with the physician.”

2. A client admitted to the hospital with acute renal failure typically takes moexipril (Univasc) for

hypertension. The client’s creatinine clearance is 32 mL/min and the pharmacy recommends a 50% dose reduction for this medication. The client’s typical dose is 7.5 mg. The nurse would expect the physician to order: A. 3.75 mg B. 2.25 mg C. 4.25 mg D. 5.75 mg 3. The nurse is preparing potassium bicarbonate (TriLyte) for a pediatric client scheduled for a

colonoscopy. The directions state to provide the prep at an estimated rate of 25 mL/kg/hr. The child weighs 55 lb. The nurse should encourage the child to drink how much of the solution each hour?

A. 1 cup B. 2 cups C. 2.5 cups D. 4 cups 4. The student nurse is preparing to give a client 20 mEq of potassium chloride (K-LOR). Directions

say to mix the powdered medication with at least 4 oz of juice or water. The instructor would be satisfied with the student’s preparation if the student had which of the following?

A. 80 mL of apple juice B. 120 mL of grape juice C. 2/3 cup of water D. 1 cup of fruit punch 5. While monitoring a client receiving chemotherapy set to infuse over 3 hours, the nurse notes after

the first hour that just over 160 mL of the original 500 mL has infused. Which action by the nurse is best?

A. Alter the pump setting to infuse at 150 mL/hr.

B. Alter the pump setting to infuse at 200 mL/hr to ensure the medication finishes on time.

C. Assure the client the infusion is running appropriately and document current assessment.

D. Instruct the client the infusion will be completed in another 2.5 hours and do not

change the infusion rate.

6. The nurse is caring for a client starting diuretic therapy and is placed on strict intake and output

measurements. In counseling this client to maintain at least 1,500 mL intake per day, which beverages should the nurse instruct the client to avoid?

A. Citrus juices and alcohol B. Coffee, beer, and most soda pop C. Tomato juice, diet drinks, and lemonade D. Electrolyte-based drinks, tea, and artificial sweeteners 7. The nurse is preparing to provide evening medications. It is currently 8 p.m. The nurse will pass

medications scheduled at which military time?

A. 1600 B. 1800 C. 2000 D. 2200 Completion Complete each statement.

1. The nurse is preparing to provide finasteride (Proscar) 5 mg daily in combination with doxazosin

(Cardura) 2 mg daily to a client with benign prostatic hypertrophy. The pharmacy provides the finasteride in a 5-mg tablet and the doxazosin in a 1-mg tablet. How many pills will the nurse provide?

2. While working in the pediatric clinic, the nurse examines the mouth of a 5-year-old patient being

treated for leukemia and notes white patches and scattered ecchymosis. The nurse suspects the child has thrush and expects the physician to order fluconazole (Diflucan). This medication is typically dosed at 3 mg/kg. The child weighs 42 lb. How many mg will be in each dose? (Round to the nearest 10 mg).

3. The nurse is passing morning meds for a client with hypertension taking fosinopril (Monopril) 30

mg. The pharmacy supplies this medication as a 20-mg tablet. How many tablets will the nurse provide?

4. The nurse is preparing to provide losartan (Cozaar) suspension (2.5 mg/mL) for a client whose dose

is 50 mg. How many mL will be provided?

5. The nurse receives orders to start metronidazole (Flagyl) 50 mg/kg/24 hours divided into three equal

doses for a child that weighs 33 lbs. The medication is provided in 250-mg tablets. How many tablets will the nurse provide with each dose?

6. Meloxicam (Mobic) is dispensed in solution with 7.5 mg/5 mL. The physician has ordered 0.125

mg/kg daily for a child with juvenile arthritis who weighs 68 lbs. How many mL will the nurse provide? (Round to the nearest tenth).

7. Trimethoprim and sulfamethoxazole (Septra) suspension contains 200 mg sulfamethaxazole in each

teaspoon. The physician has ordered 2 teaspoons every 12 hours. What is the total daily dose of sulfamethaxazole in mg?

8. The nurse is caring for a 12-year-old patient who, after a kidney transplantation, is to receive

sirolimus (Rapamune). The child weighs 38 kg and has a body surface area of 1.2 m2. The medication has been ordered at a dose of 1 mg/m2/day and is provided by pharmacy in a 60 mg/60 mL-solution mixed in glass bottle for oral provision. How many mL will the nurse provide?

9. A nurse working in the oncology clinic is providing doxorubicin (Adriamycin) 60 mg/m2 to a client

whose body surface area is 1.6 m2. What dose of doxorubicin (in mg) will be sent by the pharmacy?

10. While providing care to a client with advanced neuroblastoma, the nurse is preparing chemotherapy

dosed at 75 mg/m2. The client’s body surface area is 1.8 m2. What dose (in mg) of chemotherapy will be provided?

11. All chemotherapy orders are to be double-checked by two nurses. Orders read, “Cisplatin 20

mg/m2.” The nurse has 100 mg/100 mL vial of cisplatin and the client’s body surface area is 1.4 m2.

How much cisplatin in mL will the nurse draw up for infusion?

12. The drug label of cefpodoxime (Vantin) indicates it should be suspended in 44 mL of distilled water

to create 75 mL with a final concentration of 50 mg/5 mL. The client’s dose is 10 mg/kg/day divided into two equal doses. The client weighs 88 lbs. How much medication in mL will the nurse provide with each dose? (Round to the nearest full mL).

13. An antibiotic is reconstituted with 29 mL distilled water to create 50 mL of solution with a

concentration of 100 mg/5 mL. How much medication in mL would the nurse obtain to provide a dose of 45 mg? (Round to the nearest hundredth).

14. A client has been ordered to receive IM ceftazidime (Ceptaz). The 1 gram vial is to be mixed with 3

mL sterile diluent to create a final solution concentration of 250 mg/mL. The client’s dose is 500 mg.

How many mL will the nurse provide?

15. The nurse is preparing to hang ciprofloxacin (Cipro) IVPB. The medication order is for 400 mg in

100 mL to infuse over 1 hour. What rate (mL/hr) should be set on the IV pump to ensure appropriate drug delivery?

16. The ordered antibiotic is sent from pharmacy in 50 mL of solution. The label says to infuse over 30

minutes. What rate (mL/hr) would be set on the IV pump?

17. The charge nurse is doing client rounds and notes a client is receiving blood at a set rate of 100

mL/hr. The blood transfusion has finished and 500 mL of 0.9% NS is hanging as backup. In order to complete the transfusion, the nurse will flush the tubing by infusing 50 mL of the 0.9% NS over 10 minutes. What rate (mL/hr) should the pump be set to for the 0.9% NS infusion?

18. The nurse is providing levofloxacin (Levaquin) 750 mg over 90 minutes. The antibiotic comes from

pharmacy in a 150-mL solution bag. What rate (mL/hr) should be set on the IV pump to infuse the medication correctly?

19. The nurse is helping to support a medical station during a triathlon. A runner comes to the area with

signs of heatstroke and the nurse is instructed to initiate an infusion of 1 liter D5.45NS over 8 hours.

Macrodrip tubing with a drip factor of 10 gtt/mL is available. What rate (gtts/min) will the nurse use to set the infusion? (Round to the nearest full drop).

20. While training for a disaster drill, the nurse is told to infuse a 500-mL bag of IV fluids over 2 hours

using a microdrip set up. What rate (gtts/min) will be used for this scenario?

21. The hospital has experienced a power outage and is on back-up generator electrical support. The

nursing staff is asked to convert all nonmedication IVs to gravity control. The nurse is caring for a client whose IV fluids are infusing at “keep vein open,” which is defined as 30 mL/hr per hospital policy. Using tubing with a drip factor of 15 gtt/min, what rate (gtt/min) should the nurse use for the client’s IV fluids? (Round to the nearest full drop).

22. The nurse is tallying intake for a client receiving kidney dialysis who is on a 1,200-mL fluid

restriction. The client has had 2 cups of coffee, 1 cup of water, 4 oz gelatin, 1/3 of a 10 oz cup of soup, and half a carton (240 mL) of milk. How much additional fluid in mL can the client consume for the remainder of the day?

23. The nursing instructor is supervising nursing student medication provision at 4 p.m. The client has

the following medications scheduled: 0800—acetazolamide (Diamox), carvedilol (Coreg), and lisinopril (Zestril) 1000—metoclopramide (Regland) prn 1100—polyethylene glycol (Miralax), lovenox (Fragmin) 1400—metoclopramide (Reglan) prn 1600—lisinopril (Zestril) 2000—alpraxolam, metoclopramide (Reglan) prn Which medications will the student nurse provide at this time?

1. Metoclopramide prn 2. Alprazolam and metoclopramide prn 3. Polyethylene glycol and lovenox 4. Lisinopril Matching

The nurse is preparing to reconstitute amphotericin B powder to then instill the ordered dose into a 50-mL bag of IV for piggy back provision. Place the following steps in correct order.

A. Instill sterile water into the vial with sterile powder.

B. Place a filtered needle on a sterile syringe.

C. Shake vigorously.

D. Calculate the client dose to determine the amount of solution to withdraw from the

vial.

E. Inject diluted medication into a 50-mL bag of D5W for infusion.

F. Withdraw desired dose of diluted medication.

G. Place a new sterile needle on the syringe.

1. First 2. Second 3. Third 4. Fourth 5. Fifth 6. Sixth

7.

Seventh

Chapter 8. Dosage Calculations Answer Section MULTIPLE CHOICE 1. ANS: B PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Medication Administration KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Dimensional Analysis (p. 128): 20 mL x 40 mg/mL is 800 mg Megace and is equivalent to 5 mL x 125 mg/mL or 625 mg of Megace ES. Because these two doses are reportedly equivalent and the client typically takes 1 teaspoon (5 mL) each day, the doses are equal and the client should be given the available formulation.

2. ANS: A PTS: 1 DIF: Easy TOP: Therapeutic Classification: Medication Administration KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Fraction Method (p. 131): 7.5 mg should be divided in half for a 50% reduction, resulting in 3.75 mg.

3. ANS: C PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Medication Administration KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Calculating Pediatric Dosages (p. 133): 55 lb x 0.45 is 24.75 kg x 25 mL equals 618.75 mg, which is closest to 2.5 cups (600 mL). Note 1 cup is equal to 240 mL. 4. ANS: B PTS: 1 DIF: Easy TOP: Therapeutic Classification: Medication Administration KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Reconstituting powders (p. 135): 4 oz is equivalent to 120 mL. 5. ANS: C PTS: 1 DIF: Easy TOP: Therapeutic Classification: Medication Administration KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Electronic Regulator Pumps (p. 138): The infusion rate 500 mL/3 hours is 166 mL/hr, so this infusion is running correctly and no changes should be made.

6. ANS: B PTS: 1 DIF: Easy TOP: Therapeutic Classification: NA KEY: Application MSC: NCLEX Category: Basic Care and Comfort NOT: See Calculating Fluid Balance (p. 140): Coffee, caffeinated sodas, and beer have a diuretic effect on the kidneys. These beverages would be avoided for a client starting diuretic therapy to avoid dehydration.

7. ANS: C PTS: 1 DIF: Easy TOP: Therapeutic Classification: Medication Administration KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Military Time (p. 140): Military time for 8 p.m. is 2000.

COMPLETION 1. ANS: 3 pills PTS: 1 DIF: Easy TOP: Therapeutic Classification: Medication Administration KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Formulation Method (p. 126): Dose divided by on hand (D/H) for finasteride is 5 mg/5 mg for one

tablet and 2 mg/1 mg for two tablets of doxazosin for a total of three pills.

2. ANS: 60 mg PTS: 1 DIF: Easy TOP: Therapeutic Classification: Medication Administration KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Dimensional Analysis (p. 128): 42 lb divided by 2.2 lb/kg is 19.0 kg multiplied by 3 mg/kg for 57 mg, which rounds up to 60 mg.

3. ANS: 1.5 tablets PTS: 1 DIF: Easy TOP: Therapeutic Classification: Medication Administration KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Formulation Method (p. 126): D/H—30 mg divided by 20 mg/tablet is 1.5 tablets.

4. ANS: 20 mL PTS: 1 DIF: Easy TOP: Therapeutic Classification: Medication Administration KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Formulation Method (p. 126): D/H—50 mg divided by 2.5 mg/mL is 20 mL. 5. ANS: 1 tablet PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Medication Administration KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Calculating Pediatric Dosages (p. 133): 33 lb x 0.45 kg/lb is 14.85 or 15 kg. 15 kg x 50 mg/kg/day is 750 mg per day, which is divided into 3 equal doses of 250 mg. The medication is provided in 250-mg tablets so one tablet should be given with each dose.

6. ANS: 2.6 mL PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Medication Administration KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Calculating Pediatric Dosages (p. 133): 69 lb x 0.45 lb/kg is 31.05 kg or 31 kg. 31 kg x 0.125 mg/kg is 3.875 mg, divided by 7.5 mg/5 mL is 2.58 mL or 2.6 mL. 7. ANS: 800 mg PTS: 1 DIF: Easy TOP: Therapeutic Classification: Medication Administration KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Calculating Pediatric Dosages (p. 133): 2 teaspoons will contain 400 mg (2 x 200 mg/tsp) and this dose is given twice daily so the total daily dose is 800 mg.

8. ANS: 1.2 mL PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Medication Administration KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Calculations Using Body Surface Area (p. 135): 1.2 m2 x 1 mg/m2/day is 1.2 mg/day. 1.2 mg x 60 mg/60 mL is 1.2 mL per dose.

9. ANS: 96 mg PTS: 1 DIF: Easy TOP: Therapeutic Classification: Medication Administration KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Calculation Using Body Surface Area (p. 135): 1.6 m2 x 60 mg/m2 is 96 mg.

10. ANS: 135 mg

PTS: 1 DIF: Easy TOP: Therapeutic Classification: Medication Administration KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Calculation Using Body Surface Area (p. 135): 75 mg/m2 x 1.8 m2 is 135 mg.

11. ANS: 28 mL PTS: 1 DIF: Easy TOP: Therapeutic Classification: Medication Administration KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Calculation Using Body Surface Area (p. 135): 1.4 m2 x 20 mg/m2 is 28 mg. 28 mg x 100 mL/ 100 mg is 28 mL for infusion.

12. ANS: 20 mL PTS: 1 DIF: Hard TOP: Therapeutic Classification: Medication Administration KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Reconstituting Powders (p. 135): 88 lbs divided by 2.2 lb/kg is 40 kg. A dose is 10 mg/kg/day x 40 kg, which equals 400 mg. Divide that into two equal doses for 200 mg per dose. The concentration is 50 mg/5 mL, so the D/H is (200 mg/50 mg) x 5 mL, which equals 20 mL. 13. ANS: 2.25 mL PTS: 1 DIF: Easy TOP: Therapeutic Classification: Medication Administration KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Reconstituting Powders (p. 135): The D/H is 45 mg/100 mg x 5 mL for a total of 2.25 mL. 14. ANS: 2 mL PTS: 1 DIF: Easy TOP: Therapeutic Classification: Medication Administration KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Reconstituting Powder (p. 135): The D/H ratio is 500 mg/250 mg x 1 mL is 2 mL. 15. ANS: 100 mL/hr PTS: 1 DIF: Easy TOP: Therapeutic Classification: Medication Administration KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Electronic Regulator Pumps (p. 138). 100 mL of medication should infuse over 1 hour so the rate is 100 mL/hr.

16. ANS: 100 mL/hr PTS: 1 DIF: Easy TOP: Therapeutic Classification: Medication Administration KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Electronic Regulator Pumps (p. 138): 50 mL of medication will infuse over 0.5 hr, so 50/0.5 is 100 mL/hr.

17. ANS: 300 mL/hr PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Medication Administration KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Electronic Regulator Pumps (p. 138): The nurse will infuse 50 mL in 10 minutes. 50 mL divided by 10 min and then multiplied by 60 min/hr to convert to a mL/hr rate is 300 mL/hr.

18. ANS: 100 mL/hr PTS: 1 DIF: Easy TOP: Therapeutic Classification: Medication Administration KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Electronic Regulator Pumps (p. 138): 150 mL divided by 90 minutes then multiplied by 60

minutes/hour is 100 mL/hr.

19. ANS: 21 gtts/min PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Medication Administration KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Manual IV Sets (p. 139): 1,000 mL divided by 480 min (8 hr x 60 min/hr) multiplied by the drip factor of 10 gtt/min is 20.8 or 21 gtts/min.

20. ANS: 250 gtt/min PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Medication Administration KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Manual IV Sets (p. 139): The microdrip factor is 60 gtt/mL. Volume 500 mL divided by time in min, 120, multiplied by drop factor 60 gtt/min is 250 gtt/min.

21. ANS: 8 gtt/min PTS: 1 DIF: Easy TOP: Therapeutic Classification: Medication Administration KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Manual IV Sets (p. 139): Volume, 30 mL, divided by time, 60 min, multiplied by the drip factor 15 gtt/min is 7.5 gtt/min, which rounds up to 8 gtt/min.

22. ANS: 140 mL PTS: 1 DIF: Moderate TOP: Therapeutic Classification: NA KEY: Application MSC: NCLEX Category: Basic Care and Comfort NOT: See Calculating Fluid Balance (p. 140): Adding total intake in mL: 480 mL coffee, 240 mL water, 120 mL gelatin, 100 mL of soup, 120 mL milk is 1060 mL. That total subtracted from the daily limit of 1200 mL is 140 mL remaining.

23. ANS: 4 PTS: 1 DIF: Easy TOP: Therapeutic Classification: Medication Administration KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Military Time (p. 140): Military time for 4 p.m. is 1600, so only the Lisinopril is due at this time.

MATCHING 1. ANS: A PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Medication Administration KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Reconstituting Powders (p. 135): The amount of diluent is used to reconstitute powder to a final solution. Think carefully about the steps involved and place them in sequential order.

2. ANS: C PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Medication Administration KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Reconstituting Powders (p. 135): The amount of diluent is used to reconstitute powder to a final solution. Think carefully about the steps involved and place them in sequential order.

3. ANS: D PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Medication Administration KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Reconstituting Powders (p. 135): The amount of diluent is used to reconstitute powder to a final solution. Think carefully about the steps involved and place them in sequential order.

4. ANS: B PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Medication Administration KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Reconstituting Powders (p. 135): The amount of diluent is used to reconstitute powder to a final solution. Think carefully about the steps involved and place them in sequential order.

5. ANS: F PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Medication Administration KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Reconstituting Powders (p. 135): The amount of diluent is used to reconstitute powder to a final solution. Think carefully about the steps involved and place them in sequential order.

6. ANS: G PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Medication Administration KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Reconstituting Powders (p. 135): The amount of diluent is used to reconstitute powder to a final solution. Think carefully about the steps involved and place them in sequential order.

7. ANS: E PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Medication Administration KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Reconstituting Powders (p. 135): The amount of diluent is used to reconstitute powder to a final solution. Think carefully about the steps involved and place them in sequential order.

Chapter 9. Enteral Medications and Administration Multiple Choice Identify the choice that best completes the statement or answers the question.

1. The nursing instructor is supervising medication administration for a client prescribed prednisone

(Deltasone). The instructor would intervene if which of the following were observed?

A. The student provided the medication with a glass of water.

B. The student verified the client’s name and birth date prior to opening the med

package.

C. The student checked the available dosage of medication against the order.

D. The student identified side effects of the medication.

2. The nurse is preparing to provide medications to a client who recently had a stroke and has right-

sided weakness. The previous nurse reported the client is able to take pills if they are crushed and placed in applesauce. Which of the following should the nurse plan to crush? (Select all that apply.)

A. Enteric-coated aspirin tablet B. Robitussin cough syrup C. Adderall XR capsule D. Extended-release morphine E. Acetaminophen (Tylenol) tablet 3. The nurse provides teaching for the mother of a 10-year-old patient who will begin taking Adderall

XR. Which statement would the nurse include in the teaching?

A. “Your child will need to take this medication at even intervals throughout the day.”

B. “This medication is very helpful for children who have problems with bed wetting.”

C. “If your child has trouble with pills, you can crush this and add it to pudding.”

D. “This medication is designed to be released into the bloodstream all day long.”

4. A student nurse asks a friend in the program, “What does it mean when a medication is buffered?”

Which response by the friend is best?

A. “Buffered medications have been dissolved in oils or fats.”

B. “That means the medication has added antacids to reduce stomach upset.”

C. “Buffering extends the metabolism of the drug so it stays in the system longer.”

D. “You can’t crush a tablet if it is buffered because it has a special coating.”

5. A nurse finds a bottle of cough medicine elixir opened on the bathroom sink and realizes it was left

there in the middle of the night when the nurse’s spouse was up. What action by the nurse is best?

A. Determine how much elixir was taken.

B. Recap the bottle of medication and place it back in the medicine cabinet.

C. Discard any remaining medication.

D. Insist the spouse be more responsible in the future.

6. The nurse must shake which of the following prior to provision?

A. Emulsion B. Elixir C. Suspension

D. Solution 7. The nurse is preparing liquid acetaminophen (Tylenol). The recommended dose is 30 ml, which will

be provided via the client’s gastrostomy tube through which the client is currently receiving tube feeding. Which action by the nurse is best?

A. Measure the liquid in a medicine cup with the meniscus at the 30 ml mark, disconnect the tube feeding, aspirate stomach contents, flush with water, instill the Tylenol, flush with water, reconnect the tube feeding B. Measure the liquid in a medicine cup with the bottom of the fluid at the 30 ml mark, disconnect the tube feeding, aspirate stomach contents, instill the Tylenol, flush with water, re-connect the tube feeding C. Measure the medication with a tablespoon, disconnect the tube feeding, flush with water, instill the Tylenol, flush with water, reconnect the tube feeding D. Measure the liquid with a syringe, disconnect the tube feeding, aspirate stomach contents, instill the Tylenol, reconnect the tube feeding 8. The nurse notes, “Antifungal troches to buccal mucosa TID” as a new client order. The nurse

explains to the client that this medication will be delivered: A. As a capsule inserted rectally B. As a liquid under the tongue C. As a pill to be swallowed D. As a lozenge to be held in the cheek Multiple Response Identify one or more choices that best complete the statement or answer the question.

1. Which of the following medications should not be used for a client with diabetes? (Select all that

apply).

A. Emulsions B. Elixirs C. Magmas D. Solutions E. Suspensions F. Syrups Matching

The nurse is preparing to give half a tablet of diuretic to a client. Place the following steps in order.

A. Place scored medication in a scoring device and cut smoothly.

B. Explain the planned procedure to the client.

C. Place dose of medication in a medication cup.

D. Obtain medication, med cup, water, and the client chart.

E. Give the client the medication with a glass of water.

1. First 2. Second

3. Third 4. Fourth

5.

Fifth

Chapter 9. Enteral Medications and Administration Answer Section MULTIPLE CHOICE 1. ANS: A PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Medication Administration KEY: Analysis MSC: NCLEX Category: Pharmacological Therapies NOT: See Enteral Medications (p. 150): Certain medications are very irritating to the gastric mucosa and must be given with a glass of milk or food. Steroid medications cause gastric irritation and should be taken with food.

2. ANS: E PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Medication Administration KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Enteral Medications (p. 150): Enteric-coated tablets and time-released capsules should not be crushed. Syrups are medications dissolved in highly sweetened liquids. Adderall XR is an extended-release capsule.

3. ANS: D PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Medication Administration KEY: Analysis MSC: NCLEX Category: Pharmacological Therapies NOT: See Enteral Medications (p. 150): Adderall XR is an extended-release capsule used to treat attention deficit disorder. Extended-release capsules release medication throughout the day and should not be crushed.

4. ANS: B PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Medication Administration KEY: Analysis MSC: NCLEX Category: Pharmacological Therapies NOT: See Enteral Medications (p. 150): Buffered tablets have added antacids to prevent stomach irritation.

5. ANS: C PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Medication Administration KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Enteral Medications (p. 153): Elixirs must be kept tightly capped to prevent evaporation of the alcohol because this would change the concentration of the medication in the elixir and dosing errors could occur.

6. ANS: C PTS: 1 DIF: Easy TOP: Therapeutic Classification: Medication Administration KEY: Knowledge MSC: NCLEX Category: Pharmacological Therapies NOT: See Enteral Medications (p. 153): Suspensions are medications dispersed in a liquid but because the medication may not have been evenly distributed, it must be shaken before it is administered.

7. ANS: A PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Medication Administration KEY: Analysis MSC: NCLEX Category: Pharmacological Therapies NOT: See Enteral Medications (p. 154): The top of the fluid (meniscus) should be at the calibration line, stomach contents should be aspirated to verify tube placement, then a syringe is used to flush the tube with NSS, the medication is provided, flush with NSS, then reconnect the tube feeding.

8. ANS: D PTS: 1 DIF: Easy TOP: Therapeutic Classification: Medication Administration KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Enteral Medications (p. 155): The buccal pouch, or cheek, is a good route for applying medication in the mouth. Troches (a lozenge) can be held in the cheek to melt slowly over time.

MULTIPLE RESPONSE 1. ANS: B, F PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Medication Administration KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Enteral Medications (p. 153): Elixirs should not be given to children or to anyone suffering from diabetes. Syrups are medications added to highly sweetened liquids and thus are not appropriate for diabetics.

MATCHING 1. ANS: D PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Medication Administration KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Procedure Box 9.1 (p. 152): Observe the 7 rights of medication administration: Wash hands, Verify the order, Assemble needed equipment, Identify the patient and explain the procedure, Tap the medication into the cap and transfer to a scoring device if it needs to be cut in half, Place solid medication dose in medication cup, Give the medication to the client with a glass of water.

2. ANS: B PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Medication Administration KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Procedure Box 9.1 (p. 152): Observe the 7 rights of medication administration: Wash hands, Verify the order, Assemble needed equipment, Identify the patient and explain the procedure, Tap the medication into the cap and transfer to a scoring device if it needs to be cut in half, Place solid medication dose in medication cup, Give the medication to the client with a glass of water.

3. ANS: A PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Medication Administration KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Procedure Box 9.1 (p. 152): Observe the 7 rights of medication administration: Wash hands, Verify the order, Assemble needed equipment, Identify the patient and explain the procedure, Tap the medication into the cap and transfer to a scoring device if it needs to be cut in half, Place solid medication dose in medication cup, Give the medication to the client with a glass of water.

4. ANS: C PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Medication Administration KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Procedure Box 9.1 (p. 152): Observe the 7 rights of medication administration: Wash hands, Verify the order, Assemble needed equipment, Identify the patient and explain the procedure, Tap the medication into the cap and transfer to a scoring device if it needs to be cut in half, Place solid medication dose in medication cup, Give the medication to the client with a glass of water.

5. ANS: E PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Medication Administration KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Procedure Box 9.1 (p. 152): Observe the 7 rights of medication administration: Wash hands, Verify the order, Assemble needed equipment, Identify the patient and explain the procedure, Tap the medication into the cap and transfer to a scoring device if it needs to be cut in half, Place solid medication dose in medication cup, Give the medication to the client with a glass of water.

Chapter 10. Parental Medications and Administration Multiple Choice Identify the choice that best completes the statement or answers the question.

1. The nurse is applying hydrocortisone cream to a client’s rash. Which statement would be included in

the nurse’s instructions to the client?

A. “This medication increases blood flow to the skin and helps reduce pain.”

B. “This will be absorbed through the skin to help reduce the itch.”

C. “Since this is water-based it may leave a greasy feeling to your skin.”

D. “Be sure to shake this well and apply it with a cotton ball.”

2. The instructor is supervising medication administration in a home setting. Which action would

require an intervention?

A. The student wears gloves to remove a Nicoderm patch.

B. The student removes a patch from the left arm and places a new patch on the right

arm.

C. The student folds the old patch in half and discards it in the trash can.

D. The student places the patch on an area of skin that has minimal hair.

3. While teaching a client who is to begin ophthalmic ointment and drops bid, the nurse would instruct

the client to place the ointment: A. Along the inner aspect of the lower eyelid B. In the eye before putting in the drops C. Along the lash line with a cotton swab D. In a circular motion along the both lids 4. When providing ear drops for an 81-year-old patient to help soften the cerumen, which action by the

nurse is best?

A. Have the client lean his head back while sitting upright in a chair.

B. Pull the pinna up and back to straighten the ear canal.

C. Rotate the bottle gently between the hands after removing from the refrigerator.

D. Observe the seven “rights” of proper medication administration.

5. The nurse initiates therapy with normal saline nasal spray 2 sprays per nostril qid. Prior to

administration, the best action by the nurse is: A. Have the client tilt the head forward and down toward the chin B. Determine which nostril is most patent C. Verify the dosage on the multi-dose vial D. Have the client blow his or her nose 6. When preparing to provide medication to a child with asthma using a spacing chamber, the nurse

will utilize which mode of delivery?

A. Metered dose inhaler B. Nebulizer C. Continuous positive pressure machine D. Mask

7. Which of the following clients is most likely to benefit from a CPAP machine?

A. A 52-year-old client with asthma B. An 84-year-old client with chronic obstructive pulmonary disease (COPD) C. A 66-year-old client with chronic bronchitis D. A 48-year-old client with obstructive sleep apnea 8. While working with the parents of a child newly diagnosed with cystic fibrosis, the nurse prepares to

teach them how to use which type of equipment?

A. Syringe and subcutaneous needle B. Nebulizer C. Nasal dropper D. Nasogastric suction 9. A nurse working at the health clinic is administering tuberculosis tests. The test is will need to be

repeated if which of the following is noted?

A. A wheal is seen at the site of injection.

B. The needle is inserted at a 15-degree angle.

C. The nurse notes a tiny amount of blood when removing the needle.

D. Some of the medication leaks after completion of the injection.

10. When preparing to provide an IM injection at the ventrogluteal site, the nurse would identify which

landmarks?

A. Greater trochanter, anterior iliac spine, and iliac crest B. Acromial process, scapula, and humerus C. Greater trochanter of the femur and lateral femoral condyle D. Iliac crest and gluteus minimum muscle 11. The student is asked to demonstrate the Z-track method of IM injection in a lab model. Which action

would cause the instructor to intervene?

A. Student preps the dorsogluteal site.

B. The student pulls the skin laterally 1/2 inch from the injection site.

C. The student uses a dart-like motion for needle insertion.

D. The student waits 10 seconds before removing the needle.

12. The nurse is instructing a client diagnosed with diabetes on self-injection technique for insulin.

Which angle of insertion will the nurse teach the client?

A. 15 degrees B. 30 degrees C. 45 degrees D. 90 degrees 13. While preparing a client with diabetes for discharge, the nurse recognizes teaching has been effective

by which of the following statements?

A. “I will recap the needles before discarding them into the trash can.”

B. “I will rotate sites along my thighs and across my abdomen.”

C. “I will pull the skin taunt before injecting the needle.”

D. “I will insert the needle at a 30-degree angle.”

14. The nurse is caring for a client with early symptoms of shock. The physician has ordered a unit of

blood. The nurse will hang this using Y-tubing and which solution?

A. D5W B. Lactated ringers C. D5/0.45NS D. 0.9% NS 15. The nurse is attempting to flush an IV catheter without success. The site has no redness, swelling, or

pain. The nurse determines the difficulty is most likely due to which of the following?

A. Air emboli B. Infiltration C. Phlebitis D. Thrombus 16. A client turns on their call light and reports his IV site is painful and seems to be leaking. Which

action by the nurse is best?

A. Assess the site for any local tissue damage and remove the IV. B. Attempt to flush the IV site with 3 ml of NS. C. Elevate the client’s arm on a pillow and re-secure the dressing.

D. Place a tourniquet above the insertion site and cleanse the area with alcohol prep.

17. Which action by the nurse will help reduce the risk of air emboli for a client receiving intravenous

therapy?

A. Maintain sterility when spiking a new IV bag.

B. Use the flow regulator to adjust the rate of the IV fluid.

C. Make sure all tubing and ports are sufficiently filled when priming the tubing.

D. Wear gloves when starting the IV site.

18. The student nurse is preparing to provide a flu vaccine to an 18-year-old client. The medication is

provided by pharmacy in a vial containing 0.5 ml of medication. Which syringe should the student select?

A. A 100-unit insulin syringe B. A 5-ml standard syringe C. A 3-ml hypodermic syringe D. A 1-ml tuberculin syringe Multiple Response Identify one or more choices that best complete the statement or answer the question.

1. Which of the following are considered parenteral routes of medication administration? (Select all

that apply.)

A. Intramuscular B. Transdermal C. Otic D. Buccal E. Nasal F. Sublingual

2. The student nurse is providing ophthalmic medication in drop form to a 5-year-old child. Select the

appropriate actions to be taken. (Select all that apply.)

A. Pull the pinna of the ear down and back.

B. Have the child keep the affected ear up for a few minutes.

C. Encourage the child to apply light pressure to the inner part of the closed eyelid

after

instillation.

D. Wash hands and don gloves.

E. Identify the client and explain what the student will be doing.

F. Drop the medication into the affected eye while the client is looking toward the

midline.

3. Which of the following sites are recommended for intradermal injections? (Select all that apply.)

A. Forearm B. Ventrogluteal area C. Upper back D. Abdomen E. Outer thigh 4. The nurse is preparing to start an IV infusion for an adult client newly admitted with pneumonia who

will receive intravenous antibiotics. Which action will the nurse take? (Select all that apply.)

A. Use a winged IV needle for insertion.

B. Select a 20-gauge angiocath.

C. Place the tourniquet 1.5 inches above the intended insertion site.

D. Stretch the skin approximately 1 inch from the insertion site.

E. Use the drip chamber to initiate the infusion.

F. Secure the site with an occlusive waterproof dressing.

5. The nurse is providing a standard intramuscular injection of antibiotic for an adult. The ordered dose

is 1 gm. The medication is provided in a vial that is reconstituted to 1 gm/2 ml. Which actions should the nurse take? (Select all that apply.)

A. Select and prep a site for injection in the deltoid muscle.

B. Insert the needle at a 90-degree angle.

C. Use the Z-track method for injection into fatty tissue.

D. Cleanse the upper outer area of the client’s thigh.

E. Use a 1-inch 21-gauge needle.

F. Inject the medication slowly.

6. Which of the following may contribute to the development of phlebitis? (Select all that apply.)

A. Sterility is maintained when the IV bag is spiked.

B. The flow regulator is set to a rate of 125 ml/hr.

C. The medication being infused is irritating to the vein.

D. The vein being used is very small.

E. The site is cleansed with a disinfecting swab using a circular motion.

Matching

The nurse is preparing to provide a medication that comes from pharmacy in an ampule. Place the following steps in correct order.

A. Draw up the fluid with a filtered needle.

B. Verify the dose and desired amount to be withdrawn.

C. Change the needle to inject the solution into the client.

D. Place a gauze around the neck of the container.

1. First 2. Second 3. Third

4.

Fourth

Chapter 10. Parental Medications and Administration Answer Section MULTIPLE CHOICE 1. ANS: B PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Medication Administration KEY: Analysis MSC: NCLEX Category: Pharmacological Therapies NOT: See Topical Medications and Administration (p. 162): Hydrocortisone cream is issued for itchy skin patches. Lotions are similar to creams in that they are water-based and less greasy; they are painted on to allow medication to stay on the target area and not absorb into the skin—an example is calamine lotion, which must be shaken and applied with a cotton ball. The directions involve a cream, so there is no need to shake or paint this medication.

2. ANS: C PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Medication Administration KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Solid Preparations (p. 163): If patches are not disposed of properly, pets or small children finding the patches in the garbage may be exposed to the medication and become very sick. Wear gloves so the medication from the patch does not enter your body. Rotate sites to reduce the risk of skin irritation. Apply the transdermal patch to an appropriate location on the body—excess hair will make it difficult for the patch to stick and painful to remove.

3. ANS: A PTS: 1 DIF: Easy TOP: Therapeutic Classification: Medication Administration KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Ophthalmic Medication and Administration (p. 165) Procedure Box 10.2: Apply ointment by placing a line of ointment on the inner aspect of the lower eyelid; use drops before ointment if both are ordered.

4. ANS: B PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Medication Administration KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Otic Medications and Administration Procedure Box 10.3 (p. 166): Pull the pinna up and back for adults. Have the client place his or her head on a counter or lie down on an examination table with the affected ear up. Make sure the medication is at room temperature, not cold. Observe the seven rights of medication administration.

5. ANS: D PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Medication Administration KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Nasal Route of Medication Administration/Procedure Box 10.5 (p. 168): Have the client blow the nose before giving nasal drops because this clears the mucosa for maximum absorption. Ask the client to tilt his or her head backward. The medication is ordered for both nostrils so patency is not a priority. You never use nasal sprays for more than one patient.

6. ANS: A PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Medication Administration KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Inhaled Medications and Administration (p. 170): Metered dose inhalers are used with or without a spacer.

7. ANS: D PTS: 1 DIF: Moderate TOP: Therapeutic Classification: NA KEY: Analysis MSC: NCLEX Category: Pharmacological Therapies

8.

9.

10.

11.

12.

13.

14.

15.

16.

NOT: See Nebulizers (p. 172): A CPAP machine is ideal for patients with sleep apnea, in which the patient stops breathing for short periods of time while asleep.

ANS: B PTS: 1 DIF: Moderate TOP: Therapeutic Classification: NA KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Nebulizers (p. 171): Patients with cystic fibrosis also use this treatment method to deliver medication to break up the abnormally thick secretions in their lungs.

ANS: D PTS: 1 DIF: Easy TOP: Therapeutic Classification: Medication Administration KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Injectable Medications (p. 173): If some of the medication leaks or a wheal does not form, you will have to repeat the test. Intradermal injections are given with the needle at a 10 to 15-degree angle.

ANS: A PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Medication Administration KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Figure 10-10 (p. 176–177): Ventrogluteal injection site is identified by placing the heel of the hand on the greater trochanter with the thumb pointing toward the client’s naval, the index finger on the anterior iliac spine and the middle finger spread out as far as possible to the iliac crest.

ANS: B PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Medication Administration KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Procedure Box 10.10 (p. 179): Pull the skin laterally 1.5 inches from the injection site. A large muscle site is appropriate, dart-like motion should be used for needle insertion and waiting 10 seconds after injection prior to removing the needle is correct with Z-track method.

ANS: C PTS: 1 DIF: Easy TOP: Therapeutic Classification: Medication Administration KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Procedure Box 10.00 (p. 181): The needle is injected at a 45-degree angle for a subcutaneous injection.

ANS: B PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Medication Administration KEY: Analysis MSC: NCLEX Category: Pharmacological Therapies NOT: See Subcutaneous Injections (p. 180–181): Site rotation is important to prevent complications. The client generally uses the abdomen and thighs since other potential sites are difficult to reach for self-injection.

Needles should not be recapped. The skin is gently pinched or bunched before injection. The needle is inserted at a 45-degree angle.

ANS: D PTS: 1 DIF: Easy TOP: Therapeutic Classification: Medication Administration KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Intravenous Medications (p. 184): NSS is hung like a Y with the blood.

ANS: D PTS: 1 DIF: Easy TOP: Therapeutic Classification: NA KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Intravenous Setup (p. 195): Thormbus is a blood clot that could block the ability to flush a line.

Infiltration occurs when the catheter is displaced and allows IV fluids to leak into surrounding tissue. Phlebitis is an inflammation of the vein and will cause swelling, redness, or warmth. Air emboli occur if air enters the vein.

ANS: A PTS: 1 DIF: Moderate TOP: Therapeutic Classification: NA KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Complications of IV Therapy (p. 195): The symptoms are indicative of infiltration, which allows IV fluids and medications to leak into surrounding tissue, which can cause varying degrees of discomfort and even permanent damage.

