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Test Bank-Basic and Clinical Pharmacology 14th Edition Katzung Trevor-100% verified -2023-2024
Chapter 1. Introduction: The Nature of Drugs & Drug Development & Regulation 1.
A nurse working in radiology administers iodine to a patient who is having a computed tomography (CT) scan. The nurse working on the oncology unit administers chemotherapy to patients who have cancer. At the Public Health Department, a nurse administers a measles-mumps-rubella (MMR) vaccine to a 14-month-old child as a routine immunization. Which branch of pharmacology best describes the actions of all three nurses?
A)
Pharmacoeconomics
B)
Pharmacotherapeutics
C)
Pharmacodynamics
D)
Pharmacokinetics
Ans:
B Feedback: Pharmacology is the study of the biologic effects of chemicals. Nurses are involved with clinical pharmacology or pharmacotherapeutics, which is a branch of pharmacology that deals with the uses of drugs to treat, prevent, and diagnose disease. The radiology nurse is administering a drug to help diagnose a disease. The oncology nurse is administering a drug to help treat a disease. Pharmacoeconomics includes any costs involved in drug therapy. Pharmacodynamics involves how a drug affects the body and pharmacokinetics is how the body acts on the body.
2.
A physician has ordered intramuscular (IM) injections of morphine, a narcotic, every 4 hours as needed for pain in a motor vehicle accident victim. The nurse is aware this drug has a high abuse potential. Under what category would morphine be classified?
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A)
Schedule I
B)
Schedule II
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C)
Schedule III
D)
Schedule IV
Ans:
B Feedback: Narcotics with a high abuse potential are classified as Schedule II drugs because of severe dependence liability. Schedule I drugs have high abuse potential and no accepted medical use. Schedule III drugs have a lesser abuse potential than II and an accepted medical use. Schedule IV drugs have low abuse potential and limited dependence liability.
3.
When involved in phase III drug evaluation studies, what responsibilities would the nurse have?
A)
Working with animals who are given experimental drugs
B)
Choosing appropriate patients to be involved in the drug study
C)
Monitoring and observing patients closely for adverse effects
D)
Conducting research to determine effectiveness of the drug
Ans:
C Feedback: Phase III studies involve use of a drug in a vast clinical population in which patients are asked to record any symptoms they experience while taking the drugs. Nurses may be responsible for helping collect and analyze the information to be shared with the Food and Drug Administration (FDA) but would not conduct research independently because nurses do not prescribe medications. Use of animals in drug testing is done in the preclinical trials. Select patients who are involved in phase II studies to participate in studies where the participants have the disease the drug is intended to treat. These patients are monitored closely for drug action and adverse effects. Phase I studies involve healthy human volunteers who are usually paid for their participation. Nurses may observe for adverse effects and toxicity.
4. A)
What concept is considered when generic drugs are substituted for brand name drugs? Bioavailability
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B)
Critical concentration
C)
Distribution
D)
Half-life
Ans:
A Feedback: Bioavailability is the portion of a dose of a drug that reaches the systemic circulation and is available to act on body cells. Binders used in a generic drug may not be the same as those used in the brand name drug. Therefore, the way the body breaks down and uses the drug may differ, which may eliminate a generic drug substitution. Critical concentration is the amount of a drug that is needed to cause a therapeutic effect and should not differ between generic and brand name medications. Distribution is the phase of pharmacokinetics, which involves the movement of a drug to the bodys tissues and is the same in generic and brand name drugs. A drugs half-life is the time it takes for the amount of drug to decrease to half the peak level, which should not change when substituting a generic medication.
5.
A nurse is assessing the patients home medication use. After listening to the patient list current medications, the nurse asks what priority question?
A)
Do you take any generic medications?
B)
Are any of these medications orphan drugs?
C)
Are these medications safe to take during pregnancy?
D)
Do you take any over-the-counter medications?
Ans:
D Feedback: It is important for the nurse to specifically question use of over-the-counter medications because patients may not consider them important. The patient is unlikely to know the meaning of orphan drugs unless they too are health care providers. Safety during pregnancy, use of a generic medication, or classification of orphan drugs are things the patient would be unable to answer but could be found in reference books if the nurse wishes to research them.
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6.
After completing a course on pharmacology for nurses, what will the nurse know?
A)
Everything necessary for safe and effective medication administration
B)
Current pharmacologic therapy; the nurse will not require ongoing education for 5 years.
C)
General drug information; the nurse can consult a drug guide for specific drug information.
D)
The drug actions that are associated with each classification of medication
Ans:
C Feedback: After completing a pharmacology course nurses will have general drug information needed for safe and effective medication administration but will need to consult a drug guide for specific drug information before administering any medication. Pharmacology is constantly changing, with new drugs entering the market and new uses for existing drugs identified. Continuing education in pharmacology is essential to safe practice. Nurses tend to become familiar with the medications they administer most often, but there will always be a need to research new drugs and also those the nurse is not familiar with because no nurse knows all medications.
7.
A nurse is instructing a pregnant patient concerning the potential risk to her fetus from a Pregnancy Category B drug. What would the nurse inform the patient?
A)
Adequate studies in pregnant women have demonstrated there is no risk to the fetus.
B)
Animal studies have not demonstrated a risk to the fetus, but there have been no adequate studies in pregnant women.
C)
Animal studies have shown an adverse effect on the fetus, but there are no adequate studies in pregnant women.
D)
There is evidence of human fetal risk, but the potential benefits from use of the drug may be acceptable despite potential risks.
Ans:
B
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Feedback: Category B indicates that animal studies have not demonstrated a risk to the fetus. However, there have not been adequate studies in pregnant women to demonstrate risk to a fetus during the first trimester of pregnancy and no evidence of risk in later trimesters. Category A indicates that adequate studies in pregnant women have not demonstrated a risk to the fetus in the first trimester or in later trimesters. Category C indicates that animal studies have shown an adverse effect on the fetus, but no adequate studies in humans. Category D reveals evidence of human fetal risk, but the potential benefits from the use of the drugs in pregnant women may outweigh potential risks. 8.
Discharge planning for patients leaving the hospital should include instructions on the use of over-the-counter (OTC) drugs. Which comment by the patient would demonstrate a good understanding of OTC drugs?
A)
OTC drugs are safe and do not cause adverse effects if taken properly.
B)
OTC drugs have been around for years and have not been tested by the Food and Drug Administration (FDA).
C)
OTC drugs are different from any drugs available by prescription and cost less.
D)
OTC drugs could cause serious harm if not taken according to directions.
Ans:
D Feedback: It is important to follow package directions because OTCs are medications that can cause serious harm if not taken properly. OTCs are drugs that have been determined to be safe when taken as directed; however, all drugs can produce adverse effects even when taken properly. They may have originally been prescription drugs that were tested by the FDA or they may have been grandfathered in when the FDA laws changed. OTC education should always be included as a part of the hospital discharge instructions.
9.
What would be the best source of drug information for a nurse?
A)
Drug Facts and Comparisons
B)
A nurses drug guide
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C)
A drug package insert
D)
The Physicians Drug Reference (PDR)
Ans:
B Feedback: A nurses drug guide provides nursing implications and patient teaching points that are most useful to nurses in addition to need-to-know drug information in a very user friendly organizational style.Lippincotts Nursing Drug Guide (LNDG) has drug monographs organized alphabetically and includes nursing implications and patient teaching points. Numerous other drug handbooks are also on the market and readily available for nurses to use. Although other drug reference books such as Drug Facts and Comparisons, PDR, and drug package inserts can all provide essential drug information, they will not contain nursing implications and teaching points and can be more difficult to use than nurses drug guides.
10 .
The nurse is preparing to administer a medication from a multidose bottle. The label is torn and soiled but the name of the medication is still readable. What is the nurses priority action?
A)
Discard the entire bottle and contents and obtain a new bottle.
B)
Find the drug information and create a new label for the bottle.
C)
Ask another nurse to verify the contents of the bottle.
D)
Administer the medication if the name of the drug can be clearly read.
Ans:
A Feedback: When the drug label is soiled obscuring some information the safest action by the nurse is to discard the bottle and contents because drug labels contain a great deal of important information, far more than just the name of the drug. Concentration of the drug, expiration date, administration directions, and precautions may be missing from the label and so put the patient at risk. Looking up drug information in a drug handbook or consulting with another nurse will not supply the expiration date or concentration of medication. Be safe and discard the bottle and its contents.
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11 .
What aspect of pharmacology does a nurse study? (Select all that apply.)
A)
Chemical pharmacology
B)
Molecular pharmacology
C)
Impact of drugs on the body
D)
The bodys response to a drug
E)
Adverse and anticipated drug effects
Ans:
C, D, E Feedback: Nurses study pharmacology from a pharmacotherapeutic level, which includes the effect of drugs on the body, the bodys response to drugs, and both expected and unexpected drug effects. Chemical and molecular pharmacology (Options A and B) are not included in nursing pharmacology courses.
12 .
The nurse, providing patient teaching about home medication use to an older adult, explains that even when drugs are taken properly they can produce negative or unexpected effects. What are these negative or unexpected effects called?
A)
Teratogenic effects
B)
Toxic effects
C)
Adverse effects
D)
Therapeutic effects
Ans:
C Feedback: Negative or unexpected effects are known as adverse or side effects. Teratogenic effects are adverse effects on the fetus and not a likely concern for an older adult. Toxic effects occur when medication is taken in larger than recommended dosages caused by an increase in serum drug levels. Therapeutic effects are the desired actions for which the medication is prescribed.
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13 .
After administering a medication, for what would the nurse assess the patient?
A)
Drug effects
B)
Allergies
C)
Pregnancy
D)
Preexisting conditions
Ans:
A Feedback: After the medication is administered, the nurse assesses the patient for drug affects, both therapeutic and adverse. The nurse would assess the patient for allergies, preexisting conditions, and pregnancy before administering a medication.
14 .
The nurse receives an order to administer an unfamiliar medication and obtains a nurses drug guide published four years earlier. What is the nurses most prudent action?
A)
Find a more recent reference source.
B)
Use the guide if the drug is listed.
C)
Ask another nurse for drug information.
D)
Verify the information in the guide with the pharmacist.
Ans:
A Feedback: The nurse is responsible for all medications administered and must find a recent reference source to ensure the information learned about the medication is correct and current. Using an older drug guide could be dangerous because it would not contain the most up-to-date information. Asking another nurse or the pharmacist does not guarantee accurate information will be obtained and could harm the patient if the information is wrong.
15 .
What would the nurse provide when preparing a patient for discharge and home medication self-administration?
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A)
Personal contact information to use if the patient has questions
B)
Thorough medication teaching about drugs and the drug regimen
C)
Over-the-counter medications to use to treat potential adverse effects
D)
A sample size package of medication to take home until prescription is filled
Ans:
B Feedback: The nurse is responsible for providing thorough medication teaching about drugs and the drug regimen to ensure the patient knows how to take the medication and when to notify the provider. The nurse never provides personal contact information to a patient. If adverse effects arise, the patient is taught to call the health care provider and should not self-medicate with over-the-counter drugs, which could mask serious symptoms. The nurse never dispenses medication because it must be properly labeled for home use; this is done by the pharmacy.
16 .
In response to the patients question about how to know whether drugs are safe, the nurse explains that all medications undergo rigorous scientific testing controlled by what organization?
A)
Food and Drug Administration (FDA)
B)
Drug Enforcement Agency (DEA)
C)
Centers for Disease Control and Prevention (CDC)
D)
Joint Commission on Accreditation of Healthcare Organizations (JCAHO)
Ans:
A Feedback: The FDA is responsible for controlling and regulating the development and sale of drugs in the United States, allowing new drugs to enter the market only after being subjected to rigorous scientific testing. The DEA regulates and controls the use of controlled substances. The CDC monitors and responds to infectious diseases. The JCAHO is an accrediting body that inspects acute care facilities to ensure minimum standards are met.
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17 .
The nurse, assisting with Phase I drug studies, is talking with a woman who asks, Why cant I participate in this study? What would be the nurses best response?
A)
Drugs pose a greater risk to women of reproductive age.
B)
Drugs are only tested on men because they are stronger.
C)
Women are more prone to adverse effects from medications.
D)
Drugs affect women differently than they affect women.
Ans:
A Feedback: Phase I drug trials usually involve healthy male volunteers because chemicals may exert an unknown and harmful effect on ova in women which could result in fetal damage when the woman becomes pregnant. Drugs are tested on both men and women, but women must be fully informed of risks and sign a consent stating they understand the potential for birth defects. Women are not more prone to adverse effects of medications. Although some drugs may affect women differently than men, this is a rationale for why drugs need to be tested on women, not an explanation of why women are not included in a phase I study.
18 .
The patient tells the nurse about a new drug being tested to treat the disease she was diagnosed with and asks the nurse whether the doctor can prescribe a medication still in the preclinical phase of testing. What is the nurses best response?
A)
The doctor would have to complete a great deal of paperwork to get approval to prescribe that drug.
B)
Sometimes pharmaceutical companies are looking for volunteers to test a new drug and the doctor could give them your name.
C)
Drugs in the preclinical phase of testing are only tested on animals and so would not be available to you.
D)
Drugs in the preclinical phase of testing are given only to healthy young men and so would not be available to you.
Ans:
C Feedback:
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During the preclinical phase of testing drugs are tested on animals and are not available to patients. In phase I, the drug is tested on volunteers who are usually healthy young men. It is only in phase III studies that the drug is made available to prescribers who agree to closely monitor patients getting the medication. 19 .
The nurse is caring for a patient who had a severe, acute, previously unseen adverse effect of a drug in Phase III testing. The patient asks, After all the testing done on this drug, didnt they know this adverse effect could occur? What is the nurses best response? (Select all that apply.)
A)
Pharmaceutical companies sometimes underreport problems to make more money.
B)
Your response to this medication will be reported to the drug company and the Food and Drug Administration (FDA).
C)
When a drug begins to be used by a large clinical market, new adverse effects may be found.
D)
The pharmaceutical company weighs the benefits of the drug with the severity of adverse effects.
E)
After a drug reaches phase III testing it is considered an accepted drug and will not be recalled.
Ans:
B, C Feedback: When a new and unexpected adverse effect occurs, especially one of a serious nature, it is reported to the drug company who reports it to the FDA immediately. When a large number of people begin using the drug in phase III studies, it is not unusual to identify adverse effects not previously noted. It would be both unprofessional and inaccurate to imply that pharmaceutical companies put profit ahead of patient concern because lawsuits would remove any potential profit if a drug proves harmful. The FDA is responsible for weighing risk versus benefit in deciding whether to allow the drug to move to the next phase of testing. Drugs found to have serious adverse effects can be removed from the market at any time.
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20 .
The telephone triage nurse receives a call from a patient asking for a prescription for a narcotic to manage his surgical pain. The nurse explains that narcotic prescriptions must be written and cannot be called in to the pharmacy. The patient says, Why are narcotics so difficult to get a prescription for? What is the nurses best response?
A)
The Drug Enforcement Agency (DEA) determines the risk for addiction and the Food and Drug Administration (FDA) enforces their control.
B)
The increase in the number of drug addicts has made the rules stronger.
C)
The Centers for Disease Control and Prevention (CDC) regulates use of controlled substances to reduce the risk of injury.
D)
Controlled substances like narcotics are controlled by the FDA and the DEA.
Ans:
D Feedback: Controlled substances are controlled by the FDA and the DEA: the DEA enforces control while the FDA determines abuse potential. Regulations related to controlled substances have remained strict and specific and have not been significantly impacted by substance abusers. The CDC is not involved in control of narcotics and other controlled substances.
21 .
The nurse explains the Drug Enforcement Agencys (DEAs) schedule of controlled substances to the nursing assistant who asks, Do you ever get a prescription for Schedule I medications? What is the nurses best response?
A)
Schedule I medications have no medical use so they are not prescribed.
B)
Schedule I medications have the lowest risk for abuse and do not require a prescription.
C)
Schedule I medications are only prescribed in monitored units for patient safety.
D)
Schedule I medications are found in antitussives and antidiarrheals sold over the counter.
Ans:
A Feedback:
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Schedule I medications have no medical use and are never prescribed. Schedule V medications have the lowest risk for abuse and are found mostly in antitussives and antidiarrheals but they are not sold over the counter. 22 .
The nurse, working on the maternity unit, receives a call from a pregnant woman asking how she can know whether a medication is safe to take while pregnant. What is the nurses best response?
A)
You can take any drug indicated as a Category A.
B)
No medications should be taken during pregnancy.
C)
Never take medication until you receive approval from your health care provider.
D)
Most medications are safe but you need to weigh benefit against risk.
Ans:
C Feedback: The best response to a pregnant woman asking about medication usage is to talk with her obstetric practitioner because the best advice will come from someone who knows their health and pregnancy history. While Category A drugs have no known risk, they may be contraindicated by the womans health condition or pregnancy issues and many pregnant women would not know what it means to be a Category A drug. Medications can be helpful during pregnancy if taken safely and appropriately. Although risk benefit needs to be weighed, it should occur with advice from the obstetric practitioner.
23 .
A patient asks the nurse, What is a Drug Enforcement Agency (DEA) number? What is the nurses best response?
A)
DEA Numbers are given to physicians and pharmacists when they register with the DEA to prescribe and dispense controlled substances.
B)
Physicians must have a DEA number in order to prescribe any type of medication for patients.
C)
DEA numbers are case numbers given when someone breaks the law involving a controlled substance.
D)
DEA numbers are contact numbers to talk with someone at the DEA when questions arise about controlled substances.
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Ans:
A Feedback: All pharmacists and physicians must register with the DEA. They are given numbers that are required before they can dispense or prescribe controlled substances. DEA numbers are only needed when prescribing controlled substances. A DEA number is neither a case number nor a phone number.
24 .
When moving to another state, what is the nurse responsible for becoming familiar with?
A)
Local policies and procedures for controlled substance administration
B)
Local providers Drug Enforcement Agency (DEA) number for prescribing controlled substances
C)
The agency monitoring controlled substances in the new state
D)
Board of Nursing regulations of controlled substances in the new state
Ans:
A Feedback: The nurse needs to learn local policies and procedures for controlled substance administration because they can vary with some local governments more rigorous than others. Nurses do not memorize a providers DEA numbers. The DEA is a federal agency that monitors controlled substances in all states. State boards of nursing do not regulate controlled substances but may regulate how controlled substances are administered by nurses.
25 .
The patient looks at the prescription provided by the doctor and asks the nurse whether he can request a generic substitution. The nurse answers No when noting what on the prescription?
A)
No refills
B)
DAW
C)
Brand name used on prescription
D)
Patient older than 65 years of age
Ans:
B
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Feedback: DAW stands for dispense as written and means that the doctor does not want a generic substituted for the prescribed medication. Requesting no refills does not preclude the substitution of a generic medication. Even when the brand name is ordered, the pharmacist can substitute a generic equivalent so long as the prescriber does not write DAW. Generic substitutions are not impacted by the patients age. 26 .
The patient asks the nurse why generic drugs would be used and voices concerns that only the brand name product will be safe. What is the nurses best response?
A)
Generic drugs are often less expensive.
B)
Some quality control problems have been found with generic drugs.
C)
Most generic drugs are very safe and can be cost effective as well.
D)
Although initial cost is higher for a brand name it may cost less in the long run.
Ans:
C Feedback: Most generic medications are completely safe and may be identical to the brand name drug except generic medications are often less expensive, but this does not address the patients concern about safety. Although some quality control issues have occurred in the past, this does not address the patients concerns regarding safety or explain why generic drugs are prescribed and used. Although some doctors believe initial cost is higher but will cost less over time, this response also does not address the patients concerns.
27 .
While studying for the test, the nursing student encounters the following drug: papaverine (Pavabid). What does the nursing student identify the name Pavabid as?
A)
The generic name
B)
The chemical name
C)
The brand name
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D)
The chemical and generic name
Ans:
C Feedback: Several clues indicate the brand name including capitalization of the first letter in the name and in parentheses. Generic names are not capitalized; chemical names are descriptions of the chemistry of the medication resulting in complicated names.
28 .
The patient is prescribed a medication that was just placed in Phase IV study. The patient tells the nurse, This medication is too expensive. Could the doctor order a generic form of this medication? What is the nurses most accurate response?
A)
Medications are not produced in generic form until the patent expires, which normally takes several years.
B)
You can request the generic form but the binder used may make the drug less effective for this medication.
C)
The generic form of the medication would not be any less expensive because this is a relatively new medication.
D)
Generic medications are lower quality drugs and that would mean you would not be getting the best treatment available.
Ans:
A Feedback: When a new drug enters the market, it is given a time-limited patent; generic forms of the medication cannot be produced until the patent expires. Because no generic version of this drug will exist because it is so new, it is impossible to predict what binder will be used or what the cost would be.
29 .
The nurse learns that a drug needed by the patient is classified as an orphan drug and recognizes what as a reason for this classification? (Select all that apply.)
A)
The drug is rarely prescribed.
B)
The drug has dangerous adverse effects.
C)
The drug treats a rare disease.
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D)
The patent on the medication is still effective.
E)
Production by a company that only manufactures drugs.
Ans:
A, B, C Feedback: Drugs are classified as orphan drugs when they are not financially viable for a drug company to produce either because of risk for lawsuits about adverse effects or because the drug is not prescribed, which is often seen in rare diagnoses. Generic drugs are not produced until the patent expires, but this has no impact on classifying a particular drug as an orphan drug. Generic drugs are often produced by companies that only manufacture drugs without conducting research, but this has no bearing on the classification of orphan drugs.
30 .
While collecting a medication history, the patient admits to doubling the recommended dosage of an over-the-counter (OTC) medication, saying Its harmless or they would require a prescription. What is the nurses best response?
A)
OTC drugs are serious medications and carry serious risks if not taken as directed.
B)
Taking medications like that is careless and you could kill yourself doing it.
C)
Sometimes you need to take more than the package directs to treat the symptoms.
D)
Did you notify your doctor of the increased dosage you were taking?
Ans:
A Feedback: OTC drugs are no less a medication than prescription drugs and carry the same types of risks for overdosage and toxicity if directions are not followed. Although increasing the dosage is careless and dangerous, it is important to use the information as a teaching opportunity rather than scolding the patient. Agreeing with the patient or asking her if she talked to the doctor misses the teaching opportunity, which could be harmful for the patient.
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31 .
The patient asks the nurse, Is it safe to take over-the-counter (OTC) medications with prescription medications? What is the nurses best response? (Select all that apply.)
A)
OTC medications can interact with prescription medications.
B)
It is important to tell your doctor all medications you take, including OTC.
C)
OTC medications could mask or hide signs and symptoms of a disease.
D)
You should avoid taking any OTC medication when taking prescription drugs.
E)
Taking OTC medications can make your prescription medication more effective.
Ans:
A, B, C Feedback: OTC medications can interact with prescription medications or other OTC so it is always important to consult your pharmacist and provider for advice. To provide the most accurate instruction, the health care provider must know all medications taken including dietary supplements, OTC, and prescription. OTC medications could mask or hide symptoms of a disease so it is always important to consult a physician if symptoms persist. OTC medications are not prohibited when taking prescription drugs as long as no drug interaction occurs. How an OTC will impact a prescription medication varies depending on the medications involved, so it is incorrect to say it will make the prescription drug more effective.
32 .
Before administering a prescription medication, what information does the nurse find on the drug label? (Select all that apply.)
A)
Brand name
B)
Generic name
C)
Drug concentration
D)
Expiration date
E)
Adverse effects
Ans:
A, B, C, D
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Feedback: Prescription drug labels will contain the brand name, generic name, drug concentration, and expiration date. Adverse effects will not be listed on drug labels. 33 .
The nurse is preparing a medication that is new to the market and cannot be found in the nurses drug guide. Where can the nurse get the most reliable information about this medication?
A)
Package insert
B)
Another nurse
C)
Drug manufacturer
D)
Physician
Ans:
A Feedback: The most reliable information about the drug can be found on the package insert supplied by the manufacturer because it was prepared according to strict Food and Drug Administration (FDA) regulations. Asking another nurse or the physician is not reliable and cannot be verified as accurate. It would not be realistic to call the drug manufacturer for information.
34 .
The nurse explains that what drug resource book is compiled from package inserts?
A)
Nurses Drug Guide
B)
Physiciass Desk Reference (PDR)
C)
Drug Facts and Comparisons
D)
AMA Drug Evaluations
Ans:
B Feedback:
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The PDR is a compilation of information found on package inserts. The Nurses Drug Guide uses more easily understood language and incorporates nursing considerations and patient teaching points. Drug Facts and Comparisons includes cost comparison, often not found in other drug resource guides. The AMA Drug Evaluations is far less biased than the PDR and includes drugs still in the research stage of development. Chapter 2- Chapter 5 Drug Receptors & Pharmacodynamics Chapter 3. Pharmacokinetics & Pharmacodynamics: Rational Dosing & the Time Course of Drug Action Chapter 4. Drug Biotransformation Chapter 5. Pharmacogenomics 1.
Drugs do not metabolize the same way in all people. For what patient would a nurse expect to assess for an alteration in drug metabolism?
A)
A 35-year-old woman with cervical cancer
B)
A 41-year-old man with kidney stones
C)
A 50-year-old man with cirrhosis of the liver
D)
A 62-year-old woman in acute renal failure
Ans:
C Feedback: The liver is the most important site of drug metabolism. If the liver is not functioning effectively, as in patients with cirrhosis, drugs will not metabolize normally so that toxic levels could develop unless dosage is reduced. A patient with cervical cancer or kidney stones would not be expected to have altered ability to metabolize drugs so long as no liver damage existed. The patient with renal failure would have altered excretion of the drugs through the renal system but metabolism would not be impacted.
2.
A patient presents to the emergency department with a drug level of 50 units/ mL. The half-life of this drug is 1 hour. With this drug, concentrations above 25 units/mL are considered toxic and no more drug is given. How long will it take for the blood level to reach the non-toxic range?
A)
30 minutes
B)
1 hour
C)
2 hours
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D)
3 hours
Ans:
B Feedback: Half-life is the time required for the serum concentration of a drug to decrease by 50%. After 1 hour, the serum concentration would be 25 units/ mL (50/2) if the body can properly metabolize and excrete the drug. After 2 hours, the serum concentration would be 12.5 units/mL (25/2) and reach the nontoxic range. In 30 minutes the drug level would be 37.5 units/mL, whereas in 3 hours the drug level would be 6.25.
3.
A patient has recently moved from Vermont to Southern Florida. The patient presents to the clinic complaining of dizzy spells and weakness. While conducting the admission assessment, the patient tells the nurse that he have been on the same antihypertensive drug for 6 years and had stable blood pressures and no adverse effects. Since his move, he has been having problems and he feels that the drug is no longer effective. The clinic nurse knows that one possible reason for the change in the effectiveness of the drug could be what?
A)
The impact of the placebo effect on the patients response.
B)
The accumulative effect of the drug if it has been taken for many years.
C)
The impact of the warmer environment on the patients physical status.
D)
Problems with patient compliance with the drug regimen while on vacation.
Ans:
C Feedback: Antihypertensive drugs work to decrease the blood pressure. When a patient goes to a climate that is much warmer than usual, blood vessels dilate and the blood pressure falls. If a patient is taking an antihypertensive drug and moves to a warmer climate, there is a chance that the patients blood pressure will drop too low, resulting in dizziness and feelings of weakness. Even mild dehydration could exacerbate these effects. Most antihypertensives are metabolized and excreted and do not accumulate in the body. Patients must be very compliant with their drug regimen on vacation. After several years on an antihypertensive drug, the effects of that drug are known; therefore, the placebo effect should not be an issue.
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4.
An important concept taught by the nurse when providing medication teaching is the need to provide a complete list of medications taken to health care providers to avoid what?
A)
Spending large amounts of money on medications
B)
Allergic reactions to medications
C)
Drugdrug interactions
D)
Critical concentrations of medications in the body
Ans:
C Feedback: It is important that all health care providers have a complete list of the patients medications to avoid drugdrug interactions caused by one provider ordering a medication, unaware of another medication the patient is taking that could interact with the new prescription. Using the same pharmacist for all prescriptions will also help to prevent this from happening. Informing the provider of all medications taken will not reduce costs of medications, which is best accomplished by requesting generic medications. Allergies should be disclosed to all health care providers as well, but this is not why it is important to provide a complete list of medications taken. Critical concentrations are desirable because that is the amount of drug needed to cause a therapeutic effect, or, in other words, to have the effect the drug is prescribed for.
5.
A pharmacology student asks the instructor what an accurate description of a drug agonist is. What is the instructors best response?
A)
A drug that reacts with a receptor site on a cell preventing a reaction with another chemical on a different receptor site
B)
A drug that interferes with the enzyme systems that act as catalyst for different chemical reactions
C)
A drug that interacts directly with receptor sites to cause the same activity that a natural chemical would cause at that site
D)
A drug that reacts with receptor sites to block normal stimulation, producing no effect
Ans:
C
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Feedback: Agonists are drugs that produce effects similar to those produced by naturally occurring neurotransmitters, hormones, or other substances found in the body. Noncompetitive antagonists are drugs that react with some receptor sites preventing the reaction of another chemical with a different receptor site. Drugenzyme interactions interfere with the enzyme systems that stimulate various chemical reactions. 6.
A nurse is caring for a patient who has been receiving a drug by the intramuscular route but will receive the drug orally after discharge. How does the nurse explain the increased dosage prescribed for the oral dose?
A)
Passive diffusion
B)
Active transport
C)
Glomerular filtration
D)
First-pass effect
Ans:
D Feedback: The first-pass effect involves drugs that are absorbed from the small intestine directly into the portal venous system, which delivers the drug molecules to the liver. After reaching the liver, enzymes break the drug into metabolites, which may become active or may be deactivated and readily excreted from the body. A large percentage of the oral dose is usually destroyed and never reaches tissues. Oral dosages account for the phenomenon to ensure an appropriate amount of the drug in the body to produce a therapeutic action. Passive diffusion is the major process through which drugs are absorbed into the body. Active transport is a process that uses energy to actively move a molecule across a cell membrane and is often involved in drug excretion in the kidney. Glomerular filtration is the passage of water and water-soluble components from the plasma into the renal tubule.
7.
A)
A nurse is working as a member of a research team involved in exploring the unique response to drugs each individual displays based on genetic make-up. What is this area of study is called? Pharmacotherapeutics
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B)
Pharmacodynamics
C)
Pharmacoeconomics
D)
Pharmacogenomics
Ans:
D Feedback: Pharmacogenomics is the area of study that includes mapping of the human genome. In the future, medical care and drug regimens may be personally designed based on a patients unique genetic make-up. Pharmacotherapeutics is the branch of pharmacology that deals with the uses of drugs to treat, prevent, and diagnose disease. Pharmacodynamics involves how a drug affects the body. Pharmacoeconomics includes the costs involved in drug therapy.
8.
The nurse uses what term to describe the drug level required to have a therapeutic effect?
A)
Critical concentration
B)
Dynamic equilibrium
C)
Selective toxicity
D)
Active transport
Ans:
A Feedback: A critical concentration of a drug must be present before a reaction occurs within the cells to bring about the desired therapeutic effect. A dynamic equilibrium is obtained from absorption of a drug from the site of drug entry, distribution to the active site, metabolism in the liver, and excretion from the body to have a critical concentration. Selective toxicity is the ability of a drug to attach only to those systems found in foreign cells. Active transport is the process that uses energy to actively move a molecule across a cell membrane and is often involved in drug excretion in the kidney.
9. A)
A nurse is caring for a patient who is supposed to receive two drugs at the same time. What is the nurses priority action? Wash her hands before handling the medications.
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B)
Consult a drug guide for compatibility.
C)
Question the patient concerning drug allergies.
D)
Identify the patient by checking the armband and asking the patient to state his name.
Ans:
B Feedback: A nurse should first consult a drug guide for compatibility when two or more drugs are being given at the same time. After compatibility is determined the medication can be administered. The nurse will perform hand hygiene, check for patient allergies, and ensure the right patient receives the medication by using two identifiers.
10 .
The nurse is talking with a group of nursing students who are doing clinical hours on the unit. A student asks if all intramuscular (IM) drugs are absorbed the same. What factor would the floor nurse tell the students to affect absorption of the IM administration of drugs?
A)
Perfusion of blood to the subcutaneous tissue
B)
Integrity of the mucous membranes
C)
Environmental temperature
D)
Blood flow to the gastrointestinal tract
Ans:
C Feedback: A cold environmental temperature can cause blood vessels to vasoconstrict and decreases absorption or in a hot environment vasodilate and increase absorption of IM medications. Blood flow to the subcutaneous tissues interferes with subcutaneous injection and blood flow to the gastrointestinal (GI) tract causes alterations in absorption for oral medications. The condition of mucous membranes can interfere with sublingual (under the tongue) and buccal (in the cheek) administration of drugs.
11 . A)
The patient is taking a drug that affects the body by increasing cellular activity. Where does this drug work on the cell? Receptor sites
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B)
Cell membrane
C)
Golgi body
D)
Endoplasmic reticulum
Ans:
A Feedback: Many drugs are thought to act at specific areas on cell membranes called receptor sites. After the receptor site is activated, this in turn activates the enzyme systems to produce certain effects, such as increased or decreased cellular activity, changes in cell membrane permeability, or alterations in cellular metabolism. Receptor sites are generally located on the outside of cells and allow the drug to bypass the cell membrane. The Golgi body and endoplasmic reticulum are not involved in this process.
12 .
Several processes enable a drug to reach a specific concentration in the body. Together they are called dynamic equilibrium. What are these processes? (Select all that apply.)
A)
Distribution to the active site
B)
Biotransformation
C)
Absorption from the muscle
D)
Excretion
E)
Interaction with other drugs
Ans:
A, B, D Feedback: The actual concentration that a drug reaches in the body results from a dynamic equilibrium involving several processes: Absorption from the site of entry (can be from the muscle, the gastrointestinal (GI) tract if taken orally, of the subcutaneous tissue if given by that route); Distribution to the active site; biotransformation (metabolism) in the liver; excretion from the body. Interaction with other drugs is not part of the dynamic equilibrium.
13 .
A nurse is administering digoxin to a patient. To administer medications so that the drug is as effective as possible, the nurse needs to consider what?
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A)
Pharmacotherapeutics
B)
Pharmacokinetics
C)
Pharmacoeconomics
D)
Pharmacogenomics
Ans:
B Feedback: When administering a drug, the nurse needs to consider the phases of pharmacokinetics so that the drug regimen can be made as effective as possible. Pharmacogenomics is the area of study that includes mapping of the human genome. Pharmacotherapeutics is the branch of pharmacology that deals with the uses of drugs to treat, prevent, and diagnose disease. Pharmacoeconomics includes all costs involved in drug therapy.
14 .
The nurse is explaining how medications work to a group of peers and explains that disruption of a single step in any enzyme system disrupts what?
A)
Cell life
B)
Cell membrane
C)
Cell receptor sites
D)
Cell function
Ans:
D Feedback: If a single step in one of the many enzyme systems is blocked, normal cell function is disrupted. Cell life and cell membrane may be impacted by disruption of some enzymes but not all enzymes. Receptor sites would not be disrupted by disruption in a single step in the enzyme system.
15 .
The processes involved in dynamic equilibrium are key elements in the nurses ability to determine what?
A)
Dosage scheduling
B)
Amount of solution for mixing parenteral drugs
C)
Timing of other drugs the patient is taking
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D)
How long the patient has to take the drug
Ans:
A Feedback: These processes are key elements in determining the amount of drug (dose) and the frequency of dose repetition (scheduling) required to achieve the critical concentration for the desired length of time. The processes in dynamic equilibrium are not key elements in determining the amount of diluents for intramuscular (IM) drugs; they do not aid in the timing of the other drugs the patient is taking or how long the patient has to take the drug.
16 .
What factor influences drug absorption?
A)
Kidney function
B)
Route of administration
C)
Liver function
D)
Cardiovascular function
Ans:
B Feedback: Drug absorption is influenced by the route of administration. IV administration is the fastest method; drug absorption is slower when given orally. Kidney function impacts excretion, liver function impacts metabolism, and cardiovascular function impacts distribution.
17 .
What does the lipid solubility of the drug influence?
A)
Absorption of the drug
B)
Metabolism of the drug
C)
Excretion of the drug
D)
Distribution of the drug
Ans:
D Feedback:
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Factors that can affect distribution include the drugs lipid solubility and ionization and the perfusion of the reactive tissue. The lipid solubility of a drug does not influence absorption, metabolism, or excretion. 18 .
The nursing students are learning about the half-life of drugs. A student asks the instructor to explain half-life. What is the instructors best response?
A)
Half-life of a drug is the time it takes for the amount of drug in the body to decrease to half of the peak level it previously achieved.
B)
Half-life is the amount of time it takes for the drug to be metabolized by the body.
C)
Half-life is the amount of time it takes for half of the drug to reach peak level in the body.
D)
Half-life of a drug is the time it takes for the drug to reach half its potential peak level in the body.
Ans:
A Feedback: The half-life of a drug is the time it takes for the amount of drug in the body to decrease to half the peak level it previously achieved. Therefore Options B, C, and D are not correct.
19 .
The patient is taking a 2-mg dose of ropinerol XR. The drug has a half-life of 12 hours. How long will it be before only 0.25 mg of this drug remains in the patients system?
A)
24 hours
B)
36 hours
C)
48 hours
D)
60 hours
Ans:
B Feedback:
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The half-life of a drug is the time it takes for the amount of drug in the body to decrease to half of the peak level it previously achieved. At 12 hours there will be 1 mg of the drug available to the body. At 24 hours there will be 0.5 mg; at 36 hours there will be 0.25 mg; at 48 hours there will be 0.125 mg, and at 60 hours there will be 0.0625 mg. 20 .
The patient has a diagnosis of multiple sclerosis and is taking the drug interferon beta-1a (Rebif). The patient takes this drug by subcutaneous injection three times a week. The dosage is 44 mcg per injection. If the patient takes an injection on Monday, how much of the drug would still be in the patients system when she takes her next injection on Wednesday, assuming the half-life of the drug is 24 hours?
A)
22 mcg
B)
16.5 mcg
C)
11 mcg
D)
5.5 mcg
Ans:
C Feedback: The half-life of a drug is the time it takes for the amount of drug in the body to decrease to 1 half the peak level it previously achieved. On Tuesday, there would be 22 mcg remaining in the body, so option A is incorrect. On Wednesday 11 mcg would remain, so option C is the correct answer. At 12 hours before taking the next dose on Wednesday, there would be 16.5 mcg remaining. If the injection were not taken on Wednesday, 12 hours after the dose was due, there would be 5.5 mcg remaining.
21 .
The patient is a 6-year-old child who is taking 125 mg of amoxicillin every 6 hours. Assuming that the half-life of Amoxicillin is 3 hours, how much Amoxicillin would be in the childs body at the time of the next administration of the drug?
A)
62.5 mg
B)
46.875 mg
C)
31.25 mg
D)
15.625 mg
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Ans:
C Feedback: The half-life of a drug is the time it takes for the amount of drug in the body to decrease to 1 half the peak level it previously achieved. Option A would occur at 3 hours after the original dose of amoxicillin. Option B would occur 4 1/2 hours after the original dose. Option C would occur at 6 hours after the original dose. Option D would occur at 7 1/2 hours after the original dose.
22 .
A drug with a half-life of 4 hours is administered at a dosage of 100 mg. How much of the drug will be in the patients system 8 hours after administration?
A)
75 mg
B)
50 mg
C)
37.5 mg
D)
25 mg
Ans:
D Feedback: The half-life of a drug is the time it takes for the amount of drug in the body to decrease to 1 half the peak level it previously achieved. Option A would occur 2 hours after administration of the drug. Option B would occur at 4 hours. Option C would occur at 6 hours. Option D would occur at 8 hours after the original administration of the drug.
23 .
The nurse administers amoxicillin 500 mg. The half-life of this drug is approximately 1 hour. At what point would the drug level in the body be 62.5 mg if the drug was not administered again?
A)
1 hours after the original dose
B)
2 hours after the original dose
C)
3 hours after the original dose
D)
4 hours after the original dose
Ans:
C
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Feedback: The half-life of a drug is the time it takes for the amount of drug in the body to decrease to one-half of the peak level it previously achieved. At a dose of 500 mg the drug level would be 250 mg in 1 hour, 125 mg in 2 hours, 62.5 mg in 3 hours, and 31.25 mg in 4 hours so the correct answer is 3 hours. 24 .
The nurse is caring for a patient who is receiving gentamicin, 250 mg and fluconazole (Diflucan), 500 mg at the same time. The nurse knows that if these two drugs competed with each other for protein-binding sites, what would this do?
A)
Make the patient gentamicin deficient
B)
Make the patient fluconazole deficient
C)
Counteract any positive benefit the drugs would have
D)
Alter the effectiveness of both drugs
Ans:
D Feedback: Some drugs compete with each other for protein-binding sites, altering effectiveness or causing toxicity when the two drugs are given together. Nothing in the scenario would indicate that the patient would be either Gentamicin or Diflucan deficient, nor does it indicate that these drugs cannot be given together because they would counteract each other.
25 .
The student nurse asks the instructor why a patient with a central nervous system infection is receiving antibiotics that will not cross the bloodbrain barrier. What is the instructors most correct response?
A)
A severe infection alters the bloodbrain barrier to allow the drug to cross.
B)
A medication that is water soluble is more likely to cross the blood-brain barrier.
C)
Antibiotics are the exception to the bloodbrain barrier and cross easily.
D)
An infection that spreads outside the central nervous system helps drugs cross the barrier.
Ans:
A
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Feedback: Effective antibiotic treatment can occur only when the infection is severe enough to alter the bloodbrain barrier and allow antibiotics to cross. Lipidsoluble, not water-soluble, medications cross the bloodbrain barrier more easily and most antibiotics are lipid soluble, so they are not the exception. No matter where the infection originates, drugs must cross the bloodbrain barrier to treat central nervous system infections. 26 .
The patient is taking low dose aspirin daily for his heart. The nurse knows only a portion of the medication taken actually reaches the tissue due to what process?
A)
Distribution
B)
First-pass effect
C)
Reduced absorption
D)
Gastrointestinal circulation
Ans:
B Feedback: Drugs that are taken orally are usually absorbed from the small intestine directly into the portal venous system and then delivers these absorbed molecules into the liver, which immediately break the drug into metabolites, some of which are active and cause effects in the body, and some of which are deactivated and can be readily excreted from the body. As a result, a large percentage of the oral dose is destroyed at this point and never reaches the tissues. This process is not caused by distribution, absorption, or gastrointestinal circulation.
27 .
What needs to happen to the proteindrug complex for the drugs to reach the cells where the drug can act?
A)
The proteindrug complex must break itself into smaller pieces to enter the capillaries.
B)
The binding site on the protein picks up a chemical to make it soluble in the serum.
C)
The drug must break away from the protein-binding site and float freely.
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D)
The drug must be dissolved in the plasma so it can enter the capillaries and then the tissues.
Ans:
C Feedback: Most drugs are bound, to some extent, to proteins in the blood to be carried into circulation. The proteindrug complex is relatively large and cannot enter into capillaries and then into tissues to react. The drug must be freed from the proteins binding site at the tissues. This occurs without the introduction of another chemical or by dissolving in it plasma.
28 .
The nurse is reviewing the results of the patients laboratory tests. What must the nurse keep in mind when reviewing these results related to medication administration?
A)
The patients emotional response to the disease process
B)
The timing of the last dose of medication relative to when blood was drawn
C)
The possibility of a druglaboratory test interaction
D)
A change in the bodys responses or actions related to the drug
Ans:
C Feedback: The body works through a series of chemical reactions. Because of this, administration of a particular drug may alter results of tests that are done on various chemical levels or reactions as part of a diagnostic study. This druglaboratory test interaction is caused by the drug being given and not necessarily by a change in the bodys responses or actions. The patients emotional response or timing of the last dose is not important in druglaboratory interactions.
29 .
A patient has come to the clinic and been diagnosed with Lyme disease. The physician has ordered oral tetracycline. What is important for the nurse to include in the teaching plan about tetracycline? (Select all that apply.)
A)
Do not take the drug with anything high in sodium content to keep from producing a state of hypernatremia in the body.
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B)
Do not take the drug with foods or other drugs that contain calcium.
C)
Do not take the drug at the same time you take an iron supplement or with foods that are high in iron content.
D)
Avoid exposure to the sun when taking this drug as it can turn your skin purple.
E)
Avoid eating bananas at the same time you take this drug as the potassium content of the tetracycline can produce hyperkalemia in the body.
Ans:
B, C Feedback: The antibiotic tetracycline is not absorbed from the gastrointestinal (GI) tract if calcium or calcium products (e.g., milk) are present in the stomach. It cannot be taken with iron products because a chemical reaction occurs preventing absorption. Although tetracycline can increase sun sensitivity, it does not turn the skin purple. Patients who take tetracycline do not need to avoid eating bananas or foods that are high in potassium.
30 .
A nurse is caring for a patient taking multiple drugs and is concerned about a possible drugdrug interaction. What is the nurses first and best means of avoiding this problem?
A)
Consult a drug guide.
B)
Call the pharmacist.
C)
Contact the provider.
D)
Ask another nurse.
Ans:
A Feedback:
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Whenever two or more drugs are being given together, first consult a drug guide for a listing of clinically significant drugdrug interactions. Sometimes problems can be avoided by staggering the administration of the drugs or adjusting their dosages. Consulting the pharmacist is not wrong, but it would not be the first action to take. The nurse holds responsibility for his or her own practice so asking a health care provider or another nurse is based on the assumption that that professional is knowledgeable about all drugdrug interactions, which is likely not the case. 31 .
The nurse promotes optimal drug effectiveness by doing what? (Select all that apply.)
A)
Incorporate basic history and physical assessment factors into the plan of care.
B)
Evaluate the effectiveness of drugs after they have been administered.
C)
Modify the drug regimen to modify adverse or intolerable effects.
D)
Minimize the number of medications administered to patients.
E)
Examine factors known to influence specific drugs if they are to be effective.
Ans:
A, B, C, E Feedback: Incorporate basic history and physical assessment factors into any plan of care so that obvious problems can be identified and handled promptly. If a drug simply does not do what it is expected to do, further examine the factors that are known to influence drug effects. Frequently, the drug regimen can be modified to deal with that influence. Minimizing the number of medications administered is usually not an option because each drug is ordered for a reason of necessity for the patient.
32 .
The nurse administers a specific medication to an older adult patient every 4 hours. The patient has a history of chronic renal failure. Why would this patient be at risk for toxic drug levels?
A)
Cumulative effect
B)
First-pass effect
C)
Drug interactions
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D)
Cross-tolerance effect
Ans:
A Feedback: If a drug is taken in successive doses at intervals that are shorter than recommended, or if the body is unable to eliminate a drug properly, the drug can accumulate in the body, leading to toxic levels and adverse effects. This is a cumulative effect. First-pass effect addresses the reduction of available drug when taken orally due to metabolism in the liver before the drug reaches the bloodstream. Drug interactions occur when taken with other drugs, food, or complementary alternative therapies. Cross-tolerance is resistance to drugs within the same class.
33 .
The patient, diagnosed with cancer, is receiving morphine sulfate (a potent narcotic pain reliever) to relieve cancer pain. Approximately every 7 days the medication is no longer effective in controlling the patients pain and a larger dose is needed to have the same effect. How might the nurse explain why this is happening?
A)
Tolerance
B)
Cumulation
C)
Interactions
D)
Addiction
Ans:
A Feedback: The body may develop a tolerance to some drugs over time. Tolerance may arise because of increased biotransformation of the drug, increased resistance to its effects, or other pharmacokinetic factors. When tolerance occurs, the amount of the drug no longer causes the same reaction. Therefore, increasingly larger doses are needed to achieve a therapeutic effect. Cumulative effect occurs when the drug is not properly eliminated and more of the drug is administered, resulting in toxic levels accumulating. Interactions occur when the drug reacts badly with another substance such as food, another drug, or an alternative or complementary therapy. Addiction is the psychological need for a substance.
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34 .
While administering a medication that the nurse has researched and found to have limited effectiveness, the patient tells the nurse, I have read all about this drug and it is such a wonder drug. Im so lucky my doctor prescribed it because I just know it will treat my problem. The nurse suspects this drug will be more effective than usual for this patient because of what effect?
A)
Cumulative effect
B)
First-pass effect
C)
Placebo effect
D)
Cross-tolerance effect
Ans:
C Feedback: A drug is more likely to be effective if the patient thinks it will work than if the patient believes it will not work. This is called the placebo effect. If a drug is taken in successive doses at intervals that are shorter than recommended, or if the body is unable to eliminate a drug properly, the drug can accumulate in the body, leading to toxic levels and adverse effects. This is a cumulative effect. First-pass effect addresses the reduction of available drug when taken orally due to metabolism in the liver before the drug reaches the bloodstream. Cross-tolerance is resistance to drugs within the same class.
35 .
The nurse administers an intravenous medication with a half-life of 24 hours but recognizes what factors in this patient could extend the drugs half-life? (Select all that apply.)
A)
Gastrointestinal disease
B)
Kidney disease
C)
Liver disease
D)
Cardiovascular disease
E)
Route of administration
Ans:
B, C, D Feedback:
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Kidney disease could slow excretion and extend the drugs half-life. Liver disease could slow metabolism resulting in an extended half-life. Cardiovascular disease could slow distribution resulting in a longer half-life. Gastrointestinal disease would not impact half-life because the medication was injected directly into the bloodstream. Route of administration would not extend half-life because IV injection eliminates the absorption step in the process. Chapter 6. Introduction to Autonomic Pharmacology .
A 70-year-old patient has just received a drug that can cause sedation. What would be the priority nursing diagnosis for this patient?
A)
Noncompliance: Cost of the drug
B)
Deficient knowledge: Unfamiliar with drug therapy
C)
Risk for injury: Related to adverse effects of the drug
D)
Ineffective health maintenance: Need for medication
Ans:
C Feedback: Because of the patients age and that the medication causes sedation, the highest priority nursing diagnosis is related to maintaining the patients safety. Safety for the patient is the nurses number one concern. There is nothing indicated related to the cost of the drug or the risk of noncompliance for this patient. Deficient knowledge will need to be addressed but it is not the priority when compared with patient safety. There is no indication the patients need for this medication is related to an ineffective health maintenance issue.
2.
What is the responsibility of the nurse related to the patients drug therapy? (Select all that apply.)
A)
Teaching the patient how to cope with therapy to ensure the best outcome
B)
Providing therapy as well as medications
C)
Evaluating the effectiveness of therapy
D)
Altering the drug regimen to optimize outcome
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E)
Recommending appropriate over-the-counter medications to treat adverse effects of prescription drug therapy
Ans:
A, B, C Feedback: A nurse is, therefore, a key health care provider who is in a position to assess the whole patient, to administer therapy as well as medications, to teach the patient how best to cope with the therapy to ensure the most favorable outcome, and to evaluate the effectiveness of the therapy. Nurses do not alter drug therapy or recommend over-the-counter medications because prescribing is outside the nurses scope of practice.
3.
The nurse is gathering assessment data from a medication history of a 38year-old man with four children. What assessment information would be most important in providing care for this patient?
A)
The medication history of the patients mother and/or father
B)
The name of the patients pharmacy
C)
Insurance, financial support, and stability for the patient and his family
D)
The last time the patient was hospitalized
Ans:
C Feedback: In this situation, insurance, financial support, and stability would be the most important data and may determine compliance with future drug therapy. The medication history of the patients parents could indicate a pattern of overall attitude about drug therapy but is not the priority concern. The last time the patient was hospitalized could indicate whether the patient seeks medical care when appropriate or if he self-medicates, contributing to the nurses knowledge of this individual but this is not the priority concern. The name of the pharmacy would be unnecessary unless the nurse anticipates having to call a prescription in to the pharmacy for the prescriber.
4. A)
During what phase of the nursing process would the nurse be required to consider the efficacy of nursing interventions related to drug therapy? Assessment
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B)
Nursing diagnosis
C)
Interventions
D)
Evaluation
Ans:
D Feedback: Evaluation allows the nurse to review what has changed since intervening to determine whether the nursing care has had a positive, therapeutic effect moving the patient toward a more healthful life. If outcomes have not improved, the nurse begins again at the assessment phase of the nursing process with the goal of changing the plan of care to improve outcomes. The patients response to the drug and occurrence of adverse drug effects indicate the effectiveness of the nursing interventions related to drug therapy. Assessment involves a systematic, organized collection of data concerning a patient. A nursing diagnosis indicates actual or potential alterations in patient function based on the assessment of the clinical situation. Interventions are actions taken to meet the patients needs, such as administration of drugs.
5.
When the nurse reads in the drug handbook the section related to recommended dosage, it is important to remember that this suggested dosage is based on what?
A)
A 40-year-old man
B)
An average-sized adult
C)
A 150-pound adult male
D)
A healthy young adult
Ans:
C Feedback: Drug studies base the therapeutic dosage, or that dose needed to reach a critical concentration, on the physiology of a 150-pound healthy adult male. Testing is not routinely done in women because of the potential for unknown effects on the ova. Testing would not be done on an obese adult or older adult because of the potential for underlying disease, altered metabolism, or reactions to the drug. Children and adolescents are never used for testing due to ethical concerns.
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6.
A nurse is caring for a child on the pediatric unit. A drug is ordered for the child, but no pediatric dose is listed for the drug. To make sure that the right dose has been ordered, what will the nurse use to calculate the correct dose?
A)
Surface area
B)
Height
C)
Birth date
D)
Adult dosage
Ans:
A Feedback: The surface area of a child is calculated using height and weight. It is the most accurate way to determine an appropriate dosage for that child. Age does not take into consideration variations in growth. Height alone does not take into account the mass of the child. Gestational age is simply a distracter.
7.
You are evaluating the discharge teaching you have done with your patient concerning drug therapy. What statement from the patient would indicate that teaching had been effective?
A)
I have to take three pills each day and I can take them at the time that fits my schedule.
B)
I should take the white pill in the morning because the doctor wants me to take it.
C)
I will add the names and dosages of these new drugs to my medication list in my wallet.
D)
I have prescriptions at different pharmacies. I shop around for the best price for each drug.
Ans:
C Feedback:
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The patient needs to recognize the importance of keeping an updated list of all current medications and the need to share this list with all health care providers to avoid drug-drug interactions. The patient should understand exactly when to take medications, why that medication is being taken, and how to take it safely. Patients should be encouraged to use a single pharmacy because this will add another layer of safety because the pharmacy will know all drugs being prescribed to this patient. 8.
The nurse would expect to see an adjusted dosage in what patients? (Select all that apply.)
A)
Young adult women
B)
Middle-aged men
C)
Infants
D)
Neonates
E)
Older adults
Ans:
C, D, E Feedback: Patients at the extremes of the age spectrumchildren and older adultsoften require dosage adjustments based on the functional level of the liver and kidneys and the responsiveness of other organs. The childs age and developmental level will also alert the nurse to possible problems with drug delivery, such as an inability to swallow pills or follow directions related to other delivery methods. The adult, whether male or female, would not require altered dosage unless a secondary condition such as renal or hepatic alterations existed.
9.
When taking a medication history on a patient why should the nurse ask about the use of complementary or alternative therapies?
A)
Patients starting on new drugs are usually not compliant with medical regimens.
B)
Many drug-alternative therapy interactions can cause serious problems.
C)
Natural products may be more effective and the prescribed drug may not be needed.
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D)
The cost of the drug and the alternative therapy may be too expensive for the patient to handle.
Ans:
B Feedback: Alternative therapies often involve the use of herbal products, which contain natural chemicals that affect the body. Many drug-alternative therapy interactions have been reported that could cause serious adverse effects, but patients often dont think to mention these therapies when asked about the medications they are taking. The health care provider needs to be alert to these possible interactions and to adjust treatment appropriately. Cost and effectiveness may be factors, but the balancing of these therapies in the drug regimen to prevent interactions is the main concern of the nurse.
10 .
The nurse is reviewing the patients medication orders and finds an order stating amoxicillin 250 mg every 8 hours. What would the nurse question regarding this order?
A)
Dose
B)
Route
C)
Frequency of administration
D)
Allowance for generic substitution
Ans:
B Feedback: For the nurse to administer a medication, all essential components of a medication order must be written by the prescriber including drug name, dosage, route, frequency, and patient name. This order is missing the route and the drug could be given IV, IM, or PO. The nurse should call the ordering health care provider and clarify what route the medication is to be administered.
11 . A)
The home health nurse is caring for a 77-year-old patient with congestive heart failure. What would the nurse consider a priority to assess to develop the most effective plan of care related to medication administration? Description of the patients living environment
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B)
Required lifestyle changes
C)
Family members in the community
D)
Compliance with therapy to reduce risk of skin breakdown
Ans:
B Feedback: Nurses must consider how a person responds to disease and its treatment, including the changes in lifestyle that may be required. By recognizing required lifestyles during the home visit the nurse can teach the patient how to make healthy choices and support the process of changing to new choices. Although the environment would impact the physical plan of care, it would not be a factor in the administration of medications. Assessment of family members in the community would not be a necessary part of the assessment in relation to the patients drug therapy. Nothing suggests the patient is at risk for skin breakdown so this would not factor into the medication regimen.
12 .
Student nurses are learning to weigh patients and do vital signs. How does a correct weight impact administering medication?
A)
Proper dosage calculation
B)
Assessing changes in fluid balance
C)
Assessing changes in nutritional status
D)
Caloric needs
Ans:
A Feedback: Dosage of medication is often calculated based on the patients weight, so getting patients weight wrong could cause a medication error. The patients weight gives information into fluid balance, nutritional status, and caloric needs but this is not associated with drug therapy. However, a patients weight is most important in determining the appropriateness of drug dosage.
13 . A)
Teaching the patient/caregiver about her or his medications is an important step in reducing the risk of medication errors. What is an important teaching point about medications? (Select all that apply.) Speak up and ask questions.
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B)
Store medications in a warm humid place.
C)
Adjust your medication according to how you feel.
D)
Keep a list of your prescribed medications.
E)
Take all medications together in the morning.
Ans:
A, D Feedback: Appropriate patient teaching will reduce the risk of medication errors and complications. Nurses teach patients to speak up, ask questions, and act as his or her own advocate when medications are being prescribed. He should keep a complete list of medications and have a copy available at all times in case of accident. Store drugs in a dry, cool place away from children and pets that could be harmed. Take medications as they have been prescribed and do not adjust dosage without authorization from the prescriber. Take medications at the time they are prescribed to be taken, always being aware that some drugs cannot be taken together.
14 .
A 73-year-old male patient is being discharged home today. The discharge order reads: Take 10 mL of guaifenesin (Robitussin) PO q4h. This over-thecounter pharmaceutical comes in bottles with plastic measuring caps. How much should the nurse teach the patient to take at home?
A)
1/2 tsp
B)
1 tsp
C)
2 tsp
D)
1 tbsp
Ans:
C Feedback: The nurse is responsible for teaching the patient the correct drug dosage. You should teach the patient that 5 mL = 1 tsp, so 10 mL (5 2) = 2 tsp; therefore Options A, B, and D are incorrect. It is important that patients be taught how to take their medication using measurement systems they are familiar with and know how to use.
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15 .
It is important for the nurse to evaluate the efficacy of what parameter when evaluating the drug therapy of a patient?
A)
Appropriateness of drug dosages
B)
Compliance
C)
Caregivers knowledge level
D)
Nursing interventions
Ans:
D Feedback: During the evaluation phase of care, nurses evaluate how effective care has been in meeting outcome goals. Appropriateness of drug dosages should be determined before administering the medication and not when evaluating their effects. Often, compliance cannot be evaluated until the nurse evaluates the effectiveness of therapy and finds the drug is not performing as expected, at which time the nurse may question the patient about whether medications are being taken as ordered. Caregivers knowledge level is an assessment providing data that will determine the teaching plan.
16 .
The nurse is conducting an admission assessment on a patient. When collecting data related to medications the nurse asks What medications are you currently taking? After collecting this information, what other questions should the nurse ask? (Select all that apply.)
A)
Do you take any medications?
B)
What over-the-counter (OTC) medications do you take?
C)
Do you take an herbs, vitamins, or supplements?
D)
Do you take medications safely when you take them?
E)
Why do you take this medication?
Ans:
B, C Feedback:
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Patients often neglect to mention OTC drugs or alternative therapies (e.g., herbals) because they do not consider them to be actual drugs or they may be unwilling to admit their use to the health care provider. Ask patients specifically about OTC drug and alternative therapy use. The question What medications are you taking? has already been asked so there is no need to ask if they take any medications. Often, patients may take medications unsafely, so do not ask whether the patient takes drugs safely but instead assess exactly how they take medications to determine whether they are being taken safely. Patients should always know why they are taking each medication to understand whether they are getting the desired effect. 17 .
A 27-year-old man is admitted to the emergency department (ED) after a serious motorcycle accident. The patient has a head injury, abrasions covering the left side of his body, a broken left femur, and internal injuries that are not fully assessed at this time. He is transferred from the ED to the intensive care unit (ICU). The nurse who is going to care for this patient in the ICU knows that a priority responsibility in regard to drug therapy is what?
A)
Support vital functions
B)
Continue curative treatment
C)
Institute life-saving treatment
D)
Monitor patients response
Ans:
D Feedback: Because the nurse has the greatest direct and continued contact with the patient, the nurse is in the best position to detect minute changes that ultimately determine the course of drug therapytherapeutic success or discontinuation because of adverse or unacceptable responses. The nurse would support vital functions, continue curative treatment, and institute lifesaving treatment, but these actions occur regardless of drug therapy.
18 .
When assessing a patient before starting a drug regimen, why would the nurse consider it important to assess baseline kidney function?
A)
To anticipate adverse effects of drugs
B)
To determine patients baseline electrolyte levels
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C)
To determine patients ability to excrete the drug
D)
To determine patients ability to metabolize the drug
Ans:
C Feedback: Patients with kidney or liver disease require very cautious medication administration, often needing dosages to be decreased and contraindicating some drugs altogether. The patients renal status will indicate the ability to excrete the drug. Liver function is needed to assess metabolism. Electrolyte levels would be indicated by serum blood test results, not by studies of kidney function. The nurses goal is to prevent or minimize adverse effects of drugs, not to anticipate them.
19 .
A nurse is caring for a 77-year-old patient. The nurse plans care for this patient based on the knowledge that the aging process impacts drug therapy in what important way?
A)
Blood volume decreases
B)
Subcutaneous tissue increases
C)
Total body water increases
D)
Muscle mass increases
Ans:
A Feedback: As patients age, the body undergoes many normal changes that can affect drug therapy, such as a decreased blood volume, decreased gastrointestinal (GI) absorption, reduced blood flow to muscles or skin, and changes in receptor site responsiveness. As a person ages, subcutaneous tissue decreases, total body water decreases, and muscle mass decreases.
20 .
The nurse is caring for a patient who takes several drugs. What patient would the nurse monitor most closely because of an increased risk for adverse effects of medications?
A)
The school-aged child
B)
The obese middle-aged man
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C)
The adolescent
D)
The newborn infant
Ans:
D Feedback: Patients most likely to have adverse drug reactions include the very young or very old due to physiologic characteristics peculiar to these age groups. Therefore, the newborn infant would be at greater risk than the school-aged child who is at greater risk than the adolescent or middle-aged man.
21 .
Which statement best describes drug efficacy/toxicity in pediatric patients?
A)
Drug requirements for infants have been extensively studied.
B)
Drug dosage is altered by age and weight in children.
C)
Children always need smaller doses of medication than adults.
D)
Infants and children are not at risk for drug toxicity if the dosage is correct.
Ans:
B Feedback: All aspects of pediatric drug therapy must be guided by the childs age, weight, and level of growth and development. Drugs are generally studied using healthy young men and are never studied in infants because they are not old enough to give consent for themselves. Drug dosages are very specific and a big child may weigh more than an adult and require a larger dose. Even when medications are given accurately, adverse effects can occur.
22 .
A 7-year-old boy fell off a wood pile while playing. He has been admitted to the intensive care unit with multiple broken bones and internal bleeding. What should the nurse know about drug therapy in this type of patient?
A)
Adverse effects may be decreased.
B)
Therapeutic effects may be increased.
C)
Pharmacodynamics may be altered.
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D)
Pharmacokinetics remain the same.
Ans:
C Feedback: The childs developmental age will influence pharmacokinetics and pharmacodynamics; the immature liver may not metabolize drugs in the same way and the kidneys may not work as efficiently as those of an adult. Adverse effects might be increased and therapeutic effects may be decreased.
23 .
After admitting a patient to the unit, the nurse is organizing times to administer ordered medications. What important consideration will guide the nurses timing of each medication?
A)
Comfort
B)
Ethnicity of patient
C)
Gender
D)
Age
Ans:
A Feedback: Organizing the day and the drug regimen to make it the least intrusive on a patients comfort can help to prevent errors and improve compliance. Ethnicity, gender, and age should be a consideration when ordering the drug, but after the drug is chosen it should be administered in a way that will maintain the patients quality-of-life.
24 .
The nursing instructor is discussing drug therapy in the older adult. What would the instructor tell the students about what could affect therapeutic dosing in an older adult?
A)
Changes in the gastrointestinal (GI) system can reduce drug absorption.
B)
In older adults, drugs enter into circulation more quickly.
C)
In older adults, drugs are distributed to a smaller portion of the tissues.
D)
In older adults, drugs have an increased action.
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Ans:
A Feedback: As patients age, the body undergoes many normal changes that can affect drug therapy, such as a decreased blood volume, decreased GI absorption, reduced blood flow to muscles or skin, and changes in receptor site responsiveness. They are not released more quickly into circulation; distributed to a smaller portion of tissue; nor do they have an increased action.
25 .
In todays health care environment there is often more contact between the patient and the nurse than between the patient and the physician. How does this increased patient contact impact drug therapy?
A)
Choosing the best medication to treat the patients condition
B)
Assessing the patients preferred communication strategies
C)
Assessing the therapeutic success of the drug therapy
D)
Reducing dosage quickly when adverse effects arise
Ans:
C Feedback: Because the nurse has the greatest direct and continued contact with the patient, the nurse is in the best position to detect minute changes that ultimately determine the course of drug therapytherapeutic success or discontinuation because of adverse or unacceptable responses. The nurse does not choose the medication or reduce dosage because it is outside the scope of practice of the nurse. Communication strategies used by patients are not related to drug therapy.
26 .
The nurse admits a patient to the unit and learns the patient has recently been diagnosed with chronic renal failure but has not informed the primary care provider of this diagnosis. What is the nurses first priority?
A)
Administer medications ordered immediately.
B)
Maintain the patients confidentiality.
C)
Call the admitting physician immediately.
D)
Provide teaching about chronic renal failure.
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Ans:
C Feedback: Knowledge of the patients diagnosed renal failure is essential to proper medication ordering because some dosages will need to be decreased whereas other medications may be contraindicated in this patient. The nurse does not breach confidentiality when sharing information that impacts needed care to the primary care provider. Teaching about renal failure may be provided at some point but it is not the priority in this situation. Medications should not be administered until they are appropriately adjusted by a health care provider who is aware of the renal failure diagnosis.
27 .
It is often necessary to obtain baseline data prior to initiating many forms of drug therapy. These baseline data include what? (Select all that apply.)
A)
Education level
B)
Allergies
C)
Drug use
D)
Number of members in family
E)
Fathers occupation
Ans:
A, B, C Feedback: Assessing educational level allows the nurse to plan an effective teaching plan. Allergies must be fully assessed before administering any medication to prevent allergic responses. Understanding the patients current drug use informs the nurse about drugs that may interact or be impacted. Knowing the number of family members and fathers occupation would not promote safer drug administration.
28 .
A 32-year-old woman is admitted to the unit with a diagnosis of hypovolemia. The nurse is developing a care plan for this patient. What is an appropriate nursing diagnosis to help prevent medication errors?
A)
Dysfunctional gastrointestinal motility
B)
Ineffective self-health maintenance
C)
Risk for injury
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D)
Deficient fluid volume
Ans:
D Feedback: Hypovolemia is condition involving fluid volume in the body that is less than required. This would affect drug therapy for this patient and would be an important inclusion in the plan of care. The situation described does not indicate dysfunctional GI motility or ineffective self-health maintenance. A patient who is severely fluid volume deficient might be at risk for falls and injury but more information would be needed to make this determination.
29 .
The nurse applies the nursing process in medication therapy to ensure what?
A)
That medications are given at the right time
B)
That care is efficient and effective
C)
That the right dose of the drug is given to the patient
D)
That the right drug is given to the right patient at the right time
Ans:
B Feedback: Nurses use the nursing process as a decision-making, problem-solving process to improve the efficiency and effectiveness of care. Options A, C, and D are incorrect and do not describe why the nursing process is important as much as they explain how to give medications safely.
30 .
A 35-year-old male patient is admitted to the hospital with pneumonia. He was originally being treated at home, but became worse when he quit taking his antibiotic prematurely. What is an appropriate nursing diagnosis for this patient?
A)
Deficient knowledge: monitoring temperature
B)
Noncompliance
C)
Risk for injury related to hypoxia
D)
Non-adherence: overuse
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Ans:
B Feedback: This patient did not take his antibiotic as directed. He quit taking his medication too soon, probably when he began to feel better so he was noncompliant with care. Why he quit taking the medication is unknown; it could have been a knowledge deficit or inability to pay for the full prescription. This will require further assessment to determine. Further data would need to be collected to determine whether the patient is experiencing hypoxia. He did not overuse his medication so option D is inaccurate.
31 .
The nurse is reviewing the patients admission medication orders. What order would the nurse to question?
A)
Digoxin .5 mg orally nowgive one dose only
B)
Lasix 20 mg. IV every 4 hours times 3
C)
Gentamicin 80 mg IV to infuse over 1 hour every 12 hours
D)
Acetaminophen 650 mg PO every 4 hours as needed for pain
Ans:
A Feedback: The nurse should question the order for Digoxin.5 mg to make sure 0.5 mg is meant versus 5 mg, or what should have been ordered which is 0.05 mg. There should always be a 0 before a decimal point if no other number is present to make sure the decimal point is seen. The remaining orders could be administered as written.
32 .
The nursing instructor observes several nursing students administer medications to their assigned patients. The instructor would stop what student from administering the medication until the error was corrected?
A)
The student checks the label on the medication against the administration record three times.
B)
The student enters the patients room and asks the patient Are you Mr. Jones?
C)
The student checks the drugs brand name and generic name before taking it to the patient.
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D)
The student documents the medication upon exiting the patients room.
Ans:
B Feedback: When the student asks the patient, Are you Mr. Jones the patient may nod in agreement, even if that is not his name. Perhaps he misheard, or maybe he wasnt paying attention to the name, or he may just want to be agreeable but this manner of ensuring the right patient receives a medication often results in errors. The student is correct to check the medication name against the medication administration record (MAR) three times to ensure the right drug is administered. The student who checks brand name and generic name is accurate in making sure the correct drug is prepared. Medication should be documented as soon as they are given so this student is also correct.
33 .
The nurse is caring for a patient scheduled for surgery this morning who is not to be given anything orally. The nurse reviews the medication administration record and finds the patient has an important medication due but it is supposed to be given orally. What is the nurses best action?
A)
Give the medication with a small sip of water.
B)
Give the medication via a different route.
C)
Hold the medication and put a note on the front of the chart for the surgeon.
D)
Call the ordering health care provider and clarify administration.
Ans:
D Feedback: The nurse would consult with the ordering provider to determine whether the medication should be held, given by another route, or taken with a sip of water. Administering the medication with a small sip of water could cause the cancellation of the procedure, either because of the sip of water or because the medication may interfere with anesthesia. The nurse cannot change the route of administration without an order. Holding the medication would constitute a drug error because the medication was not given on time.
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34 .
The nurse admits an older adult patient to the emergency room with reports of shortness of breath on exertion and a productive cough. The nurse reviews the patients current medications and the patient says, I take one pink pill every morning. The nurse asks the name of the drug and the patient says she doesnt know. The patient cannot supply the name of the drug or the purpose in taking it either. This happens with four other medications the patient says she takes. What is an appropriate nursing diagnosis for this patient?
A)
Acute confusion
B)
Risk-prone health behavior
C)
Ineffective health maintenance
D)
Noncompliance
Ans:
C Feedback: This patient is demonstrating ineffective health maintenance because knowledge of what medications are being taken and why they are being taken is essential to her health. Patients should be instructed to carry an up- todate list of current medications to share with all health care providers. She is taking her medication as ordered according to what she said so that would eliminate risk-prone health behaviors and noncompliance. There is no indication the patient is confused.
35 .
What action does the nurse take during the intervention state of the nursing process related to drug therapy? (Select all that apply.)
A)
Administer the medication.
B)
Determine medication effectiveness.
C)
Document the medication.
D)
Analyze the data collected.
E)
Collect a nursing history.
Ans:
A, C Feedback:
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During the implementation phase, the nurse administers and documents the medication. Effectiveness of the medication is determined during the evaluation phase. Analyzing data occurs when assigning appropriate nursing diagnoses. Collecting a nursing history is part of the assessment stage of the nursing process. Chapter 7. Cholinoceptor-Activating & Cholinesterase-Inhibiting Drugs 1.
The patient has had cevimeline (Evoxac) prescribed. What would be an appropriate dosing schedule for the nurse to administer this drug?
A)
Once a day
B)
Twice a day
C)
Three times a day
D)
Every 4 hours
Ans:
C Feedback: Cevimeline should be given three times a day with meals. Once or twice a day dosing would cause a decrease in therapeutic effects of the drug and every 4 hours could lead to toxicity.
2.
A student asks the pharmacology instructor to describe the function of a cholinergic agonist. What would the instructor reply?
A)
Cholinergic agonists increase the activity of dopamine receptor sites throughout the brain and spinal cord.
B)
Cholinergic agonists decrease the activity of gamma-aminobutyric acid (GABA) receptor sites throughout the body.
C)
Cholinergic agonists increase the activity of acetylcholine receptor sites throughout the body.
D)
Cholinergic agonists decrease the activity of norepinephrine receptor sites throughout the brain and spinal cord.
Ans:
C Feedback:
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Cholinergic agonists are drugs that increase the activity of acetylcholine receptor sites throughout the body. Dopamine, GABA, and norepinephrine are not associated with cholinergic agonist function. 3.
A 10-year-old child with spina bifida is receiving bethanechol (Urecholine) for treatment of neurogenic bladder. What adverse effect will the nurse assess for?
A)
Constipation
B)
Loss of bowel and bladder control
C)
Decrease salivation
D)
Increased appetite
Ans:
B Feedback: Loss of bowel and bladder control is an adverse effect of cholinergic agents that would cause stress in a child. Diarrhea and increased salivation are also adverse effects. Increased appetite is not associated with these drugs. Children are more likely to have gastrointestinal (GI) upset that could result in a decrease in appetite.
4.
A nurse is writing a plan of care for a patient who is taking bethanechol (Urecholine). What would be an appropriate outcome for this patient?
A)
Pupillary dilation
B)
Increased blood pressure
C)
Improved bladder function
D)
Decreased secretions
Ans:
C Feedback: Bethanechol is prescribed for nonobstructive urinary retention and neurogenic bladder. The appropriate outcome for this patient would be improved bladder function. This drug causes pupillary constriction and increased secretions. This drug would not increase blood pressure. However, it could cause hypotension in the older patient.
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5.
What drug is the nurse likely to administer to diagnose myasthenia gravis in a child?
A)
Atropine (generic)
B)
Bethanechol (Urecholine)
C)
Edrophonium (Enlon, Reversol)
D)
Neostigmine (Prostigmine)
Ans:
C Feedback: Edrophonium is the drug of choice for diagnosing myasthenia gravis. Bethanechol is used to treat neurogenic bladder. Neostigmine is used for treatment of myasthenia gravis and could be used for diagnosis if edrophonium could not be used. Atropine is an anticholinergic drug and would not be used to test for myasthenia gravis.
6.
A patient is brought to the emergency department having a cholinergic reaction, which includes a severe drop in blood pressure. What drug will the nurse expect to administer?
A)
Atropine (generic)
B)
Edrophonium (Enlon, Reversol)
C)
Propranolol (Inderal)
D)
Succinylcholine (Anectine)
Ans:
A Feedback: The antidote for a cholinergic reaction is atropine. This drug will block the cholinergic sites. Edrophonium would cause an accumulation of acetylcholine and worsen the situation. Propranolol blocks beta-receptors in the sympathetic system. Succinylcholine is a neuromuscular junction drug and would not affect other sites.
7.
Memantine hydrochloride (Namenda) has been prescribed for a 63-year-old patient who has a confirmed diagnosis of Alzheimers disease. What would be the target dose for this patient?
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A)
5 mg/d
B)
10 mg b.i.d.
C)
15 mg/d
D)
20 mg b.i.d.
Ans:
B Feedback: The drug is started at 5 mg/d PO, increasing by 5 mg/d at weekly intervals. The target dose is 20 mg/d given as 10 mg b.i.d.
8.
An Alzheimers patient taking donepezil (Aricept) has a complete blood count that indicates he or she is anemic. What drug taken in combination with donepezil could be the cause of the anemia?
A)
Cimetidine (Tagamet)
B)
Ibuprofen (Advil)
C)
Diltiazem (Cardizem)
D)
Furosemide (Lasix)
Ans:
B Feedback: There could be an increased risk of gastrointestinal (GI) bleeding if donepezil is taken with a nonsteroidal anti-inflammatory drug (NSAID) because of the combination of increased GI secretions and the GI mucosal erosion associated with the use of NSAIDs. Cimetidine, diltiazem, and furosemide would not affect GI bleeding.
9.
The Air Force nurse is treating a patient who was exposed to a particular nerve gas. What drug has been approved to treat this patient?
A)
Neostigmine (Prostigmin)
B)
Pyridostigmine (Mestinon)
C)
Ambenonium (Mytelase)
D)
Edrophonium (Enlon, Reversol)
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Ans:
B Feedback: Pyridostigmine has been approved for use by military personnel who have been exposed to particular nerve gases. Neostigmine, ambenonium, and edrophonium are not approved for this use.
10 .
The nurse administers a direct-acting cholinergic agonist to the patient. When assessing this patient for drug effects, the nurse would expect to see effects arising from stimulation of what receptors?
A)
Nicotinic
B)
Alpha
C)
Beta
D)
Muscarinic
Ans:
D Feedback: The direct-acting cholinergic agonists are similar to acetylcholine (ACh) and react directly with receptor sites to cause the same reaction as if Ach had stimulated the receptor sites. These drugs usually stimulate muscarinic receptors within the parasympathetic system. They are used as systemic agents to increase bladder tone, urinary excretion, and gastrointestinal (GI) secretions. One drug is used as an ophthalmic agent to induce miosis to relieve the increased intraocular pressure of glaucoma. They have no effect on alpha and beta receptors in the sympathetic nervous system and little impact on nicotinic receptors.
11 .
The nurse is caring for a 49-year-old patient, who has been receiving bethanechol (Duvoid) for 1 week. The patient develops progressive muscle weakness and respiratory difficulty. Edrophonium is ordered and injected and the patients symptoms worsen. How would the nurse interpret this response?
A)
Myasthenic crisis
B)
Cholinergic crisis
C)
Anaphylactic reaction
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D)
Pulmonary edema
Ans:
B Feedback: The patient with a cholinergic crisis presents with progressive muscle weakness and respiratory difficulty because the accumulation of acetylcholine at the cholinergic receptor site leads to reduced impulse transmission and muscle weakness. This is a crisis when the respiratory muscles are involved. Myasthenic crisis and cholinergic crisis display similar clinical pictures. The drug edrophonium can be used as a diagnostic agent to distinguish the two conditions. If the patient improves immediately after the edrophonium injection, the problem is a myasthenic crisis, which is improved by administration of the cholinergic drug. If the patient gets worse, the problem is probably a cholinergic crisis, so withdrawal of the patients cholinergic drug along with intense medical support is indicated. The situation does not depict an anaphylactic reaction or pulmonary edema.
12 .
A 70-year-old female patient has just been diagnosed with Alzheimers disease. What cholinergic drug is used for the treatment of Alzheimers disease?
A)
Bethanechol (Duvoid)
B)
Neostigmine (Prostigmin)
C)
Donepezil (Aricept)
D)
Edrophonium (Enlon, Reversol)
Ans:
C Feedback: Currently, there are four reversible indirect-acting cholinergic agonists available to slow the progression of this disease. These include tacrine (Cognex), galantamine (Razadyne), rivastigmine (Exelon), and donepezil (Aricept). Edrophonium (Enlon, Reversol) is used to diagnose myasthenia gravis; neostigmine is used for the diagnosis and management of myasthenia gravis; and bethanechol is used to treat neurogenic bladder.
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13 .
The 38-year-old patient has just been administered edrophonium (Enlon, Reversol). The nurse will know whether this patient has myasthenia gravis if the patient exhibits what within 30 minutes after receiving the medication?
A)
Increased muscle strength
B)
Decreased adventitious breath sounds
C)
Decreased muscle spasms
D)
Increased urinary output
Ans:
A Feedback: Edrophonium is administered to diagnose myasthenia gravis because administration of this drug will cause a marked increase in muscle strength within 30 minutes of administration if the patient has this disease. Edrophonium does not produce decreased adventitious breath sounds, decreased muscle spasms, or increased urinary output.
14 .
When the nurse administers a cholinergic agonist to the patient, the nurses expectation is that what system will be stimulated?
A)
Sympathetic nervous system
B)
Parasympathetic nervous system
C)
Central nervous system
D)
Voluntary nervous system
Ans:
B Feedback: Cholinergic agonists act at the same site as the neurotransmitter acetylcholine (ACh) and increase the activity of the ACh receptor sites throughout the body. Because these sites are found extensively throughout the parasympathetic nervous system, their stimulation produces a response similar to what is seen when the parasympathetic system is activated. These drugs do not stimulate the sympathetic, central, or voluntary nervous systems.
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15 .
A 78-year-old patient is admitted to the emergency department and is diagnosed with bradycardia. The patient tells the nurse he or she is taking donepezil (Aricept), a cholinergic agent, for Alzheimers disease. The nurse will anticipate what drug will be ordered to treat the patients bradycardia?
A)
Atropine
B)
Pseudoephedrine
C)
Propranolol
D)
Bethanechol
Ans:
A Feedback: Maintain a cholinergic blocking drug on standby, such as atropine, to use as an antidote for excessive doses of cholinergic drugs to reverse overdose or counteract severe reactions arising from use of cholinergic agonists. Atropine will block cholinergic effects that are causing this patients heart rate to decline. Bethanechol will slow the heart rate further whereas propranolol and pseudoephedrine will not reverse the cholinergic stimulation.
16 .
The nurse administers bethanechol (Duvoid, Urecholine) to treat what condition?
A)
Hypertension
B)
Urinary retention
C)
Bradycardia
D)
Asthma
Ans:
B Feedback: Bethanechol is used for the treatment of nonobstructive postoperative and postpartum urinary retention, neurogenic bladder atony in adults and children older than 8 years; diagnosis and treatment of reflux esophagitis in adults, and orally in infants and children for treatment of esophageal reflux. It would be ineffective in treating hypertension, bradycardia, and asthma.
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17 .
The nurse is caring for a patient who has indirect-acting cholinergic agonists prescribed to treat myasthenia gravis. When administering this classification of drug, the nurse should assess the patient for toxic effects of the drugs including what?
A)
Paralytic ileus
B)
Abdominal distension
C)
Hypertension
D)
Muscle weakness
Ans:
D Feedback: The patient with a cholinergic crisis presents with progressive muscle weakness and respiratory difficulty because the accumulation of acetylcholine at the cholinergic receptor site leads to reduced impulse transmission and muscle weakness. This is a crisis when the respiratory muscles are involved. Toxic effects of the drug would not include paralytic ileus, abdominal distention, or hypertension.
18 .
Which indirect-acting anticholinesterase medication will the nurse administer as an antidote to neuromuscular junction blockers?
A)
Pyridostigmine (Mestinon)
B)
Donepezil (Aricept)
C)
Rivastigmine (Exelon)
D)
Ambenonium (Mytelase)
Ans:
A Feedback: Pyridostigmine is indicated for management of myasthenia gravis; antidote to neuromuscular junction blockers; increased survival after exposure to nerve gas. Donepezil and rivastigmine are used to treat Alzheimers disease. Ambenonium is used to treat myasthenia gravis.
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19 .
A patient is brought to the emergency department after a motor vehicle accident. The patient is diagnosed with multiple injuries including a bladder injury. The patient is taken to surgery and develops a nonobstructive postoperative urinary retention. What drug would the nurse expect to be ordered for this patient?
A)
Neostigmine
B)
Bethanechol
C)
Ambenonium
D)
Pyridostigmine
Ans:
B Feedback: The agent bethanechol, which has an affinity for the cholinergic receptors in the urinary bladder, is available for use orally and subcutaneously to treat nonobstructive postoperative and postpartum urinary retention and to treat neurogenic bladder atony. The other options are not indicated for this purpose.
20 .
A patient is taking memantine for Alzheimers disease. This drug does not affect what?
A)
Nicotinic receptor sites
B)
Glucagon receptor sites
C)
Gamma-aminobutyric acid (GABA) receptor sites
D)
Muscarinic receptor sites
Ans:
C Feedback: The drug, memantine hydrochloride (Namenda) has a low-to-moderate affinity for N-methyl-D-aspartate (NMDA) receptors with no effects on dopamine, GABA, histamine, glycine, or adrenergic receptor sites. It is believed that persistent activation of the central nervous system NMDA receptors contributes to the symptoms of Alzheimers disease. By blocking these sites, it is thought that the symptoms are reduced or delayed. Other options are incorrect.
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21 .
A patient is brought to the emergency department and is found to have cholinergic toxicity. What is the drug of choice to treat this condition?
A)
Atropine
B)
Epinephrine
C)
Lidocaine
D)
Edrophonium (injectable)
Ans:
A Feedback: Maintain atropine sulfate on standby as an antidote in case of overdose or severe cholinergic reaction. Epinephrine, lidocaine, and edrophonium would not be used for this purpose.
22 .
A 47-year-old man is suspected of having been exposed to nerve gas. Atropine is given to temporarily block cholinergic activity and to activate acetylcholine sites in the central nervous system. What drug does the nurse give with the atropine to free up the acetylcholinesterase to start breaking down acetylcholine?
A)
Pyridostigmine
B)
Pralidoxime
C)
Neostigmine
D)
Rivastigmine
Ans:
B Feedback:
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If nerve gas exposure is expected, patients who may have been exposed are given intramuscular injections of atropine (to temporarily block cholinergic activity and to activate acetylcholine sites in the central nervous system) and pralidoxime (to free up the acetylcholinesterase to start breaking down acetylcholine). An auto-injection is provided to military personnel who may be at risk. The injector is used to give atropine and then pralidoxime. The injections are repeated in 15 minutes. If symptoms of nerve gas exposure exist after an additional 15 minutes, the injections are repeated. If symptoms still persist after a third set of injections, medical help should be sought. Pyridostigmine, neostigmine, and rivastigmine are not used in nerve gas exposure. 23 .
A 77-year-old man is brought to the emergency department with a cholinergic overdose. The nurse knows that older adults are likely to have a greater number of adverse drug effects for what reason?
A)
They are more likely to take the medications inconsistently.
B)
All older adults have some type of chronic health problem.
C)
Older adults have a number of different physiological changes.
D)
Older adults have a poor memory and are more likely to overdose.
Ans:
C Feedback: Older patients are more likely to experience the adverse effects associated with these drugs (e.g., central nervous system, cardiovascular, gastrointestinal, respiratory, and urinary) because of normal physiological changes associated with aging. Those patients with known renal or hepatic impairment would receive a lower dosage to avoid overdose. Older people are not more likely to take medications inconsistently or to take too much medication. Not all older adults have chronic health problems.
24 .
The nurse is caring for a 45-year-old female patient who is in chronic renal failure. What cholinergic drug is contraindicated for this patient?
A)
Neostigmine
B)
Pyridostigmine
C)
Edrophonium
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D)
Galantamine
Ans:
D Feedback: Drugs used to treat Alzheimers disease are metabolized in the liver and excreted in the urine, so caution should be used in the presence of hepatic or renal dysfunction, which could interfere with the metabolism and excretion of the drugs. Dosage adjustments may be needed for neostigmine, edrophonium, and pyridostigmine if the patient has renal disease but they are not contraindicated.
25 .
A 72-year-old man is newly diagnosed with Alzheimers disease. The patients daughter asks the nurse how her fathers medication is going to help him. What will the nurse explain in laymans terms?
A)
The drugs work by increasing acetylcholine (ACh) levels in the brain and slowing the progression of the disease.
B)
The drugs work by crossing the bloodbrain barrier and cure the disease in the brain.
C)
The drugs work by increasing ACh levels in the brain and reverse the progression of the disease.
D)
The drugs work by crossing the bloodbrain barrier and decreasing ACh levels in the neuromuscular junctions.
Ans:
A Feedback: Acetylcholinesterase inhibitors that cross the bloodbrain barrier are used to manage Alzheimers disease by increasing ACh levels in the brain and slowing the progression of the disease. Decreasing ACh levels in the brain does not slow the progression, reverse the progression, or cure the disease. Decreasing ACh levels at the neuromuscular junctions has no effect on Alzheimers disease.
26 . A)
A patient has been newly diagnosed with myasthenia gravis. What important teaching will the nurse provide the family? If one dose of medication is missed double the next dose
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B)
The warning signs of drug overdose
C)
How to encourage activity when the patient is tired
D)
Importance of monitoring level of consciousness
Ans:
B Feedback: The patient who is being treated for myasthenia gravis and his or her significant other should both receive instruction in drug administration, warning signs of drug overdose, and signs and symptoms to report immediately to enhance patient knowledge about drug therapy and to promote compliance. Missed doses should not be doubled with next dose because this will lead to overdosage. Patients with myasthenia gravis will experience muscle weakness and should not be pushed to do more than they can tolerate. Level of consciousness is not a concern in patients with myasthenia gravis.
27 .
A new patient has come to the clinic. The patient tells the nurse he or she takes donepezil (Aricept). What is the priority nursing assessment related to the medication? (Select all that apply.)
A)
Nutritional status
B)
Blood pressure
C)
History of incontinence
D)
Breath sounds
E)
Muscle strength
Ans:
A, B, C Feedback:
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Gastrointestinal (GI) adverse effects can include nausea, vomiting, cramps, diarrhea, increased salivation, and involuntary defecation, so it is important for the nurse to assess nutritional status. This is made all the more important by the condition the drug is treating that often results in patients forgetting to eat healthfully. Blood pressure should be monitored because adverse effects of donepezil include hypotension, bradycardia, and heart block. Involuntary defecation and relaxation of bladder sphincter can result in incontinence so the nurse should assess for both incontinence and, if it occurred, skin integrity. Respiratory adverse effects are not associated with donepezil and muscle strength should not be impacted either. 28 .
What family of drugs is used in the treatment of myasthenia gravis?
A)
Direct-acting cholinergic agonists
B)
Muscarinic inhibitors
C)
Indirect-acting cholinergic agonists
D)
Nicotinic agonists
Ans:
C Feedback: The drugs used to treat patients with myasthenia gravis include several indirect-acting cholinergic agonists that do not cross the bloodbrain barrier and do not effect acetylcholine transmission in the brain. These drugs include ambenonium (Mytelase), edrophonium (Enlon, Reversol), neostigmine (Prostigmin), and pyridostigmine (Mestinon). Other options are incorrect.
29 .
For what purpose would the nurse in the critical care unit administer pyridostigmine?
A)
To reverse neuromuscular junction blockers
B)
To reverse smooth muscle blockade
C)
To reverse cholinergic crisis
D)
To prevent myasthenic crisis
Ans:
A
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Feedback: Pyridostigmine is approved for management of myasthenia gravis, as an antidote to neuromuscular junction blockers, and to increase survival after exposure to nerve gas. Other options are not indications for use of this drug. 30 .
A patient diagnosed with myasthenia gravis is having trouble swallowing. What anticholinesterase inhibitor would be the drug of choice for this patient?
A)
Galantamine
B)
Pyridostigmine
C)
Donepezil
D)
Bethanechol
Ans:
B Feedback: Pyridostigmine is preferred in some cases for the management of myasthenia gravis because it does not need to be taken as frequently and can be given parenterally for patients who are having difficulty swallowing. Galantamine and bethanechol cannot be given parenterally to the patient having difficulty swallowing. Donepezil is not indicated for the treatment of myasthenia gravis but is used to manage Alzheimer dementia, including severe dementia.
31 .
The nurse is treating a patient who has been exposed to nerve gas. The provider ordered pyridostigmine (Mestinon) 0.25 mg/kg. The patient weighs 96 kg. What dosage will the nurse administer to this patient?
A)
24 mg
B)
384 mg
C)
11 mg
D)
31.7 mg
Ans:
A Feedback:
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Multiply the patients weight times the ordered dose per kilogram: 0.25 96 = 24 mg. Other options are incorrect. 32 .
The nurse is caring for a patient diagnosed with Sjgrens syndrome. What medication will the nurse anticipate administering to treat this condition?
A)
Bethanechol
B)
Carbachol
C)
Ambenonium
D)
Pilocarpine
Ans:
D Feedback: Only pilocarpine is indicated for treatment of Sjgrens syndrome. None of the other medications are indicated for this purpose.
33 .
The nurse administers bethanechol to the patient on an empty stomach for what purpose?
A)
To promote rapid absorption
B)
To prevent destruction of the drug
C)
To reduce irritation of stomach lining
D)
To decrease nausea and vomiting
Ans:
D Feedback: Administer bethanechol and all oral forms of direct-acting cholinergic agonists on an empty stomach to decrease nausea and vomiting. The other options do not correctly explain the rationale for administering bethanechol on an empty stomach.
34 . A)
The nurse in the pediatric intensive care unit is caring for an infant with severe gastroesophageal reflux. What medication, if ordered, would the nurse administer to treat this condition? Bethanechol
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B)
Carbachol
C)
Cevimeline
D)
Pilocarpine
Ans:
B Feedback: Only bethanechol is indicated for the treatment of esophageal reflux in infants and children. The other drugs treat intraocular pressure, dry mouth, or to allow surgeons to perform certain surgical procedures.
35 .
The nurse is caring for a patient receiving carbachol to treat glaucoma. The patient says he or she has stopped driving at night because he or she just does not see well in the dark. What is the best nursing diagnosis for this patient?
A)
Anxiety related to poor vision
B)
Grief related to loss of driving privileges
C)
Risk for injury related to visual changes
D)
Pain related to altered vision
Ans:
C Feedback: This patient is at risk for injury related to visual changes and requires safety teaching to make the home as safe as possible. Nothing indicates the patient is experiencing anxiety, grief, or pain.
Chapter 8. Cholinoceptor-Blocking Drugs 1.
A student asks the pharmacology instructor to explain the action of anticholinergic agents. What would be the instructors best response?
A)
They block nicotinic receptors.
B)
They compete with serotonin for muscarinic acetylcholine receptor sites.
C)
They act to block the effects of the parasympathetic nervous system.
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D)
They increase norepinephrine at the neuromuscular junction.
Ans:
C Feedback: Drugs that are used to block the effects of acetylcholine are called anticholinergic drugs. Because this action lyses, or blocks, the effects of the parasympathetic nervous system, they are also called parasympatholytic agents. The drug works by blocking only the muscarinic effectors in the parasympathetic nervous system. They compete with acetylcholine for the muscarinic acetylcholine receptor sites. They do not block the nicotinic receptors and have little or no effect at the neuromuscular junction.
2.
A patient calls the clinic and talks to the nurse. The patient tells the nurse he or she is going on a cruise and is concerned about motion sickness. The patient says that a friend has recommended that he or she see his or her primary care physician to get a prescription for scopolamine. What adverse effect would the nurse inform the patient that using scopolamine may result in?
A)
Pupil constriction
B)
Tachycardia
C)
Diarrhea
D)
Urinary incontinence
Ans:
B Feedback: Scopolamine blocks the parasympathetic nervous system, which may result in dilated pupils and increased heart rate (i.e., tachycardia). Blocking the parasympathetic system also results in decreased GI activity and urinary bladder tone causing constipation and urinary retention.
3.
A)
A 29-year-old man is going on a company-sponsored deep-sea fishing trip in 2 weeks. He comes to the clinic requesting a scopolamine patch because he is afraid that he will get seasick. The medication is prescribed for him and the nurses instructions concerning use of the patch will include what? Shave the area before applying the patch.
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B)
The patchs effectiveness will last about 72 hours.
C)
When replacing the patch, apply the new patch in the same area.
D)
Do not clean the application area before applying the patch.
Ans:
B Feedback: The scopolamine patch is replaced every 3 days (i.e., 72 hours). The scopolamine patch should be applied to a clean, dry, intact, and hairless area of the body. The area should not be shaved because abrasion of the skin could occur and lead to increased absorption. Patches should be placed at new sites each time to avoid skin irritation. The old patch should be removed and the area cleaned.
4.
The nurse is taking a health history on a new patient who has been prescribed propantheline(generic) as adjunctive therapy for peptic ulcers. While collecting the health history, what will the nurse specifically assess for?
A)
Diabetes mellitus
B)
Obsessive-compulsive disorder
C)
Insomnia
D)
Glaucoma
Ans:
D Feedback: Propantheline is contraindicated for a patient with glaucoma because the drug could result in increased intraocular pressure due to pupil dilation. Diabetes mellitus, obsessive-compulsive disorder, and insomnia are not recognized as being adversely affected by this drug.
5.
A)
A nurse is admitting a patient for outpatient eye surgery. The nurse routinely administers preoperative medications for eye surgery and is aware that an increased dosage of a mydriatic is likely when given to a member of what ethnic group? African Americans
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B)
German Americans
C)
Irish Americans
D)
Scandinavian Americans
Ans:
A Feedback: African Americans with dark eyes usually require an increased dosage and may have a prolonged time to peak effect. The need for an increased dose appears to be related to the amount of pigment in the persons eyes because people with darker-pigmented eyes require a higher dose. German, Irish, and Scandinavian Americans generally have less pigmentation in their eyes and are therefore less likely to need a greater dose.
6.
A patient has been newly diagnosed with irritable bowel syndrome (IBS). The nurse knows that the most likely choice of anticholinergic drug to be prescribed for this patient is what?
A)
Atropine (generic)
B)
Dicyclomine (generic)
C)
Glycopyrrolate (Robinul)
D)
Methscopolamine (Pamine)
Ans:
B Feedback: Dicyclomine is the most likely choice of anticholinergic drug for IBS. It relaxes the GI tract and is a frequent choice in the treatment of hyperactive bowel and IBS. Atropine is used to decrease secretions, for bradycardia, pylorospasm, ureteral colic, relaxing the bladder, pupil dilation, and as an antidote for cholinergic drugs. Glycopyrrolate is used to decrease secretions and as an antidote for neuromuscular blockers. Methscopolamine is used as adjunctive therapy for ulcers.
7.
A patient has come to the clinic for a follow-up visit. He or she has been taking glycopyrrolate (Robinul) for adjunctive management of his or her peptic ulcer disease for 1 year. What would the nurse question this patient about?
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A)
Diarrhea
B)
Oral discomfort
C)
Headaches
D)
Dyspnea
Ans:
B Feedback: Patients taking anticholinergic drugs will have dry mucous membranes. Oral hygiene will be extremely important during glycopyrrolate therapy to avoid gum disease. The nurse should encourage the patient to suck on sugarless lozenges and perform frequent oral care. Diarrhea, headaches, or dyspnea should not be a concern with this drug.
8.
A 73-year-old male with Parkinsons disease comes to the clinic for routine care. The man has a comorbidity of benign prostatic hyperplasia (BPH). An anticholinergic drug is prescribed for the patient. What is the priority teaching point the nurse must give to the patient in regard to his medication?
A)
Avoid excessively hot environments.
B)
Avoid driving his car while taking the drug.
C)
Call his doctor if he cannot urinate.
D)
Take the drug with food to avoid gastrointestinal (GI) upset.
Ans:
C Feedback: Due to the patients diagnosis and drug therapy, calling the doctor if he cannot urinate would be the most important instruction. Older men with BPH have difficulty urinating and if an anticholinergic drug is taken, this can lead to urinary retention and bladder sphincter spasm. The patient should be encouraged to empty his bladder before taking the drug. Because this is an anticholinergic drug, avoiding hot environmental temperatures (reduced ability to perspire) and driving or operating machinery (possible central nervous system effects) should also be encouraged as well as taking the medication with food to help with GI upsets. However, the highest priority is addressing urinary retention issues.
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9.
A patient has been given atropine to cause mydriasis and cycloplegia. What is the expected outcome for this patient?
A)
Constricted pupils and blurred vision
B)
Dilated pupils and improved vision
C)
Dilated pupils and blurred vision
D)
Dry eyes and constricted pupils
Ans:
C Feedback: Atropine can be used to cause dilated pupils, which is mydriasis resulting in cycloplegia, which is the inability of the lens of the eye to accommodate leading to blurred vision.
10 .
Because the effects of atropine are dose related, at what dose of atropine would the nurse expect to see a patient having difficulty speaking?
A)
0.5 mg
B)
1.0 mg
C)
2.0 mg
D)
5.0 mg
Ans:
D Feedback: Toxicity of atropine is dose related. With 5.0-mg dosage, the nurse would expect marked speech disturbances, difficulty swallowing, restlessness, fatigue, headache, dry and hot skin, difficulty voiding, and reduced intestinal peristalsis. With 0.5-mg dosage of atropine, slight cardiac slowing, dryness of the mouth, and inhibition of sweating would be noticed. Definite dryness of the mouth and throat, thirst, rapid heart rate, and pupil dilation would be evident with 1.0-mg dosage. With 2.0-mg dosage, the nurse would note rapid heart rate, palpitations, marked mouth dryness, dilated pupils, and some blurring of vision.
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11 .
A 66-year-old woman presents at the clinic complaining of motion sickness. The physician orders a scopolamine patch. Which statement by the patient leads you to believe she knows how to use the patch?
A)
I will place it on my chest each morning after I shower.
B)
I will use it only if I feel sick to my stomach.
C)
I will change the patch every 4 hours. I can use the patches for 1 week.
D)
I will change the patch every 3 days.
Ans:
D Feedback: The scopolamine patch should be applied to a clean, dry, intact, and hairless area of the body. The area should not be shaved because abrasion of the skin could occur and lead to increased absorption. Patches should be placed at new sites each time to avoid skin irritation. The old patch should be removed and the area where it had been should be cleaned.
12 .
A patient is scheduled for surgery in 2 hours. The physician orders preoperative medications glycopyrrolate (Robinul) 1 mg and meperidine (Demerol) 50 mg intramuscularly. The nurse would hold the medication and consult the provider if the patient had what disorder?
A)
Tachycardia
B)
Paralytic ileus
C)
Hypertension
D)
Diabetes mellitus
Ans:
B Feedback: These drugs are also contraindicated with any condition that could be exacerbated by blockade of the parasympathetic nervous system. These conditions include stenosing peptic ulcer, intestinal atony, paralytic ileus, gastrointestinal (GI) obstruction, severe ulcerative colitis, and toxic megacolon, all of which could be exacerbated with a further slowing of GI activity. Tachycardia, hypertension, and diabetes would not be contraindications to administration of glycopyrrolate.
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13 .
The nurse is caring for a patient with atropine poisoning. What drug will the nurse administer to reverse these effects?
A)
Bethanechol
B)
Neostigmine
C)
Edrophonium
D)
Physostigmine
Ans:
D Feedback: Physostigmine can be used as an antidote for atropine poisoning. A slow intravenous injection of 0.5 to 4 mg (depending on the weight of the patient and the severity of the symptoms) usually reverses the delirium and coma of atropine toxicity. Physostigmine is metabolized rapidly, so the injection may need to be repeated every 1 to 2 hours until the atropine has been cleared from the system.
14 .
Because of the systemic effects of anticholinergic drugs, the nurse understands that older adults using these drugs are susceptible to what?
A)
Heat stroke
B)
Diarrhea
C)
Urinary frequency
D)
Hypotension
Ans:
A Feedback: Because older patients are more susceptible to heat intolerance owing to decreased body fluid and decreased sweating, extreme caution should be used when an anticholinergic drug is given that reduces sweating still further and can result in heat stroke. Older adults are not more susceptible to diarrhea, urinary frequency, and hypotension.
15 .
A 50-year-old female patient received atropine and meperidine (Demerol) preoperatively. After surgery, the patient complains of mouth dryness. What is the nurses best response?
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A)
Preoperative medications decrease saliva production but it is temporary and will improve.
B)
This is the result of all of the blood and fluid you lost during surgery.
C)
You are probably dehydrated. The IV fluids you are receiving will correct the problem.
D)
The preoperative medication causes an electrolyte imbalance making your mouth feel dry.
Ans:
A Feedback: Patients receiving anticholinergic drugs must be monitored for dry mouth, difficulty swallowing, constipation, urinary retention, tachycardia, pupil dilation and photophobia, cycloplegia and blurring of vision, and heat intolerance caused by a decrease in sweating.
16 .
Anticholinergics have varied effects on the body. What is one of those effects?
A)
Preventing vagal stimulation
B)
Stimulating the release of acetylcholine
C)
Increasing respiratory tract secretions
D)
Increasing secretion of sweat glands
Ans:
A Feedback: Adjunctive therapy to treat peptic ulcer, overactive gastrointestinal (GI) disorders; neurogenic bladder or cystitis; parkinsonism; biliary or renal colic; to decrease secretions pre-operatively; treatment of partial heart block associated with vagal activity; treatment of rhinitis or anticholinesterase poisoning.
17 .
Anticholinergic drugs are used in ophthalmology because they produce what effect?
A)
Sedation
B)
Pupil dilation
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C)
Pupil constriction
D)
Decreased lacrimal secretions
Ans:
B Feedback: Patients receiving anticholinergic drugs must be monitored for dry mouth, difficulty swallowing, constipation, urinary retention, tachycardia, pupil dilation and photophobia, cycloplegia and blurring of vision, and heat intolerance caused by a decrease in sweating.
18 .
A male patient, age 75, is started on flavoxate (Urispas). What adverse effects should the patient be made aware of?
A)
Rash
B)
Headache
C)
Weight gain
D)
Blurred vision
Ans:
D Feedback: The patient should be warned of possible blurring of vision when taking this drug, which could put the patient at risk for injury if precautions are not taken. Adverse effects could include central nervous system adverse effects, such as blurred vision, pupil dilation and resultant photophobia, cycloplegia, and increased intraocular pressure, all of which are related to the blocking of the parasympathetic effects in the eye.
19 .
The nurse administers atropine preoperatively for what purpose?
A)
Providing sedation
B)
Dilating the pupils
C)
Relaxing bladder muscles
D)
Decreasing secretions
Ans:
D
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Feedback: Atropine is administered preoperatively to reduce secretions, but added indications include gastrointestinal (GI) effects that reduce GI activity. Atropine has no sedating effects, and is not given preoperatively for its pupil dilation effects, or for its bladder muscle relaxation effects. 20 .
What is the recommended dosage for atropine for a patient with a bradycardia?
A)
0.2 to 0.4 mg
B)
0.3 to 0.5 mg
C)
0.4 to 0.6 mg
D)
0.5 to 0.7 mg
Ans:
C Feedback: The usual dosage for atropine is 0.4 to 0.6 mg intramuscularly, subcutaneously, or IV; use caution with older patients. The other options are incorrect dosages and therefore wrong.
21 .
When the nurse administers an anticholinergic drug to a child, the nurse would carefully assess for what effect that is more likely to occur in children than in adults?
A)
Rashes
B)
Pupil dilation
C)
Heat intolerance
D)
Tachycardia
Ans:
C Feedback: Children are often more sensitive to the adverse effects of the drugs, including constipation, urinary retention, heat intolerance, and confusion. Similar effects are seen in children related to pupil dilation. Tachycardia and rashes would not be associated with these drugs in children.
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22 .
The nurse is writing a plan of care for an older adult patient taking flavoxate. What is an appropriate goal for this patients plan of care?
A)
The patient will have adequate pupil dilation within 24 hours.
B)
The patient will experience fewer bronchospasms within 8 hours.
C)
The patient will experience fewer symptoms of prostatitis within 24 hours.
D)
The patient will show resolution of peptic ulcer within 2 weeks.
Ans:
C Feedback: Flavoxate is used to relieve symptoms of dysuria, urgency, nocturia, suprapubic pain, frequency, and incontinence associated with cystitis, prostatitis, urethritis, urethrocystitis, and urethrotrigonitis. As a result, the nurse would know the drug was working when the patient experienced fewer symptoms related to any one of these conditions. Because the drug is not indicated for pupil dilation, bronchospasm, or treatment of a peptic ulcer, the nurses outcomes would not be related to these conditions.
23 .
What drug would the nurse administer to treat a patient diagnosed with bronchospasm associated with chronic obstructive pulmonary disease (COPD)?
A)
Atropine
B)
Flavoxate
C)
Glycopyrrolate
D)
Ipratropium
Ans:
D Feedback:
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Ipratropium is indicated for the treatment of bronchospasm associated with COPD. Atropine is indicated for use to decrease secretions, bradycardia, pylorospasm, ureteral colic, relaxing of bladder, emotional liability with head injuries, antidote for cholinergic drugs, and pupil dilation. Flavoxate is used for the symptomatic relief of dysuria, urgency, nocturia, suprapubic pain, frequency, and incontinence associated with cystitis, prostatitis, urethritis, urethrocystitis, and urethrotrigonitis. Glycopyrrolate is indicated to decrease secretions before anesthesia or intubation, used orally as an adjunct for treatment of ulcers, to protect the patient from the peripheral effects of cholinergic drugs and to reverse neuromuscular blockade
24 .
A 72-year-old female patient is being discharged home from the hospital on newly prescribed anticholinergic drugs. A referral to the home health nurse has been made. What priority teaching point will the home health nurse emphasize when discussing the patients drugs?
A)
Do not drive or use machinery.
B)
Take lots of hot baths or showers.
C)
Keep the house warm to avoid a chill.
D)
Limit intake of fluids.
Ans:
A Feedback: Safety precautions may be needed if blurred vision and dizziness occur. The patient should be urged not to drive or perform tasks that require concentration and coordination. The home care nurse would not teach the patient to take hot baths or showers. The patient would be cautioned about inability to perspire in hot environments and to avoid them. Fluid intake should not be limited.
25 .
The nurse is caring for a new mother who received atropine before undergoing a laparoscopic tubal ligation. The patient tells the nurse that she is breast-feeding her baby and asks whether she can breast-feed when she gets home. What is the nurses best response?
A)
You can breast-feed when you get home because the drugs given before surgery will be out of your system.
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B)
You can breast-feed as soon as you get home because atropine will not cross into the breast milk.
C)
Discard all breast milk for the next week and feed the baby formula before returning to breast-feeding.
D)
Discard all breast milk for the next 24 hours and feed formula until tomorrow when you can nurse your baby.
Ans:
D Feedback: Lactating mothers should not breast-feed after receiving atropine until the drug has been fully excreted. Because atropine crosses into breast milk and the duration of action is 4 hours, it is safest to have the mother wait 24 hours to breast-feed, continuing to pump and discard the milk while feeding the infant formula. After 24 hours, she can return to breast-feeding because any atropine in breast milk will be eliminated. There is no need to wait a week and although the drug may be out of the bloodstream, the milk in her breast will still contain atropine.
26 .
The patient, who takes an anticholinergic medication, tells the nurse how much he or she enjoys experimenting with different herbal teas. What herbs will the nurse caution the patient to avoid? (Select all that apply.)
A)
Burdock
B)
Thyme
C)
Rosemary
D)
Parsley
E)
Tumeric
Ans:
A, C, E Feedback: The risk of anticholinergic effects can be exacerbated if anticholinergic agents are combined with burdock, rosemary, or turmeric and used as herbal therapy. Advise patients who use herbal therapies to avoid these combinations. Nothing indicates that thyme or parsley is contraindicated with anticholinergic medications.
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27 .
A 27-year-old male patient is taking an anticholinergic drug as adjunctive therapy to treat his peptic ulcer disease. The patient comes to the clinic and tells the nurse that he feels his heart beating. What adverse effect is the patient experiencing from the anticholinergic medication?
A)
Tachypnea
B)
Tachycardia
C)
Hypotension
D)
Urinary frequency
Ans:
B Feedback: Tachycardia and palpitations are possible adverse effects related to blocking of the parasympathetic effects on the heart; this would give the sensation of a heart beating. Tachypnea, hypotension, and urinary frequency are not generally adverse effects of anticholinergic medications and they would not be evident the way the patient described.
28 .
The 10-year-old child is brought to the respiratory clinic and is prescribed ipratropium (Atrovent). Prior to administering the medication, what would the nurse assess for?
A)
Cardiac disorders
B)
Hypertension
C)
Recent injuries
D)
Breath sounds
Ans:
D Feedback: The nurse would assess breath sounds because ipratropium is indicated for treatment of bronchospasm so it is important to get a baseline assessment to determine whether the drug improves the patients condition after administration. Cardiac disorders, hypertension, and recent injuries are all valid assessments but are likely to have been assessed during admission history taking and are not related to the purpose of administering the drug.
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29 .
The nurse is caring for a patient who has just been started on hyoscyamine (Symax and others) as adjunctive therapy for his or her peptic ulcers. When developing this patients plan of care, what nursing diagnosis would the nurse establish related to the purpose of administering this drug?
A)
Chronic pain related to peptic ulcer disease
B)
Impaired urinary elimination related to bladder relaxation
C)
Risk for hyperthermia related to decreased ability to perspire
D)
Decreased cardiac output related to cardiovascular effects
Ans:
A Feedback: All these nursing diagnoses could be used for the patient receiving an anticholinergic drug, but only chronic pain is related to the drug this patient is receiving and the purpose for which it is being administered.
30 .
What does parasympathetic nervous system blockade cause? (Select all that apply.)
A)
Decrease in heart rate
B)
Decrease in urinary bladder tone
C)
Increase in heart rate
D)
Pupil constriction
E)
Decrease in gastrointestinal (GI) activity
Ans:
B, C, E Feedback: Parasympathetic nervous system blockade causes an increase in heart rate, decrease in GI activity, decrease in urinary bladder tone and function, and pupil dilation and cycloplegia.
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31 .
The patient was involved in a motor vehicle accident and experienced a severe closed head injury resulting in increased intracranial pressure. While intubating the patient, his or her heart rate dropped and did not return to acceptable levels after the tube was in place so the nurse received an order to administer atropine. The physician is performing an exam to determine whether brain death has occurred. What assessment for brain death will be postponed until all atropine is excreted and no longer exerting an effect.
A)
Pupil response
B)
Electroencephalogram
C)
Brainstem reflexes
D)
Computed tomographic scan of the brain
Ans:
A Feedback: One test for neurological function is to shine a light in the patients eyes to test pupil reaction to light. Because this patient has received atropine, pupils will be dilated and will not react normally to light. This could be mistaken as an indication of brain death if the nurse did not know atropine had been administered. This test will be postponed until the pupils are no longer dilated by the medication. The other tests would not have to be postponed because of atropine.
32 .
The nurse is caring for a patient who is unconscious and requires an anticholinergic drug to treat bradycardia. What drug can the nurse administer IV for this purpose?
A)
Ipratropium (Atrovent)
B)
Dicyclomine (generic)
C)
Methscopolamine (Pamine)
D)
Atropine (generic)
Ans:
D Feedback:
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Atropine can be given intramuscularly (IM), subcutaneously, or IV for the treatment of bradycardia. Ipratropium is administered by inhalation to treat bronchospasm. Dicyclomine is used to treat irritable or hyperactive bowel and can be given orally or IM. Methscopolamine is administered orally to treat peptic ulcers. 33 .
What is the proper dosage of scopolamine administered by the nurse transdermally to reduce nausea and vomiting associated with motion sickness?
A)
0.32 to 0.65 mg
B)
1.5 mg
C)
3 mg
D)
3.5 mg
Ans:
B Feedback: The scopolamine transdermal patch is 1.5 mg. If administered subcutaneously (SC) or intamuscularly (IM), the dosage would be 0.32 to 0.65 mg. Pediatric dosage is 0.006 mg/kg subcutaneous, IM, or IV.
34 .
The nurse receives an order to administer glycopyrrolate 0.002 mg/kg to the pediatric patient preoperatively. The patient weighs 14 lbs. If 1 pound = 2.2 kg, how many kilograms would the nurse administer to this patient?
A)
0.013 mg
B)
0.13 mg
C)
0.028 mg
D)
0.28 mg
Ans:
A Feedback: Begin by calculating the childs weight in kilogram 14 lbs/2.2 kg = 6.36 kg. Multiply childs weight in kg by dosage in kg 6.36 0.002 = 0.01272 rounded to 0.013 mg.
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35 .
A mother calls the pediatric clinic and tells the nurse the family is planning a cross-country trip to visit some attractions the children will enjoy. Her 2year-old child gets motion sickness soon after starting the car and she would like some scopolamine patches to use. What is the nurses best response?
A)
One patch lasts for 3 days. How long will you be driving?
B)
Children cannot receive scopolamine orally or by patch.
C)
It might be better to use the oral form of the drug only on days it is needed.
D)
Scopolamine loses effectiveness if it is used for several days.
Ans:
B Feedback: Scopolamine does not come in a pediatric oral or patch formulation. Scopolamine can only be given subcutaneously, or IV. Because children cannot use the patch, asking how many days they will be traveling or suggesting oral prescription when that form is not available is incorrect. Scopolamine does not lose effectiveness.
Chapter 9. Adrenoceptor Agonists & Sympathomimetic Drugs\1. A patient is admitted to the emergency department in shock. Isoproterenol (Isuprel) is administered. What would the nurse expect the effect of the isoproterenol to be? A)
Increased blood pressure
B)
Decreased blood pressure
C)
Increased body temperature
D)
Decreased heart rate
Ans:
A Feedback: Isoproterenol stimulates beta-adrenergic receptors. Blood pressure is increased and heart rate is increased. Body temperature should not be affected.
2.
What action do sympathomimetic drugs have in the body?
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A)
Decreased heart rate
B)
Decreased blood pressure
C)
Increased respirations
D)
Increased intraocular pressure
Ans:
C Feedback: Sympathomimetic drugs increase respirations. Heart rate and blood pressure are also increased and intraocular pressure is decreased.
3.
An 80-year-old patient has been brought to the emergency department in shock. The patient is receiving dopamine (Intropin). What potentially serious adverse effect will the nurse monitor for?
A)
Blood dyscrasia
B)
Cardiac arrhythmia
C)
Hepatic toxicity
D)
Renal insufficiency
Ans:
B Feedback: Dopamine therapy can result in cardiac arrhythmias, which can be life threatening. Older patients are more likely to experience the adverse effects associated with adrenergic agonists and should be started on lower doses and monitored closely for arrhythmias and blood pressure changes. Blood dyscrasias, hepatic toxicity, and renal insufficiency are not commonly associated with dopamine use. In fact, at lower doses, dopamine increases renal perfusion.
4.
A patient comes to the clinic complaining of seasonal rhinitis. What adrenergic agonist would be prescribed for treatment of seasonal rhinitis?
A)
Dobutamine (Dobutrex)
B)
Ephedrine (generic)
C)
Dopamine (Intropin)
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D)
Norepinephrine (Levophed)
Ans:
B Feedback: Ephedrine has been used to treat seasonal rhinitis by stimulating the release of norepinephrine from nerve endings and directly acting on adrenergic receptor sites. Although ephedrine was formerly used for situations ranging from the treatment of shock to chronic management of asthma and allergic rhinitis, its use in many areas is declining because of the availability of less toxic drugs with more predictable onset and action. Dobutamine is used to treat congestive heart failure. Dopamine and norepinephrine are used to treat shock.
5.
The patient is taking midodrine (ProAmatine). What is the most important nursing action to include in the plan of care for this patient?
A)
Monitor urine output.
B)
Monitor blood pressure.
C)
Monitor heart rate.
D)
Monitor respirations.
Ans:
B Feedback: Midodrine is an oral drug used to treat orthostatic hypotension in patients who do not respond to traditional therapy. It activates alpha-adrenergic receptors, leading to peripheral vasoconstriction and an increase in vascular tone and blood pressure. This effect can cause serious supine hypertension. Patients should be monitored in the standing, sitting, and supine positions to determine whether this will be a problem. It is also important to monitor heart rate, respirations, and urine output in this patient. However, assessing for supine hypertension would pose the greatest threat to the patient and would take priority.
6.
A)
The nurse is planning discharge teaching for a patient who is taking clonidine (Catapres). What would be most important for the nurse to include when teaching about adverse effects? Pupil constriction
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B)
Strange dreams
C)
Increased urine output
D)
Increased appetite
Ans:
B Feedback: Central nervous system effects from clonidine therapy include feelings of anxiety, restlessness, depression, fatigue, strange dreams, and personality changes. However, bad dreams would be the most upsetting and stressful effect for the patient. Pupil dilation, decreased urine output, and anorexia are all adverse effects of clonidine.
7.
What drug would the nurse expect to administer if beta-specific adrenergic agonist effects are desired to prevent bronchospasm during anesthesia?
A)
Dobutamine (Dobutrex)
B)
Ephedrine (generic)
C)
Isoproterenol (Isuprel)
D)
Phenylephrine (Neo-Synephrine)
Ans:
C Feedback: Isoproterenol is a beta-specific adrenergic agonist used to prevent bronchospasm during anesthesia. Phenylephrine is an alpha-specific adrenergic agonist. Both dobutamine and ephedrine are alpha- and betaadrenergic agonists.
8.
The nurse is preparing discharge teaching for four patients. Which patient should be advised by the nurse that over-the-counter cold and allergy preparations contain phenylephrine and should be avoided?
A)
A 47-year-old woman with hypertension
B)
A 52-year-old man with adult onset diabetes
C)
A 17-year-old girl with symptoms of an upper respiratory infection
D)
A 62-year-old man with gout
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Ans:
A Feedback: Phenylephrine, a potent vasoconstrictor and alpha1-agonist with little or no effect on the heart or bronchi, is used in many combination cold and allergy products. Patients with hypertension should avoid these drugs because serious increases in blood pressure could occur. Use of this drug in patients with diabetes and gout are not contraindicated. An upper respiratory infection may be an indication for the drug.
9.
The nurse is writing a plan of care for a patient receiving an alpha-specific adrenergic agonist. What should this plan of care include?
A)
Monitoring the patient for diarrhea
B)
Monitoring blood pressure and heart rate every 2 to 4 hours
C)
Assessing skin turgor for dehydration
D)
Assessing for fatigue and lethargy
Ans:
B Feedback: Sympathetic stimulation will cause hypertension and increased heart rate so it is important these be monitored. Sympathetic stimulation will also result in increased sweating, decreased gastrointestinal activity, and a sense of anxiety and heightened awareness. Diarrhea, dehydration, fatigue, and lethargy would not be expected.
10 .
A nurse receives an order for clonidine (Catapres) for a 25-year-old pregnant woman. What is the nurses priority action?
A)
Weigh the patient to obtain correct dose/kg/day.
B)
Have a second nurse check the dose before administering the drug.
C)
Consult with the physician about the order.
D)
Make sure the patient is wearing a fetal monitor.
Ans:
C Feedback:
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The nurse would consult with the physician to ensure awareness of the pregnancy and desire to administer this drug. There are no adequate studies about use during pregnancy and lactation, so use should be reserved for situations in which the benefit to the mother outweighs any potential risk to the fetus or neonate. The nurse should question the prescriber regarding this order. It would not be necessary to implement the other options. 11 .
The nursing students are studying sympathomimetic drugs. How do these drugs act on the body?
A)
Stimulate beta receptors and block alpha-receptors
B)
Stimulate alpha-receptors and block beta-receptors
C)
Block adrenergic receptors
D)
Stimulate both alpha and beta-receptors
Ans:
D Feedback: Drugs that are generally sympathomimetic are called alphaagonists (stimulate alpha-receptors) and beta-agonists (stimulate betareceptors). These agonists stimulate all of the adrenergic receptors; that is they affect both alpha and beta-receptors.
12 .
How does ephedrine act on the body?
A)
Stimulates the release of norepinephrine
B)
Acts indirectly on beta-adrenergic receptor sites
C)
Stimulates the release of dopamine
D)
Acts indirectly on alpha-adrenergic receptor sites
Ans:
A Feedback: Ephedrine stimulates the release of norepinephrine from nerve endings and acts directly on adrenergic receptor sites. Therefore, the other options are incorrect.
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13 .
In what age group are adrenergic agonists contraindicated?
A)
Older adults
B)
Adolescents
C)
Children
D)
No age group
Ans:
D Feedback: The use of adrenergic agonists varies from ophthalmic preparations for dilating pupils to systemic preparations used to support patients experiencing shock. They are used in patients of all ages. Therefore, the other options are incorrect responses.
14 .
A patient in shock is receiving an infusion of dopamine when it is discovered that an extravasation has occurred. What drug should be on standby for this occurrence?
A)
Phenylephrine
B)
Propranolol
C)
Phenylalanine
D)
Phentolamine
Ans:
D Feedback: Maintain phentolamine on standby in case extravasation occurs; infiltration of the site with 10 mL of saline containing 5 to 10 mg of phentolamine is usually effective in saving the area. Phenylephrine, propranolol, and phenylalanine are not indicated for use when extravasation occurs.
15 .
A)
The pharmacology instructor is discussing adrenergic agonists with the nursing class. Which drugs would the instructor tell the nursing students are generally indicated for the treatment of shock, bronchospasm, and some types of asthma? Sympathomimetic drugs
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B)
Beta-blocking drugs
C)
Parasympathetic stimulating drugs
D)
Anticatecholamine drugs
Ans:
A Feedback: These drugs generally are indicated for the treatment of hypotensive states or shock, bronchospasm, and some types of asthma. Beta-blocking drugs, parasympathetic stimulating drugs, and anticatecholamine drugs are not the drugs of choice in these situations.
16 .
When studying for a pharmacology exam, a student asks her peers which agents affect both alpha- and beta-receptor sites. What would be an appropriate response to this student? (Select all that apply.)
A)
Dobutamine (Dobutrex)
B)
Epinephrine (Adrenalin, Sus-Phrine)
C)
Dopamine (Intropin)
D)
Clonidine (Catapres)
E)
Albuterol (Proventil)
Ans:
A, B, C Feedback: Agents that affect both alpha- and beta-receptor sites include dobutamine, dopamine, ephedrine, epinephrine, and norepinephrine. Clonidine is an alpha-specific adrenergic agonist; albuterol is a beta-specific adrenergic agonist.
17 .
The nurse is admitting a mental health patient and collects the medication history. The patient says he takes Haldol, midodrine, hydrochlorothiazide, acetaminophen, and Cymbalta. The nurse will call the provider to discuss what dangerous drug combination?
A)
Haldol and midodrine
B)
Hydrochlorothiazide and midodrine
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C)
Cymbalta and midodrine
D)
Acetaminophen and midodrine
Ans:
A Feedback: Midodrine can precipitate increased drug effects of digoxin, beta-blockers, and many antipsychotics. Such combinations should be avoided. The other drug combinations do not pose any immediate concerns.
18 .
A 4-year-old is admitted to the emergency department in shock after a motor vehicle accident. The patient weighs 12.5 kg. What would be the minimum safe dose of adrenalin if the pediatric dose is 0.005 to 0.01 mg/kg IV?
A)
0.0625 mg
B)
0.075 mg
C)
0.08 mg
D)
0.085 mg
Ans:
A Feedback: To calculate the minimum dosage, multiply the childs weight in kg by the lower dosage range; 12.5 0.005 = 0.0625 mg.
19 .
When giving beta-specific adrenergic agonists, at what age is an adult dose given?
A)
10 years
B)
11 years
C)
12 years
D)
13 years
Ans:
C Feedback: Adult doses are given to children who are 12 years and older (see dosages in Table 30.3, page 497.) Therefore, the other options are incorrect.
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20 .
The home health nurse is caring for a 77-year-old male patient who has just been discharged from the hospital. The patient is receiving an infusion of dobutamine (Dobutrex) to treat congestive heart failure. What is the priority nursing assessment?
A)
Capillary refill time and vital signs
B)
Effectiveness of comfort measures
C)
Dietary intake and hydration
D)
Compliance with treatment plan
Ans:
A Feedback: Dobutamine, although it acts at both receptor sites, has a slight preference for beta1-receptor sites. It is used in the treatment of heart failure because it can increase myocardial contractility without much change in rate and does not increase the oxygen demand of the cardiac muscle, an advantage over all of the other sympathomimetic drugs. Assessing capillary refill time and vital signs will allow the nurse to assess perfusion as an indicator of the effectiveness of the infusing drug. Dietary intake, compliance with treatment plan, and effectiveness of comfort measures are all important assessments but the priority assessment is perfusion.
21 .
What is the nurses rationale for administering clonidine to treat hypertension?
A)
Clonidine stimulates alpha2-receptors.
B)
Clonidine stimulates alpha1-receptors.
C)
Clonidine stimulates beta2-receptors.
D)
Clonidine stimulates beta1-receptors.
Ans:
A Feedback: Clonidine specifically stimulates alpha2-receptors and is used to treat hypertension because its action blocks release of norepinephrine from nerve axons. Therefore, the other options are incorrect answers.
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22 .
Isoproterenol is reserved for use in emergency situations. What is the rationale for this?
A)
Its onset of action
B)
Its duration of action
C)
Its adverse effects
D)
Its peak plasma concentration
Ans:
C Feedback: Because of its many adverse effects, isoproterenol is reserved for use in emergency situations that do not respond to other, safer therapies. It is not reserved for emergency use because of its onset of action, its duration of action, or its peak plasma concentration.
23 .
The nurse is preparing to give isoproterenol parenterally. Before starting to administer the drug, what does the nurse ensure is on hand in case a severe reaction occurs?
A)
An alpha-adrenergic blocker
B)
An alpha-adrenergic stimulant
C)
A beta-adrenergic stimulant
D)
A beta-adrenergic blocker
Ans:
D Feedback: Ensure that a beta-adrenergic blocker is readily available when giving parenteral isoproterenol in case severe reaction occurs. This makes other options incorrect.
24 .
A)
The nursing instructor is quizzing a student who is preparing to administer an alpha-specific adrenergic agonist to a patient. The instructor asks the student what the student will assess in this patient after administering the drug. What is the students best response? Blood pressure
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B)
Respirations
C)
Mental status
D)
Vision
Ans:
A Feedback: Monitor blood pressure, pulse, rhythm, and cardiac output regularly, even with ophthalmic preparations, to adjust dosage or discontinue the drug if cardiovascular effects are severe. Respirations, mental status, or vision may also need to be monitored but they are not impacted significantly by the drug being given.
25 .
When assessing a patient who has been prescribed midodrine, what would the nurse assess for?
A)
Pancreatic disease
B)
Renal failure
C)
Open-angle glaucoma
D)
Hypothyroidism
Ans:
B Feedback: Assess for contraindications or cautions: any known allergies to the drug to avoid hypersensitivity reactions; presence of any cardiovascular diseases, which could be exacerbated by the vascular effects of these drugs; thyrotoxicosis, or diabetes, which would lead to an increase in thyroid stimulation or glucose elevation; chronic renal failure, which could be exacerbated by drug use; renal or hepatic impairment, which could interfere with drug excretion or metabolism; and current status of pregnancy and lactation. Options A, C, and D are incorrect.
26 . A)
The patient has been taking clonidine and is now being changed to another antihypertensive drug. How will the nurse instruct the patient regarding discontinuing the clonidine? Check your blood pressure and pulse every 2 to 4 hours.
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B)
Inform your family the drug is being changed.
C)
Reduce clonidine gradually over 2 to 4 days.
D)
Keep an over-the-counter analgesic available to treat headaches.
Ans:
C Feedback: Do not discontinue clonidine abruptly because sudden withdrawal can result in rebound hypertension, arrhythmias, flushing, and even hypertensive encephalopathy and death; taper drug over 2 to 4 days. It is not necessary to teach the patient to check blood pressure and pulse every 2 to 4 hours, discuss plans for changing medications with the family, or prepare the patient for severe headaches.
27 .
The clinic nurse is teaching a patient about transdermal clonidine (Catapres). What information would be included in the nurses teaching plan? (Select all that apply.)
A)
Change the patch in the morning.
B)
Rotate the site where the patch is placed.
C)
Monitor blood pressure daily.
D)
Stop the drug immediately if adverse effects occur.
E)
Keep the physician informed of any new diagnoses or medications.
Ans:
B, C, E Feedback:
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Transdermal patches should not be placed in the same site repeatedly so it is important to instruct the patient to rotate sites to improve absorption of drug. Blood pressure should be monitored daily and the patient should be provided with acceptable ranges versus when to notify the physician because severe hypertension can occur. Due to drugdrug interactions, contraindications, and cautions related to specific diagnosis (cardiovascular disease, vasomotor spasm, thyrotoxicosis, diabetes, renal or hepatic impaiment), it is important for the patient to inform the physician if another physician prescribes a medication or a new diagnosis for decisions to be made about whether to continue the drug or change the dosage. The patch is changed weekly and not every morning. The patient should be taught not to stop the drug abruptly because it could lead to tachycardia, hypertension, arrhythmias, flushing, and even death. 28 .
The nurse needs to be aware, before administering, that what drug has a duration of action of only 1 to 2 minutes?
A)
Isoproterenol
B)
Dopamine
C)
Phenylephrine
D)
Ephedrine
Ans:
A Feedback: Isoproterenol has a duration of action lasting 1 to 2 minutes with immediate onset of action. Dopamine acts as long as the drug is infusing with peak action 10 minutes after initiating the infusion. Phenylephrines duration of action is 15 to 20 minutes. Ephedrines duration of action will depend on how the drug is administered as it could be given intramuscularly, subcutaneously, IV, or orally, but no matter by what route it is administered, the duration of action is longer than 1 to 2 minutes.
29 .
A 4-year-old girl is prescribed an albuterol (Proventil) inhaler for her asthma. What is the recommended safe dosage for this patient?
A)
1.25 to 2.5 mg q.i.d
B)
1.25 to 2.5 mg b.i.d
C)
2 mg q.i.d
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D)
0.5 to 1 mg b.i.d
Ans:
B Feedback: The recommended dosage for albuterol when given via inhaler is 1.25 to 2.5 mg b.i.d. When taken orally, the dosage is 2 mg t.i.d. or q.i.d. The other options are incorrect because they are outside the acceptable dosage range.
30 .
The nurse is caring for a male patient who is taking a monoamine oxidase inhibitor (MAOI). The patient complains of seasonal rhinitis and the intern for his service orders phenylephrine nasal spray. What is the nurses priority action?
A)
Verify patency of the nares.
B)
Review the patients medication history.
C)
Question the order with the prescriber.
D)
Position the patient to give the drug as ordered.
Ans:
C Feedback: Phenylephrine, combined with MAOIs, can cause severe hypertension, headache, and hyperpyrexia. This combination should be avoided. As a result, the priority action is to remind the intern the patient is taking an MAOI and obtain an order for a different drug. Until the new order is received, no other actions would be taken.
31 .
The nurse receives an order to begin a dopamine (Intropin) infusion at 5 mcg/kg/min. The patient weighs 50 kg. Each milliliter of solution contains 3 mg of dopamine. How many mL/h will the nurse set the pump to deliver?
A)
3 mL/h
B)
5 mL/h
C)
3,000 mL/h
D)
83.3 mL/h
Ans:
B
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Feedback: To calculate this dosage, multiply the ordered mcg by the weight (5 50 kg) to yield mcg/min (250 mcg/min) and then multiply this times 60 to get mcg/h (250 60 = 15,000 mcg/h). Convert mcg/h to mg/h (15,000/1,000 = 15 mg/h). Set up ratio (3 mg/1 mL = 15 mg/X mL) and cross multiply (3X = 15 mg). Divide both sides by 3 to yield 5 mL/h to deliver 5 mg/kg/min.
32 .
The nurse calculates the infusion rate for administering dopamine to a premature infant in the neonatal intensive care unit who is in cardiogenic shock secondary to a cardiac anomaly. What is the nurses next priority action?
A)
Insert an intravenous catheter
B)
Obtain permission from parents
C)
Ask another nurse to perform independent calculation
D)
Show the nurses calculations to the physician
Ans:
C Feedback: It is good practice to have a second person check the dosage calculation before administering the drug to avoid potential toxic effects. When having calculations double-checked, it is best to let the other person work out separate calculations rather than just looking at the nurses calculation first because this will be more likely to catch an error. The nurse would have another nurse perform calculations rather than the doctor. Only after calculations are correct would the drug be administered, usually through a central line or the nurse may establish a peripheral line. Permission from parents is not required above general permission needed to care for the neonate.
33 .
The student nurse is administering an ophthalmic adrenergic agonist. What action would reflect the need for further education about how to administer a medication ophthalmically?
A)
Rests the tip of the dropper against the lower eyelid
B)
Grasps the lower eyelid and pulls it away to form a pocket
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C)
Applies gentle pressure to the inside corner of the eye for 3 to 5 minutes
D)
Instructs the patient to close his or her eyes and look downward
Ans:
A Feedback: First, wash hands thoroughly. Do not touch the dropper to the eye or to any other surfaces. Have the patient tilt his or her head back or lie down and stare upward. Gently grasp the lower eyelid and pull the eyelid away from the eyeball. Instill the prescribed number of drops into the lower conjunctival sac and then release the lid slowly (Fig. 30.1). Have the patient close the eye and look downward. Apply gentle pressure to the inside corner of the eye for 3 to 5 minutes. Do not rub the eyeball and do not rinse the dropper. If more than one type of eyedrop is being used, wait 5 minutes before administering the next one.
34 .
When transcribing new orders for sympathomimetic medications prescribed for a geriatric patient, the nurse expects the dosage will be what?
A)
The average adult dosage
B)
Slightly higher than adult dosages
C)
The lowest possible effective dosage
D)
Approximately half the normal adult dosage
Ans:
C Feedback: Older patients should be started on lower doses of the drugs and should be monitored very closely for potentially serious arrhythmias or blood pressure changes. Other options are incorrect.
35 .
The nurse is serving a breakfast tray to the patient receiving an alpha- and beta-adrenergic agonist medication. The nurse notifies dietary of the error with the patients diet when finding what on the tray?
A)
Eggs
B)
Bacon
C)
Coffee
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D)
Milk
Ans:
C Feedback: Patients being treated with any adrenergic agonists who are also taking ma huang, guarana, or caffeine are at increased risk for overstimulation, including increased blood pressure, stroke, and death. The nurse should counsel patients to avoid these ingredients. There would be no reason to prevent the patient from ingesting eggs, bacon, or milk.
Chapter 10. Adrenoceptor Antagonist Drugs 1.
The nurse administers an adrenergic blocking agent in order to prevent release of what neurotransmitter?
A)
Epinephrine
B)
Norepinephrine
C)
Serotonin
D)
Gamma-aminobutyric acid (GABA)
Ans:
B Feedback: Adrenergic blocking agents prevent norepinephrine from being released from the adrenal medulla or from the nerve terminal from activating the receptor, which blocks sympathetic nervous system effects. Epinephrine, serotonin, and GABA are not associated with this process.
2.
What medication, if ordered for an 8-year-old patient, should the nurse question? (Select all that apply.)
A)
Amiodarone (Cordarone) 400 mg orally per 24 hours
B)
Labetalol (Normodyne) 100 mg orally b.i.d.
C)
Phentolamine (Regitine) 1 mg intramuscularly 1 to 2 hours before surgery
D)
Prazosin (Minipress) 3 mg orally t.i.d.
E)
Carvedilol (Coreg) 6.25 mg orally b.i.d.
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Ans:
A, B, E Feedback: Amiodarone, labetalol, and carvedilol are not indicated for pediatric use and do not have established pediatric dosages. Phentolamine and prazosin have established pediatric dosages and would not need to be questioned.
3.
A nurse is working with a patient who is taking an adrenergic blocking agent. While assessing the patients medication history, the nurse discovers that the patient takes several alternative therapies. What herb is the nurse concerned may interact with the adrenergic blocking agent and affect the patients blood glucose level?
A)
Ginseng
B)
Nightshade
C)
Di huang
D)
Saw Palmetto
Ans:
C Feedback: Di huang is an alternative therapy that can lower blood glucose when used in combination with adrenergic blocking agents. Ginseng increases antihypertensive effects; nightshade slows the heart rate; and saw palmetto increases the risk of urinary tract complications when used in combination with adrenergic blocking agents.
4.
A priority nursing assessment for a patient who is to receive an alpha- or beta-adrenergic blocking agent would be what?
A)
Monitoring respiratory rate
B)
Checking blood glucose level
C)
Measuring urine output
D)
Assessing heart rate
Ans:
D Feedback:
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The most serious adverse effect would be severe bradycardia, so the nurses priority would be assessing the heart rate. If the patient were identified as having diabetes, then monitoring blood glucose levels would become important because these drugs can aggravate diabetes by blocking sympathetic response including masking the usual signs and symptoms of hypoglycemia and hyperglycemia. Respiratory rate could be impacted if the patient was identified as having a condition causing bronchospasm and diabetes because the combination could worsen both conditions. Measuring urine output should be part of the patients care, but it is not the priority assessment.
5.
Bisoprolol (Zebeta) would be the drug of choice for which patient with a diagnosis of hypertension?
A)
A 7-year-old patient
B)
A 15-year-old patient
C)
A 37-year-old patient
D)
A 69-year-old patient
Ans:
D Feedback: Bisoprolol is the drug of choice for older adults. It is not associated with as many adverse effects in the elderly and regular dosing profiles can be used. This drug does not have an established pediatric dosage. Although the 37year-old patient is an adult, there are additional choices for this patient, with a more favorable adverse effect profile.
6.
What would be the teaching priority for a diabetic patient being treated with a nonselective beta-blocker?
A)
To take his own pulse
B)
To weigh himself once a week at the same time of day
C)
To avoid smoke-filled rooms
D)
To understand signs and symptoms of hypo- or hyperglycemic reaction
Ans:
D
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Feedback: Because the beta-blockers stop the signs and symptoms of a sympathetic stress reaction, the signs and symptoms associated with hypo- or hyperglycemia, the diabetic patient taking a beta-blocker will need to understand this and learn new indicators of these reactions. Taking his pulse, weekly weighing, and avoiding smoke-filled rooms are good health practices and should be done, but not specifically needed by a diabetic patient taking a beta-blocker. 7.
The nurse is caring for a patient who is receiving an adrenergic blocking agent. While writing the care plan for this patient what nursing diagnoses would be most appropriate concerning comfort?
A)
Acute pain related to cardiovascular and systemic effects
B)
Decreased cardiac output related to cardiovascular effects
C)
Ineffective airway clearance related to lack of bronchodilating effects
D)
Deficient knowledge regarding drug therapy
Ans:
A Feedback: All four options would be appropriate nursing diagnoses for a patient receiving an adrenergic blocking agent. However, acute pain would be the only nursing diagnosis related to the patients comfort level.
8.
A nurse is providing discharge instructions to a patient who is taking atenolol (Tenormin) to treat hypertension. What would the nurse teach the patient regarding a possible drugdrug interaction?
A)
Antibiotics
B)
Oral contraceptives
C)
Nonsteroidal anti-inflammatory drugs (NSAIDs)
D)
Antifungal agents
Ans:
C Feedback:
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A decreased hypertensive effect can occur if a beta-selective adrenergic blocking agent is used in combination with NSAIDs. If this combination is used, the patient should be monitored closely and dosage adjustments made. Antibiotics, oral contraceptives, and antifungal agents are not known to have a drugdrug interaction. 9.
A busy patient with many responsibilities is to have a medication ordered to treat her hypertension. To increase compliance with drug therapy, what drug would be a good choice for this patient?
A)
Acebutolol (Sectral)
B)
Atenolol (Tenormin)
C)
Bisoprolol (Zebeta)
D)
Metoprolol (Lopressor)
Ans:
D Feedback: Metoprolol would be the best choice because it has an extended release form that only needs to be taken once a day, which should increase patient compliance. Acebutolol, atenolol, and bisoprolol do not come in extended release forms.
10 .
The nurse provides patient teaching for a patient who has a new order for nadolol (Corgard) to treat hypertension. What statement by the patient concerning nadolol (Corgard) would indicate that the teaching has been effective?
A)
I should cover my head at all times while I am outdoors.
B)
Since I am taking this drug, I no longer need to worry about diet and exercise.
C)
I will not stop taking this drug abruptly and will talk to my doctor before discontinuing.
D)
I may have a very dry mouth while taking this drug.
Ans:
C Feedback:
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A patient receiving an adrenergic blocker must be aware that abruptly stopping the medication may result in a serious reaction. When changing medications or discontinuing their use, these drugs need to be tapered off gradually. This drug is not associated with photophobia or the anticholinergic effect of dry mouth. If the teaching were effective, the patient would be aware that he would need to continue lifestyle modifications, including diet and exercise. 11 .
The nurse frequently administers propranolol (Inderal) as treatment for what condition?
A)
Hypotension
B)
Angina
C)
Prevent first myocardial infarction (MI)
D)
Cluster headaches
Ans:
B Feedback: The beta-adrenergic blocking agents are used to treat cardiovascular problems (hypertension, angina, migraine headaches) and to prevent reinfarction after MI. The prototype drug, propranolol, was in fact the most prescribed drug in the country in the 1980s and is still considered a first-line drug. Propranolol does not prevent first MIs and it is not used for hypotension or cluster headaches.
12 .
A patient with benign prostatic hypertrophy (BPH) has been prescribed prazosin (Minipress) and asks the nurse what this is going to do for him. The nurses response will include what action to explain the purpose of taking this medication?
A)
Decreasing vascular tone and vasodilation
B)
Reducing the size of the prostate to reduce pressure on the urethra
C)
Relaxing the bladder and prostate and improving urine flow
D)
Lowering blood pressure
Ans:
C
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Feedback: Alpha1-selective adrenergic blocking agents block smooth muscle receptors in the prostate, prostatic capsule, prostatic urethra, and urinary bladder neck, which leads to a relaxation of the bladder and prostate and improved flow of urine in male patients. Although they also block the postsynaptic alpha1receptor sites, causing a decrease in vascular tone and vasodilation that leads to a fall in blood pressure without the reflex tachycardia that occurs when the presynaptic alpha2-receptor sites are blocked, this is not the purpose for administering the drug to a patient with BPH. They do not reduce the size of the prostate. 13 .
The nurse is caring for a 55-year-old patient receiving metoprolol (Lopressor). What statement by the patient would lead the nurse to believe that he needs additional instruction?
A)
If I have side effects from the medication, I will contact my physician before I stop taking it.
B)
I can take over-the-counter (OTC) cold medication while on metoprolol.
C)
I will take the medication on an empty stomach.
D)
I will report a weight gain of 2 pounds or more in 1 week.
Ans:
B Feedback: OTC medications can interact to increase or decrease the effects of antiadrenergic drugs. Antacids decrease the effects of beta-adrenergic blocking drugs. Decreased antihypertensive effects result when taken with ibuprofen. Other options reflect correct statements and would not indicate that the patient would need further instruction.
14 .
Nonselective adrenergic blocking agents have a variety of therapeutic uses. Which agent is used for the treatment of heart failure?
A)
Carvedilol (Coreg)
B)
Sotalol (Betapace)
C)
Propranolol (Inderal)
D)
Tamsulosin (Flomax)
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Ans:
A Feedback: available orally and is used to treat hypertension as well as congestive heart failure and left ventricular dysfunction after a myocardial infarction. Sotalol is a nonselective beta-adrenergic blocking agent used to treat potentially lifethreatening ventricular arrhythmias and to maintain normal sinus rhythm in patients with atrial fibrillation or flutter. Propranolol is a nonselective betaadrenergic blocking agent used for treatment of hypertension, angina, idiopathic hypertrophic subaortic stenosis (IHSS)induced palpitations, angina and syncope, some cardiac arrhythmias induced by catecholamines or digoxin, pheochromocytoma; prevention of reinfarction after myocardial infarction; prophylaxis for migraine headache (which may be caused by vasodilation and is relieved by vasoconstriction, although the exact action is not clearly understood); prevention of stage fright (which is a sympathetic stress reaction to a particular situation); and treatment of essential tremors. Tamsulosin is used to treat benign prostatic hyperplasia and is analpha1selective adrenergic blocking agent.
15 .
Before administering a nonselective adrenergic blocker, what should the nurse assess?
A)
Pulse and blood pressure
B)
Bowel sounds and appetite
C)
Serum albumin level
D)
Serum sodium and potassium levels
Ans:
A Feedback: Monitor vital signs and assess cardiovascular status including pulse, blood pressure, and cardiac output to evaluate for possible cardiac effects. Although assessment of bowel sounds, appetite, serum albumin level, or serum sodium and potassium levels may be important to patient care, they are not related to administration of a nonselective adrenergic blocking agent.
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16 .
A 75-year-old male patient was admitted to the unit with angina. He was started on nadolol (Corgard). The patient asks why he is taking this medication because he does not have high blood pressure. What is the nurses best response?
A)
Some beta-blockers have been approved as antianginal agents.
B)
This medication will prevent blood pressure problems later on.
C)
This drug will prevent you from developing an arrhythmia.
D)
This medication will reduce benign prostatic hypertrophy (BPH) as well as treat heart failure.
Ans:
A Feedback: Decreased heart rate, contractility, and excitability, as well as a membranestabilizing effect, lead to a decrease in arrhythmias, a decreased cardiac workload, and decreased oxygen consumption. The juxtaglomerular cells are not stimulated to release renin, which further decreases the blood pressure. These effects are useful in treating hypertension and chronic angina and can help to prevent reinfarction after a myocardial infarction by decreasing cardiac workload and oxygen consumption. Corgard will not prevent blood pressure problems, arrhythmias, or glaucoma in the future. Corgard is not used to treat BPH.
17 .
In what patient is propranolol (Inderal) contraindicated?
A)
26-year-old man with viral myocarditis
B)
45-year-old woman with heart failure who suffered a myocardial infarction
C)
42-year-old man with hypertension
D)
65-year-old woman with persistent migraines
Ans:
B Feedback: Beta-adrenergic blocking agents are contraindicated in patients with bradycardia, heart failure, and heart block. The drug would not be contraindicated in the other patients.
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18 .
What assessment finding indicates to the nurse that timolol (Timoptic) has been effective?
A)
The patients blood pressure increases.
B)
The patients intraocular pressure is reduced.
C)
The patients pulse is reduced.
D)
The patients angina is reduced.
Ans:
B Feedback: Timolol and carteolol are available in an ophthalmic form of the drug for reduction of intraocular pressure in patients with open-angle glaucoma. A decrease in intraocular pressure would indicate it has been effective. Timolol can also be used to treat hypertension but an increase in blood pressure would indicate the drug was not effective. Reduced pulse rate and reduced angina would not be related to this drug, especially if it was given in ophthalmic form when very little of the drug is absorbed systemically.
19 .
The student nurse is studying for a pharmacology exam and notices that many of the adrenergic blocking antagonists drugs studied in class have what suffix?
A)
-aine
B)
-lol
C)
-azole
D)
-triptan
Ans:
B Feedback: The suffix -lol is seen in many of the drug names for adrenergic blocking antagonists. The suffix -aine would indicate a topical anesthetic, whereas -azole indicates an antifungal, and the suffix -triptan relates to the triptans.
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20 .
A 23-year-old female patient presents at the clinic with a migraine headache. What beta-adrenergic blocking agent might the physician prescribe for the prophylactic prevention of future migraine headaches?
A)
Propranolol (Inderal)
B)
Nadolol (Corgard)
C)
Timolol (Blocadren)
D)
Sotalol (Betapace)
Ans:
A Feedback: Propranolol is indicated for the treatment of hypertension, angina pectoris, idiopathic hypertrophic subaortic stenosis, supraventricular tachycardia, tremor; prevention of reinfarction after myocardial infarction; adjunctive therapy in pheochromocytoma; prophylaxis of migraine headache; and management of situational anxiety. The other options do not treat or prevent migraine headaches.
21 .
A 5-year-old African American patient has been admitted to the pediatric intensive care unit with pheochromocytoma. The physician has ordered phentolamine. The nurse knows that the other indication for phentolamine is what?
A)
Migraine headaches
B)
Extravasation of IV norepinephrine or dopamine
C)
Life-threatening arrhythmias
D)
Heart failure
Ans:
B Feedback: Phentolamine (Regitine) is used for the prevention of cell death and tissue sloughing after extravasation of intravenous norepinephrine or dopamine, and severe hypertension reactions caused by manipulation of the pheochromocytoma before and during surgery; diagnosis of pheochromocytoma. Phentolamine would not be indicated for treatment of migraine headaches, life-threatening arrhythmias, or heart failure.
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22 .
The nurse is caring for a well-known stage actor who has suddenly developed severe stage fright that is preventing him from working. What drug does the nurse suspect will be prescribed for this patient?
A)
Carteolol (Cartrol)
B)
Nebivolol (Bystolic)
C)
Nadolol (Corgard)
D)
Propranolol (Inderal)
Ans:
D Feedback: One of the indications for use of propranolol is prevention of stage fright, which is a sympathetic stress reaction to a particular situation. None of the other options are indicated for this use.
23 .
The nurse assesses the patient receiving phentolamine (Regitine) and suspects what finding is an adverse effect of the medication?
A)
Hypertension
B)
Wheezing
C)
Tachycardia
D)
Depressed respirations
Ans:
C Feedback: Patients receiving phentolamine often experience extensions of the therapeutic effects, including hypotension, orthostatic hypotension, angina, myocardial infarction, cerebrovascular accident, flushing, tachycardia, and arrhythmiaall of which are related to vasodilation and decreased blood pressure. Headache, weakness, and dizziness often occur in response to hypotension. Nausea, vomiting, and diarrhea may also occur. Hypertension, wheezing, and depressed respiration would not be associated with phentolamine.
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24 .
The home care nurse is caring for a patient newly prescribed a nonselective beta-blocking agent. What would the nurse include in the teaching plan related to this drug? (Select all that apply.)
A)
Take with meals.
B)
Change position slowly.
C)
Avoid driving or operating hazardous machinery.
D)
Warn of possible increase in libido.
E)
Increase activity levels as much as possible.
Ans:
A, B, C Feedback: Patients should be taught to change position slowly, avoid driving or operating hazardous machinery, and to pace activities as a result of potential dizziness from orthostatic hypotension in order to avoid injury. Patients should take medicine with meals when possible. Drug is more likely to decrease libido than increase it. Activity levels should be paced and care should be taken not to overdo.
25 .
The nurse is discharging a 35-year-old patient with diabetes who has been prescribed an adrenergic blocking agent. What is the priority teaching point for the nurse to discuss with this patient?
A)
Monitor blood glucose levels closely and report any instability
B)
Document signs and symptoms of hyperglycemia and hypoglycemia
C)
Reduce carbohydrate intake more than usual while taking the new drug
D)
Increase insulin dosage to compensate for the drugs effect in increasing blood sugar
Ans:
A Feedback:
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It is important for the patient to be instructed to monitor blood sugar levels more frequently because adrenergic blocking agents mask the normal hypoand hyperglycemic manifestations that normally alert patients such as sweating, feeling tense, increased heart rate, and rapid breathing. There is no need to change the diet or the diabetic medications. There may be no signs and symptoms to record because they are blocked by the adrenergic blocker. 26 .
The home care nurse is providing teaching for a 59-year-old patient taking a nonselective beta-blocker. The nurse teaches the patient the importance of notifying the prescribing physician when what occurs related to this medication?
A)
If the patients pulse stays above 100 bpm for 3 or more days
B)
If the patient has a sudden onset of a cough
C)
If the patient falls
D)
If the patients pulse falls below 60 bpm for 3 or more days
Ans:
B Feedback: Bronchospasm, cough, rhinitis, and bronchial obstruction are related to loss of bronchodilation of the respiratory tract and vasodilation of mucous membrane vessels so a sudden onset of a cough or difficulty breathing should be immediately reported to the health care provider. Other options may need to be reported but not in relation to the nonselective beta-blocking medication.
27 .
A 31-year-old male patient has been prescribed propranolol to reduce and prevent angina. What will the nurse assess this patient for related to the medication? (Select all that apply.)
A)
Sleep disturbance
B)
Impotence
C)
Bronchospasm
D)
Gastric pain
E)
Tachycardia
Ans:
B, C, D
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Feedback: Adverse effects of propranolol that the nurse would assess for include allergic reaction, bradycardia, heart failure, cardiac arrhythmias, cerebrovascular accident, pulmonary edema, gastric pain, flatulence, impotence, decreased exercise tolerance, and bronchospasm. 28 .
Which nonselective alpha-adrenergic blocking agent is still used?
A)
Metoprolol
B)
Propranolol
C)
Timolol
D)
Phentolamine
Ans:
D Feedback: Of the nonselective alpha-adrenergic blocking agents, only phentolamine is still used today. Metoprolol is a beta1-selective adrenergic blocking agent. Timolol and propranolol are nonselective beta-adrenergic blocking agents.
29 .
The labor and delivery nurse assists with the delivery of a newborn to a woman taking an adrenergic blocker for a congenital heart defect. What organ systems may be affected in the newborn by these drugs? (Select all that apply.)
A)
Cardiovascular
B)
Respiratory
C)
Central nervous system (CNS)
D)
Gastrointestinal (GI)
E)
Genitourinary (GU)
Ans:
A, B, C Feedback:
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Adrenergic blockers can affect labor, and babies born to mothers taking these drugs may exhibit adverse cardiovascular, respiratory, and CNS effects. Problems with the GI and GU systems have not been reported. 30 .
Beta-adrenergic blocking drugs are used in children for disorders similar to those in adults. What adrenergic blocking agent is used during surgery for pheochromocytoma?
A)
Propranolol
B)
Prazosin
C)
Phentolamine
D)
Guanethidine
Ans:
C Feedback: Phentolamine is used during surgery for pheochromocytoma in children. Prazosin is used to treat hypertension in children. Propranolol and guanethidine are not indicated for use in children with a pheochromocytoma.
31 .
What are the therapeutic and adverse effects associated with the adrenergic blocking agents related to?
A)
Receptor-site specificity
B)
Sympathetic nervous system manifestations
C)
Norepinephrine release
D)
Function of the nerve terminal
Ans:
A Feedback: The therapeutic and adverse effects associated with these drugs are related to their adrenergic-receptor-site specificity; that is, the ability to react with specific adrenergic receptor sites without activating them, thus preventing the typical manifestations of sympathetic nervous system (SNS) activation. By occupying the adrenergic receptor site, they prevent norepinephrine released from the nerve terminal or from the adrenal medulla from activating the receptor, thus blocking the SNS effects.
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32 .
The specificity of the adrenergic blocking agents allows the clinician to select a drug to do what?
A)
Have the desired effect
B)
Multiply undesired effects
C)
Increase specificity with higher serum blood levels
D)
Improving concentration in the body
Ans:
A Feedback: This specificity allows the clinician to select a drug that will have the desired therapeutic effects without the undesired effects that occur when the entire sympathetic nervous system is blocked. In general, however, the specificity of adrenergic blocking agents depends on the concentration of drug in the body. Most specificity is lost with higher serum drug levels.
33 .
What agents are used primarily to treat cardiac-related conditions? (Select all that apply.)
A)
Nonselective adrenergic blocking agents
B)
Nonselective alpha-adrenergic blocking agents
C)
Alpha1-selective adrenergic blocking agents
D)
Nonselective beta-adrenergic blocking agents
E)
Beta1-selective adrenergic blocking agents
Ans:
A, D, E Feedback:
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Drugs that block both alpha- and beta-adrenergic receptors are primarily used to treat cardiac-related conditions. Phentolamine, a nonselective alphaadrenergic blocking agent, is used to treat extravasation of IV norepinephrine or dopamine and hypertension related to a pheochromocytoma. Alpha1-selective adrenergic blocking agents are used for treatment of hypertension and benign prostatic hyperplasia. The betaadrenergic blocking agents are used to treat cardiovascular problems (hypertension, angina, migraine headaches) and to prevent reinfarction after myocardial infarction. Beta1-selective adrenergic blocking agents are used for treating hypertension, angina, and some cardiac arrhythmias. 34 .
The patient takes labetalol and is scheduled for surgery. The anesthesiologist plans to use halothane as one of the anesthetic agents. The nurse consults with the anesthesiologist to ensure awareness the patients medication history knowing that the combination of labetalol and halothane will have what effect?
A)
Excessive hypotension
B)
Hypoglycemia
C)
Conduction system disturbances
D)
Vomiting
Ans:
A Feedback: There is increased risk of excessive hypotension if any of these drugs is combined with volatile liquid general anesthetics such as enflurane, halothane, or isoflurane. The effectiveness of diabetic agents is increased, leading to hypoglycemia when such agents are used with these drugs. Carvedilol has been associated with potentially dangerous conduction system disturbances when combined with verapamil or diltiazem. Vomiting is not associated with this combination of drugs.
35 .
A)
The 64-year-old patient has smoked since age 15 and has been diagnosed with chronic obstructive pulmonary disease. What classification of adrenergic blocking antagonist would be safest for this patient to treat angina? Nonselective adrenergic blocking agents
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B)
Nonselective alpha-adrenergic blocking agents
C)
Alpha1-selective adrenergic blocking agents
D)
Beta1-selective adrenergic blocking agents
Ans:
D Feedback: Beta1-selective adrenergic blocking agents have an advantage over the nonselective beta-blockers in some cases. Because they do not usually block beta2-receptor sites, they do not block the sympathetic bronchodilation that is so important for patients with lung diseases or allergic rhinitis. Consequently, these drugs are preferred for patients who smoke or who have asthma, any other obstructive pulmonary disease, or seasonal or allergic rhinitis. Nonselective adrenergic blocking agents block both alpha- and betaadrenergic receptors exacerbating respiratory conditions by the loss of norepinephrines effect of bronchodilation. Nonselective alpha-adrenergic blocking agents are not used to treat angina. Alpha1-selective adrenergic blocking agents are not used to treat angina.
Chapter 11. Antihypertensive Agents 1.
What does the clinic nurse anticipate as initial drug therapy for a 39-year-old African American man who is 25 pounds overweight and newly diagnosed with hypertension?
A)
An angiotensin-converting enzyme (ACE) inhibitor
B)
A beta-blocker
C)
A calcium channel blocker
D)
A diuretic
Ans:
D Feedback:
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African Americans are at highest risk for developing hypertension with men more likely than women to develop the disease. African Americans have documented differences in response to antihypertensive therapy. They are most responsive to single-drug therapy and diuretics. The first line use of a diuretic is in combination with diet and other lifestyle changes. The use of a calcium channel blocker and/or alpha-adrenergic blocker should follow. African Americans are less responsive to ACE inhibitors and beta-blocker. 2.
The clinic nurse assesses a patient taking benazepril (Lotensin) to control hypertension. What is the priority nursing assessment related to this drug?
A)
Mental illness
B)
Hepatic disease
C)
Renal disease
D)
Peptic ulcer disease
Ans:
C Feedback: Benazepril is an angiotensin-converting enzyme inhibitor; drugs in this class are contraindicated in the presence of impaired renal function. Mental illness, hepatic disease, or peptic ulcer disease is not a contraindication with this drug.
3.
A patient has been prescribed losartan (Cozaar) for hypertension. What patient teaching points will the nurse include about this drug include?
A)
Report onset of a cough or fever to health care provider.
B)
Limit fluid intake to decrease urinary output.
C)
Monitor blood pressure once a week.
D)
Take the drug late in the day to prevent sleepiness.
Ans:
A Feedback:
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Losartan is an angiotensin IIreceptor blocker that is associated with a cough, back pain, fever, muscle weakness, and upper respiratory tract infections, so the patient should be taught to report a fever or cough to his health care provider. Fluid intake should be normal and the drug is best taken in the morning. Blood pressure should be monitored daily, especially when first starting the drug when adverse effects are not yet known. 4.
A patient newly diagnosed with hypertension has just been given a prescription for medication. Along with promoting safety, what is the other goal of the nurses teaching plan?
A)
A blood pressure of 120/80
B)
Medication compliance
C)
A discussion with his insurance company about the cost of the drug
D)
Verbalization of why drugs should be kept out of the reach of children
Ans:
B Feedback: The nurse provides thorough patient teaching, including the name of the drug, dosage prescribed, measures to avoid adverse effects, warning signs of problems, and the need for periodic monitoring and evaluation, to enhance patient knowledge about drug therapy and to promote compliance. All of the options are realistic outcomes for this patient. However, compliance is a great concern for people who are in need of hypertensive agents. It would be most important for his or her health care provider to know that he or she has filled the prescription and is taking his or her medication as prescribed. Keeping the drug out of the reach of children would be a safety measure.
5.
A stepped care management approach to treating hypertension includes weight loss, smoking cessation, decreased use of alcohol, reducing salt in the diet, and increased physical exercise. In which step of a stepped-care management approach will the nurse teach about these changes in lifestyle?
A)
Step 1 only
B)
Steps 1 and 2
C)
Steps 1, 2, and 3
D)
Steps 1, 2, 3, and 4
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Ans:
D Feedback: Lifestyle changes are encouraged in all four steps and should be advocated for the maintenance of good health. These changes are stressed in steps 1 and 2 in the hope that drug therapy will not be necessary. However, these changes should occur in steps 3 and 4 as well.
6.
A patient taking diltiazem (Cardizem) for hypertension has come to the clinic for a follow-up appointment. What adverse effects would the nurse assess the patient for?
A)
Chest pain and pale skin
B)
Shortness of breath and wheezing
C)
Peripheral edema and bradycardia
D)
Tachycardia and increased energy level
Ans:
C Feedback: Cardiovascular adverse effects of diltiazem include bradycardia, peripheral edema, and hypotension. Skin flushing and rash may occur. There should be no effect on the lungs and usually this drug causes fatigue rather than increased energy levels.
7.
A patient who works on road construction has been diagnosed with hypertension. After attempting to decrease his blood pressure with lifestyle changes and a mild diuretic, it is determined that he will need to be placed on an angiotensin-converting enzyme (ACE) inhibitor. Based on his occupation, what is the nurses priority assessment?
A)
Chronic constipation
B)
Excessive sweating on the job
C)
Three large meals a day
D)
One beer every night
Ans:
B
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Feedback: A patient taking an ACE inhibitor should be sure to maintain fluid intake, so excessive sweating on the job places him at risk for a drop in fluid volume. Excessive sweating, vomiting, diarrhea, or dehydration need to be monitored and treated if they occur while taking an ACE inhibitor. Six smaller meals rather than three larger ones would be better and should be encouraged. However, this could be a problem with his job. The best treatment for constipation would be to increase fluid and fiber and one beer a night would be within reason when considering alcohol intake. 8.
What is the nurses priority to assess before giving a female patient her prescription for an angiotensin IIreceptor blocker (ARB)?
A)
Do you eat something when you take your medications?
B)
How much physical exercise do you get?
C)
When was your last menstrual period (LMP)?
D)
Have you always weighed 130 pounds since you grew up?
Ans:
C Feedback: It would be important to know when the patients LMP occurred and that the patient was not pregnant. These drugs can cause fetal abnormalities and fetal death. The other questions are appropriate and would help the nurse plan care for the patient; however, it would not be as important as assessing for the possibility of pregnancy before beginning of therapy. The nurse should teach the patient the need to avoid pregnancy using a barrier contraceptive.
9.
A patient taking a calcium channel blocker is seen in the clinic and diagnosed with drug toxicity. When collecting the nursing history, what finding would indicate the likely cause of this drug toxicity?
A)
Intake of alcohol
B)
The use of eggs in the diet
C)
The ingestion of grapefruit juice
D)
Intake of aged cheese
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Ans:
C Feedback: The calcium channel blockers are a class of drugs that interact with grapefruit juice. When grapefruit juice is present in the body, the concentrations of calcium channel blockers increase, sometimes to toxic levels. Advise patients to avoid drinking grapefruit juice taking a calcium channel blocker. If a patient on a calcium channel blocker reports toxic effects, ask whether he or she is drinking grapefruit juice. Use of alcohol could be important if the patient was ingesting large amounts, but that would not be the most likely cause of drug toxicity. Eggs and cheese should not exert any fooddrug interaction.
10 .
An older adult patient is taking a sustained-release antihypertensive drug. What is the nurses priority teaching point about this medication?
A)
Take your blood pressure only at night.
B)
Swallow the drug whole and do not to cut, crush, or chew it.
C)
Take the drug before bedtime.
D)
Use over-the-counter (OTC) drugs to control headache or cold symptoms.
Ans:
B Feedback: Sustained-release drugs are suspended in a matrix system that allows a steady release of the drug over time. Sustained-release drugs cannot be cut, crushed, or chewed; it destroys the matrix system and allows absorption of the complete dose all at once. Older patients should be especially cautioned about sustained-release antihypertensives that cannot be cut, crushed, or chewed to avoid the potential for excessive dosing if these drugs are inappropriately cut. Many OTC drugs contain ingredients that increase blood pressure and so are not recommended for patients with hypertension. The patient can take his or her blood pressure any time during the day but should take the drug in the morning.
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11 .
A patient has been started on losartan (Cozaar), an angiotensin IIreceptor blocker (ARB), for hypertension. After 6 weeks of therapy, it is decided that the losartan alone is not controlling the patients hypertension. What does the nurse anticipate will be added to the losartan regimen for better control of this patients hypertension?
A)
Candesartan (Atacand)
B)
Hydrochlorothiazide (Hyzaar)
C)
Captopril (Capoten)
D)
Antidiuretic hormone (ADH)
Ans:
B Feedback: When losartan therapy is started, maximal effects on blood pressure usually occur within 3 to 6 weeks. If losartan alone does not control blood pressure, a low dose of a diuretic may be added. A combination product of losartan and hydrochlorothiazide (Hyzaar) is available. Adding a second ARB such as candesartan or captopril would risk causing toxic adverse effects. ADH causes retention of water in the nephrons, which would further increase blood pressure.
12 .
The nurse is providing drug teaching for a patient who is prescribed enalapril (Vasotec). What drug specific adverse effect will the nurse include in the drug teaching?
A)
Sedation
B)
Persistent cough
C)
Tachycardia
D)
Rash
Ans:
B Feedback: Benazepril, enalapril, and fosinopril are generally well tolerated but cause an unrelenting cough, possibly related to adverse effects in the lungs, where the angiotensin-converting enzyme is inhibited, which may lead patients to discontinue the drug. This persistent cough develops in approximately 10% to 20% of patients.
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13 .
The nurse provides drug teaching to the patient prescribed captopril (Capoten). What statement made by the patient does the nurse interpret to mean teaching has been effective?
A)
I will limit my fluid intake to 1,200 mL daily.
B)
I will call my doctor if I bruise easily or become extremely tired.
C)
I will move from a reclining to a standing position slowly.
D)
I will increase my intake of foods high in potassium.
Ans:
B Feedback: Captopril has been associated with a sometimes-fatal pancytopenia, cough, and unpleasant gastrointestinal (GI) distress so the patient should be alert to symptoms related to anemia, reduction in platelets, or infection. There is no need to increase potassium intake because a slight rise in potassium level is associated with this drug. Orthostatic hypotension is not a listed adverse effect. There is no need to limit fluid intake for most patients unless they have a comorbid disorder.
14 .
The nurse provides dietary teaching to the patient with hypertension and determines the patient understood the information when what meal is selected?
A)
Hot dogs, baked beans, and cole slaw
B)
French fries, grilled hamburger, and cola drink
C)
Grilled chicken, green salad with dressing, and baked apple
D)
Bologna sandwich with mayonnaise, potato chips, and a chocolate-chip cookie
Ans:
C Feedback: Chicken, salad, and fruit are all low in sodium. The other meal options all contain foods high in sodium (i.e., hot dogs, French fries, processed meats like bologna, and potato chips).
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15 .
The nurse works with the patient, diagnosed with hypertension, and the patients family to determine the goal of drug therapy for the patient taking an antihypertensive medication is what?
A)
Maintaining compliance
B)
Maintaining the blood pressure within normal limits
C)
Maintaining a fluid volume balance
D)
Maintaining homeostasis
Ans:
B Feedback: Helping the patient to maintain the blood pressure within normal limits is the goal of drug therapy. How blood pressure is maintained within normal limits may involve balancing fluid volume and patient compliance with the plan of care, but these are interventions and not the goal of therapy. Returning the patient to homeostasis comes before maintaining homeostasis.
16 .
While studying the antihypertensive drugs, the nursing students learn that the pressure in the cardiovascular system is determined by three elements. What are they? (Select all that apply.)
A)
Heart rate
B)
Stroke volume
C)
Preload
D)
Total peripheral resistance
E)
Pulse pressure
Ans:
A, B, D Feedback: The pressure in the cardiovascular system is determined by three elements: heart rate, stroke volume, or the amount of blood that is pumped out of the ventricle with each heartbeat (primarily determined by the volume of blood in the system), and total peripheral resistance, or the resistance of the muscular arteries to the blood being pumped through. The preload and the pulse pressure are not factors that regulate pressure in the cardiovascular system.
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17 .
The nurse recognizes blood pressure is determined by three elements including what?
A)
Peripheral resistance
B)
Pulse pressure
C)
Renal blood flow
D)
Preload
Ans:
A Feedback: The pressure in the cardiovascular system is determined by three elements: heart rate, stroke volume, and peripheral resistance. The small arterioles are thought to be the most important factors in determining peripheral resistance. Because they have the smallest diameter, they are able to almost stop blood flow into capillary beds when they constrict, building up tremendous pressure in the arteries behind them as they prevent the blood from flowing through.
18 .
When a combination of drugs needs to be incorporated into the drug regimen for a hypertensive patient, what type of diuretic would the nurse expect to administer?
A)
Thiazide
B)
Loop
C)
Potassium-sparing
D)
Osmotic
Ans:
A Feedback: A somewhat controversial study, the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT), reported in 2002 that patients taking the less expensive, less toxic diuretics did better and had better blood pressure control than patients using other antihypertensive agents. Replications of this study have supported its findings, and the use of a thiazide diuretic is currently considered the first drug used in the steppedcare management of hypertension.
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19 .
The nurse is caring for a patient who has been noncompliant with treatment for hypertension. The nurse explains that untreated hypertension increases the risk of what? (Select all that apply.)
A)
Renal disease
B)
Cerebral infarction
C)
Heart failure
D)
Cholecystitis
E)
Migraine headache
Ans:
A, B, C Feedback: Hypertension is a common chronic disorder. It is estimated that at least 20% of the people in the United States have hypertension. Hypertension increases risks of myocardial infarction, heart failure, cerebral infarction and hemorrhage, and renal disease. It does not increase the risk of cholecystitis or migraine headache.
20 .
The nurse administers ambrisentan (Letairis) to the patient diagnosed with pulmonary arterial hypertension. What single indicator would the nurse use to evaluate the effectiveness of this medication?
A)
Oxygen saturation
B)
Resting respiratory rate
C)
Exercise tolerance
D)
Breath sounds
Ans:
C Feedback: Although it is certainly important to assess all aspects of oxygenation and ventilation, the single best indicator of drug effectiveness is improved exercise tolerance. Many patients can oxygenate at rest and maintain a normal resting respiration, but activity increases oxygen demand, which is when signs of pulmonary hypertension are best seen.
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21 .
The pediatric nurse examines a child with mildly elevated blood pressure who is 10% above the upper weight limits for his or her age. What is the nurses priority teaching point?
A)
Encourage activity and begin weight loss diet.
B)
Explain how to administer diuretics to reduce adverse effects.
C)
Involve social services in monitoring this childs diet.
D)
Explain the most common adverse effects of calcium channel blockers.
Ans:
A Feedback: Treatment of childhood hypertension should be done very cautiously because the long-term effects of the antihypertensive agents are not known. Lifestyle changes should be instituted before drug therapy is started if at all possible. Weight loss and increased activity may bring an elevated blood pressure back to normal in many children. As a result, the priority teaching point is to help parents understand how to adapt the childs diet to reduce weight and introduce family activities to increase exercise. Drug teaching would only be required if lifestyle changes is inadequate to lower blood pressure. There is no need to involve social services.
22 .
The nurse is caring for an obese child with hypertension and slightly elevated serum glucose levels. What would the nurse anticipate will be ordered if lifestyle changes do not return blood pressure to an acceptable limit?
A)
Lifestyle changes
B)
Mild diuretic
C)
Calcium channel blocker.
D)
Beta-blocker
Ans:
B Feedback:
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Lifestyle changes should be instituted before drug therapy if at all possible. If drug therapy is used, a mild diuretic may be tried first, with monitoring of blood glucose and electrolyte levels on a regular basis. Calcium channel blockers have been used to treat hypertension in children and may be among the first considerations if drug therapy other than mild diuretics is needed. Beta-blockers have been used with success in some children; adverse effects may limit their usefulness in others. The safety and efficacy of the angiotensin-converting-enzyme (ACE) inhibitors and the angiotensinreceptor blockers (ARBs) have not been established in children. 23 .
The emergency department nurse is asked to prepare a nitroprusside (Nitropress) infusion for a patient being brought to the hospital in an ambulance. The nurse knows this drug is only used in what circumstances?
A)
Hypertensive emergencies
B)
Hypertension in a patient having a myocardial infarction
C)
Hypertension complicated by symptoms of a stroke
D)
Hypertension associated with diabetic ketoacidosis
Ans:
A Feedback: Most of the vasodilators are reserved for use in severe hypertension or hypertensive emergencies. These include hydralazine, minoxidil, and nitroprusside. The presence of absence of a comorbidity does not increase the likelihood of use. These drugs are used when blood pressure is extremely high and needs to be reduced quickly.
24 .
The nurse cares for a diabetic patient with uncontrolled hypertension who has been prescribed losartan (Cozaar). The health care provider changes this patients prescription to losartan with hydrochlorothiazide (Hyzaar). What benefits does the nurse anticipate this patient will receive from this drug therapy? (Select all that apply.)
A)
Slows progression of diabetic nephropathy in type 2 diabetes
B)
Increases excretion of fluid and sodium resulting in lower blood volume
C)
Alters electrolyte and acidbase balance
D)
Improves control of blood pressure due to combination therapy
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E)
Produces far fewer adverse effects resulting from the combination
Ans:
A, B Feedback: Many patients require more than one type of antihypertensive to achieve good control of their blood pressure. There are now many fixed-combination drugs available for treating hypertension. This allows for fewer tablets or capsules each day, making it easier for the patient to comply with drug therapy. Losartan slows the progression of diabetic nephropathy in patients with hypertension and type 2 diabetes. Hydrochlorothiazide is a diuretic that will increase excretion of fluid and sodium resulting in a lower circulating blood volume that will help to reduce blood pressure, preload, and afterload. The two drugs will work together to better control the patients blood pressure. Alteration in electrolytes and acidbase is a reasonable expectation but it is an adverse effect and not a benefit. There are likely to be more adverse effects when taking drugs that are not fixed combinations.
25 .
The patient is diagnosed with secondary hypertension. What will be the focus of nursing care to treat this patient?
A)
Administering epinephrine
B)
Administering antihypertensives
C)
Promoting healthy lifestyle
D)
Treating the cause
Ans:
A Feedback: Most people have essential, or primary, hypertension with no known cause that is treated with medications and lifestyle changes. Patients with secondary hypertension means there is a known cause of the blood pressure elevation. There are many different things that can result in secondary hypertension; the focus of care is treating the cause whether that requires surgery, medication, or discontinuing a medication that is causing hypertension as an adverse effect.
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26 .
The patient does not want to take medication to treat his or her hypertension if he or she can avoid it and asks the nurse if there is anything else he or she can do? What lifestyle changes will the nurse recommend? (Select all that apply.)
A)
Increase time spent exercising.
B)
Eliminate all salt from your diet.
C)
Reduce intake of fluids.
D)
Lose some weight.
E)
Try meditation.
Ans:
A, D, E Feedback: Exercising, losing weight, and meditation to reduce stress are all effective changes the patient can make in her lifestyle. However, if these do not bring blood pressure to within acceptable limits, the next step in the stepped-care management approach to treat hypertension would be to introduce a diuretic, beta-blocker, angiotensin-converting enzyme inhibitor, calcium channel blocker, or angiotensin IIreceptor blocker in addition to the lifestyle changes. It is not necessary, or even possible, to eliminate all sodium from the diet but cutting back will reduce water retention. Reducing intake of fluids is not a healthy option and would not be suggested unless comorbidities, such as possibility of heart failure, were present.
27 .
The nurse evaluates the patients lifestyle for factors that are contributing to his or her diagnosis of hypertension and then addresses the need to change what factor?
A)
Working outdoors in the sun
B)
Weight lifting at the gym
C)
Married with two children
D)
Exposure to high-frequency noise
Ans:
D Feedback:
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Factors that are known to increase blood pressure in some people include high levels of psychological stress, exposure to high-frequency noise, a highsalt diet, lack of rest, and genetic predisposition. Working outdoors in the sun may increase risk for skin cancer but does not contribute to hypertension. Weight lifting is good exercise, especially if he uses low weight and frequent repetition. Being married with two children is not a contributing factor for hypertension. 28 .
A patient is admitted to the intensive care unit in shock with hypotension. What is an appropriate nursing diagnosis for this patient?
A)
Impaired gas exchange
B)
Deficient fluid volume
C)
Risk for shock
D)
Ineffective peripheral tissue perfusion
Ans:
D Feedback: An appropriate nursing diagnosis would be ineffective peripheral tissue perfusion. If blood pressure becomes too low, the vital centers in the brain, as well as the rest of the tissues of the body, may not receive enough oxygenated blood to continue functioning. Because the patient is already in shock it would not be a risk diagnosis. There is no indication of altered gas exchange or deficient fluid volume.
29 .
The nurse is caring for a patient who takes ramipril (Altace) to treat hypertension. What would be an appropriate nursing diagnosis to include in this patients care plan?
A)
Ineffective tissue perfusion related to changes in cardiac output
B)
Acute pain related to skin effects and headache
C)
Altered gas exchange related to unrelenting cough
D)
Impaired body image
Ans:
A Feedback:
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Nursing diagnoses related to drug therapy might include ineffective tissue perfusion (total body) related to changes in cardiac output because ramipril is associated with adverse effects such as reflex tachycardia, chest pain, angina, heart failure, and cardiac arrhythmias. Although dermatitis and rash may occur, headaches are not an associated adverse effect of this drug. Benazepril, enalapril, and fosinopril can cause an unrelenting cough but ramipril is not associated with this adverse effect. Impaired body image would not be associated with this drug. 30 .
What drug is a safe and effective calcium channel blocker only if the nurse administers them as sustained-release or extended-release preparations to treat hypertension?
A)
Aliskiren (Tekturna)
B)
Diltiazem (Cardizem)
C)
Atenolol (Tenormin)
D)
Metoprolol (Lopressor)
Ans:
B Feedback: The calcium channel blockers available in immediate-release and sustainedrelease forms that are used in treating hypertension include amlodipine (Norvasc), felodipine (Plendil), isradipine (DynaCirc, DynaCirc CR), and nicardipine (Cardene, Cardene SR). Other calcium channel blockers are safe and effective for this use only if they are given as sustained-release or extended-release preparations. These include diltiazem (Cardizem, Dilacor CR), nifedipine (Procardia XL), nisoldipine (Sular), and verapamil (Calan SR). Aliskiren (Tekturna) is a renin inhibitor. Atenolol (Tenormin) and Metoprolol (Lopressor) are beta-blockers, not calcium channel blockers.
31 .
The nurse works in a clinic that has many African American patients. What would the nurse need to consider when caring for patients with hypertension? (Select all that apply.)
A)
African American men are at highest risk for hypertension.
B)
African Americans respond best to single-drug therapy.
C)
African Americans are most responsive to angiotensin-converting enzyme inhibitors.
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D)
Increased adverse effects occur when using thiazide and thiazide-like diuretics.
E)
First-line use of a calcium channel blocker with changes to lifestyle is best in African Americans.
Ans:
A, B, D Feedback: In the United States, African Americans are at highest risk for developing hypertension, with men more likely than women to develop the disease. African Americans are most responsive to single-drug therapy (as opposed to combination drug regimens). African Americans are less responsive to angiotensin-converting enzyme inhibitors and beta-blockers. Increased adverse effects (e.g., depression, fatigue, drowsiness) often occur when using thiazide and thiazide-like diuretics. Because African Americans are more responsive to diuretics, the treatment approach should include the firstline use of a diuretic in combination with diet and other lifestyle changes.
32 .
The nurse is caring for a patient newly prescribed iloprost (Ventavis). What is the nurses priority teaching point about this medication?
A)
Inhale this drug six to nine times a day during waking hours.
B)
Men should not touch this pill.
C)
It is safe for use in pregnancy.
D)
The drug causes peripheral dilation of blood vessels.
Ans:
A Feedback: Iloprost is an inhaled synthetic prostacyclin that directly dilates the pulmonary vascular bed, reducing pressure in the pulmonary vascular system, increasing gas exchange, and easing the signs and symptoms of pulmonary arterial hypertension. It is inhaled using a special delivery device six to nine times a day while awake. Patients report dizziness and syncope after using the drug and are therefore encouraged to change position slowly. Men and women should not ingest the drug or get it on their skin. It is a pregnancy category C drug and so is not considered safe in pregnancy.
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33 .
No antihypertensive medication is safe during pregnancy but if the benefit for the mother outweighs the risk to the fetus, what classification of medication can the nurse administer to the hypertensive pregnant woman?
A)
Angiotensin-converting enzyme (ACE) inhibitor
B)
Angiotensin-receptor blocker (ARB)
C)
Renin inhibitor
D)
Calcium channel blocker
Ans:
D Feedback: ACE inhibitors, ARBs, and renin inhibitors should not be used during pregnancy, and women of childbearing age should be advised to use barrier contraceptives to prevent pregnancy while taking these drugs. Calcium channel blockers and vasodilators should not be used in pregnancy unless the benefit to the mother clearly outweighs the potential risk to the fetus.
34 .
The patient was unable to achieve an acceptable blood pressure with just lifestyle changes so in stage 2 of the stepped-care management of hypertension plan, an angiotensin-converting enzyme inhibitor was ordered. In step 3, when inadequate response was obtained from step 2, the nurse anticipates the provider will order what?
A)
A diuretic
B)
A beta-blocker
C)
A calcium channel blocker
D)
A vasodilator
Ans:
A Feedback: In step 3, another drug will be added for combined effect. However, fixedcombination drugs should only be used when the patient has been stabilized on each drug separately. A diuretic would be added before adding another class of medication unless the first drug was a diuretic. Vasodilators are generally used only in hypertensive emergencies.
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35 .
The nurse is caring for a patient with hypertension who is preparing to be discharged from the hospital after suffering a myocardial infarction. What drug might the nurse administer that will both treat his hypertension and reduce myocardial oxygen consumption?
A)
Captopril
B)
Losartan
C)
Diltiazem
D)
Nitroprusside
Ans:
C Feedback: Diltiazem inhibits the movement of calcium ions across the membranes of cardiac and arterial muscle cells, depressing the impulse and leading to slowed conduction, decreased myocardial contractility, and dilation of arterioles, which lowers blood pressure and decreases myocardial oxygen consumption. Captopril, losartan, and nitroprusside do not have actions to reduce myocardial oxygen consumption.
Chapter 12. Vasodilators & the Treatment of Angina Pectoris 1.
A nurse is providing patient teaching to a patient who has been experiencing unstable angina. What will the nurses explanation of this condition include?
A)
A coronary vessel has become completely occluded and is unable to deliver blood to your heart.
B)
The pain is caused by a spasm of a blood vessel, not just from the vessel narrowing.
C)
There is serious narrowing of a coronary artery that is causing a reduction in oxygen to the heart.
D)
Your bodys response to a lack of oxygen in the heart muscle is pain.
Ans:
C Feedback:
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Unstable angina is described as increased narrowing of coronary arteries with the heart experiencing episodes of ischemia even at rest. If a coronary vessel is completely occluded and unable to deliver blood to the cardiac muscle, a myocardial infarction has occurred. Prinzmetals angina is an unusual form of angina caused by spasm of the blood vessel and not just by vessel narrowing. Although pain is the bodys response to ischemia in the heart muscle, this description could encompass angina or a myocardial infarction and is not specific enough to explain the condition. 2.
The nurse cautions the patient taking nadolol (Corgard) for angina that they may experience what adverse effect?
A)
Dry mouth
B)
Decreased exercise tolerance
C)
Constipation
D)
Problems with urination
Ans:
B Feedback: Nadolol is a beta-blocker that can cause a decreased tolerance to exercise because of the inability to experience the effects of the stress reaction. Dry mouth, constipation, and problems with urination are effects often seen with anticholinergic drugs but not with beta-blockers.
3.
A patient who has been taking cyclosporine to prevent rejection of a kidney transplant has had diltiazem ordered. Why would the nurse question this order?
A)
Serious diltiazem toxicity could occur.
B)
The combination may result in elevated or even toxic cyclosporine levels.
C)
The combination could lead to kidney rejection.
D)
A kidney recipient would not effectively excrete the diltiazem.
Ans:
B Feedback:
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Potentially serious adverse effects to keep in mind include increased serum levels and toxicity of cyclosporine if they are taken with diltiazem. This combination is not associated with diltiazem toxicity. A functioning implanted kidney should still excrete diltiazem. This drug would not cause rejection of a transplanted kidney. 4.
A nurse is teaching the patient newly prescribed sublingual nitroglycerin how to take the medication. What will the nurse instruct the patient to do first?
A)
To check his radial pulse
B)
To place the tablet in the buccal cavity
C)
To take a sip of water
D)
To lie down for 15 minutes before administration
Ans:
C Feedback: The nurse should instruct the patient to take a sip of water to moisten the mucous membranes so the tablet will dissolve quickly. The patient does not need to take his pulse or lie down before drug administration. For sublingual administration, the patient will place the tablet under his tongue and not in the buccal cavity (cheek area).
5.
The nurse, caring for a patient taking a beta-blocker and a nitrate to treat angina, recognizes the need for careful monitoring as the result of what secondary diagnosis?
A)
Chronic obstructive pulmonary disease (COPD)
B)
Rheumatoid arthritis (RA)
C)
Irritable bowel syndrome (IBS)
D)
Chronic urinary tract infection (UTI)
Ans:
A Feedback:
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The nurse should assess for COPD, because the effect of beta-blockers in reducing effects of the sympathetic nervous system could exacerbate the respiratory condition. RA, IBS, and chronic UTI are not affected by the use of beta-blockers or nitrates to treat angina. 6.
What drug would the nurse administer to the patient to control angina caused by atherosclerosis that would also slow the development of further plaque buildup on the arterial wall?
A)
Diltiazem (Cardizem)
B)
Propranolol (Inderal)
C)
Amyl Nitrates (generic)
D)
Isosorbide dinitrate (Isordil)
Ans:
A Feedback: Diltiazem is a calcium channel blocker that is indicated to treat Prinzmetals angina, chronic angina, effort-associated angina, and hypertension. Research has indicated these agents slow the development of atherosclerosis. Betablockers are indicated for long-term management of angina caused by atherosclerosis, but they do not slow the development of plaque deposits on the artery wall. Propranolol is a beta-blocker. Isosorbide dinitrate and amyl nitrate are nitrates and are indicated for relief acute anginal pain, but they are not used to prevent angina and have no effect on the progression of atherosclerosis.
7.
An older adult patient who is taking metformin (Glucophage) has just been seen in the clinic. The doctor has ordered metoprolol (Toprol) for angina. What assessment data should the nurse monitor due to this drug combination?
A)
Blood pressure
B)
Blood glucose
C)
Heart rate
D)
Intake and output
Ans:
B
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Feedback: Metformin is an antidiabetic drug and the nurse should monitor the patients blood glucose frequently throughout the day. The patient will not have the usual signs and symptoms of hypoglycemia or hyperglycemia. Blood pressure, heart rate, and intake and output would not be affected by this drugdrug combination. 8.
A patient is to receive diltiazem (Cardizem) 360 mg/d orally in four divided doses. How many mg will the nurse administer per dose?
A)
30 mg
B)
60 mg
C)
90 mg
D)
120 mg
Ans:
C Feedback: The patient will take 90 mg/dose (360 divided by 4 doses equals 90 mg/ dose). Therefore, the other options are incorrect.
9.
The patient, diagnosed with angina, tells the nurse he is having chest pain. There is an order for oral sublingual nitroglycerin as needed. What action should the nurse take?
A)
Place two nitroglycerin tablets under the patients tongue and call the physician.
B)
Place one tablet under the patients tongue and repeat every 5 minutes for total of three tablets until pain has been relieved.
C)
Have the patient swallow a tablet with a full glass of water and repeat in 10 minutes.
D)
Apply a nitroglycerin transdermal patch to the patients back.
Ans:
B Feedback:
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The correct administration for sublingual administration is to place one tablet under the patients tongue and repeat every 5 minutes for a total of three tablets until pain is relieved. If pain is not relieved after three sublingual tablets, the health care provider should be notified. Transdermal application would be inappropriate and nitroglycerin is not swallowed. Administering two tablets at one time would be an inappropriate dosage and could cause serious adverse effects. 10 .
The nurse is caring for a patient who is complaining of chest pain. The nurse is to administer 40 mg of isosorbide dinitrate (Isordil) to the patient. What is the nurses priority assessment before administering the drug?
A)
Jaundice
B)
Headache
C)
Anemia
D)
Sinusitis
Ans:
C Feedback: The nurse should assess for anemia because the decrease in cardiac output could be detrimental in a patient who already has a decreased ability to deliver oxygen because of a low red blood cell count. Jaundice and sinusitis would not be a contraindication to the drug. Headache is an adverse effect of isosorbide and would be expected after administration of the drug.
11 .
A 49-year-old patient is admitted with uncontrolled chest pain. He is currently taking nitroglycerin (Nitrostat). His physician orders nifedipine (Adalat) added to his regimen. The nurse should observe the patient for what adverse effects?
A)
Hypokalemia
B)
Renal insufficiency
C)
Hypotension
D)
Hypoglycemia
Ans:
C
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Feedback: Both nitroglycerin and nifedipine have hypotension as a potential adverse effect so frequent assessment of blood pressure is important. Other cardiovascular effects include bradycardia, peripheral edema, and heart block. Skin effects include flushing and rash. Adverse effects do not include renal insufficiency, hypokalemia, or hypoglycemia. 12 .
What statements by the 54-year-old patient indicates an understanding of the nurses teaching about how to take sublingual nitroglycerin?
A)
A headache means a toxic level has been reached.
B)
I can take up to 3 tablets at 5-minute intervals.
C)
I can take as much nitroglycerin as I need because it is not habit forming.
D)
If I become dizzy after taking the medication, I should stop taking it.
Ans:
B Feedback: Sublingual nitroglycerin may be taken at 5-minute intervals up to a maximum of three doses to relieve anginal chest pain. Headaches are very common due to vasodilation and do not indicate a toxic level. Nitroglycerin causes significant peripheral vasodilation in addition to its therapeutic effects of coronary artery dilation so no more than three tablets should be taken, even though it is not habit forming. Dizziness could be an adverse effect of the drug or a manifestation of inadequate cardiac output, but it would not indicate the patient should stop taking it.
13 .
When the nurse administers a beta-adrenergic blocker to the patient with angina, the nurse expects the drug will help to control angina, but it also has what other effect?
A)
Increased heart rate
B)
Increased oxygen consumption
C)
Decreased strength of heart muscle contraction
D)
Decreased urinary output
Ans:
C
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Feedback: Beta-blockers competitively block beta-adrenergic receptors in the heart and kidneys, decreasing the influence of the sympathetic nervous system on these tissues and the excitability of the heart. As a result, it decreases the strength of cardiac contraction, reducing cardiac output, which results in lowered blood pressure and decreased cardiac workload. It does not impact urinary output. 14 .
The nurse is caring for a patient who takes nitroglycerin sublingually. When providing patient education, the nurse would tell the patient that she can expect relief of chest pain within what period of time?
A)
1 to 3 minutes
B)
5 to 10 minutes
C)
15 to 20 minutes
D)
30 to 60 minutes
Ans:
A Feedback: Nitroglycerin acts within 1 to 3 minutes. Other options are incorrect.
15 .
When providing patient education about nitroglycerin to the patient, what would the nurse include in the teaching plan about a nitroglycerin patch?
A)
It only has to be administered once a week.
B)
It is more effective than tablets in treating angina.
C)
It has a longer duration of action.
D)
It is faster acting than the tablets.
Ans:
C Feedback: Transdermal nitroglycerin has a long 24-hour duration of action compared with the sublingual form that lasts 30 to 60 minutes or oral tablets that last 8 to 12 hours. Transdermal patches are neither more nor less effective, but rather it is the speed of onset and duration of action that differ.
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16 .
Which statement by the patient would lead the nurse to believe that he has understood the teaching provided regarding angina?
A)
I will not exercise because it precipitates angina.
B)
As long as I take the medicine, I need make no lifestyle change.
C)
There is no correlation between my hypertension and angina.
D)
Heavy meals and cigarette smoking can precipitate an angina attack.
Ans:
D Feedback: Avoid stressful activities, especially in combination. For example, if you eat a big meal, do not drink coffee or alcoholic beverages with that meal. If you have just eaten a big meal, do not climb stairs; rest for a while. However, exercise is important and should not be eliminated, but managed in coordination with other activities. Smoking causes vasoconstriction that can result in angina attacks so lifestyle changes like reducing fat and calories in the diet, moderate exercise, reducing alcohol intake and avoiding smoking are all healthful choices. Hypertension does increase the risk of angina and coronary artery disease.
17 .
The nurse is caring for a patient who is taking a calcium-channel blocker. What adverse effects would the nurse caution this patient about?
A)
Hypertension and tachycardia
B)
Headache and dizziness
C)
Itching and rash
D)
Nausea and diarrhea
Ans:
B Feedback:
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The adverse effects associated with these drugs are related to their effects on cardiac output and on smooth muscle. Central nervous system (CNS) effects include dizziness, light-headedness, headache, and fatigue. Gastrointestinal (GI) effects can include nausea and hepatic injury related to direct toxic effects on hepatic cells. Cardiovascular effects include hypotension, bradycardia, peripheral edema, and heart block. Skin effects include flushing and rash. The adverse effects do not, however, include diarrhea, hypertension, tachycardia, or itching. 18 .
The nurse assesses patients receiving nifedipine (Adalat) for what adverse effects?
A)
Ascites
B)
Asthma
C)
Peripheral edema
D)
Tetany
Ans:
C Feedback: Peripheral edema, heart block, bradycardia, and hypotension can occur with calcium-channel blockers. Asthma, ascites, and tetany are not associated with these drugs.
19 .
What adverse reaction does the nurse anticipate if the 56-year-old patient takes his beta-blocker with clonidine?
A)
Hypertension
B)
Bradycardia
C)
Angina
D)
Syncope
Ans:
A Feedback:
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A paradoxical hypertension occurs when clonidine is given with betablockers, and an increased rebound hypertension with clonidine withdrawal may also occur. It is best to avoid this combination. Bradycardia, angina, and syncope are not associated with this drug combination. 20 .
An asthmatic patient taking beta-blockers should be assessed by the nurse for what potential adverse reaction?
A)
Bronchospasm
B)
Hypoglycemia
C)
Pleural effusion
D)
Pneumonia
Ans:
A Feedback: Bronchospasm can occur with beta blockade. The patient would not have to be observed for hypoglycemia, pleural effusion, or pneumonia.
21 .
The nurse should instruct the patient to take what action if three nitroglycerin tablets taken sublingually are not effective in eliminating chest pain?
A)
To call 911
B)
To call her health care provider
C)
To lie down after taking an aspirin
D)
To take more tablets until pain subsides
Ans:
A Feedback: Instruct patient that a sublingual dose may be repeated in 5 minutes if relief is not felt, for a total of three doses, if pain persists, the patient or a family member should call 911 to ensure proper medical support if a myocardial infarction should occur. She should not waste time by calling the health care provider; she can lie down while waiting for the ambulance to arrive, she should not take more tablets.
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22 .
The nurse is caring for a patient who takes metoprolol for angina. The patient asks how long it takes for the medicine to work. What is the nurses best response?
A)
15 minutes
B)
30 minutes
C)
1 hour
D)
90 minutes
Ans:
A Feedback: Oral metoprolol has an onset of action of 15 minutes. Other options are incorrect.
23 .
The nurse teaches the patient wearing a nitroglycerin patch to avoid what?
A)
Exercise
B)
Alcoholic beverages
C)
Milk products
D)
Synthetic fabrics
Ans:
B Feedback: Patients should be taught to avoid or at least decrease use of coffee, cigarettes, and alcoholic beverages. There is no need to avoid exercise, milk, or synthetic fabrics.
24 .
The nurse is caring for a patient who is taking a sustained-release (SR) oral nitrate. How should the nurse instruct this patient to take the medication?
A)
With water
B)
Sublingually until absorbed
C)
With milk or milk products
D)
1 hour after eating
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Ans:
A Feedback: Give SR forms with water, and caution the patient not to chew or crush them, because these preparations need to reach the gastrointestinal (GI) tract intact to avoid overdosage. They are not dissolved sublingually but swallowed whole. They are best taken on an empty stomach 1 hour before meals.
25 .
An adult patient who experiences angina pectoris with exertion is informed by the nurse that the leading cause of angina is what?
A)
Smoking
B)
Inadequate cardiac output
C)
Infarction of the myocardium
D)
Coronary atherosclerosis
Ans:
D Feedback: The person with atherosclerosis has a classic supply-and-demand problem. The heart may function without a problem until increases in activity or other stresses place a demand on it to beat faster or harder. Normally, the heart would stimulate the vessels to deliver more blood when this occurs, but the narrowed vessels are not able to respond and cannot supply the blood needed by the working heart. The heart muscle then becomes hypoxic. This imbalance between oxygen supply and demand is manifested as pain, or angina pectoris, which literally means suffocation of the chest. Atherosclerosis of the coronary artery can block the coronary artery completely leading to infarction. Smoking causes further vasoconstriction, increasing risk of myocardial infarction or angina. Damage to the heart muscle causes a decrease in cardiac output.
26 .
The nurse is caring for a patient prescribed ranolazine. The patient asks why this drug is different from the beta-blocker that he was previously taking. What is the nurses best response?
A)
This drug does not slow your heart rate.
B)
This drug increases myocardial oxygen demand.
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C)
This drug slows the QT intervals.
D)
This maintains blood pressure with no hypotensive effects.
Ans:
A Feedback: The newest drug approved for the treatment of angina is a piperazine acetamide agent called ranolazine. The mechanism of action of this drug is not understood. It prolongs QT intervals, does not slow heart rate or blood pressure, but decreases myocardial oxygen demand.
27 .
After the patients anginal pain is relieved he says to the nurse, That nitroglycerin works great. How does it do that? What is the nurses best response?
A)
Nitroglycerin decreases the amount of oxygen needed by the heart to function.
B)
Nitroglycerin makes the coronary arteries open much wider.
C)
Nitroglycerin promotes growth of new, smaller arteries to supply oxygen to the heart.
D)
Nitroglycerin decreases preload and afterload.
Ans:
A Feedback: The main effect of nitrates seems to be related to the drop in blood pressure that occurs. The vasodilation causes blood to pool in veins and capillaries, decreasing preload, while the relaxation of the vessels decreases afterload. The combination of these effects greatly reduces the cardiac workload and the demand for oxygen, thus bringing the supply-and-demand ratio back into balance. Because coronary artery disease causes a stiffening and lack of responsiveness in the coronary arteries, the nitrates probably have very little effect on increasing blood flow through the coronary arteries, so it would be incorrect to say that the coronary arteries become much wider. Although both preload and afterload are reduced, this is an explanation that the patient would not understand, so it is inappropriate. Nitroglycerin does not promote growth of compensatory circulation.
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28 .
An adult patient has had symptoms of unstable angina during admission to the hospital. What is the most appropriate nursing diagnosis?
A)
Deficient knowledge about underlying disease and methods for avoiding complications
B)
Anxiety related to fear of death
C)
Ineffective tissue perfusion (total body) related to reduced oxygen supply to the heart
D)
Noncompliance related to failure to accept necessary lifestyle changes
Ans:
C Feedback: The most appropriate nursing diagnosis is ineffective tissue perfusion related to reduced oxygen supply to the heart because this is the cause of the patients pain. Further assessment would be needed to determine whether the patient lacks knowledge, fears death, or has made the necessary lifestyle changes.
29 .
The nurse is preparing to administer sublingual nitroglycerin to a patient for the first time and warns that the patient may experience what right after administration?
A)
Nervousness or paresthesia
B)
Throbbing headache or dizziness
C)
Drowsiness or blurred vision
D)
Tinnitus or diplopia
Ans:
B Feedback: Headache and dizziness commonly occur at the start of nitroglycerin therapy. When administering nitroglycerin, the nurse must use caution to avoid self-contamination, especially with the topical paste formulation because the nurse can experience the same symptoms. However, the patient usually develops a tolerance. Nervousness, paresthesia, drowsiness, blurred vision, tinnitus, and diplopia do not occur as a result of nitroglycerin therapy.
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30 .
A patient is diagnosed with Prinzmetals angina. What drug would the nurse expect to administer to this patient?
A)
Nadolol
B)
Diltiazem
C)
Propranolol
D)
Metoprolol
Ans:
B Feedback: Calcium channel blockers are indicated for the treatment of Prinzmetals angina because these drugs relieve coronary artery vasospasm, increasing blood flow to the muscle cells. Diltiazem is a calcium channel blocker. Betablockers are not indicated for the treatment of Prinzmetals angina because they could cause vasospasm due to blocking of beta-receptor sites. Propranolol, nadolol, and metoprolol are beta-blockers.
31 .
The nurse is caring for a patient diagnosed with human immunodeficiency virus (HIV) and newly diagnosed angina. What drug would the nurse question if ordered?
A)
Ranolazine (Ranexa)
B)
Nitroglycerin (generic)
C)
Propranolol
D)
Diltiazem
Ans:
A Feedback: Drugdrug interactions can occur with ketoconazole, diltiazem, verapamil, macrolide antibiotics, and HIV protease inhibitors; these combinations should be avoided because ranolazine levels may become extremely high. The nurse should get a complete list of current medications and consult with the health care provider regarding drug interactions before administering the medication as ordered. Nitroglycerin, propranolol, and diltiazem have no contraindication with medications used to treat HIV.
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32 .
Other than angina, what other medical condition might the nurse treat by administering nitroglycerin?
A)
Muscular dystrophy
B)
Pulmonary embolisms
C)
Polycythemia
D)
Anal fissures
Ans:
D Feedback: In 2011, a nitroglycerin in ointment form, Rectiv 0.4%, was approved for the treatment of moderate to severe anal fissures. There is no documented benefit to the use of nitroglycerin to treat muscular dystrophy, pulmonary embolisms, or polycythemia.
33 .
What would the nurse teach the patient about potency of nitroglycerin? (Select all that apply.)
A)
The tablet should fizzle or burn when placed under the tongue.
B)
Protect the drug from heat and light.
C)
Always replace when past the expiration date.
D)
Older tablets may require you to use two tablets at one time.
E)
Nitroglycerin does not lose its potency easily.
Ans:
A, B, C Feedback: Ask the patient if the tablet fizzles or burns, which indicates potency. Always check the expiration date on the bottle and protect the medication from heat and light because these drugs are volatile and lose potency easily.
34 .
The nurse teaches the patient how to use topical nitroglycerin and includes what teaching points in the teaching plan? (Select all that apply.)
A)
Rotate application sites.
B)
Assess the skin for signs of breakdown.
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C)
Make sure no one touches the side with the medication.
D)
Do not shower with the patch in place.
E)
Increase fluid intake to avoid hypotension.
Ans:
A, B, C Feedback: Rotate the sites of topical forms of nitroglycerin to lower the risk of skin abrasion and breakdown; monitor for signs of skin breakdown to arrange for appropriate skin care as needed. Care should be taken not to touch the side of the patch with the medication by the patient or anyone assisting in applying the patch. The patient may shower with the patch in place. There is no need to increase fluid intake but patients should be encouraged to maintain adequate intake.
35 .
The provider orders isosorbide dinitrate as oral maintenance drug to prevent angina. What dosage would the nurse administer without need to question the dose?
A)
2.5 mg
B)
80 mg
C)
40 mg
D)
5 mg
Ans:
B Feedback: A maintenance oral dose of isosorbide dinitrate is 10 to 40 mg every 6 hours. Sublingual dose is 2.5 to 5 mg, sustained release is 40 to 80 mg, and the chewable tablet is 5 mg.
Page 1
Chapter 13. Drugs Used in Heart Failure 1.
A patient presents to the emergency department with rales, wheezing, and blood-tinged sputum. What does the nurse recognize that these symptoms indicate?
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A)
Cardiomyopathy
B)
Cardiomegaly
C)
Valvular heart disease
D)
Pulmonary edema
Ans:
D Feedback: In left-sided heart failure, the left ventricle pumps inefficiently resulting in a backup of blood into the lungs causing pulmonary vessel congestion and fluid leaks into the alveoli and lung tissue. As more fluid continues to collect in the alveoli, pulmonary edema develops. The patient will present with rales, wheezes, blood-tinged sputum, low oxygenation, and development of a third heart sound. Cardiomyopathy can occur as a result of a viral infection, alcoholism, anabolic steroid abuse, or a collagen disorder. It causes muscle alterations and ineffective contraction and pumping. Cardiomegaly is an enlargement of the heart due to compensatory mechanisms in congestive heart failure (CHF) and leads to ineffective pumping and eventually exacerbated CHF. Valvular heart disease leads to an overload of the ventricles because the valves do not close adequately causing blood to leak backward. This causes muscle stretching and increased demand for oxygen and energy.
2.
What electrolyte inactivates troponin and allows actin and myosin to form a bridge enabling the muscle fibers to contract?
A)
Magnesium
B)
Calcium
C)
Potassium
D)
Sodium
Ans:
B Feedback: Calcium must be present to deactivate troponin so that actin and myosin can react to form actinomycin bridges. Potassium, sodium, and magnesium do not affect troponin.
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3.
A 62-year-old African American man diagnosed with congestive heart failure and hypertension has BiDil included in his drug therapy. What nursing assessment finding would indicate the patient is developing a complication from this drug?
A)
Alopecia
B)
Photosensitivity
C)
Anorexia
D)
Orthostatic hypotension
Ans:
D Feedback: Orthostatic hypotension is an adverse effect of a combination of isosorbide dinitrate and hydralazine called BiDil. This could lead to safety concerns and should be addressed in drug teaching for this patient. Alopecia, photosensitivity, and anorexia are not adverse effects related to this drug.
4.
The nurse is preparing digoxin for an infant. What is the nurses priority intervention?
A)
To perform hand hygiene
B)
To have another nurse check dosage calculations
C)
To check the childs apical pulse
D)
To identify the patient by checking the ID bracelet
Ans:
B Feedback: The margin of safety for the dosage of this drug is very narrow in children. The dosage needs to be very carefully calculated and should be doublechecked by another nurse before administration. The other options are important and the nurse should implement all three. However, these actions are of lower priority.
5. A)
A patient asks the nurse what cardiac glycosides do to improve his condition. What is the nurses best response? They decrease the force of myocardial contractions.
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B)
They help renal blood flow and increase urine output.
C)
They increase heart rate.
D)
They increase conduction velocity.
Ans:
B Feedback: Cardiac glycosides increase intracellular calcium and allow more calcium to enter myocardial cells. This action causes an increased force of myocardial contraction, an increased cardiac output, and renal perfusion that increases urine output. Cardiac glycosides also serve to slow the heart rate and decrease conduction velocity.
6.
What is the priority nursing assessment for a patient who is about to begin digoxin therapy?
A)
Blood glucose levels
B)
Neurological function
C)
Kidney function
D)
Liver function
Ans:
C Feedback: Digoxin is primarily excreted unchanged in the urine, so caution should be exercised if renal impairment is present. Blood glucose levels and neurological and liver function would not be a priority assessment related to digoxin therapy.
7.
A triage nurse in the emergency department is assessing a 78-year-old man. It is determined that the patient is experiencing severe digoxin toxicity. What drug will the nurse administer immediately?
A)
Inamrinone (Inocor)
B)
Digoxin immune Fab (Digibind)
C)
Verapamil hydrochloride (Calan)
D)
Quinidine sulfate
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Ans:
B Feedback: Digoxin immune Fab is an antigen-binding fragment derived from specific antidigoxin antibodies. The drug is used for the treatment of life-threatening digoxin intoxication when serum levels are greater than 10 ng/mL. Inamrinone is a phosphodiesterase inhibitor that acts as a cardiotonic agent. Verapamil hydrochloride is a calcium channel blocker. Quinidine is an antiarrhythmic agent that when taken with digoxin increases both the therapeutic and toxic effects of digoxin.
8.
The nurse is providing patient teaching to a patient who has been prescribed digoxin. The patient tells the nurse that she occasionally use herbals and other alternative therapies. What herb would the nurse warn the patient to avoid taking with digoxin?
A)
Black cohosh
B)
Ginseng
C)
Saw palmetto
D)
Valerian
Ans:
B Feedback: Digoxin toxicity can occur if the drug is taken concurrently with licorice, ginseng, or hawthorn. St. Johns wort and psyllium have been shown to decrease the effectiveness of digoxin, so that combination should be avoided. There is no drug-to-drug interaction with black cohosh, saw palmetto, or valerian.
9.
The nurse administers an IV phosphodiesterase inhibitor. What drug will result in forming a precipitate if given via the same IV line without adequate flushing?
A)
Albuterol (Proventil)
B)
Nifedipine (Procardia)
C)
Furosemide (Lasix)
D)
Lovastatin (Mevacor)
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Ans:
C Feedback: Furosemide, when given with a phosphodiesterase inhibitor, forms precipitates; therefore, this combination should be avoided. Use alternate lines if both of these drugs are being given IV. There are no known drug-todrug interactions with albuterol, nifedipine, or lovastatin.
10 .
A 6-year-old child weighing 60 pounds has been prescribed oral digoxin (Lanoxin) 30 mcg/kg as a loading dose. How many milligram will she be given?
A)
0.218 mg
B)
0.418 mg
C)
0.618 mg
D)
0.818 mg
Ans:
D Feedback: First, using the formula: 2.2 pounds and 60 pounds: multiplied by kg, determine the childs weight in kg (60/2.2 = 27.27 kg). Next, using the formula: amount of drug prescribed times weight in kg, determine the dose in mcg the child should receive (30 multiplied by 27.27 = 0. 818 mcg). Then to determine the amount of mg the child should receive, use the formula: 1 mg: 1,000 mcg = X mg: 818 mcg (818/1,000 = 0.818 mg).
11 .
The nurse assesses the patient before administering digoxin (Lanoxin) and withholds the drug and notifies the physician with what finding?
A)
Respiratory rate falls below 14
B)
History reveals liver failure
C)
Pulse is 44 beats/min
D)
Blood pressure is 72/40 mm Hg
Ans:
C Feedback:
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Monitor apical pulse for 1 full minute before administering the drug to assess for adverse effects. Hold the dose if the pulse is less than 60 beats/min in an adult or less than 90 beats/min in an infant; retake pulse in 1 hour. If pulse remains low, document pulse, withhold the drug, and notify the prescriber. 12 .
When a drug is said to increase the force of contraction of the heart muscle, the nurse appropriately uses what term?
A)
Positive chronotropic
B)
Positive inotropic
C)
Negative inotropic
D)
Negative dromotropic
Ans:
B Feedback: Sympathetic stimulation causes an increase in heart rate, blood pressure, and rate and depth of respirations, as well as a positive inotropic effect (increased force of contraction) on the heart and an increase in blood volume (through the release of aldosterone). A negative inotropic effect would be one that decreased the force of a contraction. A negative dromotropic effect is one that slows the conduction of the impulse through the atrioventricular node. A positive chronotropic effect is one that increases the heart rate.
13 .
The nurse, caring for a patient who is receiving cardiac glycosides to treat heart failure, will teach the patient to follow what diet?
A)
High sodium, low potassium, high fat
B)
Low sodium, low potassium, low fat
C)
High iron, high calcium, high potassium
D)
Low sodium, high potassium, low fat
Ans:
D Feedback:
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Restrict dietary sodium to reduce edema in patients receiving cardiac glycosides. If the patient is hyponatremic or using a potassium-losing diuretic, increase potassium in diet, as well as limit fat intake to reduce weight and atherogenic activity. 14 .
What order for a digitalizing dose of digoxin (Lanoxin) for a 62-year-old man would the nurse consider appropriate and safe to administer?
A)
1.25 mg IV now
B)
0.75 mg orally now
C)
0.25 mg orally every day
D)
1 mg intramuscularly every 4 hours 24 hours
Ans:
B Feedback: Digoxin: Adult: loading dose 0.75 to 1.25 mg orally or 0.125 to 0.25 mg IV, then oral maintenance dose of 0.125 to 0.25 mg/d; decrease dose with renal impairment.
15 .
After administering an IV dose of digoxin, the nurse would expect to see effects within what period of time?
A)
30 to 120 minutes
B)
5 to 30 minutes
C)
1 hour
D)
2 hours
Ans:
B Feedback: The drug has a rapid onset of action and rapid absorption (30 to 120 minutes when taken orally, 5 to 30 minutes when given IV).
16 . A)
The patient taking digoxin (Lanoxin) has developed an infection. What antibiotic can the nurse safely administer to this patient? Zithromax
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B)
Erythromycin
C)
Tetracycline
D)
Cyclosporine
Ans:
A Feedback: Zithromax may be given without impacting the effects of digoxin. There is a risk of increased therapeutic effects and toxic effects of digoxin if it is taken with verapamil, amiodarone, quinidine, quinine, erythromycin, tetracycline, or cyclosporine. If digoxin is combined with any of these drugs, it may be necessary to decrease the digoxin dose to prevent toxicity. If one of these drugs has been part of a medical regimen with digoxin and is discontinued, the digoxin dose may need to be increased.
17 .
The 96-year-old patient is receiving digoxin (Lanoxin) and furosemide (Lasix). In the morning, the patient complains of a headache and nausea. What will the nurse do first?
A)
Contact the patients physician immediately.
B)
Check her laboratory values and vital signs.
C)
Administer acetaminophen and Maalox.
D)
Give her clear liquids and have her lie down.
Ans:
B Feedback: The nurse will check the patients digoxin level and electrolytes. Assessing vital signs is important because the risk of cardiac arrhythmias could increase due to the patients receiving furosemide, which is a potassiumlosing diuretic. The adverse effects most frequently seen with the cardiac glycosides include headache, weakness, drowsiness, and vision changes (a yellow halo around objects is often reported). Gastrointestinal (GI) upset and anorexia also commonly occur. Only after checking lab values and assessing vital signs might the nurse call the physician. Acetaminophen and Maalox would not be indicated. Having her lie down and restricting her diet to clear liquids would be appropriate but not the first actions.
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18 .
The nurse provides teaching about digoxin to the 62-year-old patient. The nurse evaluates patient understanding and determines further teaching is needed when the patient says she will do what?
A)
Take the medication daily in the morning.
B)
Take her pulse before taking her dose.
C)
Weigh herself daily at the same time.
D)
Take the medication with a meal.
Ans:
D Feedback: Avoid administering the oral drug with food or antacids to avoid delays in absorption. The other answers are appropriate actions for the patient to take when self-administering digoxin.
19 .
When administering milrinone (Primacor), the nurse will assess the patient for what common adverse effect?
A)
Hypoglycemia
B)
Confusion
C)
Hypotension
D)
Seizures
Ans:
C Feedback: The adverse effects most frequently seen with these drugs are ventricular arrhythmias (which can progress to fatal ventricular fibrillation), hypotension, and chest pain. Hypoglycemia, confusion, and seizures are not generally adverse effects of milrinone.
20 .
The nurse administers a cardiac glycoside for what therapeutic effect?
A)
To decrease cardiac output
B)
To decrease afterload
C)
To increase ventricular rate
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D)
To increase the force of the contraction of the heart
Ans:
D Feedback: Cardiac glycosides exert a negative cardiotonic and positive inotropic effect. They do not decrease cardiac output, decrease afterload, or increase the ventricular rate of the heart.
21 .
After administering digoxin, what assessment finding would indicate to the nurse that the drug was having the desired effect?
A)
Increased heart size
B)
Increased urinary output
C)
Decreased respiratory rate
D)
Increased heart rate
Ans:
B Feedback: As cardiac output improves, so does urinary output due to increased renal perfusion. Respiratory rate and heart size would not be impacted by the drug, although ventricular hypertrophy is a common finding in patients with heart failure. Heart rate would decrease as the force of contraction increases, ejecting more blood with each contraction.
22 .
What assessment finding would indicate the patients left-sided heart failure is worsening?
A)
Increased jugular venous pressure
B)
Liver enlargement
C)
Increased crackles in lung fields
D)
Increased pulse rate
Ans:
C Feedback:
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Fluid may accumulate in the lungs due to left sided heart failure. Patients may evidence dyspnea, tachypnea, and orthopnea. Right-sided failure would include increased jugular venous pressure and liver enlargement. Pulse rate could increase or decrease depending on medications administered. 23 .
Which drug is in the class of drugs called human B-type natriuretic peptides?
A)
Bosentan (Tracleer)
B)
Milrinone (Primacor)
C)
Digoxin (Lanoxin)
D)
Nesiritide (Natrecor)
Ans:
D Feedback: Nesiritide is the only drug currently available in a class of drugs called human B-type natriuretic peptides. Digoxin is a cardiac glycoside. Milrinone is a phosphodiesterase inhibitor. Bosentan is an endothelin receptor antagonist.
24 .
The nurse reviews the patients lab results and recognizes the patient is at risk for digoxin toxicity due to what electrolyte imbalance?
A)
Hyperkalemia
B)
Hypokalemia
C)
Hypernatremia
D)
Hyponatremia
Ans:
B Feedback: Electrolyte abnormalities (e.g., increased calcium, decreased potassium, decreased magnesium) could alter the action potential and change the effects of the drug. Hypokalemia and hypomagnesemia increase cardiac excitability and ectopic pacemaker activity leading to dysrhythmias.
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25 .
What common action do both cardiac glycosides and phosphodiesterase inhibitors have in common related to therapeutic action?
A)
Blocking the enzyme phosphodiesterase
B)
Increasing cellular calcium
C)
Developing ventricular arrhythmias
D)
Metabolizing in the liver and excreted in the urine
Ans:
B Feedback: The phosphodiesterase inhibitors block the enzyme phosphodiesterase. This blocking effect leads to an increase in myocardial cell cyclic adenosine monophosphate (cAMP), which increases calcium levels in the cell (Figure 44.4). Increased cellular calcium causes a stronger contraction and prolongs the effects of sympathetic stimulation, which can lead to vasodilation, increased oxygen consumption, and arrhythmias. Digoxin also increases intracellular calcium and allows more calcium to enter myocardial cells during depolarization.
26 .
The nurse evaluates an improvement in the patients heart failure (HF) status based on what assessment finding?
A)
Using fewer pillows to sleep
B)
Increased skin turgor
C)
Heart rate regular
D)
Improved mental status
Ans:
A Feedback: The degree of HF is often calculated by the number of pillows required to get relief (e.g., one-pillow, two-pillow, or three-pillow orthopnea). Fluid overload is associated with HF so skin turgor is not an indicator of improvement. Regular heart rate and normal cognition can be found with acute flare-ups of HF so these findings would not indicate improvement.
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27 .
The nurse suspects the patient may have toxic levels of digoxin in the bloodstream when what is assessed? (Select all that apply.)
A)
Irregular heart rhythms
B)
Nausea
C)
Anorexia
D)
Headache
E)
Peripheral edema
Ans:
A, B, C Feedback: Digoxin toxicity is a serious syndrome that can occur when digoxin levels are too high. The patient may present with anorexia, nausea, vomiting, malaise, depression, irregular heart rhythms including heart block, atrial arrhythmias, and ventricular tachycardia. Peripheral edema is indicative of heart failure, not digoxin toxicity. Headache is not usually associated with digoxin toxicity.
28 .
The patient has been prescribed inamrinone (Inocor). Before administering the drug the nurse needs to know the drug has what pharmacokinetic effect?
A)
Decrease in cyclic adenosine monophosphate (cAMP)
B)
Decrease in cardiac output
C)
Increase in cardiac preload
D)
Increase in cAMP
Ans:
D Feedback: Inamrinone is a phosphodiesterase inhibitor that blocks the enzyme phosphodiesterase. This blocking effect leads to an increase in myocardial cell cAMP, which increases calcium levels in the cell. These drugs do not decrease cardiac output or increase cardiac preload.
29 .
The patient has just been prescribed milrinone (Primacor). The nurse recognizes the drug is contraindicated due to the patients allergy to what?
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A)
Penicillins
B)
Salicylates
C)
Opioids
D)
Bisulfites
Ans:
D Feedback: Phosphodiesterase inhibitors are contraindicated in the presence of allergy to the drug or to bisulfites. Penicillins, salicylates, and opioids have no contraindications when used with milrinone.
30 .
The nurse administers a human B-type natriuretic peptide with the expectation it will have what action?
A)
Decrease blood volume
B)
Increase force of cardiac contraction
C)
Reduce venous return
D)
Lighten the hearts workload
Ans:
C Feedback: Human B-type natriuretic peptides are normally produced by myocardial cells as a compensatory response to increased cardiac workload and increased stimulation by the stress hormones. They bind to endothelial cells, leading to dilation and resulting in decreased venous return, peripheral resistance, and cardiac workload. They also suppress the bodys response to the stress hormones, leading to increased fluid loss and further decrease in cardiac workload. Diuretics decrease blood volume, cardiac glycosides increase force of contraction, and vasodilators lighten the hearts workload.
31 .
The nurse expects the patients heart failure (HF) is caused by what diagnosis that is responsible for 95% of the cases diagnosed?
A)
Cardiomyopathy
B)
Hypertension
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C)
Congenital anomaly
D)
Coronary artery disease (CAD)
Ans:
D Feedback: CAD is the leading cause of HF, accounting for approximately 95% of the cases diagnosed. CAD results in an insufficient supply of blood to meet the oxygen demands of the myocardium. Consequently, the muscles become hypoxic and can no longer function efficiently. When CAD evolves into a myocardial infarction, muscle cells die or are damaged, leading to an inefficient pumping effort. Cardiomyopathy, hypertension, and congenital anomaly are rarely associated with heart failure.
32 .
The nurse prepares to administer a phosphodiesterase inhibitor by what route?
A)
Oral
B)
IV
C)
Subcutaneous
D)
Intramuscular
Ans:
B Feedback: Phosphodiesterase inhibitors are only given IV. They cannot be given orally, intramuscularly, or subcutaneously.
33 .
The nurse is caring for a patient who has digoxin toxicity. As the nurse assesses the changes in the patients daily activities, what finding could indicate the cause of the toxic level?
A)
The patient has been sleeping more lately.
B)
The patient took nitroglycerin for chest pain twice yesterday.
C)
The patients daughter brought her a bag of licorice that she has been enjoying.
D)
The patients intake of sodium increased lately because shes been eating seafood.
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Ans:
C Feedback: Increased digoxin toxicity has been reported with ginseng, hawthorn, and licorice. Patients should be advised to avoid these combinations. Increased sodium intake will exacerbate the patients heart failure, which might explain why she is sleeping more and requiring nitroglycerin but these actions did not contribute to the digoxin toxicity.
34 .
The nurse admits a patient to the constant care unit with a digoxin level of 11 ng/mL and a serum potassium level of 5.2 mEq/L. Digoxin immune Fab is administered. The next day, the patients digoxin level remains elevated. What action does the nurse anticipate?
A)
Administer digoxin immune Fab again.
B)
Administer a reduced dosage of digoxin.
C)
Continue to monitor the patients digoxin level daily.
D)
Notify the health care provider of the elevated level.
Ans:
C Feedback: Serum digoxin levels will be very high and unreliable for about 3 days after the digoxin immune Fab infusion because of the high levels of digoxin in the blood. The patient should not be redigitalized for several days to 1 week after digoxin immune Fab has been used, because of the potential of fragments remaining in the blood. There is no need to notify the health care provider or to administer digoxin immune Fab again.
35 .
The nurse is preparing to administer a digitalizing dosage of digoxin to a geriatric patient. What factors will the nurse assess for first to avoid digoxin toxicity? (Select all that apply.)
A)
Renal function
B)
Low body mass
C)
Hydration
D)
Assessment of pulse
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E)
Cognitive function
Ans:
A, B, C Feedback: Factors that may contribute to elevated digoxin levels include impaired renal function, low body mass, and dehydration. Assessment of pulse and cognitive function are always important when caring for a geriatric patient, but they will not contribute to elevated digoxin levels.
Chapter 14. Agents Used in Cardiac Arrhythmias 1.
A patient with a history of atrial fibrillation has had a worsening of his or her condition. The nurse knows that the drug of choice for long-term stabilization of atrial fibrillation following electrocardioversion is what?
A)
Disopyramide (Norpace)
B)
Moricizine (Ethmozine)
C)
Procainamide (Pronestyl)
D)
Quinidine (generic)
Ans:
D Feedback: Quinidine is often the drug of choice for long-term stabilization of atrial fibrillation after the rhythm is converted by electrocardioversion. Quinidine is a class I antiarrhythmic and stabilizes the cell membrane by binding to sodium channels, depressing phase 0 of the action potential, and changing the duration of the action potential. Disopyramide, moricizine, and procainamide are all used in the treatment of life-threatening ventricular arrhythmias.
2.
What class of antiarrhythmics drug blocks potassium channels, prolonging phase 3 of the action potential and slowing the rate and conduction of the heart?
A)
I
B)
II
C)
III
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D)
IV
Ans:
C Feedback: The class III antiarrhythmics block potassium, prolonging phase 3 of the action potential, which prolongs repolarization and slows the rate and conduction of the heart. Class I drugs block the sodium channels in the cell membrane during an action potential. Class II drugs are beta-adrenergic blockers that block beta-receptors, causing a depression of phase 4 of the action potential. Class IV drugs block calcium channels in the cell membrane leading to a depression of depolarization and a prolongation of phases I and II of repolarization, which slows automaticity.
3.
The nurse is caring for a pediatric patient who has been diagnosed with paroxysmal atrial tachycardia. The order reads digoxin 10 mcg/kg orally. The child weighs 44 pounds. How many mcg will the nurse administer?
A)
50 mcg
B)
100 mcg
C)
150 mcg
D)
200 mcg
Ans:
D Feedback: The nurse will administer 200 mcg. (2.2 pounds: 1 kg = X: 20 kg, 20(10) = 200 mcg).
4.
The nurse is providing drug teaching about quinidine in preparation for the patients discharge. The nurse discusses drugfood interactions and advises the patient to drink what?
A)
Apple juice
B)
Grapefruit juice
C)
Milk
D)
Orange juice
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Ans:
A Feedback: Apple juice would be the best choice. Quinidine requires a slightly acidic urine (normal state) for excretion. Patients receiving quinidine should avoid foods that alkalinize the urine (e.g., citrus juices, vegetables, antacids, milk products), which could lead to increased quinidine levels and toxicity. Grapefruit juice has been shown to interfere with the metabolism of quinidine, leading to increased serum levels and toxic effects; this combination should be avoided.
5.
A patient has had sotalol (Betapace) ordered for treatment of a ventricular arrhythmia. What will the nurse consider when administering the drug?
A)
Sotalol has a very short duration of action
B)
Food increases the bioavailability of the drug
C)
Absorption of sotalol is decreased by the presence of food
D)
The drug is best administered intramuscularly
Ans:
C Feedback: This drug should not be taken with food because absorption is decreased. The drug should be given 1 hour before or 2 hours after a meal. Adenosine, not sotalol, has a very short duration of action and food increases the bioavailability of propranolol. Sotalol is administered by oral route only.
6.
The nurse is caring for a patient who reports insomnia since starting the antiarrhythmic agent prescribed for him or her. What antiarrhythmic agent would the nurse expect this patient is taking?
A)
Disopyramide (Norpace)
B)
Amiodarone (Cordarone)
C)
Procainamide (Pronestyl)
D)
Propranolol (Inderal)
Ans:
D
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Feedback: Class II antiarrhythmics can cause insomnia. The adverse effects associated with class II antiarrhythmics are related to the effects of blocking betareceptors in the sympathetic nervous system. CNS effects include dizziness, insomnia, unusual dreams, and fatigue. Disopyramide and procainamide are class I agents and do not cause insomnia. Amiodarone is a class III drug and is not associated with insomnia. 7.
A patient with impaired renal function is to receive dofetilide (Tikosyn) for conversion of atrial fibrillation. What is the nurses priority assessment before administering the drug?
A)
Check the patients creatinine level.
B)
Measure the urine output.
C)
Listen to breath sounds.
D)
Measure the PR interval on the electrocardiogram.
Ans:
A Feedback: When giving dofetilide to a patient with renal dysfunction, the dosage must be calculated according to the patients creatinine level to ensure the therapeutic effect while limiting toxicity. This drug can only be administered by oral route. Intake and output as well as breath sounds may need to be assessed but are not related to administering the drug. A patient in atrial fibrillation will not have a measurable PR interval.
8.
A nurse is caring for a patient who has had disopyramide (Norpace), ordered. Before administering disopyramide (Norpace) what is the nurses priority action to maintain safety?
A)
Offer the patient something to drink.
B)
Ask the patient if he or she needs to void.
C)
Raise all side rails.
D)
Place the call button within reach.
Ans:
C
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Feedback: When administering disopyramide, the nurse should make sure that all siderails are up. The central nervous system effects of the drug can include dizziness, drowsiness, fatigue, twitching, mouth numbness, slurred speech, vision changes, and tremors that can progress to convulsions. The other three options are appropriate and placing the call button within reach can also be considered a safety measure; however nothing has a higher priority than raising the beds side-rails. 9.
The nurse sees a patient in an outpatient setting who is given a new prescription for an antiarrhythmic medication to treat premature atrial contractions (PAC). The nurse has limited time with the patient and addresses what priority nursing diagnosis?
A)
Decreased cardiac output
B)
Alteration in comfort
C)
Deficient knowledge
D)
Potential for injury
Ans:
C Feedback: The patient received a new prescription and needs information about how to take the medication, when to call the provider, and potential adverse effects so the priority nursing diagnosis is deficient knowledge. It is unknown what arrhythmia the patient is treating and without this information it is impossible to know what the impact on cardiac output, comfort and potential for injury may be.
10 .
You are caring for a patient who takes an antiarrhythmic agent. What would be a priority nursing assessment before administering this drug?
A)
Assess mental status.
B)
Assess breath sounds.
C)
Assess pulses and blood pressure.
D)
Assess urine output.
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Ans:
C Feedback: The nurse should continually monitor cardiac rate and rhythm when administering an antiarrhythmic agent to detect potentially serious adverse effects and to evaluate drug effectiveness. All of the other options are appropriate assessments but are not the priority assessment.
11 .
The nurse is caring for a patient receiving propranolol. What problems, reported by the patient, does the nurse suspect is caused by the drug? (Select all that apply.)
A)
Seizures
B)
Rash
C)
Atrioventricular (AV) block
D)
Bronchospasm
E)
Dreams
Ans:
C, D, E Feedback: The adverse effects associated with class II antiarrhythmics are related to the effects of blocking beta-receptors in the sympathetic nervous system. Central nervous system effects include dizziness, insomnia, unusual dreams, and fatigue. Cardiovascular symptoms can include hypotension, bradycardia, AV block, arrhythmias, and alterations in peripheral perfusion. Respiratory effects can include bronchospasm and dyspnea. GI problems frequently include nausea, vomiting, anorexia, constipation, and diarrhea. Other effects to anticipate include a loss of libido, decreased exercise tolerance, and alterations in blood glucose levels. Seizures and rash are not usually associated with the adverse effects of propranolol.
12 .
The nurse teaches the patient receiving propranolol (Inderal) at home for management of a ventricular dysrhythmia to monitor what parameter?
A)
Daily fluid intake
B)
Daily blood pressure
C)
Weekly weight
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D)
Weekly pulse
Ans:
B Feedback: Hypotension can occur with propranolol, which is a beta-blocker, so patients should check their blood pressure and pulse every day. Propranolol does not require that fluid intake be measured. propranolol also will not require daily weight taking, but it may be necessary with a diagnosis of propranolol.
13 .
The emergency department nurse is administering IV lidocaine to a patient. What adverse effect of lidocaine therapy should the nurse assess for?
A)
Dysphagia
B)
Dizziness
C)
Excessive bruising
D)
Tinnitus
Ans:
B Feedback: Adverse effects include dizziness, light-headedness, fatigue, arrhythmias, cardiac arrest, nausea, vomiting, anaphylactoid reactions, hypotension, and vasodilation. Dysphagia, bruising, and tinnitus are not usually associated with lidocaine.
14 .
The nurse administers a bolus of lidocaine and follows it with a continuous infusion at what rate?
A)
0.25 to 0.75 mg/min
B)
1 to 4 mg/min
C)
6 to 8 mg/min
D)
10 to 20 mg/min
Ans:
B Feedback:
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Lidocaine may be delivered at 1 to 4 mg/min after a bolus. Therefore, the other options are incorrect. 15 .
The nurse administers what drug to terminate supraventricular tachycardia?