17. ANS: C PTS: 1 DIF: Easy TOP: Therapeutic Classification: NA KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Complications of IV Therapy (p. 195): Air emboli occur if air enters the vein. All air should be purged from the IV tubing before securing it to the client.

18. ANS: C PTS: 1 DIF: Easy TOP: Therapeutic Classification: Medication Administration KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Needles and Syringes (p. 190): A standard or hypodermic syringe is available in sizes ranging from 3 to 60 ml. Syringes holding 3 ml are calibrated in 0.1-ml increments; larger syringes are calibrated in 0.2-ml increments. Insulin syringes are only used for insulin. Tuberculin syringes are used for newborns and children or for TB testing. Because the injection is 0.5 ml, the 3 ml syringe is preferable to the 5-ml syringe.

MULTIPLE RESPONSE 1. ANS: A, B, C, E PTS: 1 DIF: Easy TOP: Therapeutic Classification: Medication Administration KEY: Knowledge MSC: NCLEX Category: Pharmacological Therapies NOT: See Parenteral Medications (p. 161): The parenteral routes include transdermal or topical, nasal, inhaled, ophthalmic, otic, vaginal, and types of injections including intramuscular, subcutaneous, intradermal and intravenous. Buccal and sublingual medications involve use of the gastrointestinal tract and are considered enteral routes of medication administration.

2. ANS: C, D, E PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Medication Administration KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Ophthalmic Medications and Administration (p. 165): Ophthalmic medications are placed in the eye. Wash hands and don gloves, identify the client and explain the procedure, ask the client to look upward.

Drop the medication into the affected eye.

3. ANS: A, C PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Medication Administration KEY: Knowledge MSC: NCLEX Category: Pharmacological Therapies NOT: Types of Injectable Medications Figure 10.8 (p. 173): The forearm and upper back are used for intradermal injections.

4. ANS: B, D, F PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Medication Administration KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Procedure Box 10.13 (p. 194): An angiocath would be selected for longer term use over a winged IV. The tourniquet is placed 6 to 8 inches above the intended site. Skin is stretched 1 inch from the insertion site. The flow regulator is used to initiate and alter the rate of infusion. The site is secured using occlusive waterproof dressing.

5. ANS: B, E, F PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Medication Administration KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Intramuscular and Needles and Syringes (p. 175, 186): This IM injection is larger than 2 ml and should be given in the dorsogluteal or ventrogluteal location for an adult since 1 ml is the maximum volume given in the deltoid. IM injections are given at a 90-degree angle. Z-track is used with IM injection into muscle tissue not fatty tissue. Longer needles are used for adults so 1-inch 21-gauge is appropriate.

Medication should be injected gently and slowly to reduce pain.

6. ANS: C, D PTS: 1 DIF: Moderate TOP: Therapeutic Classification: NA KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Intravenous Setup (p. 191–195): Phlebitis is inflammation of the vein and can be caused by

irritating drugs, a vein that is too small for the volume being infused, solution pH, or needle/catheter trauma.

MATCHING 1. ANS: B PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Medication Administration KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Injectable Medication Supplies (p. 184): An ampule is a small glass container. Verify drug dosage before drawing up the medication. Break the ampule by placing a gauze around the neck of the container. It is best to draw up the medication with a filtered needle and then change the needle to inject the solution into the client.

2. ANS: D PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Medication Administration KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Injectable Medication Supplies (p. 184): An ampule is a small glass container. Verify drug dosage before drawing up the medication. Break the ampule by placing a gauze around the neck of the container. It is best to draw up the medication with a filtered needle and then change the needle to inject the solution into the client.

3. ANS: A PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Medication Administration KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Injectable Medication Supplies (p. 184): An ampule is a small glass container. Verify drug dosage before drawing up the medication. Break the ampule by placing a gauze around the neck of the container. It is best to draw up the medication with a filtered needle and then change the needle to inject the solution into the client.

4. ANS: C PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Medication Administration KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Injectable Medication Supplies (p. 184): An ampule is a small glass container. Verify drug dosage before drawing up the medication. Break the ampule by placing a gauze around the neck of the container. It is best to draw up the medication with a filtered needle and then change the needle to inject the solution into the client.

Chapter 11. Integumentary System Medications Multiple Choice Identify the choice that best completes the statement or answers the question.

1. While working in a dermatologist’s office, the nurse welcomes a new client who is 15 years old. The

client has notable facial acne and a quick examination reveals scattered areas of keratinization and multiple pustules and comedos across the client’s shoulders and back. The nurse anticipates which of the following medications will be recommended?

A. Lindane (Rid-X) B. Salicylic acid (Stri-Dex) C. Anthralin (Psoriatec) D. Etanercept (Enbrel) 2. A nurse’s teenage daughter tearfully states, “I keep getting pimples on my face even though I wash it

every day and I’m not eating any chips or cookies. What can I do?” While looking at over-thecounter treatment options, what common ingredient will the nurse most likely find in topical creams and lotions?

A. Hydrocortisone B. Lidocaine C. Clotrimazole D. Benzoyl peroxide 3. The nurse is admitting a 22-year-old client to the hospital with suspected fractures of the right arm

after a bicycle accident. The client reports taking Vitamin A daily. Which of the following would the nurse expect to see during the physical examination?

A. Flushed nose and cheeks B. Oral fever blisters C. Dry patchy reddened areas on the hands and elbows D. Genital warts 4. While playing at the park with her children, the nurse notes a toddler who has honey-colored crusts

and open areas on the lips and nose. Which of the following actions should the nurse take first?

A. No action is required as the child is exhibiting symptoms of a common cold and medications will not alter the child’s symptoms.

B. Ask the child’s parent if the child has food allergies and suggest the use of an antihistamine.

C. Inform the child’s parent the child may have a common bacterial infection and should be seen by a physician for topical or systemic antibiotics.

D. Suggest the child’s parent seek treatment for suspected thrush with an oral antifungal agent.

5. A nurse working for a family practice physician sees a 48-year-old client who reports severe itching

of his hands and under arms. Examination reveals redness and irritation in the webbing of both hands and axillae. The physician orders permethrin (Elimite) cream, a scabicide. The nurse recognizes treatment has been effective by which of the following statements?

A. “I can’t believe I have lice. I wonder if I got it from my niece.”

B. “So applying this cream between my fingers and arm pits will kill the mites and

eggs.”

C. “I will need to use a fine-tooth comb to go through my hair daily for the next full

week.”

D. “Scabies only live on top of the skin, so the itch should disappear within a day.”

6. A nursing instructor informs a nursing student that the assigned client has been prescribed a

pediculicide medication. The student recognizes the client has been diagnosed with which of the following?

A. Lice B. Psoriasis C. Impetigo D. Malignant melanoma 7. The nurse is providing instructions for a client newly that will begin taking docosanol 10% (Abreva)

for HSV-1 infection. Which of the following instructions indicates further teaching is necessary?

A. “Side effects of this medication could be headache or nasal congestion.”

B. “I should apply this medication once daily.”

C. “I don’t need a prescription for this medication.”

D. “The medication helps shorten how long I’ll have symptoms because it blocks the

spread of the virus.”

8. A nurse working in the gynecology office is asked to assist in the treatment of a client with

condylomas. Which of the following actions should the nurse take?

A. Prepare the client for full-body phototherapy.

B. Ask the client if there are any known allergies to iodine.

C. Make a list of the client’s sexual partners for the past 3 weeks.

D. Assist the client to remove their clothing below the waist.

9. While performing a skin assessment for a newly admitted 82-year-old patient, the nurse notes the

client has reddened, peeling areas between his toes and around the soles of his feet. Which of the following medications would the nurse request?

A. Nystatin B. Lidocaine C. Clotrimazole D. Calcipotriene 10. Ultraviolet therapy will be most helpful for which of the following clients?

A. A 41-year-old with psoriasis B. A 55-year-old with squamous cell carcinoma C. A 15-year-old with atopic dermatitis D. A 28-year-old with basal cell carcinoma 11. Family members at a reunion on the beach return from a long walk with sunburn on their shoulders

and feet. Which of the following recommendations will the nurse make?

A. “Apply hydrocortisone cream to the area to reduce swelling.”

B. “Soak your feet in cool water and apply cold cloths to your shoulders for 20

minutes, then apply aloe vera ointment.”

C. “Take oral antihistamines to help reduce the chance of blistering.”

D. “Apply butter to the area to stop the burn.”

12. The nurse is caring for a client with extensive third-degree burns scattered across the left leg and hip.

Orders for chemical debridement using collagenase (Santyl) are noted. The nurse will take which of the following actions?

A. Apply the collagenase to the pink, open-areas within the burned area.

B. Apply the collagenase to the blackened, dead tissue within the burned area.

C. Work the collagenase into sterile 4  4 dressings and apply these uniformly across the burned area.

D. Mix the collagenase with sterile normal saline and apply soaked dressing to entire wound bed.

13. While working with a client who has extensive third-degree burns, the nurse applies becaplermin

(Regranex) gel to the client’s wound bed. The client asks, “What will that do?” Which of the following responses is best?

A. “This will kill topical bacteria and help reduce the risk of infection.”

B. “The gel helps slow tissue growth to prevent scarring that may cause contractures.”

C. “By stimulating phagocytosis, the gel reduces the amount of fluid loss within your burns.”

D. “The gel helps new tissue grow within the wound bed and increase healing.”

14. The nurse is educating a client who is to start a prescription for tacrolimus (Protopic) for the

treatment of atopic dermatitis. The nurse knows further teaching is necessary when the client states which of the following?

A. “This medication will help reduce the swelling and redness on my skin.”

B. “I should notice a big improvement in the constant itch I’ve been having.”

C. “I will have to take this medication by mouth at least three times a day.”

D. “This medication alters the local immune response on my skin but won’t increase my risk for other infections.”

15. Which of the following clients would be instructed to avoid/discontinue using the noted treatment?

A. A 16-year-old male with acne prescribed tretinoin (Retin-A) who reports has a

history of asthma B. A 21-year-old female with eczema using hydrocortisone (Cortaid) who reports she

is pregnant C. A 34-year-old male with tinea infection that reports localized itching while using

clotrimazole (Lotrimin) D. A 26-year-old female with psoriasis using fluorouracil (Efudex) who reports

photosensitivity since starting the medication 16. While performing skin assessments during a local mall screening event, the nurse would be most

concerned by which of the following findings?

A. A 55-year-old client with multiple nevi across his back and shoulders B. A 47-year-old client with a small tan, flat, scaly patch noted on his cheek C. A 39-year-old client with a purplish-black irregular shaped area on the shoulder

blade D. A 64-year-old client with reddish, firm, dry, and peeling patches noted on his

knuckles and elbows 17. A nurse working at a dermatologist’s office is working with a client with suspected basal cell

carcinoma. The nurse would most likely prepare for which of the following?

A. Liquid nitrogen cryotherapy B. Radiation therapy C. Surgical excision with wide margins D. Topical treatment with corticosteroids 18. Which of the following individuals will need a referral to determine the potential need for systemic

chemotherapy?

A. A 66-year-old patient with squamous cell carcinoma who is receiving radiation after surgical excision of the primary lesion B. A 54-year-old patient with basal cell carcinoma on the nose who is being treated with a topical immunomodulators C. A 61-year-old patient with malignant melanoma who had a wide surgical excision with clear margins D. A 48-year-old patient with basal cell carcinoma who is being treated with topical fluorouracil Multiple Response Identify one or more choices that best complete the statement or answer the question.

1. An 18-year-old male seen routinely in the dermatology clinic, has recently been given a prescription

for tretinoin (Retin-A). Which of the following statements will the nurse include in the client teaching? (Select all that apply.)

A. “This medication may increase the risk of sun burn, so be sure to wear a hat and sunscreen.”

B. “It will be particularly important for you to immediately report any thoughts of suicide while you are taking this medication.”

C. “Be sure you drink at least 10 glasses of water each day as this medication can damage your kidneys.”

D. “I’m so glad the doctor started this medication for you, it will make your psoriasis clear right up.”

E. “This medication acts by reducing oil production by the glands in your skin.”

F. “It is important for you to apply this medication with the first symptoms of burning or tingling that indicates a cold sore is forming.”

2. A school nurse is preparing a letter to parents to notify them of a recent case of head lice in a second

grade student. Which of the following statements should be included in the letter? (Select all that apply.)

A. “Any child found to have lice during the school day will immediately be given oral antibiotic therapy.”

B. “Lice rarely spread from child to child, so no special precautions need to be taken.”

C. “Children’s hair should be examined at home daily using a fine-toothed comb for small, round, white eggs or nits.”

D. “Over-the-counter shampoo products are available for the treatment of lice.”

E. “If your child is found to have lice, your health care provider should be seen to

obtain a prescription for antifungal therapy.”

3. A nurse working with adolescents recognizes that which of the following could be used to help treat

acne? (Select all that apply.)

A. Topical immunomodulators B. Oral contraceptives C. Systemic antibiotics D. Salicylic acid E. Sulfur F. Benzoyl peroxide 4. Antiviral medications can be used to treat which of the following conditions? (Select all that apply.)

A. Thrush B. Scabies C. HPV D. Herpes zoster E. HSV-2 F. Eczema 5. While performing an admission history with a client who has extensive eczema, the nurse may

anticipate the client will report a history of which other conditions? (Select all that apply.)

A. Asthma B. Recurrent urinary tract infections C. Frequent/severe sunburn in the past D. Allergic rhinitis E. Cardiomyopathy F. Sickle cell disease 6. A nurse caring for a client with psoriasis recognizes the client is very knowledgeable about his

disease by which of the following statements? (Select all that apply.)

A. “My skin peels because the cells underneath are damaged and don’t replace

themselves fast enough to maintain a protective barrier.”

B. “I traveled to Argentina and soaked in a hot spring—it was wonderful and did help

my skin.”

C. “I’ve used topical steroids and antihistamine creams, but they haven’t helped much

lately.”

D. “The doctor said if the anthralin (Psoriatec) cream doesn’t help I may need to take

methotrexate.”

E. “I keep hoping the doctor will find the medication that cures this so it will go away

for good.”

Matching

While working in the hospital with patients who have been burned, the nurse prepares to apply the initial dressings to a client with second and third degree burns. Place the following steps in order for this procedure.

A. Apply silver sufadiazine (Silvadene) to the burn area.

B. Cover the burn with sterile dressing.

C. Set up a sterile field and don sterile gloves.

D. Assess and measure the wounds.

1. First 2. Second 3. Third

4.

Fourth

Chapter 11. Integumentary System Medications Answer Section MULTIPLE CHOICE 1. ANS: B PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Dermatologic Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master Essentials Table and Bacteria (p. 207, 208): Acne is due to an increase in androgens during puberty. Abnormal keratinization (hardening of the epithelial tissue) can occur. Open comedos or black heads are oil glands plugged with melanin granules. Medications used to treat acne can be applied topically to the irritated areas, frequently the face, back, and neck. For severe acne, salicylic acid may be used topically to remove the infected skin through shedding. Lindane is a scabicide/pediculicide; anthralin and etanercept are antipsoriatic agents.

2. ANS: D PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Dermatologic Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master Essentials Table and Bacteria (p. 207–208): Over the counter medications such as creams, gels, or lotions usually contain benzoyl peroxide, a bacteriostatic agent. Hydrocortisone is an antiinflammatory, lidocaine is a topical anesthetic, and clotrimazole is a topical antifungal agent.

3. ANS: A PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Dermatologic Medications KEY: Analysis MSC: NCLEX Category: Pharmacological Therapies NOT: See Master Essentials Table and Bacteria (p. 208): Vitamin A is a retinoid commonly used in the treatment of rosacea. Rosacea is a type of skin irritation without pus that appears as flushed skin especially on the nose and cheek. Oral fever blisters are associated with HSV-1. Dry, patchy, reddened areas on the skin and joints are characteristic of psoriasis. Genital warts are associated with HPV and treated with cryosurgery, liquid nitrogen, or salicylic acid.

4. ANS: C PTS: 1 DIF: Hard TOP: Therapeutic Classification: Dermatologic Medications KEY: Analysis MSC: NCLEX Category: Safety and Infection Control NOT: See Bacteria (p. 208): Impetigo is a common bacterial infection in children (classically seen with reddened areas around the nose and lips with honey-colored crusts). It is treated with topical or oral antibiotics.

5. ANS: B PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Dermatologic Medications KEY: Analysis MSC: NCLEX Category: Pharmacological Therapies NOT: See Master Essentials Table and Parasites (p. 207–208): Scabies is a parasitic infection caused by human itch mites that burrow into the skin and lay eggs. It usually occurs in the webbing of the fingers and toes as well as the neck, axillae, and groin. The client is not being treated for, nor exhibiting symptoms of, lice.

6. ANS: A PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Dermatologic Medications KEY: Knowledge MSC: NCLEX Category: Pharmacological Therapies NOT: See Master Essentials Table and Parasites (p. 207–208): Pediculicides are used to treat lice infestations.

7. ANS: B PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Dermatologic Medications KEY: Analysis

8.

9.

10.

11.

12.

13.

14.

15.

MSC: NCLEX Category: Pharmacological Therapies NOT: See Viruses (p. 209): Abreva is a nonprescription antiviral topical medication used in the treatment of HSV-1. Applied at the first sign of a cold sore, it can be used up to five times daily and shortens the healing time by blocking viral spread. Side effects include headache and nasal congestion.

ANS: D PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Dermatologic Medications KEY: Application MSC: NCLEX Category: Basic Care and Comfort NOT: See Viruses (p. 209): Condylomas are warts on the genitals and are typically caused by HPV. Cryosurgery with liquid nitrogen or topical products containing salicylic acid may be necessary.

ANS: C PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Dermatologic Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Fungi (p. 209): Fungal infections that affect the integumentary system include tinea and candidiasis. In tinea infections, topical antifungals such as clotrimazole may be used when the infection is present on the trunk, extremities, groin, or feet. Nystatin is an oral antifungal agent. Lidocaine is a topical anesthetic. Calcipotriene is used in the treatment of psoriasis.

ANS: A PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Dermatologic Medications KEY: Application MSC: NCLEX Category: Basic Care and Comfort NOT: See Inflammatory Conditions and Medications (p. 209): Antipsoriatic agents and ultraviolet (IV) therapy are used to treat psoriasis.

ANS: B PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Dermatologic Medications KEY: Analysis MSC: NCLEX Category: Basic Care and Comfort NOT: See Burns (p. 209): Nonpharmacologic interventions for sunburn include application of cool water for 20 minutes and an herb called aloe vera. A former practice of applying butter causes more damage and should not be used.

ANS: B PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Dermatologic Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Burns (p. 211): Collagenase debrides or removes tissue and is sometimes prescribed to eliminate the dead tissue. However, it removes healthy tissue and must be applied only to the wound as ordered.

ANS: D PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Dermatologic Medications KEY: Analysis MSC: NCLEX Category: Pharmacological Therapies NOT: See Burns (p. 211): Becaplermin (Regranex) stimulates the formation of healthy new granulation tissue. Topical antibiotics such as silver sulfadiazine (Silvadene) may be used in burns. The gel stimulates tissue growth rather than slow it. Absorbent dressing materials such as Duoderm may help manage wound exudates.

ANS: D PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Dermatologic Medications KEY: Analysis MSC: NCLEX Category: Pharmacological Therapies NOT: See Atopic Dermatitis (p. 211): Topical immunomodulators such as tacrolimus (Protopic) are topical preparations that temporarily modify the skin’s immune reaction. They do not affect the immune system of the entire body.

ANS: B PTS: 1 DIF: Hard TOP: Therapeutic Classification: Dermatologic Medications KEY: Analysis MSC: NCLEX Category: Pharmacological Therapies NOT: See Master Essentials Table (p. 207): Pregnancy is a contraindication for the use of topical corticosteroids. Asthma is not associated with Retin-A therapy and is not considered a contraindication.

Localized itching is common with fungal infections and is also a known side effect of clotrimazole.

Photosensitivity is a known side effect of fluorouracil. Patients must be educated regarding side effects but therapy will not be stopped unless the side effects are not managed or overly distressing for the client.

16. ANS: C PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Dermatologic Conditions KEY: Analysis MSC: NCLEX Category: Health Promotion and Maintenance NOT: See Skin Cancer and Medications (p. 212): Purplish-black lesions with an irregular border could be malignant melanoma and the client should be immediately referred to a dermatologist for potential biopsy.

Nevi are moles. Only if changes in color, shape, or borders have been noted should an individual seek further evaluation. A small, tan, flat scaly patch particularly on the face is most descriptive of basal cell carcinoma; this individual should be seen by a dermatologist, but is not the highest priority since basal cell carcinoma rarely metastasizes. Reddish, firm, dry, and peeling patches across joints are most descriptive of psoriasis; this is not a priority client.

17. ANS: A PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Dermatologic Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Skin Cancer and Medications (p. 212): Treatment for basal cell carcinoma may require surgical excision, but topical preparation for superficial lesions such as fluorouracil or immunomodulators may be used. Liquid nitrogen cryotherapy is also an option.

18. ANS: C PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Dermatologic Medications KEY: Analysis MSC: NCLEX Category: Pharmacological Therapies NOT: See Skin Cancer and Medications (p. 212): Malignant melanoma is an unpredictable cancer with a high rate of metastasis; the need for systemic chemotherapy will be based on the depth of the lesion removed.

Squamous cell carcinoma is typically treated with surgical excision and radiation therapy. Basal carcinoma rarely metastasizes so the need for chemotherapy is unlikely.

MULTIPLE RESPONSE 1. ANS: A, B, E PTS: 1 DIF: Hard TOP: Therapeutic Classification: Dermatologic Medications KEY: Analysis MSC: NCLEX Category: Pharmacological Therapies NOT: See Master Essentials Table and Bacteria (p. 207–208): Retinoids contain vitamin A, which reduce the oil production that clog the pores. Serious side effects can be noted including birth defects and suicidal thoughts. Photosensitivity is a common side effect, so a hat and sunscreen should be used. Kidney damage is not associated with this medication, although liver function (hepatotoxicity) has been reported. The medication is used for the treatment of severe acne, not for psoriasis or oral herpetic lesions.

2. ANS: C, D PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Dermatologic Medications KEY: Analysis MSC: NCLEX Category: Safety and Infection Control NOT: See Parasites (p. 208): Lice live in hair and feed on blood. Pediculicides are used to treat lice and are applied directly to the area of infestation. Lice lay eggs called nits. After applying the pediculicide, the hair where the nits live should be combed with a special fine-toothed comb and the site inspected for at least 1 week to be sure all the nits are dead.

3. ANS: B, C, D, E, F PTS: 1 DIF: Easy TOP: Therapeutic Classification: Dermatologic Medications KEY: Knowledge MSC: NCLEX Category: Pharmacological Therapies NOT: See Master Essentials Table and Bacteria (p. 207–208): Topical immunomodulators are used for atopic dermatitis. Oral contraceptives have also been effective in decreasing the symptoms of acne and are sometimes prescribed for this purpose. Systemic antibiotics such as tetracyclines are sometimes necessary in

extreme cases of acne. Salicylic acid, sulfur, or retinoids are used topically with severe acne. Benzoyl peroxide is typically found in over-the-counter acne treatments.

4. ANS: C, D, E PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Dermatologic Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Viruses (p. 209): Examples of viruses that affect the skin are HPV (human papiloma virus), HSV-1 and 2 (herpes simplex virus), and varicella-zoster (herpes zoster).

5. ANS: A, D PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Dermatologic Conditions KEY: Comprehension MSC: NCLEX Category: Health Promotion and Maintenance NOT: See Atopic Dermatitis (p. 211): Atopic dermatitis is also called eczema. It is an allergic disorder usually associated with other atopic disease such as asthma or allergic rhinitis.

6. ANS: B, C, D PTS: 1 DIF: Hard TOP: Therapeutic Classification: Dermatologic Medications KEY: Analysis MSC: NCLEX Category: Pharmacological Therapies NOT: See Psoriasis (p. 211): Psoriasis is a chronic inflammatory skin disease in which skin cells mature in 3 to 4 days (rather than the normal 30 to 50) and upper layer skin cells are not able to shed quickly enough resulting in plaques. Treatment may include topical corticosteroids, antihistamines, salicylic acid, or phototherapy. Specific antipsoriatic agents such as Anthralin cream are used. Oral and injectable methotrexate is used for severe disease unresponsive to other therapy. Many countries, including Argentina, have spas that claim to have healing hot springs. Some investigators believe the disease has a genetic factor, others believe environmental triggers exist. It is a chronic condition that doesn’t have a cure.

MATCHING 1. ANS: D PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Dermatologic Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Burns (p. 210): Assessment is the first step of the nursing process and should occur with any dressing change. A sterile field should be set up and sterile gloves should be used to reduce the risk of infection. Sulfadiazine is an antibiotic typically used on burns and a sterile dressing should be applied to help protect the wound and absorb any exudates from broken blisters or weeping skin areas.

2. ANS: C PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Dermatologic Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Burns (p. 210): Assessment is the first step of the nursing process and should occur with any dressing change. A sterile field should be set up and sterile gloves should be used to reduce the risk of infection. Sulfadiazine is an antibiotic typically used on burns and a sterile dressing should be applied to help protect the wound and absorb any exudates from broken blisters or weeping skin areas.

3. ANS: A PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Dermatologic Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Burns (p. 210): Assessment is the first step of the nursing process and should occur with any dressing change. A sterile field should be set up and sterile gloves should be used to reduce the risk of infection. Sulfadiazine is an antibiotic typically used on burns and a sterile dressing should be applied to help protect the wound and absorb any exudates from broken blisters or weeping skin areas.

4. ANS: B PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Dermatologic Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Burns (p. 210): Assessment is the first step of the nursing process and should occur with any

dressing change. A sterile field should be set up and sterile gloves should be used to reduce the risk of infection. Sulfadiazine is an antibiotic typically used on burns and a sterile dressing should be applied to help protect the wound and absorb any exudates from broken blisters or weeping skin areas.

Chapter 12. Musculoskeletal System Medications Multiple Choice Identify the choice that best completes the statement or answers the question.

1. While supporting clients with chronic pain concerns related to musculoskeletal disease states, which

of the following medications may be used as adjunct therapy?

A. Calcitonin salmon (Miacalcin) B. Duloxetine (Cymbalta) C. Teriparatide acetate (Forteo) D. Neostigmine (Prostigmin) 2. A nurse discussing home medications with a client taking cyclobenzoprine (Flexeril) since a motor

vehicle accident left him paralyzed 3 months earlier, determines further teaching is required with which client statement?

A. “This medication helps my muscles relax so I don’t have as many spasms.”

B. “I’ve been taking this medication since I was paralyzed.”

C. “I have trouble emptying my bladder sometimes, which might be due to my injury or to the medication.”

D. “Now that it is getting to be spring, I’ll need to take my antihistamines.”

3. A student nurse is preparing to pass medications on the rehab unit. Which statement would be

included in the client teaching for an individual taking metaxalone (Skelaxin)?

A. “This medication helps reduce the spasticity in your muscles.”

B. “This medication may cause liver damage but your current liver enzymes are fine.”

C. “Please let us know if you have any stomach pain or black, tarry stools.”

D. “This medication is delivered as a nasal spray once daily.”

4. The nurse is caring for a 10-year-old child with profound cerebral palsy who takes muscle relaxants

and antispasmodics and has continued neck muscle rigidity, which increasingly interferes with his ability to turn his head. Which of the following medications is most likely to be added to the child’s treatment plan?

A. Ibuprofen (Advil) B. Baclofen (Lioresal) C. Botulinum toxin A (Botox) D. Zyloprim (Allopurinol) 5. The nurse is reviewing medications taken at home by a client diagnosed with myasthenia gravis a

year ago. Which of the following medications would the nurse anticipate the client takes?

A. Diclofenac with misoprostol (Voltaren) B. Teriparatide acetate (Forteo) C. Neostigmine (Prostigmin) D. Calcium carbonate (Os-Cal D) 6. The LPN working in a long-term care facility realizes that one of the clients was taken on an outing

without receiving his daily dose of neostigmine (Prostigmin). The nurse provides the client’s medication on his return at 4 p.m., but would communicate which of the following to the aide caring for that client?

A. “He may be more lethargic than usual this afternoon since he received his

medication late.”

B. “I expect he will be weaker and may need help with eating this evening.”

C. “Be aware that he will need to have prunes with dinner as he may be more

constipated today.”

D. “I am worried about the potential for mood swings, so watch him carefully.”

7. While providing a calcium supplement to a client with osteopenia, the nurse would also counsel the

client to ensure sufficient intake of which additional supplement?

A. Protein B. Vitamin C C. Potassium D. Vitamin D 8. The nurse recognizes that which of the following individuals is most likely to be taking calcitonin

(Miacalcin)?

A. A 21-year-old patient with a fractured femur B. A 44-year-old patient with thyroid cancer C. A 51-year-old patient with gastroesophageal reflux disease (GERD) D. A 67-year-old patient with hypertension 9. Upon admission an 85-year-old client reports taking alendronate sodium (Fosamax) once weekly but

states, “I can’t remember why I take that one; I just know I take it on Monday.” The best response by the nurse would be: A. “Ok, I’ll ask the pharmacy to give you some literature on that medication.”

B. “Oh heavens, who can keep track of all the medications people take nowadays.”

C. “That sounds like one of the new medications given for memory problems.”

D. “That medication helps strengthen your bones and prevent fractures.”

10. A 51-year-old neighbor is considering the use of hormone replacement therapy now that menopause

has started. Which of the following statements by the nurse is best?

A. “You do know that hormones increase your risk of blood clots, right?”

B. “Have you talked to your doctor about taking hormone supplements?”

C. “What menopausal symptoms are you experiencing, and what do you know about

hormone therapy?”

D. “Some people really suffer from symptoms of menopause, but it’s been pretty easy

for me.”

11. The nurse prepares to admit a 71-year-old client with a long-standing history of rheumatoid arthritis

who has been taking ibuprofen (Motrin) 600 mg tid for many years. The nurse would be most concerned if the client reported which of the following symptoms?

A. Sharp, stabbing pain in the midepigastric region B. Dull, aching joint pain in both hands C. Small squirts of urine with sneezing D. Diffuse sense of fullness in the lower left quadrant upon abdominal palpation 12. A nurse working in the orthopedic clinic reviews a list of client appointments for the day. Which of

the following clients is most likely to need uric acid level labs to be drawn?

A. An 83-year-old patient using Capsaicin for the treatment of osteoarthritis B. A 76-year-old patient taking ibuprofen (Advil) for rheumatoid arthritis C. An 84-year-old patient taking celecoxib (Celebrex) for degenerative joint disease D. A 69-year-old patient taking zyloprim (Allopurinol) for gouty arthritis 13. The nurse is preparing to give a client the first dose of newly prescribed celecoxib (Celebrex) and

notes the client has an allergy to morphine and sulfa antibiotics. Which of the following actions should the nurse take next?

A. Provide the medication as ordered since there is no risk of allergic reaction.

B. Hold the medication since it is contraindicated for clients with allergy to sulfa antibiotics.

C. Hold the medication since it is contraindicated for clients with an allergy to morphine.

D. Call the pharmacist to see if there are any concerns about taking the new medication.

14. While reviewing the medication list for a client who is to start a COX-2 inhibitor, the nurse

recognizes the need to clarify the order when it is noted that the client is already taking which of the following medications?

A. Albuterol (Prudential) B. Ceftazidime (Fortaz) C. Donepezil (Aricept) D. Perindopril (Aceon) 15. The LPN providing multiple medications for a client with numerous co-morbid conditions would

include which of the following statements while educating the client about colchicine (Colcrys)?

A. “This medication helps the pain you have due to gout.”

B. “You take this medication to prevent skeletal fractures.”

C. “This medication is one of the NSAIDs and helps reduce inflammation.”

D. “This is the medication you take to support your calcium balance.”

16. The nurse is preparing to admit a client to an acute care hospital. The client has a long history of

treatment with auranofin (Ridaura) for rheumatoid arthritis. Which of the following room placements would be best?

A. A client with pneumonia B. A client with cellulitis C. A client with a myasthenia gravis D. A client with acute appendicitis 17. The nurse is providing care for a client prescribed methylprednisolone (Medrol). The nurse knows

this medication mimics which of the following hormones naturally produced by the body?

A. Insulin B. Thyroxine C. Cortisol D. Estrogen

18. The nurse is caring for a client with shingles lesions across the back and flank. The client’s daughter

asks, “I see the doctor started a new medication called pregabalin (Lyrica) but I thought that was for seizures. Why is my dad taking that medication?” Which of the following responses by the nurse is best?

A. “I’m not sure; I will call the doctor and make sure there wasn’t a mistake.”

B. “I don’t know, but he’s been getting it for almost a week now so there shouldn’t be a problem.”

C. “We often use that medication to help with neuropathic pain conditions like shingles.”

D. “The medication helps reduce swelling along the nerve fibers and heals the lesions more quickly.”

19. While helping the RN to develop a care plan for a client with rheumatoid arthritis, the LPN

recognizes which of the following goals would be of highest priority?

A. Maintain the client’s optimal independence B. Increase fluid intake to 1,800 mL per day C. Lift 2-lb ankle weight during physical therapy routine D. Verbalize acceptance of social isolation 20. The LPN is assisting in the care of a 61-year-old woman who is to begin taking teriparatide acetate

(Forteo). Which of the following statements by the nurse is best?

A. “This medication prevents attacks of gout.”

B. “This medication alters the estrogen balance in your body to reduce the risk of

bone loss.”

C. “The class of medications called bisphosphonates is used to treat muscle spasms.”

D. “This medication will help maintain the strength of your bones.”

21. While reviewing medications for a patient with multiple sclerosis, the student nurse recognizes that

baclofen (Lioresal) is given for which the following symptoms?

A. Gout B. Calcium balance C. Muscle spasticity D. Joint pain 22. The nurse prepares to provide colchicine (Colcrys) to a patient. Which of the following assessments

indicates this medication is effective?

A. Client’s large toe is less red and swollen B. Client reports decreased pain in the lower back C. The nurse notes serum calcium levels have increased D. The client reports he did not have any leg spasms during the night 23. A nurse is receiving shift-to-shift report for a client with multiple medical problems. The client is

receiving auranofin (Ridaura). The nurse recognizes this medication is ordered to address which of the following health care problems?

A. Dystonia B. Rheumatoid arthritis C. Gout D. Osteoporosis

Multiple Response Identify one or more choices that best complete the statement or answer the question.

1. A nurse working with an orthopedic unit recognizes that which class of medications would be most

helpful in the treatment of disease states that cause dystonia? (Select all that apply.)

A. Calcium supplements B. Nonsteroidal anti-inflammatory agents (NSAIDS) C. Antispasmodics D. Corticosteroids E. Muscle relaxants 2. While discussing the use of botulinum toxin A (Botox) in the treatment of chronic muscle spasms,

the nurse recognizes the client understands the treatment by which of the following statements?

(Select all that apply.)

A. “This treatment usually lasts for 3 to 6 months and then needs to be repeated.”

B. “The doctor will inject the muscle with Botox to paralyze it so the spasms stop.”

C. “I will give myself daily injections of Botox to keep the muscles relaxed.”

D. “The treatment team will probably use local anesthetic since this treatment can cause significant pain.”

E. “The hope is that my paralysis will be cured once the muscles stop having so many spasms.”

3. A young client with rheumatoid arthritis is considering therapy with disease-modifying

antirheumatic drugs and asks the nurse for a list of these medications so the client can read about each specific drug. Which of the following medications would be included on the list? Select all that apply.

A. Dexamethasone (Decadron) B. Methotrexate (Rheumatrex) C. Sulfasalazine (Azulfidine) D. Cyclosporine (Neoral) E. Gold aurothioglucose (Solganal) 4. While providing care for a client taking dexamethasone (Decadron), the nurse is aware that this

medication may mask which of the following symptoms? (Select all that apply.)

A. Redness associated with a local skin irritation B. Fever associated with pneumonia C. Inflammation related to a soft tissue injury D. Orthostatic hypotension present with dehydration E. Pupil response associated with increased cranial pressure 5. A nurse working in the Veteran’s Administration is preparing to receive a client from the operating

room with a new left foot amputation. The nurse would anticipate which of the following medications to be part of the treatment plan to manage both acute and chronic phantom limb pain?

(Select all that apply.)

A. Morphine (Roxanol) B. Dantrolene (Dantrium) C. Metaxalone (Skelaxin)

D. Amitriptyline (Elavil) E. Teriparatide acetate (Forteo) F. Carbamazepine (Tegretol) 6. While assisting in the care of a postmenopausal women with osteoporosis who takes calcitonin

(Miacalcin), which of the following would the nurse include in the patient’s plan of care? (Select all that apply.)

A. Provide supplemental iron B. Encourage weight-bearing exercises C. Encourage smoking cessation D. Maintain prolonged bed rest E. Encourage limited alcohol consumption F. Increase protein intake Matching

The nurse is planning to provide calcitonin (Miacalcin) for a client with hypocalcemia. Place the following steps in correct order to provide this medication.

A. Squeeze the dispenser to provide a mist spray.

B. Instruct the client to block the opposite nostril.

C. Ask the client to assume a sitting position leaning slightly forward.

D. Place the dispenser into the client’s nostril.

E. Wash hands and don gloves.

1. First 2. Second 3. Third 4. Fourth

5.

Fifth

Chapter 12. Musculoskeletal System Medications Answer Section MULTIPLE CHOICE 1. ANS: B PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Musculoskeletal System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Medications to Treat Muscular Disorders and Master Essentials Table (p. 219–221): Cymbalta is an antidepressant used for the treatment of chronic low back pain. Antidepressants are often used as adjunct therapy in the treatment of chronic pain. Miacalcin is a form of calcitonin used to treat hypocalcemia. Forteo is a bisphosphonate used to treat hypocalcemia. Prostigmin is a cholinesterase inhibitor used to treat myasthenia gravis.

2. ANS: D PTS: 1 DIF: Hard TOP: Therapeutic Classification: Musculoskeletal System Medications KEY: Analysis MSC: NCLEX Category: Pharmacological Therapies NOT: See Medications to Treat Muscular Disorders and Master Essentials Table (p. 220): Flexeril is a muscle relaxant used to help reduce spasms and rigidity that can cause urinary retention. The use of antihistamines may cause an interaction, so the addition of new medications should be made under the direction of a physician and with caution.

3. ANS: A PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Musculoskeletal System Medications KEY: Analysis MSC: NCLEX Category: Pharmacological Therapies NOT: See Medications to Treat Muscular Disorders and Master Essentials Table (p. 219–220): Skelaxin is an antispasmodic. Side effects include anxiety, blurred vision, dizziness, confusion, headache, dry mouth, tremors, decreased blood pressure, diarrhea, urinary retention/incontinence, and weakness. Liver damage is not associated with this class of medications, nor is GI distress/ulceration/bleeding. The medication is provided as an oral pill. Miacalcin is provided as a nasal spray and used for the treatment of hypocalcemia or osteoporosis.

4. ANS: C PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Musculoskeletal System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Medications to Treat Muscular Disorders and Master Essentials Table (p. 219, 221): Botox is used to block acetylcholine and paralyze the muscle and has been used to treat abnormal head position or other mobility issues related to severe rigidity. Ibuprofen is an NSAID used to treat pain and inflammation of arthritis. Baclofen is a muscle relaxant and may be used but in the situation described, the child is already on muscle relaxants and Botox is the more likely choice for a new treatment option. Allopurinol is used in the treatment of gout and reduces uric acid levels.