A)
Lidocaine (Lidocaine Parenteral)
B)
Flecainide (Tambocor)
C)
Adenosine (Adenocard)
D)
Dronedarone (Multaq)
Ans:
C Feedback: Adenosine depresses conduction at the atrioventricular node and is used to restore NSR (normal sinus rhythm) in patients with paroxysmal supraventricular tachycardia. Adenosine is used to treat supraventricular tachycardias, including those caused by the use of alternate conduction pathways in adults. Lidocaine is used to treat life-threatening ventricular arrhythmias during myocardial infarction or cardiac surgery; it is also used as a bolus injection in emergencies when monitoring is not available to document exact arrhythmia. Flecainide is used to treat life-threatening ventricular arrhythmias in adults; prevention of paroxysmal atrial tachycardia (PAT) in symptomatic patients with no structural heart defect. Dronedarone is used to treat paroxysmal or persistent atrial fibrillation or atrial flutter in patients with multiple risk factors for coronary artery disease who are currently in sinus rhythm or scheduled for conversion.
16 .
For what condition would the nurse expect to administer lidocaine via IV drip?
A)
Decrease in arterial oxygen saturation (SaO2)
B)
Increase in blood pressure
C)
Multiple premature ventricular contractions (PVCs)
D)
Increase in intracranial pressure (ICP)
Ans:
C
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Feedback: Lidocaine drips are indicated for the treatment of life-threatening ventricular arrhythmias such as long or frequent runs of PVCs. Lidocaine would not be indicated for the treatment of hypoxia, hypertension, or increased ICP. 17 .
The nurse is caring for a patient who takes an antiarrhythmic agent and is reporting a complete lack of appetite. Which cardiac antiarrhythmic agent would the nurse suspect the patient is taking?
A)
Diltiazem (Cardizem)
B)
Propranolol (Inderal)
C)
Lidocaine (Lidocaine Parenteral)
D)
Amiodarone (Cordarone)
Ans:
B Feedback: Propranolol frequently causes gastrointestinal (GI) problems such as nausea, vomiting, anorexia, constipation, and diarrhea. Diltiazem could cause nausea and vomiting but would not cause anorexia. Lidocaine can lead to changes in taste, nausea, and vomiting but does not cause anorexia. Amiodarone has adverse effects including nausea, vomiting, GI distress, weakness, dizziness, hypotension, heart failure, arrhythmia, a potentially fatal liver toxicity, and ocular abnormalities but does not cause anorexia.
18 .
A 92-year-old patient is being sent home on disopyramide (Norpace) for a ventricular arrhythmia. He asks the nurse why he must continue to take this drug. The nurses best response would be that failure to treat a ventricular arrhythmia may what?
A)
Lead to renal failure
B)
Result in hypertension
C)
Result in death
D)
Cause heart failure
Ans:
C Feedback:
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Ventricular arrhythmias cause a dramatic reduction in cardiac output and will result in death if not treated. The patient needs to be taught the importance of taking his medication every day as ordered. Generally, ventricular arrhythmias are not associated with renal failure, hypertension, or heart failure. 19 .
The nurse is providing drug teaching for a patient who is to be discharged taking dofetilide (Tikosyn). What drug will the nurse teach the patient to avoid due to a drug-drug interaction?
A)
Cimetidine
B)
Furosemide
C)
Acetaminophen
D)
Antacids
Ans:
A Feedback: There is an increased risk of serious adverse effects if dofetilide is combined with ketoconazole, cimetidine, or verapamil, so these combinations should be avoided. There is no known increased risk associated with furosemide, acetaminophen, or antacids but other specific drugdrug interaction are reported, so it is important to check a current drug handbook before administering these medications.
20 .
The patient asks the nurse, Will I have to take this antiarrhythmic agent for the rest of my life? The nurse, having reviewed the CAST study, responds by saying what?
A)
Yes, you will have to take this drug for life.
B)
The drug is indicated for short-term treatment of life-threatening ventricular arrhythmias.
C)
This drug may need to be changed but youll take an antiarrhythmic for life.
D)
After the arrhythmia is corrected, the drug will be stopped.
Ans:
B
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Feedback: The CAST study, a large research study run by the National Heart and Lung Institute, found that long-term treatment of arrhythmias may have an uncertain effect on mortality, and in some cases may actually lead to increased cardiac death, which is the basis for the current indication for antiarrhythmics to be used only short-term to treat life-threatening ventricular arrhythmias. 21 .
What patient factor would result in the nurse administering a reduced dosage of disopyramide (Norpace)?
A)
Dehydration
B)
Hypertension
C)
Renal impairment
D)
Chronic diarrhea
Ans:
C Feedback: Caution should be used with renal or hepatic dysfunction, which could interfere with the biotransformation and excretion of these drugs. Caution is not indicated with the findings of dehydration, hypertension, or chronic diarrhea.
22 .
The nurse is administering an intravenous infusion of amiodarone (Cordarone). What should the nurse be aware of?
A)
The possible drugdrug interaction with nonsteroidal anti-inflammatory drugs (NSAIDs)
B)
The possible development of very serious cardiac arrhythmias
C)
The possible development of peripheral edema
D)
The possible development of a fatal renal toxicity
Ans:
B Feedback:
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Amiodarone has been associated with a potentially fatal liver toxicity rather than a renal toxicity, ocular abnormalities, and the development of very serious cardiac arrhythmias. Sotalol may have a loss of effectiveness if combined with NSAIDs. Diltiazem is associated with peripheral edema. 23 .
The nurse reviews the patients medical history and determines class II antiarrhythmics are contraindicated due to the patients history of what condition?
A)
Asthma
B)
Colitis
C)
Migraine headache
D)
Antidiarrheals
Ans:
A Feedback: Class II antiarrhythmics are contraindicated in patients with asthma because they could worsen the condition due to blockage of beta-receptors. They are not contraindicated in patients with colitis, migraine headache, or diarrhea.
24 .
What would the nurse teach the diabetic patient to monitor for when beginning a class II antidysrhythmic drug regimen in addition to insulin?
A)
Weight loss
B)
Reduced peripheral perfusion
C)
Hypoglycemia
D)
Exercise intolerance
Ans:
C Feedback: Increased hypoglycemia is possible if these drugs are combined with insulin; so patients should be taught to monitor their blood sugar levels often. Recurrent hypoglycemic episodes may indicate the need to reduce insulin dosage, but this advice would need to come from the health care provider. Class II antiarrhythmic drugs are normally not associated with weight loss, reduced peripheral perfusion, or exercise intolerance.
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25 .
The nurse assesses the patients rhythm strip and notes several premature ventricular contractions, which the nurse recognizes is caused by what?
A)
Stimulation of the ventricles from an ectopic focus in the ventricles
B)
Stimulation of the ventricles from the atrioventricular node
C)
Stimulation of the ventricles from the Purkinje fibers
D)
Stimulation of the ventricles from the bundle of His
Ans:
A Feedback: Premature ventricular contractions are stimulations of the cells caused by an ectopic focus in the ventricles causing an early contraction. The source of these ectopic foci could be anywhere within the ventricles, but the end result is reduced cardiac output due to reduced force of contraction.
26 .
When the nurse is caring for a patient with a cardiac arrhythmia, the priority goal for the patient is what?
A)
To maintain nutritional intake
B)
To maintain fluid intake
C)
To maintain cardiac output
D)
To maintain urine output
Ans:
C Feedback: Disruptions in the normal rhythm of the heart can interfere with myocardial contractions and affect the cardiac output, the amount of blood pumped with each beat. Arrhythmias that seriously disrupt cardiac output can be fatal. Therefore, the primary goal of treating a cardiac arrhythmia is to maintain adequate cardiac output to support life. The other goals may be important to individual patient care, but sustaining life takes priority.
27 .
The nurse is caring for a 3-year-old awaiting a heart transplant who requires an antiarrhythmic agent to control a supraventricular arrhythmia. What drug, if ordered, would the nurse question?
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A)
Digoxin
B)
Propranolol
C)
Procainamide
D)
Verapamil
Ans:
D Feedback: Verapamil should be avoided in children and, if ordered, would require the nurse to question the drug. Adenosine, propranolol, procainamide, and digoxin have been successfully used to treat supraventricular arrhythmias, with propranolol and digoxin being the drugs of choice for long-term management.
28 .
The nurse suspects drug toxicity in the patient who has been receiving lidocaine by infusion over the past 2 days to control a ventricular arrhythmia. What assessment would the nurse perform to determine the accuracy of the suspicion of toxicity?
A)
Neurological assessment
B)
Serum lidocaine level
C)
Renal function studies
D)
Hepatic function studies
Ans:
B Feedback: If lidocaine is used for ventricular arrhythmias related to cardiac surgery or digoxin toxicity, serum levels should be monitored regularly to determine the appropriate dose and to avoid the potential for serious proarrhythmias and other adverse effects. Neurological assessment may indicate adverse effects but would not confirm lidocaine toxicity. Renal and hepatic function would not confirm lidocaine toxicity.
29 .
The nurse performs an electrocardiogram and finds the older adult patient is in atrial fibrillation (AF). Time of onset is unknown but could be as long as 3 months earlier when the patient was last assessed. What drug will the nurse expect to be ordered?
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A)
Anticoagulant
B)
Digoxin
C)
Quinidine
D)
Ibutilide
Ans:
A Feedback: If the onset of AF is not known and it is suspected that the atria may have been fibrillating for longer than 1 week, the patient is better off staying in AF without drug therapy or electrocardioversion. Prophylactic oral anticoagulants are given to decrease the risk of clot formation and emboli being pumped into the system. In 2011, the American Heart Association and American College of Cardiology endorsed dabigatran (Pradaxa) as the anticoagulant of choice for prophylaxis in AF. Conversion in this case could result in potentially life-threatening embolization of the lungs, brain, or other tissues. Administration of other antiarrhythmics would not be indicated.
30 .
What nursing assessment will the nurse perform to determine the hemodynamic effect of the patients arrhythmia?
A)
Obtain an electrocardiographic rhythm strip.
B)
Obtain a serum drug level.
C)
Assess the patients level of consciousness.
D)
Assess the patients blood pressure (BP) and pulse rate.
Ans:
D Feedback: BP and pulse rate are indicators of the hemodynamic effect of arrhythmias and are nursing measures that do not require a physicians order. Obtaining an electrocardiogram or checking drug levels requires a physicians order. The patient will be conscious and alert with non-life-threatening arrhythmias, even when cardiac output is reduced. Serum drug levels would indicate the therapeutic or toxic level of drugs in the body but would not indicate hemodynamic effects of the drug.
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31 .
What class of antiarrhythmics will the nurse administer to the patient in symptomatic paroxysmal tachycardia because it markedly depresses phase 0 with extreme slowing of conduction?
A)
Class Ib
B)
Class Ic
C)
Class II
D)
Class III
Ans:
B Feedback: Class Ic drugs markedly depress phase 0, with a resultant extreme slowing of conduction, but have little effect on the duration of the action potential. As a result, they are indicated for the treatment of paroxysmal tachycardia. Class Ib drugs depress phase 0 somewhat and actually shorten the duration of the action potential. The class II antiarrhythmics are beta-adrenergic blockers that block beta-receptors, causing a depression of phase 4 of the action potential. The class III antiarrhythmics block potassium channels and slow the outward movement of potassium during phase 3 of the action potential, thus prolonging it.
32 .
What class of antiarrhythmic agents does the nurse administer to slow the outward movement of potassium during phase 3 of the action potential?
A)
Class Ib
B)
Class Ic
C)
Class II
D)
Class III
Ans:
D Feedback:
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The class III antiarrhythmics block potassium channels and slow the outward movement of potassium during phase 3 of the action potential, prolonging it. Class Ib drugs depress phase 0 somewhat and actually shorten the duration of the action potential. Class Ic drugs markedly depress phase 0, with a resultant extreme slowing of conduction, but have little effect on the duration of the action potential. The class II antiarrhythmics are betaadrenergic blockers that block beta-receptors, causing a depression of phase 4 of the action potential. 33 .
What class of antiarrhythmic agents does the nurse administer to depress generation of the action potentials and delaying phases 1 and 2 of repolarization?
A)
Class Ib
B)
Class II
C)
Class III
D)
Class IV
Ans:
D Feedback: The class IV antiarrhythmics block the movement of calcium ions across the cell membrane, depressing the generation of action potentials and delaying phases 1 and 2 of repolarization, which slows automaticity and conduction. Class Ib drugs depress phase 0 somewhat and actually shorten the duration of the action potential. The class II antiarrhythmics are beta-adrenergic blockers that block beta-receptors, causing a depression of phase 4 of the action potential. The class III antiarrhythmics block potassium channels and slow the outward movement of potassium during phase 3 of the action potential, thus prolonging it.
34 .
The nurse is teaching a class for newly hired cardiac care nurses and is discussing dronedarone (Multaq). What statement, if made by the nurse, is accurate? (Select all that apply.)
A)
Dronedarone has properties of all four classes of antiarrhythmics.
B)
Dronedarone reduces the risk of hospitalization in patients in atrial fibrillation.
C)
Dronedarone has many drugdrug interactions that need to be reviewed.
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D)
It is an oral drug taken once a day.
E)
Common adverse effects of dronedarone include ventricular arrhythmias.
Ans:
A, B, C Feedback: Dronedarone has properties of all four classes of antiarrhythmics and the mechanism by which it helps suppress atrial arrhythmias is not fully understood. It is used to reduce the risk of hospitalization in patients with paroxysmal or persistent atrial fibrillation or flutter who have risk factors for cardiovascular disease and who are in sinus rhythm or are scheduled to be converted to sinus rhythm. The drug is taken orally twice a day. Many drugdrug interactions have been associated with the drug and this situation should always be reviewed before starting or stopping any drugs while on this drug. Grapefruit juice should not be consumed while taking this drug. The most common adverse effects seen with dronedarone are heart failure, prolonged QT interval, nausea, diarrhea, and rash. It should never be used during pregnancy because it has been associated with fetal abnormalities.
35 .
What class of antiarrhythmic agent would the nurse be most likely to administer to a lactating new mother?
A)
Class Ib
B)
Class II
C)
Class III
D)
Class IV
Ans:
B Feedback: Class I, III, and IV agents should not be used during lactation; if they are needed, another method of feeding the baby should be used. This leaves only class II drugs for consideration if the mother is lactating.
Chapter 15. Diuretic Agents 1.
The class of diuretics that act to block the chloride pump in the distal convoluted tubules and leads to a loss of sodium and potassium and a minor loss of water is what?
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A)
Carbonic anhydrase inhibitors
B)
Osmotic diuretics
C)
Potassium-sparing diuretics
D)
Thiazide diuretics
Ans:
D Feedback: Thiazide diuretics work to block the chloride pump, which leads to a loss of sodium, potassium, and some water. They are considered mild diuretics. Carbonic anhydrase inhibitors work to block the formation of carbonic acid and bicarbonate in the renal tubules. Osmotic diuretics use hypertonic pull to remove fluid from the intravascular spaces and to deliver large amounts of water into the renal tubules. Potassium-sparing diuretics are mild and act to spare potassium in exchange for the loss of sodium and water.
2.
The nurse is providing discharge instructions to a 72-year-old patient who has been discharged home on a diuretic. What would the patients instructions regarding the use of a diuretic at home include?
A)
Measuring intake and output of urine
B)
To weigh themselves on the same scale, at the same time of day, in the same clothing
C)
Restrict fluids to 500 mL/d to limit the need to urinate
D)
Decrease exercise to conserve energy
Ans:
B Feedback: Patients taking a diuretic at home need to learn to weigh themselves every day, at the same time, and in the same clothes to monitor for loss or retention of fluid. They should not be asked to measure urine output or to decrease activity. Restricting fluids can lead to a rebound fluid retention when compensatory mechanisms are activated.
3.
The emergency department (ED) nurse is caring for a patient who is experiencing pulmonary edema. The patient is treated with furosemide (Lasix). What will the nurse monitor?
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A)
Sodium levels
B)
Bone narrow function
C)
Calcium levels
D)
Potassium levels
Ans:
D Feedback: Furosemide is associated with loss of potassium, so that the patient will need to be monitored carefully for low potassium levels, which could cause cardiac arrhythmias and further aggravate pulmonary edema. The nurse would not monitor sodium or calcium levels or bone marrow function because of the effects of the drug during the acute treatment of pulmonary edema.
4.
The nurse on the coronary unit is caring for a patient with known coronary artery disease who is being treated with cholestyramine (Questran) and hydrochlorothiazide (HydroDIURIL). What action will the nurse take?
A)
Call the physician and refuse to give the drugs without further orders.
B)
Make sure that the drugs are given at least 2 hours apart.
C)
Give the patient an antacid with the drugs.
D)
Check the patients blood glucose level before giving the drugs.
Ans:
B Feedback: Because of its effects in the GI tract, cholestyramine should be taken at least 2 hours earlier or later than hydrochlorothiazide to ensure the absorption of hydrochlorothiazide. This combination of drugs can be used effectively. An antacid would further aggravate drug absorption and would not be recommended. Blood glucose levels would not be affected by either of these drugs.
5. A)
The pharmacology instructor is discussing diuretic drugs with the nursing class. What would the instructor cite as an adverse effect of loop diuretics? Hyperkalemia
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B)
Alkalosis
C)
Hypertension
D)
Hypercalcemia
Ans:
B Feedback: Alkalosis is a drop in serum pH to an alkaline state due to bicarbonate loss in urine. Hypokalemia, hypocalcemia, and hypotension are also adverse effect of these drugs. Therefore, the other options are not correct.
6.
A patient with glaucoma has been prescribed a diuretic as treatment of his or her disease process. What drug does the nurse suspect that the patient will be prescribed?
A)
Acetazolamide (Diamox)
B)
Spironolactone (Aldactone)
C)
Chlorthalidone (Hygroton)
D)
Bendroflumethiazide (Naturetin)
Ans:
A Feedback: Acetazolamide is used to treat glaucoma. The inhibition of carbonic anhydrase results in decreased secretion of aqueous humor of the eye. Spironolactone is a potassium-sparing diuretic used to treat edema caused by congestive heart failure, liver disease, hypertension, hyperkalemia, and hyperaldosterone. Chlorthalidone is a thiazide-like diuretic and bendroflumethiazide, a thiazide diuretic, are used to treat edema caused by congestive heart failure, liver disease, kidney disease, and as adjunct treatment of hypertension.
7.
A)
A patient comes to the clinic for a 1-month follow-up appointment. The patient tells the nurse he or she has been taking chlorothiazide (Diruil) for a month and now has leg cramps and feels tired all the time. What will the nurse consider as the cause of the patients symptoms? Hypercalcemia
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B)
Hypocalcemia
C)
Hyperkalemia
D)
Hypokalemia
Ans:
D Feedback: Hypokalemia results from the loss of potassium in the distal tubule and causes muscle weakness, fatigue, and arrhythmias. Hyperkalemia presents with cardiac arrhythmias and occasionally muscle weakness. Hypercalcemia is characterized by fatigue, depression, mental confusion, nausea, vomiting, and constipation. Hypocalcemia presents with muscle spasms, facial grimacing, possible convulsions, irritability, and depression.
8.
A patient has been prescribed furosemide (Lasix). Because this drug causes potassium loss, what will the nurse instruct the patient to eat?
A)
Peaches
B)
Apples
C)
Pears
D)
Pineapple
Ans:
A Feedback: Peaches, as well as bananas, oranges, raisins, and other fruits, spices, and vegetables are high in potassium and consuming them should be encouraged when taking furosemide. Apples, pears, and pineapple, however, do not replace potassium in the body.
9.
A 10-year-old child has edema caused by a heart defect. The patient is taking furosemide (Lasix). The dosage is 6 mg/kg/d. The child weighs 76 pounds. How many mg does the child receive in each dose?
A)
20 mg
B)
50 mg
C)
105 mg
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D)
210 mg
Ans:
D Feedback: The nurse will administer 210 mg/dose of the drug (2.2 pounds: 1 kg = 76 pounds: kg, 76 divided by 2.2 = 34.5, 35 times 6 = 210 mg).
10 .
The nurse is caring for a patient who is taking acetazolamide (Diamox) for treatment of glaucoma. What drug, if taken with acetazolamide (Diamox), would cause the nurse to contact the physician?
A)
Indomethacin (Indocin)
B)
Colestipol (Colestid)
C)
Lithium (Eskalith)
D)
Ibuprofen (Motrin)
Ans:
C Feedback: An increase in the excretion of lithium can occur when taken with acetazolamide, so that special monitoring or a dosage adjustment may be necessary. Indomethacin, colestipol, and ibuprofen do not produce drug-todrug interactions when given with acetazolamide.
11 .
A 68-year-old patient, who has type 1 diabetes, is to receive hydrochlorothiazide (HydroDIURIL). Before administration of this medication, what information is most important for the nurse to communicate to the patient?
A)
His or her insulin dose may need to be increased.
B)
His or he insulin dose may need to be decreased.
C)
He or she will need to have him or her urine checked for ketones four times a day.
D)
He or she will need to have a creatinine clearance done once a month.
Ans:
A Feedback:
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Caution should be used with the following conditions, which include systemic lupus erythematosus (SLE), which frequently causes glomerular changes and renal dysfunction that could precipitate renal failure in some cases; glucose tolerance abnormalities or diabetes mellitus, which is worsened by the glucose-elevating effects of many diuretics; and gout, which reflects an abnormality in normal tubule reabsorption and secretion. There would be no reason to check ketones four times daily or to have a creatinine clearance once a month. 12 .
When evaluating an 82-year-old patient receiving hydrochlorothiazide (HydroDIURIL), what laboratory value deviations may be related to the medication?
A)
Elevated uric acid levels
B)
Reduced blood urea nitrogen (BUN) levels
C)
A serum potassium level of 4.7 mEq/L
D)
A hemoglobin A1C of 4.8
Ans:
A Feedback: Uric acid excretion is decreased because thiazides interfere with its secretory mechanism. High levels of uric acid can result in a condition called gout. Hydrochlorothiazide does not reduce BUN levels. Thiazide diuretics may lead to hypokalemia and increase blood glucose levels. The potassium and hemoglobin A1C levels are normal and not affected by the medication.
13 .
What statement by the 62-year-old patient indicates that the patient understand the nurses teaching about diuretics?
A)
I will weigh myself daily and report significant changes.
B)
I will have to limit my high sugar foods.
C)
If my leg gets swollen again, Ill take an additional pill.
D)
I will take my medication before bedtime on an empty stomach.
Ans:
A Feedback:
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Daily weights and blood pressures should be monitored at home in a patient taking diuretics. Options B, C, and D would indicate that further teaching is needed. 14 .
The nurse is providing discharge instruction to a patient who has just begun using diuretics. The nurse counsels the patient that it is most important to monitor the intake of foods that contain which element?
A)
Calcium
B)
Potassium
C)
Glucose
D)
Magnesium
Ans:
B Feedback: Potassium is the most important element to monitor in the diet because diuretics are most likely to lead to hyper- or hypokalemia depending on the diuretic prescribed. Calcium, glucose, and magnesium may need to be monitored in the diet but potassium would be the most important.
15 .
The nurse is talking with a group of nursing students. What drug would the nurse tell them, when combined with furosemide (Lasix), is likely to cause hearing loss?
A)
Codeine
B)
Ciprofloxacin (Cipro)
C)
Digoxin (Lanoxin)
D)
Gentamicin (Garamycin)
Ans:
D Feedback: The risk of ototoxicity increases if loop diuretics are combined with aminoglycoside antibiotics (gentamicin) or cisplatin. No known increased risk of ototoxicity exists when furosemide is taken with codeine, ciprofloxacin, or digoxin.
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16 .
A student asks the pharmacy instructor what the difference is between the diuretics spironolactone (Aldactone) and furosemide (Lasix). What would the instructor reply?
A)
Potassium losses are lower with spironolactone.
B)
Potassium losses are greater with spironolactone.
C)
Water losses are greater with spironolactone.
D)
Sodium losses are greater with spironolactone.
Ans:
A Feedback: Spironolactone is a potassium sparing diuretic; therefore, it promotes retention of potassium. Furosemide promotes greater water, sodium, and potassium losses than spironolactone.
17 .
The nurse is caring for a patient with a severe head injury. An osmotic diuretic is ordered. The nurse understands which drug is an osmotic diuretic?
A)
Spironolactone (Aldactone)
B)
Bumetanide (Bumex)
C)
Mannitol (Osmitrol)
D)
Ethacrynic (Edecrin)
Ans:
C Feedback: Mannitol is an osmotic diuretic. Spironolactone is a potassium sparing diuretic. Bumetanide and ethacrynic are loop diuretics.
18 .
The staff educator in the ICU is talking with a group of new nurses about osmotic diuretics. The educator would tell the new nurses that osmotic diuretics act on which site in the nephron?
A)
Proximal tubule
B)
Glomerulus
C)
Ascending limb of loop of Henle
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D)
Collecting tubule
Ans:
B Feedback: These drugs are freely filtered at the renal glomerulus, poorly reabsorbed by the renal tubule, not secreted by the tubule, and resistant to metabolism. Therefore, options A, C, and D are not correct.
19 .
A 64-year-old patient in hypertensive crisis is to receive furosemide (Lasix) 40 mg IV. Lasix comes in 100 mg/10 mL containers. How will the nurse administer the medication?
A)
Give 4 mL over 1 to 2 minutes IV.
B)
Give 4 mL over 10 minutes.
C)
Flush the line with normal saline, give 1 mL/min, flush again when finished.
D)
Fix 10 mL in an IV piggyback and deliver it over 30 minutes.
Ans:
A Feedback: Administer furosemide (Lasix) 40 mg over 1 to 2 minutes IV. The other options are not correct.
20 .
A 91-year-old patient is being discharged on the diuretic spironolactone (Aldactone). What is the major adverse effect of this type of medication?
A)
Hypokalemia
B)
Hyperkalemia
C)
Gastric irritation
D)
Hypertension
Ans:
B Feedback:
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The most common adverse effect of potassium-sparing diuretics is hyperkalemia, which can cause lethargy, confusion, ataxia, muscle cramps, and cardiac arrhythmias. Hypokalemia, gastric irritation, and hypertension are not recognized as adverse effects of spironolactone. 21 .
The nurse is conducting an admission assessment of a patient who has been prescribed hydrochlorothiazide (HydroDIURIL). Which situation would contraindicate the administration of hydrochlorothiazide (HydroDIURIL)?
A)
Allergy to sulfa drugs
B)
Allergy to codeine
C)
BP 160/96
D)
Blood glucose level of 140 mg/dL
Ans:
A Feedback: Thiazide and thiazide-like diuretics are contraindicated with allergy to thiazides or sulfonamides to prevent hypersensitivity reactions. The other options are not correct.
22 .
The nurse is caring for a patient who has just been diagnosed with essential hypertension. The nurse is aware that the health care provider will begin therapy with which classification of diuretics?
A)
Loop diuretics
B)
Carbonic anhydrous inhibitors
C)
Thiazide and thiazide-like diuretics
D)
potassium-sparing diuretics
Ans:
C Feedback: Thiazides are considered to be mild diuretics compared with the more potent loop diuretics. These agents are the first-line drugs used to manage essential hypertension when drug therapy is needed. Loop and potassium-sparing diuretics and carbonic anhydrous inhibitors would be used in combination with or after the thiazide diuretics are no longer effective.
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23 .
A female patient has a history of frequent bladder infections. Which classification of diuretic would not be recommended for this patient?
A)
Thiazide and thiazide-like diuretics
B)
Loop diuretics
C)
potassium-sparing diuretics
D)
Osmotic diuretics
Ans:
A Feedback: Urine is slightly alkalinized when the thiazides or thiazide-like diuretics are used because they block reabsorption of bicarbonate. This effect can cause problems for patients who are susceptible to bladder infections. Loop, potassium sparing, and osmotic diuretics do not have this effect.
24 .
What is the term for the action of a diuretic in a patient with glaucoma?
A)
Intraocular pressure (IOP)
B)
Osmotic pull
C)
Diuresis
D)
Potassium sparing
Ans:
B Feedback: Glaucoma is an eye disease characterized by increased pressure in the eyeknown as intraocular pressure (IOP)which can cause optic nerve atrophy and blindness. Diuretics are used to provide osmotic pull to remove some of the fluid from the eye, which decreases IOP, or as adjunctive therapy to reduce fluid volume and pressure in the cardiovascular system, which also decreases pressure in the eye somewhat. Potassium sparing refers to a class of diuretics that help to retainpotassium.
25 .
A patient has just begun to take a prescribed diuretic. Why would the nurse tell the patient to drink 8 to 10 glasses of water daily (unless it is counterindicated)?
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A)
To decrease the action of the reninangiotensin cycle
B)
To make more concentrated plasma
C)
To dilute the urine
D)
To avoid rebound edema
Ans:
D Feedback: Care must be taken when using diuretics to avoid fluid rebound, which is associated with fluid loss. If a patient stops taking in water and takes the diuretic, the result will be a concentrated plasma of smaller volume. The decreased volume is sensed by the nephrons, which activate the reninangiotensin cycle. When concentrated blood is sensed by the osmotic center in the brain, antidiuretic hormone (ADH) is released to retain water and dilute the blood. The result can be rebound edema as fluid is retained. Drinking 8 to 10 glasses of water will not decrease the action of the reninangiotensin cycle, or make plasma more concentrated. It may produce urine that is dilute but that is not the reason it is recommended.
26 .
A patient has just been prescribed furosemide (Lasix). After reviewing the patients medication history, what drug would cause the nurse concern when taken with furosemide (Lasix)?
A)
Acetaminophen
B)
Ferrous sulfate (Feosol)
C)
Naproxen sodium (Naprosyn)
D)
Ampicillin
Ans:
C Feedback: Naproxen sodium is a nonsteroidal antiinflammatory drug. There may also be a decreased loss of sodium and decreased antihypertensive effects if these drugs are combined with indomethacin, ibuprofen, salicylates, or other nonsteroidal antiinflammatory drugs. The patient receiving this combination should be monitored closely and appropriate dosage adjustments should be made. There is no contraindication to the intercurrent use of acetaminophen, ferrous sulfate, or ampicillin.
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27 .
A patient with glaucoma has been prescribed acetazolamide (Diamox). What adverse effects would the nurse caution the patient about? (Select all that apply.)
A)
Paresthesia
B)
Confusion
C)
Drowsiness
D)
Vomiting
E)
Hyperkalemia
Ans:
A, B, C Feedback: Metabolic acidosis is a relatively common and potentially dangerous adverse effect that occurs when bicarbonate is lost. Hypokalemia is also common. Patients also complain of paresthesias of the extremities, confusion, and drowsiness. Vomiting and hyperkalemia are not common adverse effects
28 .
A patient who was recently prescribed spironolactone calls the clinic and complains that he is not urinating as much as he did when he first started taking this medication. What would be an appropriate question for the nurse to ask this patient?
A)
Are you taking a salicylate?
B)
Are you taking acetaminophen?
C)
Are you taking ibuprofen?
D)
Are you using a lot of salt?
Ans:
A Feedback: The diuretic effect decreases if potassium-sparing diuretics are combined with salicylates. Dosage adjustment may be necessary to achieve therapeutic effects. There is no decrease in effect when spironolactone is combined with acetaminophen, ibuprofen, and increased sodium intake.
29 .
The nurse is writing a plan of care for a patient who is taking a diuretic. What would be an appropriate nursing diagnosis for this patient?
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A)
Impaired urinary elimination
B)
Monitor the patient response to the drug
C)
Imbalanced nutrition: More than body requirements
D)
Risk for fluid volume overload
Ans:
A Feedback: Nursing diagnoses related to drug therapy may include impaired urinary elimination related to drug effect. Options B, C, and D would not be appropriate nursing diagnoses.
30 .
A patient has been prescribed hydrochlorothiazide (HydroDIURIL) and the nurse is preparing to give the patient discharge instructions. Which adverse effects may this patient experience while taking this medication? (Select all that apply.)
A)
Constipation
B)
Dizziness
C)
Polyphagia
D)
Nocturia
E)
Muscle cramps
Ans:
B, D, E Feedback: The adverse effects associated with hydrochlorothiazide are dizziness, vertigo, orthostatic hypotension, nausea, anorexia, vomiting, dry mouth, diarrhea, polyuria, nocturia, muscle cramps, and spasms. The patient would not experience polyphagia (great hunger) and constipation.
31 .
A)
A patient has just begun therapy with furosemide (Lasix), and the nurse is instructing the patient about the need to include foods high in potassium in the diet. Which foods would be appropriate for this patient to choose? (Select all that apply.) Prunes
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B)
Apples
C)
Watermelon
D)
Lima beans
E)
Rice
Ans:
A, C, D Feedback: Foods high in potassium include avocados, bananas, broccoli, cantaloupe, dried fruits, grapefruit, lima beans, nuts, navy beans, oranges, peaches, potatoes, prunes, rhubarb, Sanka coffee, sunflower seeds, spinach, tomatoes, and watermelon. Apples and rice are not potassium-rich foods.
32 .
A nursing instructor is teaching a group of students about loop diuretics. Which would be included in this classification? (Select all that apply.)
A)
Acetazolamide
B)
Torsemide
C)
Ethacrynic acid
D)
Mannitol
E)
Bumetanide
Ans:
B, C, E Feedback: Torsemide, ethacrynic acid, and bumetanide are examples of loop diuretics. Acetazolamide is a carbonic anhydrous inhibitor and mannitol is an osmotic diuretic.
33 .
The nurse is caring for a patient with edema who has just begun taking a diuretic. What will the nurse use to evaluate the effectiveness of this medication? (Select all that apply.)
A)
Daily weight
B)
Decrease in edema
C)
Increase in blood pressure
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D)
Increase in urinary output
E)
Increase in pulse
Ans:
A, B, D Feedback: Responsiveness to the use of a diuretic can be measured by daily weights, increased urinary output, decrease in edema, decrease in blood pressure and pulse rate. Options C and E are not correct.
34 .
The nurse has just administered 150 g of mannitol IV to a patient with increased intracranial pressure. What is most important for the nurse to monitor in the hour after administration?
A)
Weight of patient
B)
Blood pressure of patient
C)
Pulse of patient
D)
Respiratory rate of patient
Ans:
B Feedback: The most common and potentially dangerous adverse effect related to an osmotic diuretic is the sudden drop in fluid levels. Mannitol peaks 1 hour after administration, therefore, it would be most important to monitor blood pressure. Weight is the best indicator over time but would not be as effective in indicating a dangerous fluid drop as the blood pressure. Respiratory and pulse rates would also not be as effective as blood pressure in evaluating dangerous fluid drops.
Chapter 16-Chapter 17 Histamine, Serotonin, & the Ergot Alkaloids Chapter 17. Vasoactive Peptides MULTIPLE CHOICE 1. The nurse is assessing the patients leg for peripheral vascular disease (PVD) and is unable to palpate the pedal pulse in either foot. Which action will the nurse take first?
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a .
Contact the health care provider for further orders.
b .
Request x-ray studies of the lower extremities.
c .
Request that the patient lie flat.
d .
Obtain a Doppler ultrasound device for auscultation.
ANS: D The Doppler ultrasound device may aid in determining peripheral blood flow. This is not a sufficient cause to notify the health care provider and does not warrant radiologic examination without further assessment. Positioning will not affect the assessment of pedal pulses.
2. What is the action of pentoxifylline (Trental), a hemorheologic agent used to treat chronic occlusive arteriole disease?
a .
Vasodilates the peripheral arteries
b .
Potentiates the blood clotting mechanism
c .
Increases erythrocyte flexibility
d .
Increases blood viscosity
ANS: C Pentoxifylline enhances red blood cell (erythrocyte) flexibility, which reduces blood viscosity. This allows for more blood to perfuse into the tissues. Muscle tissues become better oxygenated and intermittent claudication is reduced. Pentoxifylline does not cause vasodilation. Pentoxifylline acts to decrease clotting and decreases blood viscosity.
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3. Which assessment verifies increased blood perfusion to the lower extremities?
a .
Toes cool to the touch
b .
Decreased sensation below the knees
c .
Increased amplitude of pedal pulses
d .
Paleness of the foot
ANS: C The pressure of blood as it is pushed against an artery is detected as a pulse. Increased pulse amplitude indicates increased blood flow. Coolness and decreased sensation usually correlate with decreased blood perfusion. Paleness or blanching does not indicate increased blood perfusion.
4. Which patient statement indicates to the nurse that the patient has a good understanding of PVD?
a .
Symptoms are warning signs of the increased potential to develop diseases.
b .
Pharmacologic treatments can reverse the disease process.
c .
Surgical interventions will cure the disease.
d .
Controlling contributing factors may affect the progression of the disease.
ANS: D Patients must be taught the interrelationships between the PVD and other related diseases that they may have, such as diabetes, hypertension, angina, and hyperlipidemia. Control or lack of control of the contributing factors of these related diseases will significantly affect the
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progression of the PVD. PVD is usually a development that is related to other diseases already present in the body. PVD can be controlled but not cured or completely reversed. Surgical interventions will not cure the disease, although it may somewhat control the vascular damage.
5. The nurse is assessing a patient on papaverine therapy and notes tachycardia, which is a compensatory effect of which condition?
a .
Hypoventilation
b .
Hypotension
c .
Excessive sympathetic stimulation
d .
Adrenergic suppression
ANS: B An adverse effect of papaverine therapy is hypotension. When blood pressure drops, cardiac output decreases, and there is less available oxygenated blood flowing to the periphery. Baroreceptors trigger the heart to increase the rate, which causes tachycardia to maintain cardiac output and the perfusion of oxygenated blood to the tissues. Tachycardia is not compensatory for hypoventilation, sympathetic stimulation, or adrenergic suppression.
6. When assessing a client recently prescribed pentoxifylline (Trental), which medication will alert the nurse to monitor closely for adverse effects?
a .
Antilipemic
b .
Antihypertensive
c .
Antibiotic
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d .
Antipsychotic
ANS: B Patients receiving pentoxifylline frequently display a small reduction in systemic blood pressure. An antihypertensive medication may potentiate this effect. Patients must be monitored for hypotension, and therapy may have to be reduced to minimize adverse effects. Pentoxifylline does not interact with antilipemic, antibiotic, or antipsychotic agents.
7. The nurse advises a patient taking papaverine to consult the health care provider or pharmacist before taking which over the counter (OTC) medication?
a .
Laxatives
b .
Cough and cold remedies
c .
Vitamin supplements
d .
Acetaminophen
ANS: B OTC cough and cold preparations may counteract the effects of papaverine. Laxatives, vitamin supplements, and acetaminophen do not interact with papaverine.
8. A patient has recently been prescribed cilostazol (Pletal). Which statement by the patient indicates that this medication is effective?
a .
I have less leg cramping when I walk.
b .
My pulse rate is more regular.
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c .
I have had fewer episodes of angina.
d .
My blood pressure has decreased.
ANS: A The primary therapeutic outcome expected from cilostazol is improved tissue perfusion, with a reduced frequency of pain, improved tolerance to exercise, and improved peripheral pulses. A more regular pulse, decreased episodes of angina, and decreased blood pressure are not expected outcomes of cilostazol administration.
9. The nurse has completed teaching to a patient recently prescribed cilostazol (Pletal). Which statement by the patient indicates a need for further teaching?
a .
I will sit down if I feel lightheaded or faint.
b .
Because this medication helps my circulation, I will try to quit smoking.
c .
Grapefruit juice will increase the effects of this medication.
d .
Diarrhea may occur but likely will stop with continued therapy.
ANS: C Grapefruit juice inhibits the metabolism of cilostazol and would decrease the effects of the medication. Sitting down when feeling lightheaded is an appropriate patient action. Smoking may limit the benefits of taking cilostazol. Diarrhea is usually mild and tends to resolve with continued therapy.
10. The nurse observes a patient taking papaverine hydrochloride to be flushed and diaphoretic following the initial dose. The nurses best response is to:
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a .
hold the next dose.
b .
assess blood glucose.
c .
provide comfort measures.
d .
immediately notify the physician.
ANS: C Flushing and sweating are considered common side effects of papaverine hydrochloride. Providing comfort measures is the best response after the initial dose. It is not necessary to hold the next dose. Assessing blood glucose is not indicated. It is not necessary to notify the physician at this time.
11. The nurse is preparing to provide personal care to a patient with peripheral vascular disease. When providing foot care, the nurse will:
a .
assist the patient to a supine position.
b .
keep feet moistened with lotion.
c .
trim toenails daily.
d .
change socks daily.
ANS: D To avoid skin breakdown, the patient should change socks daily. Blood flow is improved when the head of the bed is elevated 12 to 16 inches. Supine position is contraindicated. Feet should be kept dry on a person with peripheral vascular disease. Toenails should be trimmed when necessary, preferably by a podiatrist.
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MULTIPLE RESPONSE 12. Which are included in the baseline assessment of PVD? (Select all that apply.)
a .
History of heart disease
b .
Smoking and dietary habits
c .
Current medications
d .
Weight
e .
Limb pain
f .
Mental status
ANS: A, B, C, D, E Age, gender, race, family history of incidence of symptoms of PVD, hypertension, and cardiac disease indicate risk factors for developing PVD. Smoking causes vasoconstriction, and dietary habits can cause atherosclerosis, predisposing the patient to PVD. Current medications are essential to know in order to prescribe a pharmacological agent without exposing the patient to possible drug interactions. Weight may factor into calculations for prescribing medications to treat PVD. Limb pain is a symptom of PVD and may allow the health care provider to assess the extent of existing disease. Mental status is not included in the baseline assessment of PVD.
13. The nurse is preparing a teaching plan for a patient with Raynauds disease who is soon to be discharged. What information will be included to improve circulation and prevent complications of this disease? (Select all that apply.)
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a .
Begin a daily exercise program.
b .
Keep hands and feet warm.
c .
Surgery is often the most effective treatment.
d .
Elevate the lower extremities when reclining.
e .
Smoking cessation will improve outcomes.
ANS: A, B, E Daily exercise, maintenance of extremity warmth, and smoking cessation promote circulation and prevent complications. Surgery is not an effective treatment for Raynauds disease. Patients with Raynauds disease should not elevate their extremities when reclining.
14. What will the nurse include in the discharge teaching plan for a patient with PVD? (Select all that apply.)
a .
Intermittent cold applications to the extremities
b .
Heat therapy
c .
Stress reduction techniques
d .
An exercise program
e .
Bed positioning techniques
ANS: C, D, E Diseases such as diabetes, hypertension, angina, and hyperlipidemia are interrelated with PVD. Stress reduction techniques will assist patients in reducing blood pressure, smoking, and
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overeating. A daily exercise program can significantly improve collateral circulation. Bed positioning techniques, such as elevating the bed 12 to 16 inches, improve blood flow to the periphery. Intermittent cold applications to the extremities and heat therapy will not benefit the patient with PVD.
15. Which are necessary steps in the assessment of the patient preparing for treatment PVD with pentoxifylline (Trental)? (Select all that apply.)
a .
Check for intolerance to caffeine.
b .
Obtain baseline data on pain that may be present.
c .
Obtain test results for PT and aPTT.
d .
Perform baseline gastrointestinal assessment to determine if the patient has nausea, vomiting, or dyspepsia.
e .
Ask specifically if the patient has any cardiac symptoms or dizziness.
f .
Schedule the patient for an exercise stress test.
ANS: A, B, D, E Before beginning therapy with pentoxifylline, the nurse should determine intolerance to caffeine. To evaluate therapeutic effects of prescribed medications, a baseline is needed against which to compare future assessments. Before beginning therapy with pentoxifylline, the nurse should determine baseline gastrointestinal symptoms and assess for cardiac symptoms, pain, and dizziness. Bleeding times do not apply to therapy with this drug. Exercise stress testing is not part of the premedication assessment.
16. The nurse has admitted a resident with the diagnosis of PVD to a long term care facility. When providing care to this patient, the nurse will: (Select all that apply.)
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a .
initiate elevation of lower extremities.
b .
implement pain management as ordered.
c .
assess skin temperature.
d .
vigorously dry feet after washing.
e .
palpate pedal pulses.
ANS: B, C, E Pain management, assessment of skin temperature, and palpation of pedal pulses are indicated with the care of a patient with PVD. The nurse needs to check with the health care provider before initiating elevation of the extremities. It is contraindicated in patients with arterial insufficiency. After bathing, feet should be gently dried. Vigorous rubbing is contraindicated.
Chapter 18. The Eicosanoids: Prostaglandins, Thromboxanes, Leukotrienes, & Related Compounds MULTIPLE CHOICE 1. A nursing student asks the nurse to explain the role of cyclooxygenase-2 (COX-2) and its role in inflammation. The nurse will explain that COX-2 a. converts arachidonic acid into a chemical mediator for inflammation. b. directly causes vasodilation and increased capillary permeability. c. irritates the gastric mucosa to cause gastrointestinal upset. d. releases prostaglandins, which cause inflammation and pain in tissues. ANS: A COX-2 is an enzyme that converts arachidonic acid into prostaglandins and their products, and this synthesis causes pain and inflammation. They do not act directly to cause inflammation. COX-1 irritates the gastric mucosa. COX-2 synthesizes but does not release prostaglandins.
2. A nursing student asks how nonsteroidal antiinflammatory drugs (NSAIDs) work to suppress inflammation and reduce pain. The nurse will explain that NSAIDs
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a. exert direct actions to cause relaxation of smooth muscle. b. inhibit cyclooxygenase that is necessary for prostaglandin synthesis. c. interfere with neuronal pathways associated with prostaglandin action. d. suppress prostaglandin activity by blocking tissue receptor sites. ANS: B NSAIDs act by inhibiting COX-1 and COX-2 to help block prostaglandin synthesis. They do not have direct action on tissues, nor do they interfere with chemical receptor sites or neuronal pathways. 3. A patient is taking ibuprofen 400 mg every 4 hours to treat moderate arthritis pain and reports that it is less effective than before. What action will the nurse take? a. Counsel the patient to discuss a prescription NSAID with the provider. b. Recommend adding aspirin to increase the antiinflammatory effect. c. Suggest asking the provider about a short course of corticosteroids. d. Tell the patient to increase the dose to 800 mg every 4 hours. ANS: A The patient should discuss another NSAID with the provider if tolerance has developed to the over-the-counter NSAID. Patients should not take aspirin with NSAIDs because of the increased risk of bleeding and gastrointestinal upset. Steroids are not the drugs of choice for arthritis because of their side effects and are not used unless inflammation is severe. A prescription NSAID would be used prior to starting corticosteroids. Increasing the dose will increase side effects but may not increase desired effects. The maximum dose per day is 2400 mg, which would most likely be exceeded when increasing the dose to 800 mg every 4 hours. 4. A patient who is taking aspirin for arthritis pain asks the nurse why it also causes gastrointestinal upset. The nurse understands that this is because aspirin a. increases gastrointestinal secretions. b. increases hypersensitivity reactions. c. inhibits both COX-1 and COX-2. d. is an acidic compound. ANS: C Aspirin is a COX-1 and COX-2 inhibitor. COX-1 protects the stomach lining, so when it is inhibited, gastric upset occurs. Aspirin does not increase gastrointestinal secretions or hypersensitivity reactions. It is a weak acid.
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5. A patient is taking aspirin to help prevent myocardial infarction and is experiencing moderate gastrointestinal upset. The nurse will contact the patients provider to discuss changing from aspirin to which drug? a. A COX-2 inhibitor b. Celecoxib (Celebrex) c. Enteric-coated aspirin d. Nabumetone (Relafen) ANS: C Aspirin is used to inhibit platelet aggregation to prevent cardiovascular accident and myocardial infarction. Patients taking aspirin for this purpose would not benefit from COX-2 inhibitors, since the COX-1 enzyme is responsible for inhibiting platelet aggregation. The patient should take enteric-coated aspirin to lessen the gastrointestinal distress. Celecoxib and nabumetone are both COX-2 inhibitors.
6. A patient who is 7 months pregnant and who has arthritis asks the nurse if she can take aspirin for pain. The nurse will tell her not to take aspirin for which reason? a. It can result in adverse effects on her fetus. b. It causes an increased risk of Reyes syndrome. c. It increases hemorrhage risk. d. It will cause increased gastrointestinal distress. ANS: A Patients should not take aspirin during the third trimester of pregnancy because it can cause premature closure of the ductus arteriosus in the fetus. It does not increase her risk of Reyes syndrome. Aspirin taken within a week of delivery will increase the risk of bleeding. It can cause gastrointestinal distress, but this is not the reason for caution. 7. The nurse is performing a health history on a patient who has arthritis. The patient reports tinnitus. Suspecting a drug adverse effect, the nurse will ask the patient about which medication? a. Aspirin (Bayer) b. Acetaminophen (Tylenol) c. Anakinra (Kineret) d. Prednisone (Deltasone) ANS: A Aspirin causes tinnitus at low toxicity levels. The nurse should question the patient about this
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medication. The other medications do not have this side effect. 8. The nurse is teaching a patient about using high-dose aspirin to treat arthritis. What information will the nurse include when teaching this patient? a. A normal serum aspirin level is between 30 and 40 mg/dL. b. You may need to stop taking this drug a week prior to surgery. c. You will need to monitor aspirin levels if you are also taking warfarin. d. Your stools may become dark, but this is a harmless side effect. ANS: B Aspirin should be discontinued prior to surgery to avoid prolonged bleeding time. A normal serum level is 15 to 30 mg/dL. Patients taking warfarin and aspirin will have increased amounts of warfarin, so the INR will need to be monitored. Tarry stools are a symptom of gastrointestinal bleeding and should be reported. 9. A patient who takes high-dose aspirin to treat rheumatoid arthritis has a serum salicylate level of 35 mg/dL. The nurse will perform which action? a. Assess the patient for tinnitus. b. Monitor the patient for signs of Reyes syndrome. c. Notify the provider of severe aspirin toxicity. d. Request an order for an increased aspirin dose. ANS: A Mild toxicity occurs at levels above 30 mg/dL, so the nurse should assess for signs of toxicity, such as tinnitus. This level will not increase the risk for Reyes syndrome. Severe toxicity occurs at levels greater than 50 mg/dL. The dose should not be increased.
10. The nurse provides teaching for a patient who will begin taking indomethacin (Inderal) to treat rheumatoid arthritis. Which statement by the patient indicates a need for further teaching? a. I should limit sodium intake while taking this drug. b. I should take indomethacin on an empty stomach. c. I will need to check my blood pressure frequently. d. I will take the medication twice daily. ANS: B Indomethacin is very irritating to the stomach and should be taken with food. It can cause sodium retention and elevated blood pressure, so patients should limit sodium intake. The
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medication is taken twice daily. 11. The nurse is caring for a postpartum woman who is refusing opioid analgesics but is rating her pain as a 7 or 8 on a 10-point pain scale. The nurse will contact the provider to request an order for which analgesic medication? a. Diclofenac sodium (Voltaren) b. Ketoprofen (Orudis) c. Ketorolac (Toradol) d. Naproxyn (Naprosyn) ANS: C Ketorolac is the first injectable NSAID and has shown analgesic efficacy equal or superior to that of opioid analgesics. The other NSAIDs listed are not used for postoperative pain. 12. A patient who has osteoarthritis with mild to moderate pain asks the nurse about taking overthe-counter ibuprofen (Motrin). What will the nurse tell this patient? a. It may take several weeks to achieve therapeutic effects. b. Unlike aspirin, there is no increased risk of bleeding with ibuprofen. c. Take ibuprofen twice daily for maximum analgesic benefit. d. Combine ibuprofen with acetaminophen for best effect. ANS: A OTC NSAIDs can be effective for mild to moderate arthritis pain, but the effects may not appear for several weeks. NSAIDs carry a risk for bleeding. Ibuprofen is taken every 4 hours or QID. Ibuprofen should not be combined with aspirin or acetaminophen. 13. The nurse is caring for a patient who has been taking an NSAID for 4 weeks for osteoarthritis. The patient reports decreased pain, but the nurse notes continued swelling of the affected joints. The nurse will perform which action? a. Assess the patient for drug-seeking behaviors. b. Notify the provider that the drug is not effective. c. Reassure the patient that swelling will decrease eventually. d. Remind the patient that this drug is given for pain only. ANS: B This medication is effective for both pain and swelling. After 4 weeks, there should be some decrease in swelling, so the nurse should report that this medication is ineffective. There is no indication that this patient is seeking an opioid analgesic. The drug should be effective within several weeks. NSAIDs are given for pain and swelling.
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14. The nurse is discussing celecoxib (Celebrex) with a patient who will use the drug to treat dysmenorrhea. What information will the nurse include in teaching? a. Do not take the medication during the first 2 days of your period. b. The initial dose will be twice the amount of subsequent doses. c. Take this medication with food to minimize gastrointestinal upset. d. Take the drug on a regular basis to prevent dysmenorrhea. ANS: B The initial dose of Celebrex is twice that of subsequent doses. The medication should not be taken just before a period. It does not need to be taken with food. It is taken as needed. 15. The nurse is caring for a patient who has rheumatoid arthritis and who is receiving infliximab (Remicade) IV every 8 weeks. Which laboratory test will the nurse anticipate that this patient will need? a. Calcium level b. Complete blood count c. Electrolytes d. Potassium ANS: B Infliximab is an immunomodulator and can cause agranulocytosis, so patients should have regular CBC evaluation.
16. The nurse is teaching a patient about taking colchicine to treat gout. What information will the nurse include when teaching this patient about this drug? a. Avoid all alcohol except beer. b. Include salmon in the diet. c. Increase fluid intake. d. Take on an empty stomach. ANS: C The patient who is taking colchicine should increase fluid intake to promote uric acid excretion and prevent renal calculi. Foods rich in purine should be avoided, including beer, and some sea foods, such as salmon. Gastric irritation is a common problem, so colchicine should be taken with food.
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17. Which antigout medication is used to treat chronic tophaceous gout? a. Allopurinol (Zyloprim) b. Colchicine c. Probenecid (Benemid) d. Sulfinpyrazone (Anturane) ANS: A Allopurinol inhibits the biosynthesis of uric acid and is used long-term to manage chronic gout. Colchicine does not inhibit uric acid synthesis or promote uric acid secretion and is not used for chronic gout. Probenecid can be used for chronic gout but is not the first choice. Sulfinpyrazone has many serious side effects. 18. The nurse is assessing a patient who has gout who will begin taking allopurinol (Zyloprim). The nurse reviews the patients medical record and will be concerned about which laboratory result? a. Elevated BUN and creatinine b. Increased serum uric acid c. Slight increase in the white blood count d. Increased serum glucose ANS: A Antigout drugs are excreted via the kidneys, so patients should have adequate renal function. 19. The nurse provides teaching for a patient who will begin taking allopurinol. Which statement by the patient indicates understanding of the teaching? a. I should increase my vitamin C intake. b. I will get yearly eye exams. c. I will increase my protein intake. d. I will limit fluids to prevent edema. ANS: B Patients taking allopurinol can have visual changes with prolonged use and should have yearly eye exams. It is not necessary to increase vitamin C. Protein can increase purine intake, which is not recommended. Patients should consume extra fluids.
Chapter 19-Chapter 21 Nitric Oxide Drugs Used in Asthma Chapter 21. Introduction to the Pharmacology of CNS Drugs
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1.
A 70-year-old man is being treated for chronic obstructive pulmonary disease (COPD) with theophylline (Theo-Dur). What will be a priority assessment by the nurse?
A)
Ingestion of fatty foods
B)
Weight
C)
Activity level
D)
Use of nicotine
Ans:
D Feedback: Nutritional status, weight, and activity level would be important for a nurse to know about a COPD patient. However, it would be most important for the nurse to know whether the patient smokes or uses tobacco in other ways or smoking cessation methods that involve nicotine. Nicotine increases the metabolism of theophyllines; the dosage may need to be increased to produce a therapeutic effect.
2.
A 6-year-old child weighing 52 pounds has had a loading dose of aminophylline (Truphylline). The nurse is ready to administer the regular prescribed dose of 4 mg/kg every 4 hours for three doses. How many milligram will the patient receive in 12 hours?
A)
44 mg
B)
94 mg
C)
284 mg
D)
344 mg
Ans:
C Feedback: First, using the formula: 2.2 pounds and 52 pounds: times kg, determine the childs weight in kg (52/2.2 = 23.64). Next, using the formula of amount of drug prescribed times weight in kg, determine the amount the child will receive in one dose (4 times 23.64 = 94.56). To determine the mg in a 12hour period multiply 94.56 times 3 = 283.68. Round to 284 mg. Options A, B, and D are not correct.
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3.
A patient is in the clinic to have blood drawn to assess his or her theophylline level. The patient is taking theophylline (Theo-Dur) and appears to being doing well on the drug. He or she reports no problems. What serum level will the nurse expect the patient to have?
A)
Between 0.5 to 5 mcg/mL
B)
Between 10 to 20 mcg/mL
C)
Between 25 to 35 mcg/mL
D)
Between 40 to 50 mcg/mL
Ans:
B Feedback: Therapeutic theophylline levels should be between 10 and 20 mcg/mL. A level between 0.5 and 5 mcg/mL would be low and would not produce a therapeutic effect. Levels between 25 and 50 mcg/mL would be too high and could cause serious adverse effects.
4.
A patient presents to the emergency department (ED) having an acute asthma attack. An ED physician has ordered a sympathomimetic (epinephrine). The nurse expects what as the therapeutic effect of this drug?
A)
Decrease the inflammatory response in the airways
B)
Reduce the surface tension within the alveoli allowing for gas exchange
C)
Inhibit the release of histamine and slow-reacting substance of anaphylaxis (SRSA) to prevent the allergic asthmatic response
D)
Cause dilation of the bronchi with increased rate and depth of respiration
Ans:
D Feedback: Epinephrine will cause the bronchi to dilate and also cause the rate and depth of respiration to increase. Inhaled steroids decrease the inflammatory response and lung surfactants reduce the surface tension within the alveoli. Mast cell stabilizers inhibit the release of histamine and SRSA to prevent the allergic response. Options A, B, and C are not correct.
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5.
An inhaled sympathomimetic drug has been ordered for a teenage athlete who has exercise-induced asthma. What should the patient be instructed to do?
A)
Use the inhaler every day at the same time each day.
B)
Use the inhaler as soon as the symptoms start.
C)
Use the inhaler 30 to 60 minutes before exercising to ensure peak therapeutic levels when needed.
D)
Use the inhaler 2 to 3 hours before exercising to ensure peak effectiveness.
Ans:
C Feedback: Teaching a patient about using an inhaled sympathomimetic for management of exercise-induced asthma should include instructions to use the inhaler 30 to 60 minutes before exercising to ensure therapeutic levels when needed. The inhaler would not be used daily and waiting until symptoms occur will be too late for prevention. Options B and D are not correct.
6.
A premature newborn is being treated for respiratory distress syndrome. The nurse teaches the parents about what adverse effect that can occur with the use of lung surfactants?
A)
Kidney dysfunction
B)
Cardiac arrhythmias
C)
High fever
D)
Collapsed lung
Ans:
D Feedback: Lung surfactants used therapeutically can cause many adverse effects including pneumothorax (collapsed lung), hypotension, pulmonary leak, hyperbilirubinemia, and sepsis. Other adverse effects may occur in the infant related to the degree of immaturity of the childs system and may not be related to the drug therapy. Options A, B, and C are not correct.
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7.
A patient who has chronic bronchial asthma has had a mast cell stabilizer prescribed. What drug would the physician prescribe?
A)
Ipratropium or budesonide
B)
Isoetharine or montelukast
C)
Nedocromil or cromolyn
D)
Aminophylline or caffeine
Ans:
C Feedback: Nedocromil and cromolyn are mast cell stabilizers used in the treatment of asthma. Aminophylline and caffeine are xanthines. Ipratropium is an anticholinergic drug and budesonide is a corticosteroid. Isoetharine is a sympathomimetic drug and montelukast is a leukotriene receptor antagonist.
8.
A 76-year-old man with asthma is being treated with an anticholinergic. What will the nurse be careful to assess for?
A)
Cardiac arrhythmias
B)
Prostatic hypertrophy
C)
Thyroid conditions
D)
Parkinsonism
Ans:
B Feedback: Anticholinergics can produce urinary hesitancy and urinary retention, conditions that would aggravate the signs and symptoms of prostatic hypertrophy. Older patients given anti-cholinergics should be encouraged to empty the bladder before taking the drug. These drugs are used to treat parkinsonism. Thyroid conditions and cardiac arrhythmias are not cautions or contraindications to the use of these drugs.
9. A)
A patient with chronic bronchial asthma is prescribed montelukast (Singulair). What will the nurse instruct the patient to avoid taking? Aspirin
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B)
Penicillin
C)
Sertraline (Zoloft)
D)
Nifedipine (Procardia)
Ans:
A Feedback: The nurse would instruct the patient to avoid aspirin, which might cause an increased montelukast level and toxicity. The other options do not cause drugdrug interactions with montelukast.
10 .
A patient presents at the emergency department in acute respiratory distress. A quick assessment by the triage nurse indicates that the patient experienced difficulty breathing immediately after taking Combivent for the first time. The nurse suspects that the patient may be allergic to what?
A)
Aspirin
B)
Penicillin
C)
Peanuts
D)
Ragweed pollen
Ans:
C Feedback: Combivent is a combination drug of ipratropium and albuterol. The propellant used to make ipratropium has a cross-sensitivity to the antigen that causes peanut allergies. Aspirin, penicillin, and ragweed pollen are not associated with this drug.
11 .
The nurse has admitted a patient (who takes ipratropium) to the respiratory unit with an acute exacerbation of chronic obstructive pulmonary disease (COPD). While writing a plan of care for this patient, what would be the most appropriate nursing diagnosis to use?
A)
Deficient knowledge regarding alternative therapy
B)
Imbalanced nutrition: Less than body requirements
C)
Acute pain related to renal effects of the drug
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D)
Disturbed thought processes related to central nervous system (CNS) effects
Ans:
B Feedback: Nursing diagnoses related to drug therapy might include acute pain related to CNS, gastrointestinal (GI), or respiratory effects of the drug; imbalanced nutrition: Less than body requirements, related to dry mouth and GI upset; and deficient knowledge regarding drug therapy. Options A, C, and D are not correct.
12 .
A patient, diagnosed with asthma, has been prescribed tiotropium (Spiriva). What should the nurse teach the patient about this drug? (Select all that apply.)
A)
It makes you fatigued.
B)
You need to stay out of direct sunlight.
C)
It is an anticholinergic.
D)
You only need to take it once a day.
E)
It has a rapid onset of action and a long duration.
Ans:
C, D, E Feedback: Tiotropium is the first drug approved for once-daily maintenance treatment of bronchospasm associated with chronic obstructive pulmonary disease (COPD). Patients who cannot tolerate the sympathetic effects of the sympathomimetics might respond to the anticholinergic drugs ipratropium (Atrovent) or tiotropium. Tiotropium has a rapid onset of action and a long duration, with a half-life of 5 to 6 days. Tiotropium is not associated with fatigue or photosensitivity.
13 .
The nurse is providing health teaching to a newly diagnosed asthmatic patient. The patient has been prescribed theophylline. What is contraindicated with the use of this drug?
A)
Using insulin
B)
Taking anti-inflammatory drugs
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C)
Exercising
D)
Smoking cigarettes
Ans:
D Feedback: Nicotine increases the metabolism of xanthines in the liver so that xanthine dosage must be increased in patients who continue to smoke while using xanthines. In addition, extreme caution must be used if the patient decides to decrease or discontinue smoking because severe xanthine toxicity can occur. Bronchoconstriction is not caused by using insulin and anti-inflammatory drugs do not cause bronchoconstriction. Exercise with a physicians supervision is encouraged in individuals with asthma.
14 .
What action by the patient would indicate that the patient understands how to use an inhaler?
A)
The patient inhales as soon as the inhaler enters his or her mouth.
B)
The patient holds his or her breath for several seconds after releasing the medication.
C)
The patient administers three doses of medication within a 1-minute time frame.
D)
The patient exhales as soon as he or she compresses the inhaler.
Ans:
B Feedback: Holding the breath prevents exhalation of medication still remaining in the mouth. The patient should inhale when the canister is compressed, not as soon as the inhaler enters his or her mouth. The patient should only administer one dose of medication at a time and the patient should wait to exhale until after the breath has been held as long as possible.
15 .
A patient, newly diagnosed with chronic obstructive pulmonary disease (COPD), calls the clinic and asks the nurse to explain what the newly prescribed medications are for. What would be the most appropriate response by the nurse?
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A)
The medications that have been ordered for you are what the physician thinks will help you the most.
B)
The medications that have been ordered for you are to help you breathe easier.
C)
The medications that have been ordered for you are designed to work together to help you feel better.
D)
The medications that have been ordered for you are to help relieve the inflammation and promote dilation of the bronchi.
Ans:
D Feedback: Drug treatment of asthma and COPD aims to relieve inflammation and promote bronchial dilation. The other options do not give the patient information about the use of these new medications.
16 .
The nurse is caring for a patient who is taking an adrenergic bronchodilator. In what disease process should adrenergic bronchodilators be used cautiously?
A)
Liver failure
B)
Renal failure
C)
Respiratory failure
D)
Heart failure
Ans:
D Feedback: Adrenergic drugs cause cardiac stimulation. Patients with liver failure, renal failure, or respiratory failure do not need to use adrenergic bronchodilators cautiously.
17 .
The patient is a 34-year-old man who recently started taking theophylline. The nurse knows that medication teaching has been successful when he agrees to what activity?
A)
Avoiding caffeine
B)
Eating foods high in potassium
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C)
Limiting fluid intake to 1,000 mL a day
D)
Taking the medicine on an empty stomach
Ans:
A Feedback: Both theophylline and caffeine are xanthenes. Theophylline increases cardiac output and heart rate. Caffeine also stimulates heart rate. This can have an additive effect. Eating foods high in potassium, limiting fluid intake, or taking the medicine on an empty stomach are not indications that the patient has understood the nurses teaching.
18 .
The nurse caring for a 38-year-old patient started on albuterol (Proventil) should advise the patient that he or she may experience what adverse effect?
A)
Polydipsia
B)
Tachycardia
C)
Hypotension
D)
Diarrhea
Ans:
B Feedback: Adrenergic agents stimulate beta1-adrenergic receptors in the heart as well as beta2-adrenergic receptors in the lungs. Adrenergic agents do not cause polydipsia, hypotension, or diarrhea.
19 .
The nursing instructor is discussing bronchodilators with a group of nursing students. The students understand the instruction when they identify what drug is most effective in treating acute bronchospasm?
A)
Ipratropium bromide (Atrovent)
B)
Epinephrine (Adrenalin)
C)
Cromolyn (Intal)
D)
Ephedrine
Ans:
B
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Feedback: Epinephrine may be injected subcutaneously in an acute attack of bronchoconstriction, with therapeutic effects in 5 minutes that last 4 hours. It is considered the drug of choice for the treatment of acute bronchospasm. Ipratropium bromide has an onset of action of 15 minutes when inhaled with a duration of 3 to 4 hours. Cromolyn is not for use during acute times of bronchospasm but is used to help prevent bronchospasm. Ephedrine can be used in acute bronchospasm but epinephrine remains the drug of choice. 20 .
A patient with chronic obstructive pulmonary disease (COPD) presents at the emergency department in acute respiratory distress. The patients family tells the nurse that the patients problems began right after the patient took his or her first dose of ipratropium (Atrovent). What would the nurse suspect is the problem?
A)
An allergy to milk
B)
Overexertion by the patient
C)
Patient not taking the medications correctly
D)
An allergy to soy products
Ans:
D Feedback: The use of ipratropium or tiotropium is contraindicated in the presence of known allergy to the drug or to soy products or peanuts (the vehicle used to make ipratropium an aerosol contains a protein associated with peanut allergies) to prevent hypersensitivity reactions. An allergy to milk is not associated with sensitivity to ipratropium. Overexertion would not cause the patient to develop respiratory distress after using ipratropium for the first time. Misuse of the inhaler would not cause respiratory distress.
21 .
The nurse has provided health teaching for a 15-year-old boy newly diagnosed with asthma. What statement, made by the patient, indicates that he has a good understanding of the teaching the nurse has done regarding inhalers?
A)
I should hold my breath when administering a puff.
B)
The aerosol canister should be shaken well before using.
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C)
I need to take three short quick breaths when I administer the inhaler.
D)
A second aerosol medication cannot be administered until 30 minutes after the first aerosol medication.
Ans:
B Feedback: Inhalers should be shaken well, immediately before each use. It would not be appropriate to teach the patient to hold his breath when administering a puff, to take three short quick puffs when administering the inhaler, or that a second aerosol medication should not be administered until 30 minutes after the first dose of aerosol medication.
22 .
The nurse is writing a plan of care for a patient newly admitted to the floor with an asthma attack that occurred while exercising. What would be the most appropriate intervention for this patient?
A)
Assist patients with moderate to severe asthma in obtaining a home nebulizer unit
B)
Try to prevent or reduce panic, which may initiate bronchospasm
C)
Teach patient to use an inhaler before exercising
D)
Monitor peak flow rates, especially in children
Ans:
C Feedback: Teach patient who use one of these drugs for exercise-induced asthma to use it 30 to 60 minutes before exercising to ensure peak therapeutic effects when they are needed. The most important intervention would be to use a bronchodilator as prophylaxis for a patient with exercise-induced asthma. It would not be monitoring peak flow rates, trying to prevent or reduce panic, or assisting patient in obtaining a home nebulizer unit.
23 . A)
A patient tells the nurse that a friend has recommended the use of caffeine to treat the patients asthma. The nurse counsels the patient to begin treatment immediately with the prescribed medication for what reason? Caffeine can aggravate the drugs used to treat asthma.
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B)
Most natural products are less toxic or more potent than traditional asthma medications.
C)
Natural products decrease the adverse effects associated with adrenergic bronchodilators.
D)
Delays in appropriate treatment can have serious, even fatal, consequences.
Ans:
D Feedback: The xanthines, including caffeine and theophylline, come from a variety of naturally occurring sources. These drugs were formerly the main treatment choices for asthma and bronchospasm. However, because they have a relatively narrow margin of safety, and they interact with many other drugs, they are no longer considered the first-choice bronchodilators. Delays in appropriate treatment can have serious, even fatal, consequences. Natural products do not decrease the adverse effects associated with adrenergic bronchodilators. Natural products have not been proven to be less toxic or more potent than prescribed asthma medications. Caffeine does not aggravate drugs used to treat asthma, but it can have an additive effect.
24 .
Epinephrine, formerly the drug of choice for acute attacks of bronchoconstriction, has been replaced by what?
A)
Short-acting bronchodilators are the drug of choice in this situation.
B)
Nothing has replaced epinephrine as drug of choice in this situation.
C)
Self-administered metered-dose inhalers (MDIs)
D)
Long-acting beta2-adrenergic agonists (LABAs)
Ans:
B Feedback: Epinephrine, the prototype drug, is the drug of choice in adults and children for the treatment of acute bronchospasm, including that caused by anaphylaxis; it is also available for inhalation therapy. Because epinephrine is associated with systemic sympathomimetic effects, it is not the drug of choice for patients with cardiac conditions. Options A, C, and D are not correct.
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25 .
A patient has an acute asthma attack. A bronchodilator is used to bring the exacerbation under control. What drug would be used to prevent acute bronchoconstriction?
A)
Salbutamol (Ventolin)
B)
Salmeterol (Serevent)
C)
Fenoterol (Berotec)
D)
Terbutaline (Bricanyl)
Ans:
B Feedback: Salmeterol (Serevent) and formoterol (Foradil) and are long-acting beta2adrenergic agonists used only for prophylaxis of acute bronchoconstriction. Options A, C, and D are all short-acting beta2-adrenergic agonists and not used for prophylaxis.
26 .
A patient is prescribed salmeterol with dosage on a 4 to 6 hour schedule for treatment of exercise-induced asthma. What is the recommended dosing schedule of asthma experts regarding this drug?
A)
30 minutes before exercise to prevent dyspnea during exercise
B)
Every 15 minutes during exercise to prevent dyspnea
C)
As needed to treat or prevent dyspnea during exercise
D)
Every 1 to 2 hours to treat or prevent dyspnea during exercise
Ans:
A Feedback: Salmeterol (Serevent) adult and pediatric (12-year-old and older): two puffs every 12 hours; or two puffs 30 to 60 minutes before exercise. Therefore, options B, C, and D are incorrect.
27 . A)
The pharmacology instructor is explaining the difference between bronchodilators and anti-inflammatory drugs. How does an antiinflammatory drug reduce bronchoconstriction? Increases ability to metabolize medication
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B)
Decreases formation of mucus secretions
C)
Increases reactivity to medication
D)
By decreasing airway hyperreactivity to various stimuli
Ans:
D Feedback: Bronchodilators, or antiasthmatics, are medications used to facilitate respirations by dilating the airways. They are helpful in symptomatic relief or prevention of bronchial asthma and for bronchospasm associated with chronic obstructive pulmonary disease (COPD). Reducing inflammation prevents and reduces bronchoconstriction by decreasing airway hyperreactivity to various stimuli that decreases mucosal edema and formation of mucus secretions that narrow airways. Anti-inflammatory drugs do not increase the ability to metabolize medication or increases reactivity to medication.
28 .
Why are inhaled steroids used to treat asthma and chronic obstructive pulmonary disease (COPD)?
A)
They act locally to decrease release of inflammatory mediators.
B)
They act locally to improve mobilization of edema.
C)
They act locally to increase histamine release.
D)
They act locally to decrease histamine release.
Ans:
A Feedback: When administered into the lungs by inhalation, steroids decrease the effectiveness of the inflammatory cells. This has two effects, which are decreased swelling associated with inflammation and promotion of betaadrenergic receptor activity, which may promote smooth muscle relaxation and inhibit bronchoconstriction. Options B, C, and D are incorrect.
29 . A)
The nurse is caring for a patient with chronic obstructive pulmonary disease. The plan of care will focus on what patient problem? Pain
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B)
Obstructed airway
C)
Activity intolerance
D)
Adverse effects of medication therapy
Ans:
B Feedback: Asthma, emphysema, chronic obstructive pulmonary disease (COPD), and respiratory distress syndrome (RDS) are pulmonary obstructive diseases. All but RDS involve obstruction of the major airways. RDS obstructs the alveoli. Pain, activity intolerance, and adverse effects of medication therapy are conditions identified to detect, manage, and minimize the unexpected outcomes the nurse should be especially aware of the potential for an obstructed airway in these patients.
30 .
The clinic nurse is caring for a patient who has just been diagnosed with chronic obstructive pulmonary disease (COPD). The patient asks the nurse what COPD means. What would be the nurses best response?
A)
It is an umbrella term for diseases like acute bronchitis.
B)
It means that the lungs have been damaged in such a way that there airflow is limited in and out of the lungs.
C)
It means your lungs cant expand and contract like they are supposed to, which makes it hard for you to breathe.
D)
It is a term that covers so many lung diseases I cant list them all.
Ans:
B Feedback: The obstruction of asthma, emphysema, and COPD can be related to inflammation that results in narrowing of the interior of the airway and to muscular constriction that results in narrowing of the conducting tube. With chronic inflammation, muscular and cilial action is lost, and complications related to the loss of these protective processes can occur, such as infections, pneumonia, and movement of inhaled substances deep into the respiratory system. In severe COPD, air is trapped in the lower respiratory tract, the alveoli degenerate and fuse together, and the exchange of gases is greatly impaired. Options A, C, and D are not incorrect, but option B is the best response.
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31 .
The nurse is caring for a child who has been newly diagnosed with asthma. What environmental modifications should the nurse encourage the parents to make to help their child avoid future attacks? (Select all that apply.)
A)
Make sure the child begins herbal therapy as soon as possible.
B)
Avoid crowded areas as much as possible.
C)
Keep the child away from any known allergens.
D)
Encourage the child to use a broom to sweep the bedroom every day.
E)
Keep the child away from areas that are filled with cigarette smoke.
Ans:
B, C, E Feedback: Parents need to be encouraged to take measures to prevent acute attacks, including avoidance of known allergens, smoke-filled rooms, and crowded or dusty areas. OTC drugs and herbal remedies should be avoided if possible. The child should not be sweeping the bedroom because this will produce a lot of dust.
32 .
The nursing instructor is talking to a group of nursing students about the treatment regimen for children with asthma. The students indicate they understand the information when they identify which class of drugs that comprise this regimen? (Select all that apply.)
A)
Long-acting inhaled steroids
B)
Xanthines
C)
Leukotriene-receptor antagonists
D)
Topical steroid nasal decongestants
E)
Beta-agonists
Ans:
A, C, E Feedback:
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Antiasthmatics are frequently used in children. The leukotriene-receptor antagonists have been found to be especially effective for long-term prophylaxis in children. Acute episodes are best treated with a beta-agonist and then a long-acting inhaled steroid or a mast cell stabilizer. Xanthines (e.g., theophylline) have been used in children, but because of their many adverse effects and the better control afforded by newer agents, its use is reserved for patients who do not respond to other therapies. Topical steroid nasal decongestants may be used for symptom relief for nasal congestion but are not a regular part of asthma therapy in children. 33 .
The nurse has just admitted a patient with asthma and the emergency department doctor has ordered the patient to begin taking zafirlukast (Accolate). The nurse would hold the medication and contact the physician if the patient reported taking which medication at home? (Select all that apply.)
A)
Propranolol
B)
Warfarin
C)
Acetaminophen
D)
Ampicillin
E)
Terfenadine
Ans:
A, B, E Feedback: Use zafirlukast with caution if propranolol, theophylline, terfenadine, or warfarin is taken at the same time because increased toxicity can occur. Toxicity may also occur if these drugs are combined with calcium channel blockers, cyclosporine, or aspirin. No reported change of toxicity occurs when the patient is currently taking acetaminophen or ampicillin.
34 .
A patient with asthma is going to begin taking an inhaled steroid. The nurse teaching the patient that what adverse effects may occur when using this drug? (Select all that apply.)
A)
Headache
B)
Rebound congestion
C)
Sepsis
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D)
Epistaxis
E)
Depression
Ans:
A, B, D Feedback: Adverse effects associated with the use of inhaled steroids include irritability, not depression, headache, rebound congestion, local infection, not sepsis and epistaxis.
35 .
The nursing instructor is discussing the use of sympathomimetics in patients who have acute bronchospasm. The instructor shares with the students that this classification of drugs is contraindicated or only used with great caution in patients with what disorders? (Select all that apply.)
A)
Hypothyroidism
B)
Cardiac disease
C)
Kidney disease
D)
Diabetes mellitus
E)
Peripheral vascular disease
Ans:
B, D, E Feedback: Before administering a sympathomimetic the nurse should assess for possible contraindications or cautions that include any known allergies to any drug in this class, cigarette use, cardiac disease, vascular disease, arrhythmias, diabetes, and hyperthyroidism. Sympathomimetics have no known adverse effects in hypothyroidism or kidney disease.
Chapter 22-Chapter 23 Sedative-Hypnotic Drugs Chapter 23. The Alcohols 1.
According to the sliding filament theory, what is the initial action in a muscle contraction?
A)
Troponin is freed and prevents actin and myosin from reacting with each other.
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B)
Calcium binds to troponin, which causes the release of actin and myosin binding sites.
C)
Actin and myosin molecules react with each other sliding along the filament and making it shorter.
D)
Muscle filament relaxes or slides back to the resting position.
Ans:
C Feedback: Actin and myosin molecules react with each other again and again, sliding along the filament and making it shorter. This is a contraction of the muscle fiber according to the sliding filament theory. As the calcium is removed from the cell during repolarization of the muscle membrane, the troponin is freed and once again prevents the actin and myosin from reacting with each other. The muscle filament then relaxes or slides back to the resting position. Muscle tone results from a dynamic balance between excitatory and inhibitory impulses to the muscle.
2.
When causing depolarization of the muscle membranes, what neurotransmitter interacts with the nicotinic cholinergic receptors leading to the release of calcium ions?
A)
Acetylcholine
B)
Serotonin
C)
D-gluconamidoethyl methacrylate (GAMA)
D)
Epinephrine
Ans:
A Feedback: At the acetylcholine receptor site on the effectors side of the synapse, the acetylcholine interacts with the nicotinic cholinergic receptors causing the depolarization. Serotonin, GAMA, and epinephrine are not part of muscle contraction and relaxation.
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3.
The nurse, working in the preoperative holding area, is caring for a 70-yearold patient who is scheduled to receive succinylcholine as part of general anesthesia. When collecting the nursing history, what condition would require the nurse to notify the anesthesiologist of the need for caution?
A)
Bone fracture
B)
Malnutrition
C)
Fluid volume overload
D)
Narrow-angle glaucoma
E)
Pregnancy
Ans:
A, B, D Feedback: Succinylcholine should be used with caution in patients with fractures because the muscle contractions it causes might lead to additional trauma; in patients with narrow-angle glaucoma or penetrating eye injuries because intraocular pressure increases. Extreme caution is necessary in the presence of genetic or disease-related conditions causing low plasma cholinesterase levels (e.g., cirrhosis, metabolic disorders, carcinoma, burns, dehydration, malnutrition, hyperpyrexia, thyroid toxicosis, collagen diseases, exposure to neurotoxic insecticides).
4.
The nurse is caring for a patient who received succinylcholine during surgery. The nurse would expect the patient to spend more time in the postanesthesia care unit due to prolonged paralysis and inability to breathe if the patient was from what ethnic group?
A)
American Japanese
B)
Alaskan Eskimos
C)
Native Americans
D)
Hawaiian natives
Ans:
B Feedback:
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Alaskan Eskimos belong to a genetic group that is predisposed to low plasma cholinesterase levels, making them susceptible to prolonged paralysis after succinylcholine use. The other ethnic groups do not have this genetic predisposition. 5.
A patient scheduled for surgery is to have a nondepolarizing neuromuscular junction (NMJ) blocker as adjunctive anesthesia. The nurse will have cause for concern about prolonged paralysis if the patient has been taking what medication?
A)
An aminoglycoside
B)
Aminophylline
C)
A barbiturate anesthetic
D)
A cephalosporin
Ans:
A Feedback: Combining nondepolarizing NMJ blockers with aminoglycosides can result in prolonged paralysis, and this combination should be avoided. This interaction does not occur with barbiturate anesthetics, cephalosporins, or aminophylline.
6.
A patient is having outpatient surgery that should last only 45 minutes. The patient is planning to go home immediately after the surgery is complete. What nondepolarizing neuromuscular junction blocker will most likely be used as an adjunct therapy to general anesthesia for this patient?
A)
Atracurium (Tracrium)
B)
Cisatracurium (Nimbex)
C)
Pancuronium (Pavulon)
D)
Rocuronium (Zemuron)
Ans:
D Feedback:
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Rocuronium has a rapid onset of action and a short duration, making it a drug of choice for outpatient surgical procedures when the patient will be leaving to go home and will need to be awake, alert, and mobile. Atracurium, cisatracurium, and pancuronium are associated with longer paralysis and recovery. 7.
A patient is taking aminophylline for their chronic obstructive pulmonary disease. The patient is about to undergo emergency surgery and will receive an neuromuscular junction (NMJ) blocker as part of the procedure. It is important for the nurse to take what action?
A)
Make sure the patient receives the aminophylline on a regular schedule to maintain therapeutic levels.
B)
Monitor the patient very closely for signs of early arousal and return of muscle function.
C)
Carefully explain all that is going on because the patient will be unable to talk.
D)
Switch the patient to theophyllines before the procedure begins.
Ans:
B Feedback: Aminophylline can cause a decreased effectiveness of NMJ blockers, leading to reduced paralysis and early return of movement. If a patient has emergency surgery and has been taking aminophylline, the patient should be carefully monitored for early arousal and return of movement. The patient will not be awake during surgery using an NMJ blocker and will be intubated to ensure respirations. Aminophylline and other xanthine derivatives like the theophyllines will have the same effect.
8.
The nurse is caring for a patient who is being maintained on mechanical ventilation. Atracurium is administered to limit the resistance to mechanical ventilation. What is the nurses priority assessment?
A)
Hypotension
B)
Tachycardia
C)
Bradycardia
D)
Increased secretions
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Ans:
C Feedback: Bradycardia is a common adverse effect associated with atracurium. The nurse should monitor the patient regularly to avoid serious adverse effects. Increased secretions and hypotension are common with tubocurarine. Option B is a distracter.
9.
The nurse is preparing a patient for surgery who will receive a neuromuscular junction blocker during the procedure. It is important for the nurse to review the patients medication history for concurrent use of what?
A)
Angiotensin-converting enzyme (ACE) inhibitors
B)
Beta blockers
C)
Calcium channel blockers
D)
Montelukast
Ans:
C Feedback: When calcium channel blockers are used concurrently with neuromuscular junction blockers, the patient is at increased risk of prolonged paralysis. The dose of the neuromuscular junction blocker should be lowered if this combination cannot be avoided and the patient should be monitored closely. There is no anticipated drugdrug interaction with ACE inhibitors, beta blockers, or montelukast.
10 .
An elderly patient has received a neuromuscular junction blocker during surgery. What would be an appropriate nursing diagnosis for this patient?
A)
Excess fluid volume
B)
Risk for impaired skin integrity
C)
Deficient fluid volume
D)
Chronic confusion
Ans:
B Feedback:
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An elderly or frail patient will need extra nursing care to prevent skin breakdown during the period of paralysis because skin tends to be thinner and more susceptible to breakdown. Therefore, risk of impaired skin integrity would be an appropriate nursing diagnosis. Fluid excess or deficit should not be a concern and the patient may be acutely confused when awakening, but there is no reason to think he or she would remain chronically confused if he was not before surgery. 11 .
What are the primary uses of neuromuscular junction blockers (NMJ) blockers? (Select all that apply.)
A)
To facilitate endotracheal intubation
B)
To sedate patient for general anesthesia
C)
To prevent injury during electroconvulsive therapy
D)
To provide greater ease in extubating patient
E)
To facilitate mechanical ventilation
Ans:
A, C, E Feedback: NMJ blockers are primarily used as adjuncts to general anesthesia, to facilitate endotracheal intubation, to facilitate mechanical ventilation, and to prevent injury during electroconvulsive therapy. NMJ blockers do not sedate the patient who will be paralyzed after administration but will remain alert unless another medication is given. These medications would not be given before extubation because respiratory muscles would be paralyzed, resulting in the inability to breathe.
12 .
The pharmacology instructor is discussing nondepolarizing neuromuscular junction blockers (NMJ) blockers with the nursing class. How would the instructor explain the action of nondepolarizing NMJ blockers?
A)
Blocks acetylcholine (ACh) from acting
B)
Acts like ACh then prevents repolarization
C)
Takes the place of ACh in the depolarizing/repolarizing process
D)
Stops depolarization in the axion
Ans:
B
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Feedback: Depolarizing NMJ blockers cause muscle paralysis by acting like ACh. They excite (depolarize) the muscle and prevent repolarization and further stimulation. Options A, C, and D are incorrect. 13 .
A patient is to have surgery and it is planned that atracurium (Tracrium) is to be used as an adjunct to general anesthesia. How will the atracurium work?
A)
Act as agonist to acetylcholine
B)
Stops depolarization in the axion
C)
Act as antagonist to acetylcholine
D)
Stops repolarization in the axion
Ans:
C Feedback: Nondepolarizing neuromuscular junction blockers compete with acetylcholine (ACh) for the ACh receptor site and after they occupy the site, stimulation cannot occur. This results in paralysis because the muscle cannot respond. Other options are incorrect.
14 .
The nurse is caring for a patient who is receiving pancuronium (Pavulon) to facilitate mechanical ventilation. The patient is also receiving a barbiturate. How will the nurse administer these two medications?
A)
They can be mixed and given in the same syringe.
B)
Administer IM quickly after mixing the two drugs.
C)
Shake vigorously when mixed in one syringe.
D)
If given together, a precipitate may form.
Ans:
D Feedback: Do not mix this drug with any alkaline solutions such as barbiturates because a precipitate may form, making it inappropriate for use. Pancuronium is only given IV. Shaking does not prevent precipitation.
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15 .
The nurse is caring for a patient who is scheduled for abdominal surgery in the morning and is scheduled to receive rocuronium (Zemuron). The patient asks the nurse to describe the adverse effects of rocuronium. What would the nurse describe for the patient?
A)
This drug is associated with pulmonary hypertension.
B)
This drug contains benzyl alcohol.
C)
This drug is associated with bradycardia.
D)
This drug is associated with an increased heart rate.
Ans:
A Feedback: Rocuronium may be associated with pulmonary hypertension. Cisatracurium (Nimbex) contains benzyl alcohol; Atracurium (Tracrium) is associated with bradycardia; and Pancuronium (Pavulon) is associated with an increased heart rate.
16 .
The postanesthesia care unit (PACU) nurse is caring for a patient that had succinylcholine (Anectine) as an adjunct to anesthesia. What is the nurses priority assessment while caring for this patient?
A)
Movement
B)
Temperature
C)
Mental status
D)
Heart rate
Ans:
B Feedback: Succinylcholine is more likely to cause malignant hyperthermia than other drugs so it is very important that the nurse carefully monitor the patients temperature while in the PACU. Movement, mental status, and heart rate monitoring are all routine components of PACU care, but after receiving this medication, temperature monitoring becomes the priority.
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17 .
The nurse is caring for a patient scheduled for abdominal surgery in the morning. The patient confides that he or she watched a movie last week about someone who had surgery and the anesthetic did not work, but no one knew because that patient could not move. What nursing diagnosis will the nurse include in this patients plan of care?
A)
Alteration in fluid volume
B)
Deficient knowledge regarding drug therapy
C)
Fear related to paralysis
D)
Risk for skin impairment
Ans:
C Feedback: Nursing diagnoses related to drug therapy may include Fear related to paralysis. This care plan would not include alteration in fluid volume; deficient knowledge regarding drug therapy; or risk for skin impairment.
18 .
The nurse is caring for a patient in the intensive care unit who has been receiving neuromuscular junction (NMJ) blockers, sedatives, and analgesics for the past 2 weeks. The NMJ blocker therapy has been discontinued and the other medications are being reduced gradually. The patient is now alert and awake, communicating with his or her family by using paper and pencil. The family asks why the patient cannot sustain normal respirations. What is the nurses best response? (Select all that apply.)
A)
His or her muscles need to get their strength back again.
B)
This is a common occurrence in situations like this.
C)
He or she is likely to breathe better each day.
D)
The drugs created temporary muscle damage.
E)
He or she will not be taken off the mechanical ventilator until he is ready.
Ans:
A, B, C, E Feedback:
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After 2 weeks of muscle paralysis, the muscles are weak and will take time to strengthen as the patient begins using them again. Profound and prolonged muscle paralysis is always possible; patients must be supported until they are able to resume voluntary and involuntary muscle movement. When the respiratory muscles are paralyzed, depressed respiration, bronchospasm, and apnea are anticipated adverse effects so the patient will remain ventilated until he or she can demonstrate adequate respiratory effort. The drugs did not damage the muscle, but lack of use has weakened them.
19 .
The nurse is caring for a very anxious 33-year-old female patient scheduled for abdominal surgery today. The patient says the anesthesiologist said she would receive succinylcholine (Anectine) during surgery and asks the nurse how long it will take before the medicine starts to work. What is the nurses best response?
A)
1 to 2 minutes
B)
30 to 60 seconds
C)
5 to 10 minutes
D)
30 minutes
Ans:
B Feedback: Succinylcholine has an onset of action of 30 to 60 seconds. The other options are incorrect.
20 .
The patient returns from surgery complaining about muscle pain after receiving succinylcholine during the procedure. After reviewing the postoperative orders, which of these ordered analgesics will the nurse administer to treat this pain?
A)
Aspirin
B)
Acetaminophen (Tylenol)
C)
Ketorolac (Toradol)
D)
Morphine
Ans:
A
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Feedback: Succinylcholine is associated with muscle pain, related to the initial muscle contraction reaction. A nondepolarizing neuromuscular junction blocker may be given first to prevent some of these contractions and the associated discomfort. Aspirin also alleviates much of this pain after the procedure. Tylenol is not an antiinflammatory medication and would not be appropriate. Toradol and morphine provide stronger pain relief than what is indicated for this discomfort. 21 .
A student asks the pharmacology instructor how succinylcholine differs from acetylcholine (ACh). What should the instructor respond?
A)
Succinylcholine is not broken down instantly.
B)
It results in a prolonged contraction of the muscle.
C)
The muscle becomes hyper stimulated by succinylcholine.
D)
Succinylcholines duration of action is about 2 hours.
Ans:
A Feedback: Unlike endogenous ACh, succinylcholine is not broken down instantly. Succinylcholine, a depolarizing NMJ blocker, attaches to the ACh-receptor site on the muscle cell, causing a prolonged depolarization of the muscle. This depolarization causes stimulation of the muscle and muscle contraction (seen as twitching) and then as flaccid paralysis, so the contraction of the muscle is not prolonged and the muscle is incapable of being stimulated. The duration of effects of succinylcholine is 4 to 6 minutes and not 2 hours.
22 .
The certified registered nurse anesthetist documents the anesthesia plan as using a depolarizing neuromuscular junction (NMJ) blocker as adjunct to other anesthetics on the patient when they go to surgery. The nurse would understand from this note that the patient will receive what drug?
A)
Rocuronium (Zemuron)
B)
Pancuronium (Pavulon)
C)
Succinylcholine (Anectine, Quelicin)
D)
Cisatracurium (Nimbex)
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Ans:
C Feedback: Currently the only agent classified as a depolarizing NMJ blocker is succinylcholine. rocuronium, pancuronium, and cisatracurium are all nondepolarizing NMJ blockers.
23 .
The nurse administers pancuronium to the mechanically ventilated patient in the pediatric intensive care unit. What assessment finding would the nurse suspect is an adverse effect resulting from the drug?
A)
Bradycardia
B)
Bronchospasm
C)
Should not be used in neonates
D)
Associated with pulmonary hypertension
Ans:
B Feedback: Adverse effects of pancuronium include respiratory depression, apnea, bronchospasm, and cardiac arrhythmias. Rocuronium is associated with pulmonary hypertension, cisatracurium should not be used in neonates, and atracurium is associated with bradycardia.
24 .
The nursing student asks the mental health nurse why pancuronium was administered to the patient before electroconvulsive therapy was performed. What is the mental health nurses best response?
A)
To prevent aspiration of vomitus
B)
To reduce the pain of the procedure
C)
To put the patient to sleep
D)
To reduce the intensity of muscle contractions
Ans:
D Feedback:
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Pancuronium is used, in this case, to induce skeletal muscle relaxation and to reduce the intensity of muscle contractions in electroconvulsive therapy. Pancuronium has no analgesic or amnesic effects. It would not reduce the risk of aspiration unless an endotracheal tube was placed with the cuff inflated and then it would not be the drug that was preventing aspiration. 25 .
When a nondepolarizing neuromuscular junction blocker is used as an adjunct to surgery, what classification of medications could reverse the neuromuscular blockage leading to early arousal and return of muscle function?
A)
Xanthines
B)
Barbiturates
C)
Opiates
D)
Antihypertensives
Ans:
A Feedback: Administering xanthines (e.g., theophylline, aminophylline) could result in reversal of the neuromuscular blockage. Patients receiving this combination of drugs should be monitored very closely during the procedure for the potential of early arousal and return of muscle function. Barbiturates, opiates, and antihypertensives do not reverse neuromuscular blockage.
26 .
The nursing instructor asks the student nurse what causes the respiratory obstruction that can occur with many of the depolarizing neuromuscular junction (NMJ) blockers. What is the students most accurate response?
A)
Acetylcholine (ACh)
B)
Histamine release
C)
Serotonin
D)
Hyperkalemia
Ans:
B Feedback:
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The histamine release associated with many of the depolarizing NMJ blockers can cause respiratory obstruction with wheezing and bronchospasm. Hyperkalemia is an adverse effect of the depolarizing NMJ blockers, ACh is what is acted on by the NMJ blockers, and serotonin is a distracter for this question. 27 .
The nurse is assisting the nurse practitioner who is preparing to intubate the patient. The nurse practitioner has ordered atracurium and midazolam (Versed), a short acting benzodiazepine used to sedate the patient. In what order will the nurse administer these medications?
A)
It does not matter; they can be given in any order.
B)
Give the midazolam first and then atracurium a few moments later.
C)
Give atracurium and then give midazolam a few moments later.
D)
Benzodiazepines are contraindicated with atracurium.
Ans:
B Feedback: Atracurium induces muscular paralysis resulting in the inability to breath due to paralysis of respiratory muscles but it has no impact on perception of consciousness. Receiving this drug before being sedated would be frightening and extremely anxiety provoking for the patient, so the sedative should be given first to reduce perception and consciousness before administering atracurium. There is no contraindication of benzodiazepines and the order they are given does matter.
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28 .
When a normal muscle functions, several actions take place. In what order do these actions occur?
1. Acetylcholine (ACh) is broken down by acetylcholinesterase. 2. ACh interacts with the nicotinic cholinergic receptors. 3. ACh is released by the motor nerve. 4. ACh crosses the synaptic cleft. 5. The muscle membrane is depolarized. 6. The muscle membrane is repolarized. Put these actions in the correct order. A)
1, 3, 5, 2, 4, 6
B)
2, 4, 6, 5, 3, 1
C)
6, 5, 4, 1, 2, 3
D)
3, 4, 2, 5, 1, 6
Ans:
D Feedback: Normal muscle function involves the arrival of a nerve impulse at the motor nerve terminal, followed by the release of the neurotransmitter, ACh into the synaptic cleft. At the acetylcholine receptor site on the effector side of the synapse, ACh interacts with the nicotinic cholinergic receptors, causing depolarization of the muscle membrane. ACh is then broken down by acetylcholinesterase (an enzyme), freeing the receptor for further stimulation.
29 .
The patient has been mechanically ventilated for the past week and is receiving a neuromuscular junction (NMJ) blocker, an analgesic, and a sedative. The goal is to extubate the patient. What medication will the nurse stop administering first?
A)
NMJ blocker
B)
Sedative
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C)
Analgesic
D)
All three medications will be stopped at the same time.
Ans:
A Feedback: NMJ blockers have no effect on pain perception or consciousness and should not be used without sedation so the NMJ blocker should be removed first. Because the patient has been receiving analgesics for a week, he or she will have to be weaned off them to overcome dependence. Sedatives can be removed more quickly after the NMJ blockers effects are gone.
30 .
The student asks the physiology instructor where the motor neuron communicates with a skeletal muscle fiber. What would the instructor respond?
A)
Synapse
B)
Neuromuscular junction
C)
Synaptic cleft
D)
Afferent junction
Ans:
B Feedback: The neuromuscular junction (NMJ) simply is the point at which a motor neuron communicates with a skeletal muscle fiber. The synapse and synaptic cleft are part of the NMJ. The afferent junction is a distracter for this question.
31 .
What drug will the nurse administer to reverse the actions of neuromuscular junction (NMJ) blocker?
A)
Cholinesterase inhibitor
B)
Xanthine
C)
Halothane
D)
Aminoglycoside
Ans:
A
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Feedback: Ensure that a cholinesterase inhibitor is readily available to overcome excessive neuromuscular blockade caused by nondepolarizing NMJ blockers. Although xanthines reverse NMJ blocking effects, they would not be administered for that purpose because their effects are not predictable. Halothane and aminoglycosides enhance paralytic effects of NMJ blockers. 32 .
How can the nurse assess the degree of neuromuscular blockage the patient is experiencing?
A)
Peripheral nerve stimulator
B)
Measure vital signs
C)
Assess response to painful stimuli
D)
Test reflexes
Ans:
A Feedback: Have a peripheral nerve stimulator on standby to assess the degree of neuromuscular blockade, if appropriate. Vital signs can indicate degree of sedation and assess pain sensation, but they are not an indicator of the degree of neuromuscular blockade. Response to painful stimuli would be more of an indication of effects of sedation and/or analgesic than degree of muscular blockade. Any neuromuscular junction blockage would reduce or eliminate reflexes so it would not be a means of assessing degree of blockage.
33 .
Why will the nurse administer a small dose of nondepolarizing neuromuscular junction (NMJ) blocker before administering succinylcholine?
A)
To reduce discomfort of depolarization of muscles
B)
To reduce the risk of malignant hyperthermia
C)
To reduce negative effects of dantrolene
D)
To increase the duration of effect for succinylcholine
Ans:
A Feedback:
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Succinylcholine is associated with muscle pain related to the initial muscle contraction reaction. A nondepolarizing NMJ blocker may be given first to prevent some of these contractions and the associated discomfort. Administering a small dose of nondepolarizing NMJ blocker will not reduce the risk of malignant hyperthermia or increase the duration of effects. Dantrolene is a drug given to treat malignant hyperthermia. 34 .
The nurse administers a sedative followed by a neuromuscular junction (NMJ) blocker after which the neonatologist attempts to intubate the patient without success. While waiting for the anesthesiologist to come to the unit to establish an artificial airway, what is the nurses priority of care?
A)
Reposition the patient frequently.
B)
Monitor oxygen saturation.
C)
Monitor respirations and pulse rate.
D)
Use a bag-valve-mask to ventilate the patient.
Ans:
D Feedback: Following administration of an NMJ blocker, the patient will be unable to breathe independently so maintaining an airway and breathing for the patient using a bag-valve mask is the nurses number-one priority. The patient will not be repositioned until after the artificial airway is placed (endotracheal tube or tracheostomy). Monitoring oxygen saturation and pulse will be second in priority after providing breathing for the patient. The patient will have no independent respirations until the NMJ is metabolized.
35 .
The nurse is caring for the intensive care unit patient who is mechanically ventilated and receiving a neuromuscular junction (NMJ) blocker, a sedative, and an analgesic. What are priorities of nursing care for this patient? (Select all that apply.)
A)
Reposition patient frequently.
B)
Ensure care of the patients eyes.
C)
Monitor temperature.
D)
Provide a means for patient communication.
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E)
Increase ventilator breaths per minute as needed.
Ans:
A, B, C Feedback: Frequent repositioning is important because the patient is unable to move and protect skin integrity independently. The loss of blink reflex due to muscle paralysis from NMJ blockers can result in conjunctival damage so eye care is very important. Monitor patient temperature for prompt detection and treatment of malignant hyperthermia. The patient cannot communicate while receiving NMJ blocker. Ventilator changes are made by physician order in most facilities and are usually based on arterial blood gas results.
Chapter 24. Antiseizure Drugs 1.
A patient is admitted to the emergency department with severe recurrent convulsive seizures. What drug would the nurse expect to be ordered for use in emergency control of status epilepticus?
A)
Phenytoin (Dilantin)
B)
Diazepam (Valium)
C)
Phenobarbital (Luminal)
D)
Ethosuximide (Zarontin)
Ans:
C Feedback: Phenobarbital is used for emergency control of status epilepticus. This barbiturate inhibits impulse conduction in the ascending reticular activating system (RAS), depresses the cerebral cortex, alters cerebellar function, and depresses motor nerve output. Phenobarbital stabilizes nerve membranes throughout the central nervous system (CNS) directly by influencing ionic channels in the cell membrane, thereby decreasing excitability and hyperexcitability to stimulation. By decreasing conduction through nerve pathways, it reduces the tonicclonic, muscular, and emotional responses to stimulation. Phenobarbital depresses conduction in the lower brainstem and the cerebral cortex and depresses motor conduction. Phenytoin is used to prevent status epilepticus but is not used to stop seizures after they have started; diazepam is used for short-term treatment of status epilepticus. Ethosuximide is used for absence seizures.
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2.
The pharmacology instructor is discussing drugs used for the treatment of partial seizures. What accurately describes the physiological action of carbamazepine?
A)
Reduces electrical activity
B)
Alters sodium and calcium channels
C)
Increases gamma-aminobutyric acid (GABA) activity and blocks sodium and calcium channels to stop action potentials
D)
Depresses conduction in the brainstem and cortex
Ans:
C Feedback: Carbamazepine increases GABA activity and blocks sodium and calcium channels to stop action potentials. Succinimides reduce electrical activity. Acetazolamides reduce electrical activity and alter sodium and calcium channels. Barbiturates depress conduction in the brainstem and the cortex.
3.
A 7-year-old girl is brought to the clinic by her mother. The mother states that the child will be engaged in some activity at home and then will just stop for a few seconds and then pick up the activity again as if there had been no break in what she was doing. The nurse suspects the child might be demonstrating what type of seizure?
A)
Tonicclonic seizure
B)
Absence seizure
C)
Myoclonic seizure
D)
Status epilepticus
Ans:
B Feedback:
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Absence seizures involve abrupt periods of loss of consciousness lasting 3 to 5 seconds. Tonic-clonic seizures involve dramatic muscle contractions, loss of consciousness, and a recovery period characterized by confusion and exhaustion. Myoclonic seizures involve short, sporadic periods of muscle contractions lasting for several minutes. These types of seizures are rare. Status epilepticus seizures are the most dangerous and rapidly occur one after another. 4.
A patient is brought into the emergency department in status epilepticus. The nurse administers phenobarbital 320 mg IV according to protocol. Family members ask the nurse how long it will take to stop the seizures. What is the nurses best response?
A)
The onset of action for the medication is 5 minutes.
B)
We should see results in about 10 minutes.
C)
It will probably take about 30 minutes before the seizures begin to subside.
D)
It may be an hour before the seizures stop.
Ans:
A Feedback: The onset of IV phenobarbital is 5 minutes; however, it is important not to confuse when the onset of action will occur and when the seizures will stop because additional interventions may be needed to stop the seizure activity in some cases. For intramuscular and subcutaneous administration, the onset should be between 10 and 30 minutes. Onset for an oral dose is between 30 and 60 minutes.
5.
The nurse evaluates the patients serum phenytoin (Dilantin) level and determines the level is therapeutic when it is within what range?
A)
Between 5 and 12 mcg/mL
B)
Between 10 and 20 mcg/mL
C)
Between 15 and 50 mcg/mL
D)
Between 40 and 100 mcg/mL
Ans:
B
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Feedback: The therapeutic serum level range for phenytoin is between 10 and 20 mcg/ mL. The other options are incorrect. 6.
A nurse is teaching a patient about his or her newly prescribed drug, phenytoin (Dilantin) for a seizure disorder. What will the nurse alert the patient to as a serious adverse effect of this drug?
A)
Drowsiness
B)
Fatigue
C)
Rash
D)
Lethargy
Ans:
C Feedback: Serious liver, bone marrow, and potentially serious dermatological adverse effects can occur with phenytoin. Drowsiness, fatigue, and lethargy are adverse effects of hydantoins and classified as not serious.
7.
An 8-year-old child has been diagnosed with a seizure disorder and phenytoin (Dilantin) has been prescribed for him or her. What nursing diagnosis would be appropriate if the child demonstrated adverse effects to the drug?
A)
Deficient fluid volume
B)
Impaired skin integrity related to dermatological effects
C)
Noncompliance for drug therapy
D)
Sleep deprivation
Ans:
B Feedback:
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Impaired skin integrity related to dermatological effects would be appropriate because phenytoin can cause potentially serious dermatological effects as well as gum disease and stained teeth. Usually this drug will cause the patient to be sleepy all day and should enhance sleep at night. Deficient fluid volume is not a concern with this drug. Noncompliance will probably not be an issue at this age because the parents and school nurse will administer the medication. 8.
A patient is taking ethosuximide (Zarontin) for absence seizures. He or she complains of gastrointestinal (GI) upset associated with the drug. The nurse will encourage the patient to do what?
A)
Take the drug 1 hour before or 2 hours after a meal.
B)
Decrease the dosage.
C)
Take the drug with food.
D)
Discontinue the drug and ask his or her physician to prescribe another drug.
Ans:
C Feedback: If GI irritation occurs with ethosuximide, the patient should be encouraged to take the medication with food to reduce this adverse effect. A nurse would never tell a patient to decrease the dosage or discontinue a drug. That advice should only be given by the patients medication prescriber. Taking the drug 1 to 2 hours after meals would not reduce this effect.
9.
The drug of choice for the treatment of partial seizures is what?
A)
Carbamazepine (Tegretol)
B)
Clorazepate (Tranxene)
C)
Felbamate (Felbatol)
D)
Gabapentin (Neurontin)
Ans:
A Feedback:
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Carbamazepine is often the drug of choice for treatment of partial seizures. It has the ability to inhibit polysynaptic responses and to block sodium channels to prevent the formation of repetitive action potentials in the abnormal focus. Clorazepate is indicated for anxiety and alcohol withdrawal and used as adjunctive therapy for partial seizures. Felbamate has been associated with severe liver failure and aplastic anemia and is now reserved for those patients who do not respond to other therapies. Gabapentin is used as adjunctive therapy in the treatment of partial seizures and for the treatment of postherpetic neuralgia. 10 .
A patient who has been taking lamotrigine (Lamictal) for the past 2 weeks calls the clinic and reports to the nurse that he or she has developed a rash. What should the nurse tell him or her to do?
A)
To continue taking the drug and that the rash will go away
B)
To talk to he or she physician and that he will prescribe a cream to apply to the rash
C)
To decrease the dosage by half for 2 weeks and then take the prescribed dose
D)
To discontinue the drug and return to the clinic immediately
Ans:
D Feedback: The nurse should inform the patient to discontinue the drug and return to the clinic. Rashes associated with the use of lamotrigine can be life-threatening. The patient needs to return to the clinic to be evaluated and will need a change of medication. Discontinuing the medication will cause the rash to clear. The nurse is not licensed to adjust the dosage of a drug for a patient.
11 .
The school nurse sees a child on the playground have an absence seizure identified by the occurrence of what characteristics?
A)
Alterations in consciousness that last seconds
B)
Automatic and repetitive movements
C)
Abnormal movements and bizarre behavior
D)
Sustained contraction of skeletal muscle
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Ans:
A Feedback: Absence seizures are characterized by abrupt alterations in consciousness that last only a few seconds. Characteristics of an absence seizure do not include automatic and repetitive movements, abnormal movements and bizarre behavior, or sustained contraction of skeletal muscle.
12 .
The nurse is providing patient education for a patient newly prescribed a hydantoin antiseizure medication. What would the nurse be sure to teach the patient regarding the dangers of abrupt withdrawal?
A)
Hypertensive crisis
B)
Cardiac dysrhythmias
C)
Respiratory arrest
D)
Status epilepticus
Ans:
D Feedback: Discontinuing hydantoins could result in status epilepticus so that drugs should be withdrawn, or added to the medication regimen, carefully to avoid danger. An abrupt withdrawal of antiseizure medications would not precipitate hypertensive crisis, dysrhythmias, or respiratory arrest.
13 .
A patient is brought to the emergency department in the midst of an active clonictonic seizure. What is the most appropriate antiseizure drug for the nurse to administer intravenously to terminate acute convulsive seizures?
A)
Diazepam (Valium)
B)
Phenytoin (Dilantin)
C)
Ethosuximide (Zarontin)
D)
Gabapentin (Neurontin)
Ans:
A Feedback:
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The drug of choice for acute seizures is intravenous benzodiazepine, usually diazepam. Phenytoin is administered to control and prevent seizures but is not the drug of choice to stop an active seizure. Gabapentin and ethosuximide are administered for partial seizures. 14 .
The nurse is caring for a patient receiving ethotoin to control seizure activity. When reviewing the patients laboratory results, the nurse would assess the patient is in a therapeutic level when the lab result is within what range?
A)
5 to 15 mcg/mL
B)
10 to 20 mcg/mL
C)
15 to 50 mcg/mL
D)
20 to 30 mcg/mL
Ans:
C Feedback: Therapeutic serum ethotoin levels range between 15 and 50 mcg/mL. Options A, B, and D are incorrect.
15 .
The nurse, working in the emergency room, admits a 13-month-old child reported by the parents to have had a clonictonic seizure at home with no history of a seizure disorder. What is the nurses priority intervention?
A)
Monitor serum phenytoin level.
B)
Take the childs temperature.
C)
Place the child in a tepid bath.
D)
Administer an antipyretic medication.
Ans:
B Feedback:
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The first action of the nurse is to measure body temperature to determine whether the child has a fever, which could explain why the seizure occurred. Febrile seizures are common in young children. They are related to very high fevers and usually involve clonictonic seizure. Febrile seizures most frequently occur in children and they are usually self-limited and do not reappear. The nurse would not treat a fever by administering antipyretics or providing a tepid bath until temperature is measured. There would be no reason to check phenytoin levels if the child has no history of seizure disorder. 16 .
Richard, 15 years old, has been diagnosed with epilepsy. He is to be sent home on oral phenytoin 100 mg b.i.d. What statement by Richards mother leads the nurse to believe she has understood drug teaching?
A)
I will make sure he takes the medication on an empty stomach.
B)
I will stop the drug immediately if any side effects occur.
C)
I will make sure he has routine visits to the dentist.
D)
I will weigh him daily and feed him a high-calorie diet.
Ans:
C Feedback: Gingival hyperplasia is common in patients, especially children, who take phenytoin, which makes regular dentist visits important to oral health. Taking the medication on a full stomach or with meals reduces gastrointestinal (GI) adverse effects. The mother should call the health care provider if adverse effects are noted and needs to understand the risks associated with abrupt withdrawal of the medication. Daily weight taking and high-calorie diets are not associated with phenytoin administration.
17 .
The mother of a child newly diagnosed with drug-resistant epilepsy asks the nurse why two antiepileptic drugs have been prescribed for her daughter. What is the nurses best answer?
A)
To decrease overall cost
B)
To decrease risk of adverse effects
C)
To minimize seizures in resistant epilepsy
D)
To increase movement of sodium ions into the cell
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Ans:
C Feedback: When monotherapy is ineffective, a second, and sometimes a third, drug may be added in an attempt to control seizures. It does not decrease overall cost or reduce the risk of side effects or increase movement of sodium ions into the cell.
18 .
The patients serum drug level is elevated and indicates a toxic level. What will the nurse assess for in this patient? (Select all that apply.)
A)
Liver toxicity
B)
Bone marrow suppression
C)
Serious dermatological reactions
D)
Tooth loss
E)
Renal damage
Ans:
A, B, C Feedback: Toxic levels of phenytoin increase the likelihood of adverse effects so the nurse would assess for liver toxicity, bone marrow suppression, or serious dermatological reactions. Gingival hyperplasia, not tooth loss, is associated with phenytoin toxic effects. Renal damage is not associated with phenytoin.
19 .
A patient has a new order for carbamazepine (Tegretol). What does the nurse know is a contraindication to administration of carbamazepine?
A)
Bone marrow depression
B)
Bipolar disorder
C)
Allergy to sulfonamides
D)
Diabetes
Ans:
A Feedback:
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Bone marrow suppression would be considered a contraindication to administration of carbamazepine therapy. Contraindications to the use of Tegretol do not include bipolar disorder, an allergy to sulfonamides, or diabetes. 20 .
A patient with liver impairment needs an antiepileptic drug. What drug would be safest for patients with liver impairment?
A)
Levetiracetam (Keppra)
B)
Lamotrigine (Lamictal)
C)
Phenobarbital
D)
Valproic acid (Depakene)
Ans:
A Feedback: Levetiracetam is a newer drug chemically unrelated to other antiepileptic drug. Most of the drug is excreted by the kidneys and is not metabolized by the liver so it would be safer for the patient with liver disease. The other options are all metabolized by the liver, so the patient with liver disease will need a lower dosage.
21 .
The nurse is caring for a patient diagnosed with generalized seizures and will appropriately administer what classifications of medications to this patient? (Select all that apply.)
A)
Succinimides
B)
Acetazolamide
C)
Valproic acid
D)
Hydantoin
E)
Benzodiazepines
Ans:
D, E Feedback:
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Drugs used to treat generalized seizures include the hydantoins, barbiturates, and benzodiazepines. Drugs used to treat absence seizuresa particular type of generalized seizureinclude the hydantoins, succinimides, acetazolamide, valproic acid, and zonisamide. 22 .
The nurse is caring for a 4-year-old child diagnosed with a seizure disorder requiring an antiseizure agent. Using mg/kg as the comparison, how will the childs dose compare with an adults dose?
A)
Children require a smaller mg/kg dose than an adult.
B)
Children require a larger mg/kg dose than an adult.
C)
Mg/kg dose is the same for adults and children.
D)
Dosing varies by medication.
Ans:
B Feedback: Older children (2 months to 6 years of age) absorb and metabolize many of these drugs more quickly than adults and require a larger dosage per kilogram to maintain therapeutic levels.
23 .
What factors contribute to determining the drug of choice for a patient with epilepsy? (Select all that apply.)
A)
Age
B)
Type of epilepsy
C)
Patient characteristics
D)
Preferred adverse effect
E)
Gender
Ans:
A, B, C Feedback:
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The drug of choice for any given situation depends on the type of epilepsy, patient age, specific patient characteristics such as cultural variations, and patient tolerance for associated adverse effects as opposed to preferred adverse effect. No adverse effects would be preferred but, because nearly all drugs have some adverse effects, determining what is tolerable to a particular patient is important to consider. Gender does not play a role in determining drug of choice. 24 .
The nurse anticipates a reduced dosage due to cultural differences when caring for patients from what cultural groups? (Select all that apply.)
A)
Arab Americans
B)
Asian Americans
C)
African Americans
D)
White American
E)
Native American
Ans:
A, B Feedback: Because of differences in liver enzyme functioning among Arab Americans and Asian Americans, patients in these ethnic groups may not metabolize antiseizure agents in the same way as patients in other ethnic groups. They may require not only lower doses to achieve the same therapeutic effects but also frequent dose adjustment. Nothing indicates a need to alter dosage for African Americans, Whites, or Native Americans.
25 .
A patient with a seizure disorder has had a recent change in medication. What data would the nurse collect to evaluate the effectiveness of the new drug? (Select all that apply.)
A)
Evaluate vital signs.
B)
Evaluate laboratory drug level.
C)
Assess for adverse effects.
D)
Assess for change in seizure activity.
E)
Assess for cost of therapy.
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Ans:
B, C, D Feedback: Interview and assess for any change in seizure activity; interview and assess for avoidance of adverse drug effects, especially those that impair safety; when available, check laboratory reports of serum drug levels for therapeutic ranges or evidence of underdosing or overdosing. Measuring vital signs is part of every patient visit but does not contribute to evaluation of drug effectiveness. For example, if the patient has had a sudden increase in number of seizures, but is not currently having a seizure, vital signs will likely be within normal range. Cost of therapy does not indicate the effectiveness of drugs. Cost should be considered when prescribing drugs, not when they are being evaluated.
26 .
A patient is brought in to the emergency department by ambulance in status epilepticus. What drug may be used for this patient?
A)
Carbamazepine
B)
Clorazepate
C)
Ethotoin
D)
Fosphenytoin
Ans:
D Feedback: Only fosphenytoin is indicated for the treatment of status epilepticus. Carbamazepine is used to treat seizure disorders as well as trigeminal neuralgia and bipolar disorder but it is not indicated for status epilepticus. Clorazepate and ethotoin are used in long-term treatment of partial seizure disorders, alone, or with other antiepileptic drugs but would not be used for status epilepticus.
27 .
The patient has serum drug levels of an antiepileptic drug ordered. The patient asks the nurse why drug levels are measured. What is the nurses best response?