5. ANS: C PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Musculoskeletal System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Medications to Treat Muscular Disorders and Master Essentials (p. 221): One type of medication used to treat myasthenia gravis consists of cholinesterase inhibitors such as Neostigmine, which block cholinesterase and therefore facilitate acetylcholine accumulation.

6. ANS: B PTS: 1 DIF: Hard TOP: Therapeutic Classification: Musculoskeletal System Medications KEY: Analysis MSC: NCLEX Category: Pharmacological Therapies NOT: See Medications to Treat Muscular Disorders and Master Essentials (p. 221): Clients with myasthenia

7.

8.

9.

10.

11.

12.

13.

14.

gravis take neostigmine to help with muscle control. If the client missed a dose of this medication, the nurse would be concerned about increased weakness and skeletal muscle fatigue. The medication does not cause lethargy, constipation, or mood swings as typical side effects, so the nurse does not need to be concerned about these issues related to the altered medication administration time.

ANS: D PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Musculoskeletal System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Abnormal Calcium Levels and Osteoporosis, and Master Essentials Table (p. 219, 221–222): Vitamin D may be added to facilitate calcium usage since it assists in the absorption of calcium from the stomach.

ANS: B PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Musculoskeletal System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Abnormal Calcium Levels and Osteoporosis, and Master Essentials Table (p. 219, 221–222): The thyroid and parathyroid glands ensure proper amounts of circulated and stored calcium in the body. Miacalcin is given in the treatment of hypocalcemia.

ANS: D PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Musculoskeletal System Medications KEY: Analysis MSC: NCLEX Category: Pharmacological Therapies NOT: See Abnormal Calcium Levels and Osteoporosis, and Master Essentials Table (p. 219, 221–222): Fosamax is a bisphosphonate and is given to inhibit bone resorption and thereby reduce the risk of fracture.

ANS: C PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Musculoskeletal System Medications KEY: Analysis MSC: NCLEX Category: Health Promotion and Maintenance NOT: See Abnormal Calcium Levels and Osteoporosis, and Master Essentials Table (p. 219, 221–222): Estrogen replacement therapy (ERT) inhibits bone resorption of calcium and reduces the risk of osteoporosis, but there are side effects such as increased risk of breast and uterine cancer and the formation of blood clots.

The nurse should ensure the individual is aware of this information and should encourage the client to discuss the use of ERT with her physician. Statement 2 is closed ended, while statement 3 begins a dialog and allows the nurse to assess the client’s knowledge level and provide appropriate education.

ANS: A PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Musculoskeletal System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Medications for Bone and Joint Inflammation, and Master Essentials Table (p. 219, 223): Nonsteroidal anti-inflammatory agents can cause GI ulcers and bleeding as well as increased bleeding times, so any reports of sharp, stabbing epigastric pain should alert the nurse to potential GI bleeding.

ANS: D PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Musculoskeletal System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Medications for Bone and Joint Inflammation, and Master Essentials Table (p. 219, 223): Elevated uric acid levels are seen in gouty arthritis and zyloprim (Allopurinol) is taken to lower uric acid levels in the body.

ANS: B PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Musculoskeletal System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Medications for Bone and Joint Inflammation, and Master Essentials Table (p. 219, 223): COX-2 inhibitors cannot be used by patients who are allergic to sulfa drugs.

ANS: D PTS: 1 DIF: Hard TOP: Therapeutic Classification: Musculoskeletal System Medications KEY: Analysis MSC: NCLEX Category: Pharmacological Therapies

15.

16.

17.

18.

19.

20.

21.

22.

NOT: See Medications for Bone and Joint Inflammation, and Master Essentials Table (p. 219): Albuterol is a bronchodilator – there is no contraindication or interaction with this medication. Ceftazidime is a cephalosporin antibiotic—there is no contraindication with this medication. Donepezil is used to treat Alzheimer’s disease. Perindopril is a long acting ACE inhibitor with potential interactions with a COX-2 inhibitor so orders should be clarified.

ANS: A PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Musculoskeletal System Medications KEY: Analysis MSC: NCLEX Category: Pharmacological Therapies NOT: See Medications for Bone and Joint Inflammation, and Master Essentials Table (p. 219, 223): ANS: C PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Musculoskeletal System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master Essentials Table and Disease-Modifying Antirheumatic Drugs (p. 220, 224): Auranofin is a DMARD. Long term therapy will place the client at increased risk for infection due to the immune system suppression caused by the medication. Placing the client in a room with a non-infectious roommate is most important. The client with myasthenia gravis has no known infection while the other clients are being treated for an infectious process.

ANS: C PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Musculoskeletal System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master Essentials Table and Corticosteroids (p. 224): Glucocorticosteroid agents mimic cortisol, which is a hormone produced by the adrenal gland responsible for reducing inflammation.

ANS: B PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Musculoskeletal System Medications KEY: Analysis MSC: NCLEX Category: Pharmacological Therapies NOT: See Drug Spotlight 12.1 (p. 221): Pregabalin is an antiepileptic medication used to treat fibromyalgia, shingles pain, and diabetic neuropathy. The medication blocks pain signals from the brain reducing the sensations of pain. It does not alter swelling along nerve fibers. The nurse should always attempt to address client or family questions directly whenever possible.

ANS: A PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Musculoskeletal System Medications KEY: Application MSC: NCLEX Category: Basic Care and Comfort NOT: See Master Essentials Table and Medications for Phantom Limb Pain (p. 225): Maintaining optimal independent functioning should be one of the goals for every health care worker when caring for individuals with musculoskeletal problems. Increased fluid intake may be helpful to reduce constipation for clients who are immobile, but is not always necessary for the treatment of rheumatoid arthritis. Weight lifting will most likely not be part of the physical therapy plan for this client since the goal will be to maintain joint function rather than increase strength. Social isolation should be avoided with daily activities and psychosocial support.

ANS: D PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Musculoskeletal System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master Essentials Table and Medications (p. 219; 222): Bisphosphonates are similar to bisphosphonate salts, which are found naturally in the body and help to treat osteomalacia and osteoporosis.

These medications are not used for gout or muscle spasm and do not alter the estrogen balance of the body.

ANS: C PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Musculoskeletal System Medications KEY: Knowledge MSC: NCLEX Category: Pharmacological Therapies NOT: See Master Essentials Table (p. 219–220): Baclofen is a muscle relaxant/antispasmodic medication.

ANS: A PTS: 1 DIF: Moderate

TOP: Therapeutic Classification: Musculoskeletal System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master Essentials Table (p. 219–220): Colchicine is an antigout medication so effective therapy will result in decreased symptoms of gout including decreased pain, redness and swelling in large joint of the toes.

23. ANS: A PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Musculoskeletal System Medications KEY: Knowledge MSC: NCLEX Category: Pharmacological Therapies NOT: See Master Essentials Table (p. 219–220): Auranofin is a disease-modifying antirheumatic drug used in the treatment of rheumatoid arthritis.

MULTIPLE RESPONSE 1. ANS: C, E PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Musculoskeletal System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Medications to Treat Muscular Disorders (p. 220): Dystonia is an abnormal tension in one area of the body. Medications used to treat some of the muscular problems found in these disorders include muscle relaxants and antispasmodics.

2. ANS: A, B, D PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Musculoskeletal System Medications KEY: Analysis MSC: NCLEX Category: Pharmacological Therapies NOT: See Medications to Treat Muscular Disorders and Master Essentials (p. 221): Botox treatment reaches maximum effectiveness after 6 weeks and must be repeated every 3 to 6 months. The treatment paralyzes a muscle or muscle group and in some cases once the muscle is paralyzed, strengthening exercises can be done, however a client’s paralysis will not be altered. Because it causes pain, it is usually administered with a local anesthetic.

3. ANS: B, C, D, E PTS: 1 DIF: Hard TOP: Therapeutic Classification: Musculoskeletal System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master Essentials Table and Disease-Modifying Antirheumatic Drugs (p. 224): Dexamethasone is a glucocorticosteroid while the others all belong to the class of drugs known as DMARDs (disease-modifying antirheumatic drugs). These medications work by suppressing the immune system, thereby slowing the autoimmune process associated with rheumatoid arthritis.

4. ANS: A, B, C PTS: 1 DIF: Hard TOP: Therapeutic Classification: Musculoskeletal System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master Essentials Table and Corticosteroids (p. 224): Steroid therapy reduces the body’s ability to fight infection and may mask symptoms associated with inflammation or injury such as redness, fever, or inflammation. Steroids would not impact blood pressure or pupil response.

5. ANS: A, C, E PTS: 1 DIF: Hard TOP: Therapeutic Classification: Musculoskeletal System Medications KEY: Analysis MSC: NCLEX Category: Pharmacological Therapies NOT: See Master Essentials Table and Medications for Phantom Limb Pain (p. 225): Morphine is a narcotic used in the treatment of acute and chronic pain. Tricyclic antidepressants such as amitriptyline are often used in chronic pain management to alter chemical messengers that relay pain signals and to help with sleep.

Anticonvulsants such as carbamazepine quiet damaged nerve fiber and prevent or slow pain signals.

Dantrolene and metaxalone are muscle relaxant/antispasmodics—there is no indication these medications will be needed. Teriparatide acetate is a bisphosphonate and would not be used in this case.

6. ANS: B, C, E PTS: 1 DIF: Moderate

TOP: Therapeutic Classification: Musculoskeletal System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master Essentials Table and Abnormal Calcium Levels and Osteoporosis (p. 219–220; 222): Risk factors for hypocalcemia include smoking, lack of exercise, high alcohol consumption, anorexia nervosa, estrogen or testosterone deficiency, poor nutrition, and obesity.

MATCHING 1. ANS: E PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Musculoskeletal System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Abnormal Calcium Levels and Osteoporosis (p. 222): Calcitonin (Miacalcin) is available as a nasal spray. With this type of question, read carefully and place the steps in chronological order. Hands should be washed and gloves worn prior to the procedure. Clients generally assume a sitting or standing position with the head tilted slightly forward to allow the nasal spray to enter the nasal passage and sinuses.

2. ANS: C PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Musculoskeletal System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Abnormal Calcium Levels and Osteoporosis (p. 222): Calcitonin (Miacalcin) is available as a nasal spray. With this type of question, read carefully and place the steps in chronological order. Hands should be washed and gloves worn prior to the procedure. Clients generally assume a sitting or standing position with the head tilted slightly forward to allow the nasal spray to enter the nasal passage and sinuses.

3. ANS: D PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Musculoskeletal System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Abnormal Calcium Levels and Osteoporosis (p. 222): Calcitonin (Miacalcin) is available as a nasal spray. With this type of question, read carefully and place the steps in chronological order. Hands should be washed and gloves worn prior to the procedure. Clients generally assume a sitting or standing position with the head tilted slightly forward to allow the nasal spray to enter the nasal passage and sinuses.

4. ANS: B PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Musculoskeletal System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Abnormal Calcium Levels and Osteoporosis (p. 222): Calcitonin (Miacalcin) is available as a nasal spray. With this type of question, read carefully and place the steps in chronological order. Hands should be washed and gloves worn prior to the procedure. Clients generally assume a sitting or standing position with the head tilted slightly forward to allow the nasal spray to enter the nasal passage and sinuses.

5. ANS: A PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Musculoskeletal System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Abnormal Calcium Levels and Osteoporosis (p. 222): Calcitonin (Miacalcin) is available as a nasal spray. With this type of question, read carefully and place the steps in chronological order. Hands should be washed and gloves worn prior to the procedure. Clients generally assume a sitting or standing position with the head tilted slightly forward to allow the nasal spray to enter the nasal passage and sinuses.

Chapter 13. Nervous System Medications Multiple Choice Identify the choice that best completes the statement or answers the question.

1. The nurse is providing care for a client with a history of manic-depression. Which of the following

classifications of medications would the nurse expect to find prescribed for the client?

A. Narcotics B. Benzodiazepines C. Cholinergics D. Psychotropics 2. A nursing student asks another student, “What does the blood brain barrier have to do with

medications?” Which of the following responses by the student is best?

A. “The barrier helps reduce the risk of infection, so not as many antibiotics are

needed.”

B. “It prevents some medications from affecting the central nervous system.”

C. “There are only a few medications that don’t cross the barrier, so we have to know

those.”

D. “It has to do with how medications affect brain growth in a developing fetus.”

3. While studying for the medication exam, the nursing student determines that norepinephrine

(Levophed), if given to a patient, would be contraindicated for which of the following individuals?

A. A 52-year-old patient with a blood pressure of 186/94 B. A 49-year-old patient with a pulse of 65 C. A 61-year-old patient with a respiratory rate of 18 D. A 75-year-old patient with a history of seizures 4. The LPN is collecting history information for a client planning outpatient surgery. Which of the

following statements by the client would cause the nurse to contact the anesthesiologist?

A. “I forgot to sign the consent form while I was in the office last time.”

B. “I usually take alprazolam (Xanax) to help me sleep a couple times a week.”

C. “I used my pilocarpine (Pilopine) eye drops this morning but didn’t take any of my

pills.”

D. “I brushed my teeth this morning with just a sip of water.”

5. While counseling the mother of an 18-month-old child diagnosed with a viral infection, the nurse

should include which of the following statements in the client’s teaching?

A. “The doctor will probably prescribe an antibiotic to help with the ear pain.”

B. “Be sure not to give the baby anything with aspirin in it.”

C. “You can crush a regular acetaminophen (Tylenol) and put it in the baby’s bottle.”

D. “The doctor might order a narcotic to help the baby sleep.”

6. The LPN is providing care for a client who reports an allergy to acetaminophen (Tylenol) and

penicillin. The client has orders for morphine 1 mg IM every 2 hours prn for severe pain, and Percocet, two tablets every 4 hours prn for moderate pain. The client reports pain of 4 on a 10-point scale. Which of the following actions should the nurse take first?

A. Ask the client what kind of reaction was seen when penicillin was taken.

B. Ask the client which medication the client would like to use for pain management.

C. Provide the client with 2 tablets of Percocet.

D. Contact the RN so orders can be clarified.

7. The LPN is assisting with a newly admitted client who reports taking 800 mg ibuprofen (Advil) four

times daily for chronic back pain. Which action by the nurse is most appropriate?

A. Ask the client if the ibuprofen is effective for the pain.

B. Notify the RN of the prescribed dose.

C. Ask the client if he’s experienced any abdominal pain.

D. Inform the client that aspirin may be a more effective pain reliever.

8. The LPN is caring for a client one day after a total hip replacement. The client has orders for a

Dilaudid PCA machine and currently reports his pain is well controlled. The nurse would be most concerned by which of the following findings?

A. The client’s wife reports his last bowel movement was the day before surgery.

B. The client’s blood pressure is 126/62 and pulse rate is 60.

C. The nurse notes the client has not voided since the Foley was removed 3 hours ago.

D. The client is difficult to arouse with a respiratory rate of 10.

9. The LPN is working with an elderly client who reports difficulty sleeping. When reviewing the

client’s record, the nurse notes numerous prn medications. Which of the following would the nurse suggest at this time?

A. Alprazolam (Xanax) B. Oxycodone with ibuprofen (Combunox) C. Clonazepam (Klonopin) D. Eszopiclone (Lunesta) 10. While assisting with the care of a client with a history of alcohol abuse, the LPN determines the

client’s withdrawal symptoms are worsening. Which of the following actions should the nurse take next?

A. Provide the client with warm blankets and turn out the lights and reduce noise levels.

B. Call the family to see if someone can come with the client.

C. Determine if the client has an order for prn diazepam (Valium).

D. Inform the RN that the client is in need of restraints.

11. An LPN working in a physician’s office receives a call from the parent of a child who recently

started taking dexmethylphenidate hydrochloride (Focalin). The parent reports, “My son says he hasn’t slept well for the past three days.” Which of the following statements by the nurse is best?

A. “Does your son watch TV or play video games in his room at night?”

B. “Insomnia is a common side effect with this type of medication and it may take a while for your son to adjust.”

C. “I suggest you just give him half a pill in the morning today and see what happens.”

D. “When does he usually take the medication?”

12. While working with a client who is taking selegiline (Eldepryl), the LPN recognizes the client

understands the required dietary restrictions, if the client selects which of the following lunches?

A. Bologna sandwich on wheat bread with chips and a diet soda B. Hamburger with an onion bun, coleslaw, and a glass of milk C. Pepperoni pizza with a side salad and ranch dressing with iced tea D. Stir fried rice and vegetables with soy sauce and a cup of coffee 13. While studying for the pharmacology examination, the student nurse identifies that sertraline

(Zoloft), paroxetine (Paxil), and fluoxetine (Prozac) are all examples of which classification of medications?

A. Monoamine oxidase inhibitor agents B. Selective serotonin reuptake inhibitors C. Tricyclic antidepressants D. Mood stabilizers 14. The LPN is working with a client whose medication list includes lithium. The LPN would be most

concerned by which of the following?

A. The client reports blurry vision and sensitivity to light.

B. The client’s urinary output was 1,600 mL the previous day.

C. The client reports following a low-salt diet.

D. The lab report indicates the client’s lithium level is therapeutic.

15. An LPN is approached by a friend whose mother was recently diagnosed with Alzheimer’s disease.

The friend states, “The doctor wants to put her on donepezil (Aricept) right away, but right now she’s just occasionally forgetful. We had no idea she had Alzheimer’s and I worry about side effects.” Which of the following is the best response by the nurse?

A. “It is hard to know the best way to go with this diagnosis. Have you gotten a second opinion?”

B. “Early diagnosis and treatment seems to be giving the best results for long-term function.”

C. “I’ve given that medication many times and most people don’t have any side effects.”

D. “I’m so sorry to hear about this. What do your siblings think you should do?”

16. While discussing the care plan of a client living in a long-term care facility who has Parkinson’s

disease, the LPN emphasizes that the client has been more forgetful, has been wandering at night, and seems more withdrawn in his behavior. Which of the following suggestions for the plan of care is best?

A. Encourage the client to take advantage of more social outings and activities.

B. Discuss an increased exercise program with the physical therapist.

C. Suggest the physician evaluate the client for use of a rivastigmine (Exelon) patch.

D. Determine if the client would like to have a bird in her room to keep him company.

17. While caring for a client in the pediatric clinic, the nurse notes the physician has prescribed otic

benzocaine (Americaine Otic) for a child. The LPN’s instructions to the child’s parents will be based on an understanding that this medication: A. Is used in the topical treatment of conjunctivitis B. Is provided in a cream formulation to be placed along the inner eyelid C. Will help numb the inner ear and relieve pain D. Will kill yeast associated with thrush

18. As students are studying, one student asks, “What is the difference between anesthetics that are

esters and those that are amides?” Which of the following responses is best?

A. “Amides don’t last as long so they are very helpful with conscious sedation.”

B. “Novocaine is an ester, so just keep that in your mind as an example.”

C. “The esters are used as inhaled anesthetics and the amides are not.”

D. “Both are local anesthetics but esters are used topically since the risk of

anaphylaxis is high.”

19. While assisting in the care of a client receiving a bright yellow IV solution containing thiamine and

other vitamin B supplements, the LPN concludes the client is most likely being treated for which of the following?

A. Osteoporosis B. Alcohol withdrawal C. Seizure disorder D. Parkinson’s disease 20. The LPN is preparing to provide a dose of cough syrup and notes it contains alcohol as a listed

ingredient. The LPN would notify the aide to be aware that the client is at increased risk for which of the following?

A. Falls B. Incontinence C. Bronchospasms D. Anorexia 21. While assisting in the care of a client diagnosed with petit mal seizures, the LPN overhears the

treatment team discussing the addition of ethosuximide (Zarontin) to the client’s medication regimen. The nurse is aware that this medication works by: A. Altering the transfer of sodium ions across a synaptic membrane B. Delaying the movement of calcium over the neuron C. Increasing the neurologic sensitivity to electric stimuli and lowering the seizure threshold D. Blocking GABA transmitters in the brain 22. The nurse is assisting in the care of a 35-year-old man who is diagnosed with depression. The client

is interested in starting treatment with selegline (Eldepryl). Which of the following factors would be of most concern to the health care team?

A. The patient smokes a pack of cigarettes each day.

B. The patient lives alone.

C. The patient has a history of heart disease.

D. The patient has a history of seizures.

23. The nurse is counseling a patient who will begin taking diazepam (Valium). Which of the following

statements indicates further teaching is required?

A. “I might feel sleepy with this medication.”

B. “I shouldn’t drive until I know how you’re going to respond to this medication.”

C. “This medication can be addictive, so I should only take it if I really need it.”

D. “I can drink alcohol as long as I don’t get drunk.”

24. Which of the following lab values would the nurse be most concerned with for a client who was

taking phenytoin (Dilantin)?

A. Uric acid level B. Hemoglobin C. Creatinine D. Liver enzymes 25. The student nurse recognizes that citalopram (Celexa) would most likely be taken by which of the

following clients?

A. A 26-year-old patient with a history of schizophrenia B. A 16-year-old patient diagnosed with alcoholism C. A 27-year-old patient with a history of seizures D. A 42-year-old patient with a history of depression 26. A nurse working in an outpatient psychiatric clinic and assists with the care of a 24-year-old patient

with schizophrenia who started taking chlorpromazine (Thorazine) three days ago. Which of the following should be reported to the physician immediately?

A. The patient reports no bowel movement since he started the medication.

B. The client is blinking rapidly and making odd facial movements involuntarily.

C. Patient says, “I heard the angels talking again last night.”

D. Patient reports he is staying at a homeless shelter four blocks away.

Multiple Response Identify one or more choices that best complete the statement or answer the question.

1. While passing medications in a long-term care facility, the nurse recognizes that a medication

affecting the autonomic nervous system may cause which of the following symptoms? (Select all that apply.)

A. Changes in pupil size B. Spastic twitching in the legs C. Fine tremors in the hands D. Altered heart rate E. Flushing of the skin F. Dryness of oral mucous membranes 2. The student nurse has been assigned to assist in the care of a client with a history of seizures. The

student anticipates which of the following medications may be included in the client’s profile?

(Select all that apply.)

A. Atropine (Atropen) B. Phenytoin (Dilantin) C. Ethosuximide (Zarontin) D. Topiramate (Topamax) E. Methylphenidate (Ritalin) F. Amitriptyline (Elavil)

3. An LPN from the dementia unit has been pulled to work on the long-term psych unit of an extended

care facility. When the charge nurse mentions, “Many of our clients have hallucinations and take neuroleptic medications,” the LPN is aware that may include which of the following? (Select all that apply.)

A. Chlorpromazine (Thorazine) B. Clozapine (Clopine) C. Thioridazine (Mellaril) D. Citalopram (Celexa) E. Pemoline (Cylert) F. Phentermine (Zantryl) 4. The LPN is reinforcing discharge instructions for a client who received a new prescription for

tamsulosin (Flomax). The nurse determines teaching has been effective by which of the following client statements? (Select all that apply.)

A. “This medication can interact with alcohol so I must avoid drinking.”

B. “I might get sleepy when I take this, so I shouldn’t drive.”

C. “Tamsulosin is an adrenergic blocker so it might lower my blood pressure and heart rate.”

D. “This medication will help with urine flow since I have an enlarged prostate.”

E. “I might get addicted to this medication, so I can only use it for a few weeks.”

Chapter 13. Nervous System Medications Answer Section MULTIPLE CHOICE 1. ANS: D PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Nervous System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master Essentials Table and The Nervous System (p. 231, 232–236): Psychotropics are medications that affect the mind, emotions, or behaviors would be necessary for a client with manicdepression.

2. ANS: B PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Nervous System Medications KEY: Analysis MSC: NCLEX Category: Physiological Adaptation NOT: See Master Essentials Table and The Nervous System (p. 231, 232–236): The blood brain barrier is a barrier in the brain that prevents toxic substances and some medications from entering the brain. It serves as a protective mechanism just as the placental barrier protects a fetus. There are a number of medications that cross the blood brain barrier.

3. ANS: A PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Nervous System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master Essentials Table and The Nervous System (p. 232–236): Norepinephrine is an adrenergic medication and should be used cautiously in clients with hypertension, myocardial infarction, atrial fibrillation, or hypovolemia.

4. ANS: C PTS: 1 DIF: Hard TOP: Therapeutic Classification: Nervous System Medications KEY: Analysis MSC: NCLEX Category: Pharmacological Therapies NOT: See Master Essentials Table and Medications to Control Pain and Fever (p. 232–236; 237–238): Pilocarpine is used in the treatment of open-angle glaucoma. Because it is a cholinergic medication, it must be stopped several weeks before surgical procedures to prevent intra-operative breathing problems.

5. ANS: B PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Nervous System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master Essentials Table and Medications to Control Pain and Fever (p. 232–236; 237–238): Aspirin cannot be given to children with viral infections due to the risk of Reye’s syndrome, and the mother should be made aware of this fact. Antibiotics are generally not given to treat a viral infection. Tylenol will be dosed using children’s formulation based on the child’s weight and will not equate to an adult dose, so a standard Tylenol tablet should not be mixed in the bottle. Narcotics are used for severe pain and would not be appropriate in this scenario.

6. ANS: D PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Nervous System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master Essentials Table and Medications to Control Pain and Fever (p. 232–236; 237–238): Percocet is a combination medication that contains Tylenol. Because the client is allergic to Tylenol, this medication cannot be given and orders must be clarified.

7. ANS: C PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Nervous System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master Essentials Table and Medications to Control Pain and Fever (p. 232–236; 237–238):

8.

9.

10.

11.

12.

13.

14.

Ibuprofen is an NSAID. The listed dose is higher than recommended and chronic use of ibuprofen can cause GI irritation and bleeding, thus the assessment related to abdominal pain is the highest priority.

ANS: D PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Nervous System Medications KEY: Analysis MSC: NCLEX Category: Pharmacological Therapies NOT: See Master Essentials Table and Medications to Treat Anxiety, Insomnia, Sedation, and Seizures (p.

232–236; 239–240): An excess amount of narcotic pain medication can slow respirations to dangerous levels, decrease blood pressure significantly and cause other side effects such as constipation, urinary retention, and sedation. The biggest concern in this scenario is the lethargy and decreased respiratory rate.

ANS: D PTS: 1 DIF: Hard TOP: Therapeutic Classification: Nervous System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master Essentials Table and Medications to Treat Anxiety, Insomnia, Sedation, and Seizures (p. 232– 236; 239–240): Alprazolam and clonazepam are anxiolytic agents that can be used for anxiety, seizures,alcohol withdrawal, and muscle relaxation. While they induce sleep, the new non-narcotic benzodiazepine hypnotics such as eszopiclone help promote sleep with fewer side effects. Combunox is a narcotic pain medication and may cause drowsiness but is not the best option for sleep induction.

ANS: C PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Nervous System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master Essentials Table and Medications to Treat Anxiety, Insomnia, Sedation, and Seizures (p.

232–236; 239–240): Diazepam is used for seizures and alcohol withdrawal symptoms. While reducing stimuli and providing supervision are important actions, provision of benzodiazepine medication will do more to reduce the occurrence of seizures and support the client through the withdrawal experience. Restraint use is not appropriate at this time.

ANS: D PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Nervous System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master Essentials Table and Medications to Treat Behavioral, Emotional, and Mood Disorders (p.

232–236; 241–243): CNS stimulants such as Focalin can cause insomnia, so taking the medication early in the morning can help reduce these side effects. The nurse is not able to suggest a reduced dose and this side effect should be investigated. Television and other stimulating activities may promote insomnia, but the timing of medication delivery is a higher priority at this time.

ANS: B PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Nervous System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master Essentials Table and Medications to Treat Behavioral, Emotional, and Mood Disorders (p.

232–236; 241–243): Selegiline is a monoamine oxidase inhibitor requiring the exclusion of foods high in tyramine. Bologna, pepperoni, and soy sauce are all high in tyramine and should be avoided.

ANS: B PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Nervous System Medications KEY: Knowledge MSC: NCLEX Category: Pharmacological Therapies NOT: See Master Essentials Table and Medications to Treat Behavioral, Emotional, and Mood Disorders (p.

232–236; 241–243): These agents are all examples of selective serotonin reuptake inhibitors, a class of medications used in the treatment of depression that cause fewer side effects than the older MOAI, and TCA medications.

ANS: A PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Nervous System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master Essentials Table and Medications to Treat Behavioral, Emotional, and Mood Disorders (p.

15.

16.

17.

18.

19.

20.

21.

232–236; 241–243): Blurry vision and sensitivity to light are both symptoms of lithium toxicity. Lithium is a salt and may cause increased urinary output. The client should follow a low-salt diet. Lithium blood levels should be monitored.

ANS: B PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Nervous System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master Essentials Table and Medications to Treat Degenerative Disorders (p. 232–236; 243–244): Donepezil is an example of a cholinesterase inhibitor that shows promise in slowing the progressing of Alzheimer’s disease and the best outcomes are associated with early diagnosis and early treatment. Side effects of donepezil do occur and this issue should be discussed with the individual.

ANS: C PTS: 1 DIF: Hard TOP: Therapeutic Classification: Nervous System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master Essentials Table and Medications to Treat Degenerative Disorders (p. 232–236; 243–244): Dementia is often part of the disease process in Parkinson’s and the evaluation of appropriate use of rivastigmine will directly address the symptoms of dementia. The other options address social isolation, depression, and mobility concerns associated with Parkinson’s disease and may be appropriate, but the priority in this scenario is to determine if the medication may help limit disease progression.

ANS: C PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Nervous System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master Essentials Table and Local and General Anesthetic Medications (p. 232–236; 245): Otic benzocaine is a local anesthetic agent placed in the ear and is used to numb the ear and reduce pain for children with ear infections.

ANS: D PTS: 1 DIF: Hard TOP: Therapeutic Classification: Nervous System Medications KEY: Analysis MSC: NCLEX Category: Pharmacological Therapies NOT: See Master Essentials Table and Local and General Anesthetic Medications (p. 232–236; 245): Both classifications of medications are local anesthetics. Esters have a potential for severe allergic reactions such as anaphylactic shock and thus their use is limited to topical preparations. Amides actually last longer and novocaine is an example of an amide. Neither is used as inhaled anesthetics.

ANS: B PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Nervous System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master Essentials Table and Alcohol (p. 232–236; 245): Vitamin B and thiamine supplementation is frequently given to clients being treated with alcohol abuse and withdrawal. The vitamin B is what causes the IV fluids to be bright yellow and this is commonly referred to as a “banana bag.”

ANS: A PTS: 1 DIF: Easy TOP: Therapeutic Classification: Nervous System Medications KEY: Application MSC: NCLEX Category: Psychosocial Integrity NOT: See Master Essentials Table and Alcohol (p. 232–236; 245): Alcohol added to medication can cause confusion, vasodilatation, decreased motor coordination, and unsteady gait all of which place the client at increased risk for falls.

ANS: B PTS: 1 DIF: Hard TOP: Therapeutic Classification: Nervous System Medications KEY: Comprehension MSC: NCLEX Category: Pharmacological Therapies NOT: See Barbiturates and Antiseizure Medications (p. 232–236): Succinimides are a class of anti-seizure medications that delay the movement of calcium over the neuron. Hydantoins delay sodium crossing. Antiseizure medications are designed to reduce abnormal electrical stimulation and lower the seizure threshold.

Some medications work to intensify the effect of GABA transmitters in the brain, which suppresses abnormal

electrical activity.

22. ANS: C PTS: 1 DIF: Hard TOP: Therapeutic Classification: Nervous System Medications KEY: Comprehension MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essentials Table (p. 232–236): Selegline has precautions and contraindications for clients with heart disease. There is no identified interaction with smoking and no particular concern due to his living alone. No listed concern related to seizure history.

23. ANS: D PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Nervous System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essentials Table (p. 232–236): Diazepam is an anxiolytic that interacts with alcohol. It can cause lethargy and is addictive. It is generally recommended not to drive or operate machinery while taking this medication.

24. ANS: D PTS: 1 DIF: Hard TOP: Therapeutic Classification: Nervous System Medications KEY: Comprehension MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essentials Table (p. 232–236): Phenytoin is an anti-seizure medication that can cause impaired liver function so liver enzymes would be of the highest concern in this scenario.

25. ANS: D PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Nervous System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essentials Table (p. 232–236): Citalopram is an SSRI used in the treatment of depression.

26. ANS: B PTS: 1 DIF: Hard TOP: Therapeutic Classification: Nervous System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essentials Table (p. 232–236): Chlorpromazine is an antipsychotic medication. These medications can cause dystonic movements (uncontrolled, involuntary twitching type movements), which may remain permanent if the client remains on the medications long term. Constipation is a concerning side effect with these medications but is not the priority in this scenario. The medication is being taken for psychoses, so continued hallucinations may not be problematic; this should be investigated further by the nurse. Where the client lives is not the highest priority.

MULTIPLE RESPONSE 1. ANS: A, D, E, F PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Nervous System Medications KEY: Application MSC: NCLEX Category: Physiological Adaptation NOT: See Master Essentials Table and The Nervous System (p. 231, 232–236): The autonomic nervous system consists of those muscles over which we have no control such as pupil constriction, heart and breathing rates, release of saliva, and vasodilatation. Movement of skeletal muscles is controlled by somatic branches of the peripheral nervous system or the central nervous system.

2. ANS: B, C, D PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Nervous System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master Essentials Table and Medications to Treat Anxiety, Insomnia, Sedation, and Seizures (p.

232–236; 239–240): Phenytoin, ethosuximide, and topiramate are all antiseizure medications and could be used for this client. Atropine is an anticholinergic medication, methylphenidate is a CNS stimulant, and amitriptyline is a tricyclic antidepressant.

3. ANS: A, B, C PTS: 1 DIF: Hard TOP: Therapeutic Classification: Nervous System Medications KEY: Knowledge MSC: NCLEX Category: Pharmacological Therapies NOT: See Master Essentials Table and Local and Medications to Stabilize Mood (p. 232–236; 243): Chlorpromazine, clozapine and thioridazine are all examples of neuroleptic medications. Citalopram is an SSRI; pemoline and phentermine are CNS stimulants.

4. ANS: A, C, D PTS: 1 DIF: Hard TOP: Therapeutic Classification: Nervous System Medications KEY: Analysis MSC: NCLEX Category: Pharmacological Therapies NOT: See Master Essentials Table (p. 232–236): Tamsulosin is an adrenergic blocker typically prescribed for men with benign prostatic hypertrophy to help with urinary control. Because it is an adrenergic blocker, it can lower blood pressure and heart rate. While it may cause confusion, it should not cause drowsiness and there are no restrictions on driving for this medication. It can interact with alcohol, so alcohol should be limited. It has no addictive properties.

Chapter 14. Eye and Ear Medications Multiple Choice Identify the choice that best completes the statement or answers the question.

1. The LPN is assisting a client prepare for an eye exam. Which of the following eye drops will be used

to help allow visualization of the retina?

A. Apraclonidine HCl (lopidine) B. Acetazolamide (Diamox) C. Atropine (Atropine Ophthalmic) D. Cyclosporine (Restasis) 2. While working to assist with the admission of a client to a rehabilitation center, the LPN notes the

client takes the following medications: flunidolide (Nasalize) nasal spray daily, lamotrigine (Laical) extended release by mouth once daily and betaxolol (Betoptic S) eye drops twice daily. Based on this information, which of the following questions should the nurse ask first?

A. “How long have you been treated for an eye infection?”

B. “Do you have chronic dry eyes?

C. “When did you have eye surgery?”

D. “How long have you had glaucoma?”

3. The LPN is counseling a client newly diagnosed with glaucoma. While discussing medications that

may increase intraocular pressure, the nurse would instruct the client to use caution when taking which of the following?

A. Antihistamines B. Narcotics C. Antibiotics D. NSAIDs 4. The LPN would instruct a client using which of the following medications that the medication may

change the color of the individual’s eyes.

A. Ketorolac tromethamine (Acular) B. Dorzolamide HCl (Trusopt) C. Timilol maleate ophthalmic (Timoptic-XE) D. Bimatoprost (Lumigan) 5. The LPN is preparing to provide brimonidine tartrate (Alphagan P) eye drops to a client with

glaucoma. Which of the following instructions would the LPN include in the client teaching?

A. “This medication dilates the pupil of your eye so the fluid in your eye can drain

better.”

B. “This medication helps dilate the blood vessels in your eye and reduce the pressure within the eye ball.”

C. “These eye drops reduce the amount of fluid that your inner eye makes.”

D. “These eye drops will increase the tear production to ease your discomfort.”

6. While reviewing clients scheduled at the optometrist’s offices, the LPN determines which of the

following individuals is most likely to take medications for the treatment of glaucoma?

A. A 32-year-old patient with a history of asthma and astigmatism

B. A 74-year-old patient with a history of hypertension and diabetes C. A 61-year-old patient with a history of gastro-esophageal reflux and a hiatal hernia D. A 49-year-old patient with a history of breast cancer and anemia 7. During the care of a client with pink eye, the LPN prepares to provide gentamicin ophthalmic

(Garamycin) eye drops. Which of the statements by the LPN is best?

A. “This may burn just a bit when I instill the drops.”

B. “This medication will numb your eyes for about 15 minutes.”

C. “Your eyes will be very sensitive to light for the next 4 hours.”

D. “You will probably notice that your tears are bright yellow for a while.”

8. An LPN working in an ophthalmologist’s office is working with a client diagnosed with uveitis who

has been given a prescription for dexamethasone (AK-Dex). The nurse is aware this medication will assist with which of the following concerns?

A. Infection B. Inflammation C. Bleeding D. Intraocular pressure 9. An LPN working in an eye, ear, nose, and throat clinic, determines that long-term use of which

medications should be avoided?

A. Tetracaine (Altacaine) B. Glycerine (Osmoglyn) C. Meclizine (Antivert) D. Prednisolone ophthalmic (Econopred Plus) 10. An LPN is assisting a physician with the removal of a foreign object from the eye of a 29-year-old

individual. The LPN anticipates the physician will use which of the following medications?

A. Prednisolone ophthalmic (Econopred Plus) B. Glycerine (Osmoglyn) C. Tetracaine (Altacaine) D. Latanoprost (Xalatan) 11. A client recovering from minor eye surgery was given proparacaine (Alcaine) during the procedure.

Which of the following statements would the nurse include in the client teaching?

A. “Your eyes will probably tear uncontrollably for the next few hours.”

B. “It is important that you wear dark glasses outside.”

C. “You may notice that your tears are a strange orange color for a few days.”

D. “The medication may cause dizziness, dry mouth, and tremors.”

12. While caring for a client who just returned from cataract surgery and received glycerin (Ophthalgan

solution), the nurse would take which of the following actions?

A. Place the client in Trendelenburg position.

B. Encourage the client to reduce fiber and fluid intake for the next few days.

C. Raise the side rails and encourage the client to call for assistance out of bed.

D. Connect the client to telemetry monitoring.

13. The LPN receives a call from the parent of a 3-year-old child who was recently seen for swimmer’s

ear. The parent reports the pharmacy filled the prescription for acetic acid (Vosol) but did not tell her how to put the drops in her child’s ear. Which of the following responses by the nurse is best?

A. “Just let your child put the drops in himself, that way he won’t fight you.”

B. “Have the child sit in a chair and put his chin to his chest so the ear is facing down.”

C. “Put your child in his high chair and then have him look at the ceiling as you put in the drops.”

D. “It is usually best to have a young child lie down with the sore ear facing up.”

14. An LPN working in an outpatient clinic is counseling a client with cerumen build-up. Which of the

following over-the-counter products would be appropriate to assist with this concern?