A)
To evaluate whetherthe therapeutic range is reached
B)
To measure the amount of toxicity
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C)
To determine the effect of the drug on body systems
D)
To evaluate the effectiveness of therapy
Ans:
A Feedback: Measuring serum drug levels evaluates whether the therapeutic range of circulating drug can be found in the serum. It does not measure toxicity, which can occur even when the drug level is within prescribed range, and it does not evaluate effectiveness of therapy, which can only be evaluated by determining whether the drug is having the desired effect of reducing number of seizures. To determine the effect the drug is having on other body systems, it would be necessary to draw lab levels that measure functioning of that particular system.
28 .
The nursing instructor is discussing absence seizures and how to treat them in children. A student asks the difference between ethosuximide and methsuximide, the drugs used to control absence seizures. What is the instructors best response?
A)
Ethosuximide has more severe adverse effects than methsuximide.
B)
Seizures are more refractory to methsuximide.
C)
There is no real difference in the drugs.
D)
Methsuximide has more severe adverse effects than ethosuximide.
Ans:
D Feedback: Ethosuximide and methsuximide are indicated for the control of absence seizures. Ethosuximide should be tried first; methsuximide should be reserved for the treatment of seizures that are refractory to other agents because it is associated with more severe adverse effects.
29 .
A patient, newly diagnosed with a seizure disorder, has been prescribed valproic acid. What is one adverse effect of valproic acid that the nurse should include in the medication teaching plan?
A)
Liver toxicity
B)
Esophageal irritation
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C)
Cardiac insufficiency
D)
Muscle weakness
Ans:
A Feedback: Valproic acid is associated with liver toxicity. Esophageal irritation, cardiac insufficiency, and muscle weakness are not associated with valproic acid therapy.
30 .
While writing a care plan for a patient newly diagnosed with generalized seizures, the nurse might appropriately choose what nursing diagnosis?
A)
Risk for injury related to gastrointestinal (GI) effects
B)
Disturbed thought processes related to central nervous system effects
C)
Monitor complete blood count (CBC) before and periodically during therapy.
D)
Offer support and encouragement.
Ans:
B Feedback: Disturbed thought processes related to central nervous system (CNS) effects is a nursing diagnosis for a patient receiving any antiepileptic medication for generalized seizures. Monitoring CBC and offering support and encouragement are implementations rather than diagnosis. Risk for injury is incorrect because the risk for injury to this patient is from the CNS effects and not GI effects.
31 .
The patient, newly diagnosed with epilepsy, asks the nurse to explain the meaning of the diagnosis. What is the nurses best response?
A)
Epilepsy is a single disease that causes seizures.
B)
Epilepsy is a convulsive disorder caused by electrical discharge in the muscle.
C)
Epilepsy is characterized by sudden discharge of excessive electrical energy.
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D)
Epilepsy is the tonicclonic muscle contractions with potential to cause injury.
Ans:
B Feedback: The most prevalent of the neurological disorders, epilepsy is not a single disease but a collection of different syndromes characterized by the same feature: sudden discharge of excessive electrical energy from nerve cells located within the brain, which leads to a seizure. In some cases, this release stimulates motor nerves, resulting in convulsions, with tonicclonic muscle contractions that have the potential to cause injury, tics, and spasms. Other discharges may stimulate autonomic or sensory nerves and cause very different effects, such as a barely perceptible, temporary lapse in consciousness or a sympathetic reaction.
32 .
The nurse is providing patient teaching with a patient who is newly diagnosed with epilepsy. The patient asks, Can I still drive to work? What is the nurses best response?
A)
Not until your seizures are controlled by medication
B)
Yes, as long as you take your medications regularly.
C)
You can drive as soon as therapeutic drug levels are obtained.
D)
Epileptics need to use public transportation because a seizure could occur anytime.
Ans:
A Feedback: Patients newly diagnosed with epilepsy will not be able to drive. However, after the patients seizures are controlled (usually for 6 months to 2 years depending on state law), the patient may be able to regain the ability to drive.
33 .
A)
The nurse is caring for an 84-year-old patient in the acute care facility who was newly diagnosed with a seizure disorder. Before starting the patient on an antiepileptic medication that will be continued after discharge, what laboratory studies would the nurse want to assess? (Select all that apply.) Serum drug levels
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B)
Liver function studies
C)
Renal function studies
D)
Cardiovascular function studies
E)
Central nervous system function studies
Ans:
B, C Feedback: Baseline kidney and liver function tests should be done and results will guide dosing of the antiepileptic medication because patients with liver or kidney disease will require lower dosages of medication. Serum drug levels will not be drawn until after specific medications are started. Cardiovascular and central nervous system function studies are not indicated.
34 .
The patient has a seizure that causes rhythmic twitching of the left hand for 90 seconds with no loss of consciousness and then stops. The nurse notes this same action repeated many times throughout the day and documents this as what type of seizure?
A)
Myoclonic seizure
B)
Jacksonian seizure
C)
Psychomotor seizure
D)
Simple partial seizure
Ans:
D Feedback: This patient is having simple partial seizures, which occur in a single area of the brain and may involve a single muscle movement or sensory alteration. Myoclonic seizures involve short, sporadic periods of muscle contractions that last for several minutes. Jacksonian seizures begin in one area of the brain and involve one part of the body and then progressively spread to other parts of the body; they can develop into generalized tonicclonic seizures. Psychomotor seizures are complex seizures that involve sensory, motor, and psychic components.
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35 .
What antiepileptic classification of drugs works by stabilizing nerve membranes by influencing ionic channels in the cell membrane, thereby decreasing excitability and hyperexcitability to stimulation?
A)
Hydantoins
B)
Benzodiazepines
C)
Valproic acid
D)
Carbamazepine
Ans:
A Feedback: The hydantoins stabilize nerve membranes throughout the central nervous system directly by influencing ionic channels in the cell membrane, thereby decreasing excitability and hyperexcitability to stimulation. By decreasing conduction through nerve pathways, they reduce the tonicclonic, muscular, and emotional responses to stimulation. Valproic acid and benzodiazepines increase gamma-aminobutyric acid (GABA) effects and decrease electrical activity. Carbamazepine increases GABA activity and blocks sodium and calcium channels to stop action potentials.
Chapter 25 - Chapter 26. General Anesthetics Chapter 26. Local Anesthetics 1.
To decrease sympathetic stimulation in balanced anesthesia type of what agent would be used?
A)
Antihistamines
B)
Antiemetics
C)
Narcotics
D)
Sedative-hypnotics
Ans:
D Feedback:
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Sedative-hypnotics relax the patient, facilitate amnesia, and decrease sympathetic stimulation. Antihistamines decrease the chance of allergic reaction and help dry secretions. Antiemetics decrease the nausea and vomiting associated with gastrointestinal (GI) depression. Narcotics aid in the analgesic and sedative effects. 2.
During what stage of anesthesia would the nurse see the patients skeletal muscles relax and return of regular respirations?
A)
Stage 1: Analgesia stage
B)
Stage 2: Excitement stage
C)
Stage 3: Surgical anesthesia stage
D)
Stage 4: Medullary paralysis
Ans:
C Feedback: Stage 3 is surgical anesthesia, which involves relaxation of skeletal muscles and return of regular respirations. During this stage, eye reflexes and pupil dilation are progressively lost. Surgery can be safely performed in this stage. Stage 1 refers to the loss of pain sensation; stage 2 involves a period of excitement with sympathetic stimulation (e.g., tachycardia, increased respirations, blood pressure changes); and stage 4 involves deep central nervous system depression with loss of respiratory and vasomotor center stimuli. Death can occur rapidly at this stage if adequate support is not supplied.
3.
The nurse is developing a plan of care for the patient undergoing general anesthesia. What is a priority of care for this patient?
A)
Encourage clear fluids.
B)
Increase oxygen.
C)
Reassure the patient that about safety.
D)
Maintain regular repositioning.
Ans:
D Feedback:
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The patient would need to be moved or turned periodically to prevent skin breakdown and the formation of decubitus ulcers if the surgery lasted longer than an hour. Muscle paralysis resulting from the medications used in general anesthesia would prevent the patient from shifting himself or herself to relieve increase pressure. A patient receiving a general anesthetic would be unconscious, require respiratory support, and be connected to a mechanical ventilator to maintain respirations. Increased oxygen would not be indicated unless oxygen levels were less than adequate, and the patient would not receive anything by mouth eliminating option A. Reassurance would not be necessary for the unconscious patient.
4.
A plan of care formulated by an operating room (OR) nurse includes four nursing diagnoses. Which diagnoses will the nurse include that is directly related to safety?
A)
Deficient knowledge regarding drug therapy
B)
Disturbed sensory perception (kinesthetic, tactile) related to anesthesia
C)
Risk for impaired skin integrity related to immobility
D)
Risk for injury related to central nervous system (CNS) depressive effects of drugs
Ans:
D Feedback: The nursing diagnosis, which directly relates to safety, is high risk for injury. The other three options are only indirectly related to safety. While in the OR, the patient under general anesthetic is unable to express safety concerns and must rely completely on the surgeon and OR staff for protection.
5.
What nursing interventions would help minimize the risk of a headache in a patient recovering from spinal anesthesia?
A)
Administer a triptan intramuscularly.
B)
Administer morphine intravenously.
C)
Maintain patient in recumbent position.
D)
Place patient in Trendelenburg position.
Ans:
C
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Feedback: Patients receiving spinal anesthesia should remain in a recumbent position for as long as 12 hours. Triptan would not be effective because it is indicated for treatment of migraine headaches. Morphine would treat the headache but would not prevent it. 6.
An extremely anxious patient is beginning to awaken in the postanesthesia care unit. He or she states that his or her arms and legs feel like tree trunks and that they are hard to move. He or she also complains that his or her head feels fuzzy and that the right words will not come to his or her. What is the priority nursing intervention for this patient?
A)
Provide analgesic medication for the discomfort.
B)
Stay with patient as much as possible and provide reassurance.
C)
Provide fluids to increase his or her wakefulness.
D)
Encourage the patient to turn from side to side periodically.
Ans:
B Feedback: Most patients are disoriented and confused when awaking from anesthesia. It would be most important for the nurse to be with the patient as much as possible and reassure the patient that everything is as expected. Providing pain medication is important and may be needed during recovery if the patient reports pain, but would not be useful in treating the reported symptoms. The nurse would not provide fluids to patients immediately after surgery until ensuring the swallow reflex has returned and bowel motility has resumed. The nurse will help the patient turn from side to side, but this is not the priority nursing action at this time. However, the most effective nursing action for anxious postoperative patients is for the nurse to stay with them as much as possible.
7.
The patient appears awake but is unconscious and has no response to painful stimuli. What medication does the nurse suspect this patient has received?
A)
Thiopental (Pentothal)
B)
Midazolam (Generic)
C)
Ketamine (Ketalar)
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D)
Propofol (Diprivan)
Ans:
C Feedback: Ketamine has been associated with a bizarre state of unconsciousness in which the patient appears to be awake but is unconscious and cannot feel pain. This drug, which causes sympathetic stimulation with increase in blood pressure and heart rate, may be helpful in situations when cardiac depression is dangerous. Thiopental is a barbiturate anesthetic. Midazolam and propofol are nonbarbiturate anesthetics. None of these medications have this type of effect.
8.
Which nonbarbiturate anesthetic when used with halothane (Fluothane) can cause severe cardiac depression?
A)
Droperidol (Inapsine)
B)
Etomidate (Amidate)
C)
Ketamine (Ketalar)
D)
Propofol (Diprivan)
Ans:
C Feedback: If ketamine and halothane are used in combination, severe cardiac depression with hypotension and bradycardia may occur. Use of droperidol, etomidate, and propofol with halothane should not be a concern.
9.
The operating room nurse is developing the care plan for a 10-year-old child with asthma who is scheduled for a tonsillectomy and who will receive halothane as the anesthetic agent. Why is this an appropriate drug for this patient?
A)
Halothane is metabolized in the liver.
B)
Halothane dilates the bronchi.
C)
Halothane is excreted unchanged in the urine.
D)
Halothane causes an accumulation of secretions.
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Ans:
B Feedback: Halothane is of particular benefit to a child with asthma because it dilates bronchi. Halothane is inhaled drug so it is not metabolized in the liver or excreted in the urine. It does not cause an accumulation of secretions.
10 .
The nurse should recognize what drug is classified as an amide local anesthetic?
A)
Lidocaine (Xylocaine)
B)
Benzocaine (Dermoplast)
C)
Chloroprocaine (Nesacaine)
D)
Tetracaine (Pontocaine)
Ans:
A Feedback: Lidocaine is an example of an amide anesthetic. Benzocaine, chloroprocaine, and tetracaine are ester anesthetics.
11 .
A 21-year-old patient is positioned on the operating room table in preparation for knee surgery. After the anesthesiologist induces the patient, what is the next phase of anesthesia?
A)
Induction
B)
Maintenance
C)
Recovery
D)
Medullary paralysis
Ans:
D Feedback:
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Induction is the period from the beginning of anesthesia until stage 3, or surgical anesthesia, is reached. After induction comes the maintenance phase from stage 3 until the surgical procedure is complete. A slower, more predictable anesthetic, such as a gas anesthetic, may be used to maintain the anesthesia after the patient is in stage 3. This is followed by the recovery period that begins with the discontinuation of anesthesia. Medullary paralysis is the depth of anesthesia known as stage 4. Option C is a distracter. 12 .
The nurse is collecting a nursing history from a preoperative patient who is to receive local anesthesia. While taking the admission history, the patient says she is allergic to lidocaine. What is the nurses priority action?
A)
Notify the anesthesiologist.
B)
Cancel the surgery.
C)
Notify the surgeon.
D)
Tell the perioperative nurse.
Ans:
A Feedback: The priority action is to inform the anesthesiologist who will administer the anesthetic because local anesthesia often involves use of lidocaine. It is not within the nurses scope of practice to cancel surgery. Notifying the surgeon and the perioperative nurse is appropriate but is not the priority of care.
13 .
The nurse is caring for a patient in stage 2 of general anesthesia. What is the care priority for this patient?
A)
Rub the patients back.
B)
Monitor vital signs.
C)
Provide eye care.
D)
Reposition the patient.
Ans:
B Feedback:
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Stage 2, the excitement stage, is a period of excitement and often combative behavior, with many signs of sympathetic stimulation (e.g., tachycardia, increased respirations, blood pressure changes). Monitoring vital signs can be lifesaving at this stage. Eye care is important in stages 3 and 4. Rubbing the patients back and repositioning the patient are not indicated in this stage of anesthesia. 14 .
The patient received midazolam in combination with an inhaled anesthetic and a narcotic during surgery. The postanesthesia care unit (PACU) nurse anticipates this combination of drugs will have what impact on the patients stay in the unit?
A)
Increased use of medications to offset adverse effects
B)
Extended time needed in the unit
C)
Decreased nursing support needed
D)
Increased analgesics needed
Ans:
B Feedback: Midazolam is associated with increased toxicity and length of recovery when used in combination with inhaled anesthetics, other central nervous system depressants, narcotics, propofol, or thiopental. Because this patient received both narcotics and inhaled anesthetics, the nurse will anticipate this patients time in the PACU will be extended. The patient is likely to need fewer analgesics because it will take longer for the patient to wake from anesthesia, which will also mean fewer medications will be used. Until the patient is awake, he or she will need continuous nursing support.
15 .
The nurse is caring for a patient in the emergency department with a 2-inch laceration to the left arm caused by broken glass. The nurse suspects the local anesthetic will be administered by what method?
A)
Topical Administration
B)
Infiltration
C)
Field block
D)
Nerve block
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Ans:
B Feedback: Infiltration local anesthesia involves injecting the anesthetic directly into the tissues to be treated (e.g., sutured, drilled, cut). This injection brings the anesthetic into contact with the nerve endings in the area and prevents them from transmitting nerve impulses to the brain. Topical administration would not be absorbed deeply enough to prevent pain. Field block would be used in a larger area (e.g., the entire area required surgical repair). Nerve block would anesthetize a far larger area than is required for 2-inch laceration.
16 .
A nurse is caring for a patient who received thiopental as an anesthetic agent during surgery. What adverse effects would the nurse attribute to the medication?
A)
Tachycardia
B)
Urinary retention
C)
Tachypnea
D)
Headache
Ans:
D Feedback: Adverse effects of thiopental include emergence delirium, headache, restlessness, anxiety, cardiovascular depression, respiratory depression, apnea, salivation, hiccups, and rashes. Tachycardia, tachypnea, and urinary retention are not usually associated with this drug.
17 .
The nurse is caring for a patient who will receive an epidural block. What procedure is this patient likely to be having?
A)
Rhinoplasty
B)
Inguinal hernia repair
C)
Removal of a brain tumor
D)
Closed reduction of the right humerus
Ans:
B
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Feedback: Nerve block is a method of administering local anesthesia by injecting the anesthetic at some point along the nerve or nerves that run to and from the region in which the loss of pain sensation or muscle paralysis is desired. Several types of nerve blocks are possible.
Epidural anesthesia is an injection of the drug into the epidural space where the nerves emerge from the spinal cord. As a result, only an inguinal hernia repair would be an appropriate procedure for administering an epidural. Surgery performed about the spinal cord, such as surgery on the nose or brain, could not be anesthetized by injection of medication into the spinal cord. Closed reduction of the right humerus would not be performed using a local anesthetic.
18 .
The operating room nurse is taking the patient into the operating room when the patient says his grandmother almost died from a high fever in surgery 15 years ago. The nurse shares this information with the surgical team, recognizing this information indicates the patient is at risk for what?
A)
An allergic reaction to anesthesia
B)
Malignant hyperthermia
C)
Anxiety
D)
Hypothermia
Ans:
B Feedback: The nurse assesses for a personal or family history of malignant hyperthermia, which may be triggered by the use of general anesthetics. Identifying patients at risk is imperative because the mortality rate is very high. All of these drugs have the potential to trigger malignant hyperthermia and should be used with caution in any patient at high risk. The patients anxiety is to be expected, all patients are at risk for hypothermia because they are often uncovered in a cold room. Allergy to anesthesia must always be considered a possibility but there is no indication of a higher than normal risk in this patient.
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19 .
The circulating nurse in the day surgery center is caring for a patient who is to receive a local anesthetic. What potential complications will the nurse monitor for? (Select all that apply.)
A)
Malignant hypothermia
B)
Pain
C)
Blurred vision
D)
Peripheral vasodilation
E)
Nausea
Ans:
C, D, E Feedback: Adverse effects of local anesthetics are associated with the route of administration and the amount of drug that is absorbed systemically. These effects are related to the blockade of nerve depolarization throughout the system. Effects that may occur include central nervous system effects such as headache (especially with epidural and spinal anesthesia), restlessness, anxiety, dizziness, tremors, blurred vision, and backache; gastrointestinal (GI) effects such as nausea and vomiting; cardiovascular effects such as peripheral vasodilation, myocardial depression, arrhythmias, and blood pressure changes, all of which may lead to fatal cardiac arrest; and respiratory arrest. There is no such problem as malignant hypothermia (the condition is malignant hyperthermia) and pain may be caused by the procedure but not the anesthetic.
20 .
What nursing diagnosis would a circulating nurse use on his or her intraoperative patients who receive general anesthesia? (Select all that apply.)
A)
Disturbed sensory perception
B)
Risk for hypovolemia
C)
Risk for latex allergy response
D)
Disturbed body image
E)
Anxiety
Ans:
A, C, E
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Feedback: Nursing care of patients receiving general or local anesthetics should include safety precautions to prevent injury and skin breakdown, support and reassurance to deal with the loss of sensation and mobility, and patient teaching regarding what to expect to decrease stress and anxiety. Risk for hypovolemia and disturbed body image would be applicable to some surgical procedures but would not be related to general anesthesia. 21 .
The patient receives lidocaine as a local anesthetic before insertion of a chest tube. After the procedure the patient tells the nurse, The area is still numb. How long will this last? What is the nurses best response?
A)
15 minutes
B)
1 hour
C)
2 hours
D)
4 hours
Ans:
C Feedback: The onset of intramuscular lidocaine is 5 to 10 minutes, peaks within 5 to 15 minutes, and the duration of action is 2 hours. Options A, B, and D are distracters.
22 .
The pharmacology instructor is explaining balanced anesthesia to the students. What agents would the instructor say are involved in balanced anesthesia? (Select all that apply.)
A)
Neuromuscular junction blockers
B)
Narcotics
C)
Anticholinergics
D)
Salicylates
E)
Nonsteriodal anti-inflammatory drugs (NSAIDs)
Ans:
A, B, C Feedback:
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Balanced anesthesia involves giving a variety of drugs with specific effects to achieve analgesia, relax muscles, and invoke unconsciousness and amnesia. Classification of drugs administered includes anticholinergics, rapid intravenous anesthetics, inhaled anesthetics, neuromuscular junction blockers, and narcotics. Balanced anesthesia does not include use of salicylates or nonsteroidal anti-inflammatory drugs. 23 .
The nurse is caring for a patient who received halothane as an anesthetic agent. The patient will require additional surgery. When can halothane be used again without risk of halothanes recovery syndrome?
A)
1 week
B)
2 weeks
C)
3 weeks
D)
4 weeks
Ans:
C Feedback: Halothanes recovery syndrome is characterized by fever, anorexia, nausea, vomiting, and eventual hepatitis, which can progress to fatal hepatic necrosis. Although this syndrome is rare, halothane is not used more frequently than every 3 weeks to reduce patient risk. Other options are incorrect.
24 .
A 54-year-old patient with chronic obstructive pulmonary disease is admitted for emergency surgery. What anesthetic agent would be dangerous to use on this patient?
A)
Enflurane
B)
Desflurane
C)
Sevoflurane
D)
Isoflurane
Ans:
B Feedback:
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Desflurane is associated with a collection of respiratory reactions, including cough, increased secretions, and laryngospasm. The other options have far fewer respiratory adverse effects and would be safer for use in this patient. 25 .
The nurse is admitting a 35-year-old patient to the preoperative unit in preparation for an elective inguinal hernia repair procedure to be performed under general anesthesia. What is the nurses initial priority nursing assessment?
A)
Assess the patients anxiety.
B)
Start an IV.
C)
Show the family the waiting area.
D)
Weigh the patient.
Ans:
D Feedback: Weighing the patient is an initial priority because his or her weight will be used to determine appropriate dosing of all medications and will establish a baseline used for evaluation of any potential adverse effects. Other options are all actions the nurse will need to perform, but none are of higher priority than weighing the patient.
26 .
A very anxious patient asks the nurse what type of anesthesia they will have for a scheduled tooth extraction. The nurse would describe what type of local anesthetic in laymens terms?
A)
Topical
B)
Infiltration
C)
Field block
D)
Nerve block
Ans:
C Feedback:
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Field block local anesthesia involves injecting the anesthetic all around the area that will be affected by the procedure or surgery. This is more intense than infiltration anesthesia because the anesthetic agent comes in contact with all of the nerve endings surrounding the area. This type of block is often used for tooth extractions. Topical would not be appropriate because it would not absorb deeply enough to block pain impulses in the root of the tooth. Nerve block would not be possible for oral surgery. 27 .
The nurse receives a patient into the postanaesthesia care unit who has had surgery using the anesthetic agent methohexital. The nurse anticipates the patients need for what in the postoperative period?
A)
Assistance in maintaining respirations
B)
Assistance in moving lower extremities
C)
Positioning in Semi-Fowlers position
D)
Analgesia to control the patients pain
Ans:
D Feedback: Methohexital lacks analgesic properties so the patient may require postoperative analgesics to control pain. The patient who has surgery under methohexital does not generally require assistance in maintaining respirations or assistance in moving their lower extremities. They also do not generally require positioning in a semi-Fowlers position.
28 .
The emergency room nurse is teaching a class for newly hired graduate nurses on the different types of local anesthetic agents. How would the nurse differentiate lidocaine and procaine as a local anesthetic agent?
A)
Lidocaine is an amide that is broken down slowly and this can lead to toxicity.
B)
Lidocaine is an ester that cannot become toxic in the system because of rapid metabolism.
C)
Procaine is an amide that is broken down immediately in the tissues.
D)
Procaine is metabolized by the liver with risk of toxicity and is classified as an ester.
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Ans:
A Feedback: The ester local anesthetics are broken down immediately in the plasma by enzymes known as plasma esterases. The amide local anesthetics are metabolized more slowly in the liver. Serum levels of these drugs can become elevated and lead to toxicity. Lidocaine is an amide and procaine is an ester.
29 .
A nursing student in a pharmacology class asks the instructor why nitrous oxide is used for dental surgery. What is the instructors most accurate response?
A)
Nitrous oxide stays in the body for a long time.
B)
Nitrous oxide does not cause pressure in body compartments.
C)
Nitrous oxide does not cause muscle relaxation.
D)
Nitrous oxide does not need to be administered with oxygen.
Ans:
C Feedback: Nitrous oxide is a potent analgesic; it is used frequently for dental surgery because it does not cause muscle relaxation. It moves quickly in and out of the body so duration of action is short and recovery after dental work is quick. Nitrous oxide does need to be given in combination with oxygen to avoid hypoxia in the patient.
30 .
The nurse is admitting a patient to the postanesthesia care unit (PACU) who received halothane and ketamine as anesthesia. What is the nurses priority assessment?
A)
Blood pressure and pulse
B)
Respirations and airway
C)
Pain and respirations
D)
Temperature and airway
Ans:
A
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Feedback: If halothane and ketamine are used in combination, severe cardiac depression with hypotension and bradycardia may occur. If these agents must be used together, the patient should be monitored closely. Pain, respirations, airway, and temperature are all assessments the nurse will collect on any patient in the PACU, but they are not priority assessments associated with combining ketamine and halothane. 31 .
The nurse is assisting while the physician is suturing a wound in the urgent care clinic. The physician asks for lidocaine with epinephrine. The nurse identifies the primary reason for adding epinephrine to the lidocaine is what effect?
A)
It will sting more when it is injected into the tissue.
B)
Risk of systemic absorption is increased.
C)
Local effect is increased.
D)
Bleeding at the wound site is increased.
Ans:
C Feedback: There is less risk of systemic absorption and increased local effects if these drugs are combined with epinephrine. Epinephrine causes vasoconstriction, which reduces bleeding, slows absorption, and makes the duration of effect longer. It does sting more when injected, but that is not a reason to use it.
32 .
The nurse is caring for a patient scheduled for surgery who is to receive a barbiturate as part of the planned balanced anesthesia. What drugs, if taken by the patient, could result in a clinically important drugdrug interaction with the barbiturate? (Select all that apply.)
A)
Thyroid hormone
B)
Ibuprofen
C)
Oral contraceptive
D)
Theophylline
E)
Anticoagulant
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Ans:
C, D, E Feedback: Caution must be used when these drugs are used with any other central nervous system suppressants. Barbiturates can cause decreased effectiveness of theophylline, oral anticoagulants, beta-blockers, corticosteroids, hormonal contraceptives, phenylbutazones, metronidazole, quinidine, and carbamazepine. Combinations of barbiturate anesthetics and narcotics may produce apnea more commonly than occurs with other analgesics. Thyroid hormone and ibuprofen have no known drug interactions with barbiturates.
33 .
The nurse is caring for a patient experiencing malignant hyperthermia. What medication will be administered to treat this condition?
A)
Midazolam
B)
Dantrolene
C)
Halothane
D)
Thiopental
Ans:
B Feedback: Dantrolene is the preferred treatment for malignant hyperthermia and should always be readily available whenever anesthetics are used that could trigger the syndrome. Midazolam and thiopental are barbiturates whereas halothane is a volatile gas that can trigger malignant hyperthermia.
34 .
The nurse is caring for a patient who will undergo cardioversion in the patients room this morning. The patient will receive propofol as anesthetic during the procedure. What are the benefits of using propofol for this procedure? (Select all that apply.)
A)
It has a very rapid clearance.
B)
It produces less of a hangover effect.
C)
It allows for quick recovery from anesthesia.
D)
Its onset of action is 5 minutes.
E)
It is painless to inject IV.
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Ans:
A, B, C Feedback: Propofol often is used for short procedures because it has a very rapid clearance and produces much less of a hangover effect and allows for quick recovery. It is a very short-acting anesthetic with a rapid onset of action of 30 to 60 seconds. Propofol often causes local burning on injection.
35 .
The nurse applies a topical anesthetic to reduce sensation at the site while starting an IV. What age group is at greatest risk for systemic absorption of the topical anesthetic?
A)
Older adult
B)
Infant
C)
Toddler
D)
Adolescent
Ans:
B Feedback: When topically applying a local anesthetic, it is important to remember that there is greater risk of systemic absorption and toxicity with infants. Therefore, the other options are incorrect.
Chapter 27. Skeletal Muscle Relaxants 1.
The nurse is teaching a class on muscular coordination and explains it is the movement of what electrolyte that contributes to the process of muscle contraction and relaxation?
A)
Calcium
B)
Chloride
C)
Magnesium
D)
Hydrogen
Ans:
A
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Feedback: Calcium is released from the sarcoplasmic reticulum, which leads to the binding of calcium with troponintropomyosin. This leads to contraction of the muscle fiber. The calcium pump then moves calcium back into the sarcoplasmic reticulum, which leads to relaxation of muscle fiber. Chloride, magnesium, and hydrogen are not involved in this process. 2.
A mother brings her 9-year-old son to the clinic for a routine check up. The 9year-old boy has cerebral palsy and is very spastic. The mother asks the nurse what causes the spasticity in her son. What is the nurses best response?
A)
Your sons spasticity is caused by injury to the muscle tissue.
B)
Your sons spasticity is caused by deficiency of a neurotransmitter called serotonin.
C)
Your sons spasticity is caused by damaged sensory neurons.
D)
Your sons spasticity is caused by damaged motor neurons.
Ans:
D Feedback: Muscle spasticity is the result of damage to neurons within the central nervous system (CNS) rather than injury to peripheral structures such as the musculoskeletal system. Serotonin is not involved in the process of muscle contraction and relaxation. Although acetylcholine is released and increases muscle cell membrane permeability to sodium, which eventually leads to the release of calcium, this process does play a vital part in muscle contraction and relaxation.
3.
A nurse is providing discharge teaching for a patient who will be going home on cyclobenzaprine (Flexeril) prescribed for his acute musculoskeletal pain. The nurse will stress that the patient should avoid what?
A)
Drinking alcohol
B)
Taking antiemetics
C)
Taking antihistamines
D)
Taking antibiotics
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Ans:
A Feedback: Taking cyclobenzaprine with alcohol can cause an increase in central nervous system depression. The nurse should stress that this combination should be avoided due to possible injury or severe body system depression that could lead to coma or death. No significant concerns exist with the use of antiemetics, antihistamines, or antibiotics with this drug.
4.
The nurse provides patient teaching about chlorzoxazone (Paraflex) in preparation for the patients discharge to home. The nurse evaluates the patient understands potential adverse effects when the patient makes what statement?
A)
This drug can cause diarrhea.
B)
My urine may turn orange to purple red while taking this drug.
C)
My skin may turn yellow but that will go away when I stop taking the drug.
D)
After I take a pill it will take 2 to 3 hours before I feel the effects.
Ans:
B Feedback: The patient indicates an understanding of adverse effects of this drug by stating that his urine may be discolored while using the drug. Chlorzoxazone may discolor the urine, which will turn orange to purple-red when metabolized and excreted. Patients should be warned about this effect to prevent any fears of blood in the urine. Chlorzoxazone usually causes constipation, not diarrhea. The onset of action is usually within an hour after the drug has been taken. Yellow discoloration of the skin would indicate liver damage or dysfunction, which should be reported immediately.
5.
The nurse admits a child diagnosed with tetanus. What medication will the nurse expect to administer?
A)
Methocarbamol (Robaxin)
B)
Baclofen (Lioresal)
C)
Dantrolene (Dantrium)
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D)
Diphenhydramine (Benadryl)
Ans:
A Feedback: Methocarbamol is the drug of choice if a child needs to be treated for tetanus. Baclofen and dantrolene are not recommended for use with children. Diphenhydramine is not indicated for treatment of tetanus.
6.
A 20-year-old female patient has been diagnosed with multiple sclerosis. What drug will most likely be prescribed?
A)
Baclofen (Lioresal)
B)
Cyclobenzaprine (Flexeril)
C)
Metaxalone (Skelaxin)
D)
Orphenadrine (Banflex)
Ans:
A Feedback: Baclofen is used for treatment of muscle spasticity associated with neuromuscular diseases such as multiple sclerosis. Cyclobenzaprine, metaxalone, and orphenadrine are used for relief of discomfort associated with painful, acute musculoskeletal conditions.
7.
The nurse is caring for four patients. Which patient would have the highest risk for hepatotoxicity from dantrolene (Dantrium)?
A)
An 87-year-old man who is taking a cardiac glycosideh
B)
A 32-year-old man who is taking an antipsychotic drug
C)
A 65-year-old woman who is on hormone replacement therapy
D)
A 48-year-old woman who is taking an antihypertensive agent
Ans:
C Feedback:
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If dantrolene is combined with estrogen, the incidence of hepatocellular toxicity is increased. This combination should be avoided. Nothing indicates that patients taking a cardiac glycoside, an antipsychotic drug, and an antihypertensive would have serious adverse effects when combined with dantrolene therapy. 8.
The nurse alerts the patient to what adverse effect of tizanidine (Zanaflex) that could cause injury?
A)
Constipation
B)
Dry mouth
C)
Fatigue
D)
Hypotension
Ans:
D Feedback: Tizanidine has been associated with hypotension, which could be a safety risk especially if the patient is also taking an antihypertensive drug. Constipation, dry mouth, and fatigue are common adverse effects that do not pose a safety risk.
9.
A young woman attends a Botox Party and is injected with botulinum toxin type A to decrease frown lines between her eyebrows. Later that evening the patient is admitted to the emergency department and is hysterical, because she cannot move her eyebrows. The nurse explains that that toxin causes what?
A)
The toxin causes muscle death, which smoothes wrinkles in the area.
B)
The toxin causes muscle paralysis, preventing movement and relieving wrinkles.
C)
The drug is a toxin to nerves in the area.
D)
The drug is a permanent muscle relaxant and the muscles will never move again.
Ans:
B Feedback:
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Botulinum toxin types A and B bind directly to the receptor sites of motor nerve terminals and inhibit the release of acetylcholine, leading to local muscle paralysis. These two drugs are injected locally and used to paralyze or prevent the contractions of specific muscle groups. The action smoothes wrinkles in the area, but does not cause muscle death. The effect is temporary and does not cause nerve death. The other options are false statements. 10 .
A patient has stepped on a rusty nail and is exhibiting signs of muscle rigidity and contractions. The patients wife called the emergency department (ED) and the triage nurse told her to bring him in. The ED nurse will have which drug available for administration when the patient arrives?
A)
Carisoprodol (Soma)
B)
Cyclobenzaprine (Flexeril)
C)
Metaxalone (Skelaxin)
D)
Methocarbamol (Robaxin)
Ans:
D Feedback: The patient is exhibiting signs of tetanus and methocarbamol (Robaxin) is indicated for treatment. Carisoprodol, cyclobenzaprine, and metaxalone are not used to treat tetanus.
11 .
The nurse assesses a newly admitted patient and finds the muscle tone in his left leg has sustained muscle contraction. How will the nurse document this finding?
A)
Tonus
B)
Flaccid
C)
Atonic
D)
Spastic
Ans:
D Feedback:
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Muscle spasticity is defined as a sustained muscle contraction. Soft and flabby muscle tone is defined as atonic. A limp muscle without tone is described as flaccid. The state of readiness, known as muscle tone (tonus), is produced by the maintenance of some of the muscle fibers in a contracted state. 12 .
A patient comes to the clinic to receive a Botox injection in her forehead. The patient has adult acne across her forehead. What is the nurses priority action?
A)
Hold the injection and consult the health care provider.
B)
Cleanse the area well with an antibacterial soap.
C)
Apply a topical antibiotic after administering the Botox.
D)
Provide patient information about post-Botox injection care.
Ans:
A Feedback: Botulinum toxins should not be injected into any area with an active infection because of the risk of exacerbation of the infection. As a result, the nurse would hold the injection and consult with the physician, with the expectation the medication would be held until the acne resolved. Cleansing the area well, applying a topical antibiotic, and providing information about postinjection care would not resolve the problem and are not indicated.
13 .
The patient presents to the emergency department with muscle spasms in the back. What types of injury would the nurse recognize can result in muscle spasm? (Select all that apply.)
A)
Overstretching a muscle
B)
Wrenching a joint
C)
Tearing a tendon or ligament
D)
Breaking a bone
E)
Exercising too vigorously.
Ans:
A, B, C Feedback:
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Muscle spasms often result from injury to the musculoskeletal system (e.g., overstretching a muscle, wrenching a joint, tearing a tendon or ligament). These injuries can cause violent and painful involuntary muscle contractions. Breaking a bone or exercising would not cause muscle spasms unless one of the other options was involved. 14 .
The nurse is giving discharge instructions to a patient who just had Botox A injections around her eyes. What adverse effects would the nurse include in her discharge instructions? (Select all that apply.)
A)
Respiratory infections
B)
Flu-like syndrome
C)
Droopy eyelids
D)
Cough
E)
Diarrhea
Ans:
A, B, C Feedback: Adverse effects associated with use of botulinum toxin type A for cosmetic purposes include headache, respiratory infections, flu-like syndrome, and droopy eyelids in severe cases. Adverse effects do not include cough or diarrhea.
15 .
A patient with severe spasticity sees his physician. The physician orders dantrolene. In what circumstances is the drug dantrolene contraindicated?
A)
Spasticity that contributes to upright position
B)
Spasticity that involves both legs
C)
Spasticity that involves the arm and the leg on the same side
D)
Spasticity that contributes to mobility
Ans:
A Feedback:
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Dantrolene is contraindicated in the presence of any known allergy to the drug. It is also contraindicated in the following conditions: spasticity that contributes to locomotion, upright position, or increased function, which would be lost if that spasticity was blocked; active hepatic disease, which might interfere with metabolism of the drug and because of known liver toxicity; and lactation because the drug may cross into breast milk and cause adverse effects in the infant. The other options would not contraindicate the medication. 16 .
Which muscle relaxant was found to be embryotoxic in animal studies?
A)
Carisoprodol (Soma)
B)
Botulinum toxin A (Botox)
C)
Cyclobenzaprine (Flexeril)
D)
Dantrolene (Dantrium)
Ans:
D Feedback: Dantrolene crosses the placenta and was found to be embryotoxic in animal studies. Botulinum toxin A, carisoprodol, and cyclobenzaprine are not known to be embryotoxic.
17 .
When spinal reflexes involve synapses with interneurons within the spinal cord, what physiological adjustments are made?
A)
Coordinate movement and position
B)
Adjust response and recovery
C)
Adjust to upright position
D)
Coordinate balance
Ans:
A Feedback:
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Other spinal reflexes may involve synapses with interneurons within the spinal cord, which adjust movement and response based on information from higher brain centers to coordinate movement and position. Spinal reflexes do not adjust response and recovery, adjust the body to the upright position, or coordinate balance. 18 .
What are the simplest nerve pathways in the body?
A)
Arc reflexes
B)
Spinal reflexes
C)
Afferent nerve reflexes
D)
Spindle gamma loop
Ans:
B Feedback: The spinal reflexes are the simplest nerve pathways that monitor movement and posture. Arc reflexes and afferent nerve reflexes are distracters for this question. Spindle gamma loops respond to stretch receptors.
19 .
The anatomy and physiology instructor is discussing reflex systems with the prenursing class. What system would the instructor say causes a muscle fiber contraction that relieves the stretch?
A)
Arch reflex system
B)
Spinal reflex system
C)
Spindle gamma loop system
D)
Stretch receptor system
Ans:
C Feedback:
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A spindle gamma loop system responds to stretch receptors or spindles on muscle fibers to cause a muscle fiber contraction that relieves the stretch. In this system, nerves from stretch receptors form a synapse with gamma nerves in the spinal cord, which send an impulse to the stretched muscle fibers to stimulate their contraction. These reflexes are responsible for maintaining muscle tone and keeping an upright position against the pull of gravity and are important in helping venous return when the contracting muscle fibers massage veins to help move the blood toward the heart. The arch reflex system and the stretch receptor system are distracters for this question. The spinal reflex system is not the reflex systems that respond to stretch receptors in the body. 20 .
A 3-year-old girl with a diagnosis of spasticity caused by cerebral palsy has been admitted to the unit. The physician has ordered dantrolene to see if it relieves the spasticity in the childs arms and hands. The nurse would schedule this child for what routine screenings?
A)
Central nervous system and gastrointestinal (GI) function
B)
Respiratory and cardiovascular (CV) function
C)
Growth and development
D)
Renal and hepatic function
Ans:
A Feedback: Children prescribed dantrolene should be routinely and regularly screened for central nervous system and gastrointestinal (including hepatic) toxicity. Growth and development should be routinely screened in all children. Renal, respiratory, and CV screening is not indicated.
21 .
A patient is admitted to the unit with central spasticity after a terrible motor vehicle accident. The doctor places an intrathecal delivery pump. What medication can be administered via this route to treat the central spasticity?
A)
Baclofen (Lioresal)
B)
Cyclobenzaprine (Flexeril)
C)
Dantrolene (Dantrium)
D)
Carisoprodol (Soma)
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Ans:
A Feedback: Baclofen is available in oral and intrathecal forms and can be administered via a delivery pump for the treatment of central spasticity. Flexeril, dantrolene, and Soma are not administered intrathecally.
22 .
Baclofen is a prototype drug for the centrally acting skeletal muscle relaxants. What adverse effects do drugs in this class have? (Select all that apply.)
A)
Coronary artery disease
B)
Hypotension
C)
Urinary frequency
D)
Dizziness
E)
Bone marrow suppression
Ans:
B, C, D Feedback: Adverse effects include transient drowsiness, dizziness, weakness, fatigue, constipation, headache, insomnia, hypotension, nausea, and urinary frequency. Bone marrow suppression and coronary artery disease are not associated with therapy involving these drugs.
23 .
When caring for a patient taking dantrolene, what adverse effects would the nurse monitor for? (Select all that apply.)
A)
Bradycardia
B)
Hepatitis
C)
Urinary retention
D)
Fatigue
E)
Rash
Ans:
B, D, E Feedback:
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Adverse effects of dantrolene include drowsiness, dizziness, weakness, fatigue, diarrhea, hepatitis, myalgia, tachycardia, transient blood pressure changes, rash, and urinary frequency. Adverse effects of dantrolene do not include bradycardia or urinary retention. 24 .
The nurse is caring for a patient who is having a pump placed to deliver intrathecal baclofen and another patient who will receive dantrolene as a muscle relaxant. What nursing diagnosis would be appropriate for both care plans? (Select all that apply.)
A)
Acute pain related to GI effects of drug
B)
Risk for injury related to central nervous system (CNS) effects
C)
Disturbed body image related to muscle pain
D)
Disturbed thought processes related to CNS effects
E)
Deficient knowledge related to procedure
Ans:
A, B, D Feedback: Acute pain related to GI effects of drug, risk for injury related to CNS effects, and disturbed thought processes related to CNS effects all apply to both patients. Disturbed body image may apply to the patient having the pump placed, but this is not related to muscle pain. Only the patient having the pump placed would need information related to the procedure.
25 .
The nurse is caring for a patient who is being discharged home from the rehabilitation unit. Baclofen will be discontinued and the patient will begin taking carisoprodol as an outpatient. What is the nurses primary consideration about discontinuing administration of baclofen?
A)
Taper drug over 72 hours to reduce dependence on the drug.
B)
Alternate doses of baclofen and soma over 10 days to prevent drug withdrawal.
C)
Taper drug slowly over 1 to 2 weeks to prevent psychoses and hallucinations.
D)
Start carisoprodol immediately while continuing baclofen at full dose to establish carisoprodol level.
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Ans:
C Feedback: If using baclofen, taper drug slowly over 1 to 2 weeks to prevent the development of psychoses and hallucinations. Giving both drugs at once would risk toxicity and serious adverse effects and would never be done.
26 .
The nurse is caring for a patient receiving intrathecal baclofen via pump while participating in rigorous rehabilitation therapy. What is the nurses priority to monitor related to adverse effects of this drug?
A)
Blood pressure
B)
Pulse pressure
C)
Spasticity
D)
Respiratory status
Ans:
D Feedback: The priority to monitor is respiratory status. One of the primary adverse effects of this drug is central nervous system (CNS) depression. If the patient receives too much medication, or reaches toxic levels, respiratory rate will decline as the result of excessive CNS depression and the drug dosage will either be adjusted downward or the drug may be held until the patients respirations improve. Monitoring other vital signs including blood pressure and pulse is indicated but is not the priority.
27 .
A patient has been diagnosed with multiple sclerosis and experiences spasticity in several muscle groups. What drug would the nurse anticipate will be ordered as the drug of choice to manage spasticity associated with neuromuscular diseases?
A)
Dantrolene (Dantrium)
B)
Baclofen (Lioresal)
C)
Carisoprodol (Soma)
D)
Botulinum toxin type B (Myobloc)
Ans:
A
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Feedback: Dantrolene directly affects peripheral muscle contraction, and has become important in the management of spasticity associated with neuromuscular diseases. Baclofen, carisoprodol, and botulinum toxin type B are not the drugs of choice for management of spasticity in neuromuscular disease. 28 .
The nurse is caring for a patient taking dantrolene. How would the nurse assess the therapeutic effects of this drug?
A)
Observe the patient when emotionally stressed to assess for exacerbation of spasticity.
B)
Discontinue the drug for 2 to 4 days and assess for exacerbation of spasticity.
C)
Measure the amount of spasticity before and after administration of medication.
D)
Collect a thorough history to ask the patient any improvement has been noticed.
Ans:
B Feedback: Periodically discontinue drug for 2 to 4 days to monitor therapeutic effectiveness. A clinical impression of exacerbation of spasticity indicates a positive therapeutic effect and justifies continued use of the drug. It would not be ethical to stress the patient, there is no known measurement of spasticity, and the patient may not be able to relate how much improvement was felt because it is unlikely all spasticity will be eliminated.
29 .
What drug would the nurse expect to administer to the patient experiencing malignant hyperthermia?
A)
Orphenadrine
B)
Metaxalone
C)
Chlorzoxazone
D)
Dantrolene
Ans:
D
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Feedback: Indications for dantrolene include control of clinical spasticity resulting from upper motor neuron disorders; preoperatively to prevent or attenuate the development of malignant hyperthermia in susceptible patients; IV for management of fulminant malignant hyperthermia. The other drugs are not indicated for treatment of malignant hyperthermia. 30 .
What part of the brain does the nurse recognize the patient is using when making precise, intentional movements?
A)
Pyramidal tract
B)
Substantia nigra
C)
Brocas area
D)
Extrapyramidal tract
Ans:
A Feedback: Upper-level controls of muscle activity include the pyramidal tract in the cerebellum, which regulates precise intentional muscle movement, and the extrapyramidal tract in the cerebellum and basal ganglia, which coordinates crude movements related to unconscious muscle activity. Brocas area has to do with speech, not movement. The substantia nigra does not control muscle movement.
31 .
The patient reports pain caused by muscle spasms in his back. The nurse assesses the patient as being very anxious and notes how the anxiety results in tensing of muscles. What medication would be most effective in treating this patient?
A)
Baclofen (Lioresal)
B)
Botulinum toxin type B (Myobloc)
C)
Dantrolene (Dantrium)
D)
Diazepam (Valium)
Ans:
D Feedback:
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Adults complaining of muscle spasm pain that may be related to anxiety often respond very effectively to diazepam, which is a muscle relaxant and anxiolytic. Although many drugs, including baclofen, will treat the muscle spasm, diazepam also reduces anxiety. Dantrolene would be better indicated for spasticity than for spasm and botulinum toxin type B is not prescribed for either anxiety or muscle spasm. 32 .
What is the drug of choice for an older adult or a patient with hepatic or renal impairment?
A)
Baclofen
B)
Carisoprodol
C)
Chlorzoxazone
D)
Cyclobenzaprine
Ans:
B Feedback: Carisoprodol is the centrally acting skeletal muscle relaxant of choice for older patients and for those with hepatic or renal impairment. Although the other options may be prescribed, older adults are more likely to experience the adverse effects associated with the drug.
33 .
After administering a centrally acting skeletal muscle relaxant, what other independent nursing measures might the nurse implement to relieve pain and reduce spasm?
A)
Rest of the affected muscle
B)
Application of cold
C)
Physical therapy
D)
Order of a nonsteroidal anti-inflammatory drug
Ans:
A Feedback:
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Other measures in addition to drugs should be used to alleviate muscle spasm and pain. The nurse can independently encourage rest of the affected muscle and provide heat applications to increase blood flow to the area to remove the pain-causing chemicals. 34 .
The nurse is caring for a patient with an infusing IV who is allowed noting by mouth due to a paralytic ileus. What centrally acting medication could the nurse administer to this patient?
A)
Chlorzoxazone (Paraflex)
B)
Carisoprodol (Soma)
C)
Cyclobenzaprine (Flexeril)
D)
Orphenadrine (Banflex)
Ans:
D Feedback: Only orphenadrine (Banflex) of these options can be given parenterally, either IV or intramuscularly. The other options are available for oral use only.
35 .
What is the maximum daily dose of cyclobenzaprine (Flexeril) the nurse can administer?
A)
20 mg
B)
30 mg
C)
40 mg
D)
60 mg
Ans:
D Feedback: The normal daily dosage of cyclobenzaprine is 10 mg taken orally t.i.d., and it can be increased to a maximum of 60 mg per day.
Chapter 28. Pharmacologic Management of Parkinsonism & Other Movement Disorders
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1.
Degeneration in neurons that release a neurotransmitter leads to Parkinsons disease. What neurotransmitter is involved?
A)
Gamma-aminobutyric acid (GABA)
B)
Acetylcholine
C)
Dopamine
D)
Serotonin
Ans:
C Feedback: Degeneration of dopamine-releasing neurons in the substantia nigra leads to Parkinsons disease. When dopamine is decreased in the area of the corpus striatum, a chemical imbalance allows the cholinergic or excitatory cells to dominate. This affects the functioning of the basal ganglia and cortical and cerebellar components of the extrapyramidal motor system. This system provides coordination for unconscious muscle movements, including those that control position, posture, and movement. The result of the imbalance produces the signs and symptoms of Parkinsons disease. The corpus striatum in the brain is connected to the substantia nigra by a series of neurons that use the inhibitory neurotransmitter GABA. Higher neurons from the cerebral cortex secrete acetylcholine in the area of the corpus striatum as an excitatory neurotransmitter to coordinate movements of the body. Serotonin is not involved in these functions.
2.
A 10-year-old boy has been prescribed an antiparkinsonian drug. Which drug would the nurse expect as the first choice for this child?
A)
Benztropine (Cogentin)
B)
Diphenhydramine (Benadryl)
C)
Trihexyphenidyl (Artane)
D)
Procyclidine (Kemadrin)
Ans:
B Feedback: Parkinsons disease is rare in children. However, if a child needs an antiparkinsonian drug, diphenhydramine is the drug of choice. Benztropine, trihexyphenidyl, and procyclidine are not recommended for use in children.
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3.
A patient is newly diagnosed with Parkinsons disease. An anticholinergic drug is ordered for the patient. When reviewing the patients medical history, the nurse realizes an anticholinergic drug is contraindicated for this patient because of what secondary diagnosis? (Select all that apply.)
A)
Benign prostatic hypertrophy
B)
Narrow-angle glaucoma
C)
Myasthenia gravis
D)
Dysrhythmias
E)
Hepatic dysfunction
Ans:
A, B, C Feedback: Anticholinergics are contraindicated in the presence of narrow-angle glaucoma, GI obstruction, genitourinary (GU) obstruction, and prostatic hypertrophy, all of which could be exacerbated by the peripheral anticholinergic effects of these drugs, and in myasthenia gravis, which could be exacerbated by the blocking of acetylcholine-receptor sites at the neuromuscular synapses. These agents should be administered cautiously, but they are not contraindicated in therapy for the following conditions: tachycardia and other dysrhythmias and hypertension or hypotension because the blocking of the parasympathetic system may cause a dominance of sympathetic stimulatory activity, and in hepatic dysfunction, which could interfere with the metabolism of the drugs and lead to toxic levels.
4.
A patient is newly diagnosed with Parkinsons disease and levodopa (Dopar) has been prescribed. What patient teaching information should be considered a high priority for this patient?
A)
Avoid vitamin B6 intake.
B)
Avoid hot environments.
C)
Many adverse effects will subside when the body adjusts to the drug.
D)
Allow rest periods.
Ans:
A Feedback:
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The priority information would be to avoid vitamin B6 intake, which would include grains and bran. Vitamin B6 speeds the conversion of levodopa to dopamine before it can cross the bloodbrain barrier. This leads to Parkinsons symptoms. The other options are all important and should be discussed with the patient. However, sweating, headaches, difficulty sleeping, fatigue, weakness, and dizziness are expected adverse effects, which will eventually subside or decrease. 5.
A patient with Parkinsonism has been told that the levodopa prescribed is no longer controlling the disease. What drug would the nurse question if ordered as adjunctive therapy?
A)
Diphenhydramine (Benadryl)
B)
Pramipexole (Mirapex)
C)
Trihexyphenidyl (Artane)
D)
Vitamin B6
Ans:
D Feedback: Vitamin B6 would further decrease the therapeutic effects of levodopa and is contraindicated with levodopa, so the nurse would question this order. Pramipexole, diphenhydramine, and trihexyphenidyl are all useful adjunctive drugs when Parkinsons disease is no longer controlled with levodopa therapy alone.
6.
The nurse provides patient teaching about use of levodopa for treatment of Parkinsons disease. What statement by the patient would indicate a good understanding of levodopa?
A)
I will take the medication for about a year and then stop.
B)
I should avoid exercising while taking this drug.
C)
I should take this drug with meals to avoid GI upset.
D)
I will take megavitamins to ensure that I have good nutrition.
Ans:
C Feedback:
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The patient should be instructed to take levodopa with meals if GI upset occurs. Patients being treated for Parkinsons disease should be taught that drug treatment will be needed for life and cannot be stopped in a year. The patient should continue to be as active as possible. Multivitamins will contain vitamin B6, which should be avoided when taking levodopa. 7.
What drug does the nurse administer to treat Parkinsons disease that is also classified as an antiviral?
A)
Amantadine (Symmetrel)
B)
Entacapone (Comtan)
C)
Diphenhydramine (Benadryl)
D)
Ropinirole (Requip)
Ans:
A Feedback: Amantadine is an antiviral drug that increases the release of dopamine and is effective in Parkinsons disease so long as there is a possibility of more dopamine release. Ropinirole is a dopaminergic antiparkinsonism drugs. Entacapone is used as adjunctive treatment of idiopathic Parkinsons disease with levodopacarbidopa for patients who are experiencing wearing off of drug effects. Diphenhydramine is used, particularly in children, to treat parkinsonism and is also classified as an antihistamine.
8.
A patient has Parkinsons disease. Apomorphine (Apokyn), a dopamine agonist, has been prescribed for periods of hypomobility. What will the nurse teach the patient regarding administration of the drug?
A)
The drug will be injected intramuscularly three times a day in a range of 1.0 to 1.5 mL.
B)
The drug will be given intravenously, 50 mg every third day.
C)
The drug will be administered subcutaneously three times a day with a dosage range of 2 to 6 mg.
D)
The drug is taken orally, 20 mg three times a day.
Ans:
C
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Feedback: The drug is administered subcutaneously three times a day in a range of 2 to 6 mg per dose. A dosing pen is available for patient use. The other options are inappropriate for this drug. 9.
An order is written for a drug that is an adjunctive therapy for Parkinsons disease. The nurse reviews the order before administering the drug. What medication orders should the nurse question?
A)
Levodopa 0.5 to 1 g/d orally in 2 divided doses
B)
Amantadine (Symmetrel) 200 mg orally b.i.d.
C)
Tolcapone (Tasmar) 400 mg orally t.i.d.
D)
Selegiline (Carbex) 10 mg/d orally
Ans:
C Feedback: The order for tolcapone should be questioned. The maximum dose is 600 mg daily. The order is a total of 1,200 mg a day (400 times 3 equals 1,200 mg). The other options are correct dosages.
10 .
The expected outcome for a patient taking benztropine as drug therapy for Parkinsons disease would be what?
A)
Decrease in rigidity
B)
Decrease in light-headedness
C)
Decrease in disorientation
D)
Decrease in flushing
Ans:
A Feedback: Benztropine should cause a decrease in rigidity. Light-headedness, disorientation, and flushing are all adverse effects of benztropine and can be expected with a patient taking this drug.
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11 .
A patient is newly diagnosed with parkinsonism. Parkinsonism, which may occur in association with long-term use of antipsychotics, can be treated with what drug type?
A)
Anticholinergic agents
B)
Monoamine oxidase inhibitors (MAOIs)
C)
Synthetic antiviral agents
D)
Dopaminergic drugs
Ans:
A Feedback: Anticholinergic drugs that are centrally active are useful in treating parkinsonism. MAOIs, synthetic antiviral agents, and dopaminergic agents are incorrect.
12 .
The nurse is presenting an educational event to a local community group on Parkinsons disease. What will the nurse tell the attendees causes the classic Parkinsons disease symptoms?
A)
Decreased enzyme aromatic l-amino acid decarboxylase (AADC)
B)
Increased gamma-aminobutyric acid (GABA)
C)
Brain lesions
D)
Degeneration of dopamine-producing nerve cells
Ans:
D Feedback: Classic Parkinsons disease results from destruction or degenerative changes in dopamine-producing nerve cells in an area of the brain that controls movement.
13 .
The nurse has a patient who is receiving selegiline (Carbex, Eldepryl). What is the nurses priority assessment?
A)
Irregular heart rate
B)
Elevated blood pressure
C)
Decreased urinary output
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D)
Gingival hyperplasia
Ans:
B Feedback: The excessive stimulation of the sympathetic nervous system can cause severe hypertension and stroke so it is important for the nurse to assess blood pressure. Gingival hyperplasia is an adverse effect of phenytoin (Dilantin). Irregular heart rate and decreased urinary output are not adverse effects of selegiline.
14 .
The nurse is speaking to a group at the senior citizens center about Parkinsons disease and explains the importance of avoiding what when taking an anticholinergic medication?
A)
Strenuous exercise in high environmental temperatures
B)
Fluids high in potassium
C)
Foods high in vitamin K
D)
Anything containing red dye
Ans:
A Feedback: Anticholinergic drugs decrease sweating. As a result, the body is not as effective at reducing internal temperature as this could result in fever and heatstroke. Elderly people taking anticholinergic drugs do not need to avoid fluids high in potassium, foods high in vitamin K, or anything containing red dye.
15 .
When providing patient teaching for older adults, the nurse employs what priority strategy to improve patient understanding?
A)
Repetition
B)
Meticulous detail
C)
Extensive written teaching
D)
Family involvement
Ans:
C
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Feedback: The drugs that are used to manage Parkinsons disease are associated with many adverse effects in older people with long-term problems. In many cases, other pharmacotherapeutic agents are given to counteract the adverse effects of these drugs. So patients then have complicated drug regimens with many associated adverse effects and problems. Consequently, it is essential for these patients to have extensive written drug-teaching protocols. Repetition, attention to detail, and family involvement can further improve effectiveness of teaching, but providing written instructions is the highest priority strategy. 16 .
A patient, newly diagnosed with Parkinsons disease, has been prescribed an anticholinergic drug. What common adverse effect of anticholinergic agents used for the treatment of Parkinsons disease will the nurse share with the patient?
A)
Blood dyscrasias
B)
Diaphoresis
C)
Memory loss
D)
Diarrhea
Ans:
C Feedback: Most people diagnosed with Parkinsons disease are older adult men so it is important for the nurse to warn the patient that memory loss may occur to reduce anxiety the patient may experience with this adverse effect. Blood dyscrasias are not associated with these drugs. Constipation is more likely than diarrhea and lack of sweating rather than diaphoresis is associated with anticholinergics.
17 .
The nurse often gives another drug with levodopa (L-dopa) to decrease the amount of levodopa needed to reach a therapeutic level in the brain, thereby reducing adverse effects? What is the name of this drug?
A)
Bromocriptine
B)
Carbidopa
C)
Amantadine
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D)
Trihexyphenidyl
Ans:
B Feedback: Carbidopa is frequently given with levodopa in a fixed-dose combination product called Sinemet or Sinemet CR. When used with carbidopa, the enzyme dopa decarboxylase is inhibited in the periphery, diminishing the metabolism of levodopa in the gastrointestinal (GI) tract and in peripheral tissues, thereby leading to higher levels crossing the bloodbrain barrier. Because carbidopa decreases the amount of levodopa needed to reach a therapeutic level in the brain, the dosage of levodopa can be decreased, which reduces the incidence of adverse effects. Bromocriptine, amantadine, and trihexyphenidyl may be effective longer than levodopa but are not usually prescribed together.
18 .
When the nurse develops a plan of care for a patient newly diagnosed with Parkinsons disease, the nurse includes what appropriate goal for this patient?
A)
Deficient knowledge related to the disease process
B)
Increase compliance with drug regimen as evidenced by no missed dosages within 1 week of discharge
C)
Risk for injuries related to the disease process
D)
Symptom improvement as demonstrated by ability to ambulate the length of the hall within 24 hours of starting medication
Ans:
D Feedback: One goal of drug therapy is to reduce symptoms to allow for more normal movement involving muscles. Goals should be specific and measurable, so the ability to ambulate the length of the hall is a valid assessment. The patient cannot increase compliance when he or she has not been lacking in compliance because this is a new diagnosis. Deficient knowledge and risk for injury are nursing diagnoses and not goals.
19 . A)
The nurse is teaching a new patient about levodopa (L-dopa). What is important to instruct the patient to avoid using concurrently with L-dopa? Aspirin compounds
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B)
Multivitamin-mineral preparations
C)
Alcohol
D)
Antianginal agents
Ans:
B Feedback: Iron preparations and multivitaminmineral preparations containing iron should not be given with L-dopa. Aspirin compounds, alcohol, and antianginal agents are not contraindicated in concurrent therapy with L-dopa.
20 .
When carbidopa is given with levodopa (L-dopa), the dosage of L-dopa must be reduced. What would the reduction of L-dopa cause?
A)
Heightened levels of sedation
B)
Prolonged effect of medications
C)
Decreased adverse effects
D)
Decreased effectiveness of symptom control
Ans:
C Feedback: Because carbidopa decreases the amount of L-dopa needed to reach a therapeutic level in the brain, the dosage of L-dopa can be decreased, which reduces the incidence of adverse effects. Other options are incorrect.
21 .
What is the main purpose of the drugs used to treat Parkinsons disease?
A)
Adjust the balance of neurotransmitters.
B)
Make the catechol-O-methyltransferase (COMT) inhibitors work better.
C)
Substitute monoamine oxidase inhibitors (MAOIs) for dopamine agonists.
D)
Increase the actions of acetylcholine in the brain.
Ans:
A
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Feedback: Drugs used in Parkinsons disease increase levels of dopamine (levodopa, dopamine agonists, monoamine oxidase [MAO] inhibitors, COMT inhibitors) or inhibit the actions of acetylcholine (i.e., anticholinergic agents) in the brain. Thus, the drugs help adjust the balance of neurotransmitters. 22 .
The nurse is teaching a group of student nurses about Parkinsons disease. The nurse would determine teaching was successful if the students identified what neurotransmitters as imbalanced in Parkinsons disease?
A)
Cholinergic and anticholinergic neurotransmitters
B)
Gamma-aminobutyric acid (GABA) and dopamine
C)
GABA and anticholinergic neurotransmitters
D)
Dopamine and acetylcholine
Ans:
D Feedback: The correct balance of dopamine and acetylcholine is important in regulating posture, muscle tone, and voluntary movement. People with Parkinsons disease have an imbalance in these neurotransmitters, resulting in a decrease in inhibitory brain dopamine and a relative increase in excitatory acetylcholine.
23 .
The nurse is caring for a patient diagnosed with Parkinsons disease who has been prescribed an anticholinergic drug. When are anticholinergic drugs usually added to the therapeutic regimen?
A)
When symptoms increase
B)
Sporadically to reduce development of toleration to levodopa
C)
When levodopa does not elicit a therapeutic response
D)
During the end stage of the disease process
Ans:
C Feedback:
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Although anticholinergics are not as effective as levodopa in the treatment of advancing cases of the disease, they may be useful as adjunctive therapies and for patients who no longer respond to levodopa. They are not withheld until symptoms advance or end-stage symptoms occur and they are not given sporadically. 24 .
2 Drugs in Focus Anticholinergic Agents
A)
Combines with anticholinergic receptors to increase the action of levodopa
B)
Stimulates postsynaptic dopamine receptors directly
C)
Combines with anticholinergic receptors to increase dopamine action
D)
Inhibits postsynaptic dopamine receptors directly
Ans:
B Feedback: Ropinirole is a newer drug that directly stimulates dopamine receptors. It is also used to treat restless legs syndrome. The other options are incorrect because ropinirole only works as a dopamine receptor stimulant.
25 .
A home health nurse is visiting an elderly patient with Parkinsons disease. What would the nurse assess this man for related to common adverse effects?
A)
Blood dyscrasias
B)
Increased dopamine activity
C)
Pliability
D)
Urinary retention
Ans:
D Feedback:
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The nurse would assess the patient for urinary retention because this reaction is caused by loss of muscle tone in the bladder and is most likely to occur in elderly men who have enlarged prostate glands. Parkinsons does not generally cause blood dyscrasias. The nurse cannot assess for increased dopamine activity except to assess for reduced symptoms caused by medication therapy. Pliability is a distracter for this question. 26 .
What patient is most likely to be diagnosed with Parkinsons disease?
A)
A 45-year-old woman
B)
A 35-year-old man
C)
A 55-year-old person of either gender
D)
A 60-year-old man
Ans:
D Feedback: Although Parkinsons disease may affect people of any age, gender, or nationality, the frequency of the disease increases with age. This debilitating condition, which affects men more often than women, may be one of many chronic problems associated with aging.
27 .
The nurse is teaching a patient about antiparkinson drugs. What drug would the nurse expect to be prescribed for the patient experiencing wearing off of drug effects?
A)
Pramipexole
B)
Entacapone
C)
Ropinirole
D)
Amantadine
Ans:
B Feedback:
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Entacapone is an adjunctive drug that is prescribed when a patient with Parkinsons disease has a wearing off effect of his or her other Parkinsons medications, meaning the drugs previously prescribed are having less of an effect. Therefore, options A, C, and D are incorrect. 28 .
While providing patient education for a patient newly diagnosed with Parkinsons disease and his or her family, the nurse will explain that Parkinsons disease is characterized by what?
A)
Reduced cognitive function
B)
Abnormalities in stature
C)
Postural instability
D)
Reduced nerve transmission
Ans:
C Feedback: Parkinsons disease is a chronic, progressive, and degenerative disorder of the central nervous system (CNS) characterized by abnormalities in movement and posture (e.g., tremor, bradykinesia, joint and muscular rigidity, postural instability).
29 .
The nurse is assessing a patient who was prescribed levodopa 1 week earlier. How might the nurse evaluate the effectiveness of drug therapy?
A)
Stable mood
B)
Psoriasis
C)
Drugdrug interactions with dopaminergic agents
D)
Improvement in handwriting
Ans:
D Feedback:
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The nurse would evaluate the patient for improvement in function and reduction in symptoms. With preparations containing levodopa and with dopaminergic agents, assess for improvement in mobility, balance, posture, gait, speech, handwriting, and ability to provide self-care. Drooling and seborrhea may be abolished, and mood may be elevated. Stable mood and psoriasis are not findings associated with Parkinsons disease. Assessing for drugdrug interactions is an important nursing assessment but it is not related to evaluating effectiveness of the drug.
30 .
When describing Parkinsons disease to a patient with a new diagnosis, what statement made by the nurse would be accurate?
A)
Parkinsons disease can be cured if medication is taken regularly as prescribed.
B)
Degeneration of the neurons is arrested by medication.
C)
Surgical procedures involving the basal ganglia have had varying degrees of success.
D)
Diet-related therapy is the primary treatment for managing Parkinsons disease.
Ans:
C Feedback: Surgical procedures involving the basal ganglia have been tried with varying success at prolonging the physical degeneration caused by this disease. Drug therapy remains the primary treatment. At this time, no available treatment arrests the neuron degeneration of Parkinsons disease and the eventual decline in patient function.
31 .
What is the primary reason a nurse might administer an antiparkinsonism drug to a child?
A)
New-onset Parkinsons disease
B)
Drug abuse
C)
Fibromyalgia
D)
Parkinsonian symptoms
Ans:
D
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Feedback: The incidence of Parkinsons disease in children is very low. Children do, however, experience parkinsonian symptoms as a result of drug adverse effects, not of drug abuse. Fibromyalgia is not usually diagnosed in children either. 32 .
The nurse is caring for a patient who is unable to swallow properly. What drug would the nurse expect to be prescribed?
A)
Apomorphine (Apokyn)
B)
Bromocriptine (Parlodel)
C)
Levodopa (Dopar)
D)
Ropinirole (Requip)
Ans:
A Feedback: Only apomorphine can be given parenterally so this would be an appropriate drug to give to a patient with difficulty swallowing. Bromocriptine, levodopa, and ropinirole are only given in oral formulations.
33 .
How does the drug levodopa contrast with dopamine? (Select all that apply.)
A)
Levodopa is a precursor of dopamine.
B)
Levodopa crosses the bloodbrain barrier.
C)
Levodopa is converted to dopamine.
D)
Levodopa is effective for 8 to 10 years.
E)
Dopamine returns to levodopa for metabolism.
Ans:
A, B, C Feedback: Levodopa is a precursor of dopamine, which is deficient in parkinsonism; it crosses the bloodbrain barrier, where it is converted to dopamine and acts as a replacement neurotransmitter; it is effective for 2 to 5 years in relieving the symptoms of Parkinsons disease.
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34 .
The nurse is preparing to administer the patients first dosage of trihexyphenidyl (Artane). What will the nurse tell the patient about the dosage?
A)
Initial dose is 1 to 2 mg and then dosage is titrated up to manage symptoms of disease.
B)
Initial dose is 6 mg to establish serum levels and then 1 mg is taken daily.
C)
A 5-mg dose is taken orally twice a day starting with first dose.
D)
Take 1 to 2 mg orally every day starting with first dosage.
Ans:
A Feedback: Trihexyphenidyl (Artane) is given 1 to 2 mg orally daily initially and then titrated up to 6 to 10 mg/d with a maximum of up to 15 mg/d to control symptoms. Trihexyphenidyl is an adjunctive therapy to levodopa in treatment of parkinsonism but it can be used alone for the control of druginduced extrapyramidal disorders.
Chapter 29. Antipsychotic Agents & Lithium 1.
A group of patients are being screened to see which patients would be the best candidate for a psychotherapeutic drug trial that helps people concentrate longer on activities. Which patient would be best suited for this trial?
A)
A 28-year-old salesperson who alternates between overactivity and periods of depression
B)
A 32-year-old hyperactive nursing student who cannot focus long enough to take a test
C)
A 55-year-old physician who suddenly falls asleep during the day without warning
D)
A 16-year-old youth who say he can make the light turn on by pointing at it and hears voices
Ans:
B Feedback:
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Attention-deficit disorders involve various conditions characterized by an inability to concentrate on one activity for longer than a few minutes. The nursing student needing accommodations has an attention-deficit disorder. The salesperson exhibits signs of mania, which are characterized by periods of extreme overactivity and excitement followed by extreme depression. The physician is experiencing narcolepsy, which is defined as daytime sleepiness and sudden periods of loss of wakefulness. The teenager is schizophrenic and is exhibiting paranoia, hallucinations, and delusions. 2.
What nursing intervention is appropriate for a 70-year-old female patient receiving lithium?
A)
Instruct the patient to use barrier contraceptives.
B)
Monitor blood glucose levels.
C)
Monitor fluid and sodium intake.
D)
Encourage the patient to check daily for weight loss.
Ans:
C Feedback: Older patients, and especially those with renal impairment, should be encouraged to maintain adequate hydration and salt intake. Decreased dosages may also be necessary with the elderly. A 70-year-old patient would not be concerned about the use of contraceptives. These drugs alone do not affect glucose levels. Weight loss is usually not associated with lithium use.
3.
A nurse is caring for a patient who is taking lithium for mania. The nurses assessment includes a notation of a lithium serum level of 2.4 mEq/L. The nurse anticipates seeing what?
A)
Fine tremors of both hands
B)
Slurred speech
C)
Clonic movements
D)
Nausea and vomiting
Ans:
C Feedback:
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Serum levels of 2 to 2.5 mEq/L may produce ataxia, clonic movements, possible seizures, and hypotension. Fine hand tremors, slurred speech, and nausea and vomiting are indicative of lithium levels less than 1.5 mEq/L. 4.
The nurse administers chlorpromazine intramuscularly to the preoperative patient who is extremely anxious about surgery in the morning. What priority teaching point will the nurse provide this patient?
A)
Remain recumbent for at least 30 minutes after the injection.
B)
Do not eat for 1 hour after the drug is administered.
C)
Encourage fluids with the goal of 3,000 mL/d.
D)
Avoid eating avocados and oranges when taking this medication.
Ans:
A Feedback: When giving a parenteral form of an antipsychotic, the patient should remain recumbent to decrease the risk of injury if orthostatic hypotension occurs. Eating after drug injection should not interfere with the drugs absorption and although adequate hydration should be maintained there is no need to increase fluid intake. Avocados and oranges are not contraindicated in patients receiving this medication.
5.
The nurse is presenting an in-service at a childrens unit on hyperactivity. The nurse is told that a 6-year-old on the unit is being treated with methylphenidate (Ritalin). The presenting nurse talks about discharge teaching for this patient and the importance of monitoring what?
A)
Long bone growth
B)
Visual acuity
C)
Weight and complete blood count
D)
Urea and nitrogen levels
Ans:
C Feedback:
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Methylphenidate is associated with weight loss, bone marrow suppression, and cardiac arrhythmias. Weight, blood count, and cardiac function should be monitored regularly. The drug is not associated with renal dysfunction, visual changes, or growth retardation, so those values would not need to be regularly evaluated as part of drug therapy. 6.
The nurse is caring for a patient taking an oral neuroleptic medication. What is the nurses priority assessment to monitor for?
A)
Urge incontinence
B)
Orthostatic hypotension
C)
Bradycardia
D)
Tardive dyskinesia
Ans:
D Feedback: The nurse would monitor for and teach the patient and family about tardive dyskinesias because it is such a common adverse effect with continued use of the drug. Oral neuroleptic agents do not cause urge incontinence, orthostatic hypotension, or bradycardia.
7.
A psychotic patient is admitted through the emergency department. The physician has ordered chlorpromazine (Thorazine) 25 mg intramuscularly. After administration of the medication, what is the nurses priority to evaluate?
A)
The patients ability to ambulate
B)
Return of the patients appetite
C)
A decrease in psychotic symptoms
D)
Blood pressure and pulse
Ans:
C Feedback:
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The nurse will evaluate the effectiveness of the drug in diminishing psychotic symptoms because this is the purpose of administering the drug. Monitoring blood pressure, pulse, and appetite is part of all patient care but is not the priority evaluation criterion for this patient. The ability to ambulate and maintain adequate nutrition would be assessed but is not the priority evaluation for this patient. 8.
A patient diagnosed with bipolar disorder is to be discharged home in 48 hours. The nurse has completed patient teaching regarding the use of lithium. What statement by the patient indicates an understanding of their responsibility?
A)
I will increase my salt intake.
B)
I will increase my fluid intake.
C)
I will decrease my salt intake.
D)
I will decrease my fluid intake.
Ans:
B Feedback: To maintain a therapeutic lithium level, the patient must increase fluids. A decrease in consumption of fluids can lead to toxicity. An increase in salt intake can lead to lithium excretion and a decrease in effectiveness. A decrease in salt intake can cause retention, also leading to toxicity. Adequate salt intake is necessary to keep serum levels in therapeutic range but need not be increased or decreased.
9.
A patient has just been prescribed a phenothiazine. During patient teaching about this drug, what would be important for the nurse to tell the patient?
A)
The urine can turn pink or reddish.
B)
The urine output will be decreased.
C)
Diarrhea can be an adverse effect.
D)
Hyperexcitability can occur.
Ans:
A Feedback:
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Phenothiazines can cause the urine to turn pink or reddish. The patient should be informed that this is a simple color change and is not caused by blood in his urine. Decreased urine output is not associated with this drug. Constipation is usually an adverse effect of the drug. Drowsiness, not hyperexcitability, can occur. 10 .
A patient, in the manic phase of bipolar disorder, is being discharged home on an antimanic drug. What antimanic drug is used for long-term maintenance of bipolar disorders?
A)
Aripiprazole (Abilify)
B)
Lamotrigine (Lamictal)
C)
Quetiapine (Seroquel)
D)
Ziprasidone (Geodon)
Ans:
B Feedback: Lamotrigine is used for long-term maintenance of bipolar disorders. Aripiprazole and ziprasidone are used for acute manic and mixed episodes of bipolar disorders. Quetiapine is used as adjunct or monotherapy for the treatment of manic episodes associated with bipolar disorder.
11 .
A 16-year-old youth has just been diagnosed with schizophrenia. The parents ask the nurse what causes schizophrenia. What would be the nurses best response?
A)
Schizophrenia is caused by pain that the brain perceives.
B)
Schizophrenia is thought to occur due to trauma experienced in childhood.
C)
Schizophrenia is thought to reflect a fundamental biochemical abnormality.
D)
Schizophrenia is caused by seizure activity in the brain.
Ans:
C Feedback:
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This disorder, which seems to have a very strong genetic association, may reflect a fundamental biochemical abnormality. Mental disorders are now thought to be caused by some inherent dysfunction within the brain that leads to abnormal thought processes and responses. Schizophrenia is not caused by pain, childhood trauma, or seizure activity. 12 .
A patient on chlorpromazine is feeling better and decides they no longer need their medication. The nurse teaches the patient that abrupt withdrawal of a typical antipsychotic medication can result in what?
A)
Insomnia
B)
Tardive dyskinesia
C)
Somnolence
D)
Constipation
Ans:
A Feedback: Sudden withdrawal can cause cholinergic effects such as diarrhea, gastritis, nausea, vomiting, dizziness, arrhythmias, drooling, and insomnia. Abrupt withdrawal of a typical antipsychotic generally does not cause tardive dyskinesia, somnolence, or constipation.
13 .
A patients medication has been changed to clozapine (Clozaril). The nurse evaluates this patient for which life-threatening adverse effect?
A)
Renal insufficiency
B)
Emphysema
C)
Neuroleptic malignant syndrome
D)
Cerebrovascular accident (CVA)
Ans:
C Feedback: Neuroleptic malignant syndrome can be a life-threatening adverse effect of atypical non-phenothiazines. Renal insufficiency, emphysema, and CVA are not commonly seen adverse effects of atypical non-phenothiazines.
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14 .
The nurse is caring for an adolescent patient who began taking an antipsychotic drug last month to treat newly diagnosed schizophrenia. The drug has not been effective and the mother asks the nurse if this means the adolescents symptoms cannot be controlled by drugs. What is the nurses best response?
A)
Patients commonly have to try different drugs until the most effective drug is identified.
B)
Some patients do not respond to drugs and have to rely solely on behavior therapy.
C)
Most likely your child was not taking the medication properly as prescribed.
D)
He may need to take multiple drugs before effects will be seen that control his symptoms.
Ans:
A Feedback: A patient who does not respond to one drug may react successfully to another agent. Responses may also vary because of cultural issues. The selection of a specific drug depends on the desired potency and patient tolerance of the associated adverse effects. It is not common to have a patient who does not demonstrate some improvement from medications so it would be incorrect to tell the mother the child wont respond to any drug after trying only one medication. There is no indication the drug was taken improperly and even properly administered drugs will not work on all patients. Multiple drug therapy is not indicated by the question.
15 .
Haloperidol is a typical antipsychotic drug. What adverse effect is associated with this drug?
A)
Bradycardia
B)
Bradypnea
C)
Extrapyramidal effects
D)
Hypoglycemia
Ans:
C Feedback:
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Haloperidol produces a relatively low incidence of hypotension and sedation and a high incidence of extrapyramidal effects. Haloperidol does not generally produce bradycardia, bradypnea, or hypoglycemia. 16 .
The pharmacology instructor is explaining to their class the difference between the typical and the atypical groups of antipsychotic drugs. What medication would the instructor explain to the students has fewer extrapyramidal effects and greater effectiveness than older antipsychotic drugs in relieving negative symptoms of schizophrenia?
A)
Chlorpromazine (Thorazine)
B)
Clozapine (Clozaril)
C)
Thiothixene (Navane)
D)
Haloperidol (Haldol)
Ans:
B Feedback: Advantages of clozapine include improvement of negative symptoms without causing the extrapyramidal effects associated with older antipsychotic drugs. Chlorpromazine is a typical antipsychotic, one of the older drugs, which does cause the extrapyramidal effects. Navane is part of the thioxanthene group of typical antipsychotics. This group of drugs has low sedative and hypotensive effects but can cause extrapyramidal effects. Haloperidol is a butyrophenone group drug used in psychiatric disorders. Usually, it produces a relatively low incidence of hypotension and sedation and a high incidence of extrapyramidal effects.
17 .
The nurse, providing teaching about a typical antipsychotic newly prescribed for the patient, cautions against use of alcohol with the drug by explaining it will have what effect?
A)
Prolonged QT interval
B)
Increased central nervous system (CNS) depression
C)
Increased anticholinergic effects
D)
Increased gastrointestinal (GI) adverse effects
Ans:
B
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Feedback: Antipsychoticalcohol combinations combinations result in an increased risk of CNS depression, and antipsychoticanticholinergic combinations lead to increased anticholinergic effects, so dosage adjustments are necessary. Patients should not take thioridazine or ziprasidone with any other drug associated with prolongation of the QT interval. Increase in GI adverse effects is not associated with concurrent use of alcohol. 18 .
The nurse is caring for four patients. Which patient would the nurse know that clozapine (Clozaril) is contraindicated for?
A)
17-year-old adolescent
B)
23-year-old with diabetes insipidus
C)
32-year-old with osteoarthritis
D)
45-year-old with bone marrow depression
Ans:
D Feedback: Clozapine is associated with bone marrow suppression, a life-threatening decrease in white blood cells. Because of their wide-ranging adverse effects, antipsychotic drugs may cause or aggravate various conditions. They should be used very cautiously in patients with liver damage, coronary artery disease, cerebrovascular disease, Parkinsonism, bone marrow depression, severe hypotension or hypertension, coma, or severely depressed states. Options A, B, and C are incorrect.
19 .
The physician has ordered olanzapine (Zyprexa) for a new patient. What laboratory test should be done before administration of olanzapine?
A)
Blood glucose
B)
Urine specific gravity
C)
Cholesterol
D)
Hemoglobin and hematocrit
Ans:
A Feedback:
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Olanzapine has been associated with weight gain, hyperglycemia, and initiation or aggravation of diabetes mellitus. Other options are not necessary for patients taking olanzapine unless a secondary diagnosis indicates a need. 20 .
Parents bring a 15-year-old boy into the clinic. The parents tell the nurse that there is a family history of schizophrenia and they fear their son has developed the disease. What symptoms, if described by the family, would support their conclusion?
A)
He hears and interacts with voices no one else can hear.
B)
He is overactive and always so excitable.
C)
He falls asleep in the middle of a sentence.
D)
He cannot concentrate and his grades are suffering.
Ans:
A Feedback: Characteristics of schizophrenia include hallucinations, paranoia, delusions, speech abnormalities, and affective problems. Overactivity and excitement are associated with mania. Falling asleep suddenly describes narcolepsy. Difficulty concentrating and failing grades is associated with attention deficient disorders.
21 .
The patient taking an antipsychotic drug asks the nurse how long he will continue to feel the effects of the drug after stopping the medication. What is the nurses best response?
A)
2 to 4 hours
B)
2 to 4 weeks
C)
2 to 4 months
D)
6 months
Ans:
D Feedback: The antipsychotics are widely distributed in the tissues and are often stored there, being released for up to 6 months after the drug therapy has been stopped.
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22 .
The nurse works on an inpatient mental health unit. When administering antipsychotic medications, what patient would the nurse expect to require a standard dosage?
A)
African American adolescent diagnosed with schizophrenia
B)
Malaysian middle adult diagnosed with bipolar disorder
C)
Iranian older adult diagnosed with schizophrenia
D)
Caucasian young adult diagnosed with bipolar disorder
Ans:
D Feedback: Only the Caucasian young adult has no indications for administering a smaller than usual dosage. African Americans respond more rapidly to antipsychotic medications and have a greater risk for development of disfiguring adverse effects, such as tardive dyskinesia. Consequently, these patients should be started off at the lowest possible dose and monitored closely. Patients in Asian countries (e.g., India, Turkey, Malaysia, China, Japan, Indonesia) receive lower doses of neuroleptics and lithium to achieve the same therapeutic response as seen in patients in the United States. Arab American patients metabolize antipsychotic medications more slowly than Asian Americans do and may require lower doses to achieve the same therapeutic effects as in Caucasians.
23 .
Psychosis is a severe mental illness characterized by what?
A)
Disordered thought
B)
Increased social interaction
C)
Hypoactivity with aggressiveness
D)
Paranoid hallucinations
Ans:
A Feedback:
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Antipsychotic drugs are used mainly for the treatment of psychosis, a severe mental disorder characterized by disordered thought processes; blunted or inappropriate emotional responses; bizarre behavior ranging from hypoactivity to hyperactivity with agitation, aggressiveness, hostility, and combativeness; social withdrawal in which a person pays less-than-normal attention to the environment and other people; deterioration from previous levels of occupational and social functioning (poor self-care and interpersonal skills); hallucinations; and paranoid delusions. 24 .
The nurse is caring for a patient newly diagnosed with schizophrenia. His parents say they have heard the term before but do not really understand exactly what schizophrenia means. How would the nurse describe the disorder? (Select all that apply.)
A)
Thought disorder
B)
Difficulty functioning in society
C)
Hallucinations can be auditory, visual, or sensory
D)
Can be cured with the correct medications
E)
Enter into fugue state in most cases
Ans:
A, B, C, D Feedback: Mental disorders are thought process disorders that may be caused by some inherent dysfunction within the brain. A psychosis is a thought disorder, and schizophrenia is the most common psychosis in which delusions and hallucinations are hallmarks. Hallucinations can be auditory, visual, or sensory. Patients diagnosed with schizophrenia have difficulty functioning in society. Schizophrenic patients do not generally go into fugue states and it certainly is not a common disorder.
25 .
A 7-year-old boy is admitted to the pediatric behavioral health unit with a diagnosis of an acute psychotic episode. Aripiprazole has been ordered. Before administering the medication, what is the nurses first priority?
A)
Weigh the patient.
B)
Obtain baseline vital signs.
C)
Call the physician.
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D)
Administer the medication between meals.
Ans:
C Feedback: Of the antipsychotics, chlorpromazine, haloperidol, pimozide, prochlorperazine, risperidone, thioridazine, and trifluoperazine are the only ones with established pediatric regimens. Aripiprazole has dosages for children 13 to 17 years of age but would not be appropriate for a 7-year-old child. Weighing the patient and obtaining baseline vital signs is necessary assessment data but is not the first priority. There is nothing to indicate medications should be administered between meals.
26 .
The nurse admits a patient newly diagnosed with schizophrenia to the inpatient mental health unit. What is the priority reason for why the nurse includes the family when collecting the nursing history?
A)
The patient may not be able to provide a coherent history.
B)
The patient may not be able to speak due to reduced level of consciousness.
C)
The family will feel better if they are included in the process.
D)
The patient will be less anxious if the family listens while he answers questions.
Ans:
A Feedback: Schizophrenia, the most common psychosis, is characterized by delusions, hallucinations, and inappropriate responses to stimuli. As a result, the patient may be unable to provide a coherent history and may be unaware of his behaviors considered dysfunctional. There is no reason to suspect the patient cannot speak and reducing anxiety is not the priority rationale for including family. While family is included in treatment, the goal is to treat the patient and not make the family feel better if actions were not in the patients best interests.
27 .
The nurse is teaching the soon-to-be-discharged patient, diagnosed with schizophrenia, about his medications. What is a priority teaching point for this patient?
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A)
The patient must eat three nutritious meals daily.
B)
Over-the-counter medications may be taken with antipsychotic drugs.
C)
Cough medicines potentiate the actions of antipsychotic drugs.
D)
Alcohol consumption should be avoided.
Ans:
D Feedback: Alcohol consumption should be avoided because it increases the central nervous system (CNS) effects of the drug and may cause excessive drowsiness and decreased awareness of safety hazards in the environment. Some patients may find it easier and more effective to eat five small meals rather than three nutritious meals. While promoting good nutrition is good practice, it is not the priority. Drugdrug interactions with antipsychotic drugs are common so the nurse would teach the patient not to take any medication without consulting with the doctor or a pharmacist to make sure it is safe.
28 .
What antiepileptic medication might the nurse administer to treat bipolar disorder?
A)
Apriprazole (Abilify)
B)
Cyclobenzaprine (Flexeril)
C)
Lamotrigine (Lamictal)
D)
Temazepam (Restoril)
Ans:
C Feedback: Lamotrigine is an antiepileptic agent used for long-term maintenance of patients with bipolar disorders because it decreases occurrence of acute mood episodes. Apriprazole is an atypical antipsychotic and is not an antiepileptic medication. Flexeril is a muscle relaxant and Temazepam is a hypnotic agent. None of these medications are indicated for the treatment of bipolar disorder.
29 .
A patient, who is 77 years old, is admitted with a diagnosis of dementia. Haloperidol (Haldol) has been ordered for this patient. What nursing considerations would govern the nurses actions? (Select all that apply.)
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A)
It is classed as an atypical antipsychotic.
B)
A lowered dosage is indicated for older adult.
C)
It often has a hyperactive effect on patients.
D)
It should not be used to control behavior with dementia.
E)
It should only be given every other day.
Ans:
B, D Feedback: Haloperidol is classified as a typical antipsychotic with a high risk of extrapyramidal effects and lower risk for hypotension and sedation. Older patients may be more susceptible to the adverse effects of antipsychotic drugs. All dosages need to be reduced and patients monitored very closely for toxic effects and to provide safety measures if central nervous system effects do occur. They should not be used to control behavior with dementia. Haloperidol does not have a hyperactive effect on patients; it should not be given on an every-other-day schedule.
30 .
Which drug does not have a recommended pediatric dose?
A)
Pimozide (Orap)
B)
Lithium salts (Lithotabs)
C)
Haloperidol (Haldol)
D)
Risperidone (Risperdal)
Ans:
B Feedback: Lithium does not have a recommended pediatric dose; the drug should not be administered to children younger than 12 years old. Pimozide, haloperidol, and risperidone all have recommended pediatric doses.
31 .
The mother of a child diagnosed with attention-deficit syndrome receives a prescription for a central nervous system (CNS) stimulant to treat her child. The mother asks the nurse, I dont understand why were giving a stimulant to calm him down? What is the nurses best response to this mother?
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A)
It helps the reticular activating system (RAS), a part of the brain, to be more selective in response to incoming stimuli.
B)
It helps energize the child so they use up all of their available energy and then they can focus on quieter stimuli.
C)
No one truly understands why it works but it has been demonstrated to be very effective in treating ADHD.
D)
The drugs work really well and you will see a tremendous change in your child within a few weeks without any other treatment.
Ans:
A Feedback: The paradoxical effect of calming hyperexcitability through CNS stimulation seen in attention-deficit syndrome is believed to be related to increased stimulation of an immature RAS, which leads to the ability to be more selective in response to incoming stimuli. CNS stimulants do not cause the child to use all his energy, the effect is thought to be understood, and telling the mother the drug just works without any explanation is not appropriate and may result in noncompliance with pharmacology therapy if the mother does not understand why the drug is given.
32 .
The nurse is teaching the mother of a child diagnosed with attention-deficit hyperactivity disorder how to administer methylphenidate (Ritalin). When would the nurse instruct the mother to administer this drug?
A)
Administer at lunch every day.
B)
Administer at breakfast every day.
C)
Administer at dinner every day.
D)
Administer at bedtime.
Ans:
B Feedback: Several long-acting formulations of methylphenidate have become available that allow the drug to be given only once a day. It should always be given in the morning because administration at dinnertime or bedtime could result in insomnia.
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33 .
A child was diagnosed with attention-deficit hyperactivity disorder and methylphenidate was prescribed for treatment to be taken once a day in a sustained release form. On future visits what is a priority nursing assessment for this child?
A)
Weight and height
B)
Breath sounds and respiratory rate
C)
Urine output and kidney function
D)
Electrocardiogram (ECG) and echocardiogram
Ans:
A Feedback: The nurse needs to carefully track this childs weight and height because the drug can cause weight loss, anorexia, and nausea that could result in slowed or absent growth. There would be no need to monitor breath sounds, respiratory rate, urine output, and kidney function. Although arrhythmias may occur as an adverse effect necessitating an ECG, there is no need to perform echocardiograms.
34 .
The nurse is preparing to administer methylphenidate to the child admitted to the pediatric unit after breaking a leg when jumping off the garage roof at home. Where will the nurse find the medication?
A)
In the patients drawer
B)
In the refrigerator
C)
At the patients bedside
D)
In the controlled substance cabinet
Ans:
D Feedback: Methylphenidate is a controlled medication due to risk for physical and psychological dependence. As a result, the drug would be found in the controlled substance cabinet.
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35 .
The nurse is caring for a child receiving a central nervous system (CNS) stimulant who was admitted to the pediatric intensive care unit following repeated seizures after a closed head injury. The physician orders phenytoin to control seizures and lorazepam to be administered every time the child has a seizure. What is the nurses priority action?
A)
Call the doctor and question the administration of phenytoin.
B)
Call the doctor and question the administration of lorazepam.
C)
Wait 24 hours before beginning to administer phenytoin.
D)
Wait 24 hours before beginning to administer lorazepam.
Ans:
A Feedback: The combination of CNS stimulants with phenytoin leads to a risk of increased drug levels. Patients who receive such a combination should be monitored for toxicity. There is no contraindication for use of lorazepam.
Chapter 30. Antidepressant Agents 1.
The mental health nursing instructor is talking with the class about depression. What deficiency does the instructor explain will result in depression?
A)
Epinephrine, norepinephrine, and acetylcholine
B)
Norepinephrine, dopamine, and serotonin
C)
Acetylcholine, gamma-aminobutyric acid, and serotonin
D)
Gamma-aminobutyric acid, dopamine, and epinephrine
Ans:
B Feedback:
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A current hypothesis regarding the cause of depression is a deficiency of norepinephrine, dopamine, or serotonin, which are all biogenic amines, in key areas of the brain. Acetylcholine is a neurotransmitter that communicates between nerves and muscles. Epinephrine is a catecholamine that serves as a neurotransmitter that is released in the sympathetic branch of the autonomic nervous system and can be hormones when released from cells in the adrenal medulla. Gamma-aminobutyric acid is a neurotransmitter that inhibits nerve activity and prevents over excitability or stimulation. 2.
What is the physiological action of tricyclic antidepressants (TCAs)?
A)
Inhibiting monoamine oxidase inhibitors that break down norepinephrine
B)
Inhibiting nerve activity, which prevents over excitability or stimulation
C)
Blocking the reuptake of serotonin, which increases the levels of norepinephrine
D)
Inhibiting reuptake of norepinephrine and serotonin
Ans:
D Feedback: TCAs inhibit presynaptic reuptake of norepinephrine and serotonin, which cause an accumulation of the neurotransmitters that is thought to create the antidepressant effect. Monoamine oxidase inhibitors irreversibly inhibit monoamine oxidase that breaks down norepinephrine and serotonin. Selective serotonin reuptake inhibitors block the reuptake of serotonin; gamma-aminobutyric acid inhibits nerve activity.
3.
A nurse is working with a 9-year-old child who exhibits signs and symptoms of obsessive-compulsive disorder (OCD). What drug will the nurse anticipate may be prescribed for the child?
A)
Phenelzine (Nardil)
B)
Amitriptyline (Elavil)
C)
Fluvoxamine (Prozac)
D)
Isocarboxazid (Marplan)
Ans:
C
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Feedback: Fluvoxamine is a selective serotonin reuptake inhibitor that has established pediatric dosage guidelines for the treatment of obsessive-compulsive disorder. Isocarboxazid and phenelzine are monoamine oxidase inhibitors and should be avoided in pediatric use because of the potential drugfood interactions and other serious adverse effects. Amitriptyline is also a tricyclic antidepressant not recommended for pediatric use. 4.
A patient explains to a nurse that he had been taking amitriptyline (Elavil) for depression and that his physician changed his medication to clomipramine (Anafranil). The patient is confused and does not understand why his medication was changed. The nurses best response to the patient would be what?
A)
These drugs are similar but some patients respond better to one drug than another.
B)
Did you take the amitriptyline like you should have?
C)
Maybe the old medicine wasnt working anymore.
D)
Clomipramine is newer and will be much better for you.
Ans:
A Feedback: Because all tricyclic antidepressants (TCAs) are similarly effective, the choice of which TCA depends on individual response to the drug and tolerance of adverse effects. A patient who does not respond to one TCA may respond to another drug from this class. In addition, the nurse might inform the physician of the patients question so the physician can explain his or her rationale for changing medications. By asking the patient if he took the medication as prescribed, the nurse is insinuating that he may not have and could damage the trusting nursepatient relationship. The nurse has no basis for commenting that the medication might not be working or that another drug would work better.
5.
A patient comes to the mental health clinic for a regular appointment. The patient tells the nurse he has been taking oral fluoxetine (Prozac) 20 mg daily for the past 3 weeks and that he has lost 3 pounds during that time due to a loss of appetite. What action should the nurse take?
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A)
Teaching the patient about healthy eating to maintain weight
B)
Congratulating the patient on his weight loss and commenting how well he looks
C)
Encouraging the patient to increase fluid intake to avoid further weight loss
D)
Reassuring the patient that a decrease in weight is a common adverse effect with this medication
Ans:
D Feedback: Adverse effects of fluoxetine include anorexia and weight loss. Although teaching about healthy eating is a good idea, it is more important to teach the patient how to take the medication in a way that will reduce adverse effects as well as how to optimize healthy calories to maintain weight. The patient should increase caloric intake, not just fluid intake. The patient should continue the medication to see whether therapeutic effects are obtained and adjust nutritional intake if necessary. More information about the patients baseline weight is needed before congratulating the patient because a patient who is already too thin would not appreciate the nurses comment.
6.
A patient diagnosed with type 1 diabetes mellitus is receiving insulin. The physician has prescribed a monoamine oxidase inhibitor (MAOI) to treat this patients depression. What interaction will the nurse assess for with this drug combination?
A)
Increased risk of hypoglycemia
B)
Increased risk of hyperglycemia
C)
Increase in appetite
D)
Increased total cholesterol
Ans:
A Feedback:
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MAOIs can cause an additive hypoglycemic effect if taken with insulin or oral diabetic agents. This patient would have to be monitored closely and appropriate dosage adjustments made; he should be taught the importance of more frequent blood sugar monitoring. The drug combination in this question would not cause an increase in appetite or increased total cholesterol. 7.
A patient has been taking Prozac (fluoxetine) for the past 3 years for depression. She is seeing her gynecologist for premenopausal symptoms and during the interview with the nurse she says that she would like to try Sarafem because her friend is taking it and she says it works great. The nurses best response is what?
A)
Sarafem and Prozac are different brand names for the same generic medication.
B)
Before changing drugs it is important to consider how well you responded to Prozac.
C)
You cannot take both drugs at the same time so it will be important to decide which is best.
D)
When taking both of these drugs, it is best to take one in the morning and one at night.
Ans:
A Feedback: Prozac and Sarafem are different brand names for fluoxetine, so there is no benefit in changing the patients medication regimen and, if taken together, would result in a drug overdose. The other three responses are incorrect or inappropriate because they do not recognize that both drugs are the same.
8.
A 12-year-old patient is hospitalized with severe depression. The patient has been taking a selective serotonin reuptake inhibitor (SSRI). What is the priority nursing action for the patient?
A)
Monitor food intake for levels of tyramine.
B)
Assess for weight loss and difficulty sleeping.
C)
Monitor the patient for severe headaches.
D)
Implement suicide precautions.
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Ans:
D Feedback: Recent studies have linked the incidence of suicide attempts to the use of SSRIs in pediatric patients (see box 21.3 Focus on the Evidence). The priority concern for the nurse would be safety for the patient. Severe headache and reactions to tyramine-containing foods are associated with monoamine oxidase therapy. Weight loss and difficulty sleeping are of a lower priority concern than the patients safety.
9.
What drug, if prescribed for the patient, would indicate the need to assess the patient for depression characterized by anxiety and addictive behaviors?
A)
Imipramine (Tofranil)
B)
Venlafaxine (Effexor)
C)
Fluvoxamine (Luvox)
D)
Tranylcypromine (Parnate)
Ans:
B Feedback: Venlafaxine is used to treat and prevent depression in generalized anxiety disorder, social anxiety disorder; it also diminishes addictive behavior. Fluvoxamine is a selective serotonin reuptake inhibitor, tranylcypromine is a monoamine oxidase inhibitor, and imipramine is a tricyclic antidepressant that are not indicated for treatment of anxiety disorder and addictive behavior.
10 .
A patient receives a new prescription for fluvoxamine (Luvox). What will the nurse instruct the patient about taking the medication?
A)
Take medication after eating breakfast.
B)
Take medication with at least 8 ounces of liquid.
C)
The dosage may need to be increased if the patient is not feeling better in 2 weeks.
D)
The medication should be taken once a day before bedtime.
Ans:
D
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Feedback: Fluvoxamine is a selective serotonin reuptake inhibitor that should be taken once a day before bedtime. The medication does not require 8 ounces of fluid for absorption. It should be taken for at least 4 weeks before a therapeutic effect is noted. 11 .
The patient presents to the emergency department with a headache in the back of the head, palpitations, neck stiffness, nausea, vomiting, sweating, dilated pupils, tachycardia, and chest pain. Blood pressure measures 180/124 and heart rate is 168 beats per minute. The spouse says the only medication he takes is something for depression but she does not know the name of the drug and the patient is also unable to supply the name. What classification of antidepressant does the nurse suspect this patient is taking?
A)
Monoamine oxidase inhibitors (MAOIs)
B)
Selective serotonin reuptake inhibitors (SSRIs)
C)
Tricyclic antidepressants (TCAs)
D)
Antianxiety antidepressants
Ans:
A Feedback: MAOIs have several serious adverse effects that can be fatal. This patients symptoms indicate fatal hypertensive crisis characterized by occipital headache, palpitations, neck stiffness, nausea, vomiting, sweating, dilated pupils, photophobia, tachycardia, and chest pain. It may progress to intracranial bleeding and fatal stroke. SSRIs and TCAs are not associated with these particular symptoms. Antianxiety antidepressants are not a classification of antidepressants.
12 .
Obsessive-compulsive disorder (OCD) is a disorder that remains under investigation as to its actual neurophysiology. What tricyclic antidepressant is now approved by the Food and Drug Administration to treat OCD?
A)
Clomipramine
B)
Imipramine
C)
Nortriptyline
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D)
Amitriptyline
Ans:
A Feedback: Clomipramine is now also approved for use in the treatment of OCD. Imipramine, nortriptyline, and amitriptyline are not approved for use in treating OCD.
13 .
The nurse interviews the family of a patient hospitalized with severe depression who is prescribed a tricyclic antidepressant. What assessment data are important in planning this patients plan of care? (Select all that apply.)
A)
Recent suicide attempts
B)
Gastrointestinal (GI) obstruction
C)
Affect
D)
Physical pain
E)
Personal responsibilities
Ans:
A, B, C Feedback: When caring for a patient with a diagnosis of depression it is always important for the nurse to assess for recent suicide attempts, suicidal ideation, and any suicidal plans. After starting the medication, as the patient begins to feel better, risk of suicide increases, so ongoing assessment is essential to the patients safety. Other assessments include allergies, liver and kidney function, glaucoma, benign prostatic hypertrophy, cardiac dysfunction, GI obstruction, surgery, or recent myocardial infarction, all of which could be exacerbated by the effects of the drug. Assess history of psychiatric problems, or myelography within the past 24 hours or in the next 48 hours, or is taking a monoamine oxidase inhibitor to avoid potentially serious adverse reactions. Physical pain and personal responsibilities may be assessed but are not priority assessments unless indicated by other diagnoses.
14 .
A patient is admitted to the unit with obsessive-compulsive disorder (OCD). What drug might the nurse administer that has been found to be effective for treating OCD?
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A)
Fluvoxamine
B)
Phenelzine
C)
Desipramine
D)
Amitriptyline
Ans:
A Feedback: Fluvoxamine is indicated for the treatment of OCD and is classified as a selective serotonin reuptake inhibitor (SSRI). SSRIs are indicated for the treatment of depression, OCD, panic attacks, bulimia, premenstrual dysphoria disorder, posttraumatic stress disorder, social phobias, and social anxiety disorders. Phenelzine is indicated for depression not responsive to other agents. Desipramine and amitriptyline are tricyclic antidepressants indicated for treatment of depression especially if accompanied by anxiety or sleep disturbances.
15 .
The patient has been severely depressed since her father died 6 months ago. The physician has prescribed amitriptyline. The nurse reviews the patients chart before administering the medication. What preexisting condition would require cautious use of this drug?
A)
Osteosarcoma
B)
Cardiovascular disorders
C)
Closed head injury
D)
Bleeding ulcer
Ans:
B Feedback: Caution should be used with tricyclic antidepressants in patients with preexisting cardiovascular (CV) disorders because of the cardiac stimulatory effects of the drug and with any condition that would be exacerbated by the anticholinergic effects (e.g., angle-closure glaucoma, urinary retention, prostate hypertrophy, GI or genitourinary surgery). There is no indication that caution is needed with patients diagnosed with osteosarcoma, closed head injury, or bleeding ulcer.
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16 .
What priority teaching point does the nurse include in the teaching plan for a patient on a monoamine oxidase inhibitor (MAOI)? (Select all that apply.)
A)
Take medication at bedtime.
B)
Monitor blood pressure.
C)
Do not take over-the-counter (OTC) drugs without talking to physician.
D)
Report double vision right away
E)
Reduce tyramine intake
Ans:
B, C, E Feedback: MAOIs can cause drugdrug and drugfood interactions, which can precipitate cardiovascular effects that include orthostatic hypotension, arrhythmias, palpitations, angina, and the potentially fatal hypertensive crisis. Priority teaching points include monitoring blood pressure which will elevate with tyramine ingestion and the importance of not taking any OTC without physician or pharmacist consultation due to multiple drugdrug interactions. When taking an MAOI, you would not necessarily take the drug at bedtime or drink lots of fluid. Blurred, but not double, vision is an adverse effect of an MAOI.
17 .
A patient with severe depression has been hospitalized and the physician has ordered amitriptyline. What common adverse effect will the nurse monitor and assess the patient for? (Select all that apply.)
A)
Fever
B)
Myocardial Infarction
C)
Stroke
D)
Dry mouth
E)
Gynecomastia
Ans:
B, C, D Feedback:
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Use of tricyclic antidepressants may lead to GI anticholinergic effects, such as dry mouth, constipation, nausea, vomiting, anorexia, increased salivation, cramps, and diarrhea. Cardiovascular effects (e.g., orthostatic hypotension, hypertension, arrhythmias, myocardial infarction, angina, palpitations, stroke) may occur. Fever and gynecomastia are not normally attributed to amitriptyline therapy. 18 .
The nurse is caring for an 8-year-old clinic patient who takes imipramine. The nurse assesses the patient who does not have a history for or signs of depression, so the nurse suspects this drug was prescribed as treatment for what?
A)
Enuresis
B)
Obsessive compulsive disorder (OCD)
C)
Peripheral neuropathy
D)
Panic disorder
Ans:
A Feedback: One of the indications for use of the drug imipramine is enuresis in children older than 6 years. Imipramine is not indicated for the treatment of OCD, peripheral neuropathy, or panic disorder.
19 .
A 10-year-old patient is being seen by a physician for severe depression. The physician prescribes an antidepressant. What antidepressant could the nurse safely administer to a child?
A)
Trazodone
B)
Nortriptyline
C)
Fluvoxamine
D)
Phenelzine
Ans:
B Feedback:
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Nortriptyline has established pediatric doses and can be used in children older than 6 years but such children should be monitored closely for adverse effects. Phenelzine is a monoamine oxidase inhibitor (MAOI), a class of drugs that should be avoided in children if at all possible because of the potential for drugfood interactions and the serious adverse effects. Trazodone can be used with children but is not a first-line drug because it has many adverse effects on the central nervous system associated with its use. Luvox is an SSRI that can be used in children to treat obsessivecompulsive disorder but selective serotonin reuptake inhibitors can cause serious adverse effects in children. 20 .
The biogenic amine theory of depression states that depression results from a deficiency of biogenic amines in key areas of the brain. Why might a deficiency of these biogenic amines exist?
A)
A slowing of the action of the neurons may lead to their depletion.
B)
Monoamine oxidase (MAO) strengthens the impact of biogenic amines.
C)
The number or sensitivity of postsynaptic receptors may increase.
D)
Norepinephrine may be depleted because biogenic amines feed off of loose particles of the neurotransmitter.
Ans:
C Feedback: The three reasons for depression according to the biogenic amine theory include (1) MAO may break down biogenic amine to be recycled or restored in the neuron. (2) Rapid fire of the neurons may lead to their depletion. (3) The number or sensitivity of postsynaptic receptors may increase, thus depleting neurotransmitter levels.
21 .
It has been postulated that depression may be a syndrome that reflects either activity or lack of activity in what areas of the brain? (Select all that apply.)
A)
Limbic system
B)
Corpus callosum
C)
Reticular activating system (RAS)
D)
Substantia nigra
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E)
Basal ganglia
Ans:
A, C, E Feedback: Depression also may occur as a result of other, yet unknown causes. This condition may be a syndrome that reflects either activity or lack of activity in a number of sites in the brain, including the arousal center (i.e., RAS), the limbic system, and basal ganglia. It is not theorized that depression is associated with the corpus callosum or the substantia nigra.
22 .
What reason might the nurse give for why venlafaxine (Effexor) has become more popular with adults in treating their depression?
A)
It is taken orally.
B)
It does not have adverse effects.
C)
It can be taken during pregnancy.
D)
An extended release form is available.
Ans:
D Feedback: Venlafaxine mildly blocks reuptake of norepinephrine, 5-hydroxytriptamine, and dopamine. It has fewer adverse central nervous system effects than trazodone. Its popularity has increased with the introduction of an extendedrelease form that does away with the multiple daily doses that are required with the regular form. Venlafaxine is readily absorbed from the gastrointestinal (GI) tract, extensively metabolized in the liver, and excreted in urine. Adequate studies have not been done in pregnancy and lactation, so that it should be used during those times only if the benefit to the mother clearly outweighs the potential risk to the neonate. It is taken orally, which is the case with most antidepressants.
23 .
A 75-year-old male patient is brought to the emergency department by his family because he is talking to people who arent there. During the initial admission assessment, his daughter mentions that her mother died 4 months ago and Dad just hasnt been the same. The doctor has even put him on antidepressant medication. I go by the house every day to make sure he takes his medication. What would the nurse suspect is happening to this patient?
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A)
The patient is having hallucinations as an adverse effect of his antidepressant medication.
B)
The mental status change is due to the patients age.
C)
The patient probably has a urinary tract infection.
D)
The patient is having delusions because of his depression over the loss of his wife.
Ans:
A Feedback: Older patients may be more susceptible to the adverse effects of antidepressants from unanticipated central nervous system effects to increased sedation, dizziness, and even hallucinations. Although an infection cannot be ruled out without further testing, the history would lead the nurse to the antidepressants as the most likely cause.
24 .
Antidepressants carry a black box warning about the increased risk of suicide in what age group?
A)
Infants and children
B)
Children and adolescents
C)
Adolescents and adults
D)
Adults and older adults
Ans:
B Feedback: A black box warning was added to all antidepressants bringing attention to the increase in suicidality, especially in children and adolescents, when these drugs were used. Therefore, the other age groups are incorrect.
25 .
A patient is prescribed sertraline (Zoloft). What adverse effects should the nurse warn of when developing a medication teaching plan? (Select all that apply.)
A)
Agitation
B)
Agglutination
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C)
Insomnia
D)
Intermittent tachycardia
E)
Dry mouth
Ans:
A, C, E Feedback: The adverse effects associated with selective serotonin reuptake inhibitors, which are related to the effects of increased 5-hydroxytriptamine levels, include central nervous system effects (e.g., headache, drowsiness, dizziness, insomnia, anxiety, tremor, agitation, seizures). Gastrointestinal effects (e.g., nausea, vomiting, diarrhea, dry mouth, anorexia, constipation, changes in taste) often occur, as do genitourinary effects (e.g., painful menstruation, cystitis, sexual dysfunction, urgency, impotence). Adverse effects of sertraline do not include agglutination of blood cells or intermittent tachycardia.
26 .
The nurse is caring for a patient who is taking amitriptyline for depression. What teaching will the nurse include in the teaching plan to help the patient monitor for adverse effects?
A)
If chest pain occurs an over-the-counter pain reliever will help.
B)
Nasal congestion indicates a respiratory virus is beginning.
C)
Measure and record your blood pressure daily.
D)
Adverse effects will subside as you adjust to the medication.
Ans:
C Feedback: Cardiovascular effects of amitriptyline include orthostatic hypotension, hypertension, arrhythmias, myocardial infarction, angina, palpitations, and stroke. Miscellaneous reported effects include alopecia, weight gain or loss, flushing, chills, and nasal congestion. Teaching the patient how and when to monitor blood pressure would be an important teaching point. Chest pain could be a serious finding and patients should be taught to call 911. Nasal congestion is a possible adverse effect of the drug and not an indication of a respiratory virus infection. Adverse effects often will not subside and may continue so long as the drug is taken.
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27 .
The nurse is caring for a patient who was referred to a psychiatrist for treatment of a severe anxiety disorder. What medication does the nurse consider appropriate for this patient?
A)
Chlorpromazine (Thorazine) 25 mg three times daily orally
B)
Benztropine (Cogentin) 2 mg twice daily orally
C)
Clozapine (Clozaril) 200 mg twice daily orally
D)
Paroxetine (Paxil) 10 mg once daily orally
Ans:
D Feedback: Paroxetine is a selective serotonin reuptake inhibitor indicated for the treatment of depression, obsessive compulsive disorder, panic attacks, bulimia, premenstrual dysphoria disorder, posttraumatic stress disorders, social phobias, and social anxiety disorders. Chlorpromazine and clozapine are antipsychotic medications whereas benztropine is a drug used to treat Parkinsons disease. None of these would be appropriate options to treat anxiety disorders.
28 .
A patient comes to the clinic because she is feeling depressed and has gained some weight. The physician prescribes oral tranylcypromine (Parnate) 10 mg twice daily for an atypical depression. When prescribed in this manner, when would the nurse tell the patient to expect the drug to reach peak levels in the body?
A)
1 to 2 hours
B)
2 to 3 hours
C)
3 to 4 days
D)
4 to 5 weeks
Ans:
B Feedback: The monoamine oxidase inhibitors are well absorbed from the GI tract, reaching peak levels in 2 to 3 hours. The other time frames are incorrect.
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29 .
The nurse is creating a care plan for a patient taking a selective serotonin reuptake inhibitor (SSRI). What would be an appropriate nursing diagnosis for this patient?
A)
Risk for infection
B)
Establish suicide precautions
C)
Disturbed thought processes related to central nervous system (CNS) effects of medication
D)
Dysfunctional Family Processes
Ans:
C Feedback: Nursing diagnoses related to SSRI therapy might include: Disturbed thought processes related to central nervous system effects because adverse effects of SSRIs include headache, drowsiness, dizziness, insomnia, anxiety, tremor, agitation, and seizures. There would be no reason to expect the patient is at increased risk for infection, there is not enough information known about the patients family to know if processes are dysfunctional. Establishing suicide precautions is an intervention and not a nursing diagnosis.
30 .
A patient is admitted with a presumed diagnosis of colon cancer who takes a monoamine oxidase inhibitor for depression. What drug will the nurse keep on hand for this patient in case of the onset of an adverse reaction?
A)
Epinephrine
B)
Injectable naloxone (Narcan)
C)
Phenylalanine
D)
Phentolamine
Ans:
D Feedback: Have phentolamine or another adrenergic blocker on standby as treatment in case of hypertensive crisis. The other options are distracters for this question.
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31 .
The nurse is working on the telemetry unit and has noted that many postmyocardial-infarction (MI) patients experience depression. What medication would the nurse question if ordered for one of these patients?
A)
Amitriptyline
B)
Escitalopram
C)
Fluoxetine
D)
Fluvoxamine
Ans:
A Feedback: Amitriptyline is a tricyclic antidepressant (TCA). One contraindication to the use of TCAs includes recent myocardial infarction because of the potential occurrence of reinfarction or extension of the infarct with the cardiac effects of the drug. Selective serotonin reuptake inhibitors would be the safest antidepressant to give so there would be no need to question an order for escitalopram, fluoxetine, or fluvoxamine.
32 .
The nurse works in a mental health clinic. When a new patient arrives reporting feelings of depression, what conditions are screened for before prescribing antidepressants? (Select all that apply.)
A)
Thyroid disease
B)
Hormonal imbalance
C)
Cardiovascular disorders
D)
Parkinsons disease
E)
Diabetes mellitus
Ans:
A, B, C Feedback: Adults using these drugs should have physical causes for their depression ruled out before therapy is begun. Thyroid disease, hormonal imbalance, and cardiovascular disorders can all lead to the signs and symptoms of depression. There is no indication that Parkinsons disease or diabetes is manifested by depression.
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33 .
The nurse is teaching a patient taking a monoamine oxidase inhibitor (MAOI) about dietary changes required to minimize adverse effects of the drug. The nurse determines the patient understands a low tyramine diet when what meal is chosen?
A)
A chop salad with blue cheese, sardines, and pepperoni
B)
A sandwich with turkey, avocado, and Swiss cheese
C)
Corned beef hash, eggs, and hash browns
D)
A hamburger, French fries, and a strawberry milkshake
Ans:
D Feedback: Hamburger, French fries, and a strawberry milkshake do not contain tyramine and, although high in fat, it would not be contraindicated for a patient taking an MAOI. Blue cheese, sardines, pepperoni, Swiss cheese, and corned beef are all high in tyramine and would indicate further teaching was needed.
34 .
What drugs would the nurse consider contraindicated for the patient taking a monoamine oxidase inhibitor (MAOI)?