A. Rubbing alcohol B. Hydrogen peroxide C. Witch hazel D. Baking soda 15. While talking to a neighbor who is planning a cruise, the LPN is told, “My husband really wants to

go on this trip, but I’m a little worried about this because I get so motion sick when I’m in the car for long periods or have to fly.” Which response by the nurse is best?

A. “You may want to ask your doctor to prescribe some dimenhydrinate (Dramamine).”

B. “Sometimes it is helpful to take cefaclor (Ceclor).”

C. “I imagine the crew is very familiar with people who have motion sickness; they’ll take good care of you.”

D. “Did you have a lot of morning sickness when you were pregnant?”

16. The LPN working in a physician’s office receives a call from a client who was prescribed a

transdermal scopolamine patch for use during a long trip. The client reports, “We got home yesterday and I took the patch off, but now I’m feeling a little dizzy and nauseated.” Which of the following actions should the nurse take?

A. Notify the RN of a suspected adverse drug reaction.

B. Determine if the client has an allergy to any anti-emetics.

C. Reassure the client that this is a normal side effect of the medication and her symptoms should improve within a day.

D. Suggest the client come in to be evaluated by the physician.

17. A 69-year-old client comes to his primary physician’s office complaining of difficulty hearing.

Which action by the nurse is best?

A. Determine the client’s smoking history.

B. Examine the client’s ears for cerumen.

C. Ask the client if he or she has been taking medications for hypertension.

D. Inform the RN that the client will need a referral to an audiologist.

18. While assisting in an outpatient recover room, the LPN recognizes which of the following

individuals is at highest risk for fluid or electrolyte concerns?

A. A 59-year-old patient given glycerin (Osmoglyn) preoperatively for cataract

surgery

B. A 44-year-old patient with a history of glaucoma who takes carbachol (Isopto

Carbachol) C. A 61-year-old patient who takes meclizine (Antivert) for vertigo D. A 57-year-old patient who had surgery for a ruptured ear drum 19. An LPN is preparing to provide eye drops for an elderly client in a long-term care facility. The client

is ordered Restasis. Which of the following statements should the nurse include in the teaching?

A. “This medication helps relieve the chronic dryness in your eyes.”

B. “This is to treat your eye infection, which is looking much better.”

C. “This is one of your glaucoma eye drops; I’ll give you the other one tonight.”

D. “This medicine will make your pupils dilate, so it might be hard to watch TV for a

while.”

Multiple Response Identify one or more choices that best complete the statement or answer the question.

1. The LPN is working with the mother of a 10-year-old patient diagnosed with conjunctivitis. The

nurse would determine teaching was effective by which of the following statements? (Select all that apply).

A. “I should have my daughter wash her hands frequently and thoroughly.”

B. “It is important that she not rub her eyes.”

C. “There isn’t much that can be done; we just have to wait for it to heal on its own.”

D. “Eye infections aren’t really contagious so she we don’t have to worry about her siblings.”

E. “This is an infection of the oil gland and will get better with treatment.”

F. “I should have her use the antibiotic ointment for the full 7 days.”

2. In reviewing eye medications used at the ophthalmologist’s office, the LPN is aware that diclofenac

solution (Cambia) would be contraindicated for which of the following individuals? (Select all that apply.)

A. An 18-year-old patient with iritis and has diabetes B. A 24-year-old patient with local eye irritation who is 4 months pregnant C. A 41-year-old patient with minor eye injury who has a broken wrist D. A 55-year-old patient with conjunctivitis who has asthma E. A 34-year-old patient with uveitis who has hypertension 3. The LPN recognizes that systemic antibiotics such as clavulanate potassium (Augmentin) would be

necessary for which of the following clients? (Select all that apply.)

A. A 2-year-old patient with an outer ear infection B. A 5-year-old patient with an inner ear infection C. A 10-year-old patient with a middle ear infection D. A 12-year-old patient with cerumen E. A 15-year-old patient with vertigo 4. While participating in the care of a client who received gentamicin ophthalmic (Garamycin), the

LPN may suspect ototoxicity if the client reported which of the following symptoms. (Select all that apply.)

A. Fever B. Seizure activity C. Hearing loss D. Ringing in the ears E. Swelling in the ankles F. Altered balance Matching

An LPN is preparing to provide pilocarpine HCl ophthalmic solution. Place the steps of medication delivery in the proper order.

A. Tilt the client’s head back and pull lower lid down.

B. Remove the cap of the bottle.

C. Wash hands thoroughly.

D. Press gently on the inside corner of the eye.

E. Hold the bottle upside down and release one drop.

1. First 2. Second 3. Third 4. Fourth 5. Fifth

Place the following steps in correct order for the provision of ear drops in a 10-year-old child.

A. Place the wrist of the hand holding the dropper on the child’s cheek.

B. Squeeze the dropper to release the required dose.

C. Position the child lying down with the affected ear up.

D. Gently pull the outer ear up and back to straighten the canal.

E. Roll the medication gently in your hand to warm it.

6. First 7. Second 8. Third 9. Fourth

10.

Fifth

Chapter 14. Eye and Ear Medications Answer Section MULTIPLE CHOICE 1. ANS: C PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Eye and Ear Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Medications for Glaucoma (p. 253–255; 256): Medications such as atropine are used to facilitate eye examinations. Apraclonidine HCl is used to treat eye irritation, acetazolamide is used to treat glaucoma, and cyclosporine is used to increase tear production.

2. ANS: D PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Eye and Ear Medications KEY: Analysis MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Medications for Glaucoma (p. 253–255; 256): Betaxolol is an ophthalmic beta blocker used in the treatment of glaucoma.

3. ANS: A PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Eye and Ear Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Medications for Glaucoma (p. 253–255; 256): Some medications, such as glucocorticoids, antihypertensives, antihistamines, and antidepressants can predispose a patient to increased intraocular pressure because of a decrease in aqueous humor flow in the eye.

4. ANS: D PTS: 1 DIF: Hard TOP: Therapeutic Classification: Eye and Ear Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Medications for Glaucoma (p. 253–255; 256): Prostoglandins such as bimatoprost (Lumigan) dilate the meshwork in the anterior chambers in the Schlemm’s canals. One side effect of prostaglandins in that they change the pigmentation of the iris and thus the color of the eye.

5. ANS: B PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Eye and Ear Medications KEY: Analysis MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Medications for Glaucoma (p. 253–255; 256): Brimonidine tartrate is an alpha blocker and works to dilate blood vessels in the eye; they treat glaucoma by decreasing the production of and increasing the drainage of aqueous humor.

6. ANS: B PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Eye and Ear Medications KEY: Application MSC: NCLEX Category: Physiological Adaptation NOT: See Master the Essential Table and Medications for Glaucoma (p. 253–255; 256): Glaucoma is more prevalent among patients with hypertension, diabetes, migraines, nearsightedness and farsightedness, as well as patients of advanced age.

7. ANS: A PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Eye and Ear Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Medications for Eye Irritations and Infections (p. 253–255; 257): Gentamicin is an ophthalmic antibiotic and can cause a burning sensation in the eyes. Local ophthalmic anesthetic agents numb the eye and block the blink reflex. Cycloplegic mydriatics dilate the pupil for an eye exam making the client sensitive to light. Staining agents are used to diagnose corneal defects.

8. ANS: B PTS: 1 DIF: Moderate

9.

10.

11.

12.

13.

14.

15.

TOP: Therapeutic Classification: Eye and Ear Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Medications for Eye Irritations and Infections (p. 253–255; 257): Dexamethasone is an ophthalmic corticosteroid used for inflammation and pain related to eye injury or surgery. Uveitis is an inflammation of the eye.

ANS: D PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Eye and Ear Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Medications for Eye Irritations and Infections (p. 253–255; 257): Ophthalmic glucocorticosteroids should not be used as long-term treatment because they could suppress the immune response. Prednisolone ophthalmic is an ophthalmic corticosteroid. Tetracaine is an ophthalmic anesthetic. Glycerin is an osmotic diuretic. Meclizine is an antivertigo agent.

ANS: C PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Eye and Ear Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Medications for Eye Examinations (p. 253–255; 257): Tetracaine is an ophthalmic anesthetic used in for the removal of foreign objects. Prednisolone ophthalmic is an ophthalmic corticosteroid. Glycerin is an osmotic diuretic. Latanoprost is an ophthalmic prostaglandin.

ANS: B PTS: 1 DIF: Hard TOP: Therapeutic Classification: Eye and Ear Medications KEY: Analysis MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Medications for Eye Examinations (p. 253–255; 257): Proparacaine is a local anesthetic for the eye used in minor surgical procedures. The blink reflex is impaired with these agents so it is important to inform the patient to wear darkened glasses when going outside until the effect of the medication wears off. No excess tearing discoloration of the tears is expected. Dizziness, dry mouth, and tremors are side effects associated with osmotic diuretics used to treat glaucoma or prior to surgery when the amount of aqueous humor needs to be reduced rapidly; the client was not given a medication from this category of drugs.

ANS: C PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Eye and Ear Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Medications for Glaucoma (p. 253–255; 256): Glycerin is an osmotic diuretic used in eye surgery to reduce the amount of aqueous humor. These medications can cause dizziness, fluid and electrolyte imbalance, headache, nausea, vomiting, disorientation, and confusion. The client will be at increased risk for falls or other injury, so the side rails should be elevated and the client instructed to call for help. Trendelenburg position is not necessary; generally bending and lifting are limited after surgery. Fluids and fiber will be increased to reduce the risk of constipation, which would cause straining and increase intraocular pressure. Telemetry monitoring is not necessary.

ANS: D PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Eye and Ear Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Ear Medications (p. 253–255; 258): Ear drops in a child are best given with the child lying down with the affected ear facing up. It would not be appropriate for such a young child to give his/her own drops.

ANS: B PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Eye and Ear Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Medications and Ear Medications (p. 253–255; 259): Hydrogen peroxide can be used to decrease the amount of earwax if problems are occurring.

ANS: A PTS: 1 DIF: Moderate

16.

17.

18.

19.

TOP: Therapeutic Classification: Eye and Ear Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Medications and Ear Medications (p. 253–255; 259): Dimenhydrate is an antivertigo agent used in the prevention of motion sickness and should be taken 20 to 60 minutes prior to travel. Cefaclor is a systemic antibiotic. While the crew is most likely familiar with motion sickness, the nurse should address the question as stated rather than defer to other care takers. A history of morning sickness will increase the risk of motion sickness; however, that assessment is not the priority in this scenario.

ANS: C PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Eye and Ear Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Medications and Drug Spotlight 14.1 (p. 253–255; 259): Transdermal scopolamine is used for prevention of nausea and vomiting associated with motion sickness.

Drug withdrawal symptoms usually occur 24 hours after the patch is removed and include dizziness, nausea, vomiting, and headache.

ANS: B PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Eye and Ear Medications KEY: Application MSC: NCLEX Category: Basic Care and Comfort NOT: See Master the Essential Table and Medications (p. 253–255; 257): Cerumen is earwax, secreted by the auditory canal. Too much earwax can cause a blockage leading to loss of hearing, so the ears should be examined as a first step in exploring this client’s complaint. Smoking has not been linked to hearing loss.

Antibiotics and other drugs can cause ototoxicity, but anti-hypertensive agents are not typically associated with this concern. A referral may be needed but the ears should be examined first.

ANS: A PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Eye and Ear Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Medications (p. 253–255): Glycerin is an osmotic diuretic used to decrease intraocular pressure and can cause fluid and electrolyte disturbances.

ANS: A PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Eye and Ear Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Medications and Miscellaneous Eye Medications (p. 253–255; 257): Restasis works to treat a certain type of chronic dry eye by increasing tear production. It will not cause pupil dilatation.

MULTIPLE RESPONSE 1. ANS: A, B, F PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Eye and Ear Medications KEY: Application MSC: NCLEX Category: Safety and Infection Control NOT: See Master the Essential Table and Medications for Eye Irritations and Infections (p. 253–255; 257): One of the most common infections of the eye is conjunctivitis. It is treated with antibiotics and should be treated swiftly and completely. Eye infections can spread so it is important to have meticulous hand washing and patients should be advised not to rub the infected eye. An infection of the oil gland is called a sty.

2. ANS: A, B PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Eye and Ear Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Medications for Eye Irritations and Infections (p. 253–255; 257): For minor eye injury and irritation, NSAIDs can be used; however they are contraindicated in pregnancy and in patients with diabetes and bleeding disorders.

3. ANS: B, C PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Eye and Ear Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Ear Medications (p. 253–255; 258): Systemic antibiotics are needed for middle or inner ear infections. Outer ear infections are treated with antibiotic ear drops. Cerumen is treated with mineral oil or cerumenolytics, and meclizine is given for the treatment of vertigo.

4. ANS: C, D, F PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Eye and Ear Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Medications and Ototoxicity (p. 253–255; 259): Ototoxicity is damage to the ears and commonly occurs with certain antibiotics such as gentamicin. Symptoms include tinnitus (ringing in the ears), hearing loss, severe headache, ataxia, and balance disturbances.

MATCHING 1. ANS: C PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Eye and Ear Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Medications for Glaucoma (p. 253–255; 256): A procedure manual should be consulted to view the steps involved in providing eye medications. The nurse should wash hands thoroughly, remove the bottle’s cap, have the client tilt head back slightly, pull the lower lid down to form a pocket and then hold the bottle upside down and release one drop into the eye. Have the client press gently on the inside corner of the eye to prevent spillage or drainage down the lacrimal duct.

2. ANS: B PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Eye and Ear Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Medications for Glaucoma (p. 253–255; 256): A procedure manual should be consulted to view the steps involved in providing eye medications. The nurse should wash hands thoroughly, remove the bottle’s cap, have the client tilt head back slightly, pull the lower lid down to form a pocket and then hold the bottle upside down and release one drop into the eye. Have the client press gently on the inside corner of the eye to prevent spillage or drainage down the lacrimal duct.

3. ANS: A PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Eye and Ear Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Medications for Glaucoma (p. 253–255; 256): A procedure manual should be consulted to view the steps involved in providing eye medications. The nurse should wash hands thoroughly, remove the bottle’s cap, have the client tilt head back slightly, pull the lower lid down to form a pocket and then hold the bottle upside down and release one drop into the eye. Have the client press gently on the inside corner of the eye to prevent spillage or drainage down the lacrimal duct.

4. ANS: E PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Eye and Ear Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Medications for Glaucoma (p. 253–255; 256): A procedure manual should be consulted to view the steps involved in providing eye medications. The nurse should wash hands thoroughly, remove the bottle’s cap, have the client tilt head back slightly, pull the lower lid down to form a pocket and then hold the bottle upside down and release one drop into the eye. Have the client press gently on the inside corner of the eye to prevent spillage or drainage down the lacrimal duct.

5. ANS: D PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Eye and Ear Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies

NOT: See Master the Essential Table and Medications for Glaucoma (p. 253–255; 256): A procedure manual should be consulted to view the steps involved in providing eye medications. The nurse should wash hands thoroughly, remove the bottle’s cap, have the client tilt head back slightly, pull the lower lid down to form a pocket and then hold the bottle upside down and release one drop into the eye. Have the client press gently on the inside corner of the eye to prevent spillage or drainage down the lacrimal duct.

6. ANS: C PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Eye and Ear Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Ear Medications (p. 253–255; 258): The child should be positioned in a lying position with the affected ear up. Ear drops should be warmed slightly by rolling the bottle in your hands. Place your dominant hand holding the medication dropper on the child’s cheek/head, gently pull the outer ear up and back for a child over the age of 3, and squeeze the dropper to release the dose. Have the child remain still for a few minutes so the medication can be absorbed.

7. ANS: E PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Eye and Ear Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Ear Medications (p. 253–255; 258): The child should be positioned in a lying position with the affected ear up. Ear drops should be warmed slightly by rolling the bottle in your hands. Place your dominant hand holding the medication dropper on the child’s cheek/head, gently pull the outer ear up and back for a child over the age of 3, and squeeze the dropper to release the dose. Have the child remain still for a few minutes so the medication can be absorbed.

8. ANS: A PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Eye and Ear Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Ear Medications (p. 253–255; 258): The child should be positioned in a lying position with the affected ear up. Ear drops should be warmed slightly by rolling the bottle in your hands. Place your dominant hand holding the medication dropper on the child’s cheek/head, gently pull the outer ear up and back for a child over the age of 3, and squeeze the dropper to release the dose. Have the child remain still for a few minutes so the medication can be absorbed.

9. ANS: D PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Eye and Ear Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Ear Medications (p. 253–255; 258): The child should be positioned in a lying position with the affected ear up. Ear drops should be warmed slightly by rolling the bottle in your hands. Place your dominant hand holding the medication dropper on the child’s cheek/head, gently pull the outer ear up and back for a child over the age of 3, and squeeze the dropper to release the dose. Have the child remain still for a few minutes so the medication can be absorbed.

10. ANS: B PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Eye and Ear Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Ear Medications (p. 253–255; 258): The child should be positioned in a lying position with the affected ear up. Ear drops should be warmed slightly by rolling the bottle in your hands. Place your dominant hand holding the medication dropper on the child’s cheek/head, gently pull the outer ear up and back for a child over the age of 3, and squeeze the dropper to release the dose. Have the child remain still for a few minutes so the medication can be absorbed.

Chapter 15. Endocrine System Medications Multiple Choice Identify the choice that best completes the statement or answers the question.

1. The LPN is visiting a new mother and her infant. The mother says, “The doctor told us the baby has

cretinism and will have to take hormone therapy.” The LPN identifies that which of the following hormone imbalances occurred during the pregnancy?

A. The mother’ body released too much cortisol.

B. The mother’s body did not release enough thyroid hormone.

C. The mother’s body released too much calcitonin.

D. The mother’s body did not release enough somatotropin.

2. While shopping in the mall, the LPN notices a woman with bulging eyes. The LPN knows this

condition is related to which of the following hormonal conditions?

A. Hyperthyroidism B. Hypoparathyroidism C. Hypothyroidism D. Hyperparathyroidism 3. An LPN working in a family practice office talks to a client who recently received sodium iodine

131 for the treatment of hyperthyroidism. Which of the following assessments by the nurse is best?

A. Determine if the client has been experiencing any hair loss.

B. Ask the client to report sleeping patterns since treatment.

C. Obtain a diet history for the past 24 hours.

D. Take the client’s vital signs and note any tachycardia.

4. While providing morning medications, the LPN is aware that the risk of interactions is highest for a

client taking levothyroxine (Levothroid) concurrently with which of the following?

A. Lanoxin (Digoxin) B. Fluticasone (Flonase) C. Granisetron (Kytril) D. Insulin 5. While participating in the care of a client with Grave’s disease who is taking methimazole (Northyx),

the LPN would be most concerned by which of the following symptoms?

A. The client reports increased frequency of headaches.

B. The client’s hemoglobin has dropped 2 gm/dL in the past 2 months.

C. The client has gained 3 pounds in one month.

D. The client says, “I still have trouble remembering to take that pill; I think I forgot it

three times last month.”

6. While working with clients in an obstetric office, the LPN assists with the care of a client taking

liothyronine (Cytomel). The client states, “My husband and I are hoping to start our family soon. Do you know if I can take this while I’m pregnant?” Which response by the nurse is best?

A. “How long have you been taking the liothyronine?”

B. “Does your husband have any thyroid problems?”

C. “It is generally safe to take that medication during pregnancy.”

D. “That’s a big decision. The doctor may need to run some blood tests.”

7. In assisting with the care of a client who recently had a thyroidectomy, the nurse would monitor

which of the following laboratory values closely?

A. White blood cells B. Serum calcium C. Serum potassium D. Platelets 8. When preparing to provide morning medications, the LPN would give levothyroxine (Synthroid)

ordered daily in which of the following manners?

A. In the morning before breakfast and without any other medications B. In the morning with breakfast C. In the morning on an empty stomach with other daily meds D. In the evening before bedtime with a snack 9. The LPN is assisting in the care of a client with diabetes mellitus. The nurse aide reports the client’s

blood sugar result is 58 and the client is awake and reports feeling shaky and weak. Which action should the nurse take first?

A. Recheck the client’s blood sugar with another meter.

B. Notify the RN the client needs intravenous GlucaGen. C. Take the client’s vital signs.

D. Provide the client with oral BD Glucose.

10. At 8 a.m. the LPN is reviewing client assignments and notes one of the clients has a current blood

glucose of 264. Breakfast is routinely served at 8:30. The following orders are noted in the chart.

What action should the nurse take?

Accucheck ac and hs with sliding scale Insulin Aspart SQ: Glucose 0–150 0 units 151–200 2 units 201–250 4 units 251–300 6 units 301–350 8 units 351–400 10 units ➢ 400 Notify physician A. Provide 4 units insulin aspart SQ. B. Determine if the client has eaten anything.

C. Provide 6 units insulin aspart SQ. D. Inform the nursing assistant the blood sugar should be rechecked closer to

breakfast.

11. At 10 p.m. the LPN notes one of the clients has a blood glucose of 351. The client has sliding scale

insulin ordered as noted below. What action by the nurse is best?

Accucheck ac and hs with sliding scale Insulin Aspart SQ: Glucose 0–150 0 units 151–200 2 units

201–250 251-300 301–350 351–400 ➢ 400

4 units 6 units 8 units 10 units Notify physician

A. Provide 10 units insulin aspart SQ. B. Provide 8 units insulin aspart SQ. C. Notify the physician.

D. Ask the client if he or she is experiencing increased thirst or urination.

12. The LPN is preparing to give Lantus insulin and notices that the vial is cloudy and dated with an

open date of one week ago. Which action should the nurse take?

A. Shake the bottle to disperse the liquid.

B. Roll the bottle between the fingers prior to drawing up the dose.

C. Notify the RN that a new bottle of insulin is needed from the pharmacy.

D. Check to see if another client has a bottle of Lantus insulin that can be used.

13. The LPN is working with a client who has cystic fibrosis and takes pancrelipase (Ultrase) daily with

each meal. The nurse may expect to see which of the following?

A. Greasy stools and gas production B. Clay colored stool that floats C. Dark, tarry stools D. Soft brown stool passed once or twice daily 14. While assisting in the care of a client newly prescribed glimepiride (Amaryl), the LPN would

counsel the client to avoid which of the following?

A. Products containing Tylenol B. Products containing ibuprofen C. Products containing aspirin D. Herbal preparations with melatonin 15. The LPN performs a routine finger stick to check glucose and obtains a reading of 279 g/dL. The

LPN would anticipate standing orders to provide sliding scale coverage with which of the following types of insulin?

A. Humalog 75/25 B. Regular C. Ultralente D. Novolin 70/30 16. The LPN provides a client with NPH insulin at 8 a.m. and expects the insulin to take effect at

approximately what time?

A. 8:30 a.m.

B. 9:30 a.m.

C. 12 p.m.

D. 4 p.m.

17. The LPN provides a client with daily Lente insulin at bedtime. The client states, “I’ve never really

understood why I take insulin at night when I eat during the day.” Which response by the nurse is best?

A. “This insulin doesn’t start to work for 6 to 8 hours.

B. “Your pancreas makes insulin at night and the medication is stimulating your pancreas.”

C. “We give insulin at night to help cover the glucose released as you digest your dinner.”

D. “This is a long-acting insulin that lasts 18 to 24 hours for sustained control of your sugar.”

18. The LPN prepares to provide a client with scheduled Lispro insulin. Which action should the nurse

take first?

A. Ensure the client has something to eat within 15 minutes of insulin provision.

B. Instruct the client not to eat for at least 2 hours after insulin provision.

C. Determine the number of calories expected in the next meal.

D. Ask the client how many “carbs” have been consumed for the day thus far.

19. An LPN who works as a travel nurse is preparing to provide a client with both regular and long-

acting insulin. Which of the following steps should the nurse take?

A. Draw up the long-acting insulin first and then the regular.

B. Use two syringes, one for each type of insulin.

C. Draw up the regular insulin first and then the long-acting insulin.

D. Check the institutional policy regarding mixing of insulin.

20. The LPN is assisting in the care of a client newly diagnosed with Addison’s disease. The nurse

would expect to see new orders for which of the following?

A. Levothyroxine (Levothroid) B. Fludrocortisone acetate (Florinef) C. Nandrolone decanoate D. Methimazole (Tapazole) 21. A client taking metyrapone (Metopirone) tells the nurse that she would like to consider becoming

pregnant. The nurse’s response would be based on what information?

A. Metyrapone is a naturally occurring replacement hormone.

B. Pregnancy and breastfeeding are contraindicated for those taking metyrapone.

C. Clients who are pregnant are typically given increased doses to help support

metabolic need.

D. Metyrapone causes sterility and this woman will not be able to conceive.

22. A nurse working in a public school system is alerted to a rumor that many of the high school athletes

are using anabolic steroids to enhance their growth and performance. The nurse recognizes the use of these medications will increase the students’ risk for which of the following?

A. Mental illness B. Thyroid disorders C. Atherosclerosis D. Kidney failure

23. A patient with newly diagnosed type 2 diabetes has been instructed on self-administration of insulin.

Which of the following statements indicates patient teaching has been effective?

A. “The first thing I should do is shake the insulin bottle.”

B. “This medicine will help cure my diabetes if I use it regularly for a few months.”

C. “I should check my blood sugar at least three times a day and keep a record of

results.”

D. “I can pick one roll of fatty tissue for the shot and rotate places each week.”

24. The nurse is caring for a patient who is NPO after midnight for a bronchoscopy scheduled for 12:30

p.m. The patient normally receives acetohexamide (Dymelor) and the dose is currently due. The patient’s Accucheck result was 106. Which action by the nurse is best?

A. Hold the medication and monitor blood sugars frequently B. Give the medication with a cup of milk C. Give the medication with a sip of water D. Ask the client if he is feeling shaky or weak 25. A nurse caring for an individual taking chlorpropamide (Diabinese) would monitor which of the

following lab values to determine treatment effectiveness?

A. Glycosylated hemoglobin B. Serum progesterone levels C. Serum calcium D. Thyroid stimulating hormone (TSH) levels 26. The LPN is assisting with the care of a 38-year-old woman newly prescribed levothyroxine

(Levothroid). The nurse should include which of the following statements in the client teaching?

A. “You should take this medication at roughly the same time each day.”

B. “Once you’ve been taking this medication for a few weeks you should be cured

and the doctor will stop it.”

C. “Avoid eating broccoli or other cruciferous vegetables while taking this

medication.”

D. “The nice thing about this medication is that you won’t have a menstrual cycle

anymore.”

27. While working with a 35-year-old woman who started taking methimazole (Tapazole), the nurse

would expect to find which of the following interventions in the plan of care?

A. Teach the client self-injection techniques B. Monitor for signs and symptoms of hyperthyroidism or hypothyroidism C. Place client in protective isolation D. Perform Accucheck testing with each meal and at bedtime Multiple Response Identify one or more choices that best complete the statement or answer the question.

1. A client taking levothyroxine (Levothroid) should be counseled to anticipate which of the following

side effects? (Select all that apply.)

A. Somnolence B. Weight gain

C. Palpitations D. Hypotension E. Menstrual irregularities F. Tremors 2. The LPN identifies new orders for Novolog insulin to be given via pen device. Identify the correct

actions taken by the nurse. (Select all that apply.)

A. Remove the insulin pen from the refrigerator.

B. Return the insulin pen to the refrigerator after the dose is provided.

C. Return the insulin pen to the client’s medication drawer after provision.

D. Label the new pen device with the client’s name and birth date.

E. Identify the expiration date as 14 days after the initial dose and place this on the

label.

F. Use a standard pen device shared by multiple clients.

3. An LPN is working in a physician’s office that provides care for a number of clients on oral

antihyperglycemic agents such as glyburide (Diabeta). The LPN understands which of the following statements about these clients is also true?

A. They have been diagnosed with diabetes mellitus type 1.

B. They will never need any insulin.

C. Diet modification and exercise may control their diabetes.

D. Their bodies make insulin but do not utilize insulin correctly.

E. They will also need to take replacement enzymes such as pancrelipase (Pancrease).

4. An LPN supporting a client, who has recently been taught how to provide self-injection of insulin,

recognizes the client understands the teaching if which of the following sites are chosen? (Select all that apply.)

A. Front of the abdomen about 2 inches from the belly button B. Back of the upper arm C. Along the front of the lower arm D. Top of the thigh slightly lateral from midline E. Inner aspect of the thigh just above the knee 5. A student nurse assisting in the care of a client with diabetes type 2 is preparing to provide 12 units

of Novolog 70/30. When asked by the instructor to explain the medication, the student would include which of the following statements?

A. “This is a premixed insulin that has both short-acting and longer-acting agents.”

B. “This insulin will last 16 to 20 hours.”

C. “The onset for this insulin is approximately 15 minutes.”

D. “Clients generally use this insulin once a day.”

E. “This insulin is an intermediate-acting agent and lasts 5 to 8 hours.”

6. While walking in the mall an LPN notices an obese woman with a rounded face, and facial hair. The

LPN suspects the woman has Cushing’s disease. Which of the following health concerns would most likely also be present in the woman? (Select all that apply.)

A. Anemia B. Hypertension C. Hyperglycemia

D. Cirrhosis E. Hypercoagulability 7. An LPN works with a client with pancreatic cancer who underwent a partial pancreatectomy two

months earlier. The client now wears an insulin pump. The LPN bases care on which of the following facts?

A. The pump utilizes long-acting and short-acting insulin.

B. The pump can deliver a base rate of insulin continuously.

C. The pump can be programmed to provide extra insulin as needed.

D. The pump is instilled inside the client’s body with a small catheter that feeds into a large blood vessel.

E. Drug delivery is provided via a small subcutaneous needle.

F. The client will also need to take pancrelipase (Creon) with meals.

Matching

The LPN is preparing to provide 14 units of Levimir insulin sq. Place the following steps in correct order.

A. Roll the insulin bottle between your fingers.

B. Draw up 14 units of Levimir insulin.

C. Verify the correct medication and dose on the medication administration record.

D. Select and clean the site with alcohol and let it dry.

E. Identify the client by name and birth date.

F. Inject the needle into subcutaneous tissue and push the plunger.

G. Discard the syringe/needle in the sharps container.

1. First 2. Second 3. Third 4. Fourth 5. Fifth 6. Sixth

7.

Seventh

Chapter 15. Endocrine System Medications Answer Section MULTIPLE CHOICE 1. ANS: B PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Endocrine System Medications KEY: Comprehension MSC: NCLEX Category: Physiological Adaptation NOT: See Master the Essential Table and Medications for Thyroid and Parathyroid Disorders (p. 267–269; 269): A decrease in thyroid hormone secretion in utero and early infancy causes cretinism.

2. ANS: A PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Endocrine System Medications KEY: Comprehension MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Medications for Thyroid and Parathyroid Disorders (p. 267–269; 269): Hyperthyroidism results from an excess of thyroid hormone leading to Grave’s disease, characterized by bulging eyes.

3. ANS: D PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Endocrine System Medications KEY: Analysis MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Drug Spotlight 15.1 (p. 267–269; 270): Radioactive iodine is given in the treatment of an over active thyroid. Side effects include nausea, vomiting, chest pain, tachycardia, and hypersensitivity. The most important assessment listed would be vital signs and determining if the client had experienced any chest pain. Hair loss is not expected. Sleep alterations are not expected. Diet history would only be relevant if the client was experiencing nausea and vomiting.

4. ANS: D PTS: 1 DIF: Hard TOP: Therapeutic Classification: Endocrine System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Medications for Thyroid and Parathyroid Disorders (p. 267-269; 269): Thyroid medications such as levothyroxine interact with adrenergics, insulin, oral anticoagulants, and oral hypoglycemic agents.

5. ANS: B PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Endocrine System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Medications for Thyroid and Parathyroid Disorders (p. 267–269; 269): Methimazole is an antithyroid medication that can cause paresthesia, headache, rash, and agranulocytosis. Further evaluation of the client’s bone marrow function should be investigated with such a significant drop in hemoglobin; sources of potential bleeding may also need to be investigated to verify the drop is related to agranulocytosis rather than acute blood loss. Headaches can occur as a side effect and could be managed with over-the-counter pain medications at the physician’s discretion. Weight gain is not associated with the medication and is not the highest priority. Compliance and regular scheduling of medications is important but is not the priority in this scenario.

6. ANS: C PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Endocrine System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Medications for Thyroid and Parathyroid Disorders (p. 267–269; 269): Because this medication is a naturally occurring substance being replaced, it is safe for use during pregnancy, although breast feeding should be discussed with the physician. Thyroid levels are followed routinely, but the client’s question should be addressed by the nurse. It doesn’t matter how long the client has

7.

8.

9.

10.

11.

12.

13.

been taking the medication.

ANS: B PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Endocrine System Medications KEY: Application MSC: NCLEX Category: Reduction of Risk Potential NOT: See Master the Essential Table and Medications for Thyroid and Parathyroid Disorders (p. 267–269; 269): The thyroid and parathyroid glands are responsible for calcium balance in the body so the nurse would monitor serum calcium most closely.

ANS: A PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Endocrine System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Medications for Thyroid and Parathyroid Disorders (p. 267–269; 269): Levothyroxine is a thyroid hormone replacement that should be given at the same time each day on an empty stomach with no other medications given concurrently since consistent metabolism of the drug allows for stable blood levels. Giving the medication at night may increase the instance of insomnia.

ANS: D PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Endocrine System Medications KEY: Application MSC: NCLEX Category: Physiological Adaptation NOT: See Master the Essential Table and Medications to Treat Pancreatic Disorders (p. 267–269; 270–271): Hypoglycemia is normally treated with a small dose of glucose such as hard candy or oral glucose preparations such as BD Glucose. Intravenous or injectable glucose would only be given if the client was unconscious or couldn’t take oral medications. There is no need to recheck the glucose or take vital signs since the higher priority is to elevate the glucose level at this time.

ANS: C PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Endocrine System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Medications to Treat Pancreatic Disorders (p. 267–269; 270–271): Insulin Aspart is a short-acting insulin frequently used for sliding scale coverage and is often given prior to meals so it starts to work as food is being digested. Since the client will be eating within 15 to 30 minutes of the time the insulin is provided, the nurse can safely give the insulin at this time. Six units would be required for a glucose level of 264.

ANS: C PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Endocrine System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Medications to Treat Pancreatic Disorders (p. 267–269; 270–271): Insulin Aspart is a short-acting insulin frequently used for sliding scale coverage and is often given at bedtime to help maintain tight control of blood sugar levels. Ten units would be required for a glucose level of 351.

Signs or symptoms of hyperglycemia will most likely be present and will not alter the nurse’s decision to provide insulin coverage based on the ordered scale.

ANS: B PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Endocrine System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Medications to Treat Pancreatic Disorders (p. 267–269; 270–273): Long-acting insulin, including Lantus, is cloudy by nature. Proper handling involves rolling the vial between your fingers; do not shake the vial. A new vial is not needed since the expiration date is 1 month from the open date.

ANS: A PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Endocrine System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Medications to Treat Pancreatic Disorders (p. 267–269; 273): In clients with cystic fibrosis, the ducts in the pancreas become blocked with thick mucus and are unable to

14.

15.

16.

17.

18.

19.

20.

secrete pancreatic enzymes needed for digestion. They must take replacement enzymes with every bite of food they ingest. Side effects include nausea, vomiting, stomach pain, diarrhea, constipation, greasy stools, and gas. Clay colored stools are seen when bile is not adequately produced or released into the small intestines. Dark, tarry stools are seen with gastrointestinal bleeding. Soft brown stools passed once or twice daily represents a normal bowel pattern and may or may not be seen for this client.

ANS: C PTS: 1 DIF: Hard TOP: Therapeutic Classification: Endocrine System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Medications to Treat Pancreatic Disorders (p. 267–269; 270–271): Oral antidiabetic agents may interact with alcohol, MAO inhibitors, corticosteroids, salicylates (aspirin), and warfarin. The other medications and herbal products can be taken.

ANS: B PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Endocrine System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Types of Insulin (p. 267–269; 271–273): Regular insulin is a shortacting insulin that would be provided as coverage for an isolated, elevated glucose level. Humalog 75/25, Ultralente, and Novolin 70/30 are all premixed or long-acting insulin, not used for coverage.

ANS: B PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Endocrine System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Types of Insulin (p. 267–269; 271–273): The onset of action for NPH insulin is 1 to 2 hours, so the best option is 9:30 a.m.

ANS: D PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Endocrine System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Types of Insulin (p. 267–269; 271–273): Lente is an intermediate acting insulin with an onset of 1 to 2.5 hours and a duration of 18 to 24 hours. Insulin is given as a replacement for clients with type 1 or type 2 diabetes when their body is no longer able to make sufficient insulin; oral antidiabetic agents stimulate the pancreas to increase insulin production.

ANS: A PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Endocrine System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Types of Insulin (p. 267–269; 271–273): Lispro insulin is rapidly acting within 15 to 30 minutes, so it is important that the client be preparing or ready to eat with insulin provision. This type of insulin only lasts 3 to 5 hours and is generally given around meals. Insulin provision may be based on the number of carbohydrates included in the current meal, but will not be based on calories or previously consumed carbohydrates.

ANS: D PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Endocrine System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Types of Insulin (p. 267–269; 271–273): Generally the clear, regular insulin is drawn up first, followed by the cloudy, long-acting insulin. However, the practice of mixing insulin is not used in many institutions so the agency protocol should be checked prior to administration.

ANS: B PTS: 1 DIF: Hard TOP: Therapeutic Classification: Endocrine System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Medications that Treat Adrenal Disorders (p. 267–269; 274): Corticosteroid medications, such as fludrocortisones acetate, are used to treat Addison’s disease, which occurs when the adrenal cortex undersecretes glucocorticoid hormones. Levothyroxine is used to replace thyroid hormone. Methimazole is an anti-thyroid medication. Nandrolone decanoate is an anabolic steroid.

21. ANS: B PTS: 1 DIF: Hard TOP: Therapeutic Classification: Endocrine System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Medications that Treat Adrenal Disorders (p. 267–269): Metyrapone is a cortisol-inhibiting medication used in the treatment of Cushing’s disease; it is not a naturally occurring hormone. Pregnancy and breastfeeding are contraindications/precautions for this medication.

22. ANS: C PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Endocrine System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Medications that Treat Adrenal Disorders (p. 267–269; 274): Side effects of anabolic steroids include aggressive behavior, rage, atherosclerosis, sterility, and liver cancer.

23. ANS: C PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Endocrine System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Medications to Treat Pancreatic Disorders (p. 270–273): Blood sugar is frequently checked and coverage provided with sliding scale regular insulin. Insulin should be rolled not shaken. Diabetes is a chronic illness that is not cured with insulin although proper diet and weight management can keep it well controlled for some individuals. Sites should be rotated daily/with each injection.

24. ANS: C PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Endocrine System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Medications to Treat Pancreatic Disorders (p. 270–273): The client’s current glucose is stable and symptoms of hypoglycemia are not expected. The client will remain NPO. Institutional policy should be followed in these situations, but most typically the medication is held, blood sugar testing is done frequently, and therapy is resumed at the physician’s order.

25. ANS: A PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Endocrine System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Medications to Treat Pancreatic Disorders (p. 270–273): Chlorpropamide is an oral antidiabetic medication so glycosylated (A1C) hemoglobin levels will be most valuable in determining long-term efficacy of the medication.