A)
Selective serotonin reuptake inhibitor (SSRI)
B)
Insulin
C)
Acetaminophen
D)
Docusate (Colace)
Ans:
A Feedback: SSRIs are contraindicated because of a life-threatening serotonin syndrome that could occur. If a patient requires insulin the benefit outweighs the risk but careful monitoring of glucose levels is needed because effects of insulin may be additive with an MAOI. There is no known contraindication for acetaminophen or docusate.
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35 .
The nurse is caring for a young female patient who is 5 weeks pregnant. What statement made by the nurse about the use of antidepressants during pregnancy is most accurate?
A)
Antidepressants are used very cautiously during pregnancy and only when benefit outweighs risk.
B)
Antidepressants are contraindicated and must be discontinued if pregnancy occurs.
C)
Antidepressants must be chosen carefully because only a few are safe during pregnancy.
D)
Most antidepressants are safe during pregnancy but those that are contraindicated should be avoided.
Ans:
A Feedback: Antidepressants should be used very cautiously during pregnancy and lactation because of the potential for adverse effects on the fetus and possible neurological effects on the baby. Use should be reserved for situations in which the benefits to the mother far outweigh the potential risks to the neonate.
Chapter 31-Chapter 32. Opioid Agonists & Antagonists Chapter 32. Drugs of Abuse 1.
A geriatric patient received a narcotic analgesic before leaving the postanesthesia care unit to return to the regular unit. What is the priority nursing action for the nurse receiving the patient on the regular unit?
A)
Administer a non-steroidal anti-inflammatory drug.
B)
Encourage fluids.
C)
Create a restful, dark, quiet environment.
D)
Put side rails up and place bed in low position.
Ans:
D Feedback:
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Older patients are more susceptible to the central nervous system effects of narcotics; it is important to ensure their safety by using side rails and placing the bed in the low position in case the patient tries to get up unaided. Postoperative patients are allowed nothing by mouth until bowel function returns so an oral medication or encouraging fluids would not be appropriate. This patient will require careful observation for respiratory depression, so a dark room would be unsafe. 2.
A patient who is experiencing severe pain is administered a narcotic. What would the nurse write in the plan of care as a desirable and measurable outcome for this patient?
A)
A shorter period of time between requests for medication
B)
Reduced complaints about limited movement
C)
Lack of restlessness and ability to sustain one position
D)
Increased autonomy in providing AM care
Ans:
D Feedback: Monitor patient response to the drug (e.g., relief of pain, sedation).When pain is being adequately managed with opioid therapy, a desirable and measurable outcome would be that the patient is able to be more autonomous in providing care in the morning. Shorter periods between requests for medication would not be a desirable outcome because it is not an indicator of pain control given that some patients are reluctant to ask for medicine even though they are in pain. Patients in pain tend not to move for fear of exacerbating the pain, so lack of movement can be an indication the patient is in pain. Just because the patient does not complain of pain doesnt mean he isnt experiencing pain.
3.
The health care provider orders oral (PO) codeine as an adjunctive therapy to pain control medication. What order would be appropriate for the nurse to administer?
A)
Codeine 5 mg PO every 6 hour
B)
Codeine 10 mg PO every 4 hour
C)
Codeine 15 mg PO every 2 hour
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D)
Codeine 20 mg PO every 4 hour
Ans:
D Feedback: The correct dosage for codeine administered for pain by mouth is 15 to 60 mg q 4 to 6 hour. The other options are incorrect oral dosages because they are too low a dose or give an incorrect dosing frequency.
4.
A patient with migraine headaches is changed from an ergot to a prescription for a triptan. The nurse has completed teaching related to the drug. What statement would indicate she has a clear understanding of the new drug?
A)
My life is over. I cant function not knowing when Im going to have a headache.
B)
I will not have to avoid driving because this medication isnt sedating.
C)
I should not experience as many adverse effects from my new medication.
D)
I take my medication every hour when I have a headache.
Ans:
C Feedback: Triptans are a new class of selective serotonin receptor blockers that cause vasoconstriction; they are not associated with as many systemic adverse effects experienced in ergot therapy. Triptan therapy will enable her to live a near normal life even during headaches. Although adverse effects are fewer than those associated with ergot therapy, triptans can still cause dizziness, feelings of strangeness, and vertigo, so the patient should not drive while taking the drug. Medications are often only taken once due to prolonged half-lives, but some may be repeated in 2 to 4 hours if the headache does not subside.
5.
The nurse receives an order for a triptan for a patient diagnosed with cluster headaches. What drug would be indicated for this purpose?
A)
Almotriptan (Axert)
B)
Frovatriptan (Frova)
C)
Naratriptan (Amerge)
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D)
Sumatriptan (Imitrex)
Ans:
D Feedback: Sumatriptan, the first drug of this class, is used for the treatment of acute migraine attacks and for the treatment of cluster headaches in adults. No other triptans are approved for treatment of cluster headaches.
6.
Before administering an ergot drug to the patient for the first time, the nurse would assess the patients currently prescribed medications for what drug?
A)
Antidiabetic agents
B)
Beta adrenergic blockers
C)
Oral contraceptives
D)
Selective serotonin reuptake inhibitors (SSRIs)
Ans:
B Feedback: The concurrent use of beta blockers and ergot preparations increases the patients risk for peripheral ischemia and gangrene. This combination should be avoided. There is no indication for concern with the use of antidiabetic agents, SSRIs, and oral contraceptives with these drugs.
7.
The anatomy and physiology instructor is talking about pain sensations. What produces pain sensations when stimulated by generating nerve impulses? (Select all that apply)
A)
A-delta fibers
B)
D-delta sensory nerves
C)
Mu receptors
D)
Sigma-receptors
E)
C fibers
Ans:
A, E Feedback:
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Two small-diameter sensory nerves, A-delta and C fibers, respond to stimulation by generating nerve impulses that produce pain sensations. Largediameter sensory nerves (i.e., A fibers) transmit sensations associated with touch and temperature. Mu-receptors are primarily pain-blocking receptors; sigma-receptors cause papillary dilation and may be responsible for the hallucinations, dysphoria, and psychoses that can occur with narcotic use.
8.
A nurse is caring for a 6-year-old patient after surgery. The child has an order for meperidine (Demerol) 1.8 mg/kg IM every 3 to 4 hour as needed for pain. The child weighs 30 kg and the meperidine is available as 50 mg/ mL. How many mL will the nurse administer per dose?
A)
1 mL
B)
1.8 mL
C)
0.8 mL
D)
1.08 mL
Ans:
D Feedback: To calculate the correct amount to be administered, first multiply 1.8 mg times 30 kg (54 mg). Next determine the volume in mL that 54 mg is equal to (50 mg: 1 mL as 54 mg: mL). Solve forx (50x is equal to 54 mg; 54 divided by 50 is equal to 1.08 mL).
9.
A patient with a migraine took a dose of a prescribed triptan, eletriptan (Relpax), and 1 hour later the headache is still intense. The patients husband calls the clinic and asks the nurse what they should do. What is an appropriate nursing response?
A)
Tell her to lie down in a quiet cool room and just wait it out. It will subside.
B)
She can take another dose of the drug 2 hours after the initial dose if the headache continues.
C)
Give her a dose of an ergot drug if you have it. It will decrease the intensity of the pain.
D)
Ibuprofen may increase the action of the triptan.
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Ans:
B Feedback: A patient taking eletriptan to relieve a migraine can take another dose in 2 hours if the headache is not relieved. The combination of ergot drugs with triptans is not indicated because of the vasoconstriction caused by both. The patient will not get relief by waiting it out. Ibuprofen is an anti-inflammatory that does not affect the mechanism associated with migraines.
10 .
The nurse is caring for a patient who is receiving an opioid analgesic. What are the nurses priority assessments?
A)
Pain intensity and blood glucose level
B)
Level of consciousness and respiratory rate
C)
Respiratory rate and electrolytes
D)
Urine output and pain intensity
Ans:
B Feedback: The nurse should assess respiratory rate and level of consciousness because respiratory depression and sedation are adverse effects of opioid analgesics. Blood glucose levels, electrolytes, and urine output are not priority assessments with opioid ingestion.
11 .
The nurse is caring for a patient experiencing postoperative pain. The physician orders 2.5 mg of morphine IV every two hours. Morphine is supplied in 10 mg/mL vials. How many mL will the nurse administer?
A)
0.25 mL
B)
0.5 mL
C)
1 mL
D)
2 mL
Ans:
A Feedback:
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10 mg = 1 mL and a dose of 2.5 mg is ordered. 10 mg/1 mL: 2.5 mg/ x Cross-multiply to yield 2.5 mg = 10x. Divide each side by 10 to learn the nurse should administer 0.25 mL 12 .
A 72-year-old patient is admitted to the hospital for surgery. After the patient returns to the floor, the patients daughter tells the nurse she is concerned that her mother will overdose on morphine because she keeps pressing the button on her patient-controlled anesthesia (PCA) pump. What is the nurses best response?
A)
You should control how often she presses the button.
B)
If she will follow the directions she was given, that will not happen.
C)
The PCA device always provides the correct amount, so pressing the button is just for placebo effect.
D)
The device is preset, so your mother cannot get more than a specific amount.
Ans:
D Feedback: A PCA system using morphine provides a baseline, constant infusion of morphine and gives the patient control of the system to add bolus doses of morphine if the patient believes that pain is not being controlled. The system prevents overdose by locking out extra doses until a specific period of time has elapsed. The PCA is for the patient to control the analgesia, not for a family member to control it because the patient will fall asleep when adequate pain control is reached. If the family keeps pushing the button while the patients level of consciousness continues to decline, serious overdosage could occur. Not following directions could result in inadequate pain management but not overdosage. The button delivers small bolus dosages so it is not a placebo effect.
13 .
What drug might the nurse administer for both analgesic and antitussive effects?
A)
Codeine
B)
Aspirin
C)
Ibuprofen
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D)
Acetaminophen
Ans:
A Feedback: Codeine is a narcotic drug used for its analgesic and antitussive effects. Aspirin, ibuprofen, and acetaminophen do not have antitussive effects.
14 .
As the nurse settles the patient into his room after returning from the postanesthesia care unit (PACU), the patient says he is in severe pain. The nurse checks the medical record and sees the patient has an order for morphine 4 to 8 mg every 1 to 2 hour IV as needed for pain. The nurse sees this medication has not been administered yet so the nurse administers 4 mg. After administering the drug, the PACU nurse calls to say a dose of morphine was given and not documented. What drug will the nurse be prepared to administer if the patients respiratory rate is depressed?
A)
Naloxone hydrochloride tartrate (Narcan)
B)
Butorphanol
C)
Buprenorphine (Buprenex)
D)
Nalbuphine hydrochloride (Nubain)
Ans:
A Feedback: Naloxone is the drug of choice for treatment of opioid overdose. Butorphanol (INN) is amorphinan-type synthetic opioid analgesic that would not reverse the effects of an opioid. Buprenex (buprenorphine hydrochloride) is a narcotic-agonist-antagonist and would suppress respirations further. Nalbuphine is a synthetic opioid used commercially as an analgesic that would also depress respirations.
15 .
The nurse is providing patient teaching about a prescribed opioid analgesic. What is an important teaching point related to a possible adverse effect of this drug?
A)
Ataxia
B)
Blurred vision
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C)
Hypotension
D)
Dysrhythmias
Ans:
C Feedback: Orthostatic hypotension is commonly seen in association with some narcotics. Ataxia, blurred vision, and dysrhythmias are not commonly seen adverse effects of an opioid analgesic.
16 .
The nurse receives an order for morphine sulfate 8 mg IV every 1 hour as needed for pain. For which patient would the nurse need to question this order?
A)
A 78-year-old with osteoarthritis
B)
A 45-year-old, 1-day postoperative mastectomy
C)
A 28-year-old with a fractured tibia
D)
A 17-year-old, 1-day postoperative appendectomy
Ans:
A Feedback: Older patients are more likely to experience the adverse effects associated with narcotics, including central nervous system, gastrointestinal, and cardiovascular effects. Furthermore, a strong narcotic analgesic would not be indicated for chronic osteoarthritis pain. For both of these reasons, the nurse would question the large dosage of a narcotic. The other patients could appropriately receive morphine 8 mg unless they were smaller than average adults.
17 .
The nurse is administering morphine to a trauma patient for acute pain. Before administering the morphine, what common adverse effect should the nurse inform the patient about?
A)
Paresthesia in lower extremities
B)
Occipital headache
C)
Increased intracranial pressure
D)
Drowsiness
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Ans:
D Feedback: Common adverse effects include dizziness, drowsiness, and visual changes. Morphine does not commonly cause paresthesia in the lower extremities, an occipital headache, or increased intracranial pressure.
18 .
The nurse administers a narcotic analgesic to the postoperative patient. What is the best way for the nurse to evaluate response to the medication?
A)
Observe the patient without her awareness.
B)
Use a pain assessment tool before and 30 minutes after administration.
C)
Assess vital signs.
D)
Measure oxygen saturation.
Ans:
B Feedback: A standard pain assessment tool should be used both pre- and post-analgesia. Observing the patient when she is not aware you are watching, assessing vital signs, and measuring oxygen saturation may all contribute useful data but it would not be the best means of determining pain response following analgesic administration.
19 .
A patient, 6 days postoperative, is being weaned off an opioid analgesic. The patient reports he is getting no relief from the pain with the new non-opioid medication he is receiving. What might the nurse suspect is causing this patients pain?
A)
The patient needs a higher dose of the opioid analgesic.
B)
The patient has become addicted to the opioid medication.
C)
The patient has developed withdrawal syndrome.
D)
The patient has developed a cross-hypersensitive reaction.
Ans:
C Feedback:
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Caution should be used in cases of physical dependence on a narcotic because a withdrawal syndrome may be precipitated, the narcotic antagonistic properties can block the analgesic effect, and so intensify the pain. It is important to differentiate between addiction and dependence because addiction generally does not occur in patients receiving narcotics for medical reasons. There is no indication of a hypersensitivity reaction. Giving a higher dose of the opioid would eliminate the progress made to date on weaning the patient from the narcotic, so attempts should be made to avoid this intervention. 20 .
Which narcotic analgesics can the nurse administer to a child because she has an established pediatric dose? (Select all that apply.)
A)
Transdermal fentanyl
B)
Methadone
C)
Morphine
D)
Meperidine
E)
Hydrocodone
Ans:
C, D, E Feedback: Narcotics that have an established pediatric dose include codeine, fentanyl (but not the transdermal form), hydrocodone, meperidine, and morphine. Methadone is not recommended as an analgesic in children.
21 .
The home care nurse administers oral morphine to the patient with cancer pain. When will the nurse expect this medication to reach peak activity?
A)
10 minutes
B)
30 minutes
C)
45 minutes
D)
60 minutes
Ans:
D Feedback:
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With oral administration, peak activity occurs in about 60 minutes. The duration of action is 5 to 7 hours. 22 .
Before administering an opiate medication, what will the nurse assess?
A)
The patients weight
B)
The patients heart rate
C)
The patients respiratory rate
D)
The patients drug tolerance
Ans:
C Feedback: Check the rate, depth, and rhythm of respirations before each dose. If the patients heart rate is slower than 12 beats per minute, delay or omit the dose and report to the physician. Weight would be assessed before determining dosage. Heart rate would not be an essential assessment before administration. Drug tolerance is assessed by monitoring patients response to the medication and could not be assessed before administration.
23 .
The nursing instructor asks the student nurse to explain the action of sumatriptan. What is the students best response?
A)
Vasoconstrictive on cranial blood vessels
B)
Depresses pain response in the central nervous system
C)
Vasodilation of peripheral blood vessels
D)
Binds to acetylcholine receptors to prevent nerve transmission
Ans:
A Feedback: Sumatriptan binds to serotonin receptors to cause vasoconstrictive effects on cranial blood vessels. The other options are incorrect.
24 .
The nurse administers pentazocine cautiously to what population?
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A)
Patients with known GI disease
B)
Patients with known heart disease
C)
Patients with known urinary disease
D)
Patients with known respiratory disease
Ans:
B Feedback: Pentazocine must be administered cautiously to patients with known heart disease because the drug may cause cardiac stimulation including arrhythmias, hypertension, and increased myocardial oxygen consumption, which could lead to angina, myocardial infarction, or congestive heart failure. No indication exists that it must be given cautiously to patients with gastrointestinal, urinary, or respiratory diseases.
25 .
Narcotic agonists-antagonists have what function? (Select all that apply.)
A)
Relief of moderate-to-severe pain
B)
Adjunctive therapies to nonsteroidal anti-inflammatory drugs (NSAIDs)
C)
Relief of pain during labor and delivery
D)
Relief of orthopedic pain
E)
Adjuncts to general anesthesia
Ans:
A, C, E Feedback: These drugs have three functions: (1) relief of moderate-to-severe pain, (2) adjuncts to general anesthesia, and (3) relief of pain during labor and delivery. Adjunctive therapies to NSAIDs or specificity for orthopedic pain are not functions of this classification of medication.
26 .
You are caring for a patient taking pentazocine (Talwin). What would be an appropriate nursing diagnosis for this patients care plan?
A)
Fluid volume deficit related to diarrhea caused by medication
B)
Risk for pain related to administration of medication
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C)
Monitor timing of analgesic doses.
D)
Impaired gas exchange related to respiratory depression
Ans:
D Feedback: Nursing diagnosis may include impaired gas exchange related to respiratory depression. The drug is more likely to cause constipation due to slowing of the GI tract instead of diarrhea, so that fluid volume deficit would not be appropriate. Monitoring timing of analgesic doses is an intervention and not a nursing diagnosis. If the patient is receiving pentazocine that would indicate he is experiencing pain and is not just at risk for pain, and that the pain is not caused by the drug. The drug is given to reduce the pain so this diagnosis is incorrect.
27 .
When evaluating the effects of narcotic agonist-antagonists on a patient, what adverse effects would the nurse monitor for?
A)
Hypertension
B)
Bleeding
C)
Suppressed bone marrow function
D)
Increased pulse pressure
Ans:
A Feedback: Monitor for adverse effects (e.g., central nervous system changes, gastrointestinal (GI) depression, respiratory depression, arrhythmias, hypertension). Bleeding, bone marrow suppression, and increased pulse pressure are not normally seen with these drugs.
28 .
What is the nurses priority assessment when administering narcotics to older adults? (Select all that apply.)
A)
Central nervous system (CNS) effects
B)
Gastrointestinal effects
C)
Cardiovascular effects
D)
Urinary effects
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E)
Developmental effects
Ans:
A, B, C Feedback: Older patients are more likely to experience the adverse effects associated with these drugs, including central nervous system, gastrointestinal (GI), and cardiovascular effects. Urinary and developmental effects are not areas of high concern.
29 .
By what route will the nurse administer methylnaltrexone (Relistor)?
A)
IV
B)
Subcutaneously
C)
Intranasally
D)
Orally
Ans:
B Feedback: Relistor is only given by subcutaneous injection once each day.
30 .
According to the Gate Control Theory, what interventions by the nurse could help to block pain impulses?
A)
Administration of opioid medications
B)
Administration of narcotic agonist-antagonists
C)
Back massage
D)
Acupuncture
Ans:
C Feedback:
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According to the gate control theory, the transmission of these impulses can be modulated or adjusted all along these tracts. All along the spinal cord, interneurons can act as gates by blocking the ascending transmission of pain impulses. It is thought that the gates can be closed by stimulation of the larger A fibers and by descending impulses coming down the spinal cord from higher levels in such areas as the cerebral cortex, the limbic system, and the reticular activating system. Administration of medications does not use the Gate Control Theory. Acupuncture uses the Gate Control Theory but is not performed by the nurse. 31 .
The patient in labor receives morphine every 2 hours to manage labor pain. After 22 hours of labor the woman delivers a baby boy. What is the nurses priority action related to the newborn?
A)
Monitor for opioid effects.
B)
Administer naloxone.
C)
Monitor for withdrawal syndrome.
D)
Assess for congenital anomaly.
Ans:
A Feedback: Morphine, meperidine, and oxymorphone are often used for analgesia during labor. The mother should be monitored closely for adverse reactions, and, if the drug is used during a prolonged labor, the newborn infant should be monitored for opioid effects. Naloxone would only be given if the newborn displays opioid effects. Withdrawal syndrome would not be seen with less than 24 hours of use. Every newborn is assessed for congenital anomalies but this would not be related to administration of morphine to the mother and so would not be the highest priority.
32 .
What medication would the nurse administer to the patient in severe pain?
A)
Codeine
B)
Hydrocodone
C)
Hydromorphone
D)
Opium
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Ans:
C Feedback: Hydromorphone is indicated for moderate-to-severe pain. Codeine is indicated for mild-to-moderate pain, hydrocodone is indicated for moderate pain, and opium is indicated for treatment of diarrhea and relief of moderate pain.
33 .
The patient is brought to the emergency department in respiratory arrest after overdosing on heroin. The person accompanying the patient says he has been using heroin for years. After being administered one dose of a narcotic antagonist, the patient begins to breathe spontaneously but remains nonresponsive to stimuli so another dose of narcotic antagonist is ordered. What symptoms would indicate the patient is experiencing acute narcotic abstinence syndrome? (Select all that apply.)
A)
Tachycardia
B)
Hypertension
C)
Vomiting
D)
Confusion
E)
Sedation
Ans:
A, B, C Feedback: The most common adverse effect is an acute narcotic abstinence syndrome that is characterized by nausea, vomiting, sweating, tachycardia, hypertension, tremulousness, and feelings of anxiety. Confusion and sedation are not associated with acute narcotic abstinence syndrome.
34 .
What order for naloxone would be appropriate for the nurse to administer for reversal of opioid effects?
A)
1 mg IV repeat every 2 to 3 minutes
B)
5 mg IV repeat every 5 minutes
C)
0.1 mg IV repeat every 2 to 3 minutes
D)
0.4 mg IV repeat every 3 minutes
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Ans:
C Feedback: 0.1 to 0.2 mg is given IV and then repeated every 2 to 3 minutes for reversal of opioid effects. If the patient has overdosed on opioids the dose would be 0.4 to 2 mg every 2 to 3 minutes. The other options are incorrect.
Chapter 33. Agents Used in Cytopenias; Hematopoietic Growth Factors 1.
The nurse is caring for a patient in end-stage renal failure and anemia. What is the cause of this patients anemia?
A)
Low serum iron levels
B)
Low erythropoietin levels
C)
Inadequate oxygenation of tissue
D)
Lack of B12 and folic acid intake
Ans:
B Feedback: Anemia can occur if erythropoietin levels are low. This is seen in association with renal failure, when the kidneys are no longer able to produce erythropoietin. Low iron levels, hypoxia, and vitamin deficiency are not likely to be the primary cause of anemia in a patient with kidney failure.
2.
A 2-year-old child weighing 32 pounds is to take ferrous sulfate (Feosol) 6 mg/kg/d PO. How many milligram will the child receive per dose?
A)
47 mg
B)
67 mg
C)
87 mg
D)
107 mg
Ans:
C Feedback:
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The nurse will administer 87 mg per dose. The childs weight is first converted to kilograms by dividing 32 by 2.2, or 32/2.2 = 14.5 kg. Next, calculate the dose by multiplying weight times mg/kg/d or 14.5 6 = 87 mg. 3.
A nurse caring for a 28-year-old woman with renal failure is to start the patient on epoetin alfa therapy for iron replacement. What will the nurse assess before initiating therapy?
A)
Weight
B)
Last menstrual period
C)
Intake and output (I & O) for a 24-hour period
D)
Blood type
Ans:
B Feedback: The use of epoetin alfa is not recommended during pregnancy or lactation because of potential adverse effects to the fetus or baby. It is important to determine that the patient is not pregnant before drug therapy has started so the nurse would assess when the patient last menstruated. The patients weight, I & O, and blood type are not important factors in determining whether the drug can be used.
4.
The nurse improves patient compliance with the drug regimen of epoetin alfa by providing what?
A)
An appointment card for each drug administration day
B)
A calendar to mark the days of the week the drug is to be administered
C)
A referral for community transportation
D)
The telephone number of the pharmacy where the medication can be purchased
Ans:
B Feedback:
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The nurse should provide the patient with a calendar with the days the drug is to be administered marked clearly to remind her when the dose is due. The patient can be taught to self-administer the drug so there is no need for an appointment or arranging transportation. The patient can use her choice of pharmacy and would not need the telephone number. 5.
A patient who has anemia and a severe GI absorption disorder has been ordered iron dextran (INFeD). What is the most appropriate nursing diagnosis for the patient related to the administration of this drug?
A)
Acute pain related to drug administration
B)
Deficient knowledge regarding drug therapy
C)
Risk for injury related to CNS effects
D)
Disturbed body image related to drug staining of teeth
Ans:
A Feedback: Iron dextran is a parenteral form of iron. It is given intramuscularly and must be given by the Z-track method. It can be very painful. Certainly, deficient knowledge and risk for injury are appropriate diagnoses for this patient but would not be related to the administration of the drug. Because this medication is not given orally, tooth staining would not be a concern.
6.
A 22-year-old woman who has severe dysmenorrhea has been prescribed ferrous gluconate (Fergon) to treat iron deficiency anemia. What is it important for the nurse to instruct the patient to avoid when taking the drug?
A)
Eggs
B)
Chocolate
C)
Pork
D)
Whole wheat
Ans:
A Feedback:
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Iron is not absorbed if taken with antacids, eggs, milk, coffee, or tea. These substances should not be administered concurrently. Chocolate, pork, and whole wheat do not produce drugfood interactions when consumed with an iron supplement. 7.
The nurse develops a care plan for a patient who has been prescribed a folic acid derivative that includes what priority nursing diagnosis?
A)
Deficient knowledge regarding drug therapy
B)
Monitor possibility of hypersensitivity reactions
C)
Acute pain related to injection or nasal irritation
D)
Risk for fluid volume imbalance related to cardiovascular effects
Ans:
D Feedback: Nursing diagnoses related to drug therapy might include: Risk for fluid volume imbalance related to cardiovascular effects. Deficient knowledge and acute pain might apply to this patient, but the priority nursing diagnosis this patient, but the priority nursing diagnosis for this patient is the risk for fluid imbalance related to cardiovascular effects. Monitoring for hypersensitivity is not a nursing diagnosis.
8.
Before administering an iron preparation, what should the nurse assess?
A)
Red blood cell count (RBC)
B)
Hematocrit and hemoglobin
C)
Aspartate aminotransferase levels
D)
Serum creatinine levels
Ans:
B Feedback:
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Hematocrit and hemoglobin levels should be assessed before administration because the drug will be evaluated for effectiveness by the response of these levels to drug treatment. These levels are also used to determine dosage. Counting RBCs would indicate the number of blood cells per cubic millimeter but not iron or oxygen content. Aspartate aminotransferase levels are associated with liver function and serum creatinine levels are associated with renal function. 9.
What ordered dosage for epoetin alfa (Procrit) could the nurse administer without needing to question the order?
A)
0.45 mcg/kg IV once per week
B)
1 mg/d IM
C)
100 mg/d PO
D)
150 units/kg subcutaneously three times per week
Ans:
D Feedback: An appropriate dosage of epoetin alfa is 50 to 100 units/kg IV or subcutaneously, 3 days a week. Darbepoetin alfa can be administered by IV or subcutaneously once a week, and the usual dose is 0.45 mcg/kg. Folic acid (Folvite) is administered orally, IM, subcutaneously or IV; the usual dosage is 1 mg. The usual dose of ferrous sulfate is 100 to 200 mg/d PO.
10 .
After assessing the patient receiving erythropoietin drug therapy, the nurse suspects what finding is an adverse effect of erythropoietin drug therapy?
A)
Constipation
B)
Hypotension
C)
Edema
D)
Depression
Ans:
C Feedback:
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Potential adverse effects of an erythropoietin are edema, nausea, vomiting, chest pain, diarrhea, and hypertension. Options A, B, and D are not associated with these drugs. 11 .
A 62-year-old female patient is started on vitamin B12 for pernicious anemia. When the nurse develops the plan of care, what expected outcome will the nurse include?
A)
Decreased bleeding
B)
Increased hemoglobin
C)
Decreased joint pain
D)
Less fatigue
Ans:
B Feedback: Vitamin B12 is essential for normal functioning of red blood cells (RBCs) so the drug would be evaluated as successful in treating the disorder if the patients hemoglobin and RBC count increased after administration. Expected outcomes do not include decreased bleeding, decreased joint pain, or less fatigue.
12 .
A 50-year-old patient with pernicious anemia asks why she cant just take a vitamin B12 pill instead of getting an injection. What is the nurses best response to her question?
A)
Pernicious anemia is caused by the bodys inability to absorb vitamin B12.
B)
Oral ingestion of vitamin B12 irritates the GI tract and bleeding could occur.
C)
Pernicious anemia alters mucous membrane lining of the bowel and impairs absorption.
D)
With severe deficiencies like yours, oral vitamin B12 does not work fast enough.
Ans:
A Feedback:
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Vitamin B12 cannot be taken orally, because one problem with pernicious anemia is an inability by the patient to absorb vitamin B12 due to low levels of intrinsic factor. Other options are incorrect. 13 .
The nurse instructs a patient taking oral iron preparations about which potential adverse effect?
A)
Clay-colored stools
B)
Hypotension
C)
Constipation
D)
Frequent flatus
Ans:
C Feedback: The most common adverse effects associated with oral iron supplements are related to direct GI irritation (e.g., GI upset, anorexia, nausea, vomiting, diarrhea, dark stools, and constipation). Oral iron supplements do not cause hypotension, clay-colored stools, or frequent flatus.
14 .
When providing patient teaching for a 30-year-old primigravida diagnosed with sickle cell anemia, but not currently in crisis, the priority teaching point is what?
A)
Avoidance of infection
B)
Constipation prevention
C)
Control of pain
D)
Iron-rich foods
Ans:
A Feedback: Severe, acute episodes of sickling with blood vessel occlusion may be associated with acute infections and the bodys reactions to the immune and inflammatory responses. Avoidance of infection is, then, a priority teaching point. Pain would be a concern only if the patient is in crisis. Constipation prevention and iron-rich foods would not be the priority at this time.
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15 .
What drugs might the nurse administer that have been developed to stimulate erythropoiesis? (Select all that apply.)
A)
Levoleucovorin
B)
Hydroxocobalamin
C)
Darbepoetin alfa
D)
Methoxy polyethylene glycol-epoetin beta
E)
Epoetin alfa
Ans:
C, D, E Feedback: Patients who are no longer able to produce enough erythropoietin in the kidneys may benefit from treatment with exogenous erythropoietin (EPO), which is available as the drugs epoetin alfa (Epogen, Procrit), darbepoetin alfa (Aranesp), and methoxy polyethylene glycol-epoetin beta (Mircera). Both darbepoetin alfa and methoxy polyethylene glycol-epoetin beta are approved to treat anemias associated with chronic renal failure, including patients receiving dialysis. Levoleucovorin and hydroxocobalamin are not erythropoiesis-stimulating agents.
16 .
What anemia does the nurse classify as a type of hemolytic anemia?
A)
Iron deficiency anemia
B)
Megaloblastic anemia
C)
Pernicious anemia
D)
Sickle cell anemia
Ans:
D Feedback: Another type of anemia is hemolytic anemia, which involves a lysing of red blood cells because of genetic factors or from exposure to toxins. Sickle cell anemia is a type of hemolytic anemia. Iron deficiency and megaloblastic anemias are different classifications of anemia.
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17 .
What medication does the nurse administer to treat anemia associated with chronic renal failure?
A)
Methoxy polyethylene glycol-epoetin beta
B)
Ferrous sulfate exsiccated
C)
Levoleucovorin
D)
Hydroxyurea
Ans:
A Feedback: Both darbepoetin alfa and methoxy polyethylene glycol-epoetin beta are approved to treat forms of anemia associated with chronic renal failure, including in patients receiving dialysis. Ferrous sulfate exsiccated is used to treat iron deficiency. Levoleucovorin is administered to diminish toxicity and counteract the effects of impaired methotrexate elimination and of inadvertent overdose of folic acid antagonists after high-dose methotrexate therapy for osteosarcoma. Hydroxyurea is used to reduce the frequency of painful sickle cell crises and to decrease the need for blood transfusions in adults with sickle cell anemia.
18 .
The nurse is caring for a patient diagnosed with pernicious anemia and anticipates this patient will require supplemental what?
A)
Iron
B)
Vitamin B12
C)
Erythropoietin
D)
Oxygen
Ans:
B Feedback: Pernicious anemia occurs when the gastric mucosa cannot produce intrinsic factor and vitamin B12 cannot be absorbed. Other options are incorrect.
19 . A)
When providing patient teaching the nurse warns the patient to avoid what triggers of an episode of sickling? (Select all that apply.) Acute infections
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B)
Immune response
C)
Exposure to heat
D)
Inflammatory responses
E)
Metabolic alkalosis
Ans:
A, B, D Feedback: Severe, acute episodes of sickling with occluded blood vessels may be associated with acute infections and the bodys reactions to the immune and inflammatory responses. Exposure to heat and metabolic alkalosis are not considered triggers.
20 .
The nurse teaches hemodialysis patients that anemia occurs because damaged kidneys fail to produce what?
A)
Erythropoietin
B)
Renin
C)
Angiotensin
D)
Urine
Ans:
A Feedback: People with chronic renal failure are often anemic because their kidneys are unable to produce erythropoietin. The production of renin and angiotensin impact the patients blood pressure. Anemia is not caused by lack of urine production.
21 .
A patient has been prescribed epoetin alfa. The nurse determines the drug is contraindicated as a result of what finding in the patient history?
A)
Asthma
B)
Irritable bowel syndrome
C)
Hypertension
D)
Shortness of breath
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Ans:
C Feedback: Erythropoiesis-stimulating agents are contraindicated in the presence of uncontrolled hypertension because of the risk of worsening hypertension when red blood cell counts increase and the pressure within the vascular system also increases. There is no contraindication to the use of erythropoiesis-stimulating agents for patients with asthma, irritable bowel syndrome, or shortness of breath.
22 .
An older adult patient, diagnosed with pernicious anemia, asks the nurse what causes this disorder. The nurses best response is that there is a lack of intrinsic factor secreted needed for absorption of vitamin B12 where?
A)
Large bowel
B)
Lower esophagus
C)
Stomach
D)
Small bowel
Ans:
D Feedback: Intrinsic factor, also secreted by the gastric mucosa, combines with dietary vitamin B12 so that the vitamin can be absorbed in the ileum, located in the small bowel. Other options are incorrect.
23 .
What genetic carrier screening would be appropriate for an African American couple planning to begin a family?
A)
Renal failure
B)
Sickle cell anemia
C)
Iron deficiency anemia
D)
Vitamin B12 deficiency
Ans:
B Feedback:
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Sickle cell anemia is a chronic hemolytic anemia that occurs most commonly in people of African descent, so it would be appropriate to have genetic screening to determine the risk associated with having children. The other answers are incorrect because they are not associated with people of African descent. 24 .
The nurse is caring for a child who is prescribed supplemental iron therapy in liquid form. What is the priority parent teaching to be provided by the nurse?
A)
The iron should be taken through a straw.
B)
Positive results from treatment will be seen in 1 to 2 weeks.
C)
Results will be evaluated through the childs appearance.
D)
Dosages are determined by serum iron levels.
Ans:
A Feedback: Iron doses for replacement therapy are determined by age. If a liquid solution is being used, the child should drink it through a straw to avoid staining the teeth. Periodic blood counts should be performed; it may take 4 to 6 months of oral therapy to reverse an iron deficiency. Remember that iron can be toxic to children, so that iron supplements should be kept out of their reach and administration monitored.
25 .
The nurse admits a 26-year-old patient with sickle cell anemia. What drug does the nurse anticipate administering?
A)
Hydroxyurea
B)
Methoxy polyethylene glycol-epoetin beta
C)
Vitamin B12
D)
Leucovorin
Ans:
A Feedback:
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Indications for use of hydroxyurea include reducing the frequency of painful crises and the need for blood transfusions in adult patients with sickle cell anemia. Other options would not be used to treat a patient with sickle cell anemia. 26 .
The nurse admits a child to the pediatric unit who has an abnormally high serum iron level. What chelating agent will be appropriate to treat this child?
A)
Calcium disodium edetate
B)
Deferoxamine
C)
Dimercaprol
D)
Succimer
Ans:
B Feedback: Deferoxamine is given IM, IV, or subcutaneously to treat elevated iron levels. Calcium disodium edetate and succimer are used to treat elevated lead levels. Dimercaprol treats arsenic, gold, and mercury poisoning.
27 .
The nurse is caring for a patient who just received a cancer diagnosis. The patient tells the nurse, I saw the commercials on TV and I want to start taking Procrit immediately so I dont get tired from chemotherapy. What is the nurses best response?
A)
Procrit is only effective if you develop anemia from chemotherapy that is caused by low levels of erythropoietin.
B)
Before the doctor will order this drug, you will need to be found to have anemia so we will draw some blood for lab work while youre here.
C)
Chemotherapy causes anemia and only when that happens will it be appropriate to prescribe Procrit for you.
D)
The doctor may order Procrit for you when it is appropriate, but now is not the appropriate time for you to take this drug.
Ans:
A Feedback:
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There is a risk of decreasing normal levels of erythropoietin if epoetin alfa (Procrit), or any of this classification of drug (erythropoiesis-stimulating agents), is given to patients who have normal renal functioning and adequate levels of erythropoietin. The patient should be taught that the drug will only be prescribed if he develops anemia due to inadequate erythropoietin. Although it is true the doctor may prescribe the drug when it is appropriate, this answer does not explain why it is inappropriate to prescribe it now. Anemia alone is not sufficient cause for prescribing Procrit and not all chemotherapy results in anemia. 28 .
What drug used to treat anemia might the nurse administer as an antineoplastic drug because it is cytotoxic?
A)
Epoetin alfa
B)
Ferrous sulfate
C)
Hydroxocobalamin
D)
Hydroxyurea
Ans:
D Feedback: Hydroxyurea is a cytotoxic antineoplastic drug that is also used to treat leukemia, ovarian cancer, and melanoma. The other options would not serve this purpose.
29 .
The nurse is caring for a patient diagnosed with a megaloblastic anemia and administers what drug?
A)
Folic acid
B)
Hydroxyurea
C)
Ferrous sulfate
D)
Epoetin alfa
Ans:
A Feedback:
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Folic acid and vitamin B12 are given as replacement therapy for dietary deficiencies, as replacement in high-demand conditions such as pregnancy and lactation, and to treat megaloblastic anemia. Hydroxyurea is used to treat sickle cell anemia. Ferrous sulfate is indicated for the treatment of iron deficiency anemia. Epoetin alfa is administered to treat anemias caused by inadequate erythropoietin production, such as in renal failure. 30 .
The nurse is preparing the patient prescribed hydroxocobalamin for discharge and teaches the patient to be alert for what adverse effects? (Select all that apply.)
A)
Itching
B)
Peripheral edema
C)
Hypotension
D)
Heart failure
E)
Constipation
Ans:
A, B, D Feedback: Hydroxocobalamin has been associated with itching, rash, and signs of excessive vitamin B12levels, which can also include peripheral edema and heart failure. Hypotension and constipation are not adverse effects of hydroxocobalamin therapy.
31 .
The patient has taken epoetin alfa (Epogen) with good results for several months. On this visit, the nurse analyzes the patients lab results and finds indications of severe anemia and cytopenias. What order will the nurse anticipate receiving?
A)
Increase the dosage of Epogen.
B)
Change the patient to another erythropoiesis-stimulating agent.
C)
Discontinue Epogen.
D)
Begin administering Epogen IV instead of subcutaneously.
Ans:
C Feedback:
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In patients treated with Epogen or any drug in this class who develop severe anemia after improvement, the drug should be stopped and should not be changed to another drug in the class because it is likely due to patients development of neutralizing antibodies. Increasing the dosage will not help and changing the route of administration will not reverse the process after antibodies have formed. 32 .
The patient receiving epoetin alfa (Procrit) asks the nurse why it has to be administered IV because he read that it could be self-administered subcutaneously. What is the nurses best response?
A)
Giving the drug IV reduces risk of a potentially serious response to the drug.
B)
Giving the drug by the IV route makes it begin working sooner.
C)
Only patients with renal disease can receive the drug subcutaneously.
D)
It is all determined by physician preference and this doctor prefers the IV route.
Ans:
A Feedback: It is now recommended that patients receive Procrit and other drugs in this classification intravenously rather than subcutaneously because this reduces the risk of antibody production that can result from severe anemia. This decision is not based on speed of onset, diagnosis, or physician preference.
33 .
The nurse is administering an erythropoiesis-stimulating agent to a patient with renal failure and anemia. What is the maximum hemoglobin level the nurse would want to assess when reviewing this patients lab results?
A)
8 g/dL
B)
10 g/dL
C)
12 g/dL
D)
14 g/dL
Ans:
C Feedback:
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In recent years, the Food and Drug Administration alerted providers to the importance of a target hemoglobin of no more than 12 g/dL when using erythropoiesis-stimulating agents. As a result, other options are either too low or too high. 34 .
For what purpose would the nurse administer postoperative epoetin alfa to the patient who is a Jehovahs Witness?
A)
Reduce the need for allogenic blood transfusion
B)
Treatment of anemia associated with chronic renal failure
C)
Treatment of HIV infection
D)
To prevent the need for chemotherapy
Ans:
A Feedback: Jehovahs Witnesses often refuse allogenic blood transfusions because of their religious beliefs. Indications for the use of epoetin alfa include treatment of anemia associated with chronic renal failure, related to treatment of HIV infection or to chemotherapy in cancer patients, to reduce the need for allogenic blood transfusions in surgical patients. There is no indication in this question that the patient has chronic renal failure, HIV, or need for chemotherapy.
35 .
For what purpose might the nurse administer folic acid to the patient? (Select all that apply.)
A)
Nutritional deficiency
B)
Megaloblastic anemia
C)
Pregnancy or preparation for pregnancy
D)
Sickle cell anemia
E)
Renal failure
Ans:
A, B, C Feedback:
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Folic acid is indicated for the treatment of megaloblastic anemia caused by sprue and to replace a nutritional deficiency. It is also given to women who are, or plan to become, pregnant to reduce the risk of a neural tube disorder in the fetus. It is not indicated for the treatment of sickle cell anemia or renal failure. Chapter 34. Drugs Used in Disorders of Coagulation 1.
A patient is admitted to the hospital with deep vein thrombosis. A 10,000unit dose of heparin is administered subcutaneously. What drug does the nurse keep on hand to reverse the effects of heparin if the patient begins to bleed?
A)
Antithrombin (Thrombate III)
B)
Desirudin (Iprivask)
C)
Protamine sulfate
D)
Vitamin K
Ans:
C Feedback: The antidote for heparin is protamine sulfate. This drug forms stable salts as soon as it comes in contact with heparin. The reaction immediately reverses heparins anticoagulation effects. Vitamin K reverses the effect of warfarin. Antithrombin and desirudin are anticoagulants that would not be administered with heparin.
2.
Prior to beginning anticoagulant therapy, the nurse will question the female patient about what?
A)
Last menstrual period
B)
Peptic ulcers
C)
Urinary tract infection
D)
Weight
Ans:
B Feedback:
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The nurse should screen for conditions that could be exacerbated by increased bleeding tendencies, including hemorrhagic disorders, recent trauma, spinal puncture, gastrointestinal (GI) ulcers, recent surgery, intrauterine device placement, tuberculosis, presence of indwelling catheters, and threatened abortion. Beginning anticoagulant therapy with active peptic ulcers could result in severe bleeding. Last menstrual period, urinary tract infection, and weight should not impact anticoagulant therapy. 3.
The nurse is caring for a female patient who is nursing her 3-month-old infant. What will the nurse instruct the patient to do prior to starting heparin to treat venous thrombosis?
A)
Wait an hour after taking the anticoagulant before feeding the infant.
B)
Push fluids to clear the drug from her system before feeding the infant.
C)
Find another method of feeding the infant while taking this drug.
D)
Continue breast-feeding because heparin does not enter breast milk.
Ans:
D Feedback: Although some adverse fetal effects have been reported with its use during pregnancy, heparin does not enter breast milk, and so it is the anticoagulant of choice if one is needed during lactation. As a result, there is no need to wait an hour, push fluids, or find another method of feeding the baby.
4.
The nurse receives a patient having an acute myocardial infarction (MI) to the emergency department. What drug will the nurse administer before transferring the patient to a larger facility?
A)
Anagrelide (Agrylin)
B)
Clopidogrel (Plavix)
C)
Ticlopidine (Ticlid)
D)
Tenecteplase (TNKase)
Ans:
D Feedback:
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Arrange to administer tenecteplase to reduce mortality associated with acute MI as soon as possible after the onset of symptoms because the timing for the administration of tenecteplase is critical to resolve the clot before permanent damage occurs to the myocardial cells. Anagrelide is used to treat essential thrombocytopenia. Clopidogrel is used to treat patients who are at risk for ischemic events; ticlopidine is used to reduce the risk of thrombotic stroke. 5.
A nurse is preparing to discharge a patient newly prescribed warfarin (Coumadin). While assessing the patients knowledge of the drug, what would indicate that the patient needs further instruction concerning drug therapy?
A)
I love to eat homegrown tomatoes in the summer.
B)
I take aspirin for my arthritis.
C)
I walk 2 miles a day.
D)
I drink a glass of wine about once a week.
Ans:
B Feedback: Increased bleeding can occur if a salicylate is taken in combination with warfarin. The nurse will instruct the patient to stop taking aspirin. Walking, eating tomatoes, and drinking an occasional glass of wine should not interfere with the therapeutic effects of warfarin.
6.
The nurse is caring for a patient with a fever and severe diarrhea in addition to thrombophlebitis. How will this patients condition impact the clotting process?
A)
Depleted production of Hageman factor
B)
Increased production of thrombin
C)
Activation of plasminogen
D)
Reduced production of fibrinolysin
Ans:
C Feedback:
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Plasminogen is the basis for the clot-dissolving system. It is converted to plasmin (fibrinolysin) by several factors including Hagemans factor, which is factor XII found in circulating blood. Activated thrombin breaks down fibrinogen to form fibrin threads, which form a clot inside the blood vessel. Patients with diarrhea or fever could alter the normal clotting process by, respectively, loss of vitamin K from the intestine or activation of plasminogen. 7.
The nurse is caring for a patient who received protamine sulfate in error. The patient is not receiving, and has never received, heparin. What effect does the nurse assess for in this patient?
A)
Coagulation effects
B)
No effect
C)
Anticoagulant effects
D)
Antiplatelet effects
Ans:
C Feedback: Paradoxically, if protamine is given to a patient who has not received heparin, it has anticoagulant effects. Protamine is normally used as an antidote to heparin overdose but if heparin was not administered, it does not have coagulation or antiplatelet effects. Since it has anticoagulant effects it cannot be said to have no effect.
8.
A patient is being discharged home on warfarin. The discharge teaching by the nurse should include a warning to avoid what?
A)
St. Johns wort
B)
Tarragon
C)
Ginkgo
D)
Saw palmetto
Ans:
C Feedback:
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Many of the herbal remedies are known to alter blood coagulation and should be avoided when taking anticoagulants. Patients taking these drugs should be cautioned to avoid angelica, cats claw, chamomile, chondroitin, feverfew, garlic, Ginkgo, goldenseal, grape seed extract, green leaf tea, horse chestnut seed, psyllium, and turmeric. If a patient who is taking an anticoagulant presents with increased bleeding and no other interaction or cause is found, question the patient about the possibility of use of herbal therapies. St. Johns wort, tarragon, and saw palmetto are not implicated as having an interaction with anticoagulants. 9.
The nurse administers clopidogrel (Plavix) appropriately to the patient with what condition?
A)
Maintaining the patency of grafts
B)
Treating peripheral artery disease
C)
Preventing emboli from valve replacements
D)
Dissolving a pulmonary embolus and improving oxygenation
Ans:
B Feedback: Clopidogrel is used to inhibit platelet aggregation, decreasing the formation of clots in narrowed or injured blood vessels like those found in peripheral artery disease. Maintaining the patency of grafts or preventing emboli from valve replacements would be accomplished using an anticoagulant. Dissolving emboli would be accomplished using streptokinase or a similar enzyme to stimulate the conversion of plasminogen to plasmin.
10 .
The nurse is caring for a patient who is going home on warfarin (Coumadin). What lab test will the patient require to evaluate therapeutic effects of the drug?
A)
Activated partial thromboplastin time (APTT) only
B)
International normalized ratio (INR) only
C)
Prothrombin time (PT) and INR
D)
PT and APTT
Ans:
C
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Feedback: PT and INR are ordered to evaluate for therapeutic effects of warfarin. Normal values of PT is 1.3 to 1.5 times the control value and the ratio of PT to INR is 2 to 3.5. 11 .
What drug would the nurse administer for its antiplatelet effects? (Select all that apply.)
A)
Ticlid
B)
Iprivask
C)
Arixtra
D)
ReoPro
E)
Activase
Ans:
A, D Feedback: Antiplatelet agents available for use include abciximab (ReoPro), anagrelide (Agrylin), aspirin, cilostazol (Pletal), clopidogrel (Plavix), dipyridamole (Persantine), eptifibatide (Integrilin), ticlopidine (Ticlid), ticagrelor (Brilinta), and tirofiban (Aggrastat). Iprivask and Arixtra are anticoagulants, and Actuvase is a thrombolytic agent.
12 .
A 76-year-old patient is receiving IV heparin 5,000 units every 8 hours. An activated thromboplastin time (aPTT) is drawn 1 hour before the 8:00 AM dose; the aPTT is at 3.5 times the control value. What is the nurses priority action?
A)
Give a larger dose to increase the aPTT.
B)
Give the dose as ordered and chart the results.
C)
Check the patients vital signs prior to administering the dose.
D)
Hold the dose and call the result to the physician.
Ans:
D Feedback:
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The therapeutic level of heparin is demonstrated by an activated partial thromboplastin time (aPTT) that is 1.5 to 3 times the control value. The patients value is 3.5 times control, which indicates clotting time is a bit too delayed and the dosage will likely either be reduced or a dosage may be held according to the order received from the physician. It would be inappropriate to give two doses at once, give the dose and chart the results, or simply check the vital signs without holding the dose and calling the physician. 13 .
The nurse evaluates the effects of warfarin (Coumadin) by monitoring what laboratory test?
A)
Red blood cell count (RBC)
B)
Activated thromboplastin time (APT)
C)
Prothrombin time (PT) and international normalized ratio (INR)
D)
Platelet count
Ans:
C Feedback: The warfarin dose is regulated according to the INR. INR is based upon the PT. The other options are incorrect.
14 .
The nurse discovers a patient receiving warfarin is bleeding. What drug would the nurse prepare to counteract this drug?
A)
Vitamin E
B)
Vitamin K
C)
Protamine sulfate
D)
Calcium gluconate
Ans:
C Feedback: Injectable vitamin K is used to reverse the effects of warfarin. Protamine sulfate is used to reverse the effects of heparin. Vitamin E reduces effects of warfarin but is not used for that purpose. Calcium gluconate would not be indicated for this patient.
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15 .
The nurse evaluates that additional patient teaching is needed regarding anticoagulants when the patient states that he will do what?
A)
Carry a Medic Alert card with him.
B)
Report to the lab once a month.
C)
Use acetaminophen for arthritis pain.
D)
Use a disposable safety razor to shave.
Ans:
D Feedback: The patient should use an electric razor to shave rather than a disposable razor that could nick his skin and increase risk of bleeding. Carrying a MedicAlert card, getting regular follow-up lab work, and use of acetaminophen would all be appropriate actions that would not indicate the need for further teaching.
16 .
The nurse teaches the patient taking warfarin (Coumadin) to minimize foods high in vitamin K including what type of food?
A)
Eggs
B)
Dairy products
C)
Citrus fruits
D)
Green leafy vegetables
Ans:
D Feedback: Injectable vitamin K is used to reverse the effects of warfarin. Vitamin K is responsible for promoting the liver synthesis of several clotting factors. When these pathways have been inhibited by warfarin, clotting time is increased. If an increased level of vitamin K is provided, more of these factors are produced, and the clotting time can be brought back within a normal range. Green leafy vegetables are high in vitamin K and should be avoided or minimized in the diet to prevent reversal of warfarin effects. The other food options are not high in vitamin K.
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17 .
The nurse evaluates teaching about warfarin (Coumadin) is successful when the patient makes what statement?
A)
If I miss a dose, I will take two pills the next day.
B)
I will check with the pharmacist before taking any herbal supplements.
C)
I will increase the dark-green leafy vegetables in my diet.
D)
I will take a multivitamin daily.
Ans:
B Feedback: Warfarin is involved in many drugdrug and drugherb interactions so the patients statement about checking with the doctor before starting any new drugs or supplements would be correct. The other statements made by the patient indicate the need for further teaching because he or she should not take two pills after missing a dose, there is no need to increase green leafy vegetables containing vitamin K, and multivitamin use is contraindicated.
18 .
The nurse assesses blood in the urine of the 73-year-old patient receiving warfarin (Coumadin) this morning. What actions will the nurse take? (Select all that apply.)
A)
Assess prothrombin time (PT).
B)
Assess international normalized ratio (INR).
C)
Expect to administer protamine sulfate.
D)
Expect to administer vitamin K.
E)
Assess partial thromboplastin time (PTT).
Ans:
A, B, D Feedback: Vitamin K is the antidote for warfarin. PT and INR are used to assess therapeutic levels of warfarin. PTT is used to assess therapeutic levels of heparin. Protamine sulfate is given as an antidote for heparin.
19 .
The nurse is caring for a patient following repeat coronary artery bypass grafting who has excessive bleeding. What systemic hemostatic drug will the nurse expect to administer?
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A)
Thrombin recombinant
B)
Microfibrillar collagen
C)
Human fibrin sealant
D)
Aminocaproic acid (Amicar)
Ans:
D Feedback: The hemostatic drug that is used systemically is aminocaproic acid (Amicar). Topical hemostatic agents include absorbable gelatin (Gelfoam), human fibrin sealant (Artiss, Evicel), microfibrillar collagen (Avitene), thrombin (Thrombinar, Thrombostat), and thrombin recombinant (Recothrom).
20 .
The 86-year-old patient, admitted with thrombophlebitis, is being sent home on enoxaparin (Lovenox). The nurse evaluates that he understands why enoxaparin is being used if he states that it will do what?
A)
Inhibit the formation of additional clots
B)
Stimulate production of certain clotting factors
C)
Prevent the blood from clotting
D)
Dissolve the clot
Ans:
A Feedback: Low-molecular-weight heparins inhibit thrombus and clot formation by blocking factors Xa and IIa. Because of the size and nature of the molecules, these drugs do not greatly affect thrombin, clotting, or the PT; therefore, they cause fewer systemic adverse effects.
21 .
What intervention does the nurse include in the plan of care for a patient receiving a continuous intravenous infusion of heparin?
A)
Avoiding intramuscular injections
B)
Assessing for symptoms of respiratory depression
C)
Measuring hourly urinary outputs
D)
Monitoring BP hourly
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Ans:
A Feedback: The most commonly encountered adverse effect of the anticoagulants is bleeding, ranging from bleeding gums during toothbrushing to severe internal hemorrhage. Avoid all invasive procedures, including giving IM injections, while the patient is on heparin therapy. It would not be necessary to assess for respiratory depression, measure hourly output, or monitor the BP hourly as related because of heparin administration.
22 .
The nurse is sending a patient home who will remain on anticoagulant therapy. What teaching point does the nurse make when teaching the patient about the drug? (Select all that apply.)
A)
Brush teeth gently with soft bristle brush.
B)
Wear or carry a MedicAlert notification.
C)
Warning signs of bleeding include fatigue, pallor, and increased heart rate.
D)
Treat minor side effects with over-the-counter (OTC) medications.
E)
Obtain follow-up lab work regularly as ordered.
Ans:
A, B, C, E Feedback: Patients should be taught to avoid bleeding risk by brushing teeth gently, using electric razors, and avoiding dangerous activities or falls that could cause bleeding. The patient should have a MedicAlert to notify other health care providers of anticoagulant therapy. Teach patients to recognize the signs of blood loss and stress the importance of follow-up lab work. Patients should be taught to avoid adding any new medication, prescription or OTC, without first talking to the health care provider or pharmacist to ensure safety.
23 .
Indications for the nurse to administer heparin include what? (Select all that apply.)
A)
Treatment of hemophilia
B)
Prevention and treatment of pulmonary emboli
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C)
Treatment of atrial fibrillation with embolization
D)
Prevention and treatment of venous thrombosis
E)
Diagnosis and treatment of disseminated intravascular coagulation (DIC)
Ans:
B, C, D, E Feedback: Indications include prevention and treatment of venous thrombosis and pulmonary emboli, treatment of atrial fibrillation with embolization, and diagnosis and treatment of DIC. Heparin is not given to patients with hemophilia because the drug would worsen bleeding.
24 .
The nurse is caring for a child who needs anticoagulation therapy. What drug is approved for pediatric use?
A)
Heparin
B)
Dabigatran
C)
Rivaroxaban
D)
Low-molecular-weight heparins
Ans:
A Feedback: Heparin is approved for pediatric use. If heparin is used, the dosage should be carefully calculated based on weight and age. It should be verified by another person before the drug is administered. Dabigatran and rivaroxaban are not approved for use in children. The safety of low-molecular-weight heparins has not been established in children.
25 .
When the nurse administers warfarin it is expected that the drug will have what effect on the body?
A)
Decrease in production of vitamin Kdependentt clotting factors
B)
Increase in prothrombin
C)
Increase in vitamin Kdependent factors in the liver
D)
Increase in procoagulation factors
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Ans:
A Feedback: Warfarin, an oral anticoagulant drug, causes a decrease in the production ovitamin Kdependent clotting factors in the liver. The eventual effect is a depletion of these clotting factors and a prolongation of clotting times. It is used to maintain a state of anticoagulation in situations in which the patient is susceptible to potentially dangerous clot formation. It does not increase prothrombin, vitamin Kdependent factors in the liver, or procoagulation factors.
26 .
When the nurse administers heparin it is anticipated the drug will have what action on the patients body?
A)
Binds to factor X
B)
Blocks the formation of thrombin
C)
Binds to factor Xa
D)
Promotes the inactivation of factor VIII
Ans:
B Feedback: Heparin blocks the formation of thrombin from prothrombin. Heparin does not bind to factors X and Xa. Heparin does not inactivate factor VIII.
27 .
A young man has been diagnosed with hemophilia and the nurse is planning his discharge teaching and includes what teaching point?
A)
Using nonsteroidal anti-inflammatory drugs (NSAIDs) for mild pain
B)
Preventing trauma to the body
C)
Receiving IV factor VIII therapy at home
D)
Understanding the condition is an X-linked recessive disorder
Ans:
B Feedback:
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The nurses thorough patient teaching must include the name of the drug, dosage prescribed, measures to avoid adverse effects, warning signs of problems, and the need for periodic monitoring and evaluation. Hemophilia A is an X-linked recessive disorder that primarily affects males. Approximately 90% of persons with hemophilia produce insufficient quantities of the factor VIII. The prevention of trauma is important in people with hemophilia. The other options are incorrect. 28 .
The nurse admits a 32-year-old woman who takes oral contraceptives; she is expected to need aminocaproic acid postoperatively. The nurse recognizes this patient is at risk for what?
A)
Hypercoagulation
B)
Bleeding
C)
Pregnancy
D)
Infertility
Ans:
A Feedback: Aminocaproic acid is associated with the development of hypercoagulation states if it is combined with oral contraceptives or estrogens. Oral contraceptives do not increase the risk of pregnancy, bleeding, or infertility.
29 .
The nurse reviews the patients lab values and determines warfarin therapy is at therapeutic levels with what lab result?
A)
Partial thromboplastin time (PTT) 1.5 to 2.5 times the control
B)
Prothrombin time (PT) 1.3 to 1.5 times the control
C)
International normalized ratio (INR) of 3 to 4
D)
Activated partial thromboplastin time (aPTT) 3 to 4 times the control
Ans:
B Feedback: Warfarin is at therapeutic level when the INR is 2 to 3.5 and the PT is 1.3 to 1.5 times control. PTT and aPTT should be 1.5 to 2.5 to indicate heparin dosage is at therapeutic level.
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30 .
The patient receives a new diagnosis of peripheral artery disease and the nurse anticipates an order for what drug?
A)
Clopidogrel
B)
Persantine
C)
Aspirin
D)
Warfarin
Ans:
A Feedback: Clopidogrel (Plavix) is indicated for the treatment of patients who are at risk for ischemic events; patients with a history of myocardial infarction, peripheral artery disease, or ischemic stroke; and patients with acute coronary syndrome. Persantine, aspirin, and warfarin would not be indicated for this patient.
31 .
The nurse admits a patient in acute respiratory distress secondary to pulmonary emboli. What drug will the nurse administer to lyse the clots?
A)
Urokinase
B)
Tenecteplase
C)
Rivaroxaban
D)
Fondaparinux
Ans:
A Feedback: Urokinase is used for lysis of pulmonary emboli and treatment of coronary thrombosis. Reteplase is used to treat coronary artery thrombosis associated with an acute myocardial infarction. Rivaroxaban is used to prevent deep vein thromboses that may lead to pulmonary emboli. Fondaparinux is used to treat and prevent venous thromboembolic events.
32 .
The nurse is caring for a postpartum patient admitted to the intensive care unit with a diagnosis of disseminated intravascular coagulation (DIC). What is the drug of choice to treat this problem?
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A)
Heparin
B)
Urokinase
C)
Aspirin
D)
Warfarin
Ans:
A Feedback: The treatment of choice for DIC is heparin, an anticoagulant. It prevents the clotting phase from being completed, thus inhibiting the breakdown of fibrinogen. It may also help avoid hemorrhage by preventing the body from depleting its entire store of coagulation factors. None of the other medications listed in this question are indicated for treatment of DIC and may, in fact, make the condition worse.
33 .
By what route will the nurse administer the antihemophilic agent to the patient with hemophilia following a car accident?
A)
Oral
B)
Topical
C)
IV
D)
Sublingual
Ans:
C Feedback: All antihemophilic agents are administered IV and are not available for administration by any other route.
34 .
The nurse administers agents that control bleeding to patients with hemophilia and what other condition?
A)
Liver disease
B)
Lymes disease
C)
Disseminated intravascular coagulation (DIC)
D)
Pheochromocytoma
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Ans:
A Feedback: Drugs to control bleeding are also given to patients with liver disease because liver disease prohibits clotting factors and proteins needed for clotting from being produced in adequate quantities. Lymes disease, DIC, and pheochromocytoma are not indications for administration of agents to control bleeding.
35 .
The nurse is caring for a pediatric patient with hemophilia who receives antihemophilic factor several times a year. What should this patient be regularly screened for? (Select all that apply.)
A)
HIV
B)
Hepatitis
C)
Anemia
D)
Infection
E)
Cardiomyopathy
Ans:
A, B, C Feedback: The most common adverse effects associated with antihemophilic agents involve risks associated with the use of blood products (e.g., in a patient with hepatitis or AIDS). Patients with hemophilia should also be monitored for anemia secondary to blood loss. There is no associated risk for infection or cardiomyopathy.
Chapter 35. Agents Used in Dyslipidemia 1.
When planning patient care the nurse recognizes what patient is at greatest risk of developing coronary artery disease?
A)
A 32-year-old Asian American with total cholesterol of 120 mg/dL
B)
A 62-year-old white American with total cholesterol of 260 mg/dL
C)
A 48-year-old African American with total cholesterol of 198 mg/dL
D)
A 26-year-old Native American with total cholesterol of 150 mg/dL
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Ans:
B Feedback: White Americans have the highest incidence of coronary artery disease (CAD). This patient has total cholesterol of 260 mg/dL, which is considered high according to the Third Report of the National Cholesterol Education Program Expert Panel. The other three patients could be at risk due to cultural risk factors such as hypertension, diabetes, high (HDL) and low density lipoprotein (LDL) levels, and HDL level to cholesterol ratio. However, their total cholesterol levels fall within normal or desirable range.
2.
The nurse is assessing a patient who reports taking cholestyramine (Questran) mixed with diet cola twice per day. What is an appropriate nursing diagnosis for this patient?
A)
Acute pain related to central nervous system and GI effects
B)
Constipation related to GI effects
C)
Noncompliance related to how the drug is taken
D)
Deficient knowledge regarding drug therapy
Ans:
D Feedback: Cholestyramine should be mixed with water or other noncarbonated fluids so the nurse now recognizes the need for medication teaching and chooses the nursing diagnosis related to deficient knowledge. Nothing in this question indicates that the patient is experiencing any adverse effects from the drug so that pain and constipation would not be optimal nursing diagnoses. Until the nurse assesses the patients understanding of how to take the drug, it would be incorrect to assume noncompliance when it may actually be lack of understanding.
3.
A patient tells the nurse he has had an exacerbation of hemorrhoidal irritation. What drug would the nurse suspect is most likely to contribute to this adverse effect?
A)
Bile acid sequestrants
B)
Beta-hydroxy-beta-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors
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C)
Cholesterol absorption inhibitor
D)
Fibrates
Ans:
A Feedback: Direct gastrointestinal (GI) irritation, including nausea, constipation that may progress to fecal impaction, and aggravation of hemorrhoids, may occur with use of bile acid sequestrants. GI irritation, and specifically irritation of hemorrhoids is not associated with use of HMG-CoA reductase inhibitors, cholesterol absorption inhibitors, or fibrates.
4.
The nurse is engaged in patient teaching about a newly prescribed bile acid sequestrant that may be mixed with a carbonated beverage. What bile acid sequestrant is the nurse describing?
A)
Cholestyramine (Questran)
B)
Colesevelam (Welchol)
C)
Colestipol (Colestid)
D)
Ezetimibe (Zetia)
Ans:
C Feedback: Colestipol can be mixed with a carbonated beverage. The mixture should be stirred and all of the liquid should be swallowed. Ezetimibe is a cholesterol absorption inhibitor and comes in tablet form. The other two options are bile acid sequestrants, but should not be taken with carbonated beverages. The carbonation interferes with the absorption of the drug.
5.
The patient asks the nurse what atorvastatin (Lipitor), newly prescribed, will do. What expected outcome will the nurse describe?
A)
Decrease in serum cholesterol only
B)
Decrease in serum cholesterol and low density lipoprotein (LDL) levels
C)
Decrease in sitosterol and serum cholesterol
D)
Decrease in campesterol and LDL levels
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Ans:
B Feedback: Atorvastatin is a beta-hydroxy-beta-methylglutaryl coenzyme A reductase inhibitor and should lower serum cholesterol and LDL levels as well as prevention of a first myocardial infarction and slow the progression of coronary artery disease. A decrease in serum cholesterol alone would result from the use of a bile acid sequestrant. A cholesterol absorption inhibitor would also decrease sitosterol and campesterol levels as well as decrease levels of serum cholesterol and LDL.
6.
The nurse is taking a health history on a 38-year-old man who is taking atorvastatin (Lipitor) for high cholesterol. What will the nurse question specifically related to the safe use of this drug?
A)
Alcohol
B)
Nicotine
C)
Caffeine
D)
Herbal therapy
Ans:
A Feedback: Beta-hydroxy-beta-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors are contraindicated with active liver disease or a history of alcohol-related liver disease so it is important for the nurse to ask about the patients use of alcohol. Nicotine, caffeine, and herbal therapies are usually not identified as producing any drugdrug interactions with atorvastatin.
7.
A 9-year-old child has received an order for oral pravastatin (Pravachol) 40 mg/d for genetically linked hyperlipidemia. In preparation for patient teaching concerning this drug, what initial action will the nurse take?
A)
Ask the parents to be present for the teaching session.
B)
Determine the appropriate time to discuss the drug with the patient.
C)
Question the doctor concerning the ordered dosage.
D)
Review the childs normal daily dietary intake of fatty foods.
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Ans:
C Feedback: The nurse should question the order initially. The dosage is twice the dose for a 9-year-old is expected to receive. The other options are appropriate and would be done. However, out of safety concerns, the nurse would clarify the dosage first.
8.
The nurse is caring for a patient taking ezetimibe (Zetia) and monitors the patient for what common adverse effects?
A)
Bloating and flank pain
B)
Neuropathy and flatulence
C)
Mild abdominal pain and diarrhea
D)
Constipation and flank pain
Ans:
C Feedback: The most common adverse effects of ezetimibe are mild abdominal pain and diarrhea. Bloating and flatulence are associated with bile acid sequestrants and the fibrates. Constipation is usually associated with bile acid sequestrants. Neuropathy and flank pain are usually not associated with lipidlowering agents.
9.
The nurse is preparing a patient for discharge who will receive a prescription for an beta-hydroxy-beta-methylglutaryl coenzyme A (HMG-CoA) inhibitor. What statement by the patient demonstrates that they have a clear understanding of the teaching provided by the nurse?
A)
I will not need to follow that low-fat diet anymore because this drug will take care of my lipids.
B)
I should plan to take this drug before bedtime, because my body makes lipids mostly at night.
C)
After I start taking this drug, I will not have to worry about the exercise routine the doctor prescribed.
D)
I should take this drug first thing in the morning and make sure I drink a full glass of water.
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Ans:
B Feedback: HMG-CoA inhibitors should be taken at bedtime because the body produces lipids mostly at night. Diet and exercise are still important when taking these drugs because the drug is most effective in combination with other lipidlowering actions.
10 .
A patient taking atorvastatin (Lipitor) comes to the clinic with complaints of acute muscle pain not associated with exercise or injury. The nurse will ask questions to determine if this patient has been taking what contraindicated substance?
A)
Over-the-counter (OTC) medications
B)
Ginseng
C)
Grapefruit juice
D)
Saw palmetto
Ans:
C Feedback: Grapefruit juice can decrease the breakdown of atorvastatin, leading to increased serum levels and toxic adverse effects, including rhabdomyolysis. Patients on this drug should be cautioned to avoid drinking grapefruit juice. OTC drugs, ginseng, and saw palmetto are not associated with increased toxicity.
11 .
What are the most common adverse effects of lovastatin (Mevacor)?
A)
Nausea, flatulence, and constipation
B)
Increased appetite and blood pressure
C)
Confusion and mental disorientation
D)
Hiccups, sinus congestion, and dizziness
Ans:
A Feedback:
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GI problems such as nausea, vomiting, flatulence, constipation, or diarrhea can occur with lovastatin. Increased appetite is not associated with lovastatin but patients may think that taking this drug means they can now eat anything they want and this would indicate the need for further teaching. Confusion and mental disorientation are not associated with this drug. Hiccups, sinus congestion, and dizziness would require exploration for cause because they are not normally associated with lovastatin therapy. 12 .
The patient receives a prescription for niacin and the nurse is teaching his or her about the medication. The nurse instructs the patient to call the provider if what common adverse effect of niacin occurs?
A)
Hypotension
B)
Abdominal pain
C)
Vomiting
D)
Diarrhea
Ans:
B Feedback: Niacin is associated with intense cutaneous flushing, nausea, and abdominal pain, making its use somewhat limited. It also increases serum levels of uric acid and may predispose patients to the development of gout. Hypotension, vomiting, and diarrhea are not normally associated with the drug.
13 .
The nurse is providing medication teaching to a patient who will begin taking niacin with a bile acid sequestrant. How does the nurse instruct the patient to take these two medications?
A)
Both medications should be taken 4 to 6 hours apart.
B)
Both medications should be taken in the morning.
C)
One medication should be taken in the morning but the other is taken at bedtime.
D)
Both medications can be taken at once just before going to bed.
Ans:
A Feedback:
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When niacin is prescribed with a bile acid sequestrant, the patient should be told to take the two medications 4 to 6 hours apart in the evening, with the niacin normally taken first. 14 .
The nurse is teaching a patient about a peroxisome proliferator receptor alpha activator named Trilipix (fenofibric acid). The patient asks what this drug does. What is the nurses best response?
A)
Micelles are absorbed into the intestinal wall and combined with proteins to become chylomicrons.
B)
The drug makes the liver use cholesterol to produce more bile acids.
C)
The drug works in the brush border of the small intestine to prevent the absorption of dietary cholesterol.
D)
The drug activates a specific hepatic receptor, resulting in increased breakdown of lipids and reduction in triglyceride levels.
Ans:
D Feedback: Fenofibric acid is the first drug in this class. It activates a specific hepatic receptor that results in increased breakdown of lipids, elimination of triglyceride-rich particles from the plasma and reduction in the production to an enzyme that naturally inhibits lipid breakdown. The result is seen as a decrease in triglyceride levels, changes in low density lipoprotein production, which makes them more easily broken down in the body, and an increase in high density lipoprotein levels.
15 .
The nurse conducts a review of research related to Beta-hydroxy-betamethylglutaryl coenzyme A inhibitors and finds the only one associated with data to show a reduction in coronary artery disease and incidence of myocardial infarction is what drug?
A)
Pravastatin (Pravachol)
B)
Lovastatin (Mevacor)
C)
Atorvastatin (Lipitor)
D)
Fluvastatin (Lescol)
Ans:
A
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Feedback: Pravastatin is the only statin with outcome data to show effectiveness in decreasing coronary artery disease and incidence of myocardial infarction (MI); it prevents a first MI even in patients who do not have a documented elevated cholesterol level. The other medications do not have any evidence of effectiveness for this patient. 16 .
Which drug is most effective in reducing serum triglyceride levels?
A)
Beta-hydroxy-beta-methylglutaryl coenzyme A reductase inhibitors
B)
Bile acid sequestrants
C)
Fibrates
D)
Niacin
Ans:
C Feedback: Fibrates decrease hepatic production of triglycerides. They are the most effective drugs for reducing serum triglycerides. The other options are incorrect.
17 .
The nurse is caring for a patient who takes fluvastatin (Lescol). Which laboratory value should be assessed regularly on this patient?
A)
Blood urea nitrogen (BUN)
B)
Complete blood count (CBC)
C)
Activated partial thromboplastin time
D)
Liver function studies
Ans:
D Feedback:
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Increased concentrations of liver enzymes commonly occur, and acute liver failure has been reported with the use of atorvastatin and fluvastatin. Liver function studies should be monitored at the onset of therapy, at 6 and 12 weeks, and intermittently during course of therapy. The other tests would not be pertinent to this specific drug. 18 .
The nurse explains the action of a beta-hydroxy-beta-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitor as inhibiting what?
A)
An enzyme that controls the final step in production of cellular cholesterol
B)
An enzyme used immediately for energy
C)
An enzyme that combines with proteins to become chylomicrons
D)
An enzyme used to make bile acids
Ans:
A Feedback: HMG-CoA reductase is an enzyme that controls the final step in production of cellular cholesterol. Some fats are used immediately for energy. Bile acids act like detergents to break down or metabolize fats into small molecules called micelles, which are absorbed into the intestinal wall and combined with proteins to become chylomicrons, to allow transport throughout the circulatory system. Cholesterol is a fat that is used make bile acids.
19 .
A 54-year-old patient has a cholesterol level of 240 mg/dL. How would the nurse categorize this serum concentration of cholesterol?
A)
Optimal
B)
Desirable
C)
High
D)
Very high
Ans:
C Feedback:
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High is rated at or exceeding 240 mg/dL. Levels below 200 mg/dL are considered desirable, although lower levels may be preferred if the patient has a history of coronary artery disease. Low density lipoprotein (LDL) cholesterol below 100 mg/dL is considered optimal, whereas LDL levels above 190 or triglycerides above 500 mg/dL is considered very high. 20 .
The pharmacology instructor asks what drug inhibits peripheral breakdown of lipids, reduces low density lipoproteins (LDLs), and increases high density lipoprotein (HDL) concentrations. What is the correct answer?
A)
Fenofibrate (Tricor)
B)
Niacin (Niaspan)
C)
Atorvastatin (Lipitor)
D)
Gemfibrozil (Lopid)
Ans:
D Feedback: Gemfibrozil inhibits peripheral breakdown of lipids, reduces production of triglycerides and LDLs, and increases HDL concentrations. It is associated with gastrointestinal (GI) and muscle discomfort. Fenofibrate, niacin, and atorvastatin do not increase HDL concentrations.
21 .
A patient is being discharged on cholestyramine (Questran). Patient teaching should include what about this medication?
A)
Should be administered with other medications
B)
Should be administered 1 hour before or 4 to 6 hours after other medications
C)
Should be administered 1 hour after other medications
D)
Should be administered on an empty stomach
Ans:
B Feedback: Cholestyramine should be administered 1 hour before or 4 to 6 hours after other medications, because it may prevent the absorption of other drugs. Therefore, the other options are incorrect.
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22 .
The patient is admitted to the acute care facility with a diagnosis of acute renal failure. While collecting the nursing history the patient reveals he was taking Pravastatin to reduce lipid levels and enjoyed a glass of grapefruit juice every morning. The patient complains of muscle pain. What does the nurse suspect caused this patients renal failure?
A)
Gastric ulceration
B)
Rhabdomyolysis
C)
Congestive heart failure
D)
Drug Toxicity
Ans:
D Feedback: Grapefruit juice increases the risks of toxicity and rhabdomyolysis. However, toxicity would cause liver damage, whereas the breakdown of muscle that occurs with rhabdomyolysis results in kidney damage and acute renal failure. The patient identified no symptoms related to gastric ulceration or congestive heart failure.
23 .
The patient receives a prescription for a lipid lowering medication from the health care provider and, before discharge, asks the nurse what else he or she can do to improve his or her lipid levels besides just taking medication. What recommendation will the nurse make? (Select all that apply.)
A)
Quitting smoking
B)
Exercising
C)
Following a low sodium diet
D)
Reducing stress
E)
Avoiding alcohol
Ans:
A, B, D Feedback:
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Lifestyle changes including low-fat diet, exercise, smoking cessation, and stress reduction should be tried before any antihyperlipidemic drug is used. Avoiding alcohol is not indicated as a means to lower serum lipid levels. Although a low sodium diet is a healthy choice, it is not associated with elevating lipid levels. 24 .
A patient is diagnosed as having an elevated cholesterol level. The nurse is aware that plaque on the inner lumen of arteries begins as what?
A)
Fatty streaks
B)
White blood cells (WBCs)
C)
Foam cells
D)
Platelets and fibrin
Ans:
A Feedback: Coronary artery disease is characterized by the progressive growth of atheromatous plaques, or atheromas, in the coronary arteries. These plaques, which begin as fatty streaks in the endothelium, eventually injure the endothelial lining of the artery, causing an inflammatory reaction. This inflammatory process triggers the development of characteristic foam cells, containing fats and WBCs that further injure the endothelial lining. Over time, platelets, fibrin, other fats, and remnants collect on the injured vessel lining and cause the atheroma to grow, further narrowing the interior of the blood vessel and limiting blood flow.
25 .
The nurse is teaching a 45-year-old patient about ways to lower cholesterol levels and explains that exercise has what effect?
A)
Increases high density lipoproteins (HDLs) and decreases low density lipoproteins (LDL)
B)
Increases LDL and decreases triglycerides
C)
Decreases HDL and increases LDL
D)
Decreases both HDL and LDL
Ans:
A
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Feedback: Moderate exercise increases HDL levels, which assist in lowering LDL levels. Exercise also decreases triglyceride levels. 26 .
The nurse teaches the patient at risk for coronary artery disease (CAD) that some risk factors can be controlled or modified. What modifiable factors would the nurse include?
A)
Gender, obesity, family history, and smoking
B)
Inactivity, stress, gender, and smoking
C)
Obesity, inactivity, diet, and smoking
D)
Stress, family history, and obesity
Ans:
C Feedback: The risk factors for CAD that can be controlled or modified include obesity, inactivity, diet, stress, and smoking. Gender and family history are risk factors that cannot be controlled.
27 .
The nurse is caring for a patient with high serum cholesterol and triglyceride levels. In teaching the patient about therapeutic lifestyle changes such as diet and exercise, the nurse explains that the desired goal for cholesterol levels is what?
A)
High high density lipoprotein (HDL) values and high triglyceride values
B)
Low soluble fiber
C)
Elevated blood lipids, fasting glucose less than 100
D)
Low low density lipoprotein (LDL) values and high HDL values
Ans:
D Feedback:
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The desired goal for cholesterol readings is for a patient to have low LDL and high HDL values. HDL serves as a protective mechanism to reduce cholesterol so higher levels are desirable. High LDL levels increase plaque formation. Fiber does not contribute to risk for coronary artery disease (CAD) although a diet high in fiber is preferable. Elevated blood lipids are never desirable but control of blood sugar levels reduces CAD risk. 28 .
The nurse cares for a patient who is in her second trimester of pregnancy with extremely high serum cholesterol levels. What lipid lowering medication would be appropriate for the nurse to administer to this patient?
A)
Colesevelam (Welchol)
B)
Pravastatin (Pravachol)
C)
Simvastatin (Zocor)
D)
Atorvastatin (Lipitor)
Ans:
A Feedback: Bile acid sequestrants are the drug of choice for pregnant women if a lipidlowering agent is needed. Women of child-bearing age should not take betahydroxy-beta-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors because they are in Pregnancy Category X. Pravastatin, simvastatin, and atorvastatin are all HMG-CoA reductase inhibitors.
29 .
The nurse is teaching the patient how to reduce risk for coronary artery disease (CAD). What condition does the nurse encourage the patient to control in order to reduce CAD risk? (Select all that apply.)
A)
Obesity
B)
Hypertension
C)
Bradycardia
D)
Depression
E)
High stress levels
Ans:
A, B, E Feedback:
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Successful treatment in reducing risk for CAD involves reducing risk factors including decreasing dietary fats (decreasing total fat intake and limiting saturated fats seems to have the most impact on serum lipid levels); losing weight, which helps to decrease insulin resistance and the development of type 2 diabetes; eliminating smoking; increasing exercise levels; decreasing stress; and treating hypertension, diabetes, and gout. Depression and bradycardia have not been linked to CAD. 30 .
The nurse cares for a 10-year-old child brought to the clinic for an annual checkup who is diagnosed with hypercholesterolemia. What is the most common cause of hypercholesterolemia in children?
A)
Gender
B)
Diet
C)
Familial connection
D)
Exercise
Ans:
C Feedback: Familial hypercholesterolemia may be seen in children. Because of the importance of lipids in the developing nervous system, treatment is usually restricted to tight dietary restrictions to limit fats and calories. Gender, diet, or exercise-resistant hypercholesterolemia is possible in children, but they are not the most common causes.
31 .
The nurse is caring for an obese patient with hyperlipidemia who has tried to modify his diet to lose weight and control serum lipid levels without success. He is currently taking a combination of medications but his total cholesterol remains above 200. What future therapy might help this patient?
A)
Endocannabinoid blocker
B)
Bile acid sequestrant with niacin
C)
Beta-hydroxy-beta-methylglutaryl coenzyme A (HMG-CoA) reductase and gemfibrozil
D)
Peroxisome proliferator receptor alpha activator
Ans:
A
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Feedback: Blocking the endocannabinoid system results in feelings of satiety and decreased appetite, leading to weight loss; decreased release of growth hormone, increased oxygen and glucose use in the muscle, decreased fat synthesis in the liver, decreased levels of triglycerides and low density lipoproteins, and increased levels of high density lipoproteins, improving the lipid profile; increased sensitivity of insulin receptor sites, leading to decreased blood glucose levels; decreased fat production and storage; increased levels of adiponectin; and decreased activity of tumor necrosis factor, a proinflammatory agent, and decreased activity of C-reactive protein, which is associated with proinflammatory and prothrombotic states. Combining bile acid sequestrant with niacin or HMG-CoA with gemfibrozil is contraindicated. Peroxisome proliferator receptor alpha activators help to control lipid levels but do not contribute to dietary changes and appetite suppression. 32 .
The nurse provides patient teaching related to medication and lifestyle changes the patient can make to reduce serum lipid levels. One month later, the nurse evaluates the patient teaching as having been effective based on what data? (Select all that apply.)
A)
Total cholesterol 184
B)
High density lipoprotein (HDL) cholesterol 84
C)
Low density lipoprotein (LDL) cholesterol 164
D)
Triglycerides 184
E)
Weight loss of 8 pounds
Ans:
A, B, E Feedback: Serum lab levels within the desirable level would indicate the teaching was effective; they include a total cholesterol level of less than 200, an HDL cholesterol level of higher than 40, an LDL cholesterol level of less than 129, and a triglyceride level of less than 50. Weight loss is also a positive outcome.
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33 .
The nurse is caring for a 35-year-old woman taking a beta-hydroxy-betamethylglutaryl coenzyme A (HMG-CoA) reductase inhibitor to lower serum lipid levels. When teaching this patient about her medications what priority teaching point will the nurse include in the teaching plan?
A)
Need for frequent ophthalmic examinations
B)
Information about a cholesterol-lowering diet
C)
Use of barrier contraceptives
D)
Calling her doctor with any respiratory symptoms
Ans:
C Feedback: It is important to teach a woman of childbearing age taking HMG-CoA reductase inhibitors to use barrier contraceptives because there is a risk of severe fetal abnormalities associated with these drugs if taken during pregnancy. She should have routine ophthalmic examinations but does not need more frequent examinations. Cholesterol lowering diet should have been initiated before beginning medications to lower lipid levels. There are no associated respiratory risks with these medications so she would call the doctor with respiratory symptoms as she normally would.
34 .
When providing patient teaching to a patient beginning therapy with a betahydroxy-beta-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitor, the nurse will explain the need for regular monitoring of what laboratory studies? (Select all that apply.)
A)
Renal function tests
B)
Liver function tests
C)
Lipid panel
D)
Hemoccult of stool
E)
Albumin level
Ans:
A, B, C Feedback:
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It is important to monitor renal and liver function to identify early signs of toxicity or rhabdomyolysis. Monitoring lipid levels contributes to evaluation of the effectiveness of drug therapy. Hemoccult of stool would be more important with bile acid sequestrants that are associated with GI irritation. Altered albumin levels are not associated with HMG-CoA reductase inhibitors. 35 .
The nurse is preparing to teach the patient about diet therapy when beginning bile sequestrant medication to lower lipid levels. What important teaching point will the nurse include in the teaching plan?
A)
Increasing carbohydrate intake
B)
Reducing protein intake
C)
Increasing fiber intake
D)
Reducing fluid intake
Ans:
C Feedback: The nurse would want to teach this patient to increase fiber intake to avoid constipation that often occurs with this medication. Protein intake does not need to be reduced, but the patient should be taught to avoid fatty protein and instead meet protein needs with vegetable proteins, fish, and lean poultry. Carbohydrate intake should be reduced if weight loss is needed, otherwise no change is needed. Fluid intake should be maintained or increased if there are no diagnoses that would contraindicate fluid intake to help avoid constipation.
Chapter 36. Nonsteroidal Anti-Inflammatory Drugs, Disease-Modifying Antirheumatic Drugs, Nonopioid Analgesics, & Drugs Used in Gout 1.
A nurse has admitted a 10-year-old child to the short-stay unit. The child has complained of chronic headaches and his or her mother reports that he or she gives him or her acetaminophen (Tylenol) at least twice a day. What will the nurse evaluate?
A)
Renal function
B)
Hepatic function
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C)
Respiratory function
D)
Cardiac function
Ans:
B Feedback: The nurse should evaluate the patients hepatic function. Severe hepatotoxicity can occur from overuse of acetaminophen. Significant interferences do not occur in the kidney, heart, or lung with acetaminophen.
2.
The nurse is discussing ethnic differences in response to medication with your nursing students. What group of people would the nurse tell the students may have a decreased sensitivity to pain-relieving effects of antiinflammatory drugs and should be educated concerning signs and symptoms of gastrointestinal bleeding from use of these drugs?
A)
African Americans
B)
White Americans
C)
Hispanics
D)
Asians
Ans:
A Feedback: African Americans have a documented decreased sensitivity to painrelieving effects of many anti-inflammatory drugs. They also have an increased risk of developing GI adverse effects to these drugs. In general, White Americans, Hispanics, and Asians are at lower risk for these problems.
3.
A patient, newly diagnosed with ulcerative colitis, has been admitted to the short-stay unit. What salicylates does the nurse anticipate will be ordered for this patient?
A)
Balsalazide (Colazal)
B)
Sodium thiosalicylate (generic)
C)
Choline magnesium trisalicylate (Tricosal)
D)
Salsalate (Argesic)
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Ans:
A Feedback: Balsalazide is delivered intact to the colon, where it delivers a local antiinflammatory effect that is most effective for patients with ulcerative colitis. Choline salicylate and salsalate are used to treat pain, fever, and inflammation. Sodium thiosalicylate is used mainly for episodes of acute gout, for muscular pain, and to treat rheumatic fever.
4.
The nurse is caring for a 66-pound child with orders for choline magnesium trisalicylate (Tricosal). The orders read 50 mg/kg/d PO in two divided doses. How many milligram will the patient receive per dose?
A)
250 mg
B)
500 mg
C)
750 mg
D)
1,000 mg
Ans:
C Feedback: First, the nurse must determine the childs weight in kilogram. One kg is equal to 2.2 pounds. Divide 2.2 into 66 to equal 30 kg. Multiply 50 mg times 30 kg to equal 1,500 mg. Divide 1,500 by 2 for the divided doses, which will equal 750 mg per dose.
5.
A nurse is caring for a patient with severe rheumatoid arthritis who takes anti-inflammatory agents on a regular basis. What medication should the nurse question if ordered by the physician to be taken in addition to the antiinflammatory agent?
A)
Oral antidiabetic agent
B)
Calcium channel blocker
C)
Beta-blocker
D)
Antibiotic
Ans:
C
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Feedback: Nonsteroidal anti-inflammatory drugs have the potential to decrease antihypertensive effects from beta blockers if these drugs are taken at the same time. Patients who receive these combinations should be monitored closely and appropriate dosage adjustments made if needed. Drug interactions do not usually occur with oral antidiabetic agents, calcium channel blocking medications, or antibiotics. 6.
A nurse is assessing a patient who has been taking nonsteroidal antiinflammatory drugs (NSAID). What statement by the patient indicates to the nurse that the patient has a good understanding of the use of this therapy?
A)
I drink a glass of wine just about every night.
B)
I asked my doctor to check for blood in my stool regularly.
C)
I do not like to swallow tablets so I crush them.
D)
I drink as little water as possible when I take my medication.
Ans:
B Feedback: Taking certain anti-inflammatory drugs can irritate the gastric mucosa and increase the risk of bleeding; therefore, by asking his or her doctor to check his or her stool for bleeding, the nurse knows that the patient is aware of this. Alcohol and crushing the tablets can interfere with anti-inflammatory metabolism. A full glass of water should be taken with this medication to increase absorption.
7.
A salicylate has been prescribed for a 15-year-old patient who has been diagnosed with arthritis. The mother is concerned about giving her child a salicylate. What salicylates could the nurse tell this mother are recommended for use in children?
A)
Salsalate (Argesic)
B)
Olsalazine (Dipentum)
C)
Sodium thiosalicylate (generic)
D)
Choline magnesium trisalicylate (Tricosal)
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Ans:
D Feedback: Aspirin and choline magnesium trisalicylate are the only salicylates recommended for use in children. They should not be used when any risk of Reyes syndrome exists. Salsalate (Argesic), olsalazine (Dipentum), and sodium thiosalicylate (generic) have not been approved for pediatric use and do not provide pediatric dosing guidelines as a result.
8.
A mother has brought her 6-year-old child to the clinic. The child has a fever of 102.8F and is diagnosed with the flu. What medication will the nurse suggest for this child?
A)
Etanercept (Enbrel)
B)
Penicillamine (Depen)
C)
Acetaminophen (Tylenol)
D)
Aspirin (Bayer)
Ans:
C Feedback: Acetaminophen would be the suggested medication. It is prescribed for relief of pain and fever for influenza in children. Aspirin would be contraindicated because it increases the risk for Reyes syndrome. Etanercept and penicillamine are given for severe rheumatoid arthritis therapy.
9.
A nurse is presenting an educational event for a group of new parents. One topic that the nurse addresses is the overuse of acetaminophen, which can cause liver toxicity. What would the nurse tell the parents it is important to do?
A)
Do not give acetaminophen (Tylenol) unless you receive a doctors order.
B)
Check the label of over-the-counter (OTC) medications carefully to watch for inclusions of acetaminophen in the ingredients.
C)
Monitor their childs temperature carefully and regulate the Tylenol dose based on the fever.
D)
Mix OTC childrens medications to get the best coverage for their childs symptoms.
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Ans:
B Feedback: Inadvertent overdose with acetaminophen frequently occurs because of the combining of OTC drugs that contain the same ingredients. Parents should be taught to carefully check the labels of OTC products and follow the dosage guidelines. A prescription is not required for acetaminophen. Dosage guidelines are the best guide to follow to prevent overdose.
10 .
A mother asks the nurse how acetaminophen works. What statement best describes the therapeutic action of acetaminophen?
A)
Acetaminophen (Tylenol) works by blocking the increase of interleukin-1.
B)
Acetaminophen reacts with free-floating tumor necrosis (TNF) factor released by active leukocytes.
C)
Acetaminophen acts directly on the hypothalamus to cause vasodilation and sweating.
D)
Acetaminophen is taken up by macrophages, thus inhibiting phagocytosis and release of lysosomal enzymes.
Ans:
C Feedback: Acetaminophen acts on the hypothalamus to cause vasodilation and sweating to reduce fever. The mechanism of action as an analgesic is not understood. Anakinra (Kineret) blocks the increased interleukin-1, which is responsible for the degradation of cartilage in rheumatoid arthritis. Etanercept (Enbrel) reacts with free-floating TNF released by active leukocytes in autoimmune inflammatory disease to prevent the damage caused by TNF. Gold compounds are taken up by macrophages, which, in turn, inhibits phagocytosis and releases lysosomal enzymes, which causes damage associated with inflammation.
11 .
A)
Antipyretic drugs (e.g., aspirin, ibuprofen, acetaminophen) often are used to alleviate the discomforts of fever and to protect vulnerable organs, such as the brain, from extreme elevations in body temperature. However, the use of aspirin in children is limited due to the possibility of what disease? Munchausens syndrome
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B)
Guillain-Barr syndrome
C)
Angelmans syndrome
D)
Reyes syndrome
Ans:
D Feedback: Salicylates like aspirin are contraindicated for the treatment of childhood fevers because of the risk of Reyes syndrome in children and teenagers. Munchausens syndrome is an unusual condition characterized by habitual pleas for treatment and hospitalization for a symptomatic but imaginary acute illness. Guillain-Barr syndrome is an idiopathic, peripheral polyneuritis that occurs 1 to 3 weeks after a mild episode of fever associated with a viral infection or with immunization. Angelmans syndrome is an autosomal recessive syndrome characterized by jerky puppet-like movements, frequent laughter, mental and motor retardation, a peculiar open-mouthed facial expression, and seizures. Salicylates like aspirin are not contraindicated for patients with Munchausens syndrome, Guillain-Barr syndrome, or Angelmans syndrome.
12 .
A patient has been diagnosed with severe rheumatoid arthritis and hylan G-F 20 has been ordered. How is this drug given?
A)
Injected into the joint
B)
Orally
C)
IM
D)
Sub Q
Ans:
A Feedback: Hyaluronidase derivatives (e.g., hylan G-F 20, sodium hyaluronate) have elastic and viscous properties. These drugs are injected directly into the joints of patients with severe rheumatoid arthritis of the knee. They seem to cushion and lubricate the joint and relieve the pain associated with degenerative arthritis. They are given weekly for 3 to 5 weeks and are not given by any other route.
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13 .
A nurse is caring for a patient in the early stage of rheumatoid arthritis. The nurse would expect what medication classification to be used in the treatment of this patient?
A)
Antimalarial agents
B)
Nonsteroidal anti-inflammatory drugs (NSAIDs)
C)
Xanthine oxidase inhibitors
D)
Uricosuric agents
Ans:
B Feedback: NSAIDs are indicated for relief of the signs and symptoms of rheumatoid arthritis and osteoarthritis, for relief of mild to moderate pain, for treatment of primary dysmenorrhea, and for fever reduction. Antimalarial agents are used in the treatment of systemic lupus erythematosus. Xanthine oxidase inhibitors and uricosuric agents are used in the treatment of gout.
14 .
The nurse is caring for a patient who receives anakinra (Kineret) for arthritis. By what route will the nurse administer this medication?
A)
Into the affected joint directly
B)
Oral
C)
Intramuscular
D)
Subcutaneous
Ans:
D Feedback: Anakinra is administered subcutaneously every day and is often used in combination with other antiarthritis drugs. No other route is appropriate.
15 .
The nurse is preparing to administer a nonsteroidal anti-inflammatory drug (NSAID) to an older patient. What NSAID is associated with increased toxicity and should be avoided if possible?
A)
Naproxen (Aleve)
B)
Ibuprofen (Motrin)
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C)
Indomethacin (Indocin)
D)
Etodolac (Lodine)
Ans:
A Feedback: Geriatric warnings have been associated with naproxen, ketorolac, and ketoprofen because of reports of increased toxicity when they are used by older patients. These NSAIDs should be avoided in this population if possible. No such warnings exist for ibuprofen, indomethacin, or etodolac.
16 .
What medication used to treat rheumatic arthritis not only has antiinflammatory effects but is also used in premature infants to close a patent ductus arteriosus?
A)
Penicillamine
B)
Indomethacin
C)
Antimalarials
D)
Prednisone
Ans:
B Feedback: Indomethacin given IV is used in premature infants to close a patent ductus arteriosus and avoid a surgical procedure. Penicillamine, antimalarials, and prednisone are not used for this purpose.
17 .
When the nurse learns that the patient with rheumatic arthritis is complaining of stomatitis, the nurse should further assess the patient for the adverse effects of what medication?
A)
Corticosteroids
B)
Gold-containing compounds
C)
Antimalarials
D)
Salicylate therapy
Ans:
B
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Feedback: Various adverse effects are common with the use of gold salts and are probably related to their deposition in the tissues and effects at that local level: stomatitis, glossitis, gingivitis, pharyngitis, laryngitis, colitis, diarrhea, and other GI inflammation; gold-related bronchitis and interstitial pneumonitis; bone marrow depression; vaginitis and nephrotic syndrome; dermatitis, pruritus, and exfoliative dermatitis; and allergic reactions ranging from flushing, fainting, and dizziness to anaphylactic shock. The diseasemodifying antirheumatic drug (DMARD) category of antimalarials may cause visual changes, GI upset, rash, headaches, photosensitivity, and bleaching of hair. Tinnitus is associated with salicylate therapy. Hirsutism is associated with corticosteroid therapy.
18 .
A patient with rheumatoid arthritis is taking gold salts. What drugs should the nurse teach this patient that are contraindicated when taking gold salts? (Select all that apply.)
A)
Antimalarials
B)
Cytotoxic drugs
C)
Salicylates
D)
Penicillamine
E)
Anticoagulants
Ans:
A, B, D Feedback: These drugs should not be combined with penicillamine, antimalarials, cytotoxic drugs, or immunosuppressive agents other than low-dose corticosteroids because of the potential for severe toxicity. No contraindication exists for therapy involving gold salts and salicylates or anticoagulants.
19 .
The nurse teaches a patient with rheumatic disease who is being prescribed salicylate therapy to monitor himself or herself for what?
A)
Tinnitus
B)
Visual changes
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C)
Stomatitis
D)
Hirsutism
Ans:
A Feedback: Tinnitus is associated with salicylates. The disease-modifying antirheumatic drug (DMARD) category of antimalarials may cause visual changes, GI upset, skin rash, headaches, photosensitivity, and bleaching of hair. Eighth cranial nerve damage and stomatitis are associated with gold therapy. Hirsutism is associated with corticosteroid therapy.
20 .
The nurse assesses laboratory results related to blood clotting when the assigned patient takes what drug regularly? (Select all that apply.)
A)
Salicylates
B)
Nonsteroidal anti-inflammatory drugs (NSAIDs)
C)
Gold compounds
D)
Acetaminophen
E)
Disease-modifying antirheumatic drugs (DMARDs)
Ans:
A, B Feedback: Salicylates and NSAIDs can both inhibit blood clotting resulting in bleeding if not monitored. Gold compounds, acetaminophen, and DMARDs do not have a known impact on blood clotting.
21 .
What is chrysotherapy?
A)
Treatment with antimalarials
B)
Treatment with salicylates
C)
Treatment with disease-modifying antirheumatic drugs (DMARDs)
D)
Treatment with gold salts
Ans:
D
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Feedback: Chrysotherapy is the clinical name for treatment with gold salts in which gold is taken up by macrophages, which then inhibit phagocytosis. It is reserved for use in patients who are unresponsive to conventional therapy and can be very toxic. Options A, B, and C are incorrect. 22 .
What drugs used to treat rheumatoid arthritis are contraindicated in a patient who has a history of toxic levels of heavy metals?
A)
Gold salts
B)
COX-2 inhibitors
C)
Propionic acids
D)
Fenamates
Ans:
A Feedback: Gold salts can be extremely toxic and are contraindicated in the presence of any known allergy to gold, severe diabetes mellitus, congestive heart failure, severe debilitation, renal or hepatic impairment, hypertension, blood dyscrasias, recent radiation treatment, history of toxic levels of heavy metals, and pregnancy or lactation. COX-2 inhibitors, propionic acids, and fenamates have no contraindications related to prior toxic levels of heavy metals.
23 .
Which of these anti-inflammatory drugs have geriatric warnings? (Select all that apply.)
A)
Sulindac (Clinoril)
B)
Indomethacin (Indocin)
C)
Ketorolac (Toradol)
D)
Naproxen (Naprosyn)
E)
Ketoprofen (Orudis)
Ans:
C, D, E Feedback:
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Geriatric warnings have been associated with naproxen, ketorolac, and ketoprofen because of reports of increased toxicity when they are used by older patients. These nonsteroidal anti-inflammatory drugs should be avoided if possible. Sulindac and indomethacin are not associated with toxicity in older patients. 24 .
A patient presents at the emergency department complaining of dizziness, mental confusion, and difficulty hearing. What should the nurse suspect is wrong with the patient?
A)
Anakinra toxicity
B)
Ibuprofen toxicity
C)
Salicylism
D)
Acetaminophen toxicity
Ans:
C Feedback: Salicylism can occur with high dosage of aspirin. Dizziness, ringing in the ears, difficulty hearing, nausea, vomiting, diarrhea, mental confusion, and lassitude can occur. This combination of adverse effects is not associated with anakinra toxicity, ibuprofen toxicity, or acetaminophen toxicity.
25 .
A mother brings her 3-year-old child to the emergency department telling the nurse the child has eaten a bottle of baby aspirin. The mother cannot tell the nurse how many tablets were in the bottle. What dose of salicylate would be toxic in a child?
A)
2g
B)
3g
C)
4g
D)
5g
Ans:
C Feedback: Acute salicylate toxicity may occur at doses of 20 to 25 g in adults or 4 g in children. Therefore, options A, B, and D are incorrect.
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26 .
A patient arrives at the emergency department brought by his or her friends. The friends tell the nurse that the patient has taken a whole bottle of aspirin. Blood work for salicylate toxicity is run. What does the nurse expect the results to be?
A)
>5 g
B)
>10 g
C)
>15 g
D)
>20 g
Ans:
D Feedback: Acute salicylate toxicity may occur at doses of 20 to 25 g in adults or 4 g in children. Options A, B, and C would not be high enough to indicate salicylate toxicity.
27 .
The nursing instructor is discussing COX-2 inhibitors with her nursing students. Where would the instructor tell her students that COX-2 inhibitors work?
A)
At sites of trauma and injury
B)
Wherever prostaglandins are present
C)
At the sites of blood clotting
D)
In the kidney
Ans:
A Feedback: The COX-2 inhibitors are thought to act only at sites of trauma and injury to more specifically block the inflammatory reaction. COX-1 is present in all tissues and seems to be involved in many body functions including blood clotting, protecting the stomach lining, and maintaining sodium and water balance in the kidney.
28 .
The clinic nurse is caring for a patient who is taking a COX-2 inhibitor and knows that this patient needs to be assessed for what? (Select all that apply.)
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A)
Bleeding time
B)
Liver function
C)
Altered hearing
D)
Gastrointestinal (GI) effects
E)
Water retention
Ans:
A, D, E Feedback: COX-2 inhibitors have an impact on many body functions and patients receiving this therapy should be assessed for GI effects, changes in bleeding time, and water retention. Patients taking COX-2 inhibitors do not need to be evaluated for liver function or altered hearing because these are not common adverse effects.
29 .
Why do COX-2 inhibitors increase the risk for cardiovascular problems? (Select all that apply.)
A)
Vasoconstriction is blocked.
B)
Vasodilation is blocked.
C)
Platelet clumping is blocked.
D)
Water and sodium balance is altered.
E)
Gastrointestinal (GI) integrity is altered.
Ans:
B, C Feedback: Recent studies suggest that COX-2 inhibitors may block some protective responses in the body, such as vasodilation and inhibited platelet clumping, which is protective if vessel narrowing or blockage occurs. Blocking this effect could lead to cardiovascular problems. Vasoconstriction is not blocked, water and sodium balance is not altered, and GI integrity is not impacted by COX-2 inhibitors but can be impacted by COX-1 inhibitors.
30 .
When nonsteroidal anti-inflammatory drugs (NSAIDs) are combined with loop diuretics, there is a potential for what?
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A)
Decreased antihypertensive effect
B)
Decreased diuretic effect
C)
Lithium toxicity
D)
Anaphylactoid reactions
Ans:
B Feedback: Diuretic effect is often decreased when NSAIDs are taken with loop diuretics. There is a potential for decreased antihypertensive effect of betablockers if NSAIDs are combined and there have also been reports of lithium toxicity, especially when lithium is combined with ibuprofen.
31 .
The nurse is caring for a patient who reports taking 800 mg of ibuprofen three times a day for relief of menstrual cramps. What lab results will the nurse find most significant in assessing this patient?
A)
Complete blood count
B)
White blood cell differential
C)
Arterial blood gas
D)
Cholesterol and triglyceride profile
Ans:
A Feedback: Ibuprofen, like all nonsteroidal anti-inflammatory drugs, can cause irritation to the GI mucosa and block platelet clumping, both of which can result in bleeding. Blood loss due to dysmenorrhea can exacerbate these risks so it is important to assess the complete blood count to monitor for excessive blood loss. White blood cell differential would be impacted by infection, which is not indicated here. Arterial blood gas, cholesterol, and triglyceride levels would not be impacted by ibuprofen.
32 .
When caring for a patient diagnosed with rheumatoid arthritis, the patient tells the nurse that he or she has had insufficient response to nonsteroidal anti-inflammatory drugs (NSAIDs) and his or her condition continues to worsen. What drug does the nurse anticipate will be ordered next for this patient?
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A)
Auranofin (Ridaura)
B)
Ibuprofen (Motrin)
C)
Acetaminophen (Tylenol)
D)
Ketorolac (Toradol)
Ans:
A Feedback: Gold compounds such as auranofin are prescribed when more usual antiinflammatory therapies are ineffective and the patients condition worsens despite weeks or months of standard pharmacological treatment. Ibuprofen and ketorolac are NSAIDs, which have been tried without good results. Acetaminophen is not an anti-inflammatory and would not be appropriate to control this patients condition.
33 .
The patient has been diagnosed with rheumatoid arthritis. She also reports pain in various muscle groups secondary to a diagnosis of fibromyalgia and dysmenorrhea with painful cramping during menses. What drug would be most effective in treating all three of this patients problems?
A)
Naproxen (Naprosyn)
B)
Acetaminophen (Tylenol)
C)
Etanercept (Enbrel)
D)
Sodium hyaluronate (Hyalgan)
Ans:
A Feedback: Naproxen is effective in treating muscle pain, arthritis, and dysmenorrhea. Acetaminophen has no anti-inflammatory effects and would not be helpful for treating arthritis or dysmenorrhea other than some pain relief. Etanercept is useful only for treating rheumatoid arthritis; sodium hyaluronate is used to treat rheumatoid arthritis when other traditional treatment has been ineffective and the condition continues to worsen.
34 .
The nurse is teaching the patient, who has been newly prescribed etanercept (Enbrel), how to administer the medication. What statement is accurate?
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A)
Be sure to drink a whole glass of water when swallowing the pill.
B)
Do not take this medication for at least 1 hour after taking an antacid.
C)
You can use each of the subcutaneous injection sites to avoid tissue damage.
D)
Inject this medication deeply into the muscle to promote absorption.
Ans:
C Feedback: Etanercept is given by injecting it into the subcutaneous tissues. The injection sites should be rotated to avoid tissue damage. Because it is not taken orally, there is no requirement related to amount of water to be taken or waiting an hour after taking an antacid. Etanercept is not injected into the muscle but rather into the subcutaneous tissue.
35 .
The pediatric patient has a fever and the nurse is preparing to administer an antipyretic. What drug would be the best choice for this patient?
A)
Balsalazide (Colazal)
B)
Naproxen (Naprosyn)
C)
Indomethacin (Indocin)
D)
Aspirin
Ans:
B Feedback: Naproxen is approved for pediatric use and has antipyretic properties. Balsalazide is used to treat ulcerative colitis and would not be appropriate for treating a fever. Indomethacin has anti-inflammatory effects but does not have antipyretic effects. Aspirin would not be appropriate for treating a child with a fever of unknown origin due to risk of Reyes syndrome.
Chapter 37. Hypothalamic & Pituitary Hormones 1.
A patient suspected of having Cushings disease comes to the clinic. What drug might the nurse administer to test for adrenal function and responsiveness?
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A)
Corticotropin
B)
Menotropins
C)
Thyrotropin alfa
D)
Chorionic gonadotropin
Ans:
A Feedback: Corticotropin (ACTH) and cosyntropin are used for diagnostic purposes to test adrenal function and responsiveness. Menotropin is a purified preparation of gonadotropins and is used as a fertility drug. Thyrotropin alfa is used as adjunctive treatment for radioiodine ablation of thyroid tissue remnants in patients who have undergone a near-total to total thyroidectomy for welldifferentiated thyroid cancer and who do not have evidence of metastatic thyroid cancer. Chorionic gonadotropin acts like luteinizing hormone and stimulates the production of testosterone and progesterone.
2.
A nurse is working at a fertility clinic. Today she is administering ganirelix acetate (Antagon) to a woman participating in a fertility research program. By what route is this drug administered?
A)
Orally
B)
Subcutaneously
C)
Intramuscularly
D)
IV
Ans:
B Feedback: Ganirelix acetate (Antagon) is administered subcutaneously and cannot be administered orally, intramuscularly, or intravenously.
3.
A patient is taking leuprolide (Lupron) to treat prostatic cancer. The nurse caring for this patient is careful to monitor for what?
A)
Diarrhea
B)
Urinary retention
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C)
Peripheral edema
D)
Increased appetite
Ans:
C Feedback: Peripheral edema is an identified adverse effect of leuprolide therapy. Constipation not diarrhea; urinary frequency not urinary retention; and anorexia not increased appetite are also identified adverse effects.
4.
After administering somatropin (Saizen) to an 11-year-old patient with growth failure, what outcome would indicate that the drug should be stopped?
A)
Early sexual development
B)
Thyroid overactivity
C)
Closure of the epiphyses in long bones
D)
Gynecomastia
Ans:
C Feedback: Closure of the epiphyses is a sign that the drug should be stopped. Early sexual development, thyroid overactivity, and gynecomastia would not be associated with this drug.
5.
The nurse administers desmopressin (DDAVP) to the patient to treat diabetes insipidus. What assessment finding would indicate to the nurse that the desmopressin is producing a therapeutic effect?
A)
Decreased urine output
B)
Decreased water reabsorption
C)
Increased plasma osmolarity
D)
Decreased blood volume
Ans:
A Feedback:
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Desmopressin produces its antidiuretic activity in the kidneys, causing the cortical and medullary parts of the collecting duct to become permeable to water, thereby increasing water reabsorption and decreasing urine formation. These activities reduce plasma osmolarity and increase blood volume. 6.
A patient with diabetes insipidus is taking desmopressin (DDAVP). He or she is complaining of drowsiness, lightheadedness, and headache. What does the nurse suspect that he is experiencing?
A)
An allergic reaction
B)
Dehydration
C)
Depression
D)
Water intoxication
Ans:
D Feedback: The adverse effects associated with the use of desmopressin include water intoxication (drowsiness, light-headedness, headache, coma, convulsions) related to the shift to water retention and resulting electrolyte imbalance. An allergic reaction, dehydration, or depression would not be associated with these symptoms and desmopressin.
7.
What drug would the nurse expect to administer to an AIDS patient with cachexia?
A)
Bromocriptine (Parlodel)
B)
Somatropin (Saizen)
C)
Desmopressin (DDAVP)
D)
Leuprolide (Lupron)
Ans:
B Feedback:
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Indications for somatropin therapy include cachexia, long-term treatment of children with growth failure associated with various deficiencies, girls with Turners syndrome, AIDS-related wasting, growth hormone deficiency in adults, and treatment of growth failure in children of small gestational age who do not achieve catch-up growth by 2 years of age. Bromocriptine mesylate is indicated for the treatment of Parkinsons disease, hyperprolactinemia associated with pituitary adenomas, female infertility associated with hyperprolactinemia, and acromegaly; and short-term treatment of amenorrhea or galactorrhea. Desmopressin is indicated for the treatment of neurogenic diabetes insipidus and hemophilia A. Leuprolide is used as an antineoplastic agent for treatment of specific cancers. 8.
What symptoms will the nurse instruct the patient taking octreotide (Sandostatin) to report to the health care provider?
A)
Abdominal pain
B)
Alteration in consciousness
C)
Changes in vision
D)
Muscle cramps
Ans:
A Feedback: Octreotide and lanreotide have commonly been associated with the development of acute cholecystitis, cholestatic jaundice, biliary tract obstruction, and pancreatitis, which would present with abdominal pain, so patients should be taught to report this symptom. The drug is not associated with alteration in consciousness, changes in vision, or muscle cramps.
9.
The nurse has been caring for a child who has been receiving growth hormone therapy for several years. When the child returns for evaluation following a sudden growth spurt, what nursing diagnosis will the nurse add to the plan of care?
A)
Disturbed body image
B)
Deficient knowledge regarding drug therapy
C)
Imbalanced nutrition: Less than body requirements related to metabolic changes
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D)
Risk for disproportionate growth
Ans:
C Feedback: A child who is taking growth hormone may experience sudden growth, which will require increased nutritional intake, so it is important to include nutritional needs in the plan of care. More than likely an increase in caloric intake and nutrients will be necessary. Most children who are small for their age see growth as a positive thing and not a disturbed body image. After taking the drug for several years, the patient should have received adequate teaching from the nurse ot make deficient knowledge unlikely. The child should not be at risk for, but have a diagnosis of, disproportionate growth as the reason for taking the medication.
10 .
The nurse receives an order to administer leuprolide 5 mcg/kg subcutaneously to a child with precocious puberty. The child weighs 30 kg. What is the correct dosage for this child?
A)
150 mcg
B)
6 mcg
C)
68 mcg
D)
330 mcg
Ans:
A Feedback: Multiply the childs weight times the mg/kg: 30 5 = 150 mcg/dose.
11 .
The nurse is caring for a patient with infertility related to hyperprolactinemia. What drug would the nurse recognize was ordered to treat this problem?
A)
Bromocriptine mesylate
B)
Somatropin
C)
Leuprolide
D)
Desmopressin
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Ans:
A Feedback: Bromocriptine mesylate is indicated for the treatment of female infertility associated with hyperprolactinemia. Somatropin is indicated for the treatment of growth failure, Turners syndrome, AIDS wasting and cachexia, and growth hormone deficiency in adults. Leuprolide is used as antineoplastic agent for treatment of specific cancers and for treatment of endometriosis and precocious puberty that results from hypothalamic activity. Desmopressin is used for the treatment of neurogenic diabetes insipidus, von Willebrands disease, hemophilia; and is currently being studied for the treatment of chronic autonomic failure.
12 .
A child weighing 14.5 kg has von Willebrands disease. How much desmopressin (DDAVP) should be administered?
A)
4.4 mcg
B)
9.6 mcg
C)
10.3 mcg
D)
21.1 mcg
Ans:
A Feedback: The normal dosage of desmopressin used to treat von Willebrands disease is 0.3 mcg/kg. Multiply this dosage times the childs weight: 14.5 kg 0.3 g = 4.4 g.
13 .
What is the purpose of releasing hormones secreted by the hypothalamus?
A)
Stimulating or inhibiting release of hormones from the pituitary
B)
Stimulating organs within the body to secrete hormones
C)
Allowing the secretion of hormones from the hypothalamus
D)
Stimulating other glands to release hormones
Ans:
A
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Feedback: The hypothalamus uses various hormones or factors to either stimulate or inhibit the release of hormones from the anterior pituitary. These do not stimulate other organs, the hypothalamus, or other glands to release hormones. 14 .
A 48-year-old patient with acromegaly is not a candidate for other therapy. What medication, administered subcutaneously, would the nurse caring for the patient expect the physician to order?
A)
Gonadorelin hydrochloride (Factrel)
B)
Octreotide (Sandostatin)
C)
Nafarelin (Synarel)
D)
Gonadorelin acetate (Lutrepulse)
Ans:
B Feedback: Octreotide (Sandostatin) is a treatment for acromegaly in adults who are not candidates for, or cannot tolerate, other therapy. Gonadorelin hydrochloride, nafarelin, and gonadorelin acetate are not indicated for treating acromegaly.
15 .
A patient is brought to the emergency department after a motor vehicle accident. The patient is hemorrhaging, indicating that which hormone is being secreted to restore blood volume?
A)
Growth hormone (GH)
B)
Follicle-stimulating hormone (FSH)
C)
Antidiuretic hormone (ADH)
D)
Adrenocorticotropic hormone (ACTH)
Ans:
C Feedback: ADH possesses antidiuretic, hemostatic, and vasopressor properties. During hemorrhage, GH, FSH and ACTH are not involved in blood volume restoration.
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16 .
The nurse administers somatropin to a child with impaired growth due to a deficiency of endogenous growth hormone during what period of growth and development?
A)
Before the start of elementary school
B)
Any time before age 18
C)
Before the child reaches 5 feet in height
D)
Before epiphyses close
Ans:
D Feedback: Somatropin is contraindicated in the presence of closed epiphyses so the drug can be given at any time before closure of the epiphyses. Age and height are not an indication impacting when the drug is given so long as the epiphyses remain open.
17 .
The nurse would teach a patient receiving octreotide for acromegaly of the importance of baseline and periodic what?
A)
Ultrasound evaluation of the gallbladder
B)
Magnetic resonance imaging (MRI) of the brain
C)
Serum glucose levels
D)
Complete blood counts
Ans:
A Feedback: Arrange for baseline and periodic ultrasound evaluation of the gallbladder for patients receiving octreotide because common adverse effects of the drug are acute cholecystitis, cholestatic jaundice, biliary tract obstruction, and pancreatitis. A patient taking octreotide does not need baseline and periodic MRIs of the brain, serum glucose levels, or complete blood counts.
18 . A)
The nurse is caring for a patient with neurogenic diabetes insipidus and administers what drug to treat the condition? Dexamethasone (Decadron)
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B)
Desmopressin (DDAVP, Stimate)
C)
Methylprednisolone (Solu-Medrol)
D)
Physostigmine (Antilirium)
Ans:
B Feedback: Synthetic preparations of antidiuretic hormone (ADH), which are purer and have fewer adverse effects, are used to treat diabetes insipidus. Only one ADH preparation is currently available, desmopressin. Dexamethasone, methylprednisolone, and physostigmine would not be indicated for treatment of this disorder.
19 .
The nurse transcribes an order for menotropin (Pergonal), which will be administered to have what effect?
A)
Promote development of secondary sex characteristics
B)
Induce ovulation
C)
Promote bone growth
D)
Treat diabetes insipidus
Ans:
B Feedback: Menotropin (Pergonal) is used as fertility drug to stimulate ovulation and spermatogenesis. Pergonal is not used to promote the development of secondary sex hormones, to promote bone growth, or to treat diabetes insipidus.
20 .
The nurse administers desmopressin to treat a patient with diabetes insipidus. Assessment of what laboratory studies would indicate the drug is working?
A)
Increased serum sodium levels
B)
Increased red blood cell count
C)
Decreased urine specific gravity
D)
Reduced urine glucose levels
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Ans:
A Feedback: Patients with diabetes insipidus (DI) produce large amounts of dilute urine with a decrease in serum sodium levels. Administering desmopressin would reduce urine output and allow sodium levels to rise. Urine specific gravity would increase as the urine production slows and urine becomes more concentrated. There is no impact on red blood cell production with diabetes insipidus or its treatment. The urine of a patient with DI does not contain glucose.
21 .
The nurse would administer desmopressin (DDAVP) cautiously, with careful monitoring, to the patient with what co-morbidity? (Select all that apply.)
A)
Hyponatremia
B)
Asthma
C)
Severe renal dysfunction
D)
Gastrointestinal (GI) disease
E)
Epilepsy
Ans:
A, B, E Feedback: Caution should be used with any known vascular disease because of its effects on vascular smooth muscle, epilepsy, asthma, and with hyponatremia, which could be exacerbated by the effects of the drug. The drug is contraindicated and should not be used in patients with severe renal dysfunction. GI disease is not a caution or contraindication.
22 .
The nurse is caring for a 25-year-old female patient who is receiving chorionic gonadotropin alfa. What would be an appropriate nursing diagnosis for this patient?
A)
Anxiety related to injection of medication
B)
Acute pain related to need for injections
C)
Imbalanced nutrition: More than body requirements
D)
Evaluate effectiveness of the teaching plan
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Ans:
B Feedback: Nursing diagnoses related to drug therapy might include acute pain related to need for injections. Not all patients are anxious at the thought of an injection so more information would be needed. The patient is more likely to have reduced nutritional intake because of gastrointestinal (GI) adverse effects. Evaluating the effectiveness of the teaching plan is not a nursing diagnosis.
23 .
When providing patient teaching to the family of a 12-year-old child receiving Somatropin, the nurse stresses the need to notify prescriber if what manifestation occurs?
A)
Severe hip or knee pain
B)
Development of a bruise
C)
Severe hypertension
D)
Tachycardia
Ans:
A Feedback: The adverse effects that most often occur when using a growth hormone (GH) include the development of antibodies to GH and subsequent signs of inflammation and autoimmune-type reactions, such as swelling and joint pain, and the endocrine reactions of hypothyroidism and insulin resistance. It would not be necessary to notify the physician for development of a bruise. The health care provider should always be notified if a patient develops severe hypertension or tachycardia but this would not be related to administration of somatropin so it would not be included in drug teaching.
24 .
What medication would the nurse expect the physician to prescribe as palliative treatment for advanced prostate cancer?
A)
Histrelin (Vantas)
B)
Ganirelix (Antagon)
C)
Nafarelin (Synarel)
D)
Somatropin (Nutropin)
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Ans:
A Feedback: Histrelin (Vantas) is used to provide palliative treatment for advanced prostate cancer. Nafarelin (Synarel) is used for treatment of endometriosis and precocious puberty; Ganirelix (Antagon) is used for inhibition of premature luteinizing hormone surge in women undergoing controlled ovarian stimulation as part of a fertility program; Somatropin (Nutropin) is used for treatment of children with growth failure due to lack of growth hormone or to chronic renal failure.
25 .
A 4-year-old is tested and found to have deficient growth hormone (GH). What does this condition cause?
A)
Gigantism
B)
Acromegaly
C)
Syndrome of inappropriate antidiuretic hormone (SIADH)
D)
Dwarfism
Ans:
D Feedback: GH deficiency in children results in short stature (dwarfism). Excess production of GH results in gigantism and acromegaly. SIADH is caused by excessive production of antidiuretic hormone.
26 .
What hormone does the posterior pituitary gland store and release?
A)
Antidiuretic hormone (ADH)
B)
Follicle-stimulating hormone (FSH)
C)
Growth hormone (GH)
D)
Thyroid stimulating hormone (TSH)
Ans:
A Feedback:
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The posterior pituitary stores two hormones produced in the hypothalamus: ADH, also known as vasopressin and oxytocin. The posterior pituitary does not store FSH, GH, or TSH. 27 .
For what purposes might the nurse administer a hypothalamic hormone? (Select all that apply.)
A)
Diagnostic testing
B)
Synthesis of growth factors
C)
Prevent aging
D)
Treating some forms of cancer
E)
Adjuncts in fertility programs
Ans:
A, D, E Feedback: The hypothalamic hormones are not all available for pharmacological purposes. Those available are used mostly for diagnostic testing, for treating some forms of cancer, or as adjunctive therapies in fertility programs. They would not be used to prevent aging or for the synthesis of growth factor.
28 .
The nurse is caring for a patient diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH) which the nurse recognizes is caused by what?
A)
Excessive secretion of antidiuretic hormone (ADH)
B)
Insufficient secretion of ADH
C)
Excessive secretion of androgens
D)
Insufficient secretion of antidepressants
Ans:
A Feedback: SIADH occurs with excessive secretion of ADH. Insufficient secretion of ADH causes diabetes insipidus. ADH is not related to androgenic or antidepressant actions.
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29 .
The nurse explains the role of the posterior pituitary gland is to do what?
A)
It synthesizes different hormones.
B)
It makes two hormones.
C)
It stores hormones.
D)
It controls most of the metabolic functions of the body.
Ans:
C Feedback: The posterior pituitary stores two hormones produced in the hypothalamus: antidiuretic hormone (ADH, also known as vasopressin) and oxytocin. The posterior pituitary is anatomically an extension of the hypothalamus and is composed mainly of nerve fibers. Although it does not manufacture any hormones itself, it stores and releases hormones synthesized in the hypothalamus. The hypothalamus of the brain and the pituitary gland interact together to control most metabolic functions of the body and to maintain homeostasis.
30 .
The nurse is caring for a patient receiving tolvaptan and digoxin. What drugdrug interaction will the nurse assess for when reviewing this patients laboratory results?
A)
Elevated serum sodium levels
B)
Reduced digoxin levels
C)
Elevated serum potassium levels
D)
Tolvaptan toxicity
Ans:
C Feedback: Tolvaptan should be used with care with digoxin, which could cause hyperkalemia, so the nurse must carefully monitor serum potassium levels. The combination of drugs would not cause reduced digoxin levels or tolvaptan toxicity. The indication for administering tolvaptan would be to treat hyponatremia, so an elevation in serum sodium levels to normal range would be an indication the drug was working but would not be a result of a drug-drug interaction.
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31 .
The nurse is caring for a patient who has been receiving long-term growth hormone treatment to stimulate growth. What diagnostic testing would the nurse expect to see ordered as a standard part of the treatment plan? (Select all that apply.)
A)
Blood sugar level
B)
Serum electrolytes
C)
X-ray of the long-bones
D)
Nasal examination
E)
Bone density studies
Ans:
A, B, C Feedback: Periodic radiography of the long bones, as well as monitoring of blood sugar levels and electrolytes, should be a standard part of the treatment plan for children who receive any of the hypothalamic or pituitary agents. There would be no indication for nasal assessment because growth hormone is not administered nasally. Bone density would not be impacted by these drugs.
32 .
What is the nurses priority assessment when administering hypothalamic or pituitary agents to older adults?
A)
Hydration and nutrition
B)
Balance and fall risk
C)
Cognitive function
D)
Urinary incontinence
Ans:
A Feedback: Older adults may be more susceptible to the imbalances associated with alterations in the endocrine system. They should be evaluated periodically during treatment for hydration and nutrition, as well as for electrolyte balance. These drugs would not be expected to impact balance, cognitive function, or to cause incontinence so these would not be the priority assessment.
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33 .
The mother of a child awaiting a renal transplant asks the nurse whether growth hormone could be effective for her child. What is the nurses best response?
A)
Growth hormone is only used to treat short stature in children who do not produce enough growth hormone naturally.
B)
Growth hormone has been used successfully in children with renal failure but there is a lot to consider and you should talk to the doctor about it.
C)
Administration of growth hormone requires frequent injections so it would be cruel for a child with existing medical problems.
D)
You do not want to use growth hormone if you do not have to. What would make you even think of something like that?
Ans:
B Feedback: Growth hormone therapy is used with children with renal failure but the decision carries risks as well as benefits so it is important for the mother to talk to the childs primary physician and nephrologist to get recommendations for its safety. It is not just used in children with inadequate growth hormone secretion. It is never correct for the nurse to castigate the mother for a question so telling her it would be cruel or that she should not use it if it is not essential would destroy the patient/nurse relationship.
34 .
The nurse is asked to explain how to administer somatropin (Saizen) to the mother of a 6-year-old. How would the nurse explain how this drug is administered?
A)
It requires only a very small needle and doesnt hurt much at all.
B)
There will no longer be any need to rotate sites because it uses a needleless system.
C)
This system will be used until your son gets older and is more tolerant of needles.
D)
This delivers a fine mist through the skin without needles and far less discomfort.
Ans:
D Feedback:
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Saizen uses the cool.click delivery system, which is a neon-colored, needlefree system that delivers the drug through the skin using a fine mist. Tests have shown a bioequivalency of this method with standard injection techniques, and the young patients who must use this drug are much less resistant to the dosing. There are no needles but site of injection still require rotation to avoid skin damage. The child does not have to go back to a needle system when he gets older. Chapter 38. Thyroid & Antithyroid Drugs 1.
The nurse is teaching the patient, newly diagnosed with Gravess disease, about the normal functioning of the thyroid gland. What hormone will the nurse tell the patient controls production and release of thyroid hormones?
A)
Thyrotropin-releasing hormone (TRH)
B)
Thyroid-stimulating hormone (TSH)
C)
Tetraiodothyronine
D)
Triiodothyronine
Ans:
B Feedback: Thyroid hormone production and release are regulated by the anterior pituitary hormone called thyroid-stimulating hormone (TSH). The secretion of TSH is regulated by thyrotropin-releasing hormone (TRH), a hypothalamic regulating factor. Tetraiodothyronine and triiodothyronine are thyroid hormones produced by the thyroid gland because of TSH stimulation.
2.
A child is diagnosed with hypothyroidism. The nurse anticipates an order for the drug of choice when treating children, which is what?
A)
Liothyronine (Cytomel)
B)
Liotrix (Thyrolar)
C)
Levothyroxine (Synthroid)
D)
Methimazole (Tapazole)
Ans:
C
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Feedback: Levothyroxine is the drug of choice in children because of its predictable bioavailability and reliability. Liothyronine and liotrix tend to have more adverse effects and, although they can be used in children, are not the drugs of choice. Methimazole is an antithyroid drug and is used to treat hyperthyroidism. 3.
A patient is at risk for thrombosis formation and is taking an oral anticoagulant. The patient has been newly diagnosed with hypothyroidism and placed on levothyroxine (Synthroid). What will the nurse monitor the patient for?
A)
Tachycardia
B)
Elevated body temperature
C)
Increased time spent sleeping
D)
Increased bruising and bleeding
Ans:
D Feedback: The effectiveness of an oral anticoagulant is increased if it is used in combination with a thyroid hormone. This may lead to increased bleeding and the need to decrease the dosage of the oral anticoagulant. Tachycardia would be found with hyperthyroidism and the effect of levothyroxine is not increased with the drug combination. Increased time spent sleeping would indicate lowering of thyroid function and the treatment should increase thyroid function. Increased body temperature is associated with hyperthyroidism.
4.
The nurse is providing patient teaching regarding the administration of levothyroxine (Synthroid). What is the nurses priority teaching point?
A)
Take the medication after breakfast.
B)
Take the medication with a full glass of water.
C)
Remain in the upright position for 30 minutes after administering.
D)
Take the medication before going to bed at night.
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Ans:
B Feedback: The patient should be instructed to take the medication with a full glass of water to help prevent difficulty swallowing and esophageal atresia. The medication should be taken on an empty stomach before breakfast. There is no need to maintain an upright position. The medication should be taken as a single daily dose before breakfast each day to ensure consistent therapeutic levels.
5.
The nurse instructs the patient with a new prescription to treat hyperthyroidism and includes the importance of regular lab studies to monitor for bone marrow suppression, which can be an adverse effect of this drug. What drug is the nurse teaching the patient about?
A)
Methimazole (Tapazole)
B)
Propylthiouracil (PTU)
C)
Sodium iodide I131 (Generic)
D)
Potassium iodide (Thyro-Block)
Ans:
A Feedback: Methimazole is associated with bone marrow suppression, so the patient using this drug must have frequent blood tests to monitor for this effect. Propylthiouracil is associated with GI effects. The most common adverse effect of sodium iodide I131 and potassium iodide is hypothyroidism. Other effects of these two drugs include metallic taste and burning in the mouth, sore teeth and gums, diarrhea, cold symptoms, stomach upset, stained teeth, rash, and the development of goiter.
6.
A patient is seen in the clinic and diagnosed with hyperthyroidism. Potassium iodide is prescribed. The nurse reviews the patients medical record before administering the drug. What assessment finding would cause the nurse to alter the plan of care?
A)
A daily walk of 3 miles a day
B)
A low fat, low sodium diet
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C)
A bowel movement every 2 to 3 days
D)
Digoxin 0.125 mg daily
Ans:
D Feedback: Potassium iodide will cause the patient to move from hyperthyroidism to hypothyroidism, thus altering the patients metabolism. Digoxin has a small margin of safety that could be altered by a change in thyroid function. The patient will need to be monitored carefully for an alteration in digoxin effects that may include an increased heart rate, arrhythmia, or reduced cardiac output. A daily walk of 3 miles, a low fat, low sodium diet, and a bowel movement every 2 to 3 days are important for maintenance of a healthy lifestyle but would not alter the plan of care.
7.
A patient with Pagets disease calls the clinic and tells the nurse that she is experiencing flushing of the face and hands and a rash. The patient states that she is taking calcitonin, salmon (Calcimar) for her Pagets disease. What is the nurses best response?
A)
We expected this to happen. Just ignore it and please do not worry about it.
B)
You will need to see the doctor immediately. Come in as soon as possible.
C)
This is a common adverse effect of your medication that will lessen with time.
D)
This is a serious adverse effect. Stop taking the drug and see the doctor today.
Ans:
C Feedback: The most common adverse effects seen with this drug include flushing of the face and hands, rash, nausea and vomiting, urinary frequency, and local inflammation at the site of injection. Many of these adverse effects lessen with time, the duration varying with each individual patient. Although it is an expected adverse effect, the nurse needs to provide more teaching instead of simply telling the patient to ignore it and to not worry. The patient does not need to be seen and this is not a serious adverse effect.
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8.
The nurse is teaching the patient with a new prescription for ibandronate (Boniva) how to take the medication. Which instruction provided by the nurse is correct?
A)
Take 150 mg once a month on the same day of the month.
B)
Take 70 mg once a week on the same day of the week.
C)
Take 400 mg/d.
D)
Take 3 mg once per month on the same day of the month.
Ans:
A Feedback: Ibandronate can be taken daily, monthly, or every 3 months. Taking 150 mg orally once a month on the same day of the month would be correct. If given IV every 3 months, the dose is 3 mg and if taken daily, the dose is 2.5 mg/d. All other options are incorrect.
9.
The nurse admits an elderly patient in thyroid crisis for whom surgery is not an option. What antithyroid drug would the nurse expect will be ordered?
A)
Methimazole (Tapazole)
B)
Radioactive iodine (Generic)
C)
Propylthiouracil (PTU)
D)
Potassium iodide (Thyro-Block)
Ans:
B Feedback:
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If antithyroid agents are needed in the older adult patient, sodium iodide I131 may be the drug of choice because it has fewer adverse effects than the other agents. The use of sodium iodide is reserved for those patients who are not candidates for surgery, women who cannot become pregnant, and elderly patients with such severe, complicating conditions that immediate thyroid destruction is needed. Radioactive iodine targets the thyroid cells and destroys them without many adverse effects. Methimazole and propylthiouracil are antithyroid drugs but have cardiovascular adverse effects that might be unacceptable in an elderly patient who is not a candidate for surgery. Effects of potassium iodide are short-lived and may precipitate further thyroid enlargement and dysfunction so they would not be used in a patient who is not a candidate for surgery because they would not provoke long-term effects.
10 .
The nurse is providing care for a man diagnosed with osteoporosis. What drug will the nurse administer that is the only drug approved for treatment in men?
A)
Etidronate (Didronel)
B)
Pamidronate (Aredia)
C)
Tiludronate (Skelid)
D)
Alendronate (Fosamax)
Ans:
D Feedback: Alendronate is the only bisphosphonate that has been approved for the treatment of osteoporosis in men. Etidronate is used to treat Pagets disease, postmenopausal osteoporosis, and heterotopic ossification. Pamidronate is used to treat Pagets disease, postmenopausal osteoporosis in women, hypercalcemia of malignancy, and osteolytic bone lesions in cancer patients. Tiludronate is used to treat Pagets disease that is not responsive to other treatment.
11 .
What assessment findings would the nurse expect to see in a patient who overdosed on levothyroxine (Synthroid)?
A)
Nervousness, tachycardia, tremors
B)
Somnolence, bradycardia, paresthesia
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C)
Hyperglycemia, hypertension, edema
D)
Buffalo hump, constipation, sodium loss
Ans:
A Feedback: More pronounced adverse effects of levothyroxine would be seen including tremors, headache, nervousness, palpitations, tachycardia, allergic skin reactions, diarrhea, nausea, vomiting. Somnolence, bradycardia, and paresthesia would be more likely with insufficient drug intake, which would cause hypothyroidism and other symptoms. Hyperglycemia, edema, buffalo hump, constipation, or sodium loss would not be associated with excess thyroid hormone.
12 .
After administering propylthiouracil (PTU), what effect would the nurse anticipate the drug will have in the patients body?
A)
To destroy part of the thyroid gland
B)
To inhibit production of thyroid hormone in the thyroid gland
C)
To suppress the anterior pituitary glands secretion of thyroid-stimulating hormone (TSH)
D)
To suppress the hypothalamuss production of thyrotropin-releasing hormone (TRH)
Ans:
B Feedback: PTU is a thioamide that acts by lowering thyroid hormone levels by preventing the formation of thyroid hormone in the thyroid cells, which lowers the serum levels of thyroid hormone. They also partially inhibit the conversion of thyroxine to triiodothyronine at the cellular level. Iodine solutions oversaturate thyroid cells and top production of thyroid hormone. Radioactive iodine destroys part of the thyroid gland. PTU does not impact production or secretion of TSH or TRH.
13 .
The nurse provides teaching regarding levothyroxine to a 55-year-old patient diagnosed with Hashimotos disease. What statement made by the patient does the nurse interpret to mean that the drug teaching had been understood?
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A)
I can take this medication at any time of day.
B)
I should take this medication on an empty stomach in the morning.
C)
I may take this with a sip of water in the morning.
D)
If I feel nauseated, I may take this drug with an antacid.
Ans:
B Feedback: Adults who require thyroid replacement therapy need to understand that this will be a lifelong need. An established routine of taking the tablet first thing in the morning may help the patient comply with the drug regimen. The drug should be taken on an empty stomach with a full glass of water. Antacids would slow or prevent absorption of the hormone replacement, so the patient should be corrected.
14 .
The nurse, developing a care plan for a patient diagnosed with hypothyroidism, creates what appropriate nursing diagnosis?
A)
Imbalanced nutrition: Less than body requirements
B)
Ineffective thermoregulation: Excess or ineffective airway clearance
C)
Decreased cardiac output
D)
Ineffective airway clearance
Ans:
C Feedback: Decreased cardiac output is related to hypothyroidism. Hyperthyroidism results in increased caloric needs and the nursing diagnosis of Imbalanced nutrition: Less than body requirements. Thyroid dysfunction would not normally result in Ineffective thermoregulation: Excess or ineffective airway clearance.
15 .
The nurse is caring for a 5-year-old child diagnosed with hypothyroidism whose mother voices skepticism about giving the child drugs. In explaining the need for medication, what will the nurse tell this mother could result if her daughters condition remains untreated so she can make an informed decision?
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A)
Mental retardation
B)
Renal dysfunction
C)
Immune deficiency
D)
Paralytic ileus
Ans:
A Feedback: Children who are born without a thyroid gland or who have a nonfunctioning gland develop a condition called cretinism. If untreated, these children will have poor growth and development and mental retardation because of the lack of thyroid hormone stimulation. The child would not be at increased risk of renal dysfunction, immune deficiency, or paralytic ileus.
16 .
A patient is diagnosed with a simple goiter and asks the nurse what caused it. What is the nurses best response?
A)
A goiter is the result of too much thyroxine.
B)
A goiter is the result of a chloride deficiency.
C)
A goiter is the result of too much TSH.
D)
A goiter is the result of an iodine deficiency.
Ans:
C Feedback: Goiter (enlargement of the thyroid gland) is an effect of hyperthyroidism, which occurs when the thyroid is overstimulated by thyroid stimulating hormone (TSH). This can happen if the thyroid gland does not produce sufficient thyroid hormones to turn off the hypothalamus and anterior pituitary. In the bodys attempt to produce the needed amount of thyroid hormone, the thyroid is continually stimulated by increasing levels of TSH. There is a deficiency of thyroxine. It is not related to chloride or iodine deficiencies.
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17 .
The patient with hypothyroidism takes levothyroxine daily and has triiodothyronine (T3), thyroxine (T4), and thyroid-stimulating hormone (TSH) levels drawn in the laboratory to check appropriateness of prescribed dosage. What results would the nurse analyze as indicating the need for a higher dosage of medication?
A)
Elevated TSH, elevated T3, and reduced T4 levels
B)
Reduced TSH, elevated T3 and T4 levels
C)
Elevated TSH, reduced T3 and T4 levels
D)
Reduced TSH, T3, and T4 levels
Ans:
C Feedback: TSH levels would be elevated to stimulate increased thyroid hormone secretion whereas T4 and T3 will be low, which indicates the need for a higher dosage of medication. If TSH level is low, it would indicate a reduction in dosage would be needed, particularly if T3 and T4 levels are elevated.
18 .
A patient presents at the clinic with complaints of weight loss despite an increased appetite. The nurse assesses this patient for what?
A)
Chronic thyroiditis
B)
Hypercalcemia
C)
Hypothyroidism
D)
Hyperthyroidism
Ans:
D Feedback: Hyperthyroidism is manifested by increased metabolism and energy usage. It is not manifested by chronic thyroiditis, hyperglycemia, or hypothyroidism.
19 . A)
What patient will the nurse assess most closely for secondary hyperparathyroidism? The 12-year-old patient with hypothyroidism
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B)
The 68-year-old patient with chronic renal failure
C)
The 35-year-old patient with diabetes mellitus
D)
The 48-year-old patient with hyperthyroidism
Ans:
B Feedback: Secondary hyperparathyroidism occurs most frequently in patients with chronic renal failure. Primary hyperparathyroidism occurs more often in women between 60 and 70 years of age. Although hyperparathyroidism can occur at any age, the patient with diabetes or thyroid disorder would not be at higher risk for the disorder.
20 .
What drug would the nurse appropriately administer to the patient to treat hypothyroidism?
A)
Teriparatide
B)
Methimazole
C)
Propylthiouracil
D)
Levothyroxine
Ans:
D Feedback: Levothyroxine (Synthroid, Levoxyl, Levothroid), a synthetic salt of thyroxine, is the most frequently used replacement hormone to treat hypothyroidism because of its predictable bioavailability and reliability. Propylthiouracil and methimazole would be used to treat hyperthyroidism; teriparatide is an antihypocalcemic agent.
21 .
The nurse is caring for a patient with a history of myocardial infarction and heart failure. What thyroid replacement drug would the nurse question if ordered?
A)
Liothyronine
B)
Levothyroxine
C)
Thyroid desiccated
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D)
Methimazole
Ans:
A Feedback: Liothyronine and liotrix have a greater incidence of cardiac adverse effects and are not recommended for use in patients with potential cardiac problems or patients who are prone to anxiety reactions. Levothyroxine would be the drug of choice and thyroid desiccated would not be contraindicated. Methimazole is a treatment for hyperthyroidism and would not be appropriate for the patient with hypothyroidism.
22 .
The nurse is caring for a patient newly diagnosed with hypothyroidism. The patient also takes theophylline to control asthma symptoms. What changes will need to be made to the patients theophylline dose?
A)
Decrease theophylline dosage immediately.
B)
Increase theophylline dosage immediately.
C)
Increase theophylline dose when normal thyroid function returns.
D)
Decrease theophylline dose when normal thyroid function returns.
Ans:
B Feedback: Theophylline clearance is decreased in hypothyroid states. As the patient approaches normal thyroid function, theophylline dose may need to be adjusted frequently. As the drug is cleared more quickly, the dosage may need to be increased.
23 .
The nurse is caring for a 57-year-old woman who is complaining about gaining so much weight after menopause and suggests that thyroid hormone replacement would help her lose weight and speed up her metabolism. What is the nurses best response?
A)
Inducing a state of hyperthyroidism would result in weight loss.
B)
People who are not hypothyroid should not take thyroid hormones.
C)
People who take thyroid hormones without cause will end up damaging their heart.
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D)
The body compensates for the extra hormone by reducing the amount secreted.
Ans:
D Feedback: Taking thyroid hormone with normal thyroid function results in disruption of the hypothalamicpituitarythyroid control resulting in decreased production of thyrotropin-releasing hormone (TRH) and thyroid-stimulating hormone (TSH) as the hypothalamus and pituitary sensed the rising levels of thyroid hormone. Because the thyroid was no longer stimulated to produce and secrete thyroid hormone, thyroid levels would actually fall. This would put the patient at greater risk of gaining weight. There is no evidence it would cause heart damage. Because thyroid hormone production is reduced, a state of hyperthyroidism is not induced. Even though the statement that people who are not hypothyroid should not take thyroid hormones is correct, it does not provide enough information to dissuade this patient from a dangerous practice.
24 .
The patient is 8 weeks pregnant and requires an antithyroid medication. The nurse identifies what drug as the drug of choice for this patient?
A)
Propylthiouracil
B)
Radioactive iodine
C)
Alendronate
D)
Methimazole
Ans:
A Feedback: If an antithyroid drug is essential during pregnancy, propylthiouracil (PTU) is the drug of choice because it is less likely to cross the placenta and cause problems for the fetus. Radioactive agents should not be used. Bisphosphonates should be used during pregnancy only if the benefit to the mother clearly outweighs the potential risk to the fetus. Methimazole is an antithyroid medication but would not be the drug of choice for the pregnant woman.
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25 .
The nurse is discharging a patient with a new prescription for levothyroxine. What would the nurse teach the patient to report to her health care provider? (Select all that apply.)
A)
Nervousness
B)
Insomnia
C)
Chest pain
D)
Loss of hair
E)
Nausea
Ans:
A, B, C Feedback: Report chest pain, heart palpitations, nervousness, or insomnia. These adverse effects result from excessive stimulation and may indicate that drug dosage or intake of other stimulants needs to be reduced. Loss of hair is usually only seen in the first few months of therapy in children; nausea need not be reported unless it is persistent or interferes with adequate caloric intake.
26 .
The nurse tells the patient his or her serum calcium level is elevated and the patient asks what controls calcium levels in the body. What is the nurses best response?
A)
Renin
B)
Parathyroid hormone (PTH)
C)
Thyroid-stimulating hormone (TSH)
D)
Epoetin
Ans:
B Feedback: PTH is the most important regulator of serum calcium levels in the body. Renin controls blood pressure, epoetin stimulates production of red blood cells, and TSH stimulates thyroid hormone secretion.
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27 .
The nurse is caring for a patient diagnosed with hyperparathyroidism who asks the nurse why parathyroid hormone (PTH) is important. The nurse explains that PTH performs what actions in the body? (Select all that apply.)
A)
Stimulation of osteoclasts
B)
Increased intestinal absorption of calcium
C)
Stimulation of calcitriol production
D)
Increased excretion of calcium from kidneys
E)
Decreased retention of vitamin D
Ans:
A, B, C Feedback: PTH has many actions, including stimulation of osteoclasts or bone cells to release calcium from the bone, increased intestinal absorption of calcium, increased calcium reabsorption from the kidneys, and stimulation of cells in the kidney to produce calcitriol. PTH increases absorption of calcium from the kidney and increases retention of vitamin D.
28 .
The nurse is teaching the patient how to take his newly prescribed alendronate and includes what teaching points? (Select all that apply.)
A)
Take the drug in the morning.
B)
Wait 60 minutes before eating breakfast.
C)
Take the drug with a full glass of water.
D)
Remain upright for 30 minutes after taking the medication.
E)
Eat a breakfast high in calcium after taking the medication.
Ans:
A, C, D Feedback:
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Alendronate, ibandronate, and risedronate need to be taken on arising in the morning, with a full glass of water, fully 30 minutes before any other food or beverage, and the patient must then remain upright for at least 30 minutes; taking the drug with a full glass of water and remaining upright for at least 30 minutes facilitates delivery of the drug to the stomach. These drugs should not be given to anyone who is unable to remain upright for 30 minutes after taking the drug because serious esophageal erosion can occur. There is no need to eat a high-calcium breakfast, although the patient should make certain of adequate calcium intake. 29 .
The nurse is caring for an asthmatic patient prescribed zoledronic acid. What important question should the nurse ask this patient?
A)
Can you take aspirin without experiencing any bad effects?
B)
Are you taking theophylline to treat your asthma?
C)
Do you have a history of diarrhea?
D)
Are you taking digoxin?
Ans:
A Feedback: Zoledronic acid should be used cautiously in aspirin-sensitive asthmatic patients. Gastrointestinal (GI) distress may increase if bisphosphonates are combined with aspirin; this combination should, therefore, be avoided if possible. There is no drug interaction between theophylline and zoledronic acid or between digoxin and zoledronic acid. A history of diarrhea would not impact the ability to administer zoledronic acid.
30 .
The nurse is caring for a pediatric patient with hypercalcemia. What condition would the nurse suspect is causing this altered serum calcium level?
A)
Radiation injury
B)
Malignancy
C)
Kidney failure
D)
Hypothyroidism
Ans:
B
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Feedback: Hypercalcemia is relatively rare in children, although it may be seen with certain malignancies. It would not result from a radiation injury, which would be more likely to affect the thyroid gland and it would not be caused by kidney failure or hypothyroidism. 31 .
The nurse is caring for a patient who takes alendronate. What lab studies would the nurse assess regularly?
A)
Serum iodine
B)
Serum potassium
C)
Serum calcium
D)
Serum iron
Ans:
C Feedback: Alendronate and risedronate are commonly used drugs for osteoporosis and calcium lowering. Serum calcium levels need to be monitored carefully with any of the drugs that affect calcium levels. Administration of alendronate would not require monitoring of iodine, potassium, or iron levels.
32 .
The patient, newly prescribed cinacalcet hydrochloride (Sensipar), asks the nurse how this drug works. What is the nurses best response?
A)
It slows or blocks bones resorption of calcium.
B)
It promotes entry of calcium into bone.
C)
It balances the effects of parathyroid hormone to lower serum calcium levels.
D)
It increases the receptors sensitivity to extracellular calcium.
Ans:
B Feedback:
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Cinacalcet hydrochloride is a calcimimetic drug that increases the sensitivity of the calcium-sensing receptor to activation by extracellular calcium. In increasing the receptors sensitivity, cinacalcet lowers parathyroid hormone (PTH) levels, causing a concomitant decrease in serum calcium levels. Bisphosphonates act to slow or block bone resorption; by doing this, they help to lower serum calcium levels, but they do not inhibit normal bone formation and mineralization. Calcitonins balance the effects of PTH by reducing calcium levels. Cinacalcet does not promote entry of calcium into the bone. 33 .
The nurse reviews the patients laboratory results and sees that the serum calcium level is acceptable as long as it is within what range?
A)
1 and 3 mg/dL
B)
4 and 6 mg/dL
C)
6 and 8 mg/dL
D)
9 and 11 mg/dL
Ans:
D Feedback: Calcium is an electrolyte that is used in many of the bodys metabolic processes. These processes include membrane transport systems, conduction of nerve impulses, muscle contraction, and blood clotting. To achieve all of these effects, serum levels of calcium must be maintained between 9 and 11 mg/dL. Other options are incorrect.
34 .
What electrolyte affects parathyroid hormone (PTH) secretion other than calcium?
A)
Magnesium
B)
Sodium
C)
Potassium
D)
Zinc
Ans:
A Feedback:
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Another electrolytemagnesiumalso affects PTH secretion by mobilizing calcium and inhibiting the release of PTH when concentrations rise above or fall below normal. Sodium, potassium, and zinc do not affect PTH function. 35 .
The nurse administers teriparatide (Forteo) and evaluates the drug as effective in achieving desired effects when what is assessed?
A)
Increase in serum calcium and phosphorous
B)
Increase in serum calcium and decrease in serum phosphorous
C)
Decrease in serum calcium and phosphorous
D)
Decrease in serum calcium and increase in serum phosphorous
Ans:
B Feedback: With once-daily administration, teriparatide stimulates new bone formation, leading to an increase in skeletal mass. It increases serum calcium and decreases serum phosphorous.
Chapter 39. Adrenocorticosteroids & Adrenocortical Antagonists 1.
The nurse administers fludrocortisone (Florinef) to a patient diagnosed with salt-losing adrenogenital syndrome and then assesses for what therapeutic action?
A)
Development of hypokalemia and elevated serum glucose level
B)
An increase in sodium and water reabsorption and potassium excretion
C)
Headache, edema, weakness, arrhythmias, and hypertension
D)
Sodium and water depletion along with potassium retention
Ans:
B Feedback: Fludrocortisones therapeutic effects include an increase in sodium and water reabsorption with potassium excretion. Headache, edema, weakness, arrhythmias, and hypertension are adverse, and not therapeutic, effects. Hypokalemia is possible but glucose levels should not be impacted.
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2.
When developing a plan of care for the patient receiving a glucocorticoid, what nursing diagnosis would be of highest priority?
A)
Deficient fluid volume related to water retention
B)
Risk for injury related to muscle weakness
C)
Imbalanced nutrition: less than body requirements
D)
Risk for infection related to immunosuppression
Ans:
D Feedback: Risk for infection related to immunosuppression would be the appropriate nursing diagnosis because steroids suppress the immune system, which puts the patient at risk for infection. Nutritional imbalance is more likely to be more than body requirements than less than body requirements. Excess fluid volume is more appropriate than deficient fluid volume. Glucocorticoids are not associated with muscle weakness.
3.
What glucocorticoids could the nurse only administer orally?
A)
Cortisone (Cortone Acetate)
B)
Hydrocortisone (Cortef)
C)
Prednisone (Deltasone)
D)
Triamcinolone (Aristocort)
Ans:
C Feedback: Prednisone is available in oral form only and is used for replacement therapy for adrenal insufficiency, and treatment of allergic and inflammatory disorders. Cortisone can be administered orally or intramuscularly and is used for replacement therapy. Hydrocortisone, used for replacement therapy, is administered by the oral, IV, intramuscular, topical, ophthalmic, rectal, and intra-articular routes. Triamcinolone is administered by the oral, intramuscular, inhalant, intra-articular, and topical routes and is used for treatment of allergic and inflammatory disorders and in the management of asthma.
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4.
The mother asks the nurse for a steroid cream to put on her infants diaper rash. What teaching will the nurse provide the mother? (Select all that apply.)
A)
Topical corticosteroids are very effective treatment for diaper rash.
B)
Topical corticosteroid application should not be occluded with a diaper.
C)
Topical corticosteroids should not be applied to open lesions.
D)
Use of topical corticosteroids should be limited in children.
E)
Topical corticosteroids should be applied in a thick coat to the rash.
Ans:
B, C, D Feedback: Topical use of corticosteroids should be limited in children because their body surface area is comparatively large and the amount of the drug absorbed in relation to weight is greater than in an adult. When the medication is used in children, it should be applied sparingly and the area should not be occluded with a diaper. The nurse should not make a judgment nor should he or she allow a patient or family member to dictate a treatment just because he or she wants it. More effective treatments for diaper rash than corticosteroids are available.
5.
An older adult patient taking high-dose corticosteroids to treat arthritis requests a pneumonia vaccine. What is the nurses best response?
A)
Pneumonia vaccines are only given if you are at risk for serious pulmonary problems.
B)
Live virus vaccines cannot be given to people who are significantly immunosuppressed.
C)
Patients taking corticosteroids are well protected from viruses and do not need vaccines.
D)
Corticosteroids interact with the pneumococcal vaccine to create serious adverse effects.
Ans:
B Feedback:
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Corticosteroids block the inflammatory response and are very helpful in conditions such as arthritis. However, they also block the immune response, making a person immunosuppressed. The vaccine would not be given to this patient because of the increased risk for infection. An older adult would be considered at high risk for pneumonia so getting the vaccine would be encouraged if not for taking corticosteroids. Corticosteroids do not protect against viruses. The vaccine is contraindicated because of risk for infection and not because of a potential drugdrug interaction. 6.
A patient who is steroid dependent due to adrenocortical insufficiency calls the clinic and is very upset, telling the nurse of the extreme stress he or she is experiencing right now. What does the nurse expect the health care provider will order concerning his or her medication?
A)
The dosage may continue as ordered.
B)
The medication may be discontinued until stress declines.
C)
The dosage of the medication may be increased.
D)
The dosage of the medication may be decreased.
Ans:
C Feedback: The patients body will initiate a stress reaction. Normally, activation of the stress reaction can cause release of adrenocorticotropic hormone (ACTH) and secretion of the adrenocortical hormones. A patient with adrenocortical insufficiency may not be able to supplement the increased need for ACTH. The stress reaction may block the immune and inflammatory systems, making the body more susceptible to pathogens. Therefore, an increase in medication may be necessary to prevent further adrenal insufficiency and to meet the increased demands for corticosteroids in the body under stress.
7.
A nurse is providing patient education to a patient who has had corticosteroids prescribed. What drug will the nurse teach the patient to avoid while taking the corticosteroids?
A)
Aspirin
B)
Dimenhydrinate (Dramamine)
C)
Ibuprofen (Advil)
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D)
Famotidine (Pepcid)
Ans:
A Feedback: Serum levels and effectiveness may decrease if corticosteroids are combined with salicylates. Dimenhydrinate, ibuprofen, and famotidine have not been found to produce drugdrug interaction.
8.
The nurse is caring for a patient with a heightened stress response following a fearful experience. When assessing this patient, what findings will the nurse attribute to this response? (Select all that apply.)
A)
Elevated serum blood glucose
B)
Reduced inflammatory response
C)
Heightened immune response
D)
Increased blood volume
E)
Extreme hunger
Ans:
A, B, D Feedback: The stress response causes an increase in blood volume and a release of glucose for energy. It also slows the rate of protein production and blocks the activities of the inflammatory and immune systems, which reserves energy. This patient is unlikely to be hungry.
9.
The nurse is providing patient education to a patient taking a glucocorticoid and advises the patient to take his or her medication at what time of the day?
A)
At bedtime
B)
With the noon meal
C)
At 3:00 PM
D)
Immediately on awakening in the morning
Ans:
D Feedback:
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Glucocorticoids should be taken immediately on awaking in the morning to mimic the normal diurnal pattern. The peak levels of cortisol usually come between 6:00 and 8:00 AM. The levels then fall off slowly and reach a low in the late evening with the lowest levels around midnight. For those patients who work night shifts, the schedule would be changed to accommodate their sleep pattern. Waiting until later in the day could result in sleeplessness. 10 .
An 8-year-old with asthma has been prescribed triamcinolone (Aristocort). What dosage of medication would the nurse appropriately deliver?
A)
One inhalation per day
B)
One inhalation b.i.d.
C)
Two inhalations every 3 hours
D)
Two inhalations t.i.d.
Ans:
D Feedback: Pediatric dosage is individualized based on severity and response. However, children between 6 and 12 years of age are prescribed one to two inhalations t.i.d. or q.i.d. The other options are incorrect based on the recommended dosage.
11 .
The nurse, caring for a patient experiencing stress, knows that activation of the stress reaction will cause the release of what?
A)
Glucose
B)
Aldosterone
C)
Adrenocorticotropic hormone (ACTH)
D)
Oxytocin
Ans:
C Feedback:
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Activation of the stress reaction through the sympathetic nervous system bypasses the usual diurnal rhythm and causes release of ACTH and secretion of the adrenocortical hormonesan important aspect of the stress (fight-orflight) response. Glucose will eventually be released to supply energy, but first ACTH and adrenocortical hormones must stimulate this response. Aldosterone can be released without ACTH stimulation when the blood surrounding the adrenal gland is high in potassium. This is a direct stimulus for aldosterone release. Oxytocin is released to promote the let-down reflex in the lactating woman and to stimulate uterine contractions but is not involved in the stress response.
12 .
The nurse is developing a plan of care for an 84-year-old diabetic patient who is receiving oral hydrocortisone 40 mg daily for treatment of arthritis. What is this patients priority nursing intervention?
A)
Increasing sodium in diet
B)
Restricting protein in diet
C)
Increasing fluids to 2,000 mL/d
D)
Monitoring blood glucose levels frequently
Ans:
D Feedback: Caution should be used in patients with diabetes because the glucoseelevating effects disrupt glucose control. More frequent blood sugar monitoring is this patients priority intervention. Sodium, protein, and fluid intake do not need to be altered.
13 .
A patient with adrenal insufficiency has been admitted to the intensive care unit in adrenal crisis. What assessment findings support this diagnosis? (Select all that apply.)
A)
Physiological exhaustion
B)
Hypertension
C)
Fluid shift
D)
Shock
E)
Septicemia
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Ans:
A, C, D Feedback: Symptoms of adrenal crisis include physiological exhaustion, hypotension, fluid shift, shock, and even death. Hypotension rather than hypertension would be expected. Septicemia is a possible cause of adrenal crisis, not a symptom.
14 .
The nurse is providing discharge teaching for a patient prescribed prednisone to be taken on alternate days. The patient asks why he cannot take half a pill every day. What is the nurses best response?
A)
To eliminate adverse side effects
B)
To prolong therapeutic effects
C)
To prevent steroid tolerance
D)
To decrease adrenal suppression
Ans:
D Feedback: Alternate-day maintenance therapy is used with short-acting drugs whenever possible to decrease the risk of adrenal suppression. Alternate-day therapy would not eliminate adverse effects or prolong therapeutic effects. There is no such thing as steroid tolerance.
15 .
The clinic nurse receives a call from the mother of a 4-year-old child on long-term corticosteroid therapy saying the child woke up with a cold and is pulling on his ear. What instructions will the nurse provide?
A)
Encourage fluids, monitor his temperature, and he will be better in 3 days.
B)
Take him to the emergency room (ER) immediately.
C)
Bring him to the clinic to be seen today.
D)
Hang up and call 911.
Ans:
C Feedback:
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Children receiving long-term therapy should be protected from exposure to infection. Special precautions should be instituted to avoid injury. If injuries or infections do occur, the child should be seen by a primary care provider as soon as possible. There is no need to treat this as an emergency so the mother need not rush the child to the ER or call 911, but she should be encouraged to have the child seen today at the clinic. It would not be appropriate to give home care instructions until he has been seen at the clinic. 16 .
When doing a shift assessment on the patient, the nurse would report what symptoms as a possible adverse effect of intranasal methylprednisolone? (Select all that apply.)
A)
Headache
B)
Impaired wound healing
C)
Epistaxis
D)
Hypotension
E)
Nasal irritation
Ans:
A, B, C, D, E Feedback: Intranasal administration of hydrocortisone can result in headache, nausea, nasal irritation, fungal infections, epistaxis, rebound congestion, perforation of the nasal septum, anosmia, and urticaria. Systemically administered hydrocortisone has many possible adverse effects including impaired wound healing and hypotension, but these would not be likely to be associated with intranasal administration of hydrocortisone.
17 .
The nurse is providing dietary teaching to the patient on long-term mineralocorticoid therapy and includes what teaching point?
A)
Decreasing sodium
B)
Increasing calcium
C)
Increasing vitamin D
D)
Increasing potassium
Ans:
D
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Feedback: Mineralocorticoids cause sodium and water retention and potassium excretion. These patients benefit from a diet with increased potassium. They would not decrease sodium intake as the drug is often administered for the purpose of increasing serum sodium levels. Calcium and vitamin D intake would be the same for this patient as any other patient of similar age and gender. 18 .
The nurse anticipates an order for a glucocorticoid when caring for a patient with what condition?
A)
Hypoglycemia
B)
Appendicitis
C)
Arthritis
D)
Septicemia
Ans:
C Feedback: Glucocorticoids are indicated for the short-term treatment of many inflammatory disorders, to relieve discomfort, and to give the body a chance to heal from the effects of inflammation. They block the actions of arachidonic acid, which leads to a decrease in the formation of prostaglandins and leukotrienes. Without these chemicals, the normal inflammatory reaction is blocked. Hypoglycemia would more safely be treated with glucose. Appendicitis and septicemia are infections that would contraindicate the use of glucocorticoids because of the immunosuppressant effects of the drugs.
19 .
The 2-year-old patient with asthma is placed on a short-term dose of prednisone. What important instruction will the nurse provide the patient about this drug?
A)
Increase intake of carbohydrates.
B)
The child may receive immunizations while on this drug.
C)
Do not stop this medication suddenly; you will have to taper dosage gradually.
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D)
Reduce intake of protein until drug therapy is complete.
Ans:
C Feedback: Prednisone is usually ordered for short-term use with tapering dosage. It is important to instruct the parent to taper doses and to not just stop the drug suddenly when discontinuing from high doses so as to give the adrenal glands a chance to recover and produce adrenocorticoids. This is the priority instruction. Parents should also be told to wait to get the child immunizations until after drug therapy is completed. There is no need to alter carbohydrate or protein intake.
20 .
When caring for a patient receiving long-term therapy with corticosteroids, the nurse would plan care incorporating interventions aimed at preventing what?
A)
Allergies
B)
Inflammation
C)
Infection
D)
Anemia
Ans:
C Feedback: When planning care for a patient taking long-term corticosteroid therapy, the nurse needs to incorporate interventions aimed at reducing risk of infection because the patients immune system will be suppressed, which places the patient at increased risk. The nurse would not try to prevent the antiinflammatory effects of the drug. The drug is not associated with causing allergies or anemia.
21 .
A 66-year-old female patient is on long-term oral glucocorticoid therapy to treat chronic obstructive pulmonary disease. When providing drug teaching, the nurse will inform this patient that she is at particular risk for what?
A)
Hyponatremia
B)
Spontaneous fractures
C)
Respiratory depression
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D)
Ineffective temperature regulation
Ans:
B Feedback: Only spontaneous fractures are considered an adverse effect of glucocorticoids; this patient would be at increased risk because her age and gender put her at higher risk for osteoporosis, which also has the adverse effect of spontaneous fractures. Long-term glucocorticoid therapy is not associated with hyponatremia, respiratory depression, or ineffective temperature regulation.
22 .
The nurse provides teaching to a patient with chronic obstructive pulmonary disease who has been prescribed budesonide (Pulmicort) two puffs and fluticasone (Flovent) three puffs t.i.d. The nurse evaluates that further teaching is needed when the patient makes what statement?
A)
Take all five puffs as quickly as possible.
B)
Replace the inhalers before they run out.
C)
Rinse the mouth after taking the medication.
D)
Continue medication even when symptoms start to subside.
Ans:
A Feedback: The nurse needs to review how to administer the drug via inhalation because the patient must hold the medication in the airways as long as possible before exhaling and should not try to rush the treatment. The other statements are correct and would not require clarification.
23 .
The home health nurse provides patient teaching to his or her patient who is taking oral prednisolone. The nurse provides what instruction to reduce the occurrence of nausea?
A)
Take with a meal.
B)
Take 1 hour before meals.
C)
Take before bedtime.
D)
Split the dose into two equal doses.
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Ans:
A Feedback: Steroids, taken on an empty stomach, would exacerbate the nausea. If the patient takes only one dose per day, it should be taken immediately after breakfast. If spaced throughout the day, eating something before taking the pill will reduce risk of nausea. Timing is dictated by frequency of administration, and if only taken once daily, the medication should be taken in the morning (so bedtime is inappropriate). Splitting the dose would decrease effectiveness and would be inappropriate for the nurse to suggest because it is outside the scope of nursing practice. Taking the medication before meals would mean it was being taken on an empty stomach.
24 .
What would be important for the nurse to teach the parents of a pediatric patient about the use of topical corticosteroids?
A)
Apply the medication sparingly.
B)
Apply directly to open lesions.
C)
After applying cover with a bandage.
D)
Reapply as often as needed to keep the rash coated with the medication.
Ans:
A Feedback: Topical use of corticosteroids should be limited in children, because their body surface area is comparatively large, so that the amount of the drug absorbed in relation to weight is greater than in an adult. Apply sparingly and do not use in the presence of open lesions. Do not occlude treated areas with dressings or diapers, which may increase the risk of systemic absorption.
25 .
The nurse is teaching the patient who will require long-term corticosteroid therapy how to reduce the risk of infection. What suggestions will the nurse include?
A)
Avoid large crowds of people tightly packed together.
B)
Avoid working in areas with other people.
C)
Avoid exercising to reduce risk of injury.
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D)
Avoid touching other people who may carry germs.
Ans:
A Feedback: With long-term therapy, the importance of avoiding exposure to infectioncrowded areas, people with colds or the flu, activities associated with injuryshould be stressed. If an injury or infection should occur, the patient should be encouraged to seek medical care. These patients do not need to avoid work, exercise, or touching others but they should use good hand hygiene to avoid infection from these sources.
26 .
The nurse is caring for an African American patient who received a kidney transplant and receives methylprednisolone for immunosuppression. What is the nurses priority assessment specific to this patient?
A)
Assessing capillary refill time
B)
Assessing cardiac rhythm
C)
Assessing white blood cell count
D)
Assessing blood glucose levels
Ans:
D Feedback: African Americans develop increased toxicity to the corticosteroid methylprednisoloneparticularly when it is used for immunosuppression after renal transplantation. This toxicity can include severe steroid-induced diabetes mellitus. A priority intervention with this patient is monitoring blood glucose levels. Assessment of capillary refill time and cardiac rhythm would not be indicated by the data supplied about this patient. White blood cell counts should be monitored on any patient receiving long-term corticosteroids but is not specific to this patient.
27 .
The nurse is caring for a patient who is diagnosed with protein-deficient malnutrition. Why would an order to administer androgens to this patient be appropriate?
A)
Androgens reduce the bodys requirement for protein.
B)
Androgens increase the bodys absorption of protein from the bowel.
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C)
Androgens stimulate protein production and decrease protein breakdown.
D)
Androgens reduce carbohydrate metabolism and promote lipid absorption.
Ans:
C Feedback: Androgens are a form of the male sex hormone called testosterone. They affect electrolytes, stimulate protein production, and decrease protein breakdown, which will help to reverse the patients protein malnutrition in addition to a high-protein diet. They do not reduce the bodys need for protein, increase protein absorption from the bowel, or impact carbohydrate and lipid metabolism.
28 .
The nurse is caring for a patient who works night shift from 2200 (10 pm) to 0600 (6 am) and normally sleeps from 0800 (8 am) until 1600 (4 pm) each day. The nurse would teach this patient to take his or her corticosteroid at what time of the day?
A)
06:00 (6 am)
B)
08:00 (8 am)
C)
16:00 (4 pm)
D)
22:00 (10 pm)
Ans:
C Feedback: If a person works all night and goes to bed at 8 am, arising at 4 pm to carry on the days activities before going to work at 10 pm, the hypothalamus will release corticotropin-releasing hormone at about 4 pm in accordance with the new sleepwake cycle. It usually takes 2 or 3 days for the hypothalamus to readjust. A patient on this schedule who is taking replacement corticosteroids would then need to take them at 4 pm, or on arising. All other options would not be optimal.
29 . A)
For what reason might a nurse administer androgen injections to a 9-year-old boy? Ovarian atrophy
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B)
Dwarfism
C)
Acromegaly
D)
Hypogonadism
Ans:
D Feedback: Androgens are used pharmacologically to treat hypogonadism or to increase protein growth and red blood cell production. Androgens are not used in a male to treat ovarian atrophy. Androgens are not used to treat dwarfism or acromegaly.
30 .
A patient is taking low-dose corticosteroids on a long-term basis for chronic obstructive pulmonary disease. The nurse assesses this patient knowing prolonged use of corticosteroids puts the patient at risk for what?
A)
Adrenal storm
B)
Adrenal atrophy
C)
Stunted growth
D)
Hypothalamic insufficiency
Ans:
B Feedback: Prolonged use of corticosteroids suppresses the normal hypothalamicpituitary axis and leads to adrenal atrophy from lack of stimulation. The other options are all distracters for this question with no connection to long-term use of corticosteroids.
31 .
The nurse administers prednisone orally at 8 am. When would the nurse expect the drug to reach peak effect?
A)
9 to 10 am
B)
12 to 1 pm
C)
8:30 to 9:00 am
D)
4 to 6 pm
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Ans:
A Feedback: Prednisones peak effect occurs 1 to 2 hours after administering the drug. If given at 8 am, the expected peak would occur between 9 and 10 am.
32 .
Nursing care for the postoperative patient requiring long-term glucocorticoid therapy will be directed at overcoming what adverse effect of the drug?
A)
Poor wound healing
B)
Inflammation
C)
Autoimmune response
D)
Lack of mobility
Ans:
A Feedback: Patients taking long-term glucocorticoid therapy will have impaired wound healing so nursing care is directed toward promoting healing. The drug has an anti-inflammatory effect so that would not need to be overcome. There is no autoimmune response or lack of mobility so these do not have to be overcome.
33 .
The nurse is teaching a class for his or her peers about glucocorticoids. What will the nurse say is initially blocked, resulting in the drugs antiinflammatory action?
A)
Arachidonic acid
B)
Phagocytes
C)
Lymphocytes
D)
Antibodies
Ans:
A Feedback:
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Glucocorticoids block the actions of arachidonic acid, which leads to a decrease in the formation of prostaglandins and leukotrienes. They also impair the ability of phagocytes to leave the bloodstream and move to injured tissues; they inhibit the ability of lymphocytes to act within the immune system, including blocking the production of antibodies. Blocking arachidonic acid is, however, the initial action. 34 .
What hormones does the adrenal medulla secrete?
A)
Renin and erythropoietin
B)
Norepinephrine and epinephrine
C)
Epinephrine and dopamine
D)
Dopamine and serotonin
Ans:
B Feedback: The adrenal medulla is actually part of the sympathetic nervous system (SNS). It is a ganglion of neurons that releases the neurotransmitters norepinephrine and epinephrine into circulation when the SNS is stimulated.
35 .
The adrenal cortex responds to adrenocorticotropic hormone (ACTH), which responds to corticotropin-releasing hormone (CRH) from the hypothalamus in a daily pattern called what?
A)
Pituitary rhythm
B)
hypothalamicpituitary axis
C)
Diurnal rhythm
D)
Circadian rhythm
Ans:
C Feedback:
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The adrenal cortex responds to ACTH released from the anterior pituitary. ACTH, in turn, responds to CRH released from the hypothalamus. This happens regularly during a normal day in what is called diurnal rhythm. Pituitary rhythm is a distracter; the term does not exist. The hypothalamicpituitary axis involves the interaction between the two glands. Circadian rhythm involves when people prefer to be most active, such as people who say they are morning people. Chapter 40. The Gonadal Hormones & Inhibitors 1.
The nurse is caring for a female patient who would like to start taking oral contraceptives. What assessment finding may indicate the patient is not a good candidate for these drugs?
A)
Decreased appetite
B)
Dehydration
C)
Occasional headaches
D)
History of deep vein thrombosis
Ans:
D Feedback: Estrogens are contraindicated in the presence of a history of thromboembolic disorders because of the increased risk of thrombus and embolus development. A loss of appetite would not contraindicate oral contraceptives but would require further assessment to determine the cause. Dehydration would require fluid administration to correct but is not a contraindication to oral contraceptives. Occasional headaches are not uncommon and would not contraindicate contraceptive use.
2.
The nurse is caring for a patient with an intact uterus who requests hormone replacement for short-term use to reduce menopausal symptoms. What combination drug would be appropriate for this patient?
A)
Estrace
B)
Premphase
C)
Premarin
D)
Estratab
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Ans:
B Feedback: The patient would be given Premphase because it is a combination of estrogen and progesterone. The combination is important to help avoid risk of endometrial hyperplasia. Estrace, Premarin, and Estratab contain only estrogen so they are not combination drugs.
3.
The nurse is caring for a patient who just had subdermal implantation of NuvaRing. As part of drug teaching, the nurse will tell the patient this implant needs to be removed when?
A)
3 months
B)
6 months
C)
1 year
D)
3 years
Ans:
D Feedback: Etonogestrel, in addition to being available as a vaginal ring, NuvaRing, is available as a subdermal implant that may be left in place for up to 3 years and then must be removed. Another implant could be placed at that time.
4.
A patient tells the nurse she is taking soy, calcium, and a multivitamin as an alternative to taking hormone replacement pills. What is the nurses priority response?
A)
Increase her iron supplement.
B)
Discontinue her calcium supplement.
C)
Decrease the amount of carbohydrates in her diet.
D)
Increase calcium supplementation.
Ans:
B Feedback:
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The nurse may advise the patient to stop using a calcium supplement because soy is not to be taken with calcium, iron, or zinc. However, the patient may have to decide whether it would be more beneficial for her to continue the calcium and discontinue the soy if osteoporosis is a concern. Decreasing carbohydrates is a healthy choice, especially for a menopausal woman, but would not be the priority concern. 5.
A patient with a seizure disorder taking phenytoin (Dilantin) requests a prescription for an oral contraceptive. What is the nurses priority response?
A)
The effect of oral contraceptives containing progestin is reduced by phenytoin.
B)
The effect of oral contraceptives containing progestin and estrogen is reduced by phenytoin.
C)
The effect of oral contraceptives containing estrogen is reduced by phenytoin.
D)
You will need to increase the dosage of your phenytoin once you start contraceptives.
Ans:
B Feedback: The effectiveness of oral contraceptives containing estrogen, progestin, or both will be reduced by phenytoin, so contraceptives will not be adequate to prevent pregnancy. There is no reason to change the dosage of phenytoin.
6.
A patient is using a progestin vaginal gel. What possible adverse effects should the nurse tell the patient about?
A)
Diarrhea
B)
Breast enlargement
C)
Abdominal pain
D)
Local skin irritation
Ans:
B Feedback:
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The use of a progestin vaginal gel is associated with breast enlargement. Constipation, not diarrhea, is also an adverse effect. Abdominal pain with progestin therapy is associated with the use of an intrauterine device for birth control, not a vaginal gel. Local skin irritation can result from use of a dermal patch contraceptive. 7.
The nurse is preparing to administer an infusion of oxytocin (Pitocin) to the pregnant patient. What is the priority assessment before beginning the infusion?
A)
Cervical dilation
B)
Cephalopelvic proportions
C)
Electrocardiogram readings
D)
Respiratory excursion
Ans:
B Feedback: Pitocin is used to stimulate labor and often results in intense uterine contractions. It is important that the nurse assess cephalopelvic proportions because a disproportion between the size of the baby and the size of the fetus could result in serious complications. Dilation may be well underway when oxytocin is started or may need to be initiated so this is not a priority assessment, although it would certainly be assessed. Respiratory excursion is expected to be limited in pregnant women because of the enlarged uterus pushing up on the diaphragm. Electrocardiogram readings should not be needed with most pregnant women unless the woman has a preexisting condition.
8.
A nurse is taking care of a woman receiving an abortifacient. The nurse is aware that the most serious adverse effect is what?
A)
Vomiting
B)
Nausea
C)
Uterine rupture
D)
Diarrhea
Ans:
C
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Feedback: All these options are adverse effects of abortifacients. However, the most serious adverse effect would be uterine rupture. A perforated uterus or uterine rupture can be life threatening and emergency measures must be taken. 9.
A 13-year-old teenage girl is started on oral contraceptives. When following this girl in the clinic, what is the nurses priority assessment?
A)
Closure of the epiphyses
B)
Menstrual patterns
C)
Nutrition
D)
Cognitive development
Ans:
B Feedback: A 13-year-old girl is still growing. Estrogens and progestins have undergone limited testing in children. Because of their effects on closure of the epiphyses, they should be used only with great caution in growing children. It is important for the nurse to monitor metabolic and other effects as well. Menstrual patterns, nutrition, and cognitive development are all components of care of the adolescent, but they are not the priority consideration.
10 .
A patient is in the clinic for a follow-up visit after having been on hormone replacement therapy for 3 months. Which report by the patient would immediately concern the nurse?
A)
Smoking a pack of cigarettes a day
B)
Gaining 10 pounds in the last 3 months
C)
Craving sugar
D)
Spending less time exercising
Ans:
A Feedback:
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All these options are poor health habits and will impact the patients health. However, the immediate concern is smoking. The nurse should stress that women who take estrogen should not smoke because of the increased risk for thrombotic events. A weight gain of 10 pounds, a craving for sugar, and a decrease in exercise would not be as immediate a concern although the nurse should address these issues. 11 .
The patient asks the nurse, Why cant I smoke when taking estrogen. Is the risk for blood clots really that high? What is the nurses best response?
A)
The risk is truly that high because estrogen increases serum triglyceride, cholesterol, and glucose levels.
B)
The risk is high because estrogen stimulates skeletal growth, causing increased production of red blood cells (RBCs).
C)
The risk is pretty high because estrogen decreases blood levels of several clotting factors.
D)
There is documented high risk because estrogen combined with nicotine creates a significant drugdrug interaction.
Ans:
D Feedback: Smoking while taking estrogens should be strongly discouraged, because the combination of therapeutic estrogen with nicotine increases the risk for development of thrombi and emboli and this risk is well documented and researched. The risk is not due to skeletal growth, decreased clotting factors, or an impact on triglycerides, cholesterol, or glucose.
12 .
The nurse is caring for a 33-year-old mother of two who has a history of asthma and migraine headaches. The patient is on a low-residue diet for colitis. What factor in the patients history may contraindicate the use of birth control pills?
A)
Migraine headaches
B)
Age
C)
Asthma
D)
Colitis
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Ans:
A Feedback: Progestins should be used with caution in patients with epilepsy, migraine headaches, asthma, or cardiac or renal dysfunction because of the potential exacerbation of these conditions. Age, asthma, and colitis would not be cautions or contraindications for the use of oral contraceptives.
13 .
The nurse is caring for a postmenopausal patient taking estradiol (Estrace) to reduce signs and symptoms of menopause. What other benefit will result from this medication?
A)
Reduced risk of endometriosis
B)
Reduced risk of dysfunctional uterine bleeding
C)
Reduced risk of osteoporosis
D)
Reduced risk of uterine cancer
Ans:
C Feedback: Estrogen slows the bone loss seen with osteoporosis so this will be an added benefit of the drug. Observe for improved bone density tests and absence of fractures. Endometriosis and dysfunctional uterine bleeding do not occur in postmenopausal women who no longer menstruate. Estrogen does not prevent uterine cancer and screening for cancer should be performed before prescribing this drug.
14 .
The nurse has been conducting patient teaching for a 16-year-old who is starting oral contraception. What statement indicates that she needs additional teaching?
A)
I will monitor my weight and have my blood pressure checked monthly.
B)
I will see my womans health provider and have a Pap smear done on a yearly basis.
C)
If I forget to take my pill for 2 consecutive days I will take three pills to catch up.
D)
I will take the pill every day at the same time and never miss a pill.
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Ans:
C Feedback: If one tablet is missed, take it as soon as possible or take two tablets the next day. If two consecutive tablets are missed, take two tablets daily for the next 2 days; then resume the regular schedule. If three consecutive tablets are missed, begin a new cycle of tablets 7 days after the last tablet was taken, and use an additional method of birth control until the start of the next menstrual period. The other statements are accurate and denote the patient understood the nurses teaching.
15 .
The patient comes to the womens health clinic to ask about emergency contraception. The patient is prescribed levonorgestrel (Plan B). How will the nurse instruct the patient to take this medication?
A)
Take one tablet within 4 days of unprotected intercourse.
B)
Take one tablet within 72 hours of unprotected intercourse and another 12 hours later.
C)
Take one tablet within 5 days of unprotected intercourse.
D)
Take one tablet within 72 hours of unprotected intercourse and another daily for 5 days.
Ans:
B Feedback: Levonorgestrel (Plan B) is taken within 72 hours of unprotected intercourse with another tablet taken 12 hours after the first. Levonorgestrel (Plan B OneStep) is taken once within 72 hours after unprotected intercourse and is available OTC for patients 17 years and older. Ulipristal (Ella) is taken once within 5 days of unprotected intercourse.
16 .
The nurse is caring for a patient taking raloxifene. What manifestation reported by the patient would raise the highest level of concern from the nurse?
A)
Headache
B)
Weight loss
C)
Calf pain
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D)
Edema
Ans:
C Feedback: The highest level of concern would be calf pain because it could indicate a possible venous thrombosis that has the potential to be life threatening. Raloxifene has been associated with GI upset, nausea, and vomiting. Changes in fluid balance may also cause headache, dizziness, visual changes, and mental changes. Hot flashes, skin rash, edema, and vaginal bleeding may occur secondary to specific estrogen receptor stimulation. However, these are not symptoms.
17 .
An adolescent patient asks the nurse, What should I do if I forget to take my birth control pill? What should the nurse reply?
A)
Abstain from intercourse for 7 days.
B)
Its okay to miss a day or two, as long as you dont go over 5 days.
C)
Just wait until your next dose, then take double the dose.
D)
Take the dose as soon as you discover your oversight.
Ans:
D Feedback: A missed pill should be taken as soon as the error is noticed. Telling the patient to abstain from intercourse would be inappropriate but if the patient misses three tablets they should use another form of birth control until the next cycle of pills is started. It is not okay to miss a dose and the highest protection is provided when the pill is taken daily without missing a dose. The sooner the missed dose is taken the better contraceptive protection provided, so patients should not wait until the next dose and then double it.
18 .
The nurse is caring for a patient who is extremely agitated about finding out she is pregnant and wants to take an abortifacient that will have the fastest possible action. What drug will the nurse expect to be ordered?
A)
Mifepristone
B)
Carboprost
C)
Prostin 15
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D)
Bepridil
Ans:
B Feedback: Carboprost is available as an intramuscular injection with an onset of 15 minutes and a 2-hour duration of effect. Mifepristone takes 5 to 7 days to produce the desired effect so would not be appropriate for this patient. Prostin 15 is only available in Europe. Bepridil is a calcium channel blocker and would not be used as an abortifacient.
19 .
The nurse, working in a womens health center, is reviewing the patients medical record and recognizes the patient with what medical history should not receive an abortifacient? (Select all that apply.)
A)
Active pelvic inflammatory disease (PID)
B)
Pulmonary disease
C)
Cardiovascular disease
D)
Hypertension
E)
Adrenal disease
Ans:
A, B, C Feedback: Abortifacients should not be used with active PID or acute cardiovascular, hepatic, renal, or pulmonary disease. Caution should be used with any history of asthma, hypertension, or adrenal disease.
20 .
The nurse is developing a nursing plan of care for a patient who will receive a fast-acting abortifacient. What nursing diagnosis would apply to care provided shortly after administering the medication?
A)
Acute pain related to uterine contractions or headache
B)
Ineffective coping related to abortion or fetal death
C)
Risk for fluid volume deficit related to blood loss, diarrhea, and diaphoresis
D)
Deficient knowledge regarding drug therapy.
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Ans:
A Feedback: The rapid-acting abortifacients work within 10 to 15 minutes , so shortly after administration of the drug, the patient will begin to have acute abdominal pain. Only after uterine contents are evacuated would the risk for fluid volume imbalance occur. Deficient knowledge regarding drug therapy should have been addressed before administering the medication. Ineffective coping usually occurs after acute symptoms subside and the patient begins to cope with the decision. 2 1 .
The nurse learns a patient receiving a new prescription for oxandrolone takes a lipid-lowering medication daily. What will the nurse tell the patient about this drug interaction?
A)
Lipid-lowering drug becomes much less effective.
B)
Increased risk of oxandrolone toxicity with this combination of drugs
C)
Increased risk of liver damage with this combination of drugs
D)
Oxandrolone becomes less effective with this combination of drugs.
Ans:
A Feedback: Anabolic steroids may alter lipid metabolism and cause a lack of effectiveness for lipid-lowering agents. Lipidlowering medications do not impact anabolic steroids and there is no increased risk for toxicity of either drug.
2 2 .
What supplement would be safest for a diabetic female athlete wishing to improve athletic performance?
A)
Bee pollen
B)
Damiana
C)
Wild yam
D)
Spirulina
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An s:
C Feedback: Wild yam is an estrogen-like herb used to increase athletic performance, slow the aging process, and improve energy and stamina. It can be toxic to the liver and may cause breast pain but is the safest of these supplements. Bee pollen is associated with serious allergic reactions and random studies have found wide variety of ingredients in each product. Damiana interferes with antidiabetic agents so it would not be appropriate for this patient. Spirulina may contain toxic metals and can cause serious reactions in children and pets. It interferes with vitamin B12absorption and there are no studies to prove it is effective in the claims it makes.
2 3 .
When a 5-year-old patient is prescribed oxandrolone (Oxandrin) to promote weight gain, how would the nurse expect the drug to be administered?
A)
Long-term
B)
Short-term
C)
Continuous
D)
Intermittent
An s:
D Feedback: Oxandrin is given intermittently to pediatric patients and should not be used on a daily basis for short, long, or continuous therapy.
2 4 .
The nurse gives a class at the local high school on the use of anabolic steroids. The nurse explains that one of the most serious and all too common side effects of using these drugs without a prescription and medical follow-up is what?
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A)
Renal stones
B)
Death
C)
Cirrhosis
D)
Malignant hyperthermia
An s:
B Feedback: Prolonged use of high doses may cause potentially lifethreatening conditions, placing the patient at risk of death. Conditions such as peliosis hepatis, hepatic neoplasms, and hepatocellular carcinoma are often seen with highdose street use of these drugs. Renal stones, cirrhosis, and malignant hyperthermia are not associated with the use of anabolic steroids.
2 5 .
When fluoxymesterone (Androxy) is administered to a 14year-old boy for hypogonadism, what is the expected result?
A)
Enlarged sex organs
B)
Decreased skin thickness
C)
Increased protein metabolism
D)
Increased sperm production
An s:
A Feedback: In prepubertal boys, administration of male sex hormonelike drugs will stimulate development of masculine characteristics and cause development of the male sexual organs. Production of sperm will occur when the boy enters puberty. These drugs are not administered to decrease skin thickness or increase protein metabolism.
2
A 69-year-old man is prescribed testosterone. The patient
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6 .
is found to have hypertension and a history of congestive failure after assessment by the nurse. What is this patient at increased risk for?
A)
Fluid retention
B)
Impotence
C)
Liver failure
D)
Kidney failure
An s:
A Feedback: Older adults often have hypertension and other cardiovascular disorders that may be aggravated by sodium and water retention associated with androgens and anabolic steroids. Testosterone would not increase the risk of impotence. Liver and kidney failure could be exacerbated by the drug if they were preexisting conditions but since that is not indicated by the question, this would be a lower risk than fluid retention.
2 7 .
The nurse is caring for a patient with cryptorchidism who is 28 years old and taking testosterone to treat his condition. What statement by this patient would lead the nurse to believe that he has understood the teaching provided about the drug?
A)
My body hair may increase.
B)
My sexual desire may increase.
C)
My voice may become higher.
D)
My skin may become clear and soft.
An s:
A Feedback: Androgenic effects include acne, edema, hirsutism (increased hair distribution), deepening of the voice, oily skin and hair, weight gain, decrease in breast size, and
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testicular atrophy. Testosterone does not make the skin clear and soft, it does not make the voice higher, and the testicular atrophy is more likely to decrease rather than increase libido. 2 8 .
A 16-year-old boy is diagnosed with delayed onset of puberty and the physician has ordered testosterone, intramuscular (IM), once every 2 weeks. What nursing intervention would be important to the patient?
A)
Discuss changes that will occur in his body.
B)
Have patient fast before injection.
C)
Have patient reduce protein intake.
D)
Decrease exercise while on this hormonal treatment.
An s:
A Feedback: It is important for this patient to understand what will happen and the changes he will see to reduce the anxiety that could occur if he didnt understand. Discuss the development of masculine characteristics as well as common adverse effects such as acne. Having the patient fast before the injection would not be necessary, nor would decreasing exercise or reducing protein intake.
2 9 .
A patient has been prescribed sildenafil citrate. What should the nurse teach the patient about this medication?
A)
Take the medication with a glass of grapefruit juice.
B)
The drug should be taken 1 hour before attempting intercourse.
C)
Facial flushing or headache should be reported to the physician immediately.
D)
A dose exceeding 80 mg will result in a change of vision, making everything appear blue.
An
B
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s: Feedback: The drug should be taken approximately 1 hour before intercourse to allow adequate time for absorption and therapeutic effects to occur. Facial flushing, mild headache, indigestion, and running nose are common side effects of sildenafil citrate and do not need to be reported unless they become acute. The blue haze that occurs with the 100-mg dosage is transient (it lasts about 1 hour). Grapefruit juice should be avoided 2 days before until 2 days after taking the medication because it prolongs the drugs metabolism and excretion. 3 0 .
A 55-year-old man presents at the clinic complaining of erectile dysfunction. The patient has a history of diabetes mellitus. The physician orders tadalafil (Cialis) to be taken 1 hour before sexual intercourse. The nurse reviews the patients history before instructing the patient on the use of this medication. What disorder (or condition) would contraindicate the use of tadalafil (Cialis)?
A)
Cataracts
B)
Penile implant
C)
Hypotension
D)
Lung cancer
An s:
B Feedback: Patients with a penile implant should not take tadalafil. Patients with cataracts, hypotension, or lung cancer may take tadalafil if needed but should do so with caution and should be carefully monitored for adverse effects.
3 1 .
For what reason might the nurse administer sildenafil to a woman?
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A)
Pulmonary arterial hypertension
B)
Sexual dysfunction
C)
Breast cancer
D)
Endometriosis
An s:
A Feedback: Sildenafil is used to treat erectile dysfunction in the presence of sexual stimulation in men and to treat pulmonary arterial hypertension in women. It is not used for sexual dysfunction, breast cancer, or endometriosis in women.
3 2 .
A 68-year-old male patient tells the nurse that he has been unable to get an erection for the past 6 months and he guesses his sex life is over. The provider orders diagnostic testing to determine whether sildenafil (Viagra) is appropriate for the patient. What is the most correct nursing diagnosis for this patient?
A)
Sexual dysfunction
B)
Disturbed body image
C)
Ineffective sexuality pattern
D)
Disturbed tactile sensory perception
An s:
A Feedback: The patient is experiencing sexual dysfunction so that would be the most appropriate nursing diagnosis. The patient did not discuss feeling let down by or unhappy with his body so disturbed body image is incorrect. The effectiveness of sexual pattern is not known. No problem with sensory perception is indicated by this question.
3
The 22-year-old patient tells the nurse he doesnt have
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3 .
trouble obtaining and maintaining an erection but wonders if taking Viagra would improve the sexual experience anyway. What is the nurses best response?
A)
The only thing Viagra does is improve blood flow to the penis to make it erect.
B)
Viagra improves stamina and sensation, making the sexual experience better.
C)
Viagra has its greatest effect if both the man and woman take it at the same time.
D)
Viagra does nothing to improve the sexual experience.
An s:
A Feedback: Viagra improves blood flow into the penis and that is its only effect. It does not improve stamina or sensation. Research has indicated it has no effect on womens sexual response. To say only that Viagra does nothing would not provide adequate information for the patient.
3 4 .
The patient is prescribed oxandrolone 2.5 mg twice a day and is told to increase the dosage to gain weight to a maximum of 20 mg/d. If each tablet contains 2.5 mg, how many tablets would the nurse tell the patient he may take per day to avoid exceeding the 20 mg/d maximum?
A)
4
B)
6
C)
8
D)
10
An s:
C Feedback: Calculate the number of tablets required to administer 20 mg by dividing 20 mg by 2.5 mg. 20/2.5 = 8 tablets
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3 5 .
The patient is prescribed sildenafil 25 mg PO one hour before sexual intercourse is planned. The patient returns for follow-up care and says that 25 mg did not produce an erection so he increased the dosage. How much of an increase would be enough to concern a nurse?
A)
50 mg
B)
75 mg
C)
100 mg
D)
25 mg
An s:
C Feedback: Normal dosage range is 25 to 100 mg so the nurse should not be concerned unless the dosage exceeded 100 mg.
1.
An type 1 (insulin-dependent) diabetic reports recurrent hypoglycemia late in the morning. After collecting his health history what finding would the nurse suspect is causing the late morning hypoglycemia?
A)
The patient likes to nap after work before his evening meal.
B)
The patient jogs 2 miles in the morning before he goes to work.
C)
The patient likes to have an early lunch with his girlfriend.
D)
The patient eats oatmeal early in the morning for breakfast.
Ans:
B Feedback: Physical exercise, such as jogging, changes insulin requirements and may result in a delayed hypoglycemic reaction. The fact that he likes to nap before dinner and has an early lunch is unrelated to his hypoglycemia. The patient eating oatmeal early in the morning would help stabilize his blood sugars until later in the morning, but the jogging would have a dramatic effect.
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2.
The nurse suspects the diabetic patient may be having a hypoglycemic reaction when what manifestation is assessed?
A)
Dry, flaky skin
B)
Diaphoresis
C)
Flushing of the face
D)
Fruity breath
Ans:
B Feedback: Diaphoresis and cool clammy skin are signs of hypoglycemia. A fruity breath is seen with ketoacidosis. Flushing of the face is associated with hyperglycemia.
3.
The nurse is preparing patient teaching for a diabetic patient who is to begin pramlintide acetate (Symlin) therapy, which will be taken in addition to insulin. What is the priority nursing instruction to include in this teaching plan?
A)
The drug is injected subcutaneously immediately before a major meal.
B)
The drug has a rapid onset of action.
C)
Inject the drug at least 2 inches away from any insulin injection site.
D)
Do not combine the drug with insulin in the same syringe.
Ans:
A Feedback: Pramlintide works to modulate gastric emptying after a meal, so correct timing of administration of this drug is essential to its function. All options are appropriate instructions for this drug. However, making sure that the patient understands that injecting the medication immediately before eating a major meal is most important because it has a dramatic effect on the therapeutic action of the drug. If the medication is not given at the correct time, the other options would be insignificant.
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4.
What type of insulin would the nurse administer if the fastest therapeutic effects are needed?
A)
Lispro (Humalog)
B)
Aspart (NovoLog)
C)
Regular (Humulin R)
D)
Glulisine (Apidra)
Ans:
D Feedback: Glulisine has an onset of 2 to 5 minutes and peaks in 30 to 90 minutes so it has the fastest onset of action. Lispro has an onset in <15 minutes and also peaks at 30 to 90 minutes. Aspart takes 10 to 20 minutes for onset and peeks in 1 to 3 hours. Regular insulin has a 30 to 60 minute onset and peaks in 2 to 4 hours.
5.
When the nurse administers an oral combination drug called Metaglip, what doses of the two medications are being administered?
A)
2.5 mg glipizide, 500 mg metformin
B)
1.25 mg glyburide, 250 mg metformin
C)
5 mg glipizide, 250 mg metformin
D)
4 mg rosiglitazone, 500 mg metformin
Ans:
A Feedback: Metaglip is a combination of 2.5 mg glipizide with 250 or 500 mg metformin or 5 mg glipizide and 500 mg metformin. Glucovance is a combination of 1.25 mg glyburide with 250 mg metformin, 2.5 mg glyburide with 500 mg metformin, and 5 mg glyburide with 500 mg of metformin. Avandamet is a combination of 1, 2, or 4 mg rosiglitazone with 500 mg metformin.
6. A)
The patient, newly diagnosed with diabetic retinopathy, asks what caused this disorder. What is the nurses best response? Inability of cells in the eye to reproduce
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B)
Increase of aqueous humor in the eye
C)
Decrease of nerve innervations throughout the eye
D)
Oxygen cannot diffuse rapidly across the membrane to tissues in the eye
Ans:
D Feedback: The bodys inability to effectively cope with carbohydrate, fat, and protein metabolism over a long period of time results in a thickening of the basement membrane in large and small blood vessels. This thickening leads to changes in oxygenation of the lining of the vessels causing damage and narrowing of the vessels. The decreased blood flow through the vessels results in the inability of oxygen to rapidly diffuse across the membrane to the tissues of the eye. The tiny vessels of the eye are narrowed and closed, which causes loss of vision. Increase of aqueous humor is seen in glaucoma. Inability of cell replication and decrease in nerve innervations throughout the eye is not associated with retinopathy.
7.
A diabetic patient is taking regular and NPH insulin to manage his diabetes. What is the best evaluation tool to measure the overall patient response to the insulin therapy?
A)
Blood pressure
B)
Bilirubin level
C)
Glycosylated hemoglobin (HbAlc) levels
D)
Fasting blood glucose levels
Ans:
C Feedback: HbAlc levels provide a 3-month average of glucose levels, which provides the best evaluation tool to measure the overall patient response to the treatment plan. Blood pressure readings would be used to evaluate a patients response to an antihypertensive drug. Bilirubin could indicate liver function. Fasting blood glucose levels provide only a baseline blood sugar and no historical overview. Comparing fasting blood glucose levels with HbAlc is like comparing a picture to a video because the HbAlc looks back across a period of 3 months whereas a blood glucose test result only tells you about the exact moment the blood was drawn.
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8.
A patient is brought to the emergency department with severe hypoglycemia. What drug would the nurse prepare to administer intravenously?
A)
Diazole (Hyperstat)
B)
Glyburide (DiaBeta)
C)
Glucagon (GlucaGen)
D)
Insulin (Humulin R)
Ans:
C Feedback: This patient will need a glucose-elevating agent. Glucagon (GlucaGen) is given parenterally only and is the preferred agent for emergency situations. Diazole is also a glucose-elevating agent but is only administered so it would take longer to take effect. Insulin would be administered for hyperglycemia. Glyburide is an oral antidiabetic agent, which is a second-generation sulfonylurea, and is administered for hyperglycemia.
9.
The nurse will question what medication order for a diabetic patient who takes insulin to control his blood sugar level?
A)
Propranolol (Inderal) 10 mg orally t.i.d.
B)
Furosemide (Lasix) 60 mg/d orally
C)
Cefaclor (Ceclor) 250 mg orally every 8 hour
D)
Metoclopramide (Reglan) 20 mg PO
Ans:
A Feedback: Propranolol is a beta-blocker and should be avoided in combination with insulin. The blocking of the sympathetic nervous system also blocks many of the signs and symptoms of hypoglycemia, hindering the patients ability to recognize problems. If propranolol must be taken, the nurse will need to teach this patient other ways to recognize hypoglycemia. Furosemide, cefaclor, and metoclopramide do not cause drugdrug interactions with insulin.
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10 .
A patient comes to the diabetes educator and asks about changing his insulin. The patient explains that his occupation takes him on long international flights and he does not want to administer insulin on the plane. What kind of insulin would the diabetic nurse educator seek an order for?
A)
Lispro (Humalog)
B)
Glulisine (Apidra)
C)
Ultralente (Humulin U Ultralente)
D)
Aspart (NovoLog)
Ans:
C Feedback: Ultralente has a duration of 20 to 36 hours and a peak time of 10 to 30 hours. This would prevent him having to administer insulin on the airplane. Lispro has a duration of 2 to 5 hours and a peak time of 30 to 90 minutes. Glulisine has a duration of 1 to 2.5 hours and a peak time of 30 to 90 minutes. Aspart has a duration of 3 to 5 hours and a peak time of 1 to 3 hours. The last three insulin types mentioned in this Rationale would likely require administration on long plane flights.
11 .
The diabetes nurse educator describes type 1 diabetes with what statement?
A)
Blood glucose level can be controlled with diet.
B)
Exogenous insulin is required for life.
C)
Oral agents can help to control blood glucose levels.
D)
It is always diagnosed in early childhood.
Ans:
B Feedback:
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Type 1 diabetes results from an autoimmune disorder that destroys pancreatic beta cells. Insulin is the only effective treatment for type 1 diabetes because pancreatic beta cells are unable to secrete endogenous insulin and metabolism is severely impaired. In type 1 diabetes, blood glucose levels cannot be controlled with diet, oral agents cannot control the disease process because they stimulate insulin production, and the patient with type 1 diabetes does not produce insulin. It can be diagnosed at other stages of the life span than just in early childhood. 12 .
A patient is admitted to the emergency department in diabetic ketoacidosis (DKA) with a blood glucose level of 485 mg/dL. The physician orders an initial dose of 25 U insulin IV. Which type of insulin will be administered?
A)
NPH insulin
B)
Humulin L insulin
C)
Humulin N insulin
D)
Regular insulin
Ans:
D Feedback: Regular insulin is a short-acting insulin that manages the hyperglycemia and hyperkalemia resulting from DKA, which is a life-threatening complication that occurs with severe insulin deficiency. Furthermore, only regular insulin can be given IV and is the drug of choice in emergency situations. Humulin N, Humulin L, and NPH are intermediate-acting forms.
13 .
What instructions would be important to give to a 50-year-old patient with type 2 diabetes who has been switched from glyburide (DiaBeta) to repaglinide?
A)
It is less potent, so you will need to take a larger dose.
B)
It stimulates insulin production, so you need to eat soon after taking the medication.
C)
It is more potent and longer lasting, so you should take it every other day.
D)
The two medications are virtually the same.
Ans:
B
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Feedback: Glyburide is a second-generation sulfonylurea that stimulates insulin release from the beta cells in the pancreas with a 2- to 4-hour onset of action. Repaglinide has an onset of action within 30 minutes with peak effect in 1 hour, and duration of action is approximately 3 to 4 hours. Because repaglinide has a much faster onset of action, it is important the patient eats within15 to 30 minutes after taking the drug to avoid hypoglycemia. Repaglinide is not less potent, it is not more potent, and the two medications are not virtually the same. 14 .
The nurse is instructing a patient how to mix NPH insulin with regular insulin in one syringe. The nurse tells the patient the mixture must be administered within how long after it is prepared?
A)
5 minutes
B)
10 minutes
C)
15 minutes
D)
20 minutes
Ans:
C Feedback: Use caution when mixing types of insulin. Administer mixtures of regular and NPH or regular and lente insulins within 15 minutes after combining them to ensure appropriate suspension and therapeutic effect.
15 .
The nurse is caring for a 3-year-old child newly diagnosed with type 1 diabetes. When developing the plan of care for this child, the nurse incorporates challenges the child faces that the adult does not, which includes what? (Select all that apply.)
A)
Children have a faster metabolic rate.
B)
Growth must be balanced with diet and activity.
C)
Insulin dose may be so small it is hard to calibrate accurately.
D)
Increased resistance by child to dietary restrictions is common.
E)
Changing metabolism makes regulating insulin difficult.
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Ans:
A, B, C Feedback: Treatment of diabetes in children is a difficult challenge of balancing diet, activity, growth, stressors, and insulin requirements. Children need to be carefully monitored for any sign of hypoglycemia or hyperglycemia and treated quickly because their fast metabolism and lack of body reserves can push them into a severe state quickly. Insulin dosage, especially in infants, may be so small that it is difficult to calibrate. Insulin often needs to be diluted to a volume that can be detected on the syringe. It is usually during adolescence when increased resistance to dietary restrictions and changing metabolism makes regulating insulin difficult so this would not be part of the plan of care for a 3-year-old.
16 .
With what patient would the nurse question the administration of human insulin?
A)
Gestational diabetes
B)
Type 2 diabetes controlled on oral antidiabetic agents with systemic infection
C)
Type 1 diabetes of many years
D)
Type 2 diabetes controlled by diet
Ans:
D Feedback: Insulin is recommended for treatment of type 2 diabetes in patients whose diabetes cannot be controlled by diet or other pharmacotherapeutic agents. If the diabetes can be controlled by diet, the pancreas is still functioning and releasing insulin. Human insulin can be used in gestational diabetes, patients with type 2 diabetes controlled on oral antidiabetic agents with systemic infection, or patients with type 1 diabetes of many years standing.
17 .
The nurse is teaching the patient about the newly prescribed external insulin pump. What are priority teaching points for the nurse to include? (Select all that apply.)
A)
Watch for signs and symptoms of infection.
B)
Check blood glucose frequently.
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C)
Change tubing frequently.
D)
Have pump calibrated weekly.
E)
Added insulin requires separate injection site.
Ans:
A, B, C, D Feedback: This pump device can be worn on a belt or hidden in a pocket and is attached to a small tube inserted into the subcutaneous tissue of the abdomen. The device slowly leaks a base rate of insulin into the abdomen all day; the patient can pump or inject booster doses throughout the day to correspond with meals and activity. The device does have several disadvantages. For example, it is awkward, the tubing poses an increased risk of infection and requires frequent changing, and the patient has to frequently check blood glucose levels throughout the day to monitor response. There is no need to calibrate the pump.
18 .
The nurse, working in the emergency department, receives a patient following a motor vehicle accident whose medical history is unknown with a blood glucose level of 325 mg/dL. What rationale does the nurse provide explaining this elevated blood glucose level?
A)
The patients accident was caused by diabetic ketoacidosis (DKA).
B)
The patient has not been taking the antidiabetic agent as prescribed.
C)
The patient most likely just finished a meal.
D)
The stress reaction caused an increase in blood sugar.
Ans:
D Feedback: The stress reaction elevates the blood glucose concentration above the normal range. In severe stress situations, the blood glucose level can be very high (300 to 400 mg/dL). The body uses that energy to fight the insult or flee from the stressor. The patient may or may not be diabetic so this is not DKA, not an indication of medication noncompliance, and not an indication the patient had just eaten.
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19 .
A patient with type 2 diabetes presents at the clinic for a routine follow-up appointment. The patient asks the nurse whether she can take the herbal supplement ginseng. What is the correct response by the nurse?
A)
It increases the risk for high blood glucose levels.
B)
It increases the risk for low blood glucose levels.
C)
There is no research to indicate what effect it will have.
D)
There is no reason ginseng cannot be taken by people with diabetes.
Ans:
B Feedback: Patients being treated with antidiabetic therapies are at an increased risk of developing hypoglycemia if they use herbals containing juniper berries, ginseng, garlic, fenugreek, coriander, dandelion root, or celery. If a patient uses these therapies, blood glucose levels should be monitored closely and appropriate dose adjustment made in the prescribed drug.
20 .
The nurse is performing diabetes screening and recognizes what ethnic group is at higher risk for diabetes but is also predisposed to a higher normal range of blood glucose?
A)
Native Americans
B)
Japanese Americans
C)
African Americans
D)
Caucasian Americans
Ans:
A Feedback: Certain ethnic groups tend to have a genetically predetermined variation in blood glucose levels, possibly caused by a variation in metabolism. For example, Native Americans, Hispanic Americans, and Japanese Americans have higher blood glucose levels than white Americans do. Groups that are more likely to develop diabetes mellitus include African Americans, Native Americans, and Hispanic Americans.
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21 .
The nurse is caring for a patient with renal dysfunction who requires an oral antidiabetic agent. What drug will the nurse expect to see ordered?
A)
Tolbutamide
B)
Chlorpropamide
C)
Tolazamide
D)
Chlorpromazine
Ans:
A Feedback: Tolbutamide is preferred for patients with renal dysfunction, who may not be able to excrete chlorpropamide, because it is more easily cleared from the body. Tolbutamide, chlorpropamide, and tolazamide are all first-generation sulfonylureas, but tolazamide is used less frequently and is usually tried after the first two drugs have been shown to be ineffective. Chlorpromazine (Thorazine) is an antipsychotic agent.
22 .
A patient with type 1 diabetes takes 12 units of regular insulin and 34 units of NPH insulin in the morning. How would the nurse explain why two different types of insulin are required to control the patients blood sugar?
A)
Different onsets and peak effects extends blood glucose control.
B)
The mixture makes each drug work more effectively.
C)
The combination reduces the adverse effects experienced.
D)
Patients are less likely to experience hypoglycemia.
Ans:
A Feedback: Regular insulin will begin working within 30 to 60 minutes and peak within 2 to 4 hours and a 6- to 12-hour duration of action whereas NPH insulin has an onset of 60 to 90 minutes and peaks in 4 to 12 hours, with a 24-hour duration of action. By giving both drugs at once, the patient gets rapid blood glucose control within 30 minutes from the regular insulin and the control lasts 24 hours due to NPHs long duration of action. The combination does not make the drugs work more effectively, it does not reduce adverse effects, and patients are more likely to experience hypoglycemia if they do not eat properly.
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23 .
What antidiabetic agent is approved for the nurse to administer to children 10 years old and older with type 2 diabetes?
A)
Pioglitazone
B)
Repaglinide
C)
Liraglutide
D)
Metformin
Ans:
D Feedback: Metformin is the only oral antidiabetic drug approved for children. It has established dosage for children 10 years of age and older. With the increasing number of children being diagnosed with type 2 diabetes, the use of other agents in children is being tested. Because metformin is the only drug approved for use with children, pioglitazone, repaglinide, and liraglutide would not be appropriate.
24 .
The nurse is caring for a pregnant patient diagnosed with pregnancy-induced diabetes. What antidiabetic agent is best suited for administration to this patient?
A)
Metformin
B)
Acarbose
C)
Insulin
D)
Glyburide
Ans:
C Feedback: Insulin therapy is the best choice for patients with diabetes during pregnancy and lactation, which are times of high stress and metabolic demands. Oral antidiabetic medications are contraindicated during pregnancy so metformin, acarbose, and glyburide are not the best choices.
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25 .
The home care nurse is caring for an older adult patient with visual impairment who cannot see the numbers on the syringe when preparing insulin for administration and cannot afford the increased cost of prefilled auto syringes. What strategy might the nurse use to help this patient comply with insulin needs between visits?
A)
Change the patient to oral antidiabetics.
B)
Prepare a weeks supply of syringes and refrigerate.
C)
Have the patient use a magnifying glass.
D)
Ask a neighbor to come over every day to prepare the medication.
Ans:
B Feedback: Older adults can have many underlying problems that complicate diabetic therapy. Poor vision and/or coordination may make it difficult to prepare a syringe. A weeks supply of syringes can be prepared and refrigerated for the usual dose of insulin. If the patient is using insulin it is most likely because oral antidiabetic medications dont work. A magnifying glass is impractical because drawing up medication requires two hands and a magnifying glass will not help the patient to see well enough to be safe. It is a big imposition to expect a neighbor to be constantly available and this would not be the best choice.
26 .
The nurse admits a patient to the emergency department and recognizes the patient is in diabetic ketoacidosis (DKA) when what manifestations are assessed? (Select all that apply.)
A)
Fruity breath
B)
Edema
C)
Dehydration
D)
Agitation
E)
slow and deep respirations
Ans:
A, C, E Feedback:
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Signs of impending dangerous complications of hyperglycemia such as DKA include the following: fruity breath as the ketones build up in the system and are excreted through the lungs; dehydration as fluid and important electrolytes are lost through the kidneys; slow and deep respirations (Kussmauls respirations) as the body tries to rid itself of high acid levels; loss of orientation and coma rather than agitation are to be expected. Edema is not a sign of DKA. 27 .
The patient with diabetes asks the nurse why different oral antidiabetic agents are ordered instead of just one drug. What is the nurses best explanation of the benefit of combining different agents?
A)
Maximum effects
B)
Additive effects
C)
Minimalistic effects
D)
Synergistic effects
Ans:
B Feedback: Five types of oral antidiabetic agents exist, all of which may be used to treat type 2 diabetes when diet and exercise alone fail to control the disorder. The drugs lower blood sugar by different mechanisms and may be used in various combinations for additive effects.
28 .
The nurse is caring for an obese woman who was just diagnosed with type 2 diabetes. When developing this patients plan of care, what is the priority nursing diagnosis?
A)
Imbalanced nutrition: more than body requirements related to obesity
B)
Risk for unstable blood glucose related to ineffective dosing of antidiabetic agents
C)
Disturbed sensory perception related to glucose levels
D)
Ineffective coping related to diagnosis and therapy
Ans:
A Feedback:
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The priority with this patient is to address her obesity because losing weight may eliminate the problem. Depending on the agent that is ordered, there may be risk for unstable blood glucose and the patient may need support to cope with the diagnosis but these are not the priority concern. Disturbed sensory perception is not indicated to be a problem at this time. 29 .
What outcome would best indicate the nurses teaching was effective and that drug therapy was appropriate?
A)
The patient can explain how to take the medication.
B)
The patient demonstrates the correct procedure for monitoring blood sugar.
C)
The patient follows an appropriate diet.
D)
Blood glucose level is stable with no diabetic complications.
Ans:
D Feedback: The single best indicator, and the goal of treatment, is to help the patient maintain a stable blood glucose level so as to be able to avoid any complications. For the patient to maintain a stable blood glucose level, he needs to understand how to take his medication, to check his blood sugar level, and to follow an appropriate diet, but the best indicator is the stable glucose level.
30 .
The nurse is caring for a postoperative patient whose diabetes has been well controlled on acarbose (Precose). The patient is not allowed to take anything orally following abdominal surgery and is receiving high-glucose total parenteral nutrition via a central IV line. What medication can the nurse administer IV to control the patients blood glucose level?
A)
Glyburide
B)
Acarbose
C)
NPH insulin
D)
Regular insulin
Ans:
D
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Feedback: Only regular insulin can be administered IV. No other insulins or oral antidiabetic medications can be given IV. 31 .
The nurse is caring for a patient with polycystic ovary syndrome. What antidiabetic drug would the nurse anticipate will be ordered?
A)
Metformin
B)
Acarbose
C)
Insulin
D)
Glyburide
Ans:
A Feedback: Metformin and pioglitazone have proven effective in increasing insulin sensitivity and decreasing androgen and luteinizing hormone levels to break the cycle and allow ovulation to occur if pregnancy is desired. A fertility drug is often used with the antidiabetic agent. Other options are not appropriate because they are not indicated for treating polycystic ovary syndrome.
32 .
The nurse is caring for an adolescent newly diagnosed with type 1 diabetes. The patient says, I cant believe Im going to spend the rest of my life sticking myself with needles. What future possibilities for insulin delivery can the nurse share with this patient? (Select all that apply.)
A)
Implantable insulin pump
B)
Insulin patch
C)
Inhaled insulin
D)
Oral insulin
E)
Pancreas transplant
Ans:
A, B, C Feedback:
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Research is ongoing to obtain approval for an implantable insulin pump, an insulin patch, and inhaled insulin. Insulin cannot be taken orally because it is destroyed by gastric secretions and transplanting a pancreas for treatment for diabetes is not likely. 33 .
The nurse is caring for a patient taking Bromocriptine (Cycloset). What is an advantage of this medication?
A)
Reduces risk of heart attack or stroke
B)
Has no adverse effects
C)
Is taken four times a day
D)
Long-term studies needed
Ans:
A Feedback: Bromocriptine-therapy patients had improved HbA1c levels, showing better glycemic control, and were less likely to have a heart attack or stroke or to die of heart disease. All drugs have adverse effects. Taking the medication four times a day and the need for long-term studies are not advantages of the drug.
34 .
The nurse transcribes an order for chlorpropamide (Diabinese). What is an appropriate dosage range for this medication?
A)
0.25 to 3 g per day
B)
2 mg per day
C)
100 to 250 mg per day
D)
5 mg orally daily
Ans:
C Feedback: The appropriate dosage range for oral chlorpropamide is 100 to 250 mg/d. Tolbutamide is 0.25 to 3 g/d. Glimepiride is 1 to 4 mg/d. Glipizide is taken 5 mg PO daily.
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35 .
What is the maximum daily dosage of metformin the nurse can administer to a child aged 10 to 16 years?
A)
500 mg
B)
850 mg
C)
2,000 mg
D)
2,550 mg
Ans:
C Feedback: Children should not receive more than 2,000 mg/d whereas adults should not receive more than 2,550 mg/d. The normal dosage for children is 500 mg/d and for adults is 500 to 850 mg/d.
Page 1
Chapter 42. Agents That Affect Bone Mineral Homeostasis 1.
According to the sliding filament theory, what is the initial action in a muscle contraction?
A)
Troponin is freed and prevents actin and myosin from reacting with each other.
B)
Calcium binds to troponin, which causes the release of actin and myosin binding sites.
C)
Actin and myosin molecules react with each other sliding along the filament and making it shorter.
D)
Muscle filament relaxes or slides back to the resting position.
Ans:
C Feedback:
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Actin and myosin molecules react with each other again and again, sliding along the filament and making it shorter. This is a contraction of the muscle fiber according to the sliding filament theory. As the calcium is removed from the cell during repolarization of the muscle membrane, the troponin is freed and once again prevents the actin and myosin from reacting with each other. The muscle filament then relaxes or slides back to the resting position. Muscle tone results from a dynamic balance between excitatory and inhibitory impulses to the muscle. 2.
When causing depolarization of the muscle membranes, what neurotransmitter interacts with the nicotinic cholinergic receptors leading to the release of calcium ions?
A)
Acetylcholine
B)
Serotonin
C)
D-gluconamidoethyl methacrylate (GAMA)
D)
Epinephrine
Ans:
A Feedback: At the acetylcholine receptor site on the effectors side of the synapse, the acetylcholine interacts with the nicotinic cholinergic receptors causing the depolarization. Serotonin, GAMA, and epinephrine are not part of muscle contraction and relaxation.
3.
The nurse, working in the preoperative holding area, is caring for a 70-yearold patient who is scheduled to receive succinylcholine as part of general anesthesia. When collecting the nursing history, what condition would require the nurse to notify the anesthesiologist of the need for caution?
A)
Bone fracture
B)
Malnutrition
C)
Fluid volume overload
D)
Narrow-angle glaucoma
E)
Pregnancy
Ans:
A, B, D
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Feedback: Succinylcholine should be used with caution in patients with fractures because the muscle contractions it causes might lead to additional trauma; in patients with narrow-angle glaucoma or penetrating eye injuries because intraocular pressure increases. Extreme caution is necessary in the presence of genetic or disease-related conditions causing low plasma cholinesterase levels (e.g., cirrhosis, metabolic disorders, carcinoma, burns, dehydration, malnutrition, hyperpyrexia, thyroid toxicosis, collagen diseases, exposure to neurotoxic insecticides). 4.
The nurse is caring for a patient who received succinylcholine during surgery. The nurse would expect the patient to spend more time in the postanesthesia care unit due to prolonged paralysis and inability to breathe if the patient was from what ethnic group?
A)
American Japanese
B)
Alaskan Eskimos
C)
Native Americans
D)
Hawaiian natives
Ans:
B Feedback: Alaskan Eskimos belong to a genetic group that is predisposed to low plasma cholinesterase levels, making them susceptible to prolonged paralysis after succinylcholine use. The other ethnic groups do not have this genetic predisposition.
5.
A patient scheduled for surgery is to have a nondepolarizing neuromuscular junction (NMJ) blocker as adjunctive anesthesia. The nurse will have cause for concern about prolonged paralysis if the patient has been taking what medication?
A)
An aminoglycoside
B)
Aminophylline
C)
A barbiturate anesthetic
D)
A cephalosporin
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Ans:
A Feedback: Combining nondepolarizing NMJ blockers with aminoglycosides can result in prolonged paralysis, and this combination should be avoided. This interaction does not occur with barbiturate anesthetics, cephalosporins, or aminophylline.
6.
A patient is having outpatient surgery that should last only 45 minutes. The patient is planning to go home immediately after the surgery is complete. What nondepolarizing neuromuscular junction blocker will most likely be used as an adjunct therapy to general anesthesia for this patient?
A)
Atracurium (Tracrium)
B)
Cisatracurium (Nimbex)
C)
Pancuronium (Pavulon)
D)
Rocuronium (Zemuron)
Ans:
D Feedback: Rocuronium has a rapid onset of action and a short duration, making it a drug of choice for outpatient surgical procedures when the patient will be leaving to go home and will need to be awake, alert, and mobile. Atracurium, cisatracurium, and pancuronium are associated with longer paralysis and recovery.
7.
A patient is taking aminophylline for their chronic obstructive pulmonary disease. The patient is about to undergo emergency surgery and will receive an neuromuscular junction (NMJ) blocker as part of the procedure. It is important for the nurse to take what action?
A)
Make sure the patient receives the aminophylline on a regular schedule to maintain therapeutic levels.
B)
Monitor the patient very closely for signs of early arousal and return of muscle function.
C)
Carefully explain all that is going on because the patient will be unable to talk.
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D)
Switch the patient to theophyllines before the procedure begins.
Ans:
B Feedback: Aminophylline can cause a decreased effectiveness of NMJ blockers, leading to reduced paralysis and early return of movement. If a patient has emergency surgery and has been taking aminophylline, the patient should be carefully monitored for early arousal and return of movement. The patient will not be awake during surgery using an NMJ blocker and will be intubated to ensure respirations. Aminophylline and other xanthine derivatives like the theophyllines will have the same effect.
8.
The nurse is caring for a patient who is being maintained on mechanical ventilation. Atracurium is administered to limit the resistance to mechanical ventilation. What is the nurses priority assessment?
A)
Hypotension
B)
Tachycardia
C)
Bradycardia
D)
Increased secretions
Ans:
C Feedback: Bradycardia is a common adverse effect associated with atracurium. The nurse should monitor the patient regularly to avoid serious adverse effects. Increased secretions and hypotension are common with tubocurarine. Option B is a distracter.
9.
The nurse is preparing a patient for surgery who will receive a neuromuscular junction blocker during the procedure. It is important for the nurse to review the patients medication history for concurrent use of what?
A)
Angiotensin-converting enzyme (ACE) inhibitors
B)
Beta blockers
C)
Calcium channel blockers
D)
Montelukast
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Ans:
C Feedback: When calcium channel blockers are used concurrently with neuromuscular junction blockers, the patient is at increased risk of prolonged paralysis. The dose of the neuromuscular junction blocker should be lowered if this combination cannot be avoided and the patient should be monitored closely. There is no anticipated drugdrug interaction with ACE inhibitors, beta blockers, or montelukast.
10 .
An elderly patient has received a neuromuscular junction blocker during surgery. What would be an appropriate nursing diagnosis for this patient?
A)
Excess fluid volume
B)
Risk for impaired skin integrity
C)
Deficient fluid volume
D)
Chronic confusion
Ans:
B Feedback: An elderly or frail patient will need extra nursing care to prevent skin breakdown during the period of paralysis because skin tends to be thinner and more susceptible to breakdown. Therefore, risk of impaired skin integrity would be an appropriate nursing diagnosis. Fluid excess or deficit should not be a concern and the patient may be acutely confused when awakening, but there is no reason to think he or she would remain chronically confused if he was not before surgery.
11 .
What are the primary uses of neuromuscular junction blockers (NMJ) blockers? (Select all that apply.)
A)
To facilitate endotracheal intubation
B)
To sedate patient for general anesthesia
C)
To prevent injury during electroconvulsive therapy
D)
To provide greater ease in extubating patient
E)
To facilitate mechanical ventilation
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Ans:
A, C, E Feedback: NMJ blockers are primarily used as adjuncts to general anesthesia, to facilitate endotracheal intubation, to facilitate mechanical ventilation, and to prevent injury during electroconvulsive therapy. NMJ blockers do not sedate the patient who will be paralyzed after administration but will remain alert unless another medication is given. These medications would not be given before extubation because respiratory muscles would be paralyzed, resulting in the inability to breathe.
12 .
The pharmacology instructor is discussing nondepolarizing neuromuscular junction blockers (NMJ) blockers with the nursing class. How would the instructor explain the action of nondepolarizing NMJ blockers?
A)
Blocks acetylcholine (ACh) from acting
B)
Acts like ACh then prevents repolarization
C)
Takes the place of ACh in the depolarizing/repolarizing process
D)
Stops depolarization in the axion
Ans:
B Feedback: Depolarizing NMJ blockers cause muscle paralysis by acting like ACh. They excite (depolarize) the muscle and prevent repolarization and further stimulation. Options A, C, and D are incorrect.
13 .
A patient is to have surgery and it is planned that atracurium (Tracrium) is to be used as an adjunct to general anesthesia. How will the atracurium work?
A)
Act as agonist to acetylcholine
B)
Stops depolarization in the axion
C)
Act as antagonist to acetylcholine
D)
Stops repolarization in the axion
Ans:
C Feedback:
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Nondepolarizing neuromuscular junction blockers compete with acetylcholine (ACh) for the ACh receptor site and after they occupy the site, stimulation cannot occur. This results in paralysis because the muscle cannot respond. Other options are incorrect. 14 .
The nurse is caring for a patient who is receiving pancuronium (Pavulon) to facilitate mechanical ventilation. The patient is also receiving a barbiturate. How will the nurse administer these two medications?
A)
They can be mixed and given in the same syringe.
B)
Administer IM quickly after mixing the two drugs.
C)
Shake vigorously when mixed in one syringe.
D)
If given together, a precipitate may form.
Ans:
D Feedback: Do not mix this drug with any alkaline solutions such as barbiturates because a precipitate may form, making it inappropriate for use. Pancuronium is only given IV. Shaking does not prevent precipitation.
15 .
The nurse is caring for a patient who is scheduled for abdominal surgery in the morning and is scheduled to receive rocuronium (Zemuron). The patient asks the nurse to describe the adverse effects of rocuronium. What would the nurse describe for the patient?
A)
This drug is associated with pulmonary hypertension.
B)
This drug contains benzyl alcohol.
C)
This drug is associated with bradycardia.
D)
This drug is associated with an increased heart rate.
Ans:
A Feedback: Rocuronium may be associated with pulmonary hypertension. Cisatracurium (Nimbex) contains benzyl alcohol; Atracurium (Tracrium) is associated with bradycardia; and Pancuronium (Pavulon) is associated with an increased heart rate.
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16 .
The postanesthesia care unit (PACU) nurse is caring for a patient that had succinylcholine (Anectine) as an adjunct to anesthesia. What is the nurses priority assessment while caring for this patient?
A)
Movement
B)
Temperature
C)
Mental status
D)
Heart rate
Ans:
B Feedback: Succinylcholine is more likely to cause malignant hyperthermia than other drugs so it is very important that the nurse carefully monitor the patients temperature while in the PACU. Movement, mental status, and heart rate monitoring are all routine components of PACU care, but after receiving this medication, temperature monitoring becomes the priority.
17 .
The nurse is caring for a patient scheduled for abdominal surgery in the morning. The patient confides that he or she watched a movie last week about someone who had surgery and the anesthetic did not work, but no one knew because that patient could not move. What nursing diagnosis will the nurse include in this patients plan of care?
A)
Alteration in fluid volume
B)
Deficient knowledge regarding drug therapy
C)
Fear related to paralysis
D)
Risk for skin impairment
Ans:
C Feedback: Nursing diagnoses related to drug therapy may include Fear related to paralysis. This care plan would not include alteration in fluid volume; deficient knowledge regarding drug therapy; or risk for skin impairment.
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18 .
The nurse is caring for a patient in the intensive care unit who has been receiving neuromuscular junction (NMJ) blockers, sedatives, and analgesics for the past 2 weeks. The NMJ blocker therapy has been discontinued and the other medications are being reduced gradually. The patient is now alert and awake, communicating with his or her family by using paper and pencil. The family asks why the patient cannot sustain normal respirations. What is the nurses best response? (Select all that apply.)
A)
His or her muscles need to get their strength back again.
B)
This is a common occurrence in situations like this.
C)
He or she is likely to breathe better each day.
D)
The drugs created temporary muscle damage.
E)
He or she will not be taken off the mechanical ventilator until he is ready.
Ans:
A, B, C, E Feedback: After 2 weeks of muscle paralysis, the muscles are weak and will take time to strengthen as the patient begins using them again. Profound and prolonged muscle paralysis is always possible; patients must be supported until they are able to resume voluntary and involuntary muscle movement. When the respiratory muscles are paralyzed, depressed respiration, bronchospasm, and apnea are anticipated adverse effects so the patient will remain ventilated until he or she can demonstrate adequate respiratory effort. The drugs did not damage the muscle, but lack of use has weakened them.
19 .
The nurse is caring for a very anxious 33-year-old female patient scheduled for abdominal surgery today. The patient says the anesthesiologist said she would receive succinylcholine (Anectine) during surgery and asks the nurse how long it will take before the medicine starts to work. What is the nurses best response?
A)
1 to 2 minutes
B)
30 to 60 seconds
C)
5 to 10 minutes
D)
30 minutes
Ans:
B
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Feedback: Succinylcholine has an onset of action of 30 to 60 seconds. The other options are incorrect. 20 .
The patient returns from surgery complaining about muscle pain after receiving succinylcholine during the procedure. After reviewing the postoperative orders, which of these ordered analgesics will the nurse administer to treat this pain?
A)
Aspirin
B)
Acetaminophen (Tylenol)
C)
Ketorolac (Toradol)
D)
Morphine
Ans:
A Feedback: Succinylcholine is associated with muscle pain, related to the initial muscle contraction reaction. A nondepolarizing neuromuscular junction blocker may be given first to prevent some of these contractions and the associated discomfort. Aspirin also alleviates much of this pain after the procedure. Tylenol is not an antiinflammatory medication and would not be appropriate. Toradol and morphine provide stronger pain relief than what is indicated for this discomfort.
21 .
A student asks the pharmacology instructor how succinylcholine differs from acetylcholine (ACh). What should the instructor respond?
A)
Succinylcholine is not broken down instantly.
B)
It results in a prolonged contraction of the muscle.
C)
The muscle becomes hyper stimulated by succinylcholine.
D)
Succinylcholines duration of action is about 2 hours.
Ans:
A Feedback:
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Unlike endogenous ACh, succinylcholine is not broken down instantly. Succinylcholine, a depolarizing NMJ blocker, attaches to the ACh-receptor site on the muscle cell, causing a prolonged depolarization of the muscle. This depolarization causes stimulation of the muscle and muscle contraction (seen as twitching) and then as flaccid paralysis, so the contraction of the muscle is not prolonged and the muscle is incapable of being stimulated. The duration of effects of succinylcholine is 4 to 6 minutes and not 2 hours. 22 .
The certified registered nurse anesthetist documents the anesthesia plan as using a depolarizing neuromuscular junction (NMJ) blocker as adjunct to other anesthetics on the patient when they go to surgery. The nurse would understand from this note that the patient will receive what drug?
A)
Rocuronium (Zemuron)
B)
Pancuronium (Pavulon)
C)
Succinylcholine (Anectine, Quelicin)
D)
Cisatracurium (Nimbex)
Ans:
C Feedback: Currently the only agent classified as a depolarizing NMJ blocker is succinylcholine. rocuronium, pancuronium, and cisatracurium are all nondepolarizing NMJ blockers.
23 .
The nurse administers pancuronium to the mechanically ventilated patient in the pediatric intensive care unit. What assessment finding would the nurse suspect is an adverse effect resulting from the drug?
A)
Bradycardia
B)
Bronchospasm
C)
Should not be used in neonates
D)
Associated with pulmonary hypertension
Ans:
B Feedback:
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Adverse effects of pancuronium include respiratory depression, apnea, bronchospasm, and cardiac arrhythmias. Rocuronium is associated with pulmonary hypertension, cisatracurium should not be used in neonates, and atracurium is associated with bradycardia. 24 .
The nursing student asks the mental health nurse why pancuronium was administered to the patient before electroconvulsive therapy was performed. What is the mental health nurses best response?
A)
To prevent aspiration of vomitus
B)
To reduce the pain of the procedure
C)
To put the patient to sleep
D)
To reduce the intensity of muscle contractions
Ans:
D Feedback: Pancuronium is used, in this case, to induce skeletal muscle relaxation and to reduce the intensity of muscle contractions in electroconvulsive therapy. Pancuronium has no analgesic or amnesic effects. It would not reduce the risk of aspiration unless an endotracheal tube was placed with the cuff inflated and then it would not be the drug that was preventing aspiration.
25 .
When a nondepolarizing neuromuscular junction blocker is used as an adjunct to surgery, what classification of medications could reverse the neuromuscular blockage leading to early arousal and return of muscle function?
A)
Xanthines
B)
Barbiturates
C)
Opiates
D)
Antihypertensives
Ans:
A Feedback:
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Administering xanthines (e.g., theophylline, aminophylline) could result in reversal of the neuromuscular blockage. Patients receiving this combination of drugs should be monitored very closely during the procedure for the potential of early arousal and return of muscle function. Barbiturates, opiates, and antihypertensives do not reverse neuromuscular blockage. 26 .
The nursing instructor asks the student nurse what causes the respiratory obstruction that can occur with many of the depolarizing neuromuscular junction (NMJ) blockers. What is the students most accurate response?
A)
Acetylcholine (ACh)
B)
Histamine release
C)
Serotonin
D)
Hyperkalemia
Ans:
B Feedback: The histamine release associated with many of the depolarizing NMJ blockers can cause respiratory obstruction with wheezing and bronchospasm. Hyperkalemia is an adverse effect of the depolarizing NMJ blockers, ACh is what is acted on by the NMJ blockers, and serotonin is a distracter for this question.
27 .
The nurse is assisting the nurse practitioner who is preparing to intubate the patient. The nurse practitioner has ordered atracurium and midazolam (Versed), a short acting benzodiazepine used to sedate the patient. In what order will the nurse administer these medications?
A)
It does not matter; they can be given in any order.
B)
Give the midazolam first and then atracurium a few moments later.
C)
Give atracurium and then give midazolam a few moments later.
D)
Benzodiazepines are contraindicated with atracurium.