26. ANS: A PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Endocrine System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essentials and Medications for Thyroid and Parathyroid Disorders (p. 267–269): Levothyroxine is a thyroid preparation that can cause palpitations, irregular heart rhythm, increased blood pressure, nervousness, insomnia, tremors, headache, weight loss, diarrhea, abdominal cramping, intolerance of heat, fever, and menstrual irregularities although it does not induce menopause. A client with hypothyroidism will need supplemental thyroid medication for the remainder of his or her life. There are no specific dietary restrictions with the medication, although it is best taken on an empty stomach and without other medications.

27. ANS: B PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Endocrine System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essentials and Medications for Thyroid and Parathyroid Disorders (p. 267–269): Methimazole is an antithyroid medication. Because this medication is used in the treatment of hyperthyroidism, the client may continue to experience such symptoms or the client may experience symptoms of hypothyroidism. Frequent monitoring of blood sugars and self-injection is not necessary. The medication is not expected to alter white blood cells to the point of requiring protective isolation, although agranulocytosis can occur and the client should be monitored.

MULTIPLE RESPONSE 1. ANS: C, E, F PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Endocrine System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Medications for Thyroid and Parathyroid Disorders (p. 267–269; 269): Thyroid medications can cause palpitations, fast heart rate, irregular heartbeat, increased blood pressure, nervousness, tremor, headache, insomnia, weight loss, diarrhea, abdominal cramps, and intolerance of heat, fever, and menstrual irregularities. Somnolence means sleepiness, which would not be expected with this medication.

2. ANS: A, C, D PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Endocrine System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Medications to Treat Pancreatic Disorders (p. 267–269; 270–273): Insulin should be kept in the refrigerator until it is opened; once opened it can remain at room temperature.

The medication will expire in 1 month and should be discarded after that time. Insulin pens should be identified for the individual client and multidose use is contraindicated.

3. ANS: C, D PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Endocrine System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Medications to Treat Pancreatic Disorders (p. 267–269; 270–271): Patients with type 2 diabetes may be managed with diet alone or with oral diabetic (antihyperglycemic) agents such as glyburide, which work to stimulate the pancreas or liver resulting in additional insulin release. Unlike clients with diabetes type 1, these clients produce insulin but it doesn’t lower the blood glucose adequately.

Diet and exercise may be enough to control their blood sugar. If oral antihyperglycemics don’t work, they will need insulin.

4. ANS: A, B, D PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Endocrine System Medications KEY: Application MSC: NCLEX Category: Health Promotion and Maintenance NOT: See Figure 15-3 (p. 273): Sites for subcutaneous injection should be rotated and include areas along the front of the abdomen away from the navel, top of the thigh, inner and outer aspects of the upper arm, across the back of the shoulder area, and along the lower back above the buttocks.

5. ANS: A, C PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Endocrine System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Types of Insulin (p. 267–269; 271–273): Novolog 70/30 is a premixed insulin with an onset of 15 minutes and a duration of 1 to 4 hours. It is often given more than once a day since its duration of action is relatively short.

6. ANS: B, C PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Endocrine System Medications KEY: Application MSC: NCLEX Category: Physiological Adaptation NOT: See Master the Essential Table and Medications that Treat Adrenal Disorders (p. 267–269; 274): In Cushing’s disease, the adrenal cortex over-secretes the glucocorticoid steroids. Patients suffer from hypertension and hyperglycemia.

7. ANS: B, C, E, F PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Endocrine System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Medications that Treat Adrenal Disorders (p. 267–269; 274): The pump only uses short-acting insulin, which is delivered with a base rate continuously or the pump can be

programmed to provide extra insulin as needed. The pump is worn externally and drug delivery is provided via a small subcutaneous needle. The client will also need to take pancrelipase (Creon) with meals since the pancreas has been partially removed and pancreatic enzymes are necessary for digestion.

MATCHING 1. ANS: E PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Endocrine System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Medications to Treat Pancreatic Disorders (p. 267–269; 270–273): Insulin should be kept in the refrigerator until it is opened; once opened it can remain at room temperature.

The client should be identified first and then the correct medication and dose verified. Sites for injection should be rotated. Insulin is mixed by rolling between the fingers prior to drawing up the dosage.

Subcutaneous tissue is used for insulin injection. Needles and syringes should be disposed of in a sharps container for proper disposal.

2. ANS: C PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Endocrine System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Medications to Treat Pancreatic Disorders (p. 267–269; 270–273): Insulin should be kept in the refrigerator until it is opened; once opened it can remain at room temperature.

The client should be identified first and then the correct medication and dose verified. Sites for injection should be rotated. Insulin is mixed by rolling between the fingers prior to drawing up the dosage.

Subcutaneous tissue is used for insulin injection. Needles and syringes should be disposed of in a sharps container for proper disposal.

3. ANS: D PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Endocrine System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Medications to Treat Pancreatic Disorders (p. 267–269; 270–273): Insulin should be kept in the refrigerator until it is opened; once opened it can remain at room temperature.

The client should be identified first and then the correct medication and dose verified. Sites for injection should be rotated. Insulin is mixed by rolling between the fingers prior to drawing up the dosage.

Subcutaneous tissue is used for insulin injection. Needles and syringes should be disposed of in a sharps container for proper disposal.

4. ANS: A PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Endocrine System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Medications to Treat Pancreatic Disorders (p. 267–269; 270–273): Insulin should be kept in the refrigerator until it is opened; once opened it can remain at room temperature.

The client should be identified first and then the correct medication and dose verified. Sites for injection should be rotated. Insulin is mixed by rolling between the fingers prior to drawing up the dosage.

Subcutaneous tissue is used for insulin injection. Needles and syringes should be disposed of in a sharps container for proper disposal.

5. ANS: B PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Endocrine System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Medications to Treat Pancreatic Disorders (p. 267–269; 270–273): Insulin should be kept in the refrigerator until it is opened; once opened it can remain at room temperature.

The client should be identified first and then the correct medication and dose verified. Sites for injection should be rotated. Insulin is mixed by rolling between the fingers prior to drawing up the dosage.

Subcutaneous tissue is used for insulin injection. Needles and syringes should be disposed of in a sharps

container for proper disposal.

6. ANS: F PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Endocrine System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Medications to Treat Pancreatic Disorders (p. 267–269; 270–273): Insulin should be kept in the refrigerator until it is opened; once opened it can remain at room temperature.

The client should be identified first and then the correct medication and dose verified. Sites for injection should be rotated. Insulin is mixed by rolling between the fingers prior to drawing up the dosage.

Subcutaneous tissue is used for insulin injection. Needles and syringes should be disposed of in a sharps container for proper disposal.

7. ANS: G PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Endocrine System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Medications to Treat Pancreatic Disorders (p. 267–269; 270–273): Insulin should be kept in the refrigerator until it is opened; once opened it can remain at room temperature.

The client should be identified first and then the correct medication and dose verified. Sites for injection should be rotated. Insulin is mixed by rolling between the fingers prior to drawing up the dosage.

Subcutaneous tissue is used for insulin injection. Needles and syringes should be disposed of in a sharps container for proper disposal.

Chapter 16. Cardiovascular System Medications Multiple Choice Identify the choice that best completes the statement or answers the question.

1. The LPN is called by a neighbor who reports her husband seems to be acting, “a little odd” and says

he feels really tired and weak. The LPN discovers the client recently stopped taking his benazepril (Lotensin) due to the fear of side effects mentioned in a television commercial. Which of the following actions by the LPN is best?

A. Instruct the woman to have her husband take an aspirin and lie down for one hour to rest.

B. Ask the woman if she has a blood pressure cuff and instruct her to take the man’s blood pressure.

C. Tell the woman to call an ambulance or get her husband to an emergency department right away.

D. Inform the woman these are withdrawal symptoms of stopping the drug and suggest he call his doctor in the morning.

2. While grocery shopping, the nurse notes a middle-aged woman in the aisle stop frequently and rub

her left arm and shoulder. As the nurse gets closer, he notes the woman is pale and appears slightly short of breath. The nurse’s additional assessment will be based on which of the following?

A. Awareness that symptoms of a myocardial infarction in woman are atypical in nature.

B. Knowledge that chronic respiratory disease is common among smokers.

C. Comprehension that early action in the presence of stroke symptoms saves lives.

D. Understanding that polypharmacy is a growing concern among middle-aged individuals.

3. The LPN is called into the room of a client with known cardiac disease at 7:30 a.m. The client

reports heavy pressure and chest pain. Which action by the nurse is best?

A. Provide the client with the atenolol (Tenormin) scheduled for 9 a.m.

B. Provide the client nitroglycerin sublingual scheduled prn.

C. Determine the client’s level of consciousness.

D. Assess the client’s respiratory rate and effort.

4. An LPN is visiting a friend in the hospital who was recently diagnosed with a right-sided thrombotic

stroke. The individual says, “I don’t understand why they want to give me blood thinners if I had bleeding in my brain.” Which of the following responses by the nurse is best?

A. “Blood thinners are used to help the heart not have to work so hard to pump blood around.”

B. “The blood brain barrier will protect your brain from the medications they give you.”

C. “Are you sure they’re giving you blood thinners? What medication have they prescribed?”

D. “Your stroke was caused by a clot that blocked blood flow to a portion of your brain, not bleeding within your brain.”

5. The LPN is providing care for a client in a rehab facility with angina pectoris with a prn order for

sublingual nitroglycerin (Nitrostat). The client reports chest pain and her BP = 155/72. Five minutes after administering the Nitrostat, the client’s blood pressure is 124/60 and chest pain is not relieved.

What action should the nurse take next?

A. Call for an ambulance.

B. Provide a second dose of nitroglycerin (Nitrostat).

C. Contact the RN for additional assessment.

D. Determine if the client has any additional cardiac medications ordered.

6. An LPN provides a client a dose of nitroglycerin (Nitroquick) spray. Which of the following would

the nurse expect?

A. The client’s blood sugar will be elevated.

B. The client’s blood pressure will be decreased.

C. The client’s heart rate will be slowed.

D. The client’s respiratory rate will be increased.

7. The LPN is assisting in the care of a client newly prescribed warfarin (Coumadin). The nurse

recognizes that teaching is effective if the client chooses which of the following meals?

A. Grilled chicken with rice pilaf, garden salad, bok choy, and ice cream B. Spinach lasagna, broccoli, fruit cocktail, and a glass of wine C. Pork chop, baked potato with butter, cooked carrots, and a sliced apple D. Chef salad, chips with humus, minestrone soup, and a cup of green tea 8. A new LPN is assisting in the admission of a client in a rehab facility that is being transferred from

the hospital after a left hip replacement. The nurse would expect the client to be taking which of the following medications?

A. Enoxaparin (Lovenox) B. Tenecteplase (TNKase) C. Aminocaproic acid (Amicar) D. Ferrous sulfate (Feosol) 9. The LPN is assisting in the care of a client who is recovering from a myocardial infarction and was

newly started on clopidogrel (Plavix). The nurse would include which of the following statements in the client teaching?

A. “You will need to have weekly blood tests done to follow your clotting and bleeding times.”

B. “This medication helps prevent platelets from sticking together and forming clots.”

C. “You should avoid taking any over the counter medications with acetaminophen (Tylenol).”

D. “Clopidogrel prevents clotting by interfering with the factors involved in the bleeding cascade.”

10. A nurse working in the emergency department is assisting in the care of a client who came in with

symptoms of a cerebral vascular accident (CVA). As the team considers the use of tissue plasminogen activator (tPA), the nurse recognizes the most important assessment would be: A. When the symptoms of stroke began B. If the client has a history of hypertension C. When the client last ate or drank anything

D. If the client has an allergy to aspirin 11. An LPN working with a client on long-term warfarin (Coumadin) therapy would be most interested

in which of the following lab values?

A. A prothrombin time (PT) B. An international normalized ration (INR) C. A Vitamin B12 level D. A serum potassium (K+) level 12. An LPN working in a gynecologist’s office is discussing medication use with a client who takes

ferrous sulfate (Feosol). The nurse would assess for which of the following side effects?

A. Urinary retention B. Blurry vision C. Gastric irritation D. Insomnia 13. In talking to a neighbor who is undergoing chemotherapy for breast cancer, the nurse learns the

woman’s most recent chemotherapy treatment was not given because her white blood cell count was too low. The nurse would expect the woman to also be receiving which of the following medications?

A. Digoxin (Cardoxin) B. Ferrous sulfate (Ferra-TD) C. Disopyramide (Norpace) D. Filgrastim (Neupogen) 14. While working in a primary care physician’s office, the LPN is collecting history data for a client

who takes sargramostim (Leukine). The nurse would be most interested in which of the following lab results for this client?

A. Serum sodium B. Serum magnesium C. White blood cell count D. Blood urea nitrogen 15. While assisting in the care of a client with pernicious anemia, the LPN would anticipate which of the

following medications?

A. Ascorbic acid (Vitamin C) orally twice daily B. Cyanocobalamin (Vitamin B12) injection monthly C. Ferrous sulfate (Fer-in-Sol) by mouth daily D. Warfarin (Coumadin) by mouth every evening 16. The LPN is working with clients in the long-term care facility. Which of the following individuals is

most likely to have frequent vital sign assessment for blood pressure monitoring included in their plan of care?

A. A 78-year-old patient who takes fluvastatin (Lescol) B. An 82-year-old patient who takes lovastatin (Mevacor) C. An 84-year-old patient who takes quinapril (Accupril) D. A 90-year-old patient who takes zaleplon (Sonata)

17. The LPN is called to the room of a client because the nurse aide determined the client’s blood

pressure is 195/101. The client complains of a moderate headache but denies blurry vision or other symptoms. What action should the nurse take next?

A. Notify the RN that the client needs to be transferred to the hospital.

B. Provide the client’s morning dose of ramipril (Altace) 30 minutes early.

C. Instruct the nursing aide to repeat the blood pressure in 15 minutes.

D. Inform the client that he should reduce his salt intake with evening meals.

18. The LPN is assisting in the care of a client newly prescribed captopril (Capoten). The nurse would

instruct the client to take which of the following precautions?

A. Avoid foods that are high in potassium B. Limit visitors and avoid crowds C. Increase the amount of fiber in the diet D. Avoid changing positions rapidly 19. A client newly prescribed hydrochlorothaizide (Esidrix) daily should be instructed to take this

medication at what time?

A. In the evening with dinner B. In the morning with or without food C. At bedtime D. Timing of the pill does not matter as long as it is taken with food 20. The LPN is reviewing client medications and lab values. Which of the following clients is most

likely to be taking potassium gluconate?

A. A client with heart failure taking bumetanide (Bumex) B. A client with hypertension taking trandolapril (Mavik) C. A client with surpraventricular tachycardia taking propafenone (Rythmol) D. A client with heart failure taking valsartan (Diovan) 21. The LPN notes that many of the clients in the long-term care facility take nisoldipine (Sular). The

LPN is aware that in addition to treating hypertension, this medication can be used to treat which of the following conditions?

A. Renal disease B. Angina C. Arrhythmias D. Hyperlipidemia 22. While providing care for a client taking diltiazem (Dilacor) the nurse would monitor for which of the

following side effects?

A. Tachycardia B. Bronchodilatation C. Palpitations D. Edema 23. The LPN caring for a client with heart failure is preparing to provide multiple medications. Which of

the following medications will impact the heart contractility?

A. Pravastatin (Pravachol) B. Trandolapril (Mavik)

C. Venlafaxine (Effexor) D. Digoxin (Cardoxin) 24. An LPN is working with a client who takes isosorbide dinitrate (IsoBid). The LPN would include

which of the following instructions to the client?

A. “This medication will interact with medications for erectile dysfunction.”

B. “You may notice that your blood sugar is altered while you’re on this medication.”

C. “It will be important for you to avoid over the counter medications containing

ibuprofen.”

D. “The physician will most likely order weekly blood tests for the first month or so.”

25. The LPN answers the phone at a primary care physician’s office. The client reports, “I recently

started taking hydralazine (Apresoline) and have been feeling very nauseated.” Which of the following responses by the nurse is best?

A. “You should try taking half a pill for a few days until the doctor is able to call you back.”

B. “This is a side effect of the medication, and I will leave a note for the physician to determine what course of action should be taken.”

C. “Because this is common with the medication, I suggest you try eating saltine crackers frequently throughout the day.”

D. “I think you should call the pharmacy and see what they suggest.”

26. The LPN is passing morning medications which include digoxin (Digetek) for a 68-year-old man

with congestive heart failure. The nurse notes the client’s BP = 112/68, P = 60, R = 18. Which action by the nurse is best?

A. Determine if the client has eaten breakfast.

B. Hold the medication and contact the RN. C. Provide the medication as ordered.

D. Ask the client if he is experiencing any difficulty breathing.

27. The LPN receives an early morning phone call from a client with heart failure. The client typically

takes digoxin (Digetek), quinapril (Accupril), and valsartan (Diovan). The client reports flu-like symptoms and states, “I haven’t been able to keep much down for about 2 days.” Which response by the nurse is best?

A. “Are you able to come in for an appointment in tomorrow afternoon?”

B. “What usually works when you are experiencing nausea and vomiting?”

C. “Have you lost much weight with this illness?”

D. “Have you noticed any greenish halos around lights?”

28. The LPN is providing medications to a client recently diagnosed with atrial fibrillation who has been

prescribed quinidine (Cardioquin) 300 mg every 6 hours. Which of the following statements would the nurse include in the client teaching?

A. “This medication alters sodium exchange in the heart muscle to block irregular rhythms.”

B. “The medication will help slow the heart rate by interfering with calcium ion exchange.”

C. “You may notice a slight tingling under your tongue when you take this medication.”

D. “You will need to wear a heart monitor when you go home.”

29. A student nurse is taking notes about the medications taken by a 72-year-old woman with a complex

cardiac history and multiple co-morbidities. The student is aware that atenolol (Tenormin) will not play a role in the treatment of which of the following co-morbid conditions?

A. Hypertension B. Hyperlipidemia C. Heart failure D. Atrial fibrillation 30. The LPN receives a phone call from a relative who reports her mother has been rushed to the

emergency department and is being treated for shock. The LPN knows the medical team will work to accomplish which of the following goals first?

A. Determine if the client has ever had shock before B. Identify the cause of the shock C. Establish an accurate means of measuring urine output D. Prevent hypoglycemia 31. While visiting a friend in the intensive care unit who experienced an acute myocardial infarction, the

LPN notes there is an IV infusing with norepinephrine (Levophed). The LPN is aware that long-term use of this medication can cause which of the following?

A. Metabolic alkalosis B. Metabolic acidosis C. Necrosis of fingers and toes D. Clotting disorders 32. While performing dietary teaching during a health fair, the nurse is aware that to prevent

hyperlipidemia, most Americans need to reduce their intake of which of the following?

A. High density lipoproteins B. Iron C. Low density lipoproteins D. Dietary fiber 33. The nurse is providing education at a community cholesterol screening event. Which of the

following individuals will need routine liver function tests as part of their medical follow-up?

A. A 58-year-old patient who takes cholestyramine (Questran) B. A 65-year-old patient who takes rosuvastatin (Crestor) C. A 61-year-old patient who takes simvastatin (Zocor) D. A 59-year-old patient who takes fenofibric acid (Trilipix) 34. While reviewing the medications taken by a client being admitted to a long-term care facility, the

nurse notes the client takes fluvastatin (Lescol) daily. The nurse should schedule this medication: A. In the morning with breakfast B. First thing in the morning on an empty stomach C. In the afternoon with lunch D. At bedtime

35. A nurse assisting in the care of a client with hyperlipidemia who has been taking lovastatin (Altocor)

for 3 months and continues to have elevated lipid levels. Which of the following actions would the nurse anticipate?

A. Lovastatin (Altocor) is replaced with simvastatin (Zocor) B. Colesevelam (Wechol) is added to the client’s regimen C. Lovastatin (Altocor) is discontinued and the client is given dietary counseling D. Lovastatin (Altocor) is continued at the current dose and labs are repeated in 3 months 36. The LPN would counsel a client newly prescribed cholestramine (Prevalite) to expect which of the

following changes in bowel pattern?

A. Diarrhea B. Pale, clay colored stools C. Constipation D. Greasy stools that float 37. A client calls the nurse at 2 p.m. stating, “I forgot to take my atenolol (Tenormin) at 8 a.m., like I

usually do. Should I take it now?” Which of the following responses by the nurse is best?

A. “Yes, it is important to take the medication each day.”

B. “How often do you forget to take your medications?

C. “It would be best to simply take two pills tomorrow.”

D. “Since it is already afternoon, just skip the dose for today.”

38. The nurse is preparing to pass morning medications, including newly prescribed bisoprolol (Zebeta),

for a patient with a history of myocardial infarction. Which action should the nurse take first?

A. Check to make sure the medication has been delivered from pharmacy.

B. Monitor the patient’s urinary output.

C. Determine if the client knows the side effects of the medication.

D. Take the patient’s pulse and blood pressure.

39. The nurse is providing care for a patient with a history of mitral valve replacement. The patient is

taking ticlopidine (Ticlid). The nurse recognizes the medication is effective by which of the following patient outcomes?

A. Patient reports chest pain is relieved after receiving the medication.

B. Patient’s heart rhythm is regular.

C. Patient’s lung sounds remain clear.

D. Patient has no symptoms of a clot formation.

40. The nurse receives orders to begin spirinolactone (Aldactone) daily with the first dose to start today.

Which of the following assessments is the highest priority within the first 2 to 4 hours after provision?

A. Urinary output B. Pain relief C. Red blood cell count D. Orthostatic hypotension Multiple Response Identify one or more choices that best complete the statement or answer the question.

1. While working in a long-term care facility, the LPN provides nitroglycerin topical (Nitro-Bid) in

paste form for a client twice each day. The nurse should caution the client that which of the following side effects may be noted? (Select all that apply.)

A. Constipation B. Flushing C. Headache D. Dizziness when changing position E. Dry cough 2. The LPN is working with a client who uses nitroglycerin (Nitrol Appli-Kit) transdermal patch for

chronic angina. What additional care or teaching should the nurse provide?

A. Encourage the client to stop smoking.

B. Instruct the client to lower dietary salt intake.

C. Instruct the client to reduce carbohydrate intake.

D. Provide a list of low-fat foods.

E. Determine the client’s typical alcohol consumption.

F. Initiate a conversation about stress and coping skills.

3. The nurse would counsel clients to avoid aspirin-containing products if they were taking which of

the following medications? (Select all that apply.)

A. Heparin B. Ticlopidine (Ticlid) C. Tirofiban (Aggrastat) D. Cyanocobalamin (Vitamin B12) E. Inamrinone (Inocor) 4. The LPN overhears a physician discussing the need to add an angiotensin receptor blocker (ARB)

agent to the medication profile for a client with hypertension. The nurse recognizes the physician may choose to order which of the following agents? (Select all that apply.)

A. Indapamide (Lozol) B. Irbesartan (Avapro) C. Nisoldipine (Sular) D. Olmesartan (Benicar) E. Prazosin (Minipress) F. Telmisartan (Micardis) 5. In studying cardiac medications, the student recognizes that cardiac output is directly impacted and

determined by which of the following? (Select all that apply.)

A. Heart rate B. Peripheral resistance C. Heart contractility D. Stroke volume E. Blood pressure 6. The nurse is counseling a client whose BMI is 28.5 and has newly started taking atorvastatin

(Lipitor). Which of the following lifestyle recommendations will the nurse make as well? (Select all that apply.)

A. Reduced salt intake B. Smoking cessation C. Weight loss D. Decreased intake of animal fats E. Increased water consumption to 10 to 12 glasses per day 7. A student nurse observing in an intensive care unit would expect albumin as part of the treatment

plan for which of the following patients? (Select all that apply.)

A. A 25-year-old patient with second and third degree burns to 40% of his body B. A 69-year-old patient with gastrointestinal bleeding C. A 61-year-old patient with lung cancer and congestive heart failure D. A 48-year-old patient with sepsis E. A 37-year-old patient with end-stage liver disease 8. A client has been newly diagnosed with congestive heart failure and begins taking

bendroflumethiazide (Naturetin). Which of the following interventions should also be included in the client’s plan of care?

A. Increase exercise B. Avoid calcium intake C. Reduce sodium intake D. Decrease potassium consumption E. Limit daily calories to 2,000 Completion Complete each statement.

1. A nurse passing medications at the nursing home and notes the client takes diltiazem (Cardizem) 90

mg po TID. The pharmacy stocks 30-mg tablets. How many tablets will the client take in a 24-hour period?

Matching

The nurse is providing care for a client with complaints of chest pain who has an order for nitroglycerin (Nitorliqual) sublingual prn to be repeated  3. Place the following actions in the correct order.

A. Repeat nitroglycerin dose if pain is unrelieved.

B. Notify RN of client situation if second dose is required.

C. Assess client vital signs.

D. Ask client to rank chest pain 5 min after initial dose.

E. Provide sl. Nitroglycerin per order.

1. First 2. Second 3. Third 4. Fourth

5.

Fifth

Chapter 16. Cardiovascular System Medications Answer Section MULTIPLE CHOICE 1. ANS: C PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Cardiovascular System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Myocardial Infarction, Stroke and Clotting (p. 283–287; 282): Benazepril is an ACE inhibitor used in the treatment of hypertension. Stopping the medication increases the client’s risk of a cerebral vascular accident and his symptoms are suspicious; medical evaluation should be sought immediately.

2. ANS: A PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Cardiovascular System Medications KEY: Analysis MSC: NCLEX Category: Physiological Adaptation NOT: See Master the Essential Table and Myocardial Infarction, Stroke and Clotting (p. 283–287; 282): Women tend to have atypical symptoms such as upper back or shoulder pain, light headedness, and unusual fatigue while experiencing a myocardial infarction. Such atypical presentation may make diagnosis more difficult. The individual described in this scenario should first be evaluated for any additional symptoms or risk factors for a myocardial infarction.

3. ANS: B PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Cardiovascular System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Myocardial Infarction, Stroke and Clotting (p. 283–287; 282): Chest pain is often indicative of ischemia or decreased oxygen delivery to the heart muscle. Nitroglycerin works to dilate the cardiac blood vessels and optimize cardiac blood flow. It would be helpful to determine the client’s vital signs including blood pressure, heart rate, respiratory rate, and oxygenation status if possible. In this scenario the priority would be to provide the nitrate.

4. ANS: D PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Cardiovascular System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Myocardial Infarction, Stroke and Clotting (p. 283–287; 282): A cerebral vascular accident can be caused by bleeding or clot formation both of which interrupt blood flow resulting in ischemia to portions of the brain. A thrombotic stroke is one that involves a clot, rather than bleeding.

5. ANS: B PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Cardiovascular System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Antianginal Medications (p. 283-287; 282): Antianginal drugs decrease angina pectoris by dilating arteries and veins. The client’s blood pressure is expected to decrease upon administration. Instructions are generally to place the tablet under the tongue and allow it to dissolve; repeat the procedure every 5 minutes for a maximum of three times. If the pain is unrelieved after three doses, the client should call emergency medical services.

6. ANS: B PTS: 1 DIF: Easy TOP: Therapeutic Classification: Cardiovascular System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Antianginal Medications (p. 283-287; 282): Antianginal medications dilate arteries and veins and result in lowered blood pressure. There will be no effect on the blood

sugar or respiratory rate and the heart rate will most likely increase in response to the hypotension.

7. ANS: C PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Cardiovascular System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Anticoagulant, Antiplatelet, Thrombolytic, and Antifibrinolytic Medications and Fast Tip 16.2 (p. 283-287; 288-290): Clients taking anticoagulants should reduce intake of green leafy vegetables, green tea, hummus, and other foods that are high in vitamin K. With the listed menu options, only one does not contain a restricted food.

8. ANS: C PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Cardiovascular System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Anticoagulant, Antiplatelet, Thrombolytic, and Antifibrinolytic Medications (p. 283–287; 288–290): Heparin and Lovenox are given by subcutaneous injection several times a day in patient at risk of developing deep vein thrombosis (DVT). It is routinely given to surgical patients.

9. ANS: B PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Cardiovascular System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Anticoagulant, Antiplatelet, Thrombolytic, and Antifibrinolytic Medications (p. 283–287; 288–290): Antiplatelet medications such as clopidogrel prevent platelets form clumping together to form clots. Weekly blood tests are not needed with anti-platelet medications. It is important to avoid aspirin products.

10. ANS: A PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Cardiovascular System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Anticoagulant, Antiplatelet, Thrombolytic, and Antifibrinolytic Medications (p. 283–287; 288–290): A patient who can be diagnosed and treated within 60 minutes of the onset of symptoms of a CVA can be given a treatment called tissue plasminogen activator.

11. ANS: B PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Cardiovascular System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Anticoagulant, Antiplatelet, Thrombolytic, and Antifibrinolytic Medications (p. 283-287; 288-290): An INR is a blood test performed to determine how long it takes blood to clot and is used primarily in patients taking Coumadin. A PT may be done as well to evaluate the client’s bleeding time but it is less specific to warfarin therapy than the INR. Vitamin K will interfere with the action of warfarin.

12. ANS: C PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Cardiovascular System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Medications That Promote Blood Cell Development (p. 283-287; 290): Ferrous sulfate can cause gastric irritation and it is often suggested clients take it with food. Liquid preparations can stain teeth.

13. ANS: D PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Cardiovascular System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Medications That Promote Blood Cell Development (p. 283-287; 290): Filgrastim is given to stimulate white blood cell development, frequently used during chemotherapy treatment to support bone marrow production. Digoxin is a cardiac glycoside often used in the treatment of heart failure. Ferrous sulfate is an iron derivative given to help support red blood cell development.

Disopyramide is a sodium channel blocker used in the treatment of arrhythmias.

14. ANS: C PTS: 1 DIF: Moderate

15.

16.

17.

18.

19.

20.

21.

TOP: Therapeutic Classification: Cardiovascular System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Medications That Promote Blood Cell Development (p. 283-287; 290): Pegfilgrastim is used to stimulate blood cell development and bone marrow production. There will be minimal impact on serum electrolytes or blood urea nitrogen levels. White blood cell levels should rise toward normal levels.

ANS: B PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Cardiovascular System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Medications That Promote Blood Cell Development (p. 283–287; 290): Vitamin B12 is used in patients who cannot absorb vitamin B12 in the GI tract, such as those with pernicious anemia. Therefore, injectable vitamin B12 is usually administered.

ANS: C PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Cardiovascular System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Medications That Decrease Blood Pressure (p. 283–287; 291–293): Quinapril is an ACE inhibitor used in the treatment of hypertension. Fluvastatin and lovastatin are cholesterol lowering agents. Zaleplon is used in the treatment of insomnia.

ANS: B PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Cardiovascular System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Medications That Decrease Blood Pressure (p. 283–287; 291–293): Ramipril is an ACE inhibitor used in the treatment of hypertension. The RN should be notified of concerning assessment findings, but the client does not need hospitalization and the priority is to reduce the current blood pressure. Close monitoring with repeat blood pressure should be done but the priority is to reduce the blood pressure. The client should be on a low-salt diet.

ANS: D PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Cardiovascular System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Medications That Decrease Blood Pressure (p. 283–287; 291–293): Captopril is an ACE inhibitor that lowers blood pressure. Clients should be cautioned about changing positions rapidly as orthostatic hypotension may occur. ACE inhibitors often decrease serum potassium so foods high in potassium do not need to be avoided. Immunosuppression and constipation are not a concern/side effect with this class of medications.

ANS: B PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Cardiovascular System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Medications That Decrease Blood Pressure (p. 283–287; 291–292): Hydrochlorothiazide is a diuretic and will result in frequent trips to the bathroom. It is important to provide this medication earlier in the day to avoid night time/sleep interruptions. The medication can be taken with or without food.

ANS: A PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Cardiovascular System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Medications That Decrease Blood Pressure (p. 283–287; 291–292): Bumetanide is a loop diuretic with a high risk of potassium loss. Clients are typically given potassium supplements with this class of medications. Trandolapril is an ACE inhibitor, propafenone is a sodium channel blocker, and valsartan is an angiotensin receptor blocker.

ANS: B PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Cardiovascular System Medications

22.

23.

24.

25.

26.

27.

28.

KEY: Comprehension MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Medications That Decrease Blood Pressure (p. 283–287; 291–292): Nisoldipine is a calcium channel blocker. This class of medications is used to treat angina and hypertension.

ANS: D PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Cardiovascular System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Medications That Decrease Blood Pressure (p. 283–287; 291–292): Diltiazem is a calcium channel blocker. Side effects associated with these agents are hypotension, constipation, bradycardia, and edema. Beta-adrenergic agents can cause bronchodilation.

ANS: D PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Cardiovascular System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Medications for Heart Failure (p. 283–287; 293–294): Digoxin is a cardiac glycoside that strengthens the heart’s contractility. Pravastatin is a lipid lowering agent. Trandolapril is an ACE inhibitor, which blocks rennin-angiotensin. Venlafaxine is an antidepressant.

ANS: A PTS: 1 DIF: Hard TOP: Therapeutic Classification: Cardiovascular System Medications KEY: Analysis MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Vasodilators (p. 283-287; 294): Isosorbide dinitrate is a vasodilator.

For this reason, it will interact with medications taken for erectile dysfunction. It will not alter blood glucose, interact with NSAIDs, or require frequent laboratory testing.

ANS: B PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Cardiovascular System Medications KEY: Analysis MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Vasodilators (p. 283-287; 294): Hydralazine is a vasodilator, a class of medications that can cause nausea, vomiting and loss of appetite. The physician should be notified and determine the next course of action. The LPN is not able to alter dosages. The physician or ordering health care provider should determine what is best for the client.

ANS: C PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Cardiovascular System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Cardiac Glycosides (p. 283–287; 294): Digoxin is a cardiac glycoside used to treat congestive heart failure and arrhythmias. It can cause bradycardia and should be held if the pulse rate is less than 60 bpm. The client in this scenario has stable blood pressure and adequate heart rate so the medication should be given as ordered. Difficulty breathing is not an expected side effect or sign of digoxin toxicity and the client’s respiratory rate is not overly high.

ANS: D PTS: 1 DIF: Hard TOP: Therapeutic Classification: Cardiovascular System Medications KEY: Analysis MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Drug Spotlight 16.2 (p. 283-287; 294): Digoxin is a cardiac glycoside used in the treatment of heart failure. Symptoms of digitalis toxicity include nausea, vomiting, diarrhea, stomach pain, slowed heart rate, and greenish halo around lights. It will be important to help determine if the client is experiencing digitalis toxicity as the priority for this scenario.

ANS: A PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Cardiovascular System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Drugs for Abnormal Heart Rhythms (p. 283–287; 294–295): Quinidine is a sodium channel blocker used in the treatment of arrhythmias. It works to slow the electrical conduction by inhibiting the transfer of sodium. The medication is taken orally, not sublingually. Clients do not generally require continuous heart monitoring in the home environment.

29. ANS: B PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Cardiovascular System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Drugs for Abnormal Heart Rhythms (p. 283–287; 294–295): Atenolol is a beta adrenergic blocker used in the treatment of hypertension and heart failure. It can also be used in the treatment of abnormal heart rhythms since it works to slow the heart rate and decrease the fight or flight response. It will not impact elevated lipid levels.

30. ANS: B PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Cardiovascular System Medications KEY: Application MSC: NCLEX Category: Physiological Adaptation NOT: See Master the Essential Table and Medications for Shock (p. 283–287; 295): The first action will be to support the client’s hemodynamic system, but ultimately the treatment for shock primarily targets the underlying cause of shock, which can be cardiogenic, hypovolemic, septic, or neurogenic in nature.

31. ANS: C PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Cardiovascular System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Medications for Shock (p. 283–287; 295): Norepinephrine is a vasopressor used to support clients with profound hypotension. Because peripheral circulation is shut down, long-term use can result in necrosis, particularly of fingers and toes.

32. ANS: C PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Cardiovascular System Medications KEY: Application MSC: NCLEX Category: Reduction of Risk Potential NOT: See Master the Essential Table and Medications for Lipid Disorders (p. 283–287; 296): Excess fat can be deposited on or in the walls of the blood vessels causing hyperlipidemia, atherosclerosis, hypertension, and heart failure. High density lipoproteins act as street sweepers and most Americans need to increase their intake of these. Low density lipoproteins deposit fat in the vessels and most Americans need to reduce their intake of these.

33. ANS: D PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Cardiovascular System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Medications for Lipid Disorders (p. 283–287; 296): Fenofibric acid is a fibric acid derivative that helps lower cholesterol by inhibiting liver formation of very low density lipoproteins. There is an associated risk of liver damage with these agents so they must have routine liver function tests done. The statin medications encourage the liver to make less cholesterol and increase the number of LDL receptors in the liver. Cholestyramine is a bile acid sequestrant that forms complexes with bile acids and causes the liver to make more bile acids from cholesterol.

34. ANS: D PTS: 1 DIF: Hard TOP: Therapeutic Classification: Cardiovascular System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Medications for Lipid Disorders (p. 283–287; 296): HMG-CoA inhibitors (statins) are generally scheduled in the evening since the liver is most actively synthesizing cholesterol during sleep; it can be given with or without food.

35. ANS: B PTS: 1 DIF: Hard TOP: Therapeutic Classification: Cardiovascular System Medications KEY: Analysis MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Medications for Lipid Disorders (p. 283–287; 296): In patients who have a very high cholesterol levels, the statins may not be sufficient and require the help of bile acid sequestrants to decrease serum lipid levels.

36. ANS: C PTS: 1 DIF: Hard TOP: Therapeutic Classification: Cardiovascular System Medications

37.

38.

39.

40.

KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Medications for Lipid Disorders (p. 283–287; 296): Bile sequestrants such as cholestramine can cause constipation, abdominal pain, nausea, vomiting, headache, and dizziness. Pale, clay colored stools are seen in clients in whom bile is not being produced or is not draining into the small intestines. Greasy stools that float are seen in malabsorption disorders.

ANS: A PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Cardiovascular System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Medications That Decrease Blood Pressure (p. 283–287; 292): Blood pressure medications should be taken routinely. How often the medication is forgotten is not the priority, doubling medications the following day is not safe, and the medication should be taken rather than being skipped.

ANS: D PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Cardiovascular System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Medications That Decrease Blood Pressure (p. 283–287; 292): Bisoprolol is a beta adrenergic blocker used to lower the client’s blood pressure and pulse rate. These medications are typically held if the pulse is lower than 60 but nurses should follow the protocol in their own institution. This medication should not impact urine output. Knowing if the parameters for safe administration have been met is higher priority than identifying if the medication is available or the client’s knowledge base.

ANS: D PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Cardiovascular System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Anticoagulants, Antiplatelet, Thrombolytic and Antifibrinolytic Medications (p. 283–287; 288–289): Ticlopidine is an antiplatelet agent used to prevent clot formation.

ANS: D PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Cardiovascular System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Medications That Decrease Blood Pressure (p. 283–287; 291–293): Spirinolactone is a potassium sparing diuretic. Diuretics clear excess fluid from the body and regulate blood pressure. Less fluid in the body creates less blood volume and thus less pressure in the blood vessels so the medications action but it is not as big a safety concern as orthostatic hypotension. Pain relief and altered red blood cell count is not expected.

MULTIPLE RESPONSE 1. ANS: B, C, D PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Cardiovascular System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Myocardial Infarction, Stroke and Clotting (p. 283–287; 282): Nitrates are used in the treatment/prevention of angina. Side effects include blurred vision, dry mouth, flushing, headache, hypersensitivity reaction, and postural hypotension.

2. ANS: A, B, D, E, F PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Cardiovascular System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Antianginal Medications Fast Tip 16.1 (p. 283–287; 288): All of the following can help treat angina: decrease dietary fats and sodium, lower blood pressure, develop coping skills for stress, exercise, decrease alcohol consumption, and stop smoking. Altering carbohydrate intake is not necessary if the client consumes low-fat options.

3. ANS: A, B, C PTS: 1 DIF: Moderate

4.

5.

6.

7.

8.

TOP: Therapeutic Classification: Cardiovascular System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Anticoagulant, Antiplatelet, Thrombolytic, and Antifibrinolytic Medications (p. 283–287; 288–290): Aspirin is an antiplatelet medications and should be avoided in clients taking other medications that increase the risk of bleeding including heparin, ticlopidine, and tirofiban.

ANS: B, D, F PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Cardiovascular System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Medications That Decrease Blood Pressure (p. 283–287; 291–292): Irbesartan, olmesartan, and telmisartan are all ARB medications used in the treatment of hypertension. These agents block angiotensin receptors to decrease blood pressure. Indapamide is a thyozide-like diuretic used to lower blood pressure; nisoldipine is a calcium channel blocker used to lower blood pressure; prazosin is a sympatholytic agent used to treat blood pressure, anxiety, PTSD, and panic attacks.

ANS: A, D PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Cardiovascular System Medications KEY: Application MSC: NCLEX Category: Physiological Adaptation NOT: See Master the Essential Table and Medications That Decrease Blood Pressure (p. 283–287; 291–293): Cardiac output relates to the volume of blood the fills the heart, the force of the heart contraction, and the ability of the heart to relax. It is indirectly impacted by multiple factors, but the direct impact, and “equation” involves heart rate and stroke volume.

ANS: B, C, D PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Cardiovascular System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Medications for Fast Tip 16.4 (p. 283–287; 296): Nonpharmacologic ways to decrease lipids include smoking cessation, decreasing dietary fats and cholesterol, avoiding stress, exercising, maintaining a healthy weight, and periodic blood cholesterol screening. Ideal BMI is 18.5 to 25. Increasing water consumption beyond the recommended 8 to 10 glasses per day is not necessary.

ANS: A, B, D PTS: 1 DIF: Hard TOP: Therapeutic Classification: Cardiovascular System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Medications for Shock (p. 283–287; 296): Plasma expanders such as albumin human may be administered by the IV route in the treatment of hypovolemic shock. In this scenario the clients at risk for shock include the client with extensive burns, gastrointestinal bleeding, and sepsis.

ANS: A, C, E PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Cardiovascular System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Medications for Heart Failure (p. 283–287; 293–294): Bendroflumethiazide is a thiazide diuretic. Potassium loss can occur with this class of medications so potassium intake should be increased. Actions that can support treatment of hypertension and heart failure include increased exercise and weight loss, reduced sodium intake, smoking cessation, and stress reduction.

COMPLETION 1. ANS: 9 tablets PTS: 1 DIF: Easy TOP: Therapeutic Classification: Cardiovascular System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies

NOT: See Master the Essential Table and Medications That Decrease Blood Pressure (p. 283–287): This is a straightforward drug calculation question. 30 mg tablets x 3 = 90 mg for each dose; 3 tablets/dose x 3 doses = 9 tablets in a 24-hour period.

MATCHING 1. ANS: E PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Cardiovascular System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Antianginal Medications (p. 283–287; 282): Nitroglycerin should be provided when chest pain begins. Monitoring vital signs will help the nurse further evaluate the client status. Nitroglycerin should be repeated in 5 minutes if the client continues to have pain. The RN should be notified if pain continues for additional assessment and in preparation of the potential need to transfer the client to the hospital if pain is unrelieved. The priority will be to provide the nitroglycerin in hopes of relieving ischemia and preventing an infarction.

2. ANS: C PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Cardiovascular System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Antianginal Medications (p. 283–287; 282): Nitroglycerin should be provided when chest pain begins. Monitoring vital signs will help the nurse further evaluate the client status. Nitroglycerin should be repeated in 5 minutes if the client continues to have pain. The RN should be notified if pain continues for additional assessment and in preparation of the potential need to transfer the client to the hospital if pain is unrelieved. The priority will be to provide the nitroglycerin in hopes of relieving ischemia and preventing an infarction.

3. ANS: D PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Cardiovascular System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Antianginal Medications (p. 283–287; 282): Nitroglycerin should be provided when chest pain begins. Monitoring vital signs will help the nurse further evaluate the client status. Nitroglycerin should be repeated in 5 minutes if the client continues to have pain. The RN should be notified if pain continues for additional assessment and in preparation of the potential need to transfer the client to the hospital if pain is unrelieved. The priority will be to provide the nitroglycerin in hopes of relieving ischemia and preventing an infarction.

4. ANS: A PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Cardiovascular System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Antianginal Medications (p. 283–287; 282): Nitroglycerin should be provided when chest pain begins. Monitoring vital signs will help the nurse further evaluate the client status. Nitroglycerin should be repeated in 5 minutes if the client continues to have pain. The RN should be notified if pain continues for additional assessment and in preparation of the potential need to transfer the client to the hospital if pain is unrelieved. The priority will be to provide the nitroglycerin in hopes of relieving ischemia and preventing an infarction.

5. ANS: B PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Cardiovascular System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Antianginal Medications (p. 283–287; 282): Nitroglycerin should be provided when chest pain begins. Monitoring vital signs will help the nurse further evaluate the client status. Nitroglycerin should be repeated in 5 minutes if the client continues to have pain. The RN should be notified if pain continues for additional assessment and in preparation of the potential need to transfer the client to the hospital if pain is unrelieved. The priority will be to provide the nitroglycerin in hopes of

relieving ischemia and preventing an infarction.

Chapter 17. Immunologic System Medications Multiple Choice Identify the choice that best completes the statement or answers the question.

1. The nurse receives a call from the parent of a 6-year-old girl who complains of a headache, sinus

congestion, and a cough. The parent asks, “Can I give him some Benadryl to help with all this congestion?” 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 60 pounds.”

C. “What other over-the-counter medications have you given him?”

D. “We don’t recommend antihistamines in children.”

2. The nurse is providing a follow-up phone call to a patient who recently started taking fexofenadine

(Allegra). Which of the following statements by the patient would indicate the medication has been effective?

A. “My joint pain is much better now.”

B. “My nose isn’t running and itchy all the time now.”

C. “I don’t have any green drainage from that cut in my arm anymore.”

D. “I passed a large worm last night, so I guess it’s working.”

3. The LPN answers the phone call of a client who has been taking prednisolone (Prelone) for the

treatment of an acute flare of systemic lupus erythematosus. The client says, “The doctor said something about stopping this medication but I can’t remember what she said.” Which response by the nurse is best?

A. “It is important to taper steroid medications slowly, so the tapering schedule should have been part of the prescription and will be written on the label.”

B. “Once you need to start taking steroids, you usually stay on them indefinitely.”

C. “I will have to check your chart and call you back next week.”

D. “What did the pharmacy tell you about the medication?”

4. An LPN takes her daughter to the primary care physician for a routine physical. In reviewing the

client’s history of asthma and noting the child’s peak flow meter is in the yellow zone, the nurse would anticipate the physician to prescribe which of the following medications?

A. Loratadine (Claritin) B. Beclomethasone (Vanceril) C. Phenylephrine (Dimetapp) D. Diflunisal (Dolobid) 5. The LPN is talking to a neighbor who recently moved to the area and says, “My allergies are just

crazy here! They’ve never been this bad before. The doctor actually gave me this nasal spray to help try and breathe through my nose again.” The nurse suspects the physician prescribed: A. Celecoxib (Celebrex) B. Cefterizine (Zyrtec) C. Azathioprine (Imuran) D. Fluticasone (Flovent)

6. The LPN is talking to a family member who was recently given propanolamine/propanolamine

(Rhindecon) to aid in the treatment of a severe sinus infection. Which statement by the nurse is best?

A. “That is a really potent antihistamine, so you will probably feel really dry.”

B. “Be aware that rebound nasal congestion occurs if you take that for more than a

few days.”

C. “Wow, I thought they outlawed that stuff because kids were making drugs out of

it.”

D. “That is a powerful antibiotic; you may get diarrhea with that.”

7. The LPN notes a new prescription for naphazoline drops (Privine). How should the nurse administer

this medication?

A. Place the drops on the tongue B. Place the drops in the ear C. Place the drops in the nose D. Place the drops sublingually 8. When asked by a client taking ibuprofen (Motrin) 8000 mg post-operatively after a robotic

hysterectomy why the physician ordered this med, the best response by the nurse is: A. “This medication helps ensure you don’t develop a post-op fever.”

B. “Ibuprofen is really good for reducing muscle spasms.”

C. “We’ve found that women who take this medication have decreased bleeding risk.”

D. “Motrin will help reduce both pain and inflammation after surgery.”

9. An LPN is caring for a client who has orders for ketorolac (Toradol). The nurse notes the client has

allergies to ibuprofen (Nuprin/Advil/Motrin) and diphenhydramine (Benadryl). Which of the following actions by the nurse is best?

A. Call the pharmacy to determine if there is any contraindication.

B. Give the medication and monitor for any signs or symptoms of rash.

C. Ask the RN to contact the physician for alternative orders for pain control.

D. Hold the medication and flag the chart for investigation by the RN. 10. An LPN is assisting in the care of a patient with rheumatoid arthritis who takes celebrex (Celecoxib).

The patient is on a pureed diet and the previous nurse on duty reported the client had some difficulty with oral pills. Which of the following actions by the nurse is best?

A. Crush the medication and sprinkle it on applesauce.

B. Contact the RN for direction.

C. Ask the physician for a different pain medication.

D. Hold the medication.

11. The LPN is assisting with the admission of a client who takes sirolimus (Rapamune). Which of the

following disease states would the nurse anticipate might be part of the client’s medical/surgical history?

A. Tuberculosis B. Kidney transplant C. Colorectal cancer D. Methicillin-resistant staphylococcus aureus infection (MRSA)

12. While talking to a cousin who has a history of lupus and takes azathioprine (Imuran), the LPN learns

her cousin has recently been diagnosed with hypertension. The nurse is aware that which of the following medications may interact with the azathioprine (Imuran) therapy?

A. Diltiazem (Cardizem) B. Pravastatin (Pravachol) C. Losartan (Cozaar) D. Acebutolol (Sectral) 13. The LPN is working with a client newly prescribed minocycline (Dynacin). Which of the following

precautions should the nurse include in the patient instructions?

A. “Be sure to wear a hat and sunscreen as this medication increases your sensitivity

to the sun.”

B. “You can stop taking this medication once your symptoms are under control.”

C. “It is important that you eat low fat meals while you are on this medication.”

D. “This medication has a deadly interaction with alcohol, so you must not drink.”

14. The LPN overhears an individual in the drug store mention, “I’m taking something called a Z-pak

for my sinus infection.” The LPN is aware that the medication the individual takes is: A. Ciprofloxacin B. Sulfamethoxazole C. Azithromycin D. Ceftizoxime 15. While working in a long-term care facility, the LPN notes an elderly woman is experiencing

symptoms of an upper respiratory infection. The LPN reports these findings to the RN and anticipates the RN will seek orders for which of the following medications?

A. Ethambutol (Myambutol) B. Clarithromycin (Biaxin) C. Amphotericin B (Fungizone) D. Nystatin (Mycostatin) 16. The LPN is assisting in the care of a client taking gentamicin (Cidomycin). The nurse would be most

concerned by which of the following lab values for this client?

A. Hmg = 12.7 g/dL B. Na+ = 138 mEq/L C. K+ = 3.6 mEq/L D. Creatinine = 1.8 mg/dL 17. The LPN is talking to a neighbor who spent multiple days in the hospital on intravenous antibiotics

including erythromycin the week before. The individual states, “I’ve had such bad diarrhea all night and it really isn’t any better today.” Which of the following statements by the nurse is best?

A. “Antibiotics commonly cause diarrhea; be sure to drink plenty of fluids.”

B. “Have you noticed any blood or pus in the stool?”

C. “Is anyone else in the family experiencing the same symptoms?”

D. “Are you taking any other medications that cause diarrhea?”

18. The LPN is assisting in the care of a client taking ethambutol (Myambutol), isoniazid (Nydrazid),

and rifampin (Rifadin). The client is scheduled for an x-ray. Which action should the nurse take next?

A. Assess the client’s breath sounds and respiratory rate.

B. Contact the RN to be sure the client can be transported.

C. Place a mask on the client and send him to the x-ray department.

D. Call the x-ray department and request a portable film.

19. The LPN working in an immunization clinic is preparing to provide tetanus immune globulin

(BayTet). Which method of administration will the nurse use?

A. Intravenous B. Intramuscular C. Subcutaneous D. Intradermal injection 20. The nurse is caring for an infant with oral thrush whose medications include mycostatin (Nystatin)

suspension. Which of the following actions should the nurse take?

A. Dilute the medication in water and provide it to the infant in a bottle.

B. Use a mouth swab to paint the inside of the infant’s mouth.

C. Use a needleless syringe and allow the baby to suck the medication out of the tip.

D. Dip a pacifier into the medication and allow the infant to suck on the pacifier.

21. While helping to clean a patient with pneumonia who is incontinent, the nurse notes the patient’s

groin folds are red, inflamed and excoriated and whitish discharge is noted from the vagina. Which of the following medications would the nurse anticipate being ordered?

A. Neomycin ointment B. Calamine lotion C. Hydrocortisone cream D. Monistat cream 22. An LPN working in a physician’s office receives a call from a woman who reports, “My daughter

was just sent home from school. They said she has lice.” Which of the following instructions by the nurse is best?

A. “We will need to see her after hours. Can you come in at 5:30 p.m.?”

B. “Head lice are a common problem in school-age children; it is nothing to worry about.”

C. “There are a number of products, such as permethrin (Elimite), sold over the counter that are effective at treating head lice.”

D. “Once you shampoo her hair and comb it out with the special comb, she should be fine.”

23. An LPN is preparing to go on a mission trip overseas to an area where malaria is prevalent. Which

action by the nurse is best?

A. Seek an immunization against malaria at the county Health Department.

B. Talk to her physician about taking atovaquone/proguanil (Malarone).

C. Plan to stay in a hotel that provides bottled water.

D. Buy piperonyl butoxide/pyrethrins (Licide) shampoo and special soaps for the trip.

24. The LPN working at the Health Department provides multiple vaccinations each day. Which type of

immunity is being transferred to the clients in this process?

A. Active natural immunity B. Passive natural immunity C. Active artificial immunity D. Passive artificial immunity 25. The LPN is assisting in the care of a patient who received chlorambucil (Leukeran) two weeks ago

for chronic myelogenous leukemia. Which of the following lab results would be most concerning to the nurse?

A. Glucose = 154 g/dl B. Potassium = 4.2 mEq/L C. Platelets = 84,000/mm3 D. Albumin = 4.0 g/dL 26. The nurse is teaching a patient with prostate cancer about the planned treatment of goserelin acetate

(Zoladex). Which of the following statements should be included in the patient teaching?

A. “You may experience hot flashes while taking these medications.”

B. “The doctor will follow CA-125 levels periodically to monitor the tumor’s

response.”

C. “You may experience hair loss while taking Zoladex.”

D. “These medications rarely impact your sex life provided you had nerve-sparing

surgery.”

27. While talking with a friend who is to start cancer treatment using a monoclonal antibody, the LPN

could include which statement regarding this class of medications?

A. “The nice thing about those medications is that they are designed to target only the

cancer cells.”

B. “Those are powerful medications that destroy rapidly growing cells in your body.”

C. “The physician will give you a pre-treatment with something to tag the cancer cells

so the antibody can find them.”

D. “Monoclonal antibodies stimulate your own immune system rather than fight the cancer cells themselves.”

28. The LPN is notified that a friend will be undergoing brachytherapy for the treatment of cancer on

Friday. The LPN is aware this individual will have what type of treatment?

A. Intravenous delivery of medications targeting the tumor cells.

B. Radiation beam treatment to the tumor area.

C. Oral delivery of a substance that is radioactive and will cause tumor cell destruction.

D. Surgical implantation of radioactive seeds into a tumor bed.

29. The LPN is working with a client who has had iodine-125 seeds implanted for the treatment of

cervical cancer. The LPN is aware this client is best placed in which of the following rooming situations?

A. In a semiprivate room with a woman who has breast cancer B. In a private room at the end of the hall with lead-lined walls C. In a private room near the nurse’s station for close monitoring

D. In a semiprivate room with a woman who has uterine cancer Multiple Response Identify one or more choices that best complete the statement or answer the question.

1. 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. Brushing at least twice daily B. Increased intake of caffeine C. Sugarless gum or candy D. Use of alcohol-based mouth wash E. Frequent mouth rinses with water 2. The LPN begins taking over-the-counter antihistamine azelastine (Astelin). Which of the following

side effects may be expected? (Select all that apply.)

A. Increased risk of infection B. Nausea and vomiting C. Sedation D. Rash E. Dizziness F. Dry mouth 3. While working in a rehab facility, the nurse recognizes ibuprofen (Motrin) should be used cautiously

or not at all in clients with which of the following conditions? (Select all that apply.)

A. Gastrointestinal bleeding B. Peripheral vascular disease C. Myocardial infarction D. Chronic pulmonary obstructive disease (COPD) E. Renal compromise F. Rheumatoid arthritis 4. The LPN is caring for a client with an allergy to penicillin. The nurse would be concerned if which

of the following medications were ordered? (Select all that apply.)

A. Ampicillin (Omnipen) B. Amoxicillin (Amoxil) C. Carbenicillin (Geocillin) D. Nafcillin (Nallpen) E. Doxycycline (Alodox) F. Erythromycin (Ery-Tab) 5. The LPN receives a call from her grown daughter who tells her, “I’ve got a bad case of bronchitis

and the doctor gave me a shot of penicillin and gave me a prescription.” What information would it be important for the nurse to convey? (Select all that apply.)

A. Some people are allergic to penicillin.

B. Penicillin antibiotics can decrease the action of oral contraceptives.

C. Penicillin treats both gram positive and gram negative bacteria.

D. Her daughter should be sure to avoid other people for at least 24 hours.

E. Her daughter should stop taking the medication once her symptoms resolve.

6. While working in an urgent care facility, the LPN assists in the care of a client who is started on

cefaclor (Ceclor). The nurse should caution the client to avoid which of the following? (Select all that apply).

A. Alcohol B. Dairy products C. Foods high in iron D. Diuretic medications E. Electrolyte drinks 7. A student nurse reviewing antibiotic therapy determines that which of the following medications

should not be given during pregnancy due to the risk of altered bone growth and staining of the teeth in the fetus? (Select all that apply.)

A. Amikacin (Amikin) B. Tetracycline (Sumycine) C. Doxycycline (Adoxa) D. Erythromycin (E.E. S. Granules) E. Ciprofloxacin (Cipro) F. Cefibuten (Cedax) 8. The nurse is caring for a patient receiving antibiotic therapy with tobramycin 100 mg every 8 hours.

Which of the following nursing actions are appropriate for this medication? (Select all that apply.)

A. Monitor the patient for signs of tinnitus, dizziness, or hearing loss.

B. Monitor renal function before and during therapy.

C. Monitor for symptoms of paralysis.

D. Infuse the medication using the same IV line that has continuous total parental

nutrition running.

E. Stop the medication if the patient develops a fever over 101°F. 9. A client with a urinary tract infection is taking sulfisoxazole (Gantrisin). The nurse recognizes that

teaching has been effective by which of the following client statements? (Select all that apply.)

A. “If I miss a dose, I should take a double dose the next day.”

B. “I must take this medication with a high fiber meal or it will cause constipation.”

C. “If I notice a rash while taking this medication I should call the doctor.”

D. “Once the burning stops, I can stop taking this and save the rest of the pills in case

I get another infection later this year.”

E. “I should not take this medication if I am pregnant.”

10. While preparing to provide medications to a client with listed allergies to sulfa medications, the

nurse would questions orders for which of the following medications? (Select all that apply.)

A. Sulfamethizole (Thiosulfil Forte) B. Sulfamethoxazole (Gantanol) C. Neomycin (Neo-Fradin) D. Paromomycin (Humatin) E. Sulfasalazine (Azulfidine) F. Levofloxacin (Levaquin)

11. The LPN caring for a client with tuberculosis instructs the client that the urine will be orange in

color if the client is taking which of the following medications? (Select all that apply.)

A. Rifampin (Rifadin) B. Cycloserine (Seromycin) C. Ethambutol (Myambutol) D. Rifabutrin (Mycobutin) E. Ethionamide (Trecator SC) 12. The LPN working with a client who has recurrent athlete’s foot is providing instruction related to

topical miconazole (Micatin) cream. Which of the following statements would be included in the nurse’s teaching?

A. “Be sure to wear white socks and reduce the amount of time you wear shoes each day.”

B. “You should wash your hands before and after application.”

C. “Anti-viral medications are designed to kill invading viruses.”

D. “The antibiotic in the cream will kill the bacteria causing the itch.”

E. “Fungal infections like to grow in warm, moist places.”

13. An LPN working in a primary care facility would anticipate acyclovir (Acivir) would most likely be

prescribed for which of the following individuals? (Select all that apply.)

A. A 22-year-old patient with genital herpes B. A 15-year-old patient with bronchitis C. A 48-year-old patient with shingles D. A 39-year-old patient with a bacterial sinus infection E. A 2-year-old patient with oral thrush 14. A client reports to the emergency room with symptoms that include sore throat, low-grade fever,

runny nose, nausea, and stomachache. His blood tests show he is positive for influenza virus. The client is given a prescription for oseltamivir (Tamiflu) and sent home. The nurse will instruct the client regarding which of the following side effects related to the medication? (Select all that apply.)

A. Hypoglycemia B. Confusion C. Joint pain D. Rash E. Seizure F. Nausea 15. The LPN is assisting in the care of a client who receives fluorouracil (Adrucil) in the treatment of

colorectal cancer. Which of the following assessments will be appropriate in the care of this client?

(Select all that apply.)

A. Determine if the client is experiencing nausea or vomiting.

B. Maintain strict intake and output measurements.

C. Encourage high-fiber, spicy foods.

D. Monitor vital signs, particularly temperature, frequently.

E. Place client in contact precautions.

F. Advise the client to perform frequent oral care.

16. The LPN has a neighbor with recurrent lymphocytic leukemia who receives weekly treatment with

alemtuzumab (Campath). When the client goes in for weekly lab draws, the LPN is aware that the following lab results would be monitored prior to initiating therapy? (Select all that apply.)

A. Prothrombin time (PTT) B. White blood cell count (WBC) C. CD-8 count D. Platelet count E. C-reactive protein 17. The LPN is talking to a friend who is undergoing treatment for breast cancer with docetaxel

(Taxotere). The nurse anticipates the friend may discuss which of the following side effects associated with this treatment? (Select all that apply.)

A. Hot flashes B. Alopecia C. Neurotoxicity D. Rash E. Diarrhea Completion Complete each statement.

1. The nurse is preparing to infuse cephalexin (Keflex) 1 gram in 100 mL over 30 minutes. What

hourly rate in mL/hr should be set on the pump?

2. The nurse is preparing to provide dexamethasone (Decadron) in liquid form. The ordered dose is 10

mg po bid. Liquid preparation is available in 2 mg/mL. How much should the nurse provide?

3. The nurse is caring for a client receiving oral ofloxacin (Floxin) 400 mg every 12 hours and the

pharmacy distributed 200-mg tablets. How many pills with the client take each day?

The nurse is providing care for a 10-year-old child whose order reads, “Ciprofloxacin 15 mg/kg po q 12 hours.” The child weighs 77 lb (35 kg). What dose of ciprofloxacin in mg should be provided?

4.

Chapter 17. Immunologic System Medications Answer Section MULTIPLE CHOICE 1. ANS: C PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Immunological System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Antihistamines (p. 303–311; 312): Diphenhydramine (Benadryl) is an over-the-counter antihistamine that comes in children formulation. It is important to recognize that many over-the-counter products for cold and allergy symptoms contain antihistamines, so knowing what the child has already taken will be an important assessment.

2. ANS: B PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Immunological System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Antihistamines (p. 303–311; 312): Fexofenadine is an antihistamine used to help control seasonal allergies. It will not affect joint pain, infectious processes, or treat worms.

3. ANS: A PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Immunological System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Glucocorticoids (p. 303–311; 312): Glucocorticoids must be used only as prescribed and discontinued slowly. Because of the serious side effects and long-term danger of immunosuppression, these medications are not given indefinitely. The nurse should check the chart to determine the ordering directions, but the client’s question should not be delayed an entire week. Knowing what the pharmacist said about the medications will not help in this scenario.

4. ANS: B PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Immunological System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Glucocorticoids (p. 303-311; 312): Beclomethasone is an inhaled corticosteroid often used in the treatment of asthma. Loratadine is an antihistamine, phenylephrine is a decongestant, and diflunisal is an NSAID. 5. ANS: D PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Immunological System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Glucocorticoids (p. 303–311; 312): Glucocorticoids such as fluticasone are administered intranasally to combat allergic rhinitis. Celecoxib is an NSAID, cefterizine is an antihistamine, and azathioprine is an immunosuppressant.

6. ANS: B PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Immunological System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Nasal Decongestants (p. 303–311; 312): Propanolamine is a nasal decongestant that causes vasoconstriction on the adrenergic receptor in the nose by affecting the sympathetic tone of the blood vessels. These medications are typically used for only 3 to 5 days; otherwise “rebound” nasal congestion occurs.

7. ANS: C PTS: 1 DIF: Moderate

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TOP: Therapeutic Classification: Immunological System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Nasal Decongestants (p. 303–311; 312): Nasal decongestants such as naphazoline drops can alleviate nasal congestion intranasally by drying secretions. Other decongestants are given orally.

ANS: D PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Immunological System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Nonsteroidal Anti-inflammatory Drugs (p. 303–311; 312): NSAID agents are effective at reducing pain, inflammation, and fever. For this scenario, the medication is being used for pain and inflammation. The nurse should be aware it may mask a fever and should be alerted to other signs and symptoms of infection.

ANS: C PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Immunological System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Nonsteroidal Anti-inflammatory Drugs (p. 303–311; 312): Ketorolac is an NSAID given in IM or IV format with similar chemical properties to ibuprofen. There is a high likelihood the client is allergic to this medication and alternative pain control medications will be needed.

ANS: A PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Immunological System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Nonsteroidal Anti-inflammatory Drugs (p. 303–311; 312): This medication is an NSAID agent. It can be safely crushed and given with pudding or applesauce. There is no reason to contact the RN or physician and no contraindication to providing the medication in crushed form.

ANS: B PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Immunological System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Immunosuppressants (p. 303-311; 312): Sirolimus is an immunosuppressant agent used to prevent rejection after organ transplantation.

ANS: A PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Immunological System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Immunosuppressants (p. 303-311; 312): Diltiazem is a calcium channel blocker, which is a class of medications that can interact with immunosuppressants. Pravastatin is a statin agent used to reduce cholesterol. Losartan is an angiotensin receptor blocker used to treat hypertension.

Acebutolol is a beta-adrenergic blocker used to treat angina and hypertension.

ANS: A PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Immunological System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Tetracycline Medications (p. 303-311; 315): Minocycline is a tetracycline antibiotic that causes increased sensitivity to the sun – sunscreen and a hat should be advised. The medication, and all antibiotics, should be taken for their full course to avoid drug resistant strains of bacteria developing. No dietary restrictions are noted for this medication and alcohol is not listed as an interaction for this medication.

ANS: C PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Immunological System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Macrolide Medications (p. 303–311; 315): A Z-pak is a trade name for azithromycin, a macrolide antibiotic used in the treatment of bacterial infections resistant to penicillin.

15. ANS: B PTS: 1 DIF: Hard TOP: Therapeutic Classification: Immunological System Medications KEY: Analysis MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Macrolide Medications (p. 303-311; 315): Clarithromycin is a macrolide antibiotic typically used in the treatment of upper respiratory infections. Ethambutol is an antituberculin medication. Amphotericin B and nystatin are both anti-fungal agents.

16. ANS: D PTS: 1 DIF: Hard TOP: Therapeutic Classification: Immunological System Medications KEY: Application MSC: NCLEX Category: Reduction of Risk Potential NOT: See Master the Essential Table and Aminoglycoside Medications (p. 303–311; 315): Gentamicin in is an aminoglycoside antibiotic. As a class, these antibiotics can cause renal compromise and should be used cautiously in clients with kidney dysfunction. The listed creatinine is higher than recognized normal levels, which are generally 0.6 to 1.2 mg/dL. 17. ANS: B PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Immunological System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Sulfonamide Medications (p. 303–311; 315): While each of these assessments may be helpful, the highest priority is to determine if the individual is experiencing symptoms of pseudomembranous colitis, which should be reported to the physician.

18. ANS: C PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Immunological System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Antituberculosis Medications (p. 303–311; 316): Ethambutol (Myambutol), isoniazid (Nydrazid), and rifampin (Rifadin) are anti-tuberculosis medications. Clients with tuberculosis are placed in respiratory isolation and must wear a mask when transported out of the room. A full respiratory assessment is not necessary prior to the film as there is no evidence in the stem that the client is in respiratory distress. A full set of films is preferable to a portable x-ray unless contraindicated.

19. ANS: B PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Immunological System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Antitoxins (p. 303–311; 316): Tetanus immune globulin is provided as an IM injection/vaccination to prevent tetanus.

20. ANS: B PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Immunological System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Antifungal Medications (p. 303–311; 316): Mycostatin is an antifungal agents used to treat oral thrush. The best way to apply the medication directly to the surface of the baby’s mucosa is with an oral swab. Diluting the medication or allowing the baby to suck it out of a medication syringe or from a pacifier will result in swallowing the medication, which is not as effective as direct application to the oral mucosa.

21. ANS: D PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Immunological System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Antifungal Medications (p. 303–311; 316): Monistat is an antifungal cream used in the treatment of yeast infections. Clients who wear briefs may develop such infections due to the warm, moist environment of a diaper. Additionally, when clients take antibiotics their natural flora are killed allowing a fungal infection to develop. This client has pneumonia and is most likely receiving antibiotics.

22. ANS: C PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Immunological System Medications

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KEY: Analysis MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Antiparasitic Medications (p. 303–311; 318): Medications containing permethrin (and other pediculocides used to treat parasites such as lice) can be purchased over the counter without a prescription. All treatment for lice must include treatment of close contacts as well as cleaning of bedding and any clothing or hair care items used on the client.

ANS: B PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Immunological System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Antiparasitic Medications (p. 303–311; 318): Atovaquone/Proguanil (Malarone) is an anti-malarial medication that should be taken in addition to personal protection such as long sleeves and pants and insect repellant. Malaria is carried by mosquitoes (not water or lice). There is no vaccine available.

ANS: C PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Immunological System Medications KEY: Comprehension MSC: NCLEX Category: Health Promotion and Maintenance NOT: See Master the Essential Table and Vaccines (p. 303-311; 319): Vaccinations provide active artificial immunity. Active natural immunity occurs when a microbe passes into the body unintentionally and the body learns to fight it. Passive natural immunity is that which is passed from mother to fetus in-utero. Passive artificial immunity occurs when antibodies are passed from a donor to a recipient.

ANS: C PTS: 1 DIF: Hard TOP: Therapeutic Classification: Immunological System Medications KEY: Analysis MSC: NCLEX Category: Reduction of Risk Potential NOT: See Master the Essential Table and Alkylating Agents (p. 303–311; 321): Chlorambucil is an alkylating agent used in the treatment of leukemia and solid tumors. This class of medications can cause bone marrow suppression and in this scenario the only abnormal lab value is the platelet count, which normally ranges from 100,000 to 400,000/mm3.

ANS: A PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Immunological System Medications KEY: Analysis MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Hormones (p. 303-311; 323): Goserelin acetate is a hormonal therapy used in the treatment of advanced prostate cancer. The medications alter the effect of testosterone in the client’s body and can result in hot flashes and other menopausal-like symptoms in the man. CA-125 is a tumor marker used to follow ovarian cancer. PSA is a tumor marker used to follow prostate cancer. Hair loss is rare with this medication, however because of the change in hormonal balance, there may be complications related to libido and sexual performance.

ANS: A PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Immunological System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Biologic Therapy (p. 303–311; 323): Monoclonal antibodies attack cancer cells only. They attach themselves to the tumor antigens and make them easily recognizable to the body’s immune system.

ANS: D PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Immunological System Medications KEY: Application MSC: NCLEX Category: Physiological Adaptation NOT: See Master the Essential Table and Radioactive Isotopes (p. 303–311; 324): Radioactive isotopes can be implanted in the form of seeds. This procedure is called brachytherapy.

ANS: B PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Immunological System Medications KEY: Application MSC: NCLEX Category: Physiological Adaptation NOT: See Master the Essential Table and Radioactive Isotopes (p. 303–311; 324): Radioactive isotopes must

be handled very carefully and facility policy will dictate the handling and disposal of body fluids. These clients are not roomed with others to reduce the risk of radiation exposure. Specialized rooms with lead-lined walls away from other rooms will reduce the risk of radiation exposure to others.

MULTIPLE RESPONSE 1. ANS: A, C, E PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Immunological System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Antihistamines (p. 303–311; 312): Advise patient that good oral hygiene, frequent rinsing of mouth with water, and sugarless gum or candy may minimize dry mouth.

Flossing is not helpful in addressing dry mouth. Caffeine has a diuretic effect and will not be helpful.

Alcohol-based mouth rinse may increase a sensation of dryness.

2. ANS: C, E, F PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Immunological System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Antihistamines (p. 303–311; 312): Azelastine is an antihistamine.

These medications can cause sedation, CNS depression, dizziness, muscle weakness, epigastric distress, and dry mouth. Increased risk of infection, nausea, and rash are not expected side effects with this medication.

3. ANS: A, E PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Immunological System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Nonsteroidal Anti-inflammatory Drugs (p. 303–311; 312): Precautions or contraindications for NSAID agents include renal disease and GI bleeding since NSAIDs increase the risk for both conditions.

4. ANS: A, B, C, D PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Immunological System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Penicillin Medications (p. 303-311; 314): The first four agents listed are derivatives of penicillin and should not be given to a client with a penicillin allergy. Doxycycline is a tetracycline antibiotic; erythromycin is a macrolide; both are potentially safe in a client with an allergy to penicillin.

5. ANS: A, B, C, D PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Immunological System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Penicillin Medications (p. 303–311; 314): Antibiotic therapy should be taken until the entire course of medication is gone to avoid the development of resistant organisms.

The other statements are all true and could be included in the client teaching.

6. ANS: A, D PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Immunological System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Cephalosporin Medications (p. 303-311; 315): Cefaclor is a cephalosporin antibiotic. Alcohol and diuretics may interact with these medications and should be avoided.

The medication does not interact with dairy products and may cause diarrhea so increased liquids and iron in the diet may help treat or reduce this risk.

7. ANS: B, C PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Immunological System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Tetracycline Medications (p. 303–311; 315): Tetracycline and doxycycline belong to the tetracycline antibiotic family. These medications can cause decreased bone growth

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and discolored teeth in a fetus or child and should not be used in pregnancy. Amikacin is an aminoglycoside; erythromycin is a macrolide; ciprofloxacin is a quinolones; cefibuten is a cephalosporin.

ANS: A, B, C PTS: 1 DIF: Hard TOP: Therapeutic Classification: Immunological System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Aminoglycoside Medications (p. 303–311; 315): Hearing loss can occur and prompt recognition and intervention are essential in preventing permanent damage. Monitor renal function as this medication is contraindicated for individuals with decreased kidney function and can cause kidney damage. Nurses should never infuse anything into a TPN line other than lipids ordered to accompany such infusions. Symptoms of infection may be expected in this client since they are receiving antibiotic therapy presumably to treat an infection.

ANS: C, E PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Immunological System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Sulfonamide Medications (p. 303–311; 315): Sulfisoxazole is a sulfonamide antibiotic typically used to treat urinary tract infections. Doses should not be doubled in medications. Instead, a missed dose should be taken as soon as it is remembered or missed completely if it is time for the next dose. The medication can be taken with or without food and is much more likely to cause diarrhea than constipation. Pregnancy is a contraindication for this family of antibiotics.

ANS: A, B, E PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Immunological System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Sulfonamide Medications (p. 303–311; 315): Sulfamethizole, sulfamethoxazole, and sulfasalazine are all sulfa antibiotics and should be questioned/not given to a client with allergies to sulfa medications.

ANS: A, D PTS: 1 DIF: Hard TOP: Therapeutic Classification: Immunological System Medications KEY: Knowledge MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Antituberculosis Medications (p. 303–311; 316): Rifampin and rifabutrin will cause the urine, stool, tears, sweat, and saliva to turn red/orange in color. The other medications are anti-tuberculosis medications but do not cause this particular side effect.

ANS: A, B, E PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Immunological System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Medications That Fight Viruses (p. 303–311; 317): Miconazole is a topical antifungal agent designed to treat fungal infections such as athlete’s foot. Clients are generally encouraged to reduce time in shoes, rotate shoes, and wear clean, white cotton socks while undergoing treatment to help reduce the heat and moisture that contribute to fungal growth.

ANS: A, C PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Immunological System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Medications That Fight Viruses (p. 303–311; 317): Acyclovir is an anti-viral agent used in the treatment of herpes and other viruses like chicken pox and shingles. A client with bronchitis or a bacterial sinus infection will need an antibiotic; a client with thrush will need an antifungal.

ANS: B, D, F PTS: 1 DIF: Hard TOP: Therapeutic Classification: Immunological System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Medications That Fight Viruses (p. 303-311; 317): Oseltamivir and other antivirals can cause confusion, diarrhea, headache, kidney disease, nausea, rash, urticaria, and vomiting.

ANS: A, B, D, F PTS: 1 DIF: Moderate

TOP: Therapeutic Classification: Immunological System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Antimetabolite Medications and Box 17.1 (p. 303–311; 322): Antimetabolite medications can cause multiple side effects. It is important for all clients receiving chemotherapy that can cause nausea/vomiting to have this monitored and treated with antiemetics promptly.

Strict intake and output should be monitored including caloric intake. Mild, soft foods are generally suggested to reduce the risk of GI irritation. Vital signs should be monitored frequently. Standard precautions are appropriate and there is no reason for the client to be placed in contact precautions. Frequent oral care will reduce the risk of stomatitis, which is particularly concerning with this medication.

16. ANS: B, D PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Immunological System Medications KEY: Application MSC: NCLEX Category: Reduction of Risk Potential NOT: See Master the Essential Table and Biological Therapy (p. 303–311; 323): Alemtuzumab is a biological response modifier used in the treatment of multiple cancers including leukemia. Leukemia is a cancer of the white blood cells and bone marrow suppression is an expected side effect of the medication, thus the white blood cell count and platelet count will be monitored with each subsequent treatment. Prothrombin time is used to evaluate bleeding time. CD-8 count is monitored in clients with HIV. C-reactive protein is used to evaluate inflammation.

17. ANS: B, C, E PTS: 1 DIF: Hard TOP: Therapeutic Classification: Immunological System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Plant Extracts (p. 303-311; 323): Docetaxel is a plant alkaloid. This class of medications is known for side effects including neurotoxicity and hair loss (alopecia) as well as altered GI function including sores in the mouth, constipation, nausea/vomiting, or diarrhea. Hot flashes or rash are not seen with this class of medications.

COMPLETION 1. ANS: 200 mL/hr PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Immunological System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Cephalosporin Medications (p. 303–311; 315): 100 mL divided by 30 minutes multiplied by the conversion factor of 60 minutes/hour = 200 mL/hr.