Ans:
B Feedback:
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Atracurium induces muscular paralysis resulting in the inability to breath due to paralysis of respiratory muscles but it has no impact on perception of consciousness. Receiving this drug before being sedated would be frightening and extremely anxiety provoking for the patient, so the sedative should be given first to reduce perception and consciousness before administering atracurium. There is no contraindication of benzodiazepines and the order they are given does matter. 28 .
When a normal muscle functions, several actions take place. In what order do these actions occur?
1. Acetylcholine (ACh) is broken down by acetylcholinesterase. 2. ACh interacts with the nicotinic cholinergic receptors. 3. ACh is released by the motor nerve. 4. ACh crosses the synaptic cleft. 5. The muscle membrane is depolarized. 6. The muscle membrane is repolarized. Put these actions in the correct order. A)
1, 3, 5, 2, 4, 6
B)
2, 4, 6, 5, 3, 1
C)
6, 5, 4, 1, 2, 3
D)
3, 4, 2, 5, 1, 6
Ans:
D Feedback: Normal muscle function involves the arrival of a nerve impulse at the motor nerve terminal, followed by the release of the neurotransmitter, ACh into the synaptic cleft. At the acetylcholine receptor site on the effector side of the synapse, ACh interacts with the nicotinic cholinergic receptors, causing depolarization of the muscle membrane. ACh is then broken down by acetylcholinesterase (an enzyme), freeing the receptor for further stimulation.
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29 .
The patient has been mechanically ventilated for the past week and is receiving a neuromuscular junction (NMJ) blocker, an analgesic, and a sedative. The goal is to extubate the patient. What medication will the nurse stop administering first?
A)
NMJ blocker
B)
Sedative
C)
Analgesic
D)
All three medications will be stopped at the same time.
Ans:
A Feedback: NMJ blockers have no effect on pain perception or consciousness and should not be used without sedation so the NMJ blocker should be removed first. Because the patient has been receiving analgesics for a week, he or she will have to be weaned off them to overcome dependence. Sedatives can be removed more quickly after the NMJ blockers effects are gone.
30 .
The student asks the physiology instructor where the motor neuron communicates with a skeletal muscle fiber. What would the instructor respond?
A)
Synapse
B)
Neuromuscular junction
C)
Synaptic cleft
D)
Afferent junction
Ans:
B Feedback: The neuromuscular junction (NMJ) simply is the point at which a motor neuron communicates with a skeletal muscle fiber. The synapse and synaptic cleft are part of the NMJ. The afferent junction is a distracter for this question.
31 .
What drug will the nurse administer to reverse the actions of neuromuscular junction (NMJ) blocker?
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A)
Cholinesterase inhibitor
B)
Xanthine
C)
Halothane
D)
Aminoglycoside
Ans:
A Feedback: Ensure that a cholinesterase inhibitor is readily available to overcome excessive neuromuscular blockade caused by nondepolarizing NMJ blockers. Although xanthines reverse NMJ blocking effects, they would not be administered for that purpose because their effects are not predictable. Halothane and aminoglycosides enhance paralytic effects of NMJ blockers.
32 .
How can the nurse assess the degree of neuromuscular blockage the patient is experiencing?
A)
Peripheral nerve stimulator
B)
Measure vital signs
C)
Assess response to painful stimuli
D)
Test reflexes
Ans:
A Feedback: Have a peripheral nerve stimulator on standby to assess the degree of neuromuscular blockade, if appropriate. Vital signs can indicate degree of sedation and assess pain sensation, but they are not an indicator of the degree of neuromuscular blockade. Response to painful stimuli would be more of an indication of effects of sedation and/or analgesic than degree of muscular blockade. Any neuromuscular junction blockage would reduce or eliminate reflexes so it would not be a means of assessing degree of blockage.
33 . A)
Why will the nurse administer a small dose of nondepolarizing neuromuscular junction (NMJ) blocker before administering succinylcholine? To reduce discomfort of depolarization of muscles
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B)
To reduce the risk of malignant hyperthermia
C)
To reduce negative effects of dantrolene
D)
To increase the duration of effect for succinylcholine
Ans:
A Feedback: Succinylcholine is associated with muscle pain related to the initial muscle contraction reaction. A nondepolarizing NMJ blocker may be given first to prevent some of these contractions and the associated discomfort. Administering a small dose of nondepolarizing NMJ blocker will not reduce the risk of malignant hyperthermia or increase the duration of effects. Dantrolene is a drug given to treat malignant hyperthermia.
34 .
The nurse administers a sedative followed by a neuromuscular junction (NMJ) blocker after which the neonatologist attempts to intubate the patient without success. While waiting for the anesthesiologist to come to the unit to establish an artificial airway, what is the nurses priority of care?
A)
Reposition the patient frequently.
B)
Monitor oxygen saturation.
C)
Monitor respirations and pulse rate.
D)
Use a bag-valve-mask to ventilate the patient.
Ans:
D Feedback: Following administration of an NMJ blocker, the patient will be unable to breathe independently so maintaining an airway and breathing for the patient using a bag-valve mask is the nurses number-one priority. The patient will not be repositioned until after the artificial airway is placed (endotracheal tube or tracheostomy). Monitoring oxygen saturation and pulse will be second in priority after providing breathing for the patient. The patient will have no independent respirations until the NMJ is metabolized.
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35 .
The nurse is caring for the intensive care unit patient who is mechanically ventilated and receiving a neuromuscular junction (NMJ) blocker, a sedative, and an analgesic. What are priorities of nursing care for this patient? (Select all that apply.)
A)
Reposition patient frequently.
B)
Ensure care of the patients eyes.
C)
Monitor temperature.
D)
Provide a means for patient communication.
E)
Increase ventilator breaths per minute as needed.
Ans:
A, B, C Feedback: Frequent repositioning is important because the patient is unable to move and protect skin integrity independently. The loss of blink reflex due to muscle paralysis from NMJ blockers can result in conjunctival damage so eye care is very important. Monitor patient temperature for prompt detection and treatment of malignant hyperthermia. The patient cannot communicate while receiving NMJ blocker. Ventilator changes are made by physician order in most facilities and are usually based on arterial blood gas results.
Chapter 43-Chapter 47. Beta-Lactam & Other Cell Wall- & Membrane-Active Antibiotics Chapter 44. Tetracyclines, Macrolides, Clindamycin, Chloramphenicol, Streptogramins, & Oxazolidinones Chapter 45. Aminoglycosides & Spectinomycin Chapter 46. Sulfonamides, Trimethoprim, & Quinolones Chapter 47. Antimycobacterial Drugs 1.
A 32-year-old female patient is admitted to the floor with a superinfection. Her orders read tigecycline (Tygacil) 100 mg IV followed by 50 mg IV every 12 hours infused over 30 to 60 minutes for 5 days. What would be important for the nurse to educate this patient about?
A)
Analgesics
B)
Antihistamines
C)
Contraceptives
D)
Decongestants
Ans:
C
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Feedback: Many antibiotics interfere with the effectiveness of oral contraceptives and unplanned pregnancies can occur. Women should be advised to use a barrier form of contraceptives when taking this drug. No known serious drugdrug interactions involve analgesics, antihistamines, or decongestants. 2.
A patient with a gram-negative infection is being treated with an aminoglycoside. What system should the nurse expect to monitor closely while the patient is taking this medication?
A)
Respiratory system
B)
Ophthalmic system
C)
Renal system
D)
Musculoskeletal system
Ans:
C Feedback: Renal function should be tested daily because aminoglycosides depend on the kidney for excretion and if the glomerular filtration rate (GFR) is abnormal it may be toxic to the kidney. The results of the renal function testing could change the daily dosage. Aminoglycosides do not usually adversely affect respiratory, hepatic, or musculoskeletal function, although baseline data concerning these systems is always needed.
3.
How would the nurse describe selective toxicity?
A)
Selective toxicity interferes with a biochemical reaction common to many different organisms.
B)
Selective toxicity will decrease invading bacteria by interfering with the pathogens ability to reproduce.
C)
Selective toxicity will eliminate bacteria by interrupting protein synthesis and damaging the pathogens cell wall.
D)
Selective toxicity is the ability of the drug to kill foreign cells without causing harm to ones own body cells.
Ans:
D
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Feedback: The choice of antibiotics in a clinical situation is determined by assessing which drug will affect the causative organism and lead to the fewest adverse effects. Selective toxicity is the ability of the drug to kill foreign cells without causing harm to the human body cells. How the antibiotic works to kill bacteria varies by drug type and may reduce the ability to reproduce, damage the cell wall, or interfere with a biochemical reaction, but this is a description of how the antibiotic works and does not describe selective toxicity
4.
A local bioterrorism medical team is learning about germ warfare. The team is instructed that a fluoroquinolone may be used to prevent an outbreak of anthrax infection. What fluoroquinolone would the nurse be most likely to administer for this purpose?
A)
Ciprofloxacin (Cipro)
B)
Gemifloxacin (Factive)
C)
Norfloxacin (Noroxin)
D)
Sparfloxacin (Zagam)
Ans:
A Feedback: Ciprofloxacin (Cipro) is the most widely used fluoroquinolone and is indicated for the prevention of anthrax infection. Gemifloxacin and sparfloxacin are most useful in treating acute episodes of chronic bronchitis and community-acquired pneumonia. Norfloxacin is recommended only for certain types of urinary tract infections.
5.
A clinic nurse is caring for a 66-pound child who has acute otitis media. The physician has ordered ceftibuten (Cedax) 9 mg/kg per day PO for 10 days. The drug comes in an oral suspension of 90 mg/5 mL. How many mL will the nurse administer?
A)
5 mL
B)
10 mL
C)
15 mL
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D)
20 mL
Ans:
C Feedback: First, using the formula: 2.2 lb/1 kg = 66 lb/X kg, determine the childs weight in kg (66/2.2 = 30 kg). Next, determine the desired dose by using the formula: amount of prescribed drug times weight in kg (9 mg/kg times 30 kg = 270 mg). To determine the volume of medication to administer, use the formula: amount of drug available/volume available = amount of drug prescribed/volume to administer (90 mg/5 mL = 270 mg/X mL, 90mg/(X) = 1,350 mg/mL, X = 15 mL).
6.
A 78-year-old woman, who lives alone and is forgetful, is being seen by her home health nurse. In reviewing the patients medication, the nurse discovers that the patient is taking Azithromycin (Zithromax) for urethritis. Why would this be a good choice of antibiotics for this patient?
A)
The half-life of the drug is 3 to 7 hours.
B)
It is taken only once a day.
C)
It has very few adverse effects.
D)
It can be given without consideration to drugdrug interactions.
Ans:
B Feedback: Given that the patient is forgetful and lives alone, a daily dose would likely promote improved compliance. Azithromycin can be administered once daily because the half-life is 68 hours. Azithromycin is associated with GI adverse effects and can cause pseudomembranous colitis; neurological symptoms can occur as well. Azithromycin (Zithromax) may adversely interact with cardiac glycosides, oral anticoagulants, theophyllines, carbamazepine, and corticosteroids to name a few agents.
7.
A 12-year-old patient with a complicated skin infection has been admitted to the pediatric unit. The physician has ordered Ertapenem (Invanz). What is the nursing priority?
A)
Transcribe the order to the medication administration record (MAR).
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B)
Perform hand hygiene before preparing the medication.
C)
Assess the patients renal and hepatic functions.
D)
Question the order by calling the physician who prescribed it.
Ans:
D Feedback: The nurse should call the physician and question the order Because this drug is not recommended for children younger than 18 years of age. Following clarification of the order, the drug would be transcribed and listed in the MAR. The nurse would then wash her hands before preparing the drug for administration. Assessment of renal and hepatic function is good practice before administering any medication but is not the nursing priority.
8.
A 22-year-old female is diagnosed with mycobacterial tuberculosis. The physician orders rifampin (Rifadin) 600 mg PO daily. What should the nurse question the patient about?
A)
Her diet
B)
Sun exposure
C)
Type of exercise she does
D)
Use of contact lenses
Ans:
D Feedback: Some antimycobacterial drugs can cause discoloration of body fluids. The orange tinged discoloration can cause permanent stain to contact lenses. The patient should avoid wearing them while on the antimycobacterial therapy. With antimycobacterial drugs there is not a concern is warranted about photosensitivity or exercise. However, due to the GI adverse effects, the nurse may want to discuss an appropriate diet if the patient experiences GI upset after beginning treatment.
9.
A)
The nurse is providing discharge teaching to a patient who is being sent home on oral tetracycline (Sumycin). What instructions should the nurse include? Take the medication only once a day.
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B)
Check pulse rate and hold the drug if lower than 60 beats per minute (bpm).
C)
Take the drug on an empty stomach.
D)
Take the medication with 2 ounces of water.
Ans:
C Feedback: Tetracycline should be taken on an empty stomach 1 hour before or 2 hours after meals with a full 8 ounces of water to ensure full absorption. Tetracycline is usually taken at least once every 12 hours. Checking the pulse and holding the dose if below 60 bpm is an action specific to the use of cardiac glycosides.
10 .
A 28-year-old patient has been prescribed penicillin for the first time. What nursing diagnosis would be most appropriate for this patient?
A)
Acute pain related to gastrointestinal (GI) effects of the drug
B)
Deficient knowledge regarding drug therapy
C)
Imbalance nutrition: less than body requirements related to multiple GI effects of the drug
D)
Constipation
Ans:
B Feedback: Because this is the first time the patient has taken penicillin, she is likely to have limited knowledge about the drug. She may not understand the importance of taking the medication as ordered to increase effectiveness of the drug or to report adverse effects. because the patient has not started the drug yet, there is no way to know what adverse effects, if any, she will experience. Only if she develops acute pain related to GI effects of the drug would this be appropriate. If GI symptoms develop it may lead to imbalanced nutrition, but that remains to be seen. No indication about constipation exists.
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11 .
The pharmacology instructor is discussing antimicrobials with the nursing class. What would the instructor tell the students about the mechanism of action of antimicrobials? (Select all that apply).
A)
Preventing cell division
B)
Causing cell death
C)
Inhibiting cell wall synthesis
D)
Causing leakage of cell wall allowing fluid to leak in
E)
Inhibiting synthesis of ribonucleic acid (RNA)
Ans:
A, B, C Feedback: Sites of cellular action of carbapenems, ketolides, lincosamides, aztreonam, penicillins, sulfonamides, tetracyclines, and antimycobacterials. Carbapenems, ketolides, and lincosamides change protein function and prevent cell division or cause cell death. Aztreonam alters cell membranes to allow leakage of intracellular substances and causes cell death; it does not cause leakage of fluid into the cell. Penicillins prevent bacteria from building their cells during division. Sulfonamides inhibit folic acid synthesis for RNA and deoxyribonucleic acid production but does not inhibit RNA synthesis
12 .
The nurse is preparing to contact the physician for an antibiotic order for the patients infection. What information will the nurse be prepared to provide for the physician to choose the proper antibiotic?
A)
First day of infection symptoms
B)
Culture and sensitivity test results
C)
The patients intake and output for past 2 days
D)
Results of complete blood count with differential
Ans:
B Feedback:
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Antibiotics are best selected based on culture results that identify the type of organism causing the infection and sensitivity testing that shows what antibiotics are most effective in eliminating the bacteria. First day of symptoms of infection is likely already known if culture and sensitivity testing has been performed. Although measurement of intake and output is one indicator of renal function, a bloodureanitrogen test and assessment of creatinine levels would be better ways of assessing renal function, which will be used to determine dose of medication but not for selection of the correct antibiotic. The white blood cell count and differential would indicate the possibility of an infection but are not needed in choosing the proper antibiotic. 13 .
A nursing student asks the pharmacology instructor for ways to minimize the emergence of drug-resistant microbial agents. What would be an appropriate response by the instructor? (Select all that apply.)
A)
Avoid the use of broad-spectrum antibacterial drugs when treating trivial or viral infections.
B)
Use narrow-spectrum agents if they are thought to be effective.
C)
Do not use vancomycin unnecessarily.
D)
Prescribe antibiotics when the patient believes they are warranted.
E)
Start the antibiotics, do culture and sensitivity tests, and provide patient education.
Ans:
A, B, C Feedback: To prevent or contain the growing threat of drug-resistant strains of bacteria, it is very important to use antibiotics cautiously, to complete the full course of an antibiotic prescription, and to avoid saving antibiotics for selfmedication in the future. You would not give antibiotics every time the patient wants them, nor would you do a culture and sensitivity test after starting antibiotics. Therefore, Options D and E are incorrect.
14 .
A student asks the pharmacology instructor if there is a way to increase the benefits and decrease the risks of antibiotic therapy. What would be an appropriate response by the instructor?
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A)
Taking drugs not prescribed for the particular illness tends to maximize risks and minimize benefits.
B)
Never use antibiotics in combination with other prescriptions or in combination with other antibiotics.
C)
Maximize antibiotic drug therapy by administering the full dose when the patient has a fever.
D)
Use antibiotics cautiously and teach patients to complete the full course of an antibiotic prescription.
Ans:
D Feedback: To prevent or contain the growing threat of drug-resistant strains of bacteria, it is very important to use antibiotics cautiously, to complete the full course of an antibiotic prescription, and to avoid saving antibiotics for selfmedication in the future. A patient and family teaching program should address these issues, as well as the proper dosing procedure for the drug (even if the patient feels better) and the importance of keeping a record of any reactions to antibiotics. Thus, taking drugs not prescribed for the particular illness tends to maximize risks and minimize benefits. Also, if the infection is viral, antibacterial drugs are ineffective and should not be used.
15 .
What is the priority reason for the nurse to consider questioning an order for tetracycline in a child younger than 8 years of age?
A)
Children younger than 8 years of age cannot take tetracyclines.
B)
Weight-bearing joints have been impaired in young animals given the drugs.
C)
Tetracyclines can damage developing teeth and bone in children younger than 8 years of age.
D)
Liver and kidney function may be damaged when it is given to children under 8 years of age.
Ans:
C Feedback:
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Use tetracyclines with caution in children younger than 8 years of age because they can potentially damage developing bones and teeth. Although the drug does not cause damage to liver and kidneys, it may be contraindicated in patients with hepatic or renal dysfunction because it is concentrated in the bile and excreted in the urine. Fluoroquinolones, not tetracyclines, are generally contraindicated for use in children (i.e., those younger than 18 years of age) because weight-bearing joints have been impaired in young animals given the drugs. Clindamycin (Dalacin C) warrants monitoring hepatic and renal function when it is given to neonates and infants. Trimethoprimsulfamethoxazole (Nu-Cotrimox) is used in children, although children younger than 2 months of age have not been evaluated. Children under 8 years of age can take tetracycline, but it should be used with caution. 16 .
After administering an antibiotic, the nurse assesses the patient for what common, potentially serious, adverse effect?
A)
Rash
B)
Pain
C)
Constipation
D)
Hypopnea
Ans:
A Feedback: Examine skin for any rash or lesions, examine injection sites for abscess formation, and note respiratory statusincluding rate, depth, and adventitious sounds to provide a baseline for indications of an allergic or adverse response to the drug. Report nausea, vomiting, diarrhea, rash, recurrence of symptoms for which the antibiotic drug was prescribed, or signs of new infection (e.g., fever, cough, sore mouth, drainage). These problems may indicate adverse effects of the drug, lack of therapeutic response to the drug, or another infection. Pain, constipation, and hypopnea are not common adverse effects of antibiotic drugs.
17 . A)
The nurse is caring for a 62-year-old patient who is receiving IV gentamicin (Garamycin). The patient complains of difficulty hearing. What should the nurse do? Hold the dose and notify the physician immediately.
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B)
Administer the dose and speak in a louder voice when talking to the patient.
C)
Administer the dose and report this information to the oncoming nurse.
D)
Administer the dose and document the finding in the nurses notes.
Ans:
A Feedback: Aminoglycosides are contraindicated in the following conditions: known allergy to any of the aminoglycosides; renal or hepatic disease that could be exacerbated by toxic aminoglycoside effects and that could interfere with drug metabolism and excretion, leading to higher toxicity; preexisting hearing loss, which could be intensified by toxic drug-related adverse effects on the auditory nerve. Ototoxicity should be reported and the drug should be stopped. You would not administer the dose and then call the physician, administer the dose and report information to oncoming nurse, or administer the dose and document the finding in the nurses notes because each additional dose administered could potentially worsen hearing loss.
18 .
The nurse is providing patient teaching before discharging a patient home. The patient is taking ciprofloxacin (Cipro). What would the nurse teach this patient is the best way to prevent crystalluria caused by ciprofloxacin (Cipro)?
A)
Eliminate red meat and seafood from the diet.
B)
Encourage at least 2 liters of fluid per day.
C)
Avoid caffeine and alcohol.
D)
Spend time in the sun each day to optimize vitamin D levels.
Ans:
B Feedback: Provide the following patient teaching: Avoid driving or operating dangerous machinery because dizziness, lethargy, and ataxia may occur; try to drink a lot of fluids and maintain nutrition (very important), even though nausea, vomiting, and diarrhea may occur. There is no need to eliminate red meat, seafood, caffeine, or alcohol from the diet, although alcohol may increase the risk of GI irritation. Patients should be taught to avoid the sun due to possible photosensitivity.
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19 .
The nurse is caring for a child weighing 30 kg. The physician orders gentamicin (Garamycin) 100 mg tid for the patient. The recommended dosage range is 6 to 7.5 mg/kg/day. What action should the nurse take?
A)
Administer the medication and assess hearing frequently.
B)
Question the physician about the frequency of administration.
C)
Question the physician about the dosage of the medication.
D)
Administer the medication and assess renal function frequently.
Ans:
C Feedback: The dosage is outside the recommended dosage range at 10 mg/kg/day so the nurse should question the dosage before administering the medication. It is appropriate to administer gentamicin tid to pediatric patients so there would be no need to question frequency of dosage. The drug should not be administered until the correct dosage is ordered so there is no need to assess hearing or renal function.
20 .
The nurse is caring for a patient with a gram-positive infection. What antibiotic would be most effective in treating this infection?
A)
Cefaclor (Ceclor)
B)
Cefoxitin (generic)
C)
Cefotaxime (Claforan)
D)
Cefazolin (Zolicef)
Ans:
A Feedback: First-generation cephalosporins are largely effective against gram-positive bacteria and include cefadroxil (generic), cefazolin (Zolicef), and cephalexin (Keflex). Second-and third-generation cephalosporins are less effective against gram-positive bacteria. Cefoxitin (generic) is a second-generation cephalosporin and cefotaxime (Claforan) and cefazolin (Zolicef) are thirdgeneration cephalosporins.
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21 .
What severe reaction would the nurse assess for if it were necessary to administer trimethoprim/sulfamethoxazole (TMP/SMX) to an older adult?
A)
Diarrhea
B)
Bone marrow depression
C)
Vomiting
D)
Decreased gastrointestinal (GI) motility
Ans:
B Feedback: TMP/SMX is associated with an increased risk of severe adverse effects in patients with reduced liver and kidney function. Because kidney function is known to decline as a natural part of aging, older adults would be at more increased risk of severe reactions and would require more careful monitoring. Severe skin reactions and bone marrow depression are the most frequently reported severe reactions. Diarrhea and vomiting are possible adverse effects of most medications but are not examples of severe reactions, although they would require proper intervention to prevent dehydration. GI motility is more likely to increase than to decrease.
22 .
What medication would the nurse question if ordered for a pediatric patient?
A)
Amikacin
B)
Cefazolin
C)
Streptomycin
D)
Levofloxacin
Ans:
D Feedback: Fluoroquinolones are contraindicated in patients who are younger than 18 years of age. Levofloxacin is the only fluoroquinolone among the answer options and is contraindicated for pediatric patients under age 18.
23 .
The nurse is caring for a patient who is receiving an aminoglycoside. What would be a priority assessment on this patient?
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A)
Respiratory function
B)
Vision
C)
Cardiac function
D)
Liver function
Ans:
A Feedback: Aminoglycosides come with a black box warning alerting health care professionals to the serious risk of ototoxicity and nephrotoxicity. Central nervous system effects include ototoxicity, possibly leading to irreversible deafness; vestibular paralysis resulting from drug effects on the auditory nerve; confusion; depression; disorientation; and numbness, tingling, and weakness related to drug-related adverse effects on other nerves. Visual alterations are not usually reported in relation to this drug. Respiratory function and liver function are not usually impacted by this drug.
24 .
The nurse provides discharge teaching for a patient who will receive a prescription for cefaclor (Ceclor). What important information will the nurse provide this patient?
A)
Avoid alcohol until 72 hours after stopping this medication.
B)
Genital itching will go away after the drug is discontinued.
C)
Monitor for yellowing of the skin or eyes and call the doctor if it occurs.
D)
Avoid grapefruit juice when taking this medication to prevent adverse effects.
Ans:
A Feedback:
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Patients should be taught to avoid alcohol for up to 72 hours after discontinuing cefaclor (Ceclor) to prevent a disulfiram-like reaction that results in unpleasant symptoms such as flushing, throbbing headache, nausea and vomiting, chest pain, palpitations, dyspnea, syncope, vertigo, blurred vision, and in extreme reactions, cardiovascular collapse, convulsions, or even death. Genital itching in women indicates the possibility of a superinfection and the patient should see her health care provider. Liver damage, indicated by jaundice, is not a likely adverse effect with this drug. There is no need to avoid grapefruit juice. 25 .
The nurse is teaching the patient about amoxicillin prior to discharge and includes what important teaching point?
A)
Blackening of the tongue may occur but will subside when the drug is discontinued.
B)
Even if it seems like the infection is not improving, the drug is still working.
C)
Yeast infections are unlikely to occur with this medication because it is narrow spectrum.
D)
Appearance of a rash is common and does not indicate an allergic reaction.
Ans:
A Feedback: One of the adverse effects of ampicillin is blackening of the tongue but the discoloration goes away after stopping the drug. If it is accompanied by swelling, the patient should be instructed to call the prescribing health care provider immediately. Many penicillin-resistant pathogens exist, so if the infection does not seem to be responding to the drug, the patient should notify the health care provider because a different antibiotic may be required. Yeast infections are very likely after taking ampicillin because it is a broad-spectrum antibiotic. Appearance of a rash should be evaluated by a health care professional because allergic reactions to this class of antibiotic are very common.
26 . A)
What drug administered by the nurse belongs to the group of Carbapenems? Primaxin
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B)
Gemifloxacin
C)
Demeclocycline
D)
Cefuroxime
Ans:
A Feedback: The group consists of three drugs: imipenem-cilastatin (Primaxin), meropenem (Merrem), and ertapenem (Invanz). Gemifloxacin is a Fluoroquinolones, Cefuroxime is a second-generation cephalosporin, and demeclocycline is a tetracycline.
27 .
An intensive care unit nurse is caring for a patient taking kanamycin. What is the nurses priority action?
A)
Giving the drug for no longer than 7 days
B)
Assessing liver function daily
C)
Contacting the ordering physician
D)
Monitoring renal function daily
Ans:
D Feedback: The potential for nephrotoxicity and ototoxicity with amikacin is very high, so the drug is used only as long as absolutely necessary and should not be administered for longer than 7 to 10 days because of its potentially toxic adverse effects, which include renal damage, bone marrow depression, and gastrointestinal (GI) complications. The nurse cannot stop administering the drug after 7 days if the doctor orders it to be given longer but the nurse could question the order and promote change to another antibiotic if necessary. Monitoring renal function is the priority action when this drug is administered and the provider should be notified if signs of renal failure occur. Liver function is not usually impacted by this drug, although a patient with preexisting liver alterations may require a change in dosage to prevent toxicity. There is no indication of a need to contact the health care provider.
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28 .
The clinic nurse is providing health teaching to a patient who has been prescribed doxycycline (Doxycin). What is a priority teaching point for this patient?
A)
Stay out of the sun.
B)
Avoid sexual activity.
C)
Take an antacid with the drug if nausea occurs.
D)
Chew the tablets completely before swallowing.
Ans:
A Feedback: Encourage the patient to apply sunscreen and wear protective clothing if sun exposure cannot be avoided to protect exposed skin from rashes and sunburn associated with photosensitivity reactions. If the patient is a woman the nurse may advise the patient to use barrier methods of contraceptives (if she is taking oral contraceptives) due to the drugdrug interaction but the patient would not be told to avoid sexual activity. Antacid therapy and chewing the tablets would be inaccurate information.
29 .
The mother of a 5-year-old asks the nurse why it seems amoxicillin is always prescribed when her child needs an antibiotic. What is the priority rationale the nurse should give the mother?
A)
It is better absorbed.
B)
It is less costly.
C)
It has a less frequent dosing schedule.
D)
It tastes better in oral form.
Ans:
A Feedback: Most penicillins are rapidly absorbed from the GI tract, reaching peak levels in 1 hour. Although amoxicillin is less expensive, that fact has far less impact on choosing the proper antibiotic than the effectiveness of the drug. Most oral antibiotics for children are available in pleasant tasting syrups so taste would not be a factor. Ampicillin is often given up to 4 times a day so it actually has a frequent dosing schedule.
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30 .
When discussing cephalosporins with the nursing class, the pharmacology instructor explains that this classification of drug is primarily excreted through which organ?
A)
Lung
B)
Liver
C)
Kidney
D)
Skin
Ans:
C Feedback: The cephalosporins are primarily metabolized in the liver and excreted in urine. These drugs cross the placenta and enter breast milk. They are not excreted through the lungs, liver, or skin.
31 .
The nurse is caring for a patient receiving an antimycobacterial who reports dizziness, headache, and drowsiness. What is the priority nursing diagnosis?
A)
Imbalanced nutrition: less than body requirements
B)
Disturbed sensory perception (kinesthetic) related to central nervous system (CNS) effects of the drug
C)
Acute pain related to gastrointestinal (GI) effects of the drug
D)
Deficient knowledge regarding drug therapy
Ans:
B Feedback: The priority concern for this patient right now is the disturbed sensory perception related to the CNS effects of the drug. Acute Pain could also be used but it would be related to CNS effects, not GI effects. There is no indication of imbalanced nutrition or deficient knowledge in the question.
32 .
The patient is admitted to the acute care facility with acute septicemia and has orders to receive gentamicin and ampicillin IV. The nurse is performing an admission assessment that includes a complete nursing history. What information provided by the patient would indicate the need to consult the health care provider before administering the ordered medication?
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A)
Takes furosemide (Lasix), a potent diuretic, daily
B)
Had prostate surgery 3 months ago
C)
History of hypothyroidism
D)
Allergic to peanuts and peanut products
Ans:
A Feedback: Aminoglycosides should be avoided if the patient takes a potent diuretic because of the increased risk of ototoxicity, nephrotoxicity, and neurotoxicity. Learning the patient takes a potent diuretic would indicate the need to consult with the health care provider before administering gentamicin. Prostate surgery, hypothyroidism, and an allergy to peanuts would not preclude administration of these medications and would not indicate a need to consult with the provider.
33 .
When the nurse cares for a patient receiving an antibiotic, what instructions will the nurse provide no matter what medication is prescribed? (Select all that apply.)
A)
Drink plenty of fluids to avoid kidney damage.
B)
Take all medications as prescribed until all of the medication is gone.
C)
Report difficulty breathing, severe headache, or changes in urine output.
D)
Take antibiotic with food to avoid gastrointestinal (GI) upset.
E)
Take safety precautions such as changing position slowly.
Ans:
A, B, C Feedback:
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The patient taking any antibiotic needs to drink plenty of fluids to avoid kidney damage and improve excretion of the metabolized drug; take all medications as prescribed until all of the medication is gone to avoid developing a resistant strain of bacteria; and report any difficulty breathing, severe headache, or changes in urine output because these are primary manifestations of serious adverse effects. Although some antibiotics need to be taken with food, others may be best taken on an empty stomach so this does not apply to all antibiotics. Not all antibiotics are associated with central nervous system (CNS) toxicity so taking safety precautions need only be included in patient teaching if they are taking a drug associated with CNS adverse effects. 34 .
The nurse is admitting a 12-year-old girl to the acute care facility and notices discolored secondary teeth. The mother says she doesnt know why the teeth are discolored because the child is very good about brushing and flossing and sees the dentist regularly. What question would the nurse ask?
A)
Has she ever received tetracycline?
B)
Has she ever received gentamicin?
C)
Has she ever received ampicillin?
D)
Has she ever received cephalexin?
Ans:
A Feedback: The nurse would question whether the child was ever given tetracycline because this drug is commonly associated with discoloration of secondary teeth when it is administered to children who still have their primary teeth. Gentamicin, ampicillin, and cephalexin are not associated with discoloration of the teeth.
35 .
The nurse is caring for a female patient whose tests confirm she is 10 weeks pregnant and has contracted tuberculosis. The health care provider orders a combination of antimycobacterials. What combination of drugs would the nurse identify as safest for this pregnant patient?
A)
Isoniazid, ethambutol, and rifampin
B)
Rifabutin, streptomycin, and rifampin
C)
Capreomycin, cycloserine, and ethionamide
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D)
Dapsone, ethambutol, and cycloserine
Ans:
A Feedback: The antituberculosis drugs are always used in combination to affect the bacteria at various cellular stages and first-line drugs are always the first choice, using second-line drugs only when the patient is unable to take the first-line medications. Because this patient is pregnant, the safest choices would be isoniazid, ethambutol, and rifampin but no drug is administered during pregnancy unless the benefit outweighs the risk. The other drug choices would be less safe and would not be used unless the safer drugs were contraindicated.
Chapter 48. Antifungal Agents 1.
A 17-year-old male patient with athletes foot is extremely upset that he cannot get rid of it. He calls the clinic and asks the nurse whether the doctor can give him an antibiotic to cure the infection. What should the nurse include in the explanation of treatment for fungal infections?
A)
Fungi differ from bacteria in that the fungus has flexible cell walls that allow for free transfer into and out of the cell.
B)
Protective layers contain sterols, which change the membrane permeability.
C)
The composition of the protective layers of the fungal cell makes the organism resistant to antibiotics.
D)
Fungi cell walls contain Candida, which makes the cells rigid.
Ans:
C Feedback: The nurse should tell the patient that the composition of the protective layers of the fungal cell makes the organism resistant to antibiotics so that antibiotics would not have any positive effect. Fungi do differ from bacteria, but the fungus has rigid cell walls that allow for free transfer in and out of the cell. The protective layers contain ergosterol, not Candida, that helps keep the cell wall rigid, not permeable.
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2.
The nurse admits a 1-year-old child to the pediatric intensive care unit (ICU) with cryptococcal meningitis. What drug will the nurse anticipate receiving an order for to treat this child?
A)
Amphotericin B (Fungizone)
B)
Fluconazole (Diflucan)
C)
Griseofulvin (Fulvicin)
D)
Ketoconazole (Nizoral)
Ans:
B Feedback: Fluconazole is used in the treatment of cryptococcal meningitis and is safe to use in a 1-year-old child. Amphotericin B has many unpleasant adverse effects and is very potent, so it would not be the first or best medication to administer initially but would be reserved for use if fluconazole was not effective. Griseofulvin is given to treat tinea pedis and tinea unguium in children. Ketoconazole is not given to children younger than 2 years because safety has not been established.
3.
The nurse is teaching the patient about a newly prescribed systemic antifungal drug. What sign or symptom will the nurse instruct the patient to report to the provider immediately?
A)
Unusual bruising and bleeding
B)
Constipation or diarrhea
C)
Red and dry eyes
D)
Increased appetite with weight gain
Ans:
A Feedback: Unusual bruising and bleeding can be an indication of hepatic toxicity, which should be reported immediately. Yellowing of the eyes, not redness, and tearing are also indicative of hepatic toxicity. Usually GI symptoms include nausea and vomiting with antiviral drugs, which could cause decreased appetite and weight loss. These symptoms should be reported if they persist but are not emergency symptoms to report immediately.
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4.
A patient who has a tinea infection calls the clinic and complains of intense local burning and irritation with use of a topical antifungal drug. Even before asking the patient, the nurse suspects he or she is applying what medication?
A)
Butoconazole (Gynazole I)
B)
Ciclopirox (Loprox)
C)
Econazole (Spectazole)
D)
Haloprogin (Halotex)
Ans:
C Feedback: Econazole can cause intense local burning and irritation in treatment of tinea infections. Butoconazole is used to treat vaginal Candida infections. Ciclopirox is used to treat toenail and fingernail tinea infections and does not produce intense burning and irritation. Haloprogin is used to treat athletes foot, jock itch, and ringworm infections and is not associated with burning or irritation.
5.
A patient asks the nurse if he or she should use a topical antifungal. The nurse is aware that the most important contraindication to topical antifungals is what?
A)
Hepatic impairment
B)
Renal impairment
C)
Congestive heart failure
D)
Known allergy to any of the antifungal drugs
Ans:
D Feedback: Topical antifungals are not absorbed systemically so they are not metabolized and excreted. As a result, the only contraindication would be an allergy to the drug. Hepatic and renal impairment and congestive heart failure would not be a contraindication because these drugs do not enter the bloodstream and impact these organ systems.
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6.
A patient with high cholesterol is taking lovastatin (Mevacor). What drug would the nurse question if it was ordered for this patient?
A)
Nifedipine (Procardia)
B)
Ciprofloxacin (Cipro)
C)
Itraconazole (Sporanox)
D)
Oxazepam (Serax)
Ans:
C Feedback: Itraconazole is an azole antifungal drug that has been associated with severe cardiovascular events when taken with lovastatin. Nifedipine, ciprofloxacin, and oxazepam have no drug interactions with lovastatin. Nifedipine is an antihypertensive drug whose effects can be increased when taken with cimetidine. The effects of ciprofloxacin are altered when taken with antacids and theophyllines. Oxazepam is an antianxiety drug that should not be taken with alcohol or theophyllines.
7.
An 85-year-old man who is a resident in an extended-care facility has athletes foot. After applying an antifungal cream, what is the nurses next action?
A)
Wipe away excess medication from the affected area.
B)
Wrap a sterile kling dressing around both feet.
C)
Elevate the feet for 30 minutes.
D)
Apply clean dry socks.
Ans:
D Feedback: Clean dry socks should be applied when treating athletes foot to help eradicate the infection because they will keep the feet dry as well as prevent the cream from being wiped away. A kling dressing is not necessary as it would bind the feet and interfere with mobility and increase the risk of systemic absorption. Medication should not be removed once applied, and there is no need to elevate the feet unless another medical condition warrants this action.
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8.
A patient comes to the clinic and is diagnosed with a vaginal fungal infection. The nurse provides patient information for self-administration of a vaginal antifungal medication. What will the nurse include in the instructions?
A)
Insert low into the opening of the vagina.
B)
Discontinue use during menstruation.
C)
Remain recumbent for at least 15 minutes after insertion.
D)
Rub the cream into the vaginal wall after insertion.
Ans:
C Feedback: The patient should remain recumbent at least 10 to 15 minutes after the medication is deposited high in the vagina so that leakage will not occur and absorption will take place. The effectiveness of the medication is determined by the consistent application for each specified dose for maximal results. The nurse would instruct the patient to continue the medication during menstruation. Stopping the drug and restarting it later can lead to the development of resistant strains of the drug. The cream need not be rubbed into the vaginal wall as it will coat the wall naturally after insertion.
9.
A patient who is using a topical antifungal agent to treat mycosis calls the clinic to report a severe rash that is accompanied by blisters. What will the nurse instruct the patient to do?
A)
Continue the drug as the prescription indicates.
B)
Scrub the rash with soap and water.
C)
Stop using the drug immediately.
D)
Decrease the amount of the medication used.
Ans:
C Feedback:
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The patient should stop using the drug. The rash could indicate sensitivity to the drug or worsening of the condition being treated. Scrubbing the rash could cause further irritation and increase the risk for other infections. Continuing the drug could cause further complications. Decreasing the medication would be ineffective in treating the infection while continuing to risk further complications. 10 .
The nurse admitted a 25-year-old woman to the unit. What would be the most important thing for the nurse to assess before administering ketoconazole?
A)
Complete blood count (CBC) and blood glucose
B)
Eating and sleeping habits
C)
Height and weight
D)
Renal and hepatic function
Ans:
D Feedback: It would be important for the nurse to know the patients CBC, blood glucose level, eating and sleeping habits, and height and weight. All of these factors could help determine a specific dosage. However, the most important factor would be the patients renal and hepatic function because hepatic or renal toxicity could occur quickly if the organs are not functioning properly.
11 .
What drug would the nurse administer orally without the need to question when treating infections caused by Candida albicans?
A)
Amphotericin B (Abelcet)
B)
Tolnaftate (Tinactin)
C)
Griseofulvin (Fulvicin)
D)
Fluconazole (Diflucan)
Ans:
D Feedback:
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Fluconazole is available for oral use and is effective in treating C. albicans. Amphotericin B is reserved for severe and potentially fatal infections, so it would not be used for a C. albicansinfection. Tolnaftate is used to treat athletes foot and is applied topically, not given orally. Griseofulvin is applied topically and is used to treat tinea, not C. albicans. 12 .
When administering a topical antifungal via the vaginal route, what action would the nurse take?
A)
Place the patient in left lateral Sims position.
B)
Applied using sterile technique
C)
Administered high into the vagina.
D)
Insert a tampon after insertion.
Ans:
C Feedback: Vaginal antifungals should be administered high into the vagina. The patient should be placed in a recumbent position for insertion. Clean technique (not sterile) should be used. Inserting a tampon after administration is not necessary.
13 .
By what route would the nurse administer amphotericin B?
A)
Intravenously
B)
Intramuscularly
C)
Orally
D)
Topically
Ans:
A Feedback: Amphotericin B is only administered by the IV route. It cannot be given intramuscularly, orally, or topically.
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14 .
What classification of medication will the nurse administer concurrently with amphotericin B (Fungizone) to help minimize the adverse reactions to this medication?
A)
Sedatives
B)
Antipyretics
C)
Beta-adrenergic blockers
D)
Diuretics
Ans:
B Feedback: Amphotericin B is often given with antipyretics to improve patient comfort and to minimize adverse reactions. Sedatives, beta-adrenergic blockers, and diuretics are not indicated for use with amphotericin B unless the patient has a coexisting diagnosis that would indicate a need for these drugs.
15 .
The nurse provides teaching about amphotericin B (Fungizone) for an 82year-old patient. The nurse evaluates the patient understood teaching when he says he could develop what condition?
A)
Diabetes
B)
Liver necrosis
C)
Kidney damage
D)
Pancreatitis
Ans:
C Feedback: Amphotericin B is nephrotoxic so the patient needs to understand the risk of kidney damage. Other risks of amphotericin B include bone marrow suppression; GI irritation with nausea, vomiting, and potentially severe diarrhea; anorexia and weight loss; and pain at the injection site with the possibility of phlebitis or thrombophlebitis, but it does not cause diabetes, liver necrosis, or pancreatitis.
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16 .
The nurse is reviewing the patients medications and sees fluconazole has been ordered. The nurse will question this order when finding the patient is taking what other medication?
A)
Digoxin
B)
Humulin insulin
C)
Acetaminophen
D)
Hydrochlorothiazide
Ans:
A Feedback: Fluconazole strongly inhibit the cytochrome P450 (CYP450) enzyme system in the liver and are associated with many drugdrug interactions, such as increased serum levels of the following agents: cyclosporine, digoxin, oral hypoglycemics, warfarin, oral anticoagulants, and phenytoin. Diphenhydramine, acetaminophen, and hydrochlorothiazide have no impact on fluconazole. There is no indication that humulin insulin, acetaminophen, and hydrochlorothiazide are contraindicated when taking fluconazole.
17 .
The nurse administers nystatin (Mycostatin) to a patient with thrush (oral candidiasis). How does the medication work in the body?
A)
Changes membrane permeability
B)
Prevents reproduction of fungal cells
C)
Fungistatic
D)
Inhibits glucan synthesis
Ans:
A Feedback: Nystatin binds to sterols in the cell wall, changing membrane permeability and allowing leaking of the cellular components, which will result in cell death. Nystatin is not a fungistatic (prevents reproduction of fungal cells) and it does not inhibit glucan synthesis.
18 .
The nurse teaches the patient to administer butoconazole (Gynazole) for vaginal candidal infection. What instructions will the nurse supply?
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A)
Fill the applicator with the medication and insert it into the vagina at bedtime.
B)
Apply the medication to the perineal area twice a day and wear white cotton underwear.
C)
Soak in a sitz bath twice daily and insert the medication into the vagina after the bath.
D)
Take one tablet by mouth and be sure to follow the medication with a full glass of water.
Ans:
A Feedback: Butoconazole (Gynazole) is administered once daily and should be inserted high into the vagina with the patient remaining recumbent for at least 10 to 15 minutes after insertion. Using the medication at bedtime helps decrease losing the medication by gravity and extends the time the medication will be in contact with the vaginal wall. The medication is not usually applied to the perineum unless the infection has traveled outside the vagina. Sitz baths are contraindicated because fungi flourish in moist environments. This medication is not administered orally and can only be applied topically.
19 .
What medication could the nurse administer in a single dose for effective treatment of the patients vaginal candidal infection?
A)
Caspofungin (Cancidas)
B)
Terbinafine (Lamisil)
C)
Ketoconazole (Nizoral)
D)
Tioconazole (Monistat-1)
Ans:
D Feedback:
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Tioconazole may be given as one dose for treatment of vaginal candidal infection. Caspofungin is given IV to treat invasive aspergillosis in patients who did not respond to other treatments and would not be used for a vaginal candidal infection. Terbinafine is administered twice daily for 1 to 4 weeks to treat topical mycosis. Ketoconazole is administered orally or topically to treat aspergillosis, leishmaniasis, cryptococcosis, blastomycosis, moniliasis, coccidioidomycosis, histoplasmosis, and mucormycosis but would not be used to treat vaginal candidal infections. 20 .
The nurse works on a renal transplant unit and receives an order for posaconazole (Noxafil) for the patient which the nurse interprets to mean the patient has what infection?
A)
Blastomycosis
B)
Aspergillus
C)
Mucormycosis
D)
Coccidioidomycosis
Ans:
B Feedback: Posaconazole is used for prophylaxis treatment of invasive Aspergillus and Candida infections in adults and children older than 13 years who are immunosuppressed secondary to antineoplastic, chemotherapy, graft-versus-host disease following transplants, or hematological malignancies. Posaconazole would not be used to treat blastomycosis, mucormycosis, or coccidioidomycosis.
21 .
The nurse admits a patient diagnosed with a systemic fungal infection and is ordered IV fluconazole. When developing the plan of care for this patient, the nurse would use what nursing diagnosis related to this medication?
A)
Chronic pain related to the gastrointestinal (GI) system, central nervous system (CNS), and local effects of drug
B)
Risk for altered perfusion secondary to system cardiovascular effects of drug
C)
Disturbed sensory perception (kinesthetic) related to CNS effects
D)
Monitor IV sites to ensure that phlebitis or infiltration does not occur.
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Ans:
C Feedback: Nursing diagnoses related to drug therapy might include disturbed sensory perception (kinesthetic) related to CNS effects. Cardiovascular effects are not a concern with this medication; acute, not chronic, pain is associated with GI, CNS, and local effects of the drug; option D is an intervention, not a nursing diagnosis.
22 .
The nurse is caring for a patient receiving an oral fungicide to treat a systemic fungal infection. What intervention would the nurse include in the plan of care?
A)
Maintain complete bed rest.
B)
Assess for cyanosis every 4 hours.
C)
Administer medication 1 hour before meals.
D)
Monitor nutritional status.
Ans:
D Feedback: Monitor nutritional status and arrange a dietary consultation as needed to ensure nutritional status secondary to gastrointestinal (GI) upset related to medication. Complete bed rest is unnecessary. Cyanosis is not an anticipated problem. Medications should be given with food not before meals.
23 .
What factors would the nurse indicate as contributing to an increase in diagnosed fungal infections? (Select all that apply.)
A)
Acquired immunodeficiency syndrome (AIDS)-related complex
B)
Increased prevalence of cancer
C)
Rise in birth rates across the country
D)
Greater number of older adults
E)
Increased use of immunosuppressants
Ans:
A, D, E Feedback:
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The incidence of fungal infections has increased with the rising number of immunocompromised peoplepatients with AIDS and AIDS-related complex (ARC), those taking immunosuppressant drugs, those who have undergone transplantation surgery or cancer treatment, and members of the increasingly larger elderly population, who are no longer able to protect themselves from the many fungi that are found throughout the environment. Cancer rates and birth rates are declining and do not contribute to the increase in diagnosis of fungal infection. 24 .
A patient who has received a heart transplant is taking cyclosporine. The patient is found to have a systemic Aspergillus infection. What drug would the nurse question if ordered for this patient?
A)
Terbinafine
B)
Posaconazole
C)
Itraconazole
D)
Ketoconazole
Ans:
D Feedback: Ketoconzaole and fluconazole strongly inhibit the cytochrome P450 (CYP450) enzyme system in the liver and is associated with many drugdrug interactions such as increased serum levels of the following agents: cyclosporine, digoxin, oral hypoglycemics, warfarin, oral anticoagulants, and phenytoin. There is no known drug interaction between cyclosporins and terbinafine, posaconazole, or itraconazole.
25 .
When caring for a patient with a secondary immunodeficiency disease following kidney transplantation being treated for candidemia the nurse can anticipate receiving an order for what medication?
A)
Amphotericin B
B)
Anidulafungin
C)
Flucytosine
D)
Butoconazole
Ans:
B
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Feedback: Anidulafungin (Eraxis) is used for the treatment of candidemia (infection of the bloodstream) and other forms of candidal infections, intra-abdominal infections, and esophageal candidiasis. Amphotericin B is not indicated in the treatment of candidemia. Flucytosine is indicated for the treatment of candidemia but is excreted primarily in the urine so would be contraindicated in a patient with a transplanted kidney. Butoconazole is a topical medication that would not be appropriate for use treating a systemic bloodborne fungal infection. 26 .
Which antifungal would the nurse explain works by inhibiting glucan synthesis
A)
Flucytosine
B)
Terbinafine
C)
Micafungin
D)
Ketoconazole
Ans:
C Feedback: The antifungal medications called echinocandins work by inhibiting glucan synthesis and micafungin is one of the drugs in this classification. Flucytosine is a miscellaneous antifungal agent, whereas terbinafine and ketoconazole are topical agents.
27 .
What antifungal would be appropriate for the nurse to administer to treat a patient with an oropharyngeal candidiasis?
A)
Itraconazole
B)
Fluconazole
C)
Posaconazole
D)
Clotrimazole
Ans:
D Feedback:
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Clotrimazole is an effective treatment for oropharyngeal candidiasis (in troche form) or to prevent oropharyngeal candidiasis in patients receiving radiation or chemotherapy. Itraconazole, fluconazole, and posaconazole would not be appropriate for this patient because they do not treat oropharyngeal candidiasis infections. 28 .
What drug would the nurse recognize as contraindicated for pediatric use?
A)
Fluconazole
B)
Terbinafine
C)
Griseofulvin
D)
Flucytosine
Ans:
D Feedback: Flucytosine does not have proven safety and efficacy in children, and extreme caution should be exercised if it is ordered. Fluconazole, terbinafine, and griseofulvin have established pediatric doses and would be drugs of choice if appropriate for a particular infection.
29 .
When caring for a 92-year-old patient, the nurse would anticipate the need for what interventions related to administration of any antifungal medications? (Select all that apply.)
A)
Dose reduction
B)
Frequent monitoring
C)
Frequent testing of liver function
D)
Shorter course of treatment
E)
Continuous cardiorespiratory monitoring
Ans:
A, B, C Feedback:
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Patients over age 85 are at increased risk for some liver dysfunction and require more careful monitoring, lower dosages, and frequent assessment of liver function studies. Course of treatment should not be shortened, but dosage should be reduced. Continuous cardiorespiratory monitoring is not indicated. 30 .
A 15-year-old patient is immunocompromised because of the adverse effects of chemotherapy. He or she has developed severe migraine headaches and is being treated with ergot. What drug would be contraindicated in this patient?
A)
Caspofungin
B)
Ketoconazole
C)
Posaconazole
D)
Terbinafine
Ans:
C Feedback: Patients being treated with voriconazole or posaconazole should be cautioned about the risk of ergotism if they combine this drug with ergot, an herb frequently used to treat migraine headache and menstrual problems. If the patient is using voriconazole, it should be suggested that ergot not be used until the antifungal therapy is finished. The other options do not have a known drug interaction with ergot.
31 .
The nurse is reading the patients medical record and discovers the patient has a mycosis and interprets this as meaning what?
A)
An infection caused by a fungus
B)
A fungus normally found on mucous membranes
C)
A systemic fungal infection
D)
A fungal infection with a secondary bacterial infection
Ans:
A Feedback: A mycosis is simply a fungal infection. It does not give any indication of type or where it is found and has nothing to do with a bacterial infection.
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32 .
The nurse admits a patient suspected of having a fungal infection. What action will the nurse need to take before a systemic antifungal can be prescribed? (Select all that apply.)
A)
Initiate IV therapy.
B)
Assess history of liver or kidney disease.
C)
Obtain a culture of the fungus.
D)
Request the patient sign a consent form.
E)
Assess history of lymphatic disease.
Ans:
B, C Feedback: The nurse would assess the patient for history of liver or kidney disease because systemic antifungals carry a higher risk of adverse effects and toxicity in patients with disease of these organs. A culture to determine the type of fungus should also be performed to increase the likelihood of the correct medication being prescribed. Not all antifungals are administered IV so this may not be necessary and would not be initiated until a drug was prescribed. A consent form is not needed by most facilities. History of lymphatic disease would not be associated with concern related to antifungal medications.
33 .
The patient is admitted for IV administration of antifungal medication with the plan to discharge the patient on oral medication in a few days. What medication would the nurse be able to administer both IV and orally?
A)
Fluconazole
B)
Itraconazole
C)
Posaconazole
D)
Terbinafine
Ans:
A Feedback:
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Fluconazole and voriconazole are available in oral and IV preparations, making it possible to start the drug IV for a serious infection and then switch to an oral form when the patients condition improves and he or she is able to take oral medications. Itraconazole, posaconazole, and terbinafine are administered only orally. 34 .
The nurse admits a patient diagnosed with diabetes who has been undergoing fertility treatment in the hopes of becoming pregnant but is not pregnant at this time. The patient has a life-threatening fungal infection and requires systemic antifungal therapy. What medication would be contraindicated in this patient?
A)
Ketoconazole
B)
Fluconazole
C)
Posaconazole
D)
Itraconazole
Ans:
A Feedback: Ketoconazole is not the drug of choice for patients with endocrine or fertility problems because of its effects on these processes. It is not known whether posaconazole crosses the placenta or enters breast milk, so it should not be used during pregnancy or lactation unless the benefits clearly outweigh the potential risks but has no risk to those with fertility or endocrine problems. Fluconazole and itraconazole would be safe for this patient.
35 .
The nurse is assessing the patients medication history and learns the patient received a prescription for voriconazole from one provider and a prescription for an ergot alkaloid from another provider. The nurse realizes this patient is at risk for, and needs to be assessed for, what condition?
A)
Liver toxicity
B)
Central nervous system (CNS) depression
C)
Ergotism
D)
Renal toxicity
Ans:
C
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Feedback: This patient is at risk for ergotism and would require an electrocardiographic or rhythm strip to assess the QT interval because ergotism manifests with prolonged QT intervals. The drug combination does not contribute to hepatic or renal toxicity or depression of the central nervous system. Chapter 49. Antiviral Agents 1.
The nurse explains why viruses are so difficult to treat when making what statement?
A)
Viruses are contained inside the human cell and cannot be destroyed without destroying the cell.
B)
Release of interferons by the host cell makes the virus replicate more quickly allowing the virus to spread.
C)
Drugs exist to treat all viral infections but they carry serious adverse effects and the benefit often does not outweigh the risk.
D)
Individual antiviral drugs are often effective in treating many different viruses because one virus in a category behaves like others in the same category.
Ans:
A Feedback: Because viruses are contained inside human cells while they are in the body, researchers have difficulty developing effective drugs that destroy a virus without harming the human host. Interferons are released by the host in response to viral invasion of a cell and act to prevent the replication of that particular virus. Some interferons that affect particular viruses can now be genetically engineered to treat particular viral infections. Other drugs that are used in treating viral infections are not natural substances and have been effective against only a limited number of viruses. Very few viruses are treatable with medications; a few more can be prevented through immunization but most have no known treatment. Each antiviral is generally only suited to treat the single virus it was developed for and will not be effective against other viruses.
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2.
While calculating the drug dose of antiviral medications for children who have AIDS a pediatric nurse uses what?
A)
The viral complications
B)
The childs age
C)
The severity of the virus
D)
The childs weight
Ans:
D Feedback: Antiviral medication dosages for children are calculated according to weight. There is no scientific data available concerning dosages based on complications or severity of illness. The ethical dilemma using children in drug studies is always a concern. Children must be monitored very carefully for adverse effects on kidneys, bone marrow, and the liver. The complications and severity of the disease may determine which drug is prescribed.
3.
A patient taking nevirapine (Viramune) as part of combination therapy for treatment of HIV took 200 mg/daily PO for 14 days. The patient is now taking 200 mg PO bid. How many mg of the medication is the patient taking daily?
A)
100 mg
B)
200 mg
C)
300 mg
D)
400 mg
Ans:
D Feedback: The patient is to take 200 mg bid, which means twice a day. (200 times 2 equals 400 mg daily.)
4. A)
What medication is only administered intravenously and is used to treat cytomegalovirus (CMV)? Cidofovir (Vistide)
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B)
Foscarnet (Foscavir)
C)
Valacyclovir (Valtrex)
D)
Valganciclovir (Valcyte)
Ans:
B Feedback: Foscarnet (Foscavir) is administered IV only. Ganciclovir and (Cytovene) can be administered by IV and orally. Valganciclovir (Valcyte) and Valacyclovir (Valtrex) are administered only by the oral route.
5.
A hospitalized patient is receiving an antiviral drug to treat cytomegalovirus. What is the nurses priority action after administering the antiviral drug?
A)
Monitor vital signs every hour.
B)
Decrease fluid intake.
C)
Keep side rails up.
D)
Encourage the patient to ambulate 10 minutes after each dose.
Ans:
C Feedback: Antiviral drugs for herpes and cytomegalovirus can cause confusion, dizziness, and other central nervous system (CNS) effects. Side rails should be up after administration to protect the patient from injury until risk for these adverse effects is lowered because not every patient will experience these effects. The patient should not be encouraged to walk after each dose because of the risk of falls if adverse effects occur. Fluid intake should be slightly increased to help decrease risk of nephrotoxicity. Vital signs should be monitored, but it would not be necessary to take them every hour unless serious adverse effects occur.
6.
A nurse is caring for a patient with HIV. What lab tests would the nurse monitor when a protease inhibitor has been ordered for this patient?
A)
A fasting blood sugar and 2-hour postprandial blood sugar
B)
Urine specific gravity and urine pH
C)
Serum alanine aminotransferase and bilirubin
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D)
Arterial blood gases and O2 saturation
Ans:
C Feedback: Serum alanine aminotransferase and bilirubin are monitored when a protease inhibitor is used due to the risk of liver damage and the need to monitor liver function. Cholesterol and triglycerides may also be elevated by the drug and should be monitored. Protease inhibitors are metabolized in the liver and partially by the cytochrome P450 oxidase system. Although some cases of kidney stones have been related to protease inhibitors use, the greatest risk is to the liver and therefore urine specific gravity and urine pH, which indicate renal function, would be less critical to assess. Lab tests for blood sugar and arterial blood gases would not be directly affected by hepatic function.
7.
A patient with renal impairment and HIV has had a medication change. What drug would be considered the drug of choice for this patient?
A)
Atazanivir (Reyataz)
B)
Lopinavir (Kaletra)
C)
Nelfinavir (Viracept)
D)
Ritonavir (Norvir)
Ans:
C Feedback: Nelfinavir is the best choice for a patient with renal impairment because very little of the drug is excreted through the kidney, with most being excreted in feces. The other drugs are all excreted through both the urine and feces, so patients with renal impairment might need dosage adjustments to avoid toxicity.
8.
The nurse is caring for a patient with hepatitis B. The patient is taking adefovir (Hepsera). Which medication would the nurse question if it were ordered?
A)
Cimetidine (Tagament)
B)
Diltiazem (Cardizem)
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C)
Diphenhydramine (Benadryl)
D)
Telbivudine (Tyzeka)
Ans:
D Feedback: Telbivudine is an antihepatitis B agent, and when given with adefovir (Hepsera) can result in severe hepatomegaly with steatosis, sometimes fatal. Cimetidine is a histamine-2 antagonist, diltiazem is a calcium channel blocker, and diphenhydramine is a first-generation antihistamine. These drugs are normally not considered nephrotoxic and could be used with adefovir.
9.
A nurse is caring for a stroke victim in the intensive care unit. The nurse notices a cold sore and requests medication. Docosanol (Abreva) is ordered. Before applying the medication, the nurse would first?
A)
Clean the area to be treated and then pat it dry.
B)
Assess the area for open lesions or abrasions.
C)
Put gloves on to protect herself.
D)
Prepare applicator for drug administration.
Ans:
B Feedback: The nurse would assess the area first to make sure no open lesions or abrasions could allow for systemic absorption of the drug. Then the nurse would clean the area and pat it dry. The nurse may apply the medication using gloves or an applicator.
10 .
A patient with AIDS is taking an antiviral agent. What comment by the patient would indicate that the teaching plan was effective?
A)
I feel like I do when I have the flu.
B)
I will continue to take the over-the-counter medication for my allergies.
C)
Excessive fatigue and a severe headache are common adverse effects of my medication.
D)
This drug will cure AIDS.
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Ans:
A Feedback: Common adverse effects of antiviral agents are flu-like symptoms, which may be related to the underlying disease. Excessive fatigue and a severe headache can indicate a serious complication and should be reported immediately. Antiviral agents do not cure the disease. HIV causes loss of helper T-cell function. This causes the immune system to be depressed and allows opportunistic infections to occur. Antiviral agents reduce the number of mutant viruses that are formed and spread to noninfected cells.
11 .
The school nurse is preparing a lecture on hepatitis B for a health class in high school. What is an important teaching point for the nurse to include about the transmission of hepatitis B? (Select all that apply.)
A)
Hepatitis B is transmitted through the bite of an insect.
B)
Hepatitis B is transmitted through sexual contact.
C)
Hepatitis B is transmitted through blood-to-blood contact.
D)
Hepatitis B is transmitted from the mother to her unborn baby.
E)
Hepatitis B is transmitted through nonsexual household contact.
Ans:
B, C, D Feedback: Hepatitis B is transmitted from one person to another through sexual contact, blood-to-blood contact, or perinatally. It is not transmitted through casual contact. Several studies involving more than 1,000 uninfected, nonsexual household contacts with persons with hepatitis B infection (including siblings, parents, and children) have shown no evidence of casual transmission. Hepatitis B is not spread by mosquitoes or other insect vectors.
12 .
A 21-year-old woman presents with cytomegalovirus (CMV). The LPN says, Ive never heard of CMV before. The nurse explains to the LPN that this infection is most often seen with patients diagnosed with what?
A)
HIV
B)
Influenza
C)
Autoimmune disorder
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D)
Hepatitis B
Ans:
A Feedback: CMV is an opportunistic infection that is most often diagnosed in patients with HIV or who are immunocompromised because those with a healthy immune system can fight off CMV. CMV would not be diagnosed in patients with influenza, an autoimmune disorder, or hepatitis B because the immune system would be strong enough to destroy the CMV pathogen.
13 .
The nurse is assessing a patient admitted with AIDS who is taking a nonnucleoside reverse transcriptase inhibitor. What nursing diagnosis is most likely to be appropriate for this patient?
A)
Risk for injury related to central nervous system (CNS) effects of the drug
B)
Excess fluid volume related to renal failure
C)
Imbalanced nutrition: Less than body requirements, related to gastrointestinal (GI) effects of the drugs
D)
Ineffective health maintenance related to spiritual distress
Ans:
C Feedback: The adverse effects most commonly experienced with these drugs are GI relateddry mouth, constipation or diarrhea, nausea, abdominal pain, and dyspepsia. As a result, this patient is most at risk for imbalanced nutrition; less than body requirements. CNS effects are not common with this classification of drug. Renal failure is not a common adverse effect. Nothing indicates the possibility of spiritual distress in this situation.
14 .
A patient has just been diagnosed with HIV. When developing the teaching plan, what information would the nurse share with this patient related to use of alternative or complementary therapies?
A)
Complementary therapies such as acupuncture or herbal therapy are dangerous to patients with HIV and you are discouraged from exploring these types of therapy.
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B)
Researchers have not looked at the benefits of alternative therapy for patients with HIV, so it is suggested you avoid these therapies until research data are available.
C)
Alternative therapies have benefits and risks. Are there any types of alternative or complementary therapies that you follow or are there any herbs or supplements that you take?
D)
You do not take herbs or practice some type of alternative medicine such as acupuncture, massage therapy, hypnosis, or diet therapy, do you?
Ans:
C Feedback: With a new diagnosis of HIV, it is important for the nurse to assess the patient for use of alternative therapies because some alternative therapies are contraindicated while on antiviral medication. Options A and D are negative statements that discourage the patient from sharing information with the nurse. Option B gives the patient information, but does not elicit information in return and is therefore inappropriate for the nurse to use.
15 .
The nurse is caring for a patient hospitalized with hepatitis B. The family comes to visit and a family member asks the nurse if it is safe to visit. What is the nurses best response?
A)
You seem fearful. Why do you think you are at risk?
B)
Dont worry, you will not contract the disease from the patient.
C)
There is no risk unless you come in contact with blood and body fluids.
D)
The patient should be isolated and have limited visitation.
Ans:
C Feedback: Visitors should be reassured that they are not at risk of contracting the virus unless they come in contact with blood or body fluids. It is never appropriate to tell someone not to worry because it is neither effective nor appropriate. The reason the family member is fearful is obvious, so these questions are demeaning. Visitation does not need to be limited.
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16 .
A patient newly diagnosed with HIV is receiving patient teaching from the clinic nurse about antiviral medications. What would the nurse tell the patient needs to be reported to a health care provider?
A)
Dizziness
B)
Constipation
C)
Vomiting
D)
Rash
Ans:
D Feedback: All options provided have the potential to be an adverse effect of antiviral medications prescribed to treat HIV. Most can be managed through diet or over-the-counter medications but a rash needs to be reported immediately because it could indicate a potentially serious reaction and requires immediate intervention.
17 .
The nurse is planning care for an AIDS patient admitted with chronic severe diarrhea secondary to adverse effects of the antiviral drugs prescribed. What would be the most appropriate goal for this patient?
A)
Patient will show improved nutritional status evidenced by weight gain.
B)
Alleviation or reduction of signs and symptoms of AIDS.
C)
Patient will be able to demonstrate the effectiveness of the teaching plan.
D)
Patient will state that comfort and safety measures are effective and show compliance with the regimen.
Ans:
A Feedback: Severe chronic diarrhea is likely to result in malnutrition and weight loss along with potential alterations in fluid and electrolyte balance. The best indicator of improvement would be an improvement in nutritional status as indicated by weight gain. Although the other outcomes might be applicable to a patient with AIDS, weight gain is the priority concern for a patient with severe chronic diarrhea.
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18 .
A nurse practitioner is teaching a health class in the local high school. The NP informs the class about hepatitis B. What occupation does the NP inform the class is at the greatest risk for contracting hepatitis B?
A)
Policemen
B)
Health care workers
C)
Educators
D)
Fire fighters
Ans:
B Feedback: Health care workers are at especially high risk for contracting hepatitis B due to needle sticks and contact with the blood of infected patients. Policemen, educators, and fire fighters are not considered at high risk for contracting hepatitis B although they do face some risk because of contact with blood and body fluids.
19 .
What liver function test is a sensitive indicator of injury to liver cells and useful in detecting acute liver disease such as hepatitis?
A)
Clotting factors
B)
SGGT
C)
Serum aminotransferases
D)
Alkaline phosphatase
Ans:
C Feedback: Antiviral drugs are indicated for the treatment of adults with chronic hepatitis B who have evidence of active viral replication and evidence of either persistent elevations in serum aminotransferases or histologically active disease. The drugs inhibit reverse transcriptase in the hepatitis B virus and cause DNA chain termination, leading to blocked viral replication and decreased viral load. Clotting factor alterations will be seen only in cases of severe liver damage. Serum gamma-glutamyl transferase and alkaline phosphatase may elevate with liver damage, but serum aminotransferases are the best indicator of hepatitis B
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20 .
What drug would the nurse administer to treat chronic hepatitis C in children and adults who relapse after interferon-alfa therapy?
A)
Zanamivir (Relenza)
B)
Acyclovir (Zovirax)
C)
Cidofovir (Vistide)
D)
Ribavirin (Virazole)
Ans:
D Feedback: Ribavirin is used in combination with interferon alfa-2b as an oral drug for the treatment of chronic hepatitis C in children and adults who relapse after inferferon alfa therapy. Cidofovir is used to treat cytomegalovirus (CMV) in AIDS patients. Virazole is used to treat uncomplicated infuenza infections. Acyclovir is used for herpes infections.
21 .
Some antiviral agents are given locally to treat local viral infections. How do these medications work? (Select all that apply.)
A)
Interfere with viral metabolic processes
B)
Interfere with viral cellular replication
C)
Interfere with host metabolic processes
D)
Interfere with viral transcription
E)
Increase antibody production
Ans:
A, B Feedback: These antiviral agents act on viruses by interfering with normal viral replication and metabolic processes. They are indicated for specific local viral infections. The medications do not interfere with the invaded cell or with viral transcription and they do not increase antibody production.
22 . A)
What drug used to treat influenza A should not be used by nursing mothers? Ribavirin (Rebetron)
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B)
Rimantadine (Flumadine)
C)
Valganciclovir (Valcyte)
D)
Acyclovir (Zovirax)
Ans:
B Feedback: Rimantadine is embryotoxic in animals and should be used during pregnancy only if the benefits clearly outweigh the risks. The drug should not be used by nursing mothers because it crosses into breast milk and can cause toxic reactions in the neonate. Valganciclovir is used to treat cytomegalovirusrelated retinitis in AIDS patients. Acyclovir is used to treat herpes simplex outbreaks. Ribavirin is used as a treatment of influenza A, respiratory syncytial virus (RSV), and herpes virus infections; treatment of children with RSV; has undergone testing for use in several other viral conditions. It is teratogenic and is rated pregnancy category X, but no warnings are related to breast-feeding mothers.
23 .
A 25-year-old female patient presents at the clinic with fever, chills, and achy joints. The patient is diagnosed with influenza A, and ribavirin is prescribed. What should the nurse include in patient teaching about this medication?
A)
Advise women of childbearing age to remain on oral contraceptives for at least 1 month after finishing this medication.
B)
Advise women of childbearing age that this drug is also an abortifacient.
C)
Advise women of childbearing age to use barrier contraceptives.
D)
Advise women of childbearing age that this drug is safe for the fetus.
Ans:
C Feedback: For ribavirin, advise women of childbearing age to use barrier contraceptives if they are taking this drug. The drug has been associated with serious fetal effects, but it has not been associated with spontaneous abortions. Oral contraceptives should not be stopped and barrier contraceptives should be used in addition.
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24 .
A patient has been prescribed ribavirin for influenza A. The patient is experiencing nausea, vomiting, and diarrhea. What would the nurse be sure to include in the patient teaching about this medication?
A)
Do not take with anticholinergic medications.
B)
Do not take with acetaminophen or aspirin.
C)
Do not take with antiarrhythmics.
D)
Do not take with antacids.
Ans:
D Feedback: Ribavirin levels may be reduced if given with antacids. Patients who receive amantadine or rimantadine may experience increased atropine-like effects if either of these drugs is given with an anticholinergic drug. Patients taking rimantadine may also experience a loss of effectiveness of aspirin and acetaminophen if these are also being used. Rifampin is known to decrease the effectiveness of many drugs, including antiarrhythmics.
25 .
The nurse is caring for a patient who is prescribed cidofovir, IV. What other medication will the nurse administer with cidofovir?
A)
Probenecid
B)
Paroxetine hydrochloride
C)
Penciclovir
D)
Prostigmin
Ans:
A Feedback: Cidofovir, which is given by IV infusion, reaches peak levels at the end of the infusion; in studies, it was cleared from the system within 15 minutes after the infusion was completed. It is excreted unchanged in the urine and must be given with probenecid to increase renal clearance of the drug. Paroxetine hydrochloride is Paxil, an antidepressant; Penciclovir is an antiviral cream; Prostigmin is an anticholinesterase agent used in myasthenia gravis. None of these drugs are used with cidofovir except for probenecid.
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26 .
The nurse admits a patient for treatment of cytomegalovirus (CMV). The patient has been ordered foscarnet (Foscavir), 40 mg/kg q812h given over 2 hours. By what route would the nurse administer this drug?
A)
Sub q
B)
IV
C)
IM
D)
PO
Ans:
B Feedback: Foscarnet is available in intravenous (IV) form only. It reaches peak levels at the end of the infusion and has a half-life of 4 hours. About 90% of foscarnet is excreted unchanged in the urine making it highly toxic to the kidneys. Use caution and at reduced dosage in patients with renal impairment. Options A, C, and D are incorrect.
27 .
A patient comes to the clinic with a herpes outbreak. The nurse notes from the patients chart that the patient is just beginning a course of antibiotics prescribed by another physician in the clinic. What classification of antibiotic should not be taken with an antiviral medication used to treat herpes?
A)
Penicillin
B)
Beta-Lactam
C)
Aminoglycoside
D)
Macrolide
Ans:
C Feedback: The risk of nephrotoxicity increases when agents indicated for the treatment of herpes and cytomegalovirus are used in combination with other nephrotoxic drugs, such as the aminoglycoside antibiotics. No contraindication exists for penicillins, beta-lactams, or macrolide antibiotics.
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28 .
A nonnucleoside reverse transcriptase inhibitor has direct effects on the HIV virus activities within the cell. What drug is a nonnucleoside reverse transcriptase inhibitor?
A)
Econazole nitrate (Spectazole)
B)
Oxaliplatin (Eloxatin)
C)
Olanzapine (Zyprexa)
D)
Efavirenz (Sustiva)
Ans:
D Feedback: The nonnucleoside reverse transcriptase inhibitors now available include: delavirdine (Rescriptor), efavirenz (Sustiva), and nevirapine (Viramune). Econazole nitrate is an antifungal cream, olanzapine is an atypical antipsychotic, and oxaliplatin is an antineoplastic agent.
29 .
An immunocompromised 3-year-old has been exposed to avian flu. The patient is brought to the clinic and the mother reports that the patient has had flu-like symptoms for the past 12 hours. What medication would you expect the physician to order for this patient?
A)
Oseltamivir (Tamiflu)
B)
Amantadine (Symmetrel)
C)
Ribavirin (Rebetron)
D)
Zanamivir (Relenza)
Ans:
A Feedback: Oseltamivir is the only antiviral agent that has been shown to be effective in treating avian flu. Therefore Options B, C, and D are incorrect.
30 . A)
The nurse is providing discharge teaching for a patient going home on the medication entecavir (Baraclude). What is the priority teaching point for this patient? Take the whole course of the medication as prescribed.
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B)
Take this medication with grapefruit juice.
C)
Do not stop taking this medication or allow the prescription to run out.
D)
The patient will take this medication for the rest of his life.
Ans:
C Feedback: A potential risk for hepatitis B exacerbation could occur when the drugs are stopped. Therefore, teach patient the importance of not running out of the drugs and using extreme caution when discontinuing these drugs. Options A, B, and D are incorrect responses.
31 .
The nurse is caring for a patient who is taking adefovir to treat hepatitis B. The nurse would hold the medication and notify the health care provider if assessing the signs and symptoms of what? (Select all that apply.)
A)
Lactic acidosis
B)
Hepatotoxicity
C)
Headache
D)
Nausea
E)
Asthenia
Ans:
A, B Feedback: Withdraw the drug and monitor the patient if he or she develops signs of lactic acidosis or hepatotoxicity because these adverse effects can be life threatening. Headache, nausea, and asthenia are potential adverse effects but are not life threatening and would not require withdrawal of the drug.
32 .
The nurse is caring for an asymptomatic preschool-aged child who has cystic fibrosis and has been exposed to influenza A before receiving the appropriate immunization. What antiviral medication might the nurse administer to this child?
A)
Rimantadine (Flumadine)
B)
Zanamivir (Relenza)
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C)
Oseltamivir (Tamiflu)
D)
Amantadine (Symmetrel)
Ans:
C Feedback: Amantadine is indicated for the prevention of respiratory virus infections and can be given to children older than 1 year of age. This would be appropriate in a child with a chronic respiratory illness who could die as the result of developing a respiratory virus. Zanamivir is not indicated for children younger than 7 years of age. Rimantadine is administered as prophylaxis against influenza A virus in children older than 10 years of age. Oseltamivir is indicated for patients who are symptomatic for less than 2 days, but this child is asymptomatic.
33 .
For what viruses might the nurse administer acyclovir (Zovirax)? (Select all that apply.)
A)
Herpes simplex virus
B)
Shingles
C)
Chickenpox
D)
HIV
E)
Cytomegalovirus (CMV)
Ans:
A, B, C Feedback: Acyclovir is indicated for the treatment of herpes simplex virus, shingles, and chickenpox as well as topically for treating herpes labialis. Acyclovir is not effective against HIV or CMV.
34 .
The nurse is caring for a patient whose condition has continued to decline on other antiviral medications and is now prescribed nevirapine (Viramune). What other medications will the nurse assess for to avoid a drugdrug interaction with this new prescription? (Select all that apply.)
A)
Oral contraceptives
B)
Protease inhibitors
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C)
St. Johns wort
D)
Ergot derivatives
E)
Antiarrhythmics
Ans:
A, B, C Feedback: Effectiveness may be lessened if nevirapine is combined with hormonal contraceptives or protease inhibitors. St. Johns wort should not be used with this drug or any nonnucleoside reverse transcriptase inhibitors because a decrease in antiviral effects can occur. Antiarrhythmics are contraindicated when taking delavirdine, not nevirapine. Ergot derivatives are contraindicated with efavirenz, not nevirapine.
35 .
The nurse is caring for a pregnant woman diagnosed with HIV on prenatal drug screening. What medication would the nurse expect to administer to reduce the risk of maternal to fetal transmission of the virus?
A)
Lamivudine (Epivir)
B)
Zidovudine (Retrovir)
C)
Stavudine (Zerit XR)
D)
Tenofovir (Viread)
Ans:
B Feedback: AZT, or zidovudine is administered to prevent the transmission of HIV from mother to child and can be administered to both after birth to treat symptomatic HIV. The other medications (options A, C, and D) are not used for this purpose.
Chapter 50- Chapter 51. Miscellaneous Antimicrobial Agents; Disinfectants, Antiseptics, & Sterilants Chapter 51. Clinical Use of Antimicrobial Agents 1.
A patient asks the nurse how an anti-infective produces a therapeutic effect. What key point will the nurse explain to this patient?
A)
Drugs used to treat infections date back to the 17th century.
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B)
All anti-infectives work in the same way to destroy organisms.
C)
Selective toxicity determines the appropriate drug dosage needed.
D)
The goal of anti-infectives is to interfere with normal functioning of the organism.
Ans:
D Feedback: The goal of anti-infectives is to interfere with the normal function of the invading organism to prevent it from reproducing and to cause cell death without affecting host cells. Each class of anti-infectives works in a different way, but all have the same goal. Because bacteria cells have a slightly different composition than human cells, the bacteria are destroyed without interfering with the host. The first drugs used to treat systemic infections were developed in the early 20th century. The term selective toxicity refers to the ability to affect certain proteins or enzyme systems that are used by infecting organisms, but not by human cells.
2.
The nursing student learns about anti-infectives in class and demonstrates the need to study more when making what statement about how antiinfectives work?
A)
Some anti-infectives interfere with biosynthesis of the pathogens cell wall.
B)
Some anti-infectives prevent the cells of the organism from using essential substances.
C)
Many anti-infectives interfere with the steps involved in protein synthesis.
D)
Some anti-infectives interfere with ribonucleic acid (RNA) synthesis in the cell leading to cell death.
Ans:
D Feedback:
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Some anti-infectives interfere with deoxyribonucleic acid (DNA) synthesis, not RNA synthesis, in the cell, leading to inability to divide and causing cell death. The fluoroquinolones work in this way. The other three options are correct and would not indicate the need for further study time. Penicillins interfere with biosynthesis of the cell wall, sulfonamides prevent organisms from using substances essential to their growth and development, whereas aminoglycosides, macrolides, and chloramphenicol interfere with protein synthesis. 3.
The nurse administers a drug to treat Neisseria gonorrhoeae that works on no other bacteria. How would the nurse describe this drug?
A)
Broad spectrum
B)
Narrow spectrum
C)
Bactericidal
D)
Bacteriostatic
Ans:
B Feedback: Without knowing the name of the antibiotic and how it works to treat N. gonorrhoeae, the only thing that can be said is that it is a narrow-spectrum anti-infective because it only treats one specific organism. Broad-spectrum anti-infectives treat multiple organisms. The name of the drug and how it works would need to be known to determine whether it is bacteriocidal or bacteriostatic.
4.
The nurse has provided patient teaching for a patient who will be discharged to home on an anti-infective. What statement made by the patient indicates the nurse needs to provide additional teaching concerning the use of antiinfectives?
A)
Antibiotics will not help me when I have a viral infection.
B)
A bacterial culture will be done before antibiotics are prescribed for me.
C)
I could develop diarrhea as a result of taking an antibiotic.
D)
I will stop taking the antibiotic as soon as I feel better.
Ans:
D
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Feedback: Compliance with anti-infective therapy is a concern. Patients tend to stop taking the drugs when they begin to feel better. A nurse should instruct the patient to take the entire course of prescribed drug to ensure a sufficient period to rid the body of pathogens and to help prevent the development of resistance. Antibiotics are not prescribed for viral infections. It is important that cultures be performed before antibiotics are prescribed to determine what organism is causing the infection so that the correct drug is prescribed. Diarrhea is the most common adverse effect from anti-infectives. 5.
The nurse attends a class on preventing resistance to anti-infectives and learns that the critical concept in preventing the development of resistant strains of microbes is what?
A)
Exposure of pathogens to an antimicrobial agent without cellular death
B)
Drug dosages that are below a therapeutic level
C)
The duration of drug use
D)
Frequency of drug ingestion
Ans:
C Feedback: Exposure of pathogens to an antimicrobial agent without cellular death leads to the development of resistance so it is important to limit the use of these agents to treat pathogens with a known sensitivity to the drug being used. Drug dosages are also important in preventing the development of resistance. However, the duration of drug use is critical to ensure that microbes are completely eliminated and not given the chance to grow and develop resistant strains. It is hard to convince patients that they must always complete the entire course of antimicrobial agents when they begin to feel better, because stopping early favors the emergence of drug-resistant strains.
6.
A)
The pathophysiology class is learning how microorganisms develop resistance to anti-infective drugs. What is one way the nursing students would learn that microorganisms develop resistance to anti-infective drugs? By rearranging their deoxyribonucleic acid (DNA) to produce membranes that are permeable to the drug
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B)
By producing an enzyme that stimulates the drug
C)
By changing the cellular membrane to allow the drug entry into the cell
D)
By altering binding sites on the membrane or ribosomes so that the drug cannot enter the cell
Ans:
D Feedback: Microorganisms have developed resistance by changing cellular permeability to prevent the drug from entering the cell by altering binding sites on the membranes or on ribosomes so the drug can no longer be accepted and by producing enzymes that deactivate the drug. Microorganisms have not been found to be able to rearrange their DNA to change their membrane structure.
7.
The nurse, writing a care plan for a patient on an aminoglycoside, includes what intervention to reduce the accumulation of the drug in the kidney?
A)
Avoid caffeine intake.
B)
Increase fluids.
C)
Decrease activity.
D)
Increase consumption of fruits and vegetables.
Ans:
B Feedback: To prevent the accumulation of anti-infective drugs in the kidneys, which can damage the kidney, patients taking anti-infective drugs should be well hydrated. Decreasing the dosage will likely reduce the therapeutic action and increase risk of resistance. There is no evidence of association between caffeine intake and drug accumulation in the kidney. Decreasing activity and increasing fruits and vegetables in the diet would not be effective in decreasing drug accumulation.
8.
When conducting patient teaching about using antibiotic medications, what is it critical for the nurse to include to help stop the development of resistant strains of microorganisms?
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A)
Antibiotics should be used quickly to treat colds and other viral infections before the invading organism has a chance to multiply.
B)
Antibiotic dosage should be reduced and used for shorter periods of time to reduce unnecessary exposure to the drug.
C)
Prescriptions for antibiotics should be readily available so they can be filled as soon as patients suspect they have an infection.
D)
It is very important to take the full course of an antibiotic as prescribed and not save remaining drugs for future infections.
Ans:
D Feedback: Teaching patients to take the full course of their antibiotic as prescribed can help to decrease the number of drug-resistant strains. Antibiotics should only be used to treat bacterial infections that have been cultured to identify the antibiotic sensitivity and then patients should be instructed to use the antibiotic for the prescribed course, which will help to eliminate drugresistant strains. Reducing dosage and time intervals increases the chance for drug resistance because anti-infectives are most effective when taken exactly as indicated.
9.
A patient is told that he or she will have to undergo extensive dental surgery. The dentist prescribes a course of antibiotic therapy before beginning the procedures and continuing for 5 days after the procedure. What is this is an example of?
A)
Chemotherapy
B)
Curative treatment
C)
Prophylaxis
D)
Synergism
Ans:
C Feedback:
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In a situation where an infection is likely to occur, antibiotics can be used to prevent it. This is called prophylaxis. Synergism is using two antibiotics at the same time to improve their effectiveness. Chemotherapy is the use of drugs to destroy abnormal cells, usually cancer cells. Curative treatment involves treating an actual infection to promote a cure. 10 .
A patient is receiving meropenem (Merrem IV). What drug-related reaction will the nurse assess for?
A)
Gastrointestinal toxicity
B)
Hepatic toxicity
C)
Nephrotoxicity
D)
Neurotoxicity
Ans:
A Feedback: This drug has been associated with potentially fatal pseudomembranous colitis, which affects the gastrointestinal tract. This drug is not associated with liver, kidney, or nerve toxicity.
11 .
A patient is admitted to the unit and the nurse assesses whether he or she is at increased risk for infection when what factors are determined? (Select all that apply.)
A)
Malnutrition
B)
Hypertension
C)
Suppression of immune system
D)
Advanced age
E)
Decreased amylase levels
Ans:
A, C, D Feedback: Factors that suppress the host defense mechanisms include malnutrition, suppression of immune system, and advanced age. Hypertension does not predispose a person to infection neither does a decreased amylase level.
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12 .
The nurse is caring for a patient receiving penicillin. The nurse knows this type of antibiotic works by what mechanism?
A)
Inhibiting growth and development of the organism
B)
Inhibiting protein synthesis
C)
Inhibiting cell wall biosynthesis
D)
Stimulating bacterial reproduction
Ans:
C Feedback: Some anti-infectives interfere with biosynthesis of the bacterial cell wall. Because bacterial cells have a slightly different composition than human cells, this is an effective way to destroy the bacteria without interfering with the host (see Box 8.2). The penicillins work in this way. The sulfonamides inhibit growth and development of the organisms cells. Aminoglycosides, macrolides, and chloramphenicol interfere with protein synthesis. Fluoroquinolones interfere with synthesis of deoxyribonucleic acid, resulting in the inability to reproduce.
13 .
A nurse collects a culture sample of infected tissue. What does the result of testing the culture contribute to the patients care?
A)
Identifies the specific organism causing the infection
B)
Pinpoints the exact site of the infection
C)
Identifies individualized patient factors contributing to infection
D)
Describes the length of time the patient has experienced infection
Ans:
A Feedback: A culture is collected to identify the causative organism of an infection. It can help with determining the site of infection in some cases if the infection is limited only to the site where the culture is collected. It does not individualize patient factors contributing to infection. These must be determined through assessment. It cannot indicate how long the patient has had the infection, which is often determined by the white blood cell count and differential.
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14 .
A patient calls the clinic to talk to the nurse. The patient states that he or she saw the physician last week and was prescribed penicillin for a strep throat. The patient goes on to say that they feel so much better they stopped taking the drug today, even though there are a few pills left. What is the nurses best response?
A)
Okay, thank you for letting me know. I will document in your medical record that the treatment was effective.
B)
It is important that you take all the medication so all the germs are killed. Otherwise they could come right back and be even stronger.
C)
What you have described is the halo effect of the drug, making you feel better when you are still infected. Youll feel sick again when the drug is out of your system.
D)
You will need to come to the clinic and be evaluated by your physician to make sure the infection is really gone.
Ans:
B Feedback: The duration of drug use is critical to ensure that the microbes are completely, not partially, eliminated and are not given the chance to grow and develop resistant strains. The nurse must explain the importance of taking all of the prescribed medication and should not agree with the patient. This is not related to a halo effect and the patient may feel well until drug levels decrease rather than being completely eliminated from the body. The patient does not need to be seen if the infection is responding to treatment, but they must take the rest of the antibiotic.
15 .
When administering anti-infectives to patients, the nurse is aware of the risk for what potentially fatal adverse effect?
A)
Gastrointestinal toxicity
B)
Eighth cranial nerve damage
C)
Anaphylaxis
D)
Toxic effects on the kidney
Ans:
C Feedback:
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Anaphylaxis is an acute, systemic allergic response to a substance that can be fatal if medical intervention does not occur almost immediately because the airway closes due to tissue edema making it impossible to breathe. Gastrointestinal toxicity, hearing loss due to eighth cranial nerve damage and, toxic effects to the kidney are all adverse effects that may be seen with some anti-infectives. Although these adverse effects can be serious, they are not usually fatal. 16 .
A group of nursing students are giving a report on the emergence of drugresistant microbial agents. What could the students cite as a good way to minimize the emergence of drug-resistant microbial agents? (Select all that apply.)
A)
Avoid the use of broad-spectrum antibacterial drugs when treating trivial or viral infections.
B)
Use narrow-spectrum agents if they are thought to be effective.
C)
Do not use vancomycin unnecessarily.
D)
Antibiotics are best started before the culture and sensitivity report returns.
E)
Administer the smallest effective dosage available.
Ans:
A, B, C Feedback: Exposure to an antimicrobial agent leads to the development of resistance, so it is important to limit the use of antimicrobial agents to the treatment of specific pathogens known to be sensitive to the drug being used. Drug dosage is important in preventing the development of resistance. Doses should be high enough and the duration of drug therapy should be long enough to eradicate even slightly resistant microorganisms. It is best to wait until cultures return before initiating antibiotics when possible, but patients with severe infections may be started on broad -spectrum antibiotics while waiting for culture results.
17 . A)
The home care nurse is taking care of a patient on IV vancomycin for cellulitis of the left calf. How would the nurse explain how microorganisms develop resistance to anti-infective medications? Microorganisms can alter the blood supply to the infection.
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B)
Microorganisms can stop the cell from reproducing.
C)
Microorganisms produce a chemical that acts as an antagonist to the drug.
D)
Microorganisms change their cell membrane to make it look like the drug.
Ans:
C Feedback: Microorganisms develop resistance in a number of ways, including the following: changing cellular permeability to prevent the drug from entering the cell or altering transport systems to exclude the drug from active transport into the cell; altering binding sites on the membranes or ribosomes, which then no longer accept the drug; and producing a chemical that acts as an antagonist to the drug. Microorganisms do not alter the blood supply to the infection, stop a cell from reproducing, or change the appearance of the cell membrane.
18 .
Overuse of anti-infective agents is known to contribute to the onset of superinfections in the body. What is a causative agent of a superinfection?
A)
Escherichia coli
B)
Probenecid
C)
Protozoans
D)
Pseudomonas
Ans:
D Feedback: Common superinfections include vaginal or gastrointestinal yeast infections, which are associated with antibiotic therapy, and infections caused by Proteus and Pseudomonas throughout the body, which are a result of broad-spectrum antibiotic use. Probenicid is a medication, not a causative organism. Protozoa and E. coli do not usually cause superinfections.
19 .
The pharmacology instructor is explaining combination drugs to the nursing class. The instructor tells the students that a combination of anti-infective agents may be used for several reasons. What is one of them?
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A)
Some drugs are synergistic.
B)
Increased likelihood of killing the microorganisms
C)
Requires larger doses of the drugs
D)
Absorption of drugs increased
Ans:
A Feedback: Some drugs are synergistic, which means that they are more powerful when given in combination. The health care provider may be encouraged to use a smaller dosage of each drug, leading to fewer adverse effects, but still having a therapeutic impact on the pathogen. Many microbial infections are caused by more than one organism; each pathogen may react to a different anti-infective agent. Combination drugs do not have a better chance at killing the microorganism and they do not increase the absorption of the drugs.
20 .
Bactericidal agents do not prevent compounds fight infection and destroy microorganisms by inhibiting what?
A)
Protein synthesis
B)
Deoxyribonucleic acid (DNA) replication
C)
Cell wall synthesis
D)
Leukocytes
Ans:
A Feedback: Some anti-infectives are so active against the infective microorganisms that they actually cause the death of the cells they affect. These drugs are said to be bactericidal. Bactericidal action inhibits protein synthesis. Bacteriocidal agents do not prevent DNA replication , do not inhibit cell wall synthesis, and do not impact leukocytes.
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21 .
The nurse is caring for a child who weighs 30 kg. The physician orders gentamicin (Garamycin) tid. The recommended dosage range is 6 to 7.5 mg/ kg/day. Why is it important to give a dosage within this recommended range? (Select all that apply.)
A)
To avoid toxic effects
B)
To protect other patients
C)
To reduce the risk of drug-resistant organisms
D)
To eradicate the bacteria
E)
To promote lactic acid removal
Ans:
A, B, C, D Feedback: By administering the correct dosage, you avoid overdosage and reduce the risk of toxic effects. The correct dosage reduces the risk of creating drugresistant organisms; it also protects both the patient and the other patients who might be susceptible to the drug-resistant organisms as well. The proper dosage is needed to eradicate the bacteria. Lactic acid removal is not related to the proper dosage and is a distracter for this question.
22 .
The nurse is administering an anti-infective to a pediatric patient. What will the nurse assess for related to adverse effects in this patient?
A)
Cardiovascular function and perfusion
B)
Hydration and nutritional status
C)
Liver and pancreatic function
D)
Rest and sleep status
Ans:
B Feedback: Because children can have increased susceptibility to the gastrointestinal and nervous system effects of anti-infectives, monitor hydration and nutritional status carefully. Patients should be encouraged to drink fluids. Cardiovascular, hepatic, and pancreatic function are not at greater risk in children. Rest and sleep status are important but are not impacted by antiinfectives.
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23 .
A parasitic infection is suspected. What type of culture is the nurse likely to collect?
A)
Blood
B)
Urine
C)
Stool
D)
Sputum
Ans:
C Feedback: When investigators search for parasitic sources of infection, the stool is examined for ova and parasites. Blood, urine, and sputum are unlikely to reflect signs of parasitic infection.
24 .
The nurse is caring for a patient receiving IV aminoglycosides for an intractable infection in his or her leg. What would it be important for the nurse to monitor this patient for?
A)
Visual disturbances
B)
Liver dysfunction
C)
Serum glucose levels
D)
Renal dysfunction
Ans:
D Feedback: When patients are taking aminoglycosides, it is important they be monitored closely for any sign of renal dysfunction. Aminoglycosides do not generally cause visual disturbances, liver dysfunction, or altered serum glucose levels.
25 .
The nurse collects the past medical history of a patient new to the clinic. The patient states he or she is allergic to penicillin. What would the nurse question next? (Select all that apply.)
A)
What signs and symptoms were displayed with the reaction?
B)
What treatment was required to control the allergic reaction?
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C)
How was the medication administered?
D)
How many dosages were administered before the reaction occurred?
E)
Had the medication ever been prescribed before the time when the reaction occurred?
Ans:
A, D, E Feedback: It is important to determine what the allergic reaction was and when the patient experienced it (e.g., after first use of drug, after years of use). If she had been prescribed this medication before with no reaction and then had a reaction the next time it was prescribed, this would be important information to know. Some patients report having a drug allergy, but closer investigation indicates that their reaction actually constituted an anticipated effect or a known adverse effect to the drug. It would not necessarily be important to find out what was done to stop the reaction or who the caregiver was at the time of the reaction or what type of allergic reaction it was.
26 .
A patient comes to the clinic to talk with the nurse about planned overseas travel. The patient tells the nurse that he or she is planning a trip to an area of the world where malaria is common. He wants to know how to prevent contracting the disease. What should the nurse respond?
A)
We can ask the physician to give you some anti-infectives in case you get malaria.
B)
We can ask the physician for some anti-infectives for you to take prophylactically.
C)
Dont worry, if you get malaria they have some good doctors where you are going.
D)
If you get malaria, you can always be treated on the way home.
Ans:
B Feedback:
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Some anti-infectives are used as a means of prophylaxis when patients expect to be in situations that will expose them to a known pathogen, such as travel to an area where malaria is endemic, or undergoing oral or invasive gastrointestinal surgery in a person who is susceptible to subacute bacterial endocarditis. After the patient contracts malaria, it is much harder to treat so he would not start the medication or obtain treatment after being infected. 27 .
The nurse is caring for a patient who is receiving a broad-spectrum antiinfective agents. The nurse would assess the patient for what common adverse effect of broad spectrum anti-infective agents?
A)
Destruction of pathogens
B)
Decrease in infection
C)
Destruction of the normal flora
D)
Decrease in inflammation
Ans:
C Feedback: One offshoot of the use of anti-infectives, especially broad-spectrum antiinfectives, is destruction of the normal flora resulting in superinfections. Destruction of pathogens is the therapeutic effect and not an adverse effect resulting in a decrease in infection. Inflammation is reduced by resolution of infection.
28 .
Selective toxicity, or the ability to affect certain proteins or enzyme systems in the infecting organism, is a much sought-after quality in an anti-infective agent. How many anti-infective agents have this quality?
A)
75%
B)
50%
C)
25%
D)
0%
Ans:
D Feedback:
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Although anti-infective agents target foreign organisms infecting the body of a human host, they do not possess selective toxicity, which is the ability to affect certain proteins or enzyme systems used by the infecting organism but not by human cells. Because all living cells are somewhat similar, however, no anti-infective drug has yet been developed that does not affect the host. Therefore Options A, B, and C are incorrect. 29 .
The nursing instructor teaches the students about selective toxicity when one of the students asks, What happens when a drug doesnt have selective toxicity? What is the instructors best response?
A)
Healthy cells are damaged.
B)
All pathogens are destroyed in the body.
C)
Reduced enzymes are produced.
D)
Protein malnutrition
Ans:
A Feedback: When a drug does not display selective toxicity, healthy cells are damaged because the drug does not specifically target only the pathogen. Antiinfectives work by a variety of different means so one drug is not likely to kill every type of pathogen in the body. Selective toxicity does not impact enzyme production or cause protein malnutrition.
30 .
The nursing instructor is talking with the students about anti-infective medication and explains that drugs that are very selective in their actions are said to be what?
A)
Broad spectrum
B)
Narrow spectrum
C)
Bactericidal
D)
Bacteriostatic
Ans:
B Feedback:
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Some anti-infectives are so selective in their action that they are effective against only a few, or possibly only one, microorganism with a very specific metabolic pathway or enzyme. These drugs are said to have a narrow spectrum of activity. They are not called broad spectrum, which applies to a drug with little selectivity; bactericidal, which is a substance that causes death of bacteria; or bacteriostatic, which prevents replication of a bacterium. 31 .
The nurse administers polymyxin B to a patient with a gram-negative bacterial infection. What symptoms would cause the nurse to suspect drug fever, hold the medication, and call the health care provider immediately? (Select all that apply.)
A)
Fever
B)
Dizziness
C)
Ataxia
D)
Increased activity
E)
Reduced urine output
Ans:
A, B, C, E Feedback: The actions of polymyxin B on cell membranes means it can be toxic to the human host, leading to nephrotoxicity, neurotoxicity (e.g., facial flushing, dizziness, ataxia, paresthesias, drowsiness), and drug-related fever and rash. This drug is reserved for infections that do not respond to less toxic drugs; the nurse needs to be alert for serious reactions and hold the drug until notifying the provider.
32 .
The charge nurse, working on a pediatric unit, sees an order was written to administer chloramphenicol (Chloromycetin) to one of the children assigned to a new graduate nurse. The charge nurse would make sure the new graduate was familiar with what possible adverse effects of this medication? (Select all that apply.)
A)
Gray syndrome
B)
Bone marrow depression
C)
Aplastic anemia
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D)
Liver failure
E)
Hearing loss
Ans:
A, B, C Feedback: Chloramphenicol (Chloromycetin), an older antibiotic, prevents bacterial cell division in susceptible bacteria. Because of the potential toxic effects of this drug, its use is limited to serious infections for which no other antibiotic is effective. Chloramphenicol produces a gray syndrome in neonates and premature babies, which is characterized by abdominal distention, pallid cyanosis, vasomotor collapse, irregular respirations, and even death. In addition, the drug may cause bone marrow depression, including aplastic anemia that can result in death. Liver failure and hearing loss are not usually associated with this drug.
33 .
The patient in the clinic receives a prescription for an anti-infective to treat a urinary tract infection. The patient asks the nurse, Would you ask the doctor to give me refills on this prescription? I get a urinary tract infection almost once a year it seems and Id like to have a refill I can store for the next time so I dont have to come back to the clinic. What is the nurses priority response?
A)
Sure, Id be glad to ask. How many refills would you like to have?
B)
Most medications, if not used, should be discarded after a year so it is better to get a new prescription next year when you need it.
C)
This antibiotic doesnt destroy every pathogen that could cause a urinary tract infection so it is better to get the right antibiotic next time.
D)
Saving antibiotics for another time and self-diagnosing when antibiotics are needed lead to resistant organisms that no longer respond to drugs.
Ans:
D Feedback: Option A is incorrect because the patient should not be given refills to use indiscriminately. The remaining options are all important teaching points for this patient, but the priority is teaching this patient about drug-resistant organisms and how they can be prevented, as well as what happens if an infection results from a resistant organism.
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34 .
The nurse admits a patient with septicemia (i.e., infection in the bloodstream). The patient denies any allergies and the doctor has ordered cefuroxime based on blood culture results that report the active pathogen is susceptible to this drug. The patient asks what antibiotic was ordered, and when the nurse says cefuroxime, the patient says, Call my doctor and tell him I want vancomycin because Ive been reading about drug-resistant bacteria and I dont want to take any chances. What is the nurses best response?
A)
Vancomycin is a powerful drug with many adverse effects and it is reserved for when no other drug will work against the infection.
B)
There are some resistant infections that require vancomycin so you are right to prefer a stronger antibiotic.
C)
I appreciate your concern but your doctor ordered the right medication for you so dont worry about it.
D)
You cant believe anything you read on the Internet because most of it is just someones opinion and not fact.
Ans:
A Feedback: The patient is right in saying that vancomycin is effective against drugresistant bacteria but needs help to understand that he or she does not have a resistant infection as indicated by the culture and sensitivity and that use of such a powerful drug when it is not needed increases risk of developing a vancomycin-resistant infection. It is never right to tell a patient not to worry because they have every right to participate in his or her own care and should not be patronized. Although some information on the Internet may not be accurate, it would be incorrect to say it is all just someones opinion and not fact, especially given that the patients information is accurate.
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35 .
The mother brings her 18-month-old toddler to the pediatrician because the child has a fever and has been tugging on his or her left ear. Examination of the tympanic membrane confirms an ear infection and the toddler also has a cold with nasal congestion, rhinorrhea, and a cough. The provider tells the mother to apply heat and gives her a prescription for an otic anesthetic to make the ear more comfortable until the infection resolves. The mother is not happy and says she wants a prescription for an antibiotic. What important teaching points will the nurse include in the teaching plan? (Select all that apply.)
A)
Ear infections that accompany viral respiratory infections do not respond to antibiotics.
B)
Habitual use of antibiotics for viral infections contribute to development of resistant strains.
C)
Adverse effects from antibiotics in children can cause diarrhea and dehydration.
D)
Antibiotics will only be prescribed if a culture indicates the presence of bacteria in the ear.
E)
The pediatrician knows more than the mother and she should trust what she is being told.
Ans:
A, B, C Feedback: When the child has a viral respiratory infection, the organism involved in ear infections is usually viral as well. As a result, antibiotics will have no effect on the infection that will resolve independently and only comfort care is indicated. Habitual use of antibiotics for viral infections contributes to the development of resistant strains of bacteria and the adverse effects can make the child more uncomfortable causing diarrhea and dehydration. Cultures of ear fluid are almost never done because it would be an invasive procedure to remove fluid from the middle ear. It is never right for the nurse to patronize the mother, who has every right to advocate for her child, and it is more important she understand why the antibiotic is not being prescribed than telling her the pediatrician knows more.
Chapter 52. Antiprotozoal Drugs
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1.
The patient is having an acute malarial attack with chills and fever. The nurse knows chills and fever are caused by what?
A)
Formation of sporozoites into the system
B)
Rupture of red blood cells due to invasion of merozoites
C)
Invasion of the tsetse fly into the central nervous system
D)
Release of amastigotes into the blood vessels
Ans:
B Feedback: The chills and fever associated with an acute malarial attack are caused by the rupture of red blood cells containing merozoites. These symptoms are related to the pyrogenic effects of the protozoa and the toxic effects of the red blood cell components on the system. The formation of sporozoites occurs in the stomach of the mosquito when the male and female gametocytes mate and produce a zygote. Invasion of the tsetse fly causes trypanosomiasis, which affects the central nervous system. The release of amastigotes occurs in leishmaniasis, which is caused by the sand fly and is part of a cyclic pattern that causes serious skin lesions.
2.
The nurse is caring for a patient of Greek descent who plans to travel to an area of the world in which malaria is endemic. What should this patient be tested for before administering antimalarial medications?
A)
Tay-Sachs disease
B)
Glucose-6-phosphate dehydrogenase (G6PD) deficiency
C)
Plasmodium
D)
Penicillin allergy
Ans:
B Feedback:
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Patients of Mediterranean descent, including Greeks, are more likely to have a G6PD deficiency. When patients with this deficiency take primaquine, chloroquine, or quinine, an acute hemolytic crisis may occur. Patients of Mediterranean descent should be tested for G6PD deficiency before any antimalarial drugs are prescribed. Tay-Sachs disease is a disorder seen in those of middle-eastern descent that causes death of the child by age 5. Plasmodium is the genus strain that causes malaria. Penicillin allergy has no connection to this situation. 3.
The nurse is caring for a patient who is being treated with quinine (Qualaquin) for drug-resistant malaria. The nurse will monitor the patient for cinchonism that will present with what manifestations?
A)
Diarrhea, nausea, and fever
B)
Yellowing of the sclera and skin
C)
Tremors and ataxia
D)
Vomiting, tinnitus, and vertigo
Ans:
D Feedback: Patients with cinchonism or quinine toxicity may complain of tinnitus, headache, dizziness, nausea, fever, tremors, and visual disturbances. Diarrhea, yellowing of the sclera or skin, and ataxia are not associated with cinchonism.
4.
Patients receiving chloroquine (Aralen Phosphate) for malaria prophylaxis should receive patient teaching from the nurse, which includes instructions to receive what regularly?
A)
Cardiovascular studies
B)
Eye exams
C)
Immunizations
D)
Pulmonary studies
Ans:
B Feedback:
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Chloroquine is associated with visual disturbances and a patient receiving this drug should receive regular ophthalmic exams. Heart and lung toxicity is not associated with chloroquine use. Immunizations are not associated with chloroquine use. 5.
A 28-year-old woman is planning to be part of a mission team going to Central Africa. She will take mefloquine (Lariam) once a week, beginning 1 week before traveling to Africa until 4 weeks after leaving Africa. What precaution will the nurse teach this patient is needed?
A)
Avoid excessive weight gain.
B)
Have regular cancer screening.
C)
Use contraceptives to avoid pregnancy.
D)
Stop the medication if diabetes is diagnosed.
Ans:
C Feedback: Mefloquine is teratogenic and should be avoided during pregnancy. The nurse will want to determine whether a possibility exists that the patient is pregnant and warn about the need to avoid pregnancy for 2 months after completing therapy. Avoiding weight gain and having regular cancer screenings are good preventive care but not associated with mefloquine. This medication is not contraindicated in patients with diabetes.
6.
The nurse is writing a plan of care for a patient receiving antimalarial drug therapy. What nursing diagnosis would be appropriate for this patient if common adverse effects were indicated?
A)
Disturbed sensory perception (visual) related to central nervous system effects
B)
Imbalanced nutrition: more than body requirements
C)
Constipation
D)
Ineffective breathing pattern
Ans:
A Feedback:
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Visual disturbances, including blindness related to retinal damage from the drug, may occur. Patients usually have gastrointestinal (GI) upset including diarrhea, not constipation, which could produce loss of weight and not an increase. Respiratory disturbances are not associated with antimalarial agents. 7.
During a lecture on intestinal parasites, the students learn that what is the most commonly diagnosed intestinal parasite infection in the United States?
A)
Amebiasis
B)
Giardiasis
C)
Leishmaniasis
D)
Trichomoniasis
Ans:
B Feedback: The most commonly diagnosed intestinal parasite in the United States is Giardiasis. It is transmitted through contaminated water or food. Amebiasis is found in the United States but is not the most common. Leishmaniasis is transmitted through sand flies, which are not common in the United States. Trichomoniasis is a flagellated protozoan and most often is seen in the vagina and is spread during sexual intercourse by men who have no signs and symptoms of infection, it is not the most commonly diagnosed.
8.
A patient has been diagnosed with trichomoniasis. Before beginning tinidazole (Tindamax) therapy, what should the nurse question the patient about?
A)
Working conditions
B)
Use of alcohol
C)
Recent visit to a beach or desert
D)
Possibly having AIDS
Ans:
B Feedback:
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Tinidazole is prescribed for trichomoniasis, which is transmitted during sexual intercourse. The drug should not be used when there is a history of alcohol use. Alcohol use could interfere with the drugs metabolism in the liver and cause toxicity and patients should be warned to avoid consuming all alcoholic beverages while taking this medication. There is no need to question about working conditions unless transmission involved environmental contamination of food and water, which is not indicated by the question. A recent visit to a beach or desert would be indicated if the patient was diagnosed with leishmaniasis and questioning the patient concerning AIDS would be indicated if the patient had a diagnosis of Pneumocystis carinii pneumonia and would not involve trichomonas. 9.
The nurse is caring for a patient with acquired immunodeficiency syndrome (AIDS) who has been diagnosed with Pneumocystis jiroveci pneumonia. The patient is taking multiple oral agents to treat AIDS. What would be the drug of choice for this patient?
A)
Nitazoxanide (Alinia)
B)
Chloroquine
C)
Metronidazole
D)
Pentamidine
Ans:
D Feedback: Pentamidine is available as an inhalation product for the direct treatment of P. jiroveci in patients with AIDS. Because the patient is already taking multiple oral drugs, inhaler administration would be the best choice. Nitazoxanide, chloroquine, and metronidazole are not effective against P. jiroveci pneumonia.
10 .
A patient with giardiasis is being treated with metronidazole. What comment by the patient would indicate that the nurse needs to provide further teaching?
A)
I can continue to work delivering pizza because the disease is not contagious.
B)
I will not lose my hair during drug therapy.
C)
I know I will experience diarrhea during this time.
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D)
I shouldnt experience irregular menstrual periods.
Ans:
A Feedback: Although giardiasis is not contagious, the patient should be encouraged not to drive or operate heavy equipment until the effects of the drug can be assessed because metronidazole can lead to central nervous system adverse effects, including dizziness and lack of coordination. The drug may also cause diarrhea. Loss of hair and irregular menstrual periods are not associated with this drug, so these statements would be correct and would not indicate the need for further teaching.
11 .
During treatment of amebiasis with chloroquine (Aralen Phosphate), the nurse assesses the patient for what adverse effects?
A)
Diarrhea
B)
Weight gain
C)
Hypertension
D)
Seizures
Ans:
A Feedback: With amebicides, observe for anorexia, nausea, vomiting, epigastric burning, and diarrhea that can lead to malnutrition and significant weight loss, which the nurse assesses for with each visit to intervene before significant malnutrition occurs. Weight gain, hypertension, or seizures are not associated adverse effects.
12 .
The clinic nurse provides teaching for a patient prescribed pyrimethamine (Daraprim) to prevent malaria and instructs on the need to notify the prescriber immediately if what signs and symptoms occur?
A)
Diarrhea, fatigue, weight loss, and anemia
B)
Irritation, rash, or inflammation
C)
Headache, nausea, or constipation
D)
Anorexia, nausea, or vomiting
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Ans:
A Feedback: If signs of folate deficiency develop, pyrimethamine will need to be discontinued so the prescriber needs to be notified immediately. Folate deficiency presents with diarrhea, fatigue, weight loss, and anemia. The other signs and symptoms would need to be reported if significant and/or long-lasting.
13 .
The mother of a 6-month-old infant comes to the clinic. The mother is diagnosed with a protozoal infection. What would be a priority for the nurse to assess for?
A)
Whether she is breast-feeding
B)
Whether she has a support network
C)
Whether she has money to pay for the medication
D)
Whether she eats a protein-rich diet
Ans:
A Feedback: Assess for lactation because antiprotozoal drugs could enter the breast milk and be toxic to the infant. The other options are part of a complete nursing history but do not specifically relate to treatment for a protozoal infection.
14 .
A patient is prescribed mefloquine (Lariam) for malaria prophylaxis. When should the nurse instruct mefloquine be started?
A)
1 week prior to entering an endemic area
B)
1 to 2 days prior to entering an endemic area
C)
On arrival to an endemic area
D)
When mosquitoes are present
Ans:
A Feedback: Lariam should be taken 1 week prior to entering a malarial area. Therefore, options B, C, and D are incorrect.
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15 .
What statements made by the 36-year-old patient leads the nurse to believe that he or she has understood the teaching regarding metronidazole (Flagyl)?
A)
I will refrain from operating heavy machinery while I am taking this medication.
B)
I will avoid foods high in vitamin C.
C)
I will not drink alcohol while I am taking this medication.
D)
I will contact my physician if I have a cold.
Ans:
C Feedback: Patients should avoid all forms of alcohol while taking metronidazole. Patients do not need to avoid operating heavy machinery,and foods high in vitamin C, and will not contact the physician if they have colds.
16 .
The emergency room nurse admits a patient suspected of having giardiasis. What symptoms would the nurse expect the patient to present with?
A)
Voluminous soft unformed stool
B)
Frothy voluminous pale stool
C)
Pale and mucous-filled stool
D)
Frothy tan stool
Ans:
C Feedback: Diarrhea, rotten-egg-smelling stool, and pale and mucous-filled stool are commonly seen. Diarrhea is often accompanied by epigastric distress, weight loss, and malnutrition as a result of the invasion of the mucosa. Therefore, options A, B, and D are incorrect.
17 . A)
A 91-year-old man is being treated for Pneumocystis carinii pneumonia with pentamidine (NebuPent). What should the nurse measure when assessing this patient for adverse effects of the medication? Liver function tests
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B)
Serum potassium
C)
Daily blood pressure
D)
Blood urea nitrogen (BUN) and creatinine
Ans:
A Feedback: Patients receiving antiprotozoal agents should be monitored regularly to detect any serious adverse effects. Liver function tests are of particular importance to determine the appropriateness of therapy and to monitor for toxicity. Serum potassium, BUN, and creatinine would indicate kidney damage, which is not normally a risk with this drug. Blood pressure is not indicated for this medication but is an early indicator of health deterioration and is usually included in all provisions of care.
18 .
What is the priority teaching point to be provided by the nurse to a patient being treated for trichomoniasis to prevent reinfection?
A)
Meats should be fully cooked before eaten.
B)
Sexual partners should be treated.
C)
Wash hands before eating.
D)
Purify all drinking water when camping.
Ans:
B Feedback: Trichomoniasis is usually spread during sexual intercourse and men often have no symptoms. Women present with red, inflamed vaginal mucosa, itching, burning, and a yellowish green discharge. Women should be taught the importance of having their partners tested and treated simultaneously to prevent reinfection. The other options are healthy lifestyle choices but are not the primary means of preventing reinfection.
19 .
How does the nurse teach the patient to take chloroquine (Aralen Phosphate)?
A)
On an empty stomach
B)
With 8 ounces of water
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C)
With meals
D)
With orange juice followed by 8 ounces of water
Ans:
C Feedback: Chloroquine should be taken with meals to reduce gastrointestinal (GI) upset; small frequent meals may also reduce negative GI effects. Taking medications, any medication, with adequate amounts of water is always good practice but not specific to this medication. There is no indication that ingestion of orange juice makes any practical difference.
20 .
The nurse, learning about malaria, discovers that the transmission of malaria occurs when what is injected into the human body by the infected mosquito?
A)
Sporozoites
B)
Gametocytes
C)
Schizonts
D)
Merozoites
Ans:
A Feedback: Gametocytes are sucked with the blood from an infected person by the mosquito. The gametocytes mate in the stomach of the mosquito and produce a zygote that goes through several phases before forming sporozoites (spore animals) that make their way to the mosquitos salivary glands. The next person who is bitten by that mosquito is injected with thousands of sporozoites. Schizonts are the primary tissue organisms resulting from asexual cell division and reproduction after the sporozoites are introduced into the body. Merozoites are then formed from the primary schizonts.
21 .
A)
The nurse is caring for a patient who is taking antimalarial medications. The nurse teaches the patient about the medication and explains the need to report what signs and symptoms immediately because of its association with a serious adverse effect? Loss of appetite
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B)
Loss of hair
C)
Loss of vision
D)
Loss of sensation
Ans:
C Feedback: Report blurring of vision, which could indicate retinal damage; loss of hearing or ringing in the ears, which could indicate central nervous system toxicity; and fever or worsening of condition, which could indicate a drugresistant strain or noneffective therapy. Loss of appetite is such a common result of the gastrointestinal (GI) effects of the drug that the nurse should provide anticipatory guidance to teach the patient how to maintain adequate nutrition, but the patient does not need to report this unless it becomes serious or unmanageable. Loss of sensation is not a typical adverse effect the nurse would anticipate and teach about.
22 .
The nurse is caring for a patient who just returned from a trip to South America and was infected by the protozoan Trypanosoma cruzi. What will the nurse assess for in this patient?
A)
Serious lesions in the skin
B)
Sleeping sickness
C)
Severe cardiomyopathy
D)
Yellowish green vaginal discharge
Ans:
C Feedback: Chagas disease, which is caused by T. cruzi, is passed to humans by the common house fly. This protozoan results in a severe cardiomyopathy that accounts for numerous deaths and disabilities in certain regions. Sleeping sickness results from T. brucei gambiense; leishmaniasis produces serious lesions in the skin, and trichomoniasis produces a yellowish green discharge.