2. ANS: 5 mL PTS: 1 DIF: Easy TOP: Therapeutic Classification: Immunological System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Glucocorticoids (p. 303–311; 312): With a dose of 10 mg liquid preparation of 2 mg/mL the provided dose is 5 mL [10 mg ÷ 2 mg/mL = 5 mL].

3. ANS: 4 pills PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Immunological System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Quinolone Medications (p. 303–311; 315): Ofloxacin is a quinolone medication used in the treatment of upper respiratory infections. This drug calculation is done by

recognizing that the 400-mg dose will require 2 pills (200 mg each) and that the client will take 2 doses each day for a total of 4 pills.

4. ANS: 525 mg PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Immunological System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Quinolone Medications (p. 303–311; 315): Ciprofloxacin is a quinolone antibiotic. Dosage calculation requires multiplying 15 mg by 35 kg for a dose of 525 mg every 12 hours.

Chapter 18. Pulmonary System Medications Multiple Choice Identify the choice that best completes the statement or answers the question.

1. The LPN is assisting in the admission process for a client with a history of asthma. In addition to a

rescue inhaler, the LPN would expect the client may take which of the following medications?

A. Cromolyn sodium (Intal) B. Phenylephrine (Dimetapp) C. Theophylline D. Bupropion (Wellbutrin) 2. The LPN is talking to a client newly prescribed nedocromil (Tilade aerosol) who asks, “Why do I

have to take this medication? Why can’t I just take my inhaler when I have an asthma attack?”

Which of the following responses by the nurse is best?

A. “This medication helps block asthma triggers from entering your lungs.”

B. “By suppressing your immune system, this medication helps treat your asthma.”

C. “This medication helps decrease your body’s reaction to things that set off an asthma attack.”

D. “The nedocromil helps thin secretions so it is easier for you to clear your lungs.”

3. The LPN is assisting a client newly diagnosed with influenza who has been given a prescription for

oseltamivir (Tamiflu). The nurse recognizes the client is aware of potential side effects by which of the following statements?

A. “I might feel my heart racing when I take this medication.”

B. “Some people get really constipated when they take this.”

C. “The medication is likely to make me feel hungry often.”

D. “This medication may cause nervousness or difficulty sleeping.”

4. The LPN is caring for a sick child at home who has a bad cough. The nurse would choose an over-

the-counter cough syrup that contained which of the following active ingredients?

A. Albuterol B. Dextromethorphan C. Flunisolide D. Phenylephrine 5. The nurse prepares to provide guiafenesin (Mucinex) as ordered. The patient asks, “What is this

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 up.”

B. “It is a cough suppressant and will help reduce your coughing.”

C. “It dries up your secretions so you won’t feel so stuffy headed.”

D. “This helps open your airways to help you breathe.”

6. The LPN is taking a medication history from a client with chronic obstructive pulmonary disease

(COPD) who reports taking tiotropium (Spiriva). The nurse is aware the client takes this medication in what type of formulation?

A. As syrup B. As an inhaled powder

C. Sublingually D. Orally 7. The LPN is caring for a client who reports taking ipratropium (Atrovent) and budesonide (Pulmicort)

inhalers. Which action by the nurse is best?

A. Provide the ipratropium first then the budesonide.

B. Provide the budesonide first then the ipratropium.

C. Contact the physician to clarify which inhaler should be used.

D. Use the ipratropium daily and the budesonide for rescue if the client has acute

dyspnea.

8. The LPN is instructing a client how to take the prescribed theophylline (TheoCap). Which of the

following actions by the client ensures the client understood the instructions?

A. The client takes the medication every night at bedtime.

B. The client takes the medication daily on an empty stomach with a full glass of water.

C. The client takes the medication during an acute asthma attack.

D. The client takes the medication up to four times each day as needed.

9. After reviewing a new prescription for theophylline (Slo-Bid), the nurse would ensure the client

understood which of the following?

A. Careful monitoring with blood tests will be necessary.

B. The medication can greatly increase the client’s risk of bleeding.

C. Seizure medications may need to be altered as the medication lowers seizure

threshold.

D. The medication can dampen libido in some clients.

10. The LPN is working with a client in a long-term care facility who takes metaproterenol (Alupent).

The nurse is aware that the client’s blood pressure that morning was 118/68. Which action should the nurse take?

A. Provide the metaproterenol knowing there is a potential it will increase the client’s blood pressure.

B. Hold the metaproterenol since there is a potential it will decrease the client’s blood pressure.

C. Contact the RN. D. Delay administration of the metaproterenol until the blood pressure is rechecked in an hour.

11. The LPN is taking a dose of multi-symptom cold medication and is aware that which of the

following active ingredients will help reduce nasal congestion?

A. Acetylcysteine B. Guiafenesin C. Pseudoephedrine D. Codeine 12. The LPN is visiting her father who has been hospitalized with pneumonia. The LPN recognizes that

her father has thick secretions and a frequent cough. Which of the following medications might the LPN inquire to help her father?

A. Triamcinolone (Azmacort) B. Aminophylline (Phyllocontin) C. Albuterol (Proventil) D. Acetylcysteine (Mucomyst) 13. A student nurse is talking to a respiratory therapist about the various clients receiving nebulizer

treatments. Which client is most likely to receive acetylcysteine (Mucomyst)?

A. A 19-year-old patient with cystic fibrosis B. A 56-year-old patient with chronic obstructive pulmonary disease C. A 31-year-old patient with an exacerbation of asthma D. A 43-year-old patient with bronchitis 14. The nurse is caring for a client recently returned from surgery who is wearing oxygen 2L NC. The

client has continuous pulse oximeter in place and the monitor alarms and indicates the client’s oxygen saturation is 88%. Which action by the nurse is best?

A. Replace the nasal cannula with a simple face mask.

B. Notify the RN. C. Instruct the client to take deep breaths through the nose.

D. Reset the alarm to indicate a saturation of 85% or less.

15. Which of the following individuals is the most likely to receive caffeine citrate (Cafcit)?

A. A 59-year-old woman diagnosed with sleep apnea B. A 9-year-old girl diagnosed with asthma C. A 28-year-old man diagnosed with pleurisy D. A 3-day-old boy born at 30 weeks’ gestation 16. The LPN is counseling a client who is taking bupropion (Welbutrin). Which of the following

statements is most important to include in the teaching?

A. “Smoking is a very hard habit to break, so we encourage you to seek support.”

B. “Be sure you do not smoke while you are taking this medication or you could

overdose on nicotine.”

C. “This medication can cause people to think about killing themselves so it is

imperative that you notify the doctor if you have any thoughts like that.”

D. “Your prescription is only good for 10 days so you must have it filled soon or it

will expire.”

17. The nurse is assisting in the care of a client who smokes 2 packs per day. The client has been

prescribed a 14-mg nicotine patch (NicoDerm). The client expresses a desire to smoke. Which action by the nurse is best?

A. Allow the client to smoke 1 cigarette four times daily to curb their cravings.

B. Contact the physician to request an order for Nicorette gum as needed.

C. Contact the pharmacy and request a 21-mg patch.

D. Inform the client that smoking is against institutional policy and is not good for her.

18. The LPN is attempting to stop smoking and has tried to quit “cold-turkey” multiple times. This time

he is willing to seek help and wants to use a medication that will make his desire to smoke fade away. Which of the following medications will the physician most likely prescribe?

A. Bupropion (Budeprion) B. Nicotine (Nicotrol) C. Flunisolide (Aerobid) D. Varenicline (Chantix) Multiple Response Identify one or more choices that best complete the statement or answer the question.

1. The nurse is providing care for a client with a long-term history of asthma for an acute exacerbation.

The client is started on aminophylline (Phyllocontin). Which of the following side effects would the nurse include in the client teaching? (Select all that apply.)

A. Altered heart rhythm B. Excitability/CNS stimulation C. Drowsiness D. Increased blood sugar E. Constipation 2. While working at a family practice physician’s office, the LPN would counsel clients taking over-

the-counter decongestants if they were also taking which of the following? (Select all that apply.)

A. MAO inhibitors B. Barbiturates C. Beta-blockers D. Seizure medications E. Histamine blockers F. Calcium-containing antacids 3. Select the clients for whom the use of oxygen therapy is potentially dangerous. (Select all that

apply.)

A. A 4-year-old patient in a humidified mist tent with O2 at 28% B. A 31-year-old patient with pneumonia who is wearing O2 at 2 L per nasal cannula C. A 71-year-old patient with profound chronic obstructive pulmonary disease with an

O2 mask at 60% D. A baby born at 27 weeks’ gestation receiving high flow oxygen E. A 17-year-old patient with status asthmatics wearing a non-rebreather mask set

with 15 L of O2 4. The LPN is visiting an infant in the neonatal intensive care unit who has been placed on caffeine

citrate for respiratory stimulation. The nurse would attribute which of the following observations to the medication? (Select all that apply.)

A. The infant does not produce tears when she cries.

B. The infant is fussy and has difficulty sleeping.

C. The infant is wearing eye shields.

D. The infant turns her head when her cheek is stroked.

E. The infant has a low-grade fever.

Completion Complete each statement.

1. The LPN is preparing a dose of over-the-counter dextromethorphan (Robitussin) cough syrup for a

child that weighs 25 kg. The dosage chart on the box reads as follows: Under 24 lb (under 2 years) Ask the doctor 24–47 lb 1 tsp 48–95 lb 2 tsp Over 95 lb 4 tsp How much medication in tsp will the nurse give?

2. The LPN is preparing to provide a dose of over-the-counter dextromethorphan (Duratuss) cough

syrup for a child. Based on the child’s age and weight, the nurse determines the appropriate amount is 2 tsp. If there is 7.5 mg of the active ingredient in each 5 mL, what is the actual dose of medication the child is receiving (in mg)?

Matching

Client orders read: albuterol (Proventil) inhaler every 4 hours as needed for dyspnea. Place the following steps in appropriate order for the correct administration.

A. Instruct the client to inhale while depressing the inhaler to release a dose of medication.

B. Shake the inhaler for about 5 seconds.

C. Place the client in High Fowlers or sitting position.

D. Have the client place the inhaler with lips around the mouthpiece.

E. Have the client hold their breath for about 10 seconds.

F. Instruct the client to breathe out fully.

1. First 2. Second 3. Third 4. Fourth 5. Fifth

6.

Sixth

Chapter 18. Pulmonary System Medications Answer Section MULTIPLE CHOICE 1. ANS: A PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Pulmonary System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Mast Cell Stabilizers (p. 332–334; 335): Cromolyn sodium is a mast cell stabilizer, which helps prevent asthma attacks. Phenylephrine is a decongestant; theophylline is a respiratory stimulant; bupropion is a smoking cessation agent.

2. ANS: C PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Pulmonary System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Mast Cell Stabilizers (p. 332–334; 335): Nedocromil is a mast cell stabilizer. The medications decrease the body’s reaction to asthma triggers, thereby reducing the frequency of asthma attacks.

3. ANS: D PTS: 1 DIF: Hard TOP: Therapeutic Classification: Pulmonary System Medications KEY: Analysis MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Anti-influenza Agents (p. 332–334; 335): Oseltamivir is an antiinfluenza medication. Side effects include: anorexia, bronchitis, diarrhea, dizziness, dry mouth, headache, insomnia, nervousness, and urinary retention.

4. ANS: B PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Pulmonary System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Antitussives and Expectorants (p. 332–334; 335): Dextromethorphan is a cough suppressant (antitussive), which helps suppress the cough reflex. Albuterol is a bronchodilator and is not purchased over the counter or placed in cough syrups. Flunisolide is a glucocorticoid used to decrease inflammation; it is not included in cough syrups or purchased over the counter. Phenylephrine is a decongestant often included in cold remedies but does not aid in cough suppression.

5. ANS: A PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Pulmonary System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Antitussives and Expectorants (p. 332–334; 335): Guiafenesin is an expectorant; it acts to thin secretions and allow a more productive cough. Antitussives suppress the cough reflex, decongestants dry up mucous membranes. Bronchodilators help open airways.

6. ANS: B PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Pulmonary System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Anticholinergics (p. 332–334; 337): Spiriva is an inhaled powder provided in the form of a capsule, which is placed in a specialized inhaler to allow inhalation.

7. ANS: A PTS: 1 DIF: Hard TOP: Therapeutic Classification: Pulmonary System Medications KEY: Analysis MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Anticholinergics (p. 332–334; 337): Ipratropium is an anticholinergic used to dilate the bronchi while budesonide is a glucocorticoid used to decrease inflammation.

8.

9.

10.

11.

12.

13.

14.

Both inhalers are appropriate for the treatment of COPD. If both are taken at the same time, the ipratropium should be taken to help dilate the airways, allowing maximal absorption of the budesonide. Budesonide is not a rescue medication and should be taken routinely.

ANS: B PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Pulmonary System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Xanthines (p. 332–334; 337): Theophylline is a xanthine that should be taken on an empty stomach with a full glass of water for faster absorption. This is not a rescue medication and has a narrow safety margin so there is a risk of toxic effects if too much medication is taken.

ANS: A PTS: 1 DIF: Hard TOP: Therapeutic Classification: Pulmonary System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Xanthines (p. 332–334; 337): Theophylline is a xanthine and has a narrow safety margin. There is a risk of toxic effects so careful monitoring, including blood levels, is typically done. It does not increase the risk of bleeding or seizure activity, nor does it alter libido.

ANS: A PTS: 1 DIF: Hard TOP: Therapeutic Classification: Pulmonary System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Beta-adrenergic Agonists (p. 332–334; 337): The blood client’s blood pressure in this scenario is not problematic. The metaproterenol may increase the client’s blood pressure so continued monitoring is important, but there is no need to hold, delay administration, or to contact the RN. ANS: C PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Pulmonary System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Decongestants (p. 332–334; 338): Pseudoephedrine is a decongestant and is often an active ingredient in multi-symptom cold remedies. Acetylcysteine is a mucolytic; guiafenesin is an expectorant; codeine is an antitussive.

ANS: D PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Pulmonary System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Mucolytics (p. 332–334; 338): Acetylcysteine (Mucomyst) is a mucolytic that will help loosen or break up thick mucus. Triamcinolone (Azmacort) is a glucocorticoid, which decreases inflammation. Aminophylline (Phyllocontin) is a xanthine used to relieve asthma symptoms.

Albuterol (Proventil) is a beta-adrenergic agonist used to dilate the bronchi.

ANS: A PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Pulmonary System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Mucolytics (p. 332–334; 338): Acetylcysteine (Mucomyst) is a mucolytic that will help loosen or break up thick mucus. It is most commonly used as an aerosol treatment in patients with cystic fibrosis, a genetic disease causing the respiratory secretions to be extremely thick and difficult to cough up.

ANS: C PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Pulmonary System Medications KEY: Application MSC: NCLEX Category: Reduction of Risk Potential NOT: See Master the Essential Table and Oxygen (p. 332–334; 338): Oxygen is provided to treat hypoxia, or lowered oxygenation levels. Ideally oxygen saturation is above 90% to 92% for most clients. Anesthesia can slow the respiratory rate and decrease respiratory depth resulting in hypoxia. Nasal cannula provision of oxygen is appropriate if the client is able to breathe through the nose. In this scenario, instructing the client to take deep breaths through the nose will allow delivery of oxygen and should rectify the hypoxia. If the client

15.

16.

17.

18.

continues to have hypoxia and the nurse determines the client is a mouth breather, a simple mask may be appropriate. The RN should be notified with significant changes in client condition but the priority here is to increase the client’s intake of oxygen.

ANS: D PTS: 1 DIF: Hard TOP: Therapeutic Classification: Pulmonary System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Respiratory Stimulants (p. 332–334; 338–339): Caffeine citrate is a respiratory stimulant. These medications are most commonly used for premature infants whose brain is not developed and need a nudge to breathe. Medication has not proven to help with sleep apnea and the other clients are not appropriate for this medication.

ANS: C PTS: 1 DIF: Hard TOP: Therapeutic Classification: Pulmonary System Medications KEY: Analysis MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Smoking Cessation (p. 332–334; 339): Bupropion is a medication used to aid in smoking cessation. It does not contain nicotine but it can cause suicidal ideation and completion so client education is critical. It is not a controlled substance.

ANS: B PTS: 1 DIF: Hard TOP: Therapeutic Classification: Pulmonary System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Smoking Cessation (p. 332–334; 338): Nicotine containing medications deliver small, consistent doses of nicotine to help an individual gradually withdraw from nicotine use. Clients are instructed they cannot smoke while using nicotine patches to avoid nicotine overdose. While a 21-mg patch is available, the nurse will need to seek a prescription to provide it to the client. Requesting additional nicotine in the form of Nicorette gum may allow the client to help curb cravings. Although smoking may be against policy and is not a healthy habit, the best action is to seek ways to help the client curb the desire to smoke.

ANS: D PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Pulmonary System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Smoking Cessation (p. 332–334; 338): Varenicline is used with behavior modification to convince your brain that smoking is not pleasurable. The patient may smoke during treatment but slowly loses the desire to do so. Bupropion and nicotine also aid in smoking cessation, but they have different actions. Flunisolide (Aerobid) is a glucocorticoid not used in smoking cessation.

MULTIPLE RESPONSE 1. ANS: A, B, D PTS: 1 DIF: Hard TOP: Therapeutic Classification: Pulmonary System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Xanthines (p. 332–334; 337): Aminophylline is a xanthine medication. This class of medications can cause dysrhythmias, CNS stimulation, GI distress, increased blood sugar and heart rate, and urinary frequency.

2. ANS: A, C PTS: 1 DIF: Hard TOP: Therapeutic Classification: Pulmonary System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Decongestants (p. 332–334; 338): Decongestants can potentially interact with other sympathomimetic medications, MAO inhibitors, beta-blockers, and methyldopa.

3. ANS: C, D PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Pulmonary System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies

NOT: See Master the Essential Table and Oxygen (p. 332–334; 338): Too much oxygen can damage the eyes, especially of premature infants. Patients with COPD have adapted to long-term lowered O2 levels so too much oxygen can shut off or slow the client’s breathing. The type of breathing device and level of oxygen in the other examples are appropriate and not significantly dangerous, although oxygen is a flammable gas and has the potential to be dangerous for all clients. Room air levels of oxygen are 21%.

4. ANS: B, E PTS: 1 DIF: Hard TOP: Therapeutic Classification: Pulmonary System Medications KEY: Analysis MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Respiratory Stimulants (p. 332–334; 338–339): Caffeine citrate is a respiratory stimulant. These medications are most commonly used for premature infants whose brain is not developed and need a nudge to breathe. Side effects include: abdominal pain, blood in the stools, seizures, fever, bradycardia or tachycardia, sleep problems, fussiness, and loss of appetite. Premature infants may not produce tears due to underdeveloped lacrimal ducts.

COMPLETION 1. ANS: 2 tsp PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Pulmonary System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Antitussives and Expectorants (p. 332–334; 335): The child weighs 20 kg and weight must be converted to pounds by multiplying by 2.2 lb/kg for a total of 55 lb, so the child will be given 2 tsp.

2. ANS: 15 mg PTS: 1 DIF: Hard TOP: Therapeutic Classification: Pulmonary System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Antitussives and Expectorants (p. 332–334; 335): 1 tsp = 5 mL, so a dose of 2 tsp is 10 mL and the dose of active ingredient would be 7.5 mg x 2 = 15 mg.

MATCHING 1. ANS: C PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Pulmonary System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Beta-adrenergic Agonists (p. 332–334; 337): It is best to take an inhaler in an upright position. The inhaler should be shaken prior to administration and the client is encouraged to breathe out fully to empty the lungs and allow a deep inhalation after the mouth is secured around the mouthpiece and the inhaler is simultaneously depressed to release a dose of medication during inhalation. Clients are encouraged to hold their breath for about 10 seconds to trap the inhaled medication in their lungs to optimize absorption.

2. ANS: B PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Pulmonary System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Beta-adrenergic Agonists (p. 332–334; 337): It is best to take an inhaler in an upright position. The inhaler should be shaken prior to administration and the client is encouraged to breathe out fully to empty the lungs and allow a deep inhalation after the mouth is secured

3.

4.

5.

6.

around the mouthpiece and the inhaler is simultaneously depressed to release a dose of medication during inhalation. Clients are encouraged to hold their breath for about 10 seconds to trap the inhaled medication in their lungs to optimize absorption.

ANS: F PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Pulmonary System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Beta-adrenergic Agonists (p. 332–334; 337): It is best to take an inhaler in an upright position. The inhaler should be shaken prior to administration and the client is encouraged to breathe out fully to empty the lungs and allow a deep inhalation after the mouth is secured around the mouthpiece and the inhaler is simultaneously depressed to release a dose of medication during inhalation. Clients are encouraged to hold their breath for about 10 seconds to trap the inhaled medication in their lungs to optimize absorption.

ANS: D PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Pulmonary System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Beta-adrenergic Agonists (p. 332–334; 337): It is best to take an inhaler in an upright position. The inhaler should be shaken prior to administration and the client is encouraged to breathe out fully to empty the lungs and allow a deep inhalation after the mouth is secured around the mouthpiece and the inhaler is simultaneously depressed to release a dose of medication during inhalation. Clients are encouraged to hold their breath for about 10 seconds to trap the inhaled medication in their lungs to optimize absorption.

ANS: A PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Pulmonary System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Beta-adrenergic Agonists (p. 332–334; 337): It is best to take an inhaler in an upright position. The inhaler should be shaken prior to administration and the client is encouraged to breathe out fully to empty the lungs and allow a deep inhalation after the mouth is secured around the mouthpiece and the inhaler is simultaneously depressed to release a dose of medication during inhalation. Clients are encouraged to hold their breath for about 10 seconds to trap the inhaled medication in their lungs to optimize absorption.

ANS: E PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Pulmonary System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Beta-adrenergic Agonists (p. 332–334; 337): It is best to take an inhaler in an upright position. The inhaler should be shaken prior to administration and the client is encouraged to breathe out fully to empty the lungs and allow a deep inhalation after the mouth is secured around the mouthpiece and the inhaler is simultaneously depressed to release a dose of medication during inhalation. Clients are encouraged to hold their breath for about 10 seconds to trap the inhaled medication in their lungs to optimize absorption.

Chapter 19. Gastrointestinal System Medications Multiple Choice Identify the choice that best completes the statement or answers the question.

1. While counseling a patient who takes bisacodyl (Peri-Colace), the nurse determines further teaching

is required by which of the following statements?

A. “I typically need to take it about once or twice a week.”

B. “It bulks up my stool and absorbs water so I have to really increase my fluid

intake.”

C. “If I take it at night, my bowels usually move in the morning.”

D. “Taking a stool softener has been helpful since I don’t get around as much with my walker.”

2. The LPN is assisting in the care of a client who requests a suppository to aid in the passage of

constipated stool. Which of the following medications ordered on a prn basis would the nurse provide?

A. Orlistat (Xenical) B. Polyethylene glycol (MiraLax) C. Glycerine (Colace) D. Cimetidine (Tagamet) 3. The LPN is preparing for a colonoscopy and was given a prescription for polyethylene glycol

electrolyte solution (GoLYTELY). The nurse was instructed to remain on clear liquids then start the prep from 10 to 11 a.m., remain NPO after the prep, and report for the procedure at 4 p.m. She typically takes her morning blood pressure medication and vitamins at 9 a.m. with her breakfast.

Which of the following actions is best?

A. Do not take the morning medications until after the procedure.

B. Take the morning medications with a liquid breakfast at 8 a.m. or earlier.

C. Take the morning medications with breakfast at 9 a.m. as usual then start clear liquids with the prep at 10 a.m.

D. Take the blood pressure medication at 9 a.m. but not the vitamins with a clear liquid meal.

4. The LPN is talking to a client who experiences watery diarrhea frequently with menstruation.

Which of the following is an over-the-counter medication that would be useful for short-term use in this scenario?

A. Loperamide (Imodium) B. Prochlorperazine (Compazine) C. Simethicone (Mylanta gas) D. Phentermine (Zantryl) 5. The LPN is working with a client who has ulcerative colitis and is taking bismuth subsalicylate

(Pepto-Bismol). The nurse would caution the client about taking other over-the-counter products that contain which of the following?

A. Acetaminophen (Tylenol) B. Salicylate (Aspirin)

C. Ibuprofen (Advil) D. Guiafenesin (Mucinex) 6. The nurse prepares to provide scopolamine (Scopace). Which of the following instructions should

the nurse provide?

A. “Take this with your other pills and swallow them all at once; it dissolves in your

stomach.”

B. “I will dissolve this in juice and then have you drink it.”

C. “Just suck on this like a lozenge and it will dissolve over a few minutes.”

D. “I will place this patch behind your ear and the medication is absorbed through

your skin.”

7. The student nurse is studying the various types of medications that can be used to treat nausea and

vomiting. If asked which classification of these medications can also be used to treat motionsickness, the student nurse would select which of the following?

A. 5-hydroxytryptamine-3 receptor antagonists B. Antihistamines C. Anticholinergic medications D. Phenothiazines 8. Which of the following would cause the nurse to intervene for a patient taking pantoprazole

(Protonix)?

A. The client takes the medication an hour before breakfast.

B. The client has a history of gastric ulceration.

C. The client has an allergy to sulfa antibiotics.

D. The client reports having just taken a Tums for heartburn.

9. The LPN discusses the use of calcium carbonate (Tums) antacids with a client who suffers from

chronic heartburn. The LPN would include which of the following instructions in the client teaching?

A. “Take the medication once daily with your other medications.”

B. “You should drink a glass of water or milk after chewing the tablets.”

C. “If you prefer to use the liquid preparations, they come premixed and should not be shaken.”

D. “The medications generally start to work in 4 to 6 hours.”

10. The nurse is caring for a patient receiving magnesium hydroxide (Phillips Milk of Magnesia) every

two hours while awake for the treatment of a peptic ulcer. For which of the following side effects should the nurse monitor?

A. Kidney stone formation B. Headache C. Insomnia D. Tremors 11. The LPN is assisting in the care of a client who takes famatodine (Pepcid) at home. The nurse

determines the pharmacy may substitute which of the following agents during the client’s stay in the hospital?

A. Ranitidine (Zantac)

B. Metronidazole (Flagyl) C. Sucralfate (Carafate) D. Misoprostol (Cytotec) 12. A nurse working with a patient who started taking glycopyrrolate (Robinul) recognizes that patient

further teaching is necessary by which of the following statements?

A. “I’ll call the doctor immediately if I have any visual changes.”

B. “I can buy this medication over the counter.”

C. “I may experience some headache or nervousness with this medication.”

D. “People who take this medication have palpitations, so I need to tell the doctor if that happens.”

13. The LPN is assisting in the care of client recently diagnosed with cholecystitis. Surgeons have

determined the client is not able to face surgery at the time. The LPN anticipates the client will be given which of the following medications?

A. Clarithromycin (Biaxin) B. Ranitidine (Taladine) C. Ursodiol (Actigall) D. Orlistat (Alli) 14. An LPN is discussing weight loss with a co-worker who states, “I’ve been taking phentermine

(Adipex) for a few weeks and it is really helping with my weight loss.” The LPN is aware this medication has a high potential to result in which of the following?

A. Altered taste sensations B. Diarrhea C. Tolerance D. Addiction 15. While talking to a client at the weight-loss center who is taking phentermine (Zantryl), the LPN

would be most concerned by which of the following statements?

A. “I’ve lost 4 pounds this first week and I’m really excited to make so much

progress.”

B. “I just started taking this along with my other diet medications and really hope it

can help.”

C. “I know I can only use this for a short term, so I’m working hard to lose weight

now.”

D. “I’ve been exercising every day and am really motivated to get healthy again.”

16. The LPN is visiting a friend who recently delivered a 9-lb 4-oz infant. The friend confides, “I have

awful hemorrhoids now, and they are so miserable.” Which of the following statements by the nurse is best?

A. “You should have the doctor order some Preparation H and Tucks pads to help with that.”

B. “I know how terrible those can be! They will go down in a day or two.”

C. “It’s probably because the baby was so big. Did you have to push long?”

D. “Once you stop bleeding you’ll be able to apply some topical cream to the area.”

17. The LPN is preparing for a gastroscopy procedure. In addition to remaining NPO, the nurse is aware

that which of the following may be given preprocedure to help relieve gas formation?

A. Albendazole (Albenza) B. Nystatin (Mycostatin) C. Simethicone (Flatulex) D. Phentermine (Adipex) 18. An LPN working in a long-term care facility would use nystatin (Nilstat) for which of the following

clients?

A. A 75-year-old patient who has oral candidiasis B. A 69-year-old patient who has gall stones C. An 88-year-old patient who has peptic ulcer disease D. A 91-year-old patient who has loose liquid stools 19. While treating a client who has pinworms with the medication pyrantel (Antiminth), the nurse is

most likely to also provide which of the following additional medications as part of the treatment regimen?

A. Loperamide (Imodium) B. Dicyclomine (Bentyl) C. Senna/Docusate (Peri-Colace) D. Esomeprazole (Nexium) 20. The LPN working at a family practice office receives a call from the parent of a 4-year-old patient

who states, “I think she’s swallowed my father’s pills.” What response by the nurse is best?

A. “Do you have any syrup of ipecac?”

B. “What pills does your father take?”

C. “I suggest you call Poison Control at 1-800-222-1222.”

D. “I will leave a note for the doctor and have him call you back.”

21. An LPN working in a long-term care facility notes that a 92-year-old woman has lost 3 pounds in the

past week. Which of the following would the nurse request be added to the treatment plan?

A. Nutritional supplementation with Boost with meals and at bedtime B. Anti-emetic therapy with ondansetron (Zofran) every day C. Anti-depressant therapy with bupropion (Wellbutrin) D. A referral to a psychiatrist 22. The LPN is assisting in the care of a client who has had radiation therapy to the head and neck area

for squamous cell carcinoma of the salivary gland. The nurse recognizes teaching is effective by which of the following statements?

A. “The effects of the radiation and surgery have caused a lack of saliva called halitosis.”

B. “I should use alcohol-based mouth rinses to help kill the germs in my mouth.”

C. “I can use artificial saliva to help lubricate my mouth and make chewing and eating easier.”

D. “I will have to have a tube placed so I can be fed with formula for the rest of my life.”

23. An LPN is talking to a neighbor who is undergoing chemotherapy for colorectal cancer and is

interested in reducing the risk of stomatitis and infection. Which of the following would the nurse recommend?

A. Alcohol-based mouth rinse four times daily B. Brushing with baking soda and a hard bristle brush C. Dilute hydrogen peroxide rinses before and after meals and at bedtime D. Limit oral hydration to 40 ounces per day Multiple Response Identify one or more choices that best complete the statement or answer the question.

1. The LPN would expect the treatment plan would likely include psyllium (Citrucel) for which of the

following individuals? (Select all that apply.)

A. A 52-year-old patient who drinks prune juice with breakfast and has a soft brown

stool daily B. A 51-year-old patient hospitalized for an anterior myocardial infarction C. A 60-year-old patient who reports walking over a mile every day D. A 52-year-old patient reporting increased constipation since the onset of

menopause E. A 35-year-old patient who recently had a hemorrhoidectomy 2. Which of the following medications can be used to prevent or treat nausea and vomiting? (Select all

that apply.)

A. Chlorpromazine (Thorazine) B. Albendazole (Albenza) C. Metoclopramide (Reglan) D. Palonosetron (Aloxi) E. Promethazine (Phenergan) F. Ondansetron (Zofran) 3. The LPN is caring for a client with cerebral palsy who has experienced multiple episodes of

aspiration pneumonia. When reviewing the client’s meds with his parents, the nurse determines teaching has been effective by which of the following statements? (Select all that apply.)

A. “He always takes a nap in his bed after lunch.”

B. “We feed him in his wheelchair and then he watches TV from his chair after dinner.”

C. “We give him the metoclopramide (Reglan) to help increase the rate of stomach emptying.”

D. “The latest he is allowed to have anything to eat is 8 p.m. since bedtime is at 10 p.m.”

E. “He sleeps without a pillow most of the time.”

4. An LPN is preparing to participate on a mission trip to Africa. The nurse has been informed that one

of the things she will be doing is helping to distribute praziquantel (Biltricide) to the adults and children there. Which of the following would the nurse try to communicate to the people who are given this medication? (Select all that apply.)

A. The medication helps prevent malaria.

B. The medication helps kill intestinal worms.

C. Most people experience abdominal pain and diarrhea with the medication.

D. It should not be given to women who may be pregnant.

E. The medication is given as an enema.

5. The LPN would expect which of the following individuals to take some type of digestant

medication? (Select all that apply.)

A. A 5-year-old patient with cystic fibrosis B. A 15-year-old patient with type 1 diabetes C. A 27-year-old patient with Crohn’s disease D. A 34-year-old patient with lactose intolerance E. A 41-year-old patient with cerebral palsy F. A 28-year-old patient with an allergy to eggs Completion Complete each statement.

1. The nurse is caring for a patient with ulcerative colitis. New orders are received for dicyclomine

(Bentyl) 20 mg four times daily. The pharmacy provides this medication in a syrup formulation with 10 mg/5 mL. How many mL will the pharmacy need to supply for each day?

The LPN receives a call from a client who says, “I bought some infant simethicone (Mylicon) to see if it would help my baby’s tummy. The bottle says there are 40 mg in 0.6 mL, and the recommended dose for a baby is 20 mg every 4 hours. How much should I give my baby?” What is the correct amount in mL for the dosage?

2.

Chapter 19. Gastrointestinal System Medications Answer Section MULTIPLE CHOICE 1. ANS: B PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Gastrointestinal System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Medications to Treat Constipation (p. 346–348; 349): Bisacodyl is a stool softener that decreases the consistency of the stool. This type of laxative is typically used routinely for clients with limited mobility. It is not a bulk-forming laxative.

2. ANS: C PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Gastrointestinal System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Medications to Treat Constipation (p. 346–348; 349): Glycerine is an osmotic laxative given rectally to aid in the evacuation of stool within 15 to 60 minutes. Orlistat is a lipase inhibitor. Polyethylene glycol is a bulk-forming laxative given orally. Cimetidine is an H2-receptor antagonist generally used to treat nausea.

3. ANS: B PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Gastrointestinal System Medications KEY: Application MSC: NCLEX Category: Reduction of Risk Potential NOT: See Master the Essential Table and Medications to Treat Constipation (p. 346–348; 349–350): Medications taken within 1 hour of the prep may be flushed from the GI tract, so the morning medications should be taken early with a clear liquid breakfast. Skipping the medication or holding it until after the procedure may cause a rise in the client’s blood pressure.

4. ANS: A PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Gastrointestinal System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Medications to Treat Diarrhea (p. 346–348; 350): Loperamide is an antidiarrheal agent that can be purchased over the counter. Prochlorperazine is an anti-emetic; simethicone is an antigas agent; phentermine is an anorexiant.

5. ANS: B PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Gastrointestinal System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Medications to Treat Diarrhea (p. 346–348; 350): Pepto-Bismol is available as a suspension, a tablet, or in chewable form. Because it contains salicylate, it is important for clients not to take additional aspirin-based products to reduce the risk of toxicity.

6. ANS: D PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Gastrointestinal System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Medications to Treat Nausea and Vomiting (p. 346–348; 350): Scopolamine can be given by the IV, IM, or SQ route or as a transdermal disc placed behind the ear. There is not an oral formulation of this medication.

7. ANS: B PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Gastrointestinal System Medications

8.

9.

10.

11.

12.

13.

14.

15.

KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Medications to Treat Nausea and Vomiting (p. 346–348; 350-351): Antihistamines can be used to treat nausea as well as motion sickness. The other anti-emetics are not typically used for motion sickness.

ANS: D PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Gastrointestinal System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Medications to Gastroesophageal Reflux Disease (p. 346–348; 352): Pantoprazole is a proton pump inhibitor used in the treatment of gastric ulcers and reflux disease and is best taken an hour before the meal to reduce stomach acid. There is no contraindication for clients with allergy to sulfa antibiotics but the presence of an antacid will reduce absorption.

ANS: B PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Gastrointestinal System Medications KEY: Analysis MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Medications to Treat Gastroesophageal Reflux Disease (p. 346– 348; 352): Calcium carbonate is given in suspension, which must be shaken, or in chewable tablets. Chewable tablets are usually taken with a glass of water or milk. These medications alter gastric pH, which can alter the absorption of other medications so they should not be taken concurrently. They typically work within 30 minutes to 3 hours.

ANS: A PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Gastrointestinal System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Medications to Treat Peptic Ulcers (p. 346–348; 353): Antacids can cause constipation, diarrhea, electrolyte imbalances, flatulence, osteoporosis, and kidney stones.

ANS: A PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Gastrointestinal System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Medications to Treat Peptic Ulcers (p. 346–348; 353): Famatodine and ranitidine are both H2-receptor antagonists. Metronidazole is an antibiotic; sucralfate is a mucosal protectant; misoprostol is a prostaglandin.

ANS: B PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Gastrointestinal System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Antispasmodics (p. 346–348): Glycopyrrolate is an antispasmodic agent used in the treatment of ulcerative colitis, diverticulitis, and irritable bowel syndrome. It is available by prescription only and can cause visual changes, headache, nervousness, or palpitations.

ANS: C PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Gastrointestinal System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Medications to Treat Gallstones (p. 346–348; 355): Ursodiol is a medication given to decrease production of cholesterol, which can be used for clients with gall bladder disease who cannot have surgery.

ANS: D PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Gastrointestinal System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Medications to Treat Obesity (p. 346–348; 355–356): Appetite suppressants give a feeling of fullness and sometimes create nausea. Most are controlled substances and can be habit-forming, so patients must be extremely cautious when taking this medication.

ANS: B PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Gastrointestinal System Medications

16.

17.

18.

19.

20.

21.

22.

KEY: Analysis MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Medications to Treat Obesity (p. 346–348; 355–356): Phentermine is an appetite suppressant. Taking this medication concurrently with other diet medications can cause pulmonary hypertension, which can be fatal.

ANS: A PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Gastrointestinal System Medications KEY: Application MSC: NCLEX Category: Health Promotion and Maintenance NOT: See Master the Essential Table and Medications to Treat Hemorrhoids (p. 346–348; 356): Preparation H and Tucks are both topical agents that can be used to reduce the pain and itch of hemorrhoids. Addressing the client’s concerns is the highest priority. Topical agents can be applied while a woman is still bleeding after delivery.

ANS: C PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Gastrointestinal System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Medications to Treat Flatulence (p. 346–348; 356): Simethicone is an antiflatulent agent that can be given with gastroscopy and bowel radiography to help relieve gas formation.

Albendazole is an anthelmintic; nystatin is an antifungal agent; phentermine is an appetite suppressant.

ANS: A PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Gastrointestinal System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Medications to Treat Fungal Infections (p. 346–348; 356): Nystatin (Nilstat) is an antifungal used to treat oral candidiasis or thrush.

ANS: C PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Gastrointestinal System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Medications to Treat Intestinal Parasites (p. 346–348; 357): Laxatives may also be given at the same time as anthelmintic agents to help expel the dead parasites.

Senna/Docusate is a laxative. Loperamide is an anti-diarrheal agent; dicyclomine is an anti-spasmodic; esomeprazole is a proton pump inhibitor.

ANS: C PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Gastrointestinal System Medications KEY: Application MSC: NCLEX Category: Safe and Effective Care NOT: See Master the Essential Table and Medications to Induce Vomiting (p. 346–348; 356): Parents are advised to destroy any syrup of ipecac they have in the home as this is no longer recommended. Most poisonings are treated with activated charcoal. While knowing what pills the father takes is an important assessment, the highest priority is to put the parent in touch with Poison Control as quickly as possible; delaying treatment is inappropriate.

ANS: A PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Gastrointestinal System Medications KEY: Application MSC: NCLEX Category: Basic Care and Comfort NOT: See Master the Essential Table and Nutritional Supplements (p. 346–348; 358): The client’s weight loss should be evaluated more thoroughly with a calorie count, a dietary consult and discussion with the client about food preferences and eating habits. However, prior to a complete assessment, nutritional supplementation with Boost is the most appropriate first step for this scenario.

ANS: C PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Gastrointestinal System Medications KEY: Analysis MSC: NCLEX Category: Physiological Adaptation NOT: See Master the Essential Table and Mouthwashes (p. 346–348; 358): For a patient who does not produce saliva, saliva substitutes are prescribed. The lack of saliva production is called xerostomia; halitosis refers to bad breath. Alcohol-based mouth rinses are generally not used after radiation therapy as they

increase the risk of tissue breakdown called stomatitis. Most patients with head and neck surgery will need a feeding tube on a short-term basis but may be able to resume eating after they heal.

23. ANS: C PTS: 1 DIF: Hard TOP: Therapeutic Classification: Gastrointestinal System Medications KEY: Analysis MSC: NCLEX Category: Basic Care and Comfort NOT: See Master the Essential Table and Mouthwashes (p. 346–348; 358): Hydrogen peroxide is available over the counter and acts as a weak antibacterial agent in the mouth. Alcohol-based mouth rinses are typically avoided due to the increased risk of stomatitis. Soft bristle tooth brushes should be used. Oral hydration should be maintained at 1,500 to 2,000 mL (50 to 65 oz).

MULTIPLE RESPONSE 1. ANS: B, D, E PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Gastrointestinal System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Medications to Treat Constipation (p. 346–348; 349): Psyllium is a bulk-forming laxative and would be appropriate for the client with an anterior myocardial infarction and the client with a hemorrhoidectomy since it is important for both clients to reduce the need to strain with movements as well as for the client reporting constipation. The other clients either have a natural product or lifestyle choice that reduces the risk of constipation.

2. ANS: A, C, D, E, F PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Gastrointestinal System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Medications to Treat Nausea and Vomiting (p. 346–348; 350): Each of the agents listed, aside from albendazole, can be used to prevent or treat nausea and vomiting. Albendazole is an anthelmintic used to treat intestinal parasites.

3. ANS: B, C, D PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Gastrointestinal System Medications KEY: Application MSC: NCLEX Category: Reduction of Risk Potential NOT: See Master the Essential Table and Medications to Treat Gastroesophageal Reflux Disease (p. 346348; 352): Metoclopramide is a GI stimulant that helps increase gastric emptying and can be used to reduce the risk of aspiration pneumonia. The client should be fed in an upright position and should remain upright for at least 1 hour after feeding. Sleeping with the head elevated can reduce the risk of reflux and aspiration.

4. ANS: B, C, D PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Gastrointestinal System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Medications to Treat Intestinal Parasites (p. 346–348; 357): Praziquantel is an anthelmintic used to kill intestinal parasites such as roundworms, tapeworms, and pinworms. Abdominal pain and diarrhea are common side effects. The medication should not be given to pregnant women.

5. ANS: A, D PTS: 1 DIF: Hard TOP: Therapeutic Classification: Gastrointestinal System Medications KEY: Analysis MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Digestants (p. 346–348; 358): If a patient has no reason to avoid a certain food, medications can be given to assist with the digestion of the meal. One example is Lactaid.

Patients with cystic fibrosis do not produce digestive enzymes in quantities to digest any food, therefore they require digestive enzymes. The client with diabetes must avoid concentrated sugars, just as the client with an egg allergy must avoid eating eggs for medical reasons. The client with cerebral palsy will not need to avoid specific foods unless he or she has difficulty chewing or swallowing.

COMPLETION 1. ANS: 40 mL PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Gastrointestinal System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Medications to Treat Peptic Ulcers (p. 346–348; 353): Each dose of 20 mg will require 10 mL, so four doses will be equivalent to 40 mL. 2. ANS: 0.3 mL PTS: 1 DIF: Easy TOP: Therapeutic Classification: Gastrointestinal System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Medications to Treat Flatulence (p. 346–348; 356): Simethicone is an antiflatulent that is provided in appropriate doses for children and infants. 40 mg/0.6 mL = 20 mg/0.3 mL.

Chapter 20. Reproductive and Urinary System Medications Multiple Choice Identify the choice that best completes the statement or answers the question.

1. The LPN is talking to her sister about various birth control methods. Her sister says, “Bill and I just

got married and we don’t want to start a family for quite a while. Isn’t there something that works long term but isn’t permanent?” Which of the following methods of birth control would the nurse suggest?

A. Ethinyl estradiol and etonogestrel (NuvaRing) B. Nonoxynol-9 containing spermicide (Encare) C. Transdermal patches (Ortho Evra) D. Levonorgestrel intrauterine device (Mirena) 2. The LPN is assisting in the care of a client who wants to discuss hormone replacement therapy

(HRT) for menopause. The client states, “My mother died of breast cancer, so I want to avoid anything that increases my chances of getting that.” The nurse would base a response on which of the following principles?

A. There is no link between HRT and breast cancer.

B. HRT increases the risk of breast cancer development.

C. HRT decreases the risk of breast cancer development.

D. Studies involving HRT and breast cancer development have not been done.

3. A woman at 42 weeks gestation is in for an appointment with the gynecologist. The woman reports

inconsistent contractions on and off for three days and it is determined the cervix is not dilated at this time. The doctor informs the woman that they would like to provide dinoprostone (Prepidil). The nurse would help the woman understand this medication by stating which of the following?

A. “It is given in IV form and is designed to stimulate labor within a few minutes.”

B. “It is a gel placed on the cervix to help soften it and should allow labor to start in 6 hours or less.”

C. “It is a cream inserted into the vagina to help prevent cervical dilation and postpone delivery.”

D. “It is an intramuscular injection given to help reduce muscle tension and stop contractions.”

4. An LPN working at an obstetrician’s office is talking to a woman who says, “I just hope I don’t have

to have any pitocin. My sister had that when she was in labor and she said it was awful.” The nurse’s response would be based on which of the following principles?

A. If pitocin is used during delivery there is increased risk of uterine cancer later in life.

B. Pitocin is given in the physician’s office to initiate labor.

C. Women who use pitocin are being prepared for a cesarean section.

D. Pitocin is a synthetic oxytocin used to encourage uterine contractions.

5. The LPN is working in an ob/gyn office and determines which of the following individuals is most

likely to be taking terbutaline (Brethine)?

A. A 28-year-old patient with symptoms of pre-eclampsia

B. A 31-year-old patient with preterm labor C. A 38-year-old patient at 39 weeks gestation who is experiencing regular

contractions D. A 19-year-old patient who has decided to terminate a possible pregnancy after

unprotected sex 1 week ago 6. An LPN working in a fertility clinic notes that teaching has been effective if the client taking

menotropin (Humegon) states which of the following?

A. “I will swallow this pill every day to help start the ovulation process.”

B. “My husband can learn to give me the shots so an egg will ripen and be released.”

C. “There are no risks associated with fertility medications.”

D. “My husband will need to get the same shots to help increase our chances of

becoming pregnant.”

7. An LPN working at a community health fair recognizes which of the following individuals is at

highest risk for erectile dysfunction?

A. A 44-year-old man with a history of inguinal hernia B. A 50-year-old man with a history of asthma C. A 48-year-old man with a history of diabetes D. A 52-year-old man with a history of cholecystitis 8. The LPN who works in a urology clinic would be most concerned if sildenafil (Viagra) were

prescribed for which of the following individuals?

A. A 52-year-old patient with a history of hypertension B. A 65-year-old patient with a history of migraine headaches C. A 69-year-old patient with a history of benign prostatic hypertrophy D. A 74-year-old patient with a history of gastroesophageal reflux disease 9. An LPN is talking to a friend who states, “My husband is visiting the doctor today to talk about

getting a prescription for tadalifil (Cialis). He saw it on a commercial and thinks it may help. What do you know about that medication?” Which of the following responses by the nurse is best?

A. “Men take it half an hour to an hour before sexual activity to help attain and maintain an erection.”

B. “I know you can only safely take it once a week or less.”

C. “It’s placed inside the urethral shaft to stimulate erection within a couple of minutes.”

D. “As long as he doesn’t have a history of kidney disease, he should be able to take it.”

10. While visiting a friend who has recently been diagnosed with a brain tumor, the LPN notes the

patient is receiving IV mannitol (Osmitrol). Which of the following will the nurse conclude based on the provision of this medication?

A. The medication is being given to increase sedation in preparation for brain surgery.

B. The client is at increased risk for liver dysfunction due to this medication.

C. The client may experience hypertension while on this medication.

D. The medication is being given to decrease swelling in the brain caused by the tumor.

11. An LPN is caring for a client at the long-term care facility who has a history of heart failure and

routinely takes furosemide (Lasix). The nurse will be most concerned by which of the following assessment findings?

A. The client has a urinary output of 1,900 mL in 24 hours.

B. The client’s blood pressure is 124/68 mmHg. C. The client’s apical pulse is irregular.

D. The client has gained 3 pounds in 2 weeks.

12. An LPN working with the Red Cross determines which of the following individuals will be

ineligible to donate blood at this time?

A. A 64-year-old patient taking chlorthalidone (Hygroton) B. A 55-year-old patient taking indapamide (Lozol) C. A 61-year-old patient taking dutasteride (Avodart) D. A 58-year-old patient taking chlorothiazide (Diuril) 13. The LPN is providing care for a client in the long-term care facility who reports pain with urination

and a frequent need to void. The nurse anticipates which of the following medications would be added to the client’s treatment regimen?

A. Triamterene (Dyrenium) B. Phenazopyridine (Pyridium) C. Alfuzosin (Uroxatral) D. Desmopressin (DDAVP) 14. An LPN working in a rehabilitation center is assisting in the care of a client with a hip replacement

that frequently has issues with incontinence. The client is started on oxybutynin (Ditropan). Which of the following statements indicates further teaching is necessary?

A. “I’m so glad they have a medication that can help me hold onto my urine longer. It is so embarrassing to lose control.”

B. “I am much more comfortable now that this medication has reduced my bladder spasms.”

C. “I seem to get more constipated now that I’m taking this medication.”

D. “I know this medication might make my urine turn bright orange.”

15. The LPN working at a pediatrician’s office is talking to the mother of a 6-year-old patient who takes

imipramine (Tofranil). The nurse would include which of the following statements in the client teaching?

A. “Once your child starts taking this medication, her urinary tract infection should improve within a few days.”

B. “Avoid letting your child drink anything containing caffeine in the evening since it can irritate the bladder and increase bed-wetting.”

C. “This medication is given in the form of a patch that is changed once a week.”

D. “This medication acts on the loops of the kidney to alter the way fluid and electrolytes are exchanged.”

Multiple Response Identify one or more choices that best complete the statement or answer the question.

1. An LPN is advising a friend who newly started taking birth control pills. Which of the following

statements should the LPN include in the discussion? (Select all that apply.)

A. “A barrier method of birth control should still be used to protect you from sexually

transmitted diseases.”

B. “You will need to notify the doctor if you have any bleeding this month.”

C. “If you have any soreness in your legs or difficulty breathing, report to the

physician right away.”

D. “Birth control pills release a chemical that kills sperm to prevent pregnancy.”

E. “Some people taking birth control pills have sore breasts and mild weight gain.”

2. An LPN working in a campus health center talks to a young woman about starting birth control pills.

The young woman asks about side effects. Which of the following would be expected with this type of birth control?

A. Weight loss B. Mood swings C. Abdominal cramping D. Increased libido E. Breast tenderness F. Blood clot formation 3. The LPN working in a physician office determines which of the following clients would be

appropriate for hormone replacement therapy with estrogen? (Select all that apply.)

A. A 52-year-old woman with vaginal dryness and hot flashes who has a negative surgical history B. A 44-year-old woman s/p robotic hysterectomy for dysmenorrhea C. A 68-year-old man with prostate cancer D. A 28-year-old man with testicular cancer E. A 35-year-old woman seeking oral birth control pills 4. The nurse working on the labor and delivery special care unit is providing care for a woman who has

been started on magnesium sulfate. The nurse would anticipate which of the following orders to be initiated as well? (Select all that apply.)

A. Place client on telemetry B. Monitor vital signs every 2 to 4 hours C. Strict intake and output D. Check serum calcium and magnesium every 6 hours E. Monitor serum amylase daily F. Put patient in reverse isolation 5. The LPN is talking to a friend who is considering infertility treatment with clomiphene (Clomid).

The LPN is aware that this medication is associated with which of the following side effects? (Select all that apply.)

A. Multiple births B. Headache C. Flushing D. Constipation E. Ringing in the ears F. Hypertension

6. An LPN working at a family practice office identifies clients taking which of the following

medications may experience decreased libido? (Select all that apply.)

A. Ranitidine (Zantac) B. Diazepam (Valium) C. Dexmethylphenidate (Focalin) D. Clonidine (Catapres) E. Propanolol (Inderal) F. Warfarin (Coumadin) 7. The LPN is aware that diuretic therapy may be included in the treatment plan for which of the

following individuals? (Select all that apply.)

A. A 65-year-old patient with hypertension B. A 40-year-old patient with acute kidney failure C. A 51-year-old patient with bladder cancer D. A 69-year-old patient with heart failure E. A 74-year-old patient with glaucoma F. A 49-year-old patient with diabetes 8. The LPN is aware that potassium supplementation is an important component of treatment for clients

taking which of the following? (Select all that apply.)

A. Spironolactone (Aldactone) B. Furosemide (Lasix) C. Chlorthalidone (Hygroton) D. Bumetanide (Bumex) E. Torsemide (Demadex) F. Indapamide (Lozol)

Chapter 20. Reproductive and Urinary System Medications Answer Section MULTIPLE CHOICE 1. ANS: D PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Reproductive and Urinary System Medications KEY: Application MSC: NCLEX Category: Health Promotion and Maintenance NOT: See Master the Essential Table and Contraceptive Medications (p. 366–369; 369–370): Levonorgestrel intrauterine device can be placed by a physician and left in place for up to 5 years. This device contains progestin and makes the uterus a very unwelcoming place for sperm. NuvaRing must be replaced each month, Transdermal patches are replaced weekly, and spermicides are used with each act of intercourse in conjunction with barrier methods of birth control.

2. ANS: B PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Reproductive and Urinary System Medications KEY: Comprehension MSC: NCLEX Category: Reduction of Risk Potential NOT: See Master the Essential Table and Hormone Replacement Therapy (p. 366–369; 370–371): Hormone replacement therapy has been shown to increase the risk of breast cancer, stroke, and blood clots.

3. ANS: B PTS: 1 DIF: Hard TOP: Therapeutic Classification: Reproductive and Urinary System Medications KEY: Analysis MSC: NCLEX Category: Health Promotion and Maintenance NOT: See Master the Essential Table and Labor Medications (p. 366–369; 372): Normal gestation is 40 weeks so this woman’s labor should most likely be started artificially. The use of dinoprostone as a gel inserted into the cervix to allow cervical ripening generally allows labor to start within about 6 hours.

4. ANS: D PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Reproductive and Urinary System Medications KEY: Application MSC: NCLEX Category: Health Promotion and Maintenance NOT: See Master the Essential Table and Labor Medications (p. 366–369; 372): Pitocin is synthetic oxytocin used to stimulate uterine contractions. There is no association with uterine cancer, and this drug must be given in a controlled environment. Pitocin is used to encourage the labor process and ideally to prevent cesarean section.

5. ANS: B PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Reproductive and Urinary System Medications KEY: Application MSC: NCLEX Category: Health Promotion and Maintenance NOT: See Master the Essential Table and Labor Medications (p. 366–369; 372): Terbutaline is a bronchodilator but as a beta-blocker it also decreases uterine contractions and is used in preterm labor.

Magnesium sulfate is used in the treatment of pre-eclampsia; no medication is needed for the woman with symptoms of early labor who is nearly full term; mifepristone (Mifeprex) is used to stop a pregnancy during the first 7 weeks since the last menstrual period.

6. ANS: B PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Reproductive and Urinary System Medications KEY: Application MSC: NCLEX Category: Health Promotion and Maintenance NOT: See Master the Essential Table and Infertility Medications (p. 366–369; 373): Menotropin is given by injection to stimulate follicle ripening and release. This treatment is indicated in women who have functional ovaries but in whom hormonal stimulation is lacking. There are side effects associated with fertility agents including multiple birth, headache, gynecomastia, flushing, and injection site tenderness. This agent is only used in the treatment of female infertility and would not be given to a male.

7. ANS: C PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Reproductive and Urinary System Medications

8.

9.

10.

11.

12.

13.

14.

KEY: Analysis MSC: NCLEX Category: Reduction of Risk Potential NOT: See Master the Essential Table and Medications to Treat Erectile Dysfunction, Libido and Infertility (p.

366–369; 373–374): Erectile dysfunction, or impotence, is a fairly common disorder frequently related to atherosclerosis, diabetes, stroke, and hypertension.

ANS: A PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Reproductive and Urinary System Medications KEY: Analysis MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Medications to Treat Erectile Dysfunction, Libido and Infertility (p.

366–369; 373–374): Sildenafil is used in the treatment of erectile dysfunction and works to dilate the arteries leading to the penis while constricting the veins, thereby sustaining an erection. These medications can be dangerous for patients with a history of cardiovascular disease, stroke, and sickle cell anemia.

ANS: A PTS: 1 DIF: Hard TOP: Therapeutic Classification: Reproductive and Urinary System Medications KEY: Analysis MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Medications to Treat Erectile Dysfunction, Libido and Infertility (p.

366–369; 373–374): Tadalifil is taken by mouth approximately 30 to 60 minutes prior to sexual activity and no more often than once a day to help attain and maintain an erection. It should not be taken if there is a history of cardiovascular disease, stroke, or sickle cell anemia.

ANS: D PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Reproductive and Urinary System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Diuretics (p. 366–369; 374–377): Mannitol is an osmotic diuretic given to patients with increased intracranial pressure related to head trauma, brain tumor, or other illness affecting the brain to reduce brain swelling. It can cause dizziness, eye pain, anorexia, confusion, and dehydration and must be given in a controlled environment.

ANS: C PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Reproductive and Urinary System Medications KEY: Analysis MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Diuretics (p. 366–369; 374–377): Furosemide is a loop diuretic that can cause potassium loss. Hypokalemia can result in irregular heart rhythms, and this is the highest concern for the scenario above. Normal urine output is 1,500 to 2,000 mL/day and Furosemide will cause increased diuresis. The listed blood pressure is within normal limits. Weight gain in a client with heart failure should be monitored closely but the priority in this question is the irregular heart rhythm.

ANS: C PTS: 1 DIF: Hard TOP: Therapeutic Classification: Reproductive and Urinary System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Drug Spotlight 20.1 (p. 366–369; 378): Dutasteride is used in the treatment of benign prostatic hypertrophy. It prevents the conversion of testosterone to dihydrotestosterone.

Due to the potential of birth defects, pregnant women should avoid handling this medication and men should wait 6 months after treatment ends to donate blood. The other medications listed are all thiazide diuretics and pregnancy is not a contraindication for use.

ANS: B PTS: 1 DIF: Hard TOP: Therapeutic Classification: Reproductive and Urinary System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Other Medications for Urinary Disorders (p. 366–369; 377–378): The listed symptoms are indicative of a urinary tract infection. Antibiotic therapy is appropriate along with Pyridium, which is a urinary analgesic. Triamterene is a potassium-sparing diuretic; alfuzosin is used in the treatment of BPH; desmopressin is used in the treatment of bed wetting.

ANS: D PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Reproductive and Urinary System Medications

KEY: Analysis MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Other Medications for Urinary Disorders (p. 366–369; 377–378): Many medications may cause changes in urine color, but oxybutynin is not one of them. Pyridium is most known for turning urine a bright orange color. This medication is an anti-spasmodic that reduces bladder spasms and aids in the treatment of urinary incontinence by decreasing the sensation of urgency. Constipation is a listed side effect of this medication.

15. ANS: B PTS: 1 DIF: Hard TOP: Therapeutic Classification: Reproductive and Urinary System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Other Medications for Urinary Disorders (p. 366–369; 377–378): Desmopressin is a manufactured form of the naturally occurring hormone that helps control how the body uses water; it is given orally or as a nasal spray. Caffeine can irritate the bladder and should not be consumed after 6 p.m. to help avoid enuresis (bed-wetting).

MULTIPLE RESPONSE 1. ANS: A, C, E PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Reproductive and Urinary System Medications KEY: Analysis MSC: NCLEX Category: Health Promotion and Maintenance NOT: See Master the Essential Table and Contraceptive Medications (p. 366–369; 369–370): Birth control pills act by releasing hormones to mimic pregnancy. Barrier methods are the only effective method of birth control that also prevents sexually transmitted diseases. Risk for blood clot formation increases with birth control pills, so symptoms of a blood clot should be reported immediately. Other side effects include weight gain, sore breasts, and mood swings.

2. ANS: B, E, F PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Reproductive and Urinary System Medications KEY: Application MSC: NCLEX Category: Health Promotion and Maintenance NOT: See Master the Essential Table and Contraceptive Medications (p. 366–369; 369–370): Birth control pills alter normal reproductive functioning so the body behaves like it is pregnant. Side effects include weight gain, mood swings, breast tenderness, and clot formation.

3. ANS: B, C PTS: 1 DIF: Hard TOP: Therapeutic Classification: Reproductive and Urinary System Medications KEY: Analysis MSC: NCLEX Category: Health Promotion and Maintenance NOT: See Master the Essential Table and Hormone Replacement Therapy (p. 366–369; 370–371): If a woman no longer has a uterus, estrogen is replaced because there is no buildup of the endometrial lining. If the woman still has her own uterus, estrogen is usually combined with progesterone so the risk of endometrial cancer development is not increased as it would be with estrogen alone. Estrogen decreases testosterone levels and can be used to treat prostate cancer. There is no role for estrogen in the treatment of testicular cancer.

4. ANS: A, B, C, D PTS: 1 DIF: Hard TOP: Therapeutic Classification: Reproductive and Urinary System Medications KEY: Application MSC: NCLEX Category: Health Promotion and Maintenance NOT: See Master the Essential Table and Labor Medication (p. 366–369; 372): Magnesium sulfate is commonly used to treat pre-eclampsia. Side effects include hypotension, cardiac arrhythmias, and weakness.

It is thought this agent acts as a calcium channel blocker and magnesium toxicity is a potential risk so electrolytes should be monitored. Serum amylase is unrelated to this drug and there is no need for the client to be placed in reverse isolation as the risk of infection is not altered with this medication.

5. ANS: A, B, C PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Reproductive and Urinary System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Infertility Medications (p. 366–369; 373): Clomiphene is used for

the treatment of female infertility and is associated with ovarian hyper-stimulation resulting in multiple births, headache, gynecomastia, injection site pain, and vasomotor flushing.

6. ANS: A, B, D, E PTS: 1 DIF: Hard TOP: Therapeutic Classification: Reproductive and Urinary System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Medications to Treat Erectile Dysfunction, Libido and Infertility (p.

366–369; 373–374): Many medications decrease libido including Benadryl, Aldactone, Aldomet, Catapres, Chlor-Trimeton, Valium, alcohol, Zantac, Tagamet, Dopar, and Inderal. Amphetamines increase libido.

7. ANS: A, B, D, E PTS: 1 DIF: Hard TOP: Therapeutic Classification: Reproductive and Urinary System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Diuretics (p. 366–369; 374–377): Diuretic therapy is most commonly used in the treatment of hypertension and heart failure. It can also be used for clients with kidney failure if hypertension or edema is present. Glaucoma treatment may include diuretics to decrease the circulating fluid in the body, including the eyes.

8. ANS: B, C, D, E, F PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Reproductive and Urinary System Medications KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Master the Essential Table and Diuretics (p. 366–369; 374–377): Furosemide, bumetanide, and torsemide are loop diuretics. Chlorthalidone and indapamide are thiazide diuretics. Each of these cause potassium loss, and thus typically require potassium supplementation. Spironolactone is a potassium-sparing diuretic.

Chapter 21. Herbs, Vitamins, and Minerals Multiple Choice Identify the choice that best completes the statement or answers the question.

1. An LPN is having a conversation with a client who is seeking acupuncture treatment for migraine

headaches. The LPN is attempting to explain the Eastern philosophy of health and medicine. Which statement is best?

A. “The belief centers on the treatment of disease as a physiological disorder.”

B. “It involves therapies that are complimentary to traditional Western medicine.”

C. “Eastern medicine focuses on the body’s ability to heal itself.”

D. “It is based on the principle that like cures like.”

2. While participating in a seminar, the LPN becomes engaged in a conversation related to insurance

payment for complementary therapy and the use of herbal remedies. Which statement by participants in the conversation is most accurate?

A. “Herbs have been the basis of medications for thousands of years, so they will eventually be paid for by insurance companies; it will just take time.”

B. “The Food and Drug Administration has set recommended daily allowances, so herbs are not defined as medications.”

C. “There is very little scientific research for most herbs so the evidence to support effectiveness of therapy is limited.”

D. “The Eastern philosophy of health and healing that drives medical treatment in the United States does not support the use of herbal remedies.”

3. When asked what type of natural product can be used for cuts and burns, the LPN would recommend

which f the following?

A. Ginger B. Peppermint C. Rosemary D. Aloe vera 4. While working with a client who takes warfarin (Coumadin), the nurse would caution the client to

avoid foods that are high in which of the following vitamins?

A. Vitamin A B. Vitamin K C. Vitamin E D. Vitamin C 5. The LPN working with a client who has a long-standing history of alcohol abuse. Although the client

is most likely deficient in numerous vitamins and minerals, the LPN is aware that which particular vitamin is credited with protecting against imbalances caused by alcohol?

A. Vitamin D B. Vitamin B1 (thiamine) C. Vitamin C D. Vitamin E

6. The LPN is providing care for a client with anorexia who has also been diagnosed with anemia. The

nurse recognizes teaching has been effective if the client chooses a diet that is high in which of the following?

A. Calcium B. Potassium C. Iron D. Magnesium 7. In reviewing various trace minerals, the LPN recognizes that which of the following elements is

necessary for the formation of thyroxine and deficiency has been linked to myasthenia gravis?

A. Manganese B. Selenium C. Zinc D. Fluoride 8. The LPN overhears student nurses studying for their nutrition exam by focusing on the amino acids.

The LPN would intervene for which of the following statements?

A. “There are 8 essential amino acids and 12 nonessential acids.”

B. “An essential acid is one that the body has to make; it can’t be obtained in the

diet.”

C. “Amino acids are the building blocks of proteins.”

D. “Lipids are not amino acids, but they are also needed to support life.”

9. An LPN is visiting a friend in the hospital who was recently started on total parental nutrition (TPN).

The nurse is aware the client will most likely also receive which of the following?

A. Intravenous form of lipids B. Oral trace minerals C. Mega doses of vitamins D. Aromatherapy 10. The LPN visits her dentist for a routine cleaning and begins a conversation about minerals and tooth

decay. The dentist will credit protection from dental caries (cavities) to which group of minerals?

A. Selenium and silica B. Manganese and cobalt C. Fluoride and molybdenum D. Chromium and magnesium 11. The LPN is assisting in the care of a client who has a family history of high triglycerides. Which of

the following supplements would the nurse anticipate the physician will suggest?

A. Iron fortified multi-vitamin pill B. Fish oil capsules C. Selenium tablets D. Zinc-oxide containing products 12. When talking to a group of teenage girls, the LPN is told, “Cholesterol is like poison; I think it

should just be removed from everything.” Which of the following is the best response by the nurse?

A. “Cholesterol is key to blood cell formation and proper sleep-wake cycles.”

B. “Cholesterol is a building block of proteins so we need it for our muscles and brain

to function properly.”

C. “Our body makes cholesterol, so there is no need to include it in your diet.”

D. “Cholesterol is needed for hormone synthesis and stabilizes cell membranes, so in

moderate amounts, it is an important component of a balanced diet.”

13. The LPN working in an obstetrician’s office is aware that the physician recommends increasing folic

acid intake during pregnancy to help decrease the occurrence of which of the following infant disorders?

A. Cleft palate B. Spina bifida C. Cerebral palsy D. Tracheal–esophageal fistula 14. An LPN working in a wound clinic would anticipate that many of the clients would be encouraged to

increase their intake of which of the following?

A. Vitamin B6 (Pyridoxine) B. Vitamin B12 (Cobalamine) C. Vitamin C (Ascorbic acid) D. Vitamin E 15. Of interest to one particular LPN is the fact that vitamin B7 (Biotin) decreases which of the following

symptoms of aging?

A. Skin wrinkles B. Vision changes C. Gray and balding hair D. Memory and concentration 16. An LPN discovers her 10-year-old daughter has been eating calcium carbonate (Tums) because she

thinks they taste good. Which of the following side effects would the nurse anticipate?

A. Diarrhea B. Heartburn C. Nausea D. Constipation 17. An LPN is assisting with the care of a client taking a loop diuretic. Which of the following

symptoms would alert the nurse to suspect potassium deficiency?

A. Nausea, vomiting, and headache B. Confusion, muscle weakness, and arrhythmias C. Flank pain and blood in the urine D. Leg cramps and tetany 18. The LPN is talking to a friend who has recently entered menopause. The friend states, “You know I

can deal with the hot flashes; they aren’t too bad, but the insomnia is nearly making me crazy.”

Which of the following vitamin or mineral supplements may the nurse suggest?

A. Potassium B. Phosphorus C. Chromium D. Calcium

19. While working for a hematologist, the LPN learns that which of the following minerals is vital to the

formation of red blood cells?

A. Cobalt B. Phosphorus C. Magnesium D. Copper 20. An LPN who was recently diagnosed with type 2 diabetes mellitus would be most interested in the

research related to which of the following vitamins or minerals?

A. Vitamin E B. Vitamin A C. Iodine D. Chromium Multiple Response Identify one or more choices that best complete the statement or answer the question.

1. A student nurse is studying the difference between fat-soluble and water-soluble vitamins and

determines that the risk of toxicity is elevated for which of the following vitamins? (Select all that apply.)

A. Vitamin K B. Vitamin B C. Vitamin C D. Vitamin A E. Vitamin E F. Vitamin D 2. The LPN is working at a health fair and is asked, “I’m worried about osteoporosis; what vitamins

should I take?” The nurse’s response would include a discussion of which of the following vitamins and minerals? (Select all that apply.)

A. Iron B. Calcium C. Vitamin K D. Vitamin D E. Copper F. Folic acid (Vitamin B9)

Chapter 21. Herbs, Vitamins, and Minerals Answer Section MULTIPLE CHOICE 1. ANS: C PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Herbs, Vitamins, and Minerals KEY: Application MSC: NCLEX Category: Basic Care and Comfort NOT: See Vitamins, Minerals, Amino Acids and Lipids (p. 386): Eastern philosophy focuses on the body’s ability to heal itself. While some people use Eastern approaches to healing in a complimentary fashion, the philosophies themselves are different and many people in the world practice healing from a strictly Eastern viewpoint. Western philosophy believes disease is caused by a physiological disorder. Homeopathy is built on the principle that like cures like.

2. ANS: C PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Herbs, Vitamins, and Minerals KEY: Application MSC: NCLEX Category: Basic Care and Comfort NOT: See Herbal Medicines (p. 384–385): Most herbs have had less scientific testing than modern drugs, which is the main reason insurance companies refuse to pay for many alternative therapies. The FDA has set recommended daily allowances for vitamins and minerals but does not regulate herbs. Western philosophy of health and medicine drives the medical system in the United States.

3. ANS: D PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Herbs, Vitamins, and Minerals KEY: Application MSC: NCLEX Category: Basic Care and Comfort NOT: See Examples of Herbs and Possible Benefits, Table 21.1 (p. 385): Aloe vera is used to treat acne, burns, cuts, and shingles. Ginger and peppermint are both used as digestive aids. Rosemary is used to improve hair and decrease muscle tension.

4. ANS: B PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Herbs, Vitamins, and Minerals KEY: Application MSC: NCLEX Category: Basic Care and Comfort NOT: See Fat and Water Soluble Vitamins Table, 21.2 (p. 387): Vitamin K is involved in the clotting cascade and dietary intake should not vary widely while clients are taking warfarin.

5. ANS: B PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Herbs, Vitamins, and Minerals KEY: Application MSC: NCLEX Category: Basic Care and Comfort NOT: See Fat and Water Soluble Vitamins Table 21.2 (p. 387–388): Vitamin B1 (thiamine) protects the body against imbalances caused by alcohol consumption and is commonly included in IV fluids referred to as a “banana bag,” which are routinely provided to clients with such a history.

6. ANS: C PTS: 1 DIF: Easy TOP: Therapeutic Classification: Herbs, Vitamins, and Minerals KEY: Application MSC: NCLEX Category: Basic Care and Comfort NOT: See Minerals, Table 21.3 (p. 389-390): Iron is used in the treatment of iron-deficiency anemia.

7. ANS: A PTS: 1 DIF: Hard TOP: Therapeutic Classification: Herbs, Vitamins, and Minerals KEY: Application MSC: NCLEX Category: Basic Care and Comfort NOT: See Minerals, Table 21.3 (p. 390): Manganese is needed for the formation of thyroxine in the thyroid gland and deficiency is associated with hearing loss, dizziness, ataxia, and linked to myasthenia gravis.

8. ANS: B PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Herbs, Vitamins, and Minerals KEY: Application MSC: NCLEX Category: Basic Care and Comfort

9.

10.

11.

12.

13.

14.

15.

16.

17.

NOT: See Vitamins, Minerals, Amino Acids and Lipids (p. 391): The 8 essential amino acids are called essential because the body can only obtain them through the diet—they cannot be made. The other statements are true.

ANS: A PTS: 1 DIF: Easy TOP: Therapeutic Classification: Herbs, Vitamins, and Minerals KEY: Application MSC: NCLEX Category: Basic Care and Comfort NOT: See Vitamins, Minerals, Amino Acids and Lipids (p. 391): An IV form of lipids (Intralipid 20%) is available for administration to those patients who are receiving all the nutrients through IV therapy (TPN).

ANS: C PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Herbs, Vitamins, and Minerals KEY: Application MSC: NCLEX Category: Basic Care and Comfort NOT: See Minerals, Table 21.3 (p. 389–390): Fluoride and molybdenum each contribute to decreasing dental caries.

ANS: B PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Herbs, Vitamins, and Minerals KEY: Application MSC: NCLEX Category: Basic Care and Comfort NOT: See Vitamins, Minerals, Amino Acids and Lipids (p. 391): Fatty acids found in fish are available as fish oil and are considered helpful in patients with high triglycerides or a family history of heart disease.

ANS: D PTS: 1 DIF: Hard TOP: Therapeutic Classification: Herbs, Vitamins, and Minerals KEY: Analysis MSC: NCLEX Category: Basic Care and Comfort NOT: See Vitamins, Minerals, Amino Acids and Lipids (p. 391): Cholesterol is used to synthesize hormones, vitamin D, and bile. It also serves to stabilize cell membranes throughout the body.

ANS: B PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Herbs, Vitamins, and Minerals KEY: Application MSC: NCLEX Category: Basic Care and Comfort NOT: See Fat and Water Soluble Vitamins Table 21.2 (p. 388): Folic acid is important for pregnant women to help decrease the instance of spina bifida. The other infant growth and development issues have not been linked to specific vitamins or minerals.

ANS: C PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Herbs, Vitamins, and Minerals KEY: Application MSC: NCLEX Category: Basic Care and Comfort NOT: See Table Fat and Water Soluble Vitamins 21.2 (p. 387–388): Vitamin C increases wound healing and boosts the immune system.

ANS: C PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Herbs, Vitamins, and Minerals KEY: Application MSC: NCLEX Category: Basic Care and Comfort NOT: See Fat and Water Soluble Vitamins Table 21.2 (p. 388): Vitamin B7 decreases graying of hair and baldness.

ANS: D PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Herbs, Vitamins, and Minerals KEY: Application MSC: NCLEX Category: Pharmacological Therapies NOT: See Minerals, Table 21.3 (p. 389): Excess intake of calcium can cause constipation.

ANS: B PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Herbs, Vitamins, and Minerals KEY: Application MSC: NCLEX Category: Basic Care and Comfort NOT: See Minerals, Table 21.3 (p. 389): Potassium deficiency is manifested by confusion, muscular weakness, paralysis, arrhythmias, lethargy, and fatigue. Nausea, vomiting, and headache are seen more commonly with sodium deficiency. Kidney stones are seen with magnesium deficiency. Leg cramps and tetany are seen with calcium deficiency.

18. ANS: D PTS: 1 DIF: Hard TOP: Therapeutic Classification: Herbs, Vitamins, and Minerals KEY: Application MSC: NCLEX Category: Basic Care and Comfort NOT: See Minerals, Table 21.3 (p. 389): Calcium decreases insomnia and calcium balance is greatly diminished during menopause.

19. ANS: A PTS: 1 DIF: Hard TOP: Therapeutic Classification: Herbs, Vitamins, and Minerals KEY: Knowledge MSC: NCLEX Category: Basic Care and Comfort NOT: See Minerals, Table 21.3 (p. 389): Cobalt decreases pernicious anemia and increases the production of red blood cells. Phosphorus helps form bones and teeth. Magnesium helps produce energy and transmit nerve impulses. Copper decreases cancer and cardiovascular disorders, improves arthritis, and boosts the immune system.

20. ANS: D PTS: 1 DIF: Hard TOP: Therapeutic Classification: Herbs, Vitamins, and Minerals KEY: Application MSC: NCLEX Category: Basic Care and Comfort NOT: See Fat and Water Soluble Vitamins & Minerals, Tables 21.2 and 21.3 (p. 387–390): Chromium improves the production of insulin, metabolizes carbohydrates and fats, improves cholesterol levels, and decreases hunger. Vitamin E is an antioxidant and diuretic that decreases PMS and miscarriage. Vitamin A works as an anti-carcinogen, heals skin, and improves vision. Iodine aids metabolism, reduces fibrocystic breast disease, and protects against exposure to radioactive materials, prevents goiter and thyroid disorders, loosens respiratory tract mucus, and acts as an antiseptic.

MULTIPLE RESPONSE 1. ANS: A, D, E, F PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Herbs, Vitamins, and Minerals KEY: Application MSC: NCLEX Category: Basic Care and Comfort NOT: See Fat and Water Soluble Vitamins Table 21.2 (p. 387): Vitamins A, D, E, and K are fat-soluble vitamins. There is a higher risk of toxicity with these vitamins since they are not excreted by the body and are stored in fat cells. Vitamins B and C are water-soluble and excess amounts are excreted by the body so toxicity risk is low.

2. ANS: B, D PTS: 1 DIF: Moderate TOP: Therapeutic Classification: Herbs, Vitamins, and Minerals KEY: Application MSC: NCLEX Category: Basic Care and Comfort NOT: See Fat and Water Soluble Vitamins & Minerals, Tables 21.2 and 21.3 (p. 387–390): Calcium and vitamin D decrease osteoporosis. Iron is an important component of red blood cell production. Vitamin K helps clot blood. Copper is a trace mineral that acts as an antioxidant, boosts the immune system, improves arthritis, and decreases cancer and cardiovascular disease. Folic acid improves lactation, appetite, skin, decreases cancer, pain, and infection.