23 . A)
A patient with malaria is taking primaquine. What would indicate to the nurse caring for this patient that the patient has cinchonism? Diarrhea
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B)
Abdominal cramping
C)
Tan, frothy stool
D)
Vertigo
Ans:
D Feedback: Cinchonism (nausea, vomiting, tinnitus, and vertigo) may occur with high levels of primaquine. Symptoms of cinchonism do not include diarrhea, abdominal cramping, or tan, frothy stool.
24 .
A patient has been prescribed an antimalarial as prophylaxis for the disease. What assessment finding would the nurse recognize as indicating the patient has a common adverse effect?
A)
Dyspepsia
B)
Hematemesis
C)
Tarry stool
D)
Tachycardia
Ans:
A Feedback: Nausea, vomiting, dyspepsia, and anorexia are associated with direct effects of the antimalarial medications on the GI tract and the effects on central nervous system control of vomiting caused by the products of cell death and protein changes. Adverse effects from antimalarial drugs do not usually include hematemesis, tarry stool, or tachycardia.
25 .
A patient presents at the emergency department complaining of sudden onset of high fever and swelling and reddening of the limbs. Assessment shows severe hypotension. The nurse taking the patients history notes that the patient has recently returned to the United States from the African continent. The patient is admitted to the intensive care unit (ICU) suspected of having malaria caused by what protozoan?
A)
Plasmodium ovale
B)
Plasmodium falciparum
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C)
Plasmodium vivax
D)
Plasmodium malariae
Ans:
B Feedback: P. falciparum is considered to be the most dangerous type of protozoan. Infection with this protozoan results in an acute, rapidly fulminating form of the disease with high fever, severe hypotension, swelling and reddening of the limbs, loss of red blood cells, and even death. The other options are pathogens that cause milder forms of the disease and P. ovale is rarely encountered.
26 .
Pyrimethamine (Daraprim) has been ordered for the patient as prophylactic treatment of malaria. The nurse recognizes the action of this drug prevents relapse of the disease by acting on what?
A)
Changing the metabolic pathways for reproduction
B)
Disrupting the mitochondria of the plasmodium
C)
Blocking the use of folic acid
D)
Increasing the acidity of plasmodial food vacuoles
Ans:
C Feedback: Pyrimethamine is used in combination with agents that act more rapidly to suppress malaria; it acts by blockings the use of folic acid in protein synthesis by the plasmodium, eventually leading to inability to reproduce and cell death. Chloroquine changes the metabolic pathways for reproduction of the plasmodium and is toxic to parasites that absorb it. Primaquine disrupts the mitochondria of the plasmodium. Mefloquine increases the acidity of plasmodial food vacuoles causing cell rupture and death.
27 . A)
A patient, recently returned from a vacation in the tropics, is diagnosed with leishmaniasis. The patient asks the nurse how he or shes got this disease. What is the nurses best response? You got this disease from a mosquito bite.
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B)
You got this disease from unsanitary drinking water.
C)
You got this disease from eating unsanitary food.
D)
You got this disease from the bites of sand flies.
Ans:
D Feedback: Leishmaniasis is a disease caused by a protozoan that is passed from sand flies to humans. Therefore, options A, C, and D are incorrect.
28 .
The patient, newly diagnosed with African sleeping sickness, asked what caused the disease. What is the nurses best response?
A)
Trypanosoma brucei gambiense
B)
Giardia lamblia
C)
Promastigote
D)
Trypanosoma cruzi
Ans:
A Feedback: African sleeping sickness, which is caused by Trypanosoma brucei gambiense, is transmitted by the tsetse fly. After the pathogenic organism has lived and grown in human blood, it eventually invades the central nervous system, leading to acute inflammation resulting in lethargy, prolonged sleep, and even death. G. lamblia causes giardiasis; T. cruzi causes Chagas disease. A promastigote is a flagellated protozoan that causes leishmaniasis.
29 .
The patient, a physician returning from a trip to the tropics, is prescribed chloroquine and asks the nurse how it works. What is the nurses best response?
A)
Blocks the plasmodiums ability to synthesize ribonucleic acid
B)
Changes the metabolic pathways necessary for the reproduction of the plasmodium
C)
Interrupts the cell wall preventing entry of nutrients into the plasmodium
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D)
It is alkaline and decreases the ability of the parasite to synthesize deoxyribonucleic acid (DNA).
Ans:
B Feedback: Chloroquine is currently the mainstay of antimalarial therapy. This drug enters human red blood cells and changes the metabolic pathways necessary for the reproduction of the plasmodium (see Figure 12.1). In addition, this agent is directly toxic to parasites that absorb it, it is acidic, and it decreases the ability of the parasite to synthesize DNA, leading to a blockage of reproduction.
30 .
What antimalarial medication is used as a radical cure of Plasmodium vivax malaria?
A)
Chloroquine
B)
Mefloquine
C)
Pyrimethamine
D)
Primaquine
Ans:
D Feedback: Primaquine (generic) is the only drug indicated for the prevention of relapses of P. vivax and P. malariae infections and a radical cure of P. vivax malaria. It may be given in combination with other drugs that interrupt the cell cycle at other stages. None of the other options are indicated for this use.
31 .
The nurse, working in a pediatric clinic, admits a patient who will be traveling to a country where malaria is endemic. What is the safest treatment for this child?
A)
No prophylaxis is administered because of the severity of adverse effects.
B)
Call the Centers for Disease Control and Prevention (CDC) or local health department for the safest possible treatment.
C)
Administer extremely small doses of chloroquine.
D)
Any antimalarials in appropriate dosages can be administered.
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Ans:
B Feedback: Although dosages for prophylaxis have been calculated to treat malaria in children, many drugs have not been proven to be safe and efficient in that population and extreme caution is needed .If a child needs to travel to an area with endemic protozoal infections, the CDC or local health department should be consulted about the safest possible preventive measures. As a result, the other options are incorrect.
32 .
What statement, if made by the nurse, would be correct?
A)
Malaria can live without a host and be contracted from drinking standing water.
B)
Any mosquito can carry the plasmodium that transmits malaria.
C)
A major problem with controlling malaria is the mosquito that is resistant to insecticide.
D)
Widespread efforts at mosquito control have never been helpful.
Ans:
C Feedback: Widespread efforts at mosquito control have been successful, with fewer cases of malaria being reported each year. However, the rise of insecticideresistant mosquitoes has allowed malaria to continue to flourish, increasing the incidence of the disease. Malaria requires a host to live, whether it is human or mosquito. Only the female Anopheles mosquito harbors the protozoal parasite and carries it to humans.
33 .
The nurse is caring for a patient diagnosed with amebiasis caused by Entamoeba histolytica that resulted in the patient having amebic dysentery. What questions might the nurse ask in an attempt to discover how the patient came in contact with the organism? (Select all that apply.)
A)
Have you traveled outside the country recently?
B)
Have you been swimming in a lake or pond recently?
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C)
Have you been eating fresh fruits or vegetables without washing them first?
D)
Have you been bitten by a mosquito?
E)
Have you had unprotected sex recently?
Ans:
A, B, C Feedback: The disease is transmitted while the protozoan is in the cystic stage in fecal matter, from which it can enter water and soil. It can be passed to other humans who drink this water or eat food that has been grown in this ground. It is not passed by a mosquito or from sexual activity.
34 .
The nurse explains that the drugs metronidazole (Flagyl) or tinidazole (Tindamax) can be administered to treat what protozoan infections? (Select all that apply.)
A)
Trichomoniasis
B)
Giardiasis
C)
Amebiasis
D)
Pneumocystis carinii pneumonia
E)
Cryptosporidium parvum
Ans:
A, B, C Feedback: Metronidazole or tinidazole are effective treatments for trichomoniasis, giardiasis, and amebiasis. They are not effective for P carinii pneumonia or C. parvum.
35 .
How does the nurse adapt the plan of care when caring for an older adult receiving an antiprotozoal agent?
A)
Patients should be monitored more closely for toxic adverse effects.
B)
The drug dosage should be lowered for all older adults.
C)
Antiprotozoal agents should not be administered to older adults.
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D)
Female patients of appropriate age should be advised to use barrier contraceptives.
Ans:
A Feedback: Older patients may be more susceptible to the adverse effects associated with these drugs. They should be monitored closely. Dosage should only be lowered if the patient has hepatic dysfunction or if hepatic dysfunction is anticipated. Antiprotozoal agents can be administered to older adults with caution when the benefit outweighs the risk. It is not necessary for older adult women to use barrier methods of contraceptives because they are no longer of childbearing age.
Chapter 53. Clinical Pharmacology of the Antihelminthic Drugs 1.
A public health nurse is speaking to parents of first graders. When discussing worm infection, the nurse will explain that the most common type found in U.S. school-aged children is what?
A)
Pinworms
B)
Roundworms
C)
Threadworms
D)
Whipworms
Ans:
A Feedback: The most common worm infection encountered in U.S. school-aged children is pinworms. These worms are endogenous to the area and easily spread. Roundworms, whipworms, and threadworms are not as common.
2.
A mother of a 3-year-old child brings her child to the clinic. The child is diagnosed with pinworms. What drug would be the best choice for the patient?
A)
Pyrantel (Pin-Rid)
B)
Ivermectin (Stromectol)
C)
Mebendazole (Vermox)
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D)
Albendazole (Albenza)
Ans:
C Feedback: Mebendazole is the most commonly used anthelmintic for pinworms because it is available in a chewable tablet. This is a good choice for the 3-year-old patient. Pyrantel is also prescribed for pinworms but is not available in a chewable form. Ivermectin is prescribed for treatment of threadworm disease and albendazole is given to treat active lesions caused by pork tapeworm and cystic disease of the liver, lungs, and peritoneum caused by dog tapeworm.
3.
A nurse is teaching a young mother about administering pyrantel (Pin-Rid, others) to her 5-year-old child. What will the nurse emphasize about how the agent is given?
A)
In 3 doses as a 1-day treatment
B)
In a morning dose and an evening dose for 3 days
C)
B.I.D. for 10 days
D)
Give only once
Ans:
D Feedback: Pyrantel is administered orally as a single dose. Albendazole is prescribed for hydatid disease and is given twice a day for 8 to 30 days of treatment. Mebendazole is used in the treatment of diseases caused by pinworms, roundworms, whipworms, and hookworms and is given in a morning and evening dose for 3 days. Praziquantel is used to treat schistosomes and is taken in three doses as a 1-day treatment.
4.
A patient has been diagnosed with roundworms and is to be treated with albendazole. A priority nursing assessment of this patient would be to determine if the patient is taking what?
A)
Cimetidine (Tagamet)
B)
Pioglitazone (Actos)
C)
Alprazolam (Xanax)
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D)
Loperamide (Imodium)
Ans:
A Feedback: The adverse effects of albendazole, which are already severe, may increase if the drug is combined with dexamethasone, praziquantel, or cimetidine. These combinations should be avoided if at all possible; if they are necessary, patients should be monitored closely for the occurrence of adverse effects. Pioglitazone is an oral antidiabetic agent that could be taken with albendazole. Loperamide is an antidiarrheal drug that may be used for treatment of diarrhea as a result of the mebendazole and pyrantel. Alprazolam should not be a concern.
5.
What would be a priority nursing action related to the care of a patient taking albendazole (Albenza)?
A)
Check blood pressure, pulse, and respirations
B)
Weigh the patient
C)
Monitor renal function
D)
Encourage small, frequent meals
Ans:
C Feedback: It is important that the patients kidney function be monitored because a serious adverse effect of this drug is renal failure. Even though vital signs, weight, and nutrition are important and should be monitored, if the patient exhibits any signs of renal failure the drug should be stopped immediately.
6.
The nurse is caring for an adult patient receiving a prescription for an anthelmintic drug. What is a possible nursing diagnosis for this patient?
A)
Constipation
B)
Disturbed body image
C)
Acute confusion
D)
Imbalanced nutrition: More than body requirements
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Ans:
B Feedback: A potential nursing diagnosis for the patient would be disturbed body image related to diagnosis and treatment. There is a stigma associated with having helminthic infections. Treatment can cause diarrhea, loss of hair, and pruritus, which could be noticed by others and further impact the patients body image. Usually these drugs do not cause constipation; they have not been linked to confusion.
7.
A nurse is teaching a patient who has been diagnosed with trichinosis. The nurse will include in the discussion that trichinosis is caused by roundworms having what effect?
A)
Disruption of the hosts normal cellular functions causing cell death and resulting in disease
B)
Invasion of body tissues seriously damages lymphatic tissue, lungs, the central nervous system, heart, and liver
C)
Exposure to the delicate mucous membranes of the anus and colon producing local irritation
D)
Easily passed from one individual to another resulting in rapid spreading within a work place
Ans:
B Feedback: Trichinosis is a disease caused by the ingestion of the encysted larvae of the roundworm from undercooked pork. These worms exist outside the intestinal tract and can seriously damage the tissues they invade. The worms do not spread rapidly through a large group of people unless they have all eaten the undercooked pork. They do not enter cells to alter human cellular function.
8.
When instructing a patient about the therapeutic effectiveness of an anthelmintic drug, the nurse would be sure to include what?
A)
Any person exposed to the patient should also be treated.
B)
The drugs should never be taken with food.
C)
The infected person should be isolated.
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D)
Strict hygiene measures are important in eradicating the worm.
Ans:
D Feedback: When treating a patient with an anthelmintic drug, the patient should be instructed to follow strict hand washing and hygiene measures as an adjunct in eradicating the worm. Isolation is not necessary and prophylactic treatment is not effective with worms. Anthelmintics are often taken with food to decrease the gastrointestinal (GI) adverse effects.
9.
The nurse is caring for a patient diagnosed with hookworms. The patient is receiving mebendazole (Vermox). What would the nurse expect to see in this patient?
A)
Increased bilirubin
B)
Decreased hematocrit and hemoglobin
C)
Increased aspartate transaminase levels
D)
Decreased blood sugar
Ans:
B Feedback: Hookworms can cause anemia and fluid and electrolyte imbalances because of the amount of blood that is sucked from the walls of the intestine. A decreased hematocrit and hemoglobin would indicate anemia and is often found in patients with hookworm. Bilirubin and aspartate transaminase indicate liver function. Because mebendazole is not absorbed systemically, adverse effects are limited to abdominal effects such as discomfort, diarrhea, or pain so this drug would not impact bilirubin or aspartate transaminase levels. Neither the disease nor drug should decrease blood sugar.
10 .
A patient is taking an anthelmintic that is absorbed systemically. What adverse effect should the nurse inform the patient might be experienced?
A)
Abdominal discomfort
B)
Diarrhea
C)
Loss of hair
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D)
Pain
Ans:
C Feedback: Anthelmintics that are absorbed systemically could cause headache, dizziness, fever, shaking, chills, malaise, pruritus, and loss of hair. Mebendazole and pyrantel are anthelmintics that are not generally absorbed systemically and may cause abdominal discomfort, diarrhea, and pain.
11 .
A mother brings her child to the clinic where the child is diagnosed with hookworms. The mother asks how the child got hookworms. What would the nurse tell the mother is the route of entry for hookworm?
A)
Inhalation
B)
Contact with skin
C)
Ingestion of undercooked foods
D)
Blood-borne exposure
Ans:
B Feedback: The larvae penetrate the skin and then enter the blood and within about a week, reach the intestine. Inhalation, ingestion, and blood-borne exposure are incorrect.
12 .
A patient is diagnosed with an ascaris infection. The patient asks what the best way is to prevent ascaris infections. What is the nurses best response?
A)
Wash hands before eating.
B)
Do not share hairbrushes or hats.
C)
Wash fresh fruits and vegetables before eating.
D)
Avoid heavily populated areas.
Ans:
C Feedback:
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Ascaris infection occurs where sanitation is poor. Eggs in the soil are ingested with vegetables or other improperly washed foods containing the worm. The patients may be unaware until a worm in their stool is seen or the patient becomes quite ill. Teaching patients the importance of washing fresh fruit and vegetables will help them reduce risk of infection. Washing hands, avoiding sharing hairbrushes or hats, and being aware in populated areas will reduce the risk of other infections but do not relate to ascaris. 13 .
What is an appropriate nursing diagnosis for a patient with tapeworm?
A)
Imbalanced nutrition: less than body requirements
B)
Chronic pain
C)
Constipation
D)
Impaired mobility
Ans:
A Feedback: Tapeworm affects the bodys ability to absorb food products and weight loss and malnutrition often follow unless treatment is received promptly. As a result, the best nursing diagnosis is imbalanced nutrition: less than body requirements. Patients with tapeworm are often symptom-free but may experience some abdominal discomfort and distention as well as weight loss so they do not have chronic pain, constipation, or impaired mobility.
14 .
Why is it important for a nurse to inquire about any foreign travel of a patient with a suspected lymphatic or hematologic disorder?
A)
To determine the varied sexual history of the patient, if any
B)
To determine the potential exposure to infectious agents
C)
To determine whether the patient has had any blood transfusions
D)
To determine whether the patient adopted any specific dietary habits
Ans:
B Feedback:
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Knowledge of recent travel can help the nurse to pinpoint potential exposure to helminths, parasites, or other infection exposure common in the area visited. The nurse should specifically ask about foreign travel to countries where malaria or parasitic roundworms are common. Sexual history, dietary habits, or any blood transfusions that the patient may have had before would not be adequately explored by questioning travel history. 15 .
What helmintic infestation occurs in tropical areas and is carried by snails?
A)
Schistosomiasis
B)
Platyhelminths
C)
Trichinosis
D)
Filariasis
Ans:
A Feedback: Schistosomiasis is a common problem in many tropical areas where the snail that is necessary in the life cycle of the fluke lives. Trichinosis is caused by eating undercooked pork and can occur in any part of the world. Filariasis and platyhelminths are not restricted to tropical areas.
16 .
The nursing instructor is discussing helmintic infections with the nursing students. How would the instructor explain the action of anthelmintic drugs?
A)
Destroy the nervous system of the invading worm
B)
Act on metabolic pathways that are present in the invading worm
C)
Interfere in the reproductive cycle of the invading worm
D)
Cause fatal mutations in the deoxyribonucleic acid of the invading worm
Ans:
B Feedback: The anthelmintic drugs act on metabolic pathways that are present in the invading worm, but that are absent or significantly different in the human host. Other options are incorrect descriptions of how anthelmintic drugs work.
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17 .
What anthelmintics would the nurse expect will be readily absorbed from the gastrointestinal (GI) tract? (Select all that apply.)
A)
Mebendazole
B)
Pyrantel
C)
Albendazole
D)
Praziquantel
E)
Ivermectin
Ans:
D, E Feedback: Praziquantel and ivermectin are readily absorbed from the GI tract. Mebendazole, pyrantel, and albendazole are not.
18 .
A mother brings her 18-month-old son into the clinic. The child is diagnosed with pinworms. Which anthelmintic would the nurse expect to be prescribed?
A)
Pyrantel
B)
Mebendazole
C)
Ivermectin
D)
Praziquantel
Ans:
B Feedback: Mebendazole is available in the form of a chewable tablet that would be preferable for a young child. Because little of the drug is absorbed systemically, it is safe for children and has few adverse effects, thus making it safer to administer to a child. Pyrantel is not approved for children younger than 2 years old. Ivermectin and praziquantel effects are systemic and would a greater number of adverse effects.
19 .
The nurse is caring for a 26-year-old patient diagnosed with roundworms who is prescribed pyrantel. What adverse effect would the nurse teach the patient about?
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A)
Vomiting
B)
Itching
C)
Diarrhea
D)
Constipation
Ans:
C Feedback: Mebendazole and pyrantel, which are not absorbed systemically, may cause abdominal discomfort, diarrhea, or pain, but have very few other effects and are well-tolerated. Therefore options A, B, and D are incorrect.
20 .
The nurse is caring for a patient taking albendazole. When reviewing the patients medication history what drug would cause the nurse to question administering albendazole?
A)
Propranolol
B)
Fexofenadine
C)
Furosemide
D)
Dexamethasone
Ans:
D Feedback: The effects of albendazole, which are already severe, may increase if the drug is combined with dexamethasone, praziquantel, or cimetidine. These combinations should be avoided if at all possible; if they are necessary, patients should be monitored closely for occurrence of adverse effects. No contraindications are noted for propranolol, fexofenadine, or furosemide.
21 .
Why is a filariae infestation potentially fatal?
A)
Worm-like embryos overwhelm the lymphatic system
B)
Worm-like embryos invade the central nervous system (CNS)
C)
Worm-like embryos destroy the gastric mucosa
D)
Worm-like embryos hibernate in the brain
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Ans:
A Feedback: Filariasis refers to infection of the blood and tissues of healthy individuals by worm embryos, which enter the body via insect bites. These thread-like embryos, or filariae, can overwhelm the lymphatic system and cause massive inflammatory reactions. While any system can be impacted due to the effect on the blood and lymphatic system, the filariae do not invade the CNS, gastric mucosa, or the brain specifically.
22 .
The nurse is caring for a patient diagnosed with threadworm infestation. What is the nurses priority assessment related to common manifestations of this infestation?
A)
Gastroenteritis
B)
Pneumonia
C)
Hematuria
D)
Tarry stools
Ans:
B Feedback: Threadworm is a pervasive nematode that can send larvae into the lungs, liver, and central nervous system and can cause severe pneumonia or liver abscess. Threadworms do not cause gastroenteritis, hematuria, or tarry stools.
23 .
What infestation would the nurse suspect when the patient manifests with intestinal obstruction caused by the adult worms clogging the lumen of the intestine?
A)
Platyhelminth
B)
Trichinosis
C)
Nematode
D)
Cestode
Ans:
C
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Feedback: Nematode are roundworms such as the commonly encountered pinworm, whipworm, threadworm, Ascaris, or hookworm that cause a common helminthic infection in humans and can cause intestinal obstruction as the adult worms clog the intestinal lumen or severe pneumonia when the larvae migrate to the lungs and form a pulmonary infiltrate. Options A, B, and D are incorrect. 24 .
The nurse is caring for a 17-year-old girl who has just been diagnosed with a tapeworm. What is a priority nursing action for this patient?
A)
Monitor hepatic and renal function before and periodically during treatment.
B)
Provide small, frequent, nutritious meals if GI upset is severe.
C)
Instruct the patient about the appropriate dosage regimen.
D)
Offer support and encouragement.
Ans:
D Feedback: Frequently, patients have a very difficult time dealing with a diagnosis of worm infestation. It is very important for the nurse to understand the disease process and to explain the disease and treatment carefully to help the patient to cope with both the diagnosis and the treatment. Options A, B, and C are correct nursing interventions for this patient, but they are not the priority nursing intervention.
25 .
The nurse is counseling a patient who has been prescribed mebendazole for a worm infestation. What adverse effects would the nurse caution this patient about?
A)
Fever
B)
Constipation
C)
Nausea
D)
Hematuria
Ans:
A
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Feedback: Mebendazole is not absorbed systemically so it has few adverse effects. Adverse effects include transient abdominal pain, diarrhea, and fever. Adverse effects do not include constipation, nausea, or hematuria. 26 .
When teaching a class of her peers about use of the drug ivermectin, what would the nurse say is the primary route of excretion?
A)
Urine
B)
Feces
C)
Sweat
D)
Both urine and feces
Ans:
B Feedback: Ivermectin is readily absorbed from the gastrointestinal (GI) tract and reaches peak plasma levels in 4 hours. It is completely metabolized in the liver with a half-life of 16 hours and excretion is fecal. Options A, C, and D are incorrect.
27 .
Which anthelmintic medication is poorly absorbed from the gastrointestinal (GI) tract and primarily excreted in the urine?
A)
Ivermectin
B)
Praziquantel
C)
Albendazole
D)
Mebendazole
Ans:
C Feedback: Albendazole is poorly absorbed from the GI tract, reaching peak plasma levels in about 5 hours. It is metabolized in the liver and primarily excreted in urine. Although praziquantel is excreted in the urine, it is rapidly absorbed from the GI tract. Mebendazole and ivermectin are excreted in feces.
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28 .
The nurse is presenting at an educational event about pinworms at the local elementary school during an outbreak of the infestation. What suggestion would the nurse give the attendees to prevent a recurrence of the infestation?
A)
Tell the children not to share combs and brushes.
B)
Tell the children not to drink out of other peoples drinks.
C)
Avoid pajamas in favor of night gowns.
D)
Shower the children every morning.
Ans:
D Feedback: Some suggested hygiene measures that might help to control the infection include the following: Keep the childs nails cut short and hands well scrubbed, because reinfection results from the worms eggs being carried back to the mouth after becoming lodged under the fingernails when the child scratches the pruritic perianal area. Give the child a shower in the morning to wash away any ova deposited in the anal area during the night. Change and launder undergarments, bed linens, and pajamas every day. Open gowns, rather than pajamas with pants, would not be the best choice because this would allow for greater perianal scratching.
29 .
An adult presents at the clinic complaining of a cough, fever, abdominal distention, and pain. The patient is diagnosed with pneumonia and a helminth infection. What type of worm would the nurse suspect the patient has?
A)
Ascaris
B)
Platyhelminth
C)
Hookworm
D)
Schistosomiasis
Ans:
A Feedback:
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Ascaris manifestations include cough, fever, pulmonary infiltrates, abdominal distention, and pain. Platyhelminth is a flatworm that can live in the human intestine or can invade other human tissues causing malnutrition as the worm competes for the food eaten by the human. Hookworms attach to the small intestine leading to severe anemia, lethargy, fatigue, and weakness. Schistosomiasis presents with a rash and then symptoms of diarrhea and liver and brain inflammation. 30 .
A mother asks the nurse what to look for if her child has pinworms. What would be the nurses best response?
A)
Hard stools full of worms
B)
Perianal itching
C)
Upset stomach
D)
Bloody diarrhea
Ans:
B Feedback: Pinworms manifestation includes perianal itching, and occasionally, vaginal itching particularly at night when the pinworms are most active around the anal opening. Pinworms do not usually present in any other manner so the other options are incorrect.
31 .
A patient with hookworm infection states that he has a hard time following medication regimens. The nurse knows that what medication would be preferred for this patient?
A)
Pyrantel (Antiminth)
B)
Mebendazole (Vermox)
C)
Ivermectin (Stromectol)
D)
Albendazole (Albenza)
Ans:
A Feedback:
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Pyrantel can be administered as a single dose, which makes it a good choice for patients who have trouble remembering to take their medications, or have trouble following medication regimens. Mebendazole requires twice-daily dosing, which makes it less optimal for a patient who has trouble with medication regimens. Ivermectin is used to treat threadworm disease (strongyloidiasis) and river blindness (onchocerciasis). Albendazole is used to treat active lesions caused by pork tapeworm and cystic disease of the liver, lungs, and peritoneum caused by dog tapeworm. 32 .
What benefit would the nurse describe for treating pinworms and roundworms with a prescription for pyrantel instead of mebendazole?
A)
Pyrantel needs only be taken once.
B)
Mebendazole has many serious adverse effects.
C)
Pyrantel is excreted in the feces.
D)
Pyrantel is safer for children younger than 2 years.
Ans:
A Feedback: Pyrantels big advantage is that it needs only be taken one time so it is a better choice for those who may not remember to take repeated doses. Mebendazole has very few side effects because very little of the medication is absorbed systemically so that is not a reason to prescribe pyrantel. Pyrantel is mostly excreted in the feces but some is also found in urine while mebendazole is only excreted in the feces so this does not benefit prescribing pyrantel. Pyrantel has not been established as safe for use in children under 2 years old.
33 .
What laboratory test will the nurse obtain to determine what type of helminth is infecting the patient?
A)
Stool culture
B)
Stool for ova and parasite
C)
Renal function studies
D)
Liver function studies
Ans:
B
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Feedback: The only test to specifically determine what helminth is involved is a stool culture for ova and parasite. A simple stool culture would not be likely to identify the helminth. Renal and liver function studies would indicate the functioning of these organ systems but would not identify the helminth. 34 .
What assessment findings would raise the nurses level of suspicion that the patient may be infected with cestodes? (Select all that apply.)
A)
Abdominal discomfort and distention
B)
Weight loss without dieting
C)
Pneumonia
D)
Heart failure
E)
Encephalitis
Ans:
A, B Feedback: Cestodes enter the body as larvae that are found in undercooked meat or fish; they sometimes form worms that are several yards long, people with a tapeworm may experience some abdominal discomfort and distention, as well as weight loss, because the worm eats ingested nutrients. Trichinosis can result in fatal pneumonia, heart failure, and encephalitis if not treated early, but these symptoms would not be expected with cestode infection.
35 .
The nurse is caring for an 85-year-old woman diagnosed with a roundworm infection in addition to heart disease, chronic renal failure, and history of a stroke. The patient is prescribed mebendazole. What assessments will be of particular importance for this patient related to drug therapy? (Select all that apply.)
A)
Hydration
B)
Nutritional status
C)
Liver function
D)
Cognitive function
E)
Respiratory function
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Ans:
A, B, D Feedback: Mebendazole is a relatively safe drug with few adverse effects. However, infection by a helminth that impacts absorption of nutrients in a frail older woman could lead to significant dehydration and malnutrition so it would be of particular importance to assess this patient frequently and regularly. Respiratory function, liver function, and cognition would not be impacted by the helminth or the medication, but altered cognition could occur with malnutrition and/or dehydration.
Chapter 54. Cancer Chemotherapy 1.
The process of cancerous cells exhibiting a loss of cellular differentiation and organization leading to a loss of their ability to function normally is called what?
A)
Anaplasia
B)
Angiogenesis
C)
Autonomy
D)
Metastasis
Ans:
A Feedback: Cancerous cells exhibit anaplasia, which is a loss of cellular differentiation and organization that leads to a loss of their ability to function normally. Angiogenesis refers to the abnormal cells releasing enzymes that generate blood vessels in the area to supply both oxygen and nutrients to the cells. Cancerous cells exhibit autonomy, which is the ability to grow without the usual homeostatic restrictions that regulate cell growth and control. Metastasis is the process of the cancerous cells traveling from the place of origin to develop new tumors.
2.
The mitotic inhibitors interfere with the ability of a cell to divide and they block or alter deoxyribonucleic acid (DNA) synthesis, thus causing cell death. What is important for the nurse to remember when administering these drugs?
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A)
The nurse should encourage the patient to eat six small meals a day.
B)
The nurse should avoid any skin, eye, or mucous membrane contact with the drug.
C)
The nurse should avoid using a distal vein.
D)
The nurse should check for extravasation when the infusion is over.
Ans:
B Feedback: Special care needs to be taken when administering these drugs. The nurse should avoid any skin, eye, or mucous membrane contact with the drug. This type of contact can cause serious reactions and toxicity for the nurse. The nurse should check for extravasation frequently during the infusion and not wait until the infusion is completed, a distal vein should be used, nausea and vomiting are commonly experienced adverse effects of these drugs, and small meals may help the patient to maintain adequate nutrition but this is not the important concern when administering the drug.
3.
A nurse is preparing an antineoplastic agent for a 9-year-old cancer patient. Before administering an antineoplastic agent, what is the nurses priority action?
A)
Wash his or her hands.
B)
Identify the child by checking the arm band and asking him or her to state his or her name.
C)
Ensure a quiet environment so the patient can sleep during administration of the drug.
D)
Check laboratory studies to determine most recent measures of bone marrow function.
Ans:
D Feedback:
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The most important action of the nurse before administering the drug would be to check indexes of bone marrow functioning because these results will help to determine the proper dosage. Smaller dosages are administered if bone marrow function declines, whereas larger dosages can be given if bone marrow function is good. Only after this is checked will the nurse begin the process of actually administering the medication by performing hand hygiene, identifying the patient, and creating a quiet environment. 4.
A patient with leukemia receives rasburicase (Elitek) before administering chemotherapy. What is the nurses priority assessment after administration of this medication?
A)
Blood glucose levels
B)
Serum potassium levels
C)
Serum calcium levels
D)
Uric acid levels
Ans:
D Feedback: Rasburicase is approved for the management of plasma uric acid levels in patients with leukemia, lymphoma, and solid malignancies who are receiving antineoplastic therapy associated with tumor lysis and elevated serum uric acid levels. Uric acid levels should be analyzed within 4 hours of each dose of rasburicase. Blood glucose, potassium, and calcium levels should not be affected by administration of the drug.
5.
The nurse is caring for a patient at risk of severe-to-fatal interstitial lung disease. What antineoplastic agent is the nurse administering that carries this risk?
A)
Valrubicin (Valstar)
B)
Erlotinib (Tarceva)
C)
Histrelin acetate (Vantas)
D)
Triptorelin pamoate (Trelstar Depot)
Ans:
B
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Feedback: Erlotinib inhibits tyrosine kinase associated with epidermal growth factor found on surfaces of normal and cancer cells and causes serious-to-fatal interstitial lung disease. Histrelin inhibits gonadotropic secretion and decreases follicle-stimulating hormone (FSH) and luteinizing hormone (LH) and testosterone levels and suppresses testosterone production. Hot flashes are very common with this drug. Triptorelin pamoate decreases FSH and LH levels and also suppresses testosterone production. It has also been associated with sexual dysfunction, urinary tract symptoms, bone pain, and hot flashes. Valrubicin is used in intravesical therapy for carcinoma in situ of the bladder. It is also associated with severe bladder spasms. 6.
The nurse is caring for a patient who has just been diagnosed with adenocarcinoma of the pancreas. What antineoplastic does the nurse suspect the patient will receive?
A)
Bleomycin (Blenoxane)
B)
Daunorubicin (DaunoXome)
C)
Idarubicin (Idamycin)
D)
Mitomycin (Mutamycin)
Ans:
D Feedback: Mitomycin is used in before the treatment of disseminated adenocarcinoma of the stomach and pancreas. Bleomycin is used for palliative treatment of squamous cell carcinomas, testicular cancers, and lymphomas. Daunorubicin is the first-line treatment of advanced HIV infection and associated Kaposis sarcoma. Idarubicin is used in combination therapy for treatment of acute myeloid leukemia in adults.
7.
The nurse is caring for a patient receiving cyclophosphamide (Cytoxan). What is the priority nursing action for this patient?
A)
Monitor urinalysis results.
B)
Provide small, frequent meals.
C)
Administer an antiemetic when needed.
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D)
Provide oral care.
Ans:
A Feedback: The priority nursing action would be to monitor the patients urinalysis results because hemorrhagic cystitis is a potentially fatal adverse effect of cyclophosphamide. Providing small frequent meals, and oral care and administering an antiemetic are necessary to maintain nutrition when GI effects are severe but, assessments come before interventions and these interventions are of lower priority than monitoring for hemorrhagic cystitis.
8.
A 42-year-old woman with breast cancer has had a radical mastectomy. She will have radiation therapy and then begin chemotherapy. Drug therapy will consist of a combination of doxorubicin, cyclophosphamide, and paclitaxel. What will the nurse include in her teaching plan concerning the drug therapy?
A)
Stay on a low-fat diet during the course of the drug therapy.
B)
Take special care when shaving or when brushing her teeth.
C)
Continue to go to church or to the mall just as she did before the diagnosis of cancer.
D)
Stay in bed 2 days after each administration.
Ans:
B Feedback: Special care should be taken when shaving or when brushing her teeth because she may bruise more easily than normal and gums may bleed. A cancer patient should not be on a diet during chemotherapy unless prescribed. Care should be taken to avoid crowds and public places where risk of infection is greater. Cancer patients should remain as active as tolerated, but they should be careful not to overextend themselves physically to promote optimal health.
9. A)
The nurse should exercise caution when administering antimetabolites to a patient diagnosed with what? Bone marrow suppression
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B)
Diabetes mellitus
C)
Hypertension
D)
Seizure activity
Ans:
A Feedback: Bone marrow is often the index for dosing and redosing levels. Caution should be used and strict monitoring done for patients with suppressed bone marrow who are receiving an antimetabolite. Diabetes mellitus, hypertension, and seizure activity have not been identified as interfering with this drug therapy.
10 .
The nurse is caring for a patient who is receiving a combination of antineoplastic agents. The patient will most likely lose his or her hair. Why would the nurse suggest that he or she get a wig or use appropriate head cover?
A)
People may be uncomfortable seeing his or her bald head.
B)
The hair will likely grow back if the head is covered at all times.
C)
His or her self-esteem will be better if the head is covered.
D)
Heat is lost through the head and it is important to cover it during extremes in temperature.
Ans:
D Feedback: Most of the heat is lost through the head and it is important to cover the head to prevent extreme changes in core temperature, which could affect all biochemical processes in the body. Other peoples feelings should not be an issue in whether she wears a wig or not. Even though loss of hair could decrease self-esteem, patients are usually more concerned about their prognosis. Whether the head is covered or not has nothing to do with hair growing back.
11 .
A patient diagnosed with a malignancy is receiving an antimetabolite as part of his or her medication therapy. What would the nurse be sure to teach this patient about his or her antimetabolite medication? (Select all that apply.)
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A)
Report all other drugs and alternative therapies he or she is taking.
B)
Use safety measures due to possible dizziness, headache, and drowsiness.
C)
Cover the head at extremes of temperature.
D)
Plan for appropriate exercise regimens.
E)
Avoid being alone as much as possible.
Ans:
A, B, C Feedback: Provide the following patient teaching: Follow the appropriate dosage regimen, including dates to return for further doses. Patients need to be reminded to report all other drugs and alternative therapies that they might be using; maintain nutrition if GI effects are severe; cover the head at extremes of temperature if alopecia is anticipated; plan for appropriate rest periods because fatigue and weakness are common adverse effects of the drugs; avoid infection including avoiding crowded places, sick people, and working in soil; and use safety measures such as not driving or using dangerous equipment due to possible dizziness, headache, and drowsiness. The nurse would not tell the patient to plan for appropriate exercise regimens because patients are more likely to need encouragement to rest; there is no reason he cannot be alone.
12 .
The nurse explains that the signs and symptoms caused by cancer are a result of what?
A)
Overgrowth of tumor cells
B)
Enzymes that generate blood vessels
C)
Tumor cells invading healthy tissue
D)
Metastasis
Ans:
C Feedback:
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As cancer cells grow, they invade and damage healthy host tissues and this is what causes signs and symptoms of cancer. When cancer metastasizes, the tumor cells invade new tissue and other signs and symptoms occur. Cancer cells do overgrow and the abnormal cells do release enzymes that generate blood vessels, but this is not what causes the signs and symptoms of cancer. The effects of neoplasms are not caused by overgrowth of tumor cells, enzymes that generate blood vessels, or metastasis. 13 .
The nurse is caring for a patient newly diagnosed with a primary brain tumor. The patient asks the nurse where his or her tumor came from. What is the nurses best response?
A)
Your tumor originated from somewhere outside the CNS from a cell just like other cells.
B)
Your tumor is from the pituitary gland in origin.
C)
Your tumor originated from a single cell that is genetically different from nearby cells.
D)
Your tumor is from nerve tissue somewhere in your body.
Ans:
C Feedback: All cancers start with a single cell that is genetically different from the other cells in the surrounding tissue. Determining the site of the first cell to genetically mutate in this patient would require more information so it is impossible to say if the originating cell was in the CNS, the pituitary gland, or peripheral nerve tissue.
14 .
A nurse on the oncology unit is caring for a patient with an astrocytoma. The patient has just been told that the tumor is growing very fast. The patient asks the nurse how these tumors grow. What is the nurses best response?
A)
Brain tumors infiltrate the surrounding tissue.
B)
Brain tumors grow by invading the surrounding grey matter.
C)
Brain tumors grow by invading the surrounding white matter.
D)
Brain tumors spread down the spinal cord.
Ans:
A
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Feedback: Over time, these neoplastic cells grow uncontrollably, invading and damaging healthy tissue in the area and even undergoing metastasis (traveling from the place of origin to develop new tumors in other areas of the body where conditions are favorable for cell growth). The abnormal cells release enzymes that generate blood vessels. Brain tumors can invade either grey or white matter or they can spread down the spinal cord. These responses do not answer the patients question. 15 .
A patient asks the nurse what a cancer cells growth rate is called. What is the nurses best response?
A)
Cancer cells growth rate is called proliferation.
B)
Cancer cells growth rate is called anaplasia.
C)
Cancer cells growth rate is called pleomorphism.
D)
Cancer cells growth rate is called neoplasm.
Ans:
A Feedback: A cancer cell growth rate is called proliferation. Anaplasia is the loss of organization and structure, pleomorphism is the occurrence of more than one shape of the cell, and a neoplasm is the term for a new or cancerous growth occurring when abnormal cells have the opportunity to multiply and grow.
16 .
The nurse is caring for a patient receiving a combination of different antineoplastic medications. The patient asks why they use so many different medications instead of just one drug. The nurse explains that a combination does what? (Select all that apply.)
A)
Decreases the development of cell resistance
B)
Increases the length of treatment
C)
Increases the quantity of each medication used
D)
Decreases the side effects of each medication
E)
Targets different phases of the cell cycle
Ans:
A, E
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Feedback: Malignant cells that remain in a dormant phase for long periods are difficult to destroy. These cells can emerge long after cancer treatment has finishedafter weeks, months, or yearsto begin their division and growth cycle all over again. For this reason, antineoplastic agents are often given in sequence over periods of time, in the hope that the drugs will affect the cancer cells as they emerge from dormancy or move into a new phase of the cell cycle. A combination of antineoplastic agents targeting different phases of the cell cycle is frequently most effective in treating many cancers. Combinations of drugs do not increase the length of treatment, increase the quantity of medication used, or decrease the adverse effects of the medications used. 17 .
The nurse is caring for a patient who is taking bicalutamide (Casodex). For what type of cancer would the nurse administer this drug?
A)
Bladder
B)
Colon
C)
Breast
D)
Prostate
Ans:
D Feedback: Bicalutamide (Casodex) is administered in combination with a luteinizing hormone for the treatment of advanced prostate cancer. This medication would not be effective for treating bladder, colon, or breast cancer because it is a hormone modulator and works only on hormone-requiring cancers.
18 .
What nursing diagnosis is a priority for the 87-year-old woman, who has stomatitis secondary to the administration of methotrexate? (Select all that apply.)
A)
Impaired skin integrity
B)
Risk for infection
C)
Imbalanced nutrition
D)
Risk for bleeding
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E)
Hopelessness
Ans:
A, B, C, D Feedback: Because of the common adverse effects of severe bone marrow suppression, fatigue, malaise, rashes, alopecia, ulcerative stomatitis, hepatic toxicity, interstitial pneumonitis, chills, fever, and anaphylaxis, priority nursing diagnosis would include impaired skin integrity related to rash, risk for infection, and risk for bleeding related to severe bone marrow suppression. Because the patient has stomatitis, there is a risk for imbalanced nutrition less than body requirements because eating is uncomfortable and not feeling well will also reduce her appetite. Although fear and anxiety are common with any cancer diagnosis, hopelessness is usually not as common unless the patient receives a terminal diagnosis and, even then, many patients are able to remain hopeful.
19 .
What measure protects the nurse when preparing cytotoxic drugs?
A)
Wearing protective equipment such as gloves, mask, and gown
B)
Washing hands before preparation
C)
Mixing medication in a 1-L bag
D)
Administering medication IM
Ans:
A Feedback: Cytotoxic drugs are toxic chemicals and the nurse who administers them must take adequate precautions to avoid self-exposure. These precautions include protective equipment. Hand hygiene should be performed before administering any medication but this measure does not protect the nurse. Whether mixing the medication in a 1-L bag or administering it IM, the nurse must wear protective equipment.
20 . A)
The patient has just been started on an alkylating agent to treat cancer. What is the most common adverse effect of most alkylating agents that the nurse will monitor for? Bone marrow suppression
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B)
Nephrotoxicity
C)
Confusion
D)
Depression
Ans:
A Feedback: Hematological effects include bone marrow suppression, with leukopenia, thrombocytopenia, anemia, and pancytopenia, secondary to the effects of the drugs on the rapidly multiplying cells of the bone marrow. Therefore, options B, C, and D are not correct.
21 .
The patient is taking ifosfamide as part of his or her cancer treatment. Mesna (Mesnex) is added to the treatment regimen to prevent cystitis induced by the ifosfamide. The nurse explains that mesna works by what action?
A)
By increasing urine output
B)
By shielding the kidney from ifosfamide
C)
By increasing white blood cell production
D)
By combining with a metabolite of ifosfamide
Ans:
D Feedback: Mesna combines with a urotoxic metabolite of ifosfamide to reduce the damaging effects of ifosfamide. It has no effect on urine output, does not provide a shield for the kidney, and has no impact on white blood cell production.
22 .
Chlorambucil has been ordered for a patient with Hodgkins disease. The patients son asks the nurse what adverse effects this drug has. What will the nurse include when responding to this question? (Select all that apply.)
A)
Tremors
B)
Muscle twitching
C)
Confusion
D)
Gynecomastia
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E)
Alopecia
Ans:
A, B, C Feedback: Chlorambucil is a palliative treatment for chronic lymphocytic leukemia, malignant lymphomas, and Hodgkins disease. Adverse effects include tremors, muscle twitching, confusion, nausea, hepatotoxicity, bone marrow suppression, sterility, and cancer.
23 .
A patient with acute myeloblastic leukemia is taking doxorubicin. What medication, if ordered, would the nurse recognize as a cardioprotective drug used in combination with doxorubicin?
A)
Dexrazoxane (Zinecard)
B)
Ixabepilone (Ixempra)
C)
Teniposide (Vumon)
D)
Vinblastine (Velban)
Ans:
A Feedback: Dexrazoxane is a powerful chelating agent that is a cardioprotective drug that interferes with the cardiotoxic effects of doxorubicin. Ixabepilone (Ixempra) is given in combination with capecitabine for the treatment of patients with metastatic or locally advanced breast cancer. Teniposide is given in combination with other drugs for induction therapy in childhood acute lymphoblastic leukemia. Vinblastine is given in combination with other medications as part of the treatment for advanced testicular germ cell cancer.
24 .
A patient taking tamoxifen to reduce the risk of contralateral breast cancer asks the nurse about adverse effects of the drug. What is an adverse effect of tamoxifen?
A)
Stomatitis
B)
Mucositis
C)
Thrombocytopenia
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D)
Cerebrovascular accidents
Ans:
D Feedback: Adverse effects of tamoxifen include hot flashes, rash, nausea, vomiting, vaginal bleeding, menstrual irregularities, edema, pain, cerebrovascular accident, and pulmonary emboli. They do not include stomatitis, mucositis, or thrombocytopenia.
25 .
A female patient prescribed methotrexate for meningeal leukemia is asking the nurse about adverse effects of the drug. What would the nurse tell this patient should be avoided while taking methotrexate?
A)
Pregnancy
B)
Aerobic exercise
C)
Smoking
D)
Alcohol
Ans:
A Feedback: Antimetabolites are contraindicated for use during pregnancy and lactation because of the potential for severe adverse effects on the fetus and neonate. The nurse would not caution the patient against aerobic exercise, smoking, or alcohol use because of the medication she was taking.
26 .
What is the nurses priority intervention to reduce the risk of cystitis caused by cyclophosphamide (Cytoxan)?
A)
Encourage the patient to drink cranberry juice.
B)
Promote adequate rest and sleep.
C)
Encourage fluids to maintain hydration.
D)
Instruct the patient to wear only cotton underwear.
Ans:
C Feedback:
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Hemorrhagic cystitis is a potentially fatal adverse effect. Ensure that the patient is well hydrated. Drinking cranberry juice or milk helps to hydrate the patient, but what he or she drinks is less important than that he or she drinks adequate amounts of fluid. Wearing cotton underwear is not an intervention the nurse would teach the patient. 27 .
A young man asks the nurse about the goal of the cancer therapy his mother is receiving. What is the nurses best response?
A)
The goal is to limit the cancer cells so the immune system can respond without causing too much toxicity to your mother.
B)
The goal is to kill the cancer cells as quickly as possible before they can spread so your mother will be well again.
C)
The goal is to control the speed at which new cancer cells grow so the medication has a better chance to work.
D)
The goal is to keep the cancer cells from spreading all over your mothers body and choose the drug with the fewest adverse effects.
Ans:
A Feedback: The goal of cancer therapy, much like that of anti-infective therapy, is to limit the offending cells to the degree that the immune system can then respond without causing too much toxicity to the host. Therefore, options B, C, and D are not correct.
28 .
The nurse is acting as a mentor for a new graduate nurse who is delivering chemotherapy to a patient in the short-stay unit. What action performed by the new graduate would the mentor teach is not appropriate and requires correction?
A)
Checking the IV line frequently
B)
Using an infusion pump to administer the medication
C)
Premedicating the patient as ordered
D)
Starting the IV in a large, distal vein
Ans:
B
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Feedback: If at all possible, do not use an infusion pump to administer one of these drugs because it will continue to deliver the drug under pressure and can cause a severe extravasation. This would be the least beneficial to the patient. Checking the line frequently, premedicating the patient as ordered, and using a large, distal vein would be much more beneficial to the patient. 29 .
A patient with rhabdomyosarcoma has been admitted for chemotherapy with vincristine. While preparing a plan of care for this patient, what would be an appropriate nursing diagnosis?
A)
Altered body image due to severe fluid retention
B)
Risk for bleeding due to possible hemorrhagic cystitis
C)
Risk for injury related to muscle wasting and weight loss
D)
Risk of infection related to possible nosocomial infection
Ans:
C Feedback: Adverse effects of vincristine include ataxia, cranial nerve manifestations, neuritic pain, muscle wasting, constipation, leukopenia, weight loss, loss of hair, and death. As a result, the risk for injury due to weakness and falls is a significant concept. Risk for bleeding and severe fluid retention is unlikely with this drug. The risk of infection is related to bone marrow suppression, not a possible nosocomial infection. The patient is more at risk for a nosocomial infection because of the bone marrow suppression.
30 .
A patient newly diagnosed with chronic myelocytic leukemia (`) has been prescribed treatment with imatinib. The patient asks the nurse how imatinib works. What would be the nurses best response?
A)
imatinib alkylates cellular DNA.
B)
imatinib inhibits folic acid reductase, leading to inhibition of DNA synthesis and inhibition of cellular replication.
C)
imatinib binds to DNA and inhibits DNA synthesis in susceptible cells, causing cell death.
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D)
imatinib inhibits the enzyme created by the Philadelphia chromosome abnormality in CML.
Ans:
D Feedback: Imatinib is a tyrosine kinase inhibitor that selectively inhibits the Bcr-Abl tyrosine kinase created by the Philadelphia chromosome abnormality in CML and some tumor cells present in gastrointestinal stromal tumor (GIST); blocking this enzyme inhibits proliferation and induces cell division. Alkylating agents alkylate cellular DNA; antimetabolites inhibit folic acid reductase, leading to inhibition of deoxyribonucleic acid (DNA) synthesis and inhibition of cellular replication; and antineoplastic antibiotics bind to DNA and inhibit DNA synthesis in susceptible cells, causing cell death.
31 .
The patient, diagnosed with chronic myelocytic leukemia (CML), has not been responding to chemotherapy and the provider changes the patient to imatinib. The patient asks the nurse, What adverse effects am I going to have to deal with from this drug? What is the nurses best response?
A)
Adverse effects from this drug are more serious but this drug is stronger and more effective.
B)
Adverse effects are similar to other drugs including bone marrow suppression, nausea, and hair loss.
C)
Adverse effects are much less likely or severe including GI upset, headache, and muscle pain.
D)
Adverse effects vary from patient to patient and depend on your overall health as to what will occur.
Ans:
C Feedback: Patients who have CML and who have been switched to imatinib after traditional chemotherapy have been amazed at how good they feel and how much they have recovered from the numerous adverse effects of traditional chemotherapy. Administer with a meal and a full glass of water, arrange for small frequent meals if GI upset is a problem, provide analgesics for headache and muscle pain, monitor CBC, and examine for edema. Options A, B, and D are not correct.
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32 .
The nursing instructor teaches the students that antineoplastic drugs are often carcinogens. The students are surprised to hear this and ask why. The instructors best response includes what information?
A)
The drugs kill cells resulting in a need for more cellular growth with risk of a mutant cell.
B)
These drugs do so much damage to so many human cells that the patient is debilitated.
C)
If the patient remains cancer free for 2 years and then cancer is found, it is caused by the drugs.
D)
Palliative therapy promotes the growth of new cancer cells because it is not strong enough.
Ans:
A Feedback: Many neoplastic drugs result in the adverse effect of cancer because cell death caused by the agents increase the need for cellular growth, placing the patient at increased risk for a mutant cell to develop. Patients often recover completely from the adverse effects after chemotherapy is completed and do not remain debilitated. Most cancer patients are not considered to be cured until they have remained cancer free for 5 years because no cells have been identified that can remain dormant for 5 years. Palliative therapy does not promote growth of new cancer cells.
33 .
What classification of antineoplastic medication would the nurse administer that acts by inhibiting microtubular reorganization?
A)
Alkylating agents
B)
Hormone modulators
C)
Mitotic inhibitors
D)
Antimetabolites
Ans:
C Feedback:
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Mitotic inhibitors such as docetaxel and paclitaxel inhibit microtubular reorganization. Alkylating agents interfere with ribonucleic acid (RNA), deoxyribonucleic acid (DNA), or other cellular proteins. Hormone modulators react with specific receptor sites to block cell growth and activity. The antimetabolite cladribine and miscellaneous agent hydroxyurea block DNA synthesis. 34 .
The nurse transfers from the adult oncology unit to the pediatric oncology unit. What will the nurse need to add to the patients plan of care that was not a part of the adult patients care plan?
A)
Social, emotional, and intellectual stimulation
B)
Concerns related to combination drug therapy
C)
Double checking dosage calculations and appropriateness of drug dosage
D)
Monitor for hydration and nutritional status
Ans:
A Feedback: Children need to play and learn so meeting the childs social, emotional, and intellectual needs is a part of the care plan that was not as significant with adults. Administration of combination drugs, Double-checking dosage calculations and appropriateness of drug dosage, and Monitoring for hydration and nutritional status are all components of adult care as well as pediatric care.
35 .
The nurse is conducting a class for nurses hired to work on the oncology unit. What statement, if made by the nurse, would be correct regarding chemotherapy for older adults? (Select all that apply.)
A)
Older adults may be more susceptible to the central nervous system (CNS) and GI effects of these drugs.
B)
Older patients are at risk for dehydration and diminished nutritional status.
C)
Safety precautions should be instituted as soon as any drug is initiated.
D)
Dosage will need to be adjusted based on the age of the older adult.
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E)
Older adults are already somewhat immunosuppressed, so further suppression is a concern.
Ans:
A, B, E Feedback: Older adults may be more susceptible to the CNS and GI effects of some of these drugs. Older patients should be monitored for hydration and nutritional status regularly. Safety precautions should be instituted if CNS effects occur but are not needed for every drug as soon as it is initiated. Dosage is adjusted based on hepatic and renal function, not the patients age. Protecting these patients from exposure to infection and injury is a very important aspect of their nursing care because older patients are naturally somewhat immunosuppressed because of age.
Chapter 55. Immunopharmacology 1.
The bodys first-line barrier defense is considered to be what?
A)
Mast cells
B)
Mucous membranes
C)
Skin
D)
T cells
Ans:
C Feedback: The skin is the first line of barrier defense. It acts as a physical barrier to protect the internal tissues and organs of the body. Mast cells are part of cellular defense. They are found in the respiratory and GI tracts and are fixed basophils that do not circulate. Mucous membranes are a barrier defense that line the areas of the body that are exposed to external influences but do not have the benefit of skin protection. T cells are part of the immune response and provide cell-mediated immunity. Activation of a T cell by a nonself-cell results in responses that destroy foreign cells.
2. A)
The nurse recognizes what patient has lost a barrier defense increasing his risk for infection? A 68-year-old man diagnosed with prostate cancer
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B)
A 24-year-old man diagnosed with partial thickness burns
C)
A 13-year-old boy diagnosed with chickenpox
D)
A 72-year-old man diagnosed with bacterial pneumonia
Ans:
B Feedback: A burn patient loses the protective barrier of the skin and is at risk for infection. In a partial thickness burn, the glands of the skin secrete chemicals that destroy many pathogens and also the normal flora that live on the skin. A cancer patient has decreased cellular defenses. The patient with chickenpox and the patient with pneumonia both have a diminished immune defense along with the prostate cancer patient but still are at less risk for infection than the burn patient.
3.
After reviewing the results of a complete blood count on a patient who is diagnosed with an acute infection, what will the nurse expect to see elevated?
A)
Basophil count
B)
Eosinophil count
C)
Hematocrit
D)
Neutrophil count
Ans:
D Feedback: During an acute infection, the neutrophils are rapidly produced in response to the interleukins released by active white blood cells. They move to the site of insult to attack the foreign substance. Eosinophils are often increased in an allergic response. Basophils would only increase with generalized bone marrow stimulation. The hematocrit level is increased in polycythemia.
4.
A new mother calls the clinic and tells the nurse her toddler has a temperature of 102F. How does the nurse explain why the mother should not be alarmed?
A)
A fever is the bodys way of fighting an infection and supporting the bodys immune system.
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B)
Neutrophils release pyrogen, a fever-causing substance, which helps act as a catalyst for the bodys inflammatory and immune responses.
C)
Leukotrienes activated by arachidonic acid attract neutrophils to start the process of fighting inflammation.
D)
Inflammation causes the activation of a chemical called Hageman factor that initiates a process to bring more blood to the injured area and allows white blood cells to escape into the tissues.
Ans:
A Feedback: The best response by the nurse would be that a fever actually increases the efficiency of the immune and inflammatory responses, helping the body to fight the infection. While the other three statements are correct, they are more technical and include terminology that a new mother may not understand or even care about. If the appropriate response does not suffice and the mother still has questions, the nurse would then go into more detail and use the rationale from the other options to explain in greater detail.
5.
A patient presents to the emergency department with an infected wound on his left forearm. The nurse explains the inflammatory response caused by the injury will occur in what sequence?
A)
Heat, pain, redness, swelling
B)
Swelling, pain, redness, heat
C)
Redness, swelling, heat, pain
D)
Pain, redness, swelling, heat
Ans:
C Feedback: The inflammatory response will begin with redness in the direct line of the infected wound. Next, swelling will occur because of the fluid that leaks into the tissue as a result of the change in capillary permeability. The heat can be detected due to the increased blood flow to the area. Pain will be felt due to the activation of fibers by histamine and the kinin system as well as stretching of the tissue caused by the edema.
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6.
The patient with AIDS asks the nurse why his cytotoxic T cells are so important. What is the nurses best response to explain the actions of cytotoxic T cells?
A)
Cells that are programmed to identify specific proteins or antigens
B)
Cells that can either destroy a foreign cell or mark it for aggressive destruction
C)
Cells that respond to chemical indicators of immune activity and stimulate other lymphocytes to be more aggressive and responsive
D)
Cells that respond to rising levels of chemicals associated with an immune response to suppress or slow the reaction
Ans:
B Feedback: Effector or cytotoxic T cells either destroy a foreign cell or make it available for aggressive destruction. Cells that identify specific proteins or antigens are B cells. Cells that respond to chemical indicators to stimulate other cells are helper T cells. Cells that suppress or slow the reaction are suppressor T cells.
7.
A patient has a minor laceration on the left arm. What does the nurse know that will cause a patient to experience muscle and joint aches, a low-grade fever, and sleepiness when an inflammatory reaction is initiated?
A)
Bacterial toxins
B)
Interferon activity
C)
Leukotriene activity
D)
Phagocytosis
Ans:
C Feedback:
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The leukotrienes (autocoids activated through the kinin system) affect the brain to induce slow-wave sleep, believed to be an important energy conservation measure for fighting the invader. They also cause myalgia and arthralgia (muscle and joint pain)common signs and symptoms of various inflammatory diseases, which also cause reduced activity and save energy. Interferons are released in response to viral infection. Phagocytosis destroys engulfed foreign material in the body. Bacterial toxins cause local reactions unless the infection is intense and the bacteria enter the bloodstream. 8.
What body defense needs to be reduced in the patient following organ transplantation?
A)
Major histocompatibility complex
B)
Barrier defenses
C)
Lymphoid tissues
D)
Eosinophils
Ans:
A Feedback: The major histocompatability complex is the genetic identification code carried on chromosomes and produces several proteins called histocompatibility antigens located on the cell membrane that allow the body to recognize cells that are self-cells. Cells without these proteins, such as those in a transplanted organ, are identified as foreign and are targeted for destruction so this defense must be minimized to prevent damage to the transplanted organ. Barrier defenses prevent entry of pathogens into the body. Lymphoid tissue creates cellular components of the mononuclear phagocyte system, differentiates T cells, and regulates actions of the immune system. Eosinophils respond to allergic responses. Barrier defenses, lymphoid tissue, and eosinophils are not involved in the transplant rejection process.
9.
A)
The nurse is teaching a class on the inflammatory response for other nurses and discusses the role of factor XII or the Hageman factor. What substance does Hagemans factor activate to cause kininogen to be converted to bradykinin? Arachidonic acid
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B)
Prostaglandins
C)
Leukotrienes
D)
Kallikrein
Ans:
D Feedback: Hagemans factor activates kallikrein, a substance found in the local tissues, which causes the precursor substance kininogen to be converted to bradykinin and other kinins. Bradykinin causes the release of arachidonic acid from the cell membrane. Arachidonic acid causes the release of other substances called autocoids, including prostaglandins, leukotrienes, and thromboxanes
10 .
A patient who has received a heart transplant has been given an order for drugs that block T cell activity. What is the rationale behind this order?
A)
To manufacture antibodies to the foreign proteins
B)
To stimulate wound healing
C)
To combine with a complement to cause a massive inflammatory reaction
D)
To prevent an inflammatory reaction against the transplanted heart
Ans:
D Feedback: Effector or cytotoxic T cells are aggressive against nonself-cells, releasing cytokines that can either directly destroy a foreign cell or mark it for aggressive destruction. If the transplanted organ is attacked by cytokines, it will be destroyed, referred to as organ rejection. As a result, inhibition of these killer T cells is essential to continued organ function in the transplanted organ. Blocking T cells would not manufacture antibodies, stimulate wound healing, or trigger a massive inflammatory response.
11 . A)
The nurse anticipates what generalized response to the patients cellular injury? Decreased pH
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B)
Increased protein catabolism
C)
Inhibition of cell growth
D)
Inflammation
Ans:
D Feedback: The inflammatory response is the local reaction of the body to invasion or injury. Any insult to the body that injures cells or tissues sets of a series of events and chemical reactions known as the inflammatory response. Protein catabolism is the breakdown of protein into particles small enough to be carried into the cell and is an incorrect choice. Cellular injury does not inhibit cell growth or lower pH.
12 .
The nurse takes a class to better understand the immune and inflammatory responses and learns what cells help to slow or suppress the immune response?
A)
Cytotoxic T cells
B)
Helper T cells
C)
Suppressor T cells
D)
B cells
Ans:
C Feedback: Suppressor T cells respond to rising levels of chemicals associated with an immune response to suppress or slow the reaction. Helper T cells respond to the chemical indicators of immune activity and stimulate other lymphocytes, including B cells, to be more aggressive. Cytotoxic T cells are aggressive against nonself-cells.
13 .
The nurse plans care for patients with the knowledge that loss of body defenses can increase the patients risk for infection. What barrier defenses need to remain intact to prevent infection? (Select all that apply.)
A)
Skin
B)
Mucous membranes
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C)
Gastric acid
D)
Leukocytes
E)
T cells
Ans:
A, B, C Feedback: The skin is the first line of barrier defense, creating a physical barrier to prevent pathogens from entering the internal tissues. Mucous membranes are another barrier defense protecting the area without skin protection (e.g., the respiratory tract, gastrointestinal tract, genitourinary tract). Gastric acids destroy many pathogens that are ingested or swallowed, preventing them from entering the bloodstream or internal organs. Leukocytes and T cells are cellular defenses and not barrier defenses.
14 .
What is the nurse referring to when discussing B-cell immunity when the B cells are programmed to identify specific proteins or antigens?
A)
T-cell immunity
B)
Autoimmunity
C)
Passive immunity
D)
Humoral immunity
Ans:
D Feedback: B cells are programmed to identify specific proteins, or antigens. They provide what is called humoral immunity. Autoimmunity occurs when the body attacks its own self-cells. Passive immunity is the transfer of antibodies from one person to another. Active immunity is immunity produced by the body in response to an organism.
15 .
When antibodies and antigens react, they create an antigenantibody complex. This structure reveals a new receptor site that activates a series of plasma proteins called what?
A)
Complement
B)
Neutralization of viral toxins
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C)
Opsonization
D)
Histamine
Ans:
A Feedback: When the antigens and antibodies react, they form an antigenantibody complex. This new structure reveals a new receptor site on the antibody that activates a series of plasma proteins in the body called complement proteins. Options B, C, and D are distracters for this question and are not involved in this process.
16 .
The pharmacology instructor is discussing activated complement with the nursing students. What would the instructor tell the students that activated complement stimulates?
A)
Opsonization
B)
Chemotaxis
C)
Agglutination
D)
Phagocytosis
Ans:
B Feedback: Activated complement stimulates chemotaxis (movement of monocytes, neutrophils, basophils, and eosinophils toward the antigen) and the release of hydrolytic enzymes; actions that result in the destruction or inactivation of the invading antigen. Opsonization is the coating of the antigen so that it is more readily recognized by phagocytic cells. Agglutination is the clumping of cells. Phagocytosis is the destruction of pathogens or cells.
17 .
The nursing instructor explains that future exposure to an antigen previously encountered elicits a much faster response as the result of what cells forming memory cells?
A)
T cells
B)
Lymphocytes
C)
Monocytes
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D)
B cells
Ans:
D Feedback: After being activated, the B cells form memory cells that will produce antibodies for immediate release in the future if the antigen is encountered again. Although lymphocytes, monocytes, and T cells will then join in the battle to destroy the antigen, they do not produce memory cells as the B cells do.
18 .
When explaining the immune response the nursing instructor explains the role of neutrophils as doing what?
A)
Phagocytosis
B)
Producing memory cells
C)
Marking cells for destruction
D)
Initiating an immune response
Ans:
A Feedback: Neutrophils engulf and digest foreign material through the process of phagocytosis. B cells produce memory cells. Cytoxic T cells mark cells for destruction. Basophils initiate the immune response.
19 .
What specific drug group has both antiviral and antiproliferative actions?
A)
Interferons
B)
Interleukins
C)
Monoclonal antibodies
D)
Hematopoietic growth factors
Ans:
A Feedback:
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Interferons are chemicals that are secreted by cells that have been invaded by viruses and possibly by other stimuli. The interferons prevent viral replication and also suppress malignant cell replication and tumor growth. Therefore, options B, C, and D are incorrect. 20 .
Tumor necrosis factors (TNF) participate in the inflammatory response of the human body. What do they cause in the inflammatory response?
A)
Enhancing macrophage activity
B)
Tumor regression
C)
Binding of target cells
D)
Delaying or stopping macrophage migration
Ans:
B Feedback: TNF, a cytokine, is a chemical released by macrophages that inhibits tumor growth and can cause tumor regression. It also works with other chemicals to make the inflammatory and immune responses more aggressive and efficient. Therefore, options A, C, and D are incorrect.
21 .
Stressors are a variety of factors that have long been thought to have an important connection with the immune response. What could the nurse classify as a stressor? (Select all that apply.)
A)
Trauma
B)
Foreign cells
C)
Viruses
D)
Extremes of environmental conditions
E)
Self-cells
Ans:
A, B, C, D Feedback: The term stressors can include bacteria, viruses, other foreign pathogens or nonself-cells, trauma, and exposure to extremes of environmental conditions. Self-cells are not considered a stressor on the body.
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22 .
The nurse is caring for a patient with newly diagnosed multiple sclerosis (MS). The patient asks why MS is called an autoimmune disease. What is the nurses best response?
A)
The body attacks its own cells because it responds to specific selfantigens to produce antibodies.
B)
A result of response to a cell that was invaded by bacteria, leading to antibody production to similar cells.
C)
Production of autoantibodies is a normal process that goes on all the time, but immunosuppression limits B-cell response.
D)
People with multiple sclerosis have a genetic predisposition to destroy autoantibodies.
Ans:
A Feedback: Autoimmune disease occurs when the body responds to specific selfantigens to produce antibodies or cell-mediated immune responses against its own cells. The actual cause of autoimmune disease is not known, but theories speculate that (1) it could be a result of response to a cell that was invaded by a virus, leading to antibody production to similar cells; (2) production of autoantibodies is a normal process that goes continuously, but in a state of immunosuppression, the suppressor T cells do not suppress autoantibody production; or (3) a genetic predisposition to develop autoantibodies is present.
23 .
The nurse is caring for a patient with an acute infection that resulted in an immune reaction. What symptoms exhibited by the patient would the nurse recognize as being caused by interleukins? (Select all that apply.)
A)
Fever
B)
Joint pain
C)
Muscle pain
D)
Hyperactivity
E)
Insomnia
Ans:
A, B, C Feedback:
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Interleukins cause many of the symptoms associated with flu-like symptoms, all things that help the body to conserve energy including fever, joint pain (arthralgia), muscle pain (myalgia), and slow-wave sleep induction. Hyperactivity and insomnia are incorrect options. 24 .
What immunoglobulin (Ig) is present in small amounts and is thought to be related to allergic responses?
A)
IgM
B)
IgG
C)
IgE
D)
IgA
Ans:
C Feedback: Five different types of immunoglobulins have been identified: IgE is present in small amounts and seems to be related to allergic responses and to the activation of mast cells. The first immunoglobulin released is M (IgM). It contains the antibodies produced at the first exposure to the antigen. IgG, another form of immunoglobulin, contains antibodies made by the memory cells that circulate and enter the tissue; most immunoglobulin found in the serum is IgG. IgA is found in tears, saliva, sweat, mucus, and bile. It is secreted by plasma cells in the GI and respiratory tracts and in epithelial cells. These antibodies react with specific pathogens that are encountered in exposed areas of the body.
25 .
Our bodies contain various immunoglobulins (Ig). Which of these immunoglobulins is found in sweat, tears, mucus, and bile?
A)
IgG
B)
IgA
C)
IgM
D)
IgE
Ans:
B Feedback:
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Five different types of immunoglobulins have been identified: IgA is found in tears, saliva, sweat, mucus, and bile. It is secreted by plasma cells in the GI and respiratory tracts and in epithelial cells. IgE is present in small amounts and seems to be related to allergic responses and to the activation of mast cells. The first immunoglobulin released is M (IgM); it contains the antibodies produced at the first exposure to the antigen. IgG, another form of immunoglobulin, contains antibodies made by the memory cells that circulate and enter the tissue; most of the immunoglobulin found in the serum is IgG. These antibodies react with specific pathogens that are encountered in exposed areas of the body. 26 .
A 44-year-old man has come to the clinic with an exacerbated asthma attack, asthma exacerbation. He tells the nurse that his father and brother also suffer from asthma, as does his 15-year-old son. The nurse explains that there is most likely an allergic component based on a genetic predisposition. The specific allergen initiated by immunological mechanisms is usually mediated by what?
A)
Immunoglobulin A
B)
Immunoglobulin M
C)
Immunoglobulin G
D)
Immunoglobulin E
Ans:
D Feedback: Allergic reactions characterized by the action of IgE antibodies and a genetic predisposition to allergic reactions are found in diseases like asthma. IgG is the most common immunoglobulin and is found in intravascular and intercellular compartments. IgA and IgM are found in mucous secretions.
27 .
Injury to a cell membrane causes the local release of histamine. What does histamine do?
A)
Stimulates pain perception
B)
Causes vasoconstriction
C)
Decreases capillary permeability
D)
Inhibits phagocytosis
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Ans:
A Feedback: Pain comes from the activation of pain fibers by histamine and the kinin system, occurring any time a cell is injured. Histamine also causes vasodilation, increases capillary permeability, and facilitates phagocytosis.
28 .
An adolescent comes to the free clinic with complaints of allergic rhinitis. The adolescent asks the nurse what makes his nose get so stuffy. What is the nurses best response?
A)
The inside of the nose swells because of the dilation of the blood vessels.
B)
Allergies make the sinuses drain into the nasal passages and it stuffs them up.
C)
The inside of the nose swells closed because of drainage from the sinuses.
D)
Leukotrienes are attacking the mucous membranes of your nose and causing irritation.
Ans:
A Feedback: Histamine is the major mediator of allergic reactions in the nasal mucosa. Tissue edema results from vasodilation and increased capillary permeability. Tissue edema is not caused by drainage from the sinuses or from leukotrienes.
29 .
In a discussion about cancer, a student asks why the body does not phagocytize a tumor. What would be the instructors best response?
A)
Sometimes tumor cells trick the T cells into allowing them to survive.
B)
Some tumor cells do not develop an antigenantibody reaction.
C)
Some tumor cells develop a strong mast cell reaction.
D)
Tumor cells are too small to be seen by the immune system.
Ans:
A Feedback:
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Neoplasms occur when mutant cells escape normal surveillance of the immune system and begin to grow and multiply. Aging reduces efficiency of the immune system; location of mutant cells can make it difficult for lymphocytes to get to them or that mass can grow so quickly that the tumor becomes too large for the immune system to deal with. Tumors can produce antibodies that cover antigen receptor sites on the tumor and prevent recognition by cytotoxic T cells, or a weak antigenic tumor may elicit a mild response from the immune system and tricks the T cells into allowing it to survive. 30 .
What systems are activated by Hagemans factor? (Select all that apply.)
A)
Kinin system
B)
Histamine release system
C)
Clotting cascade
D)
Plasminogen system
E)
Chemotaxis system
Ans:
A, C, D Feedback: Hagemans factor is responsible for activating at least three systems in the body: the kinin system; the clotting cascade, which initiates blood clotting; and the plasminogen system, which initiates the dissolution of blood clots. Histamine release is stimulated by cell damage. Arachidonic acid activates some leukotrienes that have a property called chemotaxis, which is the ability to attract neutrophils and to stimulate them and other macrophages to be very aggressive.
31 .
The nurse assesses the patients postoperative wound and determines that the wound is inflamed, most likely because of an infection, when noting what classic symptoms? (Select all that apply.)
A)
Heat around the site of the wound
B)
Redness around the site of the wound
C)
Increase in reports of pain
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D)
Edema at the site of the wound
E)
Serosanguineous drainage from the wound
Ans:
A, B, C, D Feedback: Activation of the inflammatory response produces a characteristic clinical picture. Heat occurs because of the increased blood flow to the area. Swelling occurs because of the fluid that leaks into the tissues as a result of the change in capillary permeability. Redness is related to the increase in blood flow caused by the vasodilation. Pain comes from the activation of pain fibers by histamine and the kinin system.
32 .
When assessing the patient with tissue injury, the nurse correlates signs and symptoms to the responses occurring within the patients body. Put the inflammatory responses in the order they will occur.
A)
Activation of Hagemans factor
B)
Kininogen activates release of bradykinin
C)
Release of leukotrienes and prostaglandins
D)
Prekallikrein becomes kallikrein
E)
Release of arachidonic acid
Ans:
A, B, C, D, E Feedback: Tissue injury is followed by exposure of plasma to the injured cell, which results in activation of Hagemans factor. This stimulates prekallikrein to become active kallikrein. Kininogen activates bradykinin. Arachidonic acid is released, which activates release of leukotrienes and prostaglandins.
33 .
The patient tells the nurse she was reading about interferons on the Internet but still does not exactly understand what they do. What actions would the nurse describe as being performed by interferons? (Select all that apply.)
A)
Prevent viral replication
B)
Suppress malignant cell replication
C)
Suppress tumor growth
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D)
Stimulate T and B cells to initiate an immune response
E)
Stimulate the body to produce more T cells
Ans:
A, B, C Feedback: Interferons are chemicals that are secreted by cells that have been invaded by viruses and possibly by other stimuli. The interferons prevent viral replication and also suppress malignant cell replication and tumor growth. Interleukins stimulate T and B cells to initiate an immune response and to produce more T cells.
34 .
The nurse is caring for a patient waiting for a heart transplant. The patients spouse asks the nurse, Why dont they just choose any heart until the right heart can be found? What is the nurses best response?
A)
The more closely the new heart matches the patients tissue, the less aggressive the immune reaction will be.
B)
When the body responds to specific self-antigens to produce antibodies against its own cells, a severe immune response results.
C)
Graft-versus-host disease would result making the patient very ill.
D)
The patient would need to have suppressor T cells infused daily to maintain the heart.
Ans:
A Feedback: Transplantation of foreign tissue (e.g., moving a heart from a donor to a sick patient) results in an immune reaction. Matching a donors human leukocyte antigen markers is important as closely as possible to those of the recipient because histocompatability is essential. The more closely the transplanted heart matches the recipient, the less aggressive the immune response will be to the donated tissue. Graft-versus-host disease occurs only in stem cell or bone marrow donations, not organ transplantation. Suppressor T cells cannot be transfused like blood because they must be produced by the body to function appropriately.
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35 .
The patient, recently diagnosed with HIV, is waiting for results of his lab work to determine his T cell count and says to the nurse, What exactly is a T cell? What is the nurses best response?
A)
T cells are monocytes, which are a type of white blood cell that helps to fight off infections and other foreign bodies that enter the body.
B)
T cells are neutrophils, which are a type of white blood cell that helps to fight off infections and other foreign bodies that enter the body.
C)
T cells are lymphocytes, which are a type of white blood cell that helps to fight off infections and other foreign bodies that enter the body.
D)
T cells are basophils, which are a type of white blood cell that helps to fight off infections and other foreign bodies that enter the body.
Ans:
C Feedback: T cells are lymphocytes, a type of white blood cells with large, varied nuclei that can be either T cells or B cells. T cells are not neutrophils, which are capable of moving outside the bloodstream and phagocytizing foreign material. Basophils are myelocytic leukocytes containing chemical substances important for initiating and maintaining an immune or inflammatory response. Monocytes are macrophages capable of phagocytizing an antigen and help to remove foreign material from the body.
Chapter 56-Chapter 58 . Introduction to Toxicology: Occupational & Environmental Chapter 57. Heavy Metal Intoxication & Chelators Chapter 58. Management of the Poisoned Patient Question 1 Type: MCMA The nurse is teaching the importance of drugs for emergency preparedness to local firemen. The nurse determines that learning has occurred when the firemen make which statement(s)? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. The vendor-managed inventory (VMI) package can reach any community within 24 to 36
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hours. 2. Our local hospital is supposed to be stockpiling antibiotics. 3. The push package can reach any community within 12 hours of an attack. 4. The Strategic National Stockpile is located at the Centers for Disease Control and Prevention (CDC) in Atlanta. 5. Our countrys drug stockpile is managed by the Centers for Disease Control and Prevention (CDC). Correct Answer: 1,3,5 Rationale 1: The Strategic National Stockpile is managed by the Centers for Disease Control and Prevention (CDC). The push package can reach any community within 12 hours of an attack, and the vendor-managed inventory (VMI) package can reach any community within 24 to 36 hours. Local hospitals are discouraged from stockpiling antibiotics due to finite expiration dates on the antibiotics. The Strategic National Stockpile is located at various sites throughout the country. Rationale 2: The Strategic National Stockpile is managed by the Centers for Disease Control and Prevention (CDC). The push package can reach any community within 12 hours of an attack, and the vendor-managed inventory (VMI) package can reach any community within 24 to 36 hours. Local hospitals are discouraged from stockpiling antibiotics due to finite expiration dates on the antibiotics. The Strategic National Stockpile is located at various sites throughout the country. Rationale 3: The Strategic National Stockpile is managed by the Centers for Disease Control and Prevention (CDC). The push package can reach any community within 12 hours of an attack, and the vendor-managed inventory (VMI) package can reach any community within 24 to 36 hours. Local hospitals are discouraged from stockpiling antibiotics due to finite expiration dates on the antibiotics. The Strategic National Stockpile is located at various sites throughout the country. Rationale 4: The Strategic National Stockpile is managed by the Centers for Disease Control and Prevention (CDC). The push package can reach any community within 12 hours of an attack, and the vendor-managed inventory (VMI) package can reach any community within 24 to 36 hours. Local hospitals are discouraged from stockpiling antibiotics due to finite expiration dates on the antibiotics. The Strategic National Stockpile is located at various sites throughout the country. Rationale 5: The Strategic National Stockpile is managed by the Centers for Disease Control and
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Prevention (CDC). The push package can reach any community within 12 hours of an attack, and the vendor-managed inventory (VMI) package can reach any community within 24 to 36 hours. Local hospitals are discouraged from stockpiling antibiotics due to finite expiration dates on the antibiotics. The Strategic National Stockpile is located at various sites throughout the country. Global Rationale: Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 12-3 Question 2 Type: MCMA The nurse works for the Centers for Disease Control and Prevention (CDC). In planning for a bioterrorist attack, what will the best plan of the nurse include? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Learn the signs and symptoms of chemical and biological agents. 2. Obtain a listing of health and law enforcement contacts. 3. Assist in the stockpiling of medications. 4. Obtain current knowledge of emergency management. 5. Assist in triage at local hospitals. Correct Answer: 1,2,4 Rationale 1: The key roles of nurses in meeting the challenge of a potential bioterrorist event include education (knowledge), resources (health and law enforcement contacts), and diagnosis
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and treatment (signs and symptoms of chemical and biological agents). Stockpiling of medications is discouraged. In a bioterrorist attack, a nurse from the Centers for Disease Control and Prevention (CDC) would have a broader role than assisting local hospitals with triage. Rationale 2: The key roles of nurses in meeting the challenge of a potential bioterrorist event include education (knowledge), resources (health and law enforcement contacts), and diagnosis and treatment (signs and symptoms of chemical and biological agents). Stockpiling of medications is discouraged. In a bioterrorist attack, a nurse from the Centers for Disease Control and Prevention (CDC) would have a broader role than assisting local hospitals with triage. Rationale 3: The key roles of nurses in meeting the challenge of a potential bioterrorist event include education (knowledge), resources (health and law enforcement contacts), and diagnosis and treatment (signs and symptoms of chemical and biological agents). Stockpiling of medications is discouraged. In a bioterrorist attack, a nurse from the Centers for Disease Control and Prevention (CDC) would have a broader role than assisting local hospitals with triage. Rationale 4: The key roles of nurses in meeting the challenge of a potential bioterrorist event include education (knowledge), resources (health and law enforcement contacts), and diagnosis and treatment (signs and symptoms of chemical and biological agents). Stockpiling of medications is discouraged. In a bioterrorist attack, a nurse from the Centers for Disease Control and Prevention (CDC) would have a broader role than assisting local hospitals with triage. Rationale 5: The key roles of nurses in meeting the challenge of a potential bioterrorist event include education (knowledge), resources (health and law enforcement contacts), and diagnosis and treatment (signs and symptoms of chemical and biological agents). Stockpiling of medications is discouraged. In a bioterrorist attack, a nurse from the Centers for Disease Control and Prevention (CDC) would have a broader role than assisting local hospitals with triage. Global Rationale: Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Planning
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Learning Outcome: 12-2 Question 3 Type: MCSA The patient comes to the emergency department with an anxiety attack. He tells the nurse he heard that there was another anthrax attack in the capitol and is concerned about running out of medications. What is the best response by the nurse? 1. You dont need to worry about another attack at all; I think our government can take care of us. 2. Your health is in danger due to the anxiety; we really need to focus on reducing your anxiety now. 3. The Centers for Disease Control and Prevention (CDC) maintains a large stockpile of medications for us in case that occurs. 4. Im sure the Centers for Disease Control and Prevention (CDC) has contingency plans in the event of an anthrax attack. Correct Answer: 3 Rationale 1: The Centers for Disease Control and Prevention (CDC) maintains a stockpile of antibiotics, vaccines, medical/surgical supplies, and other patient-support supplies in the event of a bioterrorist attack. Telling the patient not to worry is a nonspecific and patronizing response. Reducing anxiety is important, but this response does not answer the patients concern. Telling the patient that the Centers for Disease Control and Prevention (CDC) has contingency plans is too vague and nonspecific. Rationale 2: The Centers for Disease Control and Prevention (CDC) maintains a stockpile of antibiotics, vaccines, medical/surgical supplies, and other patient-support supplies in the event of a bioterrorist attack. Telling the patient not to worry is a nonspecific and patronizing response. Reducing anxiety is important, but this response does not answer the patients concern. Telling the patient that the Centers for Disease Control and Prevention (CDC) has contingency plans is too vague and nonspecific. Rationale 3: The Centers for Disease Control and Prevention (CDC) maintains a stockpile of antibiotics, vaccines, medical/surgical supplies, and other patient-support supplies in the event of
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a bioterrorist attack. Telling the patient not to worry is a nonspecific and patronizing response. Reducing anxiety is important, but this response does not answer the patients concern. Telling the patient that the Centers for Disease Control and Prevention (CDC) has contingency plans is too vague and nonspecific. Rationale 4: The Centers for Disease Control and Prevention (CDC) maintains a stockpile of antibiotics, vaccines, medical/surgical supplies, and other patient-support supplies in the event of a bioterrorist attack. Telling the patient not to worry is a nonspecific and patronizing response. Reducing anxiety is important, but this response does not answer the patients concern. Telling the patient that the Centers for Disease Control and Prevention (CDC) has contingency plans is too vague and nonspecific. Global Rationale: Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 12-1 Question 4 Type: MCSA The nurse is teaching a class on anthrax to a group of emergency response workers. What is the best instruction to include? 1. Anthrax is a deadly bacterium; the most common and deadly form is gastrointestinal anthrax. 2. Cutaneous anthrax is the most common form, but inhaled anthrax is the most lethal form. 3. Anthrax most commonly affects wild rodents such as mice, rats, squirrels, and chipmunks. 4. Cutaneous anthrax is serious because it quickly spreads by person-to-person contact. Correct Answer: 2
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Rationale 1: Cutaneous anthrax is the most common, but least complicated form of anthrax. Inhalation anthrax is the least common, but most dangerous form of anthrax. Gastrointestinal anthrax is a rare form of anthrax. Anthrax most commonly affects hoofed animals such as cattle, sheep, and horses. Cutaneous anthrax cannot be spread by person-to-person contact. Rationale 2: Cutaneous anthrax is the most common, but least complicated form of anthrax. Inhalation anthrax is the least common, but most dangerous form of anthrax. Gastrointestinal anthrax is a rare form of anthrax. Anthrax most commonly affects hoofed animals such as cattle, sheep, and horses. Cutaneous anthrax cannot be spread by person-to-person contact. Rationale 3: Cutaneous anthrax is the most common, but least complicated form of anthrax. Inhalation anthrax is the least common, but most dangerous form of anthrax. Gastrointestinal anthrax is a rare form of anthrax. Anthrax most commonly affects hoofed animals such as cattle, sheep, and horses. Cutaneous anthrax cannot be spread by person-to-person contact. Rationale 4: Cutaneous anthrax is the most common, but least complicated form of anthrax. Inhalation anthrax is the least common, but most dangerous form of anthrax. Gastrointestinal anthrax is a rare form of anthrax. Anthrax most commonly affects hoofed animals such as cattle, sheep, and horses. Cutaneous anthrax cannot be spread by person-to-person contact. Global Rationale: Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 12-4 Question 5 Type: MCSA The patient has been exposed to anthrax. What treatment will the nurse plan to administer? 1. Penicillin (Bicillin LA) and vancomycin (Vancocin).
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2. Tetracycline (Sumycin) and erythromycin (Erythrocin). 3. Ampicillin (Principen) and cefepime (Maxipime). 4. Ciprofloxacin (Cipro) and doxycycline (Vibramycin). Correct Answer: 4 Rationale 1: The Food and Drug Administration (FDA) has approved the use of ciprofloxacin (Cipro) and doxycycline (Vibramycin) in combination for treatment of anthrax. Tetracycline (Sumycin) and erythromycin (Erythrocin) are not approved for the treatment of anthrax. Ampicillin (Principen) and cefepime (Maxipime) are not approved for the treatment of anthrax. Penicillin (Bicillin LA) and vancomycin (Vancocin) are not approved for the treatment of anthrax. Rationale 2: The Food and Drug Administration (FDA) has approved the use of ciprofloxacin (Cipro) and doxycycline (Vibramycin) in combination for treatment of anthrax. Tetracycline (Sumycin) and erythromycin (Erythrocin) are not approved for the treatment of anthrax. Ampicillin (Principen) and cefepime (Maxipime) are not approved for the treatment of anthrax. Penicillin (Bicillin LA) and vancomycin (Vancocin) are not approved for the treatment of anthrax. Rationale 3: The Food and Drug Administration (FDA) has approved the use of ciprofloxacin (Cipro) and doxycycline (Vibramycin) in combination for treatment of anthrax. Tetracycline (Sumycin) and erythromycin (Erythrocin) are not approved for the treatment of anthrax. Ampicillin (Principen) and cefepime (Maxipime) are not approved for the treatment of anthrax. Penicillin (Bicillin LA) and vancomycin (Vancocin) are not approved for the treatment of anthrax. Rationale 4: The Food and Drug Administration (FDA) has approved the use of ciprofloxacin (Cipro) and doxycycline (Vibramycin) in combination for treatment of anthrax. Tetracycline (Sumycin) and erythromycin (Erythrocin) are not approved for the treatment of anthrax. Ampicillin (Principen) and cefepime (Maxipime) are not approved for the treatment of anthrax. Penicillin (Bicillin LA) and vancomycin (Vancocin) are not approved for the treatment of anthrax. Global Rationale:
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Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 12-5 Question 6 Type: MCSA The patient was exposed to cutaneous anthrax 2 weeks ago. What will the nurse see when assessing the patients skin? 1. Large pustules, and later, reddish scabs 2. Small, fluid-filled vesicles, and later, small skin erosions 3. Ulcerated areas, and later, keloids 4. Small skin lesions, and later, black scabs Correct Answer: 4 Rationale 1: Cutaneous anthrax manifests as small skin lesions that develop and turn into black scabs. Small, fluid-filled vesicles, and later, small skin erosions are not seen with cutaneous anthrax. Large pustules, and later, reddish scabs are not seen with cutaneous anthrax. Ulcerated areas, and later, keloids are not seen with cutaneous anthrax. Rationale 2: Cutaneous anthrax manifests as small skin lesions that develop and turn into black scabs. Small, fluid-filled vesicles, and later, small skin erosions are not seen with cutaneous anthrax. Large pustules, and later, reddish scabs are not seen with cutaneous anthrax. Ulcerated areas, and later, keloids are not seen with cutaneous anthrax. Rationale 3: Cutaneous anthrax manifests as small skin lesions that develop and turn into black scabs. Small, fluid-filled vesicles, and later, small skin erosions are not seen with cutaneous anthrax. Large pustules, and later, reddish scabs are not seen with cutaneous anthrax. Ulcerated
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areas, and later, keloids are not seen with cutaneous anthrax. Rationale 4: Cutaneous anthrax manifests as small skin lesions that develop and turn into black scabs. Small, fluid-filled vesicles, and later, small skin erosions are not seen with cutaneous anthrax. Large pustules, and later, reddish scabs are not seen with cutaneous anthrax. Ulcerated areas, and later, keloids are not seen with cutaneous anthrax. Global Rationale: Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 12-5 Question 7 Type: MCSA The nursing instructor is teaching student nurses about the use of viruses in a bioterrorism attack. The nurse determines that learning has occurred when the students make which statement? 1. The Centers for Disease Control and Prevention (CDC) has a plan to vaccinate Americans against most viruses. 2. Actually, a bigger concern is a nuclear weapon exploding in a city. 3. Most Americans have already been vaccinated against the lethal viruses. 4. A bioterrorist attack with viruses is a real threat to Americans. Correct Answer: 4 Rationale 1: There are no effective therapies for treating patients infected by most types of viruses used in a bioterrorist attack. Mass vaccination is not appropriate until safer vaccines can be produced. The CDC does not have a plan to vaccinate Americans against most viruses. Most Americans have not been vaccinated against viruses. At this time, a nuclear weapon does not
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pose a bigger threat to American citizens than does a bioterrorism attack. Rationale 2: There are no effective therapies for treating patients infected by most types of viruses used in a bioterrorist attack. Mass vaccination is not appropriate until safer vaccines can be produced. The CDC does not have a plan to vaccinate Americans against most viruses. Most Americans have not been vaccinated against viruses. At this time, a nuclear weapon does not pose a bigger threat to American citizens than does a bioterrorism attack. Rationale 3: There are no effective therapies for treating patients infected by most types of viruses used in a bioterrorist attack. Mass vaccination is not appropriate until safer vaccines can be produced. The CDC does not have a plan to vaccinate Americans against most viruses. Most Americans have not been vaccinated against viruses. At this time, a nuclear weapon does not pose a bigger threat to American citizens than does a bioterrorism attack. Rationale 4: There are no effective therapies for treating patients infected by most types of viruses used in a bioterrorist attack. Mass vaccination is not appropriate until safer vaccines can be produced. The CDC does not have a plan to vaccinate Americans against most viruses. Most Americans have not been vaccinated against viruses. At this time, a nuclear weapon does not pose a bigger threat to American citizens than does a bioterrorism attack. Global Rationale: Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 12-7 Question 8 Type: MCSA The patient tells the nurse that she is concerned about terrorist activity and questions if everyone should be immunized against smallpox. What is the best response by the nurse? 1. The vaccine has side effects, which are serious and could kill many people.
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2. I really do not think our country has enough vaccine to do this. 3. Dont be so concerned; if an attack comes, we will immunize people then. 4. The vaccine has some serious side effects, but this is probably a good idea. Correct Answer: 1 Rationale 1: An estimated 75,000 Americans could die if all Americans were vaccinated against smallpox. There is enough vaccine for all Americans to be vaccinated against smallpox. Telling a patient not to be concerned is a condescending and non-therapeutic response. Mass immunization is not warranted at this time, so it is not a good idea to vaccinate everyone against smallpox. Rationale 2: An estimated 75,000 Americans could die if all Americans were vaccinated against smallpox. There is enough vaccine for all Americans to be vaccinated against smallpox. Telling a patient not to be concerned is a condescending and non-therapeutic response. Mass immunization is not warranted at this time, so it is not a good idea to vaccinate everyone against smallpox. Rationale 3: An estimated 75,000 Americans could die if all Americans were vaccinated against smallpox. There is enough vaccine for all Americans to be vaccinated against smallpox. Telling a patient not to be concerned is a condescending and non-therapeutic response. Mass immunization is not warranted at this time, so it is not a good idea to vaccinate everyone against smallpox. Rationale 4: An estimated 75,000 Americans could die if all Americans were vaccinated against smallpox. There is enough vaccine for all Americans to be vaccinated against smallpox. Telling a patient not to be concerned is a condescending and non-therapeutic response. Mass immunization is not warranted at this time, so it is not a good idea to vaccinate everyone against smallpox. Global Rationale: Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub:
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Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 12-7 Question 9 Type: MCSA The nursing instructor is teaching student nurses about dangerous infectious diseases. The nurse determines that learning has occurred when the students make which statement? 1. The influenza virus is the most dangerous virus today. 2. The human immunodeficiency virus is the most deadly virus we have. 3. The dengue fever virus will kill more people than any other virus. 4. The Ebola virus has the potential to kill more people than any other virus. Correct Answer: 1 Rationale 1: The influenza virus causes 3.7 million deaths per year, making it the most deadly infectious disease in the world. Although lethal, none of the other viruses (dengue fever, Ebola virus, or human immunodeficiency virus) kill as many people as influenza. Rationale 2: The influenza virus causes 3.7 million deaths per year, making it the most deadly infectious disease in the world. Although lethal, none of the other viruses (dengue fever, Ebola virus, or human immunodeficiency virus) kill as many people as influenza. Rationale 3: The influenza virus causes 3.7 million deaths per year, making it the most deadly infectious disease in the world. Although lethal, none of the other viruses (dengue fever, Ebola virus, or human immunodeficiency virus) kill as many people as influenza. Rationale 4: The influenza virus causes 3.7 million deaths per year, making it the most deadly infectious disease in the world. Although lethal, none of the other viruses (dengue fever, Ebola virus, or human immunodeficiency virus) kill as many people as influenza. Global Rationale: Cognitive Level: Applying
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Client Need: Physiological Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 12-6 Question 10 Type: MCSA The patient has been exposed to a nerve agent. For which symptoms will the nurse most likely assess? 1. Salivation, involuntary urination, and convulsions 2. Dilated pupils and increased blood pressure and heart rate 3. Pinpoint pupils, decreased blood pressure, and increased heart rate 4. Rapid breathing and cold, clammy skin Correct Answer: 1 Rationale 1: Symptoms of nerve gas exposure are related to overstimulation of acetylcholine, and can result in salivation, involuntary urination, and convulsions. The nerve agent blocks acetylcholinesterase. Dilated pupils and increased blood pressure and heart rate are symptoms of sympathetic nervous system stimulation. Pinpoint pupils, decreased blood pressure, and increased heart rate are not symptoms of overstimulation of acetylcholine. Rapid breathing and cold, clammy skin are not symptoms of overstimulation of acetylcholine. Rationale 2: Symptoms of nerve gas exposure are related to overstimulation of acetylcholine, and can result in salivation, involuntary urination, and convulsions. The nerve agent blocks acetylcholinesterase. Dilated pupils and increased blood pressure and heart rate are symptoms of sympathetic nervous system stimulation. Pinpoint pupils, decreased blood pressure, and increased heart rate are not symptoms of overstimulation of acetylcholine. Rapid breathing and cold, clammy skin are not symptoms of overstimulation of acetylcholine. Rationale 3: Symptoms of nerve gas exposure are related to overstimulation of acetylcholine, and can result in salivation, involuntary urination, and convulsions. The nerve agent blocks
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acetylcholinesterase. Dilated pupils and increased blood pressure and heart rate are symptoms of sympathetic nervous system stimulation. Pinpoint pupils, decreased blood pressure, and increased heart rate are not symptoms of overstimulation of acetylcholine. Rapid breathing and cold, clammy skin are not symptoms of overstimulation of acetylcholine. Rationale 4: Symptoms of nerve gas exposure are related to overstimulation of acetylcholine, and can result in salivation, involuntary urination, and convulsions. The nerve agent blocks acetylcholinesterase. Dilated pupils and increased blood pressure and heart rate are symptoms of sympathetic nervous system stimulation. Pinpoint pupils, decreased blood pressure, and increased heart rate are not symptoms of overstimulation of acetylcholine. Rapid breathing and cold, clammy skin are not symptoms of overstimulation of acetylcholine. Global Rationale: Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 12-8 Question 11 Type: MCSA The patient has been exposed to a nerve agent. Which antidote will the nurse plan to administer? 1. Apomorphine 2. Atropine (AtroPen) 3. Acetate of ammonia 4. Hydroxyzine (Vistaril) Correct Answer: 2 Rationale 1: Atropine is an anticholinergic drug that will reverse the symptoms of acetylcholine
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overstimulation. Hydroxyzine (Vistaril), acetate of ammonia, and apomorphine will not reverse the symptoms of acetylcholine overstimulation. Rationale 2: Atropine is an anticholinergic drug that will reverse the symptoms of acetylcholine overstimulation. Hydroxyzine (Vistaril), acetate of ammonia, and apomorphine will not reverse the symptoms of acetylcholine overstimulation. Rationale 3: Atropine is an anticholinergic drug that will reverse the symptoms of acetylcholine overstimulation. Hydroxyzine (Vistaril), acetate of ammonia, and apomorphine will not reverse the symptoms of acetylcholine overstimulation. Rationale 4: Atropine is an anticholinergic drug that will reverse the symptoms of acetylcholine overstimulation. Hydroxyzine (Vistaril), acetate of ammonia, and apomorphine will not reverse the symptoms of acetylcholine overstimulation. Global Rationale: Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 12-8 Question 12 Type: MCSA A small nuclear weapon has been detonated in a nearby city. For which immediate symptoms of radiation sickness will the nurse assess in patients who have been exposed? 1. Dilated pupils and aggression 2. Nausea, vomiting, and diarrhea 3. Weight loss and fatigue 4. Anorexia and fatigue
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Correct Answer: 2 Rationale 1: The immediate symptoms of radiation sickness include nausea, vomiting, and diarrhea. Weight loss and fatigue are late symptoms of radiation sickness. Anorexia and fatigue are not signs of radiation sickness. Dilated pupils and aggression are not signs of radiation sickness. Rationale 2: The immediate symptoms of radiation sickness include nausea, vomiting, and diarrhea. Weight loss and fatigue are late symptoms of radiation sickness. Anorexia and fatigue are not signs of radiation sickness. Dilated pupils and aggression are not signs of radiation sickness. Rationale 3: The immediate symptoms of radiation sickness include nausea, vomiting, and diarrhea. Weight loss and fatigue are late symptoms of radiation sickness. Anorexia and fatigue are not signs of radiation sickness. Dilated pupils and aggression are not signs of radiation sickness. Rationale 4: The immediate symptoms of radiation sickness include nausea, vomiting, and diarrhea. Weight loss and fatigue are late symptoms of radiation sickness. Anorexia and fatigue are not signs of radiation sickness. Dilated pupils and aggression are not signs of radiation sickness. Global Rationale: Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 12-9 Question 13 Type: MCSA The nurse administers potassium iodide (ThyroSafe) tablets to a patient who has been exposed to radiation from a nuclear weapon. What is the rationale for administering potassium iodide
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(ThyroSafe) to this patient? 1. It was administered to prevent thyroid cancer. 2. It was administered to prevent brain cancer. 3. It was administered to prevent liver cancer. 4. It was administered to prevent renal cancer. Correct Answer: 1 Rationale 1: Potassium iodide (ThyroSafe) can prevent up to 100% of the radioactive iodine from entering the thyroid gland. Potassium iodide (ThyroSafe) will not protect the liver, the kidneys, or the brain from the effects of radioactive iodine. Rationale 2: Potassium iodide (ThyroSafe) can prevent up to 100% of the radioactive iodine from entering the thyroid gland. Potassium iodide (ThyroSafe) will not protect the liver, the kidneys, or the brain from the effects of radioactive iodine. Rationale 3: Potassium iodide (ThyroSafe) can prevent up to 100% of the radioactive iodine from entering the thyroid gland. Potassium iodide (ThyroSafe) will not protect the liver, the kidneys, or the brain from the effects of radioactive iodine. Rationale 4: Potassium iodide (ThyroSafe) can prevent up to 100% of the radioactive iodine from entering the thyroid gland. Potassium iodide (ThyroSafe) will not protect the liver, the kidneys, or the brain from the effects of radioactive iodine. Global Rationale: Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 12-9 Question 14
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Type: MCSA The nurse conducts a seminar in a local community center on how Americans can be affected by radiation from a nuclear attack. The nurse determines that the education is effective when the patients make which statement? 1. I can protect myself from cancers by taking potassium iodide (ThyroSafe). 2. I need to stay inside my house for at least 2 days after the attack to be safe. 3. I need to take at least four showers every day or I will develop skin ulcers. 4. I am at risk to develop leukemia as a result of radiation exposure. Correct Answer: 4 Rationale 1: Leukemia is one of the long-term effects of radiation. Radiation will not dissipate in 2 days. Showers will not always protect the skin. Potassium iodide (ThyroSafe) will only protect against thyroid cancer. Rationale 2: Leukemia is one of the long-term effects of radiation. Radiation will not dissipate in 2 days. Showers will not always protect the skin. Potassium iodide (ThyroSafe) will only protect against thyroid cancer. Rationale 3: Leukemia is one of the long-term effects of radiation. Radiation will not dissipate in 2 days. Showers will not always protect the skin. Potassium iodide (ThyroSafe) will only protect against thyroid cancer. Rationale 4: Leukemia is one of the long-term effects of radiation. Radiation will not dissipate in 2 days. Showers will not always protect the skin. Potassium iodide (ThyroSafe) will only protect against thyroid cancer. Global Rationale: Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub:
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Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 12-9 Question 15 Type: MCSA The nurse is preparing an educational plan for parents about how to protect their children if a bioterrorist attack occurs. What is the best information to include? 1. Dont worry, the Centers for Disease Control and Prevention (CDC) has everything under control. 2. Plan to call the Centers for Disease Control and Prevention (CDC) if an attack occurs. 3. Follow the Centers for Disease Control and Prevention (CDC) guidelines for immunizations. 4. Realistically, there is nothing that can be done. Correct Answer: 3 Rationale 1: One of the roles of the Centers of Disease Control and Prevention (CDC) is to publicize recommendations for immunizations. Telling parents not to worry and that the CDC has everything under control is non-therapeutic and condescending information. Telling the parents that nothing can be done is not true, and would leave the parents feeling very powerless. Phone lines to the CDC would be overwhelmed during an attack, so calling them would elicit no information. Rationale 2: One of the roles of the Centers of Disease Control and Prevention (CDC) is to publicize recommendations for immunizations. Telling parents not to worry and that the CDC has everything under control is non-therapeutic and condescending information. Telling the parents that nothing can be done is not true, and would leave the parents feeling very powerless. Phone lines to the CDC would be overwhelmed during an attack, so calling them would elicit no information. Rationale 3: One of the roles of the Centers of Disease Control and Prevention (CDC) is to publicize recommendations for immunizations. Telling parents not to worry and that the CDC has everything under control is non-therapeutic and condescending information. Telling the parents that nothing can be done is not true, and would leave the parents feeling very powerless.
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Phone lines to the CDC would be overwhelmed during an attack, so calling them would elicit no information. Rationale 4: One of the roles of the Centers of Disease Control and Prevention (CDC) is to publicize recommendations for immunizations. Telling parents not to worry and that the CDC has everything under control is non-therapeutic and condescending information. Telling the parents that nothing can be done is not true, and would leave the parents feeling very powerless. Phone lines to the CDC would be overwhelmed during an attack, so calling them would elicit no information. Global Rationale: Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 12-3 Question 16 Type: MCSA Which of the following correctly and completely identifies the items found within the Strategic National Stockpile? 1. Bandages, airway devices, and IV supplies 2. Antibiotics and IV fluids 3. Emergency equipment 4. Antibiotics, vaccines, and support supplies Correct Answer: 4 Rationale 1: The Strategic National Stockpile consists of antibiotics, vaccines, and support supplies.
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Rationale 2: The Strategic National Stockpile consists of antibiotics, vaccines, and support supplies. Rationale 3: The Strategic National Stockpile consists of antibiotics, vaccines, and support supplies. Rationale 4: The Strategic National Stockpile consists of antibiotics, vaccines, and support supplies. Global Rationale: Cognitive Level: Remembering Client Need: Safe Effective Care Environment Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 12-3 Question 17 Type: MCMA Anthrax is a potential agent of bioterrorism that Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. can be spread easily, causing panic and disruption. 2. can cause high morbidity, but low mortality. 3. is not spread easily, but can cause high mortality. 4. can be spread easily, causing moderate mortality. Correct Answer: 1,4 Rationale 1: Anthrax is a category A infectious agent. It can be spread easily and cause high
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mortality, as well as panic and disruption. Rationale 2: Anthrax is a category A infectious agent. It can be spread easily and cause high mortality, as well as panic and disruption. Rationale 3: Anthrax is a category A infectious agent. It can be spread easily and cause high mortality, as well as panic and disruption. Rationale 4: Anthrax is a category A infectious agent. It can be spread easily and cause high mortality, as well as panic and disruption. Global Rationale: Cognitive Level: Remembering Client Need: Safe Effective Care Environment Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 12-4 Question 18 Type: MCSA Following a bioterrorism attack, the nurse finds that the victims are suffering from small, black lesions on their forearms. The nurse identifies this as a symptom most likely caused by 1. cutaneous anthrax. 2. phosgene gas. 3. gastrointestinal anthrax. 4. hydrogen cyanide. Correct Answer: 1 Rationale 1: Cutaneous anthrax produces small black lesions on the skin.
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Rationale 2: Cutaneous anthrax produces small black lesions on the skin. Rationale 3: Cutaneous anthrax produces small black lesions on the skin. Rationale 4: Cutaneous anthrax produces small black lesions on the skin. Global Rationale: Cognitive Level: Remembering Client Need: Physiological Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 12-2 and 12-5 Question 19 Type: MCSA Which of the following is a key role for the nurse in the event of a bioterrorist attack? 1. Collecting evidence that might lead to the capture of the terrorists 2. Planning that includes developing a list of health and law enforcement contacts 3. Prescribing antibiotics 4. Prescribing vaccines Correct Answer: 2 Rationale 1: The nurses role includes being educated, knowing resources, diagnosing and treating, and planning. Rationale 2: The nurses role includes being educated, knowing resources, diagnosing and treating, and planning. Rationale 3: The nurses role includes being educated, knowing resources, diagnosing and treating, and planning.
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Rationale 4: The nurses role includes being educated, knowing resources, diagnosing and treating, and planning. Global Rationale: Cognitive Level: Remembering Client Need: Safe Effective Care Environment Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 12-2 Question 20 Type: MCSA Which of the following would be most effective for the treatment of a person infected with anthrax? 1. Anthrax vaccination 2. Atropine 3. Ciprofloxacin 4. Antiviral agents Correct Answer: 3 Rationale 1: Antibiotics (such as ciprofloxacin) are indicated for the treatment of anthrax. Vaccinations are useful for prevention, while atropine and antiviral agents are not indicated for bacterial infections. Rationale 2: Antibiotics (such as ciprofloxacin) are indicated for the treatment of anthrax. Vaccinations are useful for prevention, while atropine and antiviral agents are not indicated for bacterial infections. Rationale 3: Antibiotics (such as ciprofloxacin) are indicated for the treatment of anthrax. Vaccinations are useful for prevention, while atropine and antiviral agents are not indicated for
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bacterial infections. Rationale 4: Antibiotics (such as ciprofloxacin) are indicated for the treatment of anthrax. Vaccinations are useful for prevention, while atropine and antiviral agents are not indicated for bacterial infections. Global Rationale: Cognitive Level: Remembering Client Need: Physiological Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 12-5 Question 21 Type: MCSA Atropine would be most useful for a victim of bioterrorism who experienced exposure to 1. ionizing radiation. 2. nerve gas. 3. bacterial agents. 4. viral agents. Correct Answer: 2 Rationale 1: Chemicals in nerve gas cause overstimulation by the neurotransmitter acetylcholine. Atropine blocks the attachment of this neurotransmitter to receptor sites. Rationale 2: Chemicals in nerve gas cause overstimulation by the neurotransmitter acetylcholine. Atropine blocks the attachment of this neurotransmitter to receptor sites. Rationale 3: Chemicals in nerve gas cause overstimulation by the neurotransmitter acetylcholine. Atropine blocks the attachment of this neurotransmitter to receptor sites.
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Rationale 4: Chemicals in nerve gas cause overstimulation by the neurotransmitter acetylcholine. Atropine blocks the attachment of this neurotransmitter to receptor sites. Global Rationale: Cognitive Level: Remembering Client Need: Physiological Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 12-7 Question 22 Type: MCSA Victims of a bioterrorism attack experienced initial nausea and vomiting followed by weight loss and eventual thyroid cancer. Which of the following was the most likely causative agent? 1. Chemical agent 2. Viral agent 3. Bacterial agent 4. Ionizing radiation Correct Answer: 4 Rationale 1: Exposure to radiation causes weight loss and eventual thyroid cancer. Rationale 2: Exposure to radiation causes weight loss and eventual thyroid cancer. Rationale 3: Exposure to radiation causes weight loss and eventual thyroid cancer. Rationale 4: Exposure to radiation causes weight loss and eventual thyroid cancer. Global Rationale:
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Cognitive Level: Remembering Client Need: Physiological Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 12-9 Question 23 Type: MCSA Which of the following would be the best choice for preventing thyroid cancer in persons exposed to ionizing radiation? 1. Potassium-iodine tablets 2. Calcium tablets 3. Antibiotics 4. Salt tablets Correct Answer: 1 Rationale 1: Potassium- tablets are the only recognized therapy for radiation exposure. Rationale 2: Potassium-iodine tablets are the only recognized therapy for radiation exposure. Rationale 3: Potassium-iodine tablets are the only recognized therapy for radiation exposure. Rationale 4: Potassium-iodine tablets are the only recognized therapy for radiation exposure. Global Rationale: Cognitive Level: Remembering Client Need: Physiological Integrity Client Need Sub:
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Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 12-9 Question 24 Type: MCSA Which of the following antidotes would be indicated for a patient who overdosed on a benzodiazepine? 1. Mucomyst 2. Digibind 3. Romazicon 4. Acetaminophen Correct Answer: 3 Rationale 1: Flumazenil (Romazicon) is the antidote for benzodiazepine overdose. Rationale 2: Flumazenil (Romazicon) is the antidote for benzodiazepine overdose. Rationale 3: Flumazenil (Romazicon) is the antidote for benzodiazepine overdose. Rationale 4: Flumazenil (Romazicon) is the antidote for benzodiazepine overdose. Global Rationale: Cognitive Level: Remembering Client Need: Physiological Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 12-1 Question 25
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Type: MCMA As part of emergency nursing training, the nurse is reviewing the causes of disasters. Which agents can cause potential disasters? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Radiologic agents 2. Nuclear explosives 3. Biological agents 4. Chemical agents 5. Mechanical agents Correct Answer: 1,2,3,4 Rationale 1: Potential disasters can result from radiologic agents. Rationale 2: Potential disasters can result from nuclear explosives. Rationale 3: Potential disasters can result from biologic agents. Rationale 4: Potential disasters can result from chemical agents. Rationale 5: Potential disasters cannot result from mechanical agents. Global Rationale: Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Safety and Infection Control Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 12-1
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Question 26 Type: MCMA The nurse is reviewing the components of the Strategic National Stockpile (SNS), which include Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. intravenous administration equipment. 2. antibiotics. 3. life-support medications. 4. chemical antidotes. 5. hospital beds. Correct Answer: 1,2,3,4 Rationale 1: The Strategic National Stockpile (SNS), a national repository of medical equipment, includes intravenous (IV) administration equipment. Rationale 2: The Strategic National Stockpile (SNS), a national repository of medical equipment, includes antibiotics. Rationale 3: The Strategic National Stockpile (SNS), a national repository of medical equipment, includes life-support medications. Rationale 4: The Strategic National Stockpile (SNS), a national repository of medical equipment, includes chemical antidotes. Rationale 5: The Strategic National Stockpile (SNS), a national repository of medical equipment, does not include hospital beds. Global Rationale: Cognitive Level: Remembering Client Need: Safe Effective Care Environment
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Client Need Sub: Safety and Infection Control Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 12-2 Question 27 Type: MCMA The danger from radiation exposure arises primarily from Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. the amount of exposure. 2. the long-lasting effects. 3. the amount of cellular death. 4. the distance from the initial incident. 5. the amount of potassium iodine ingested after exposure. Correct Answer: 1,2,3,4 Rationale 1: Radiation exposure can cause mass casualty deaths at the point of impact and create residual ionizing radiation for miles around the site. Some radioisotopes emit radiation for decades and even centuries. Rationale 2: When exposed to large amounts of radiation, or to small amounts over many decades, patients tend to develop certain malignancies (cellular death) such as leukemia or thyroid cancer. Rationale 3: When exposed to large amounts of radiation, or to small amounts over many decades, patients tend to develop certain malignancies (cellular death) such as leukemia or thyroid cancer. Rationale 4: Radiation exposure can cause mass casualty deaths at the point of impact and create
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residual ionizing radiation for miles around the site. Rationale 5: The ingestion of potassium iodine does not contribute to the danger of radiation exposure. Global Rationale: Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Safety and Infection Control Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 12-5 Question 28 Type: MCMA Which of the five general principles for treating acute poisoning would the nurse use to treat a patient who was exposed to an external chemical agent? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Topical decontamination 2. Increase in the rate of excretion 3. Prevention of absorption 4. Neutralization 5. Antidotes and symptomatic therapy Correct Answer: 1,4 Rationale 1: Topical decontamination includes the removal of contaminated clothing and flushing of the skin or eyes. This would be appropriate for exposure to an external chemical
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agent. Rationale 2: This would be appropriate for treating an acute poisoning through ingestion. Rationale 3: This would be appropriate for treating an acute poisoning through ingestion. Rationale 4: Application of an agent to neutralize the poison would be appropriate for an exposure to an external chemical agent. Rationale 5: Antidotes and symptomatic therapy would not be indicated for treating an external chemical agent. Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Safety and Infection Control Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 12-6 Question 29 Type: MCMA Which interventions will the nurse include when planning care to enhance the removal of poison from a patient who has overdosed on drugs? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Administering activated charcoal 2. Monitoring urine output 3. Preparing the patient for dialysis 4. Inserting a nasogastric tube
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5. Preparing corticosteroids for administration Correct Answer: 1,2,3,4 Rationale 1: Charcoal works by binding with the poison agent. Rationale 2: The patients urine output should be monitored, noting the characteristics of urine for early identification of rhabdomyolysis. Rationale 3: The patient might need dialysis for rapid removal of lethal toxins. Rationale 4: A nasogastric tube might be needed for lavage of stomach contents. Rationale 5: Corticosteroids are not used to enhance the removal of poison from the body.
Chapter 59. Special Aspects of Perinatal & Pediatric Pharmacology MULTIPLE CHOICE 1. The nurse is preparing to administer a medication to a 6-month-old infant. The nurse will monitor closely for signs of drug toxicity based on the knowledge that, compared to adults, infants have a. an increased percentage of total body fat. b. immature hepatic and renal function. c. more protein receptor sites. d. more rapid gastrointestinal transit time. ANS: B The liver and kidneys are the primary organs for metabolism and excretion and are immature in infants. This allows drugs to accumulate and increases the risk for drug toxicity. Infants have a lower proportion of body fat than adults and fewer protein receptors. They do have more rapid gastrointestinal transit time, but this decreases the amount of drug absorbed.
2. The nurse reviews information about a drug and learns that it is best absorbed in an acidic environment. When giving this drug to a 1-year-old patient, the nurse will expect to administer a dose that will be a. equal to an adult dose. b. less than an adult dose.
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c. more than an adult dose. d. twice the usual adult dose. ANS: C Because the childs gastric pH is more alkaline than the adults, less drug will be absorbed. Therefore, the dose should be increased.
3. The nurse assumes care for an infant who is showing signs of drug toxicity to a drug given several hours prior. The nurse checks the dose and confirms that the dose is consistent with standard dosing guidelines. Which characteristic of the drug will likely explain this response in this patient? a. It is acidic. b. It is highly protein-bound. c. It is not fat-soluble. d. It is water-soluble. ANS: B With fewer protein-binding sites, there is more active drug available. This requires a reduction in the dose for infants. Drugs that are acidic are not as readily absorbed in infants, since their gastric pH tends to be more alkaline. Infants have a lower proportion of body fat; fat-soluble drugs would need to be decreased to prevent toxicity. Until about age 2 years of age, pediatric patients require larger than usual doses of water-soluble drugs to achieve therapeutic effects.
4. The parent is concerned about giving a child medication because of the lack of knowledge about the effects of drugs on children. The nurse discusses legislation passed in 2002 and 2003 about pediatric pharmacology. Which is true about these laws? a. They forbid providers from prescribing medications unless they have been FDA- approved for use in children. b. They mandate consistent, evidence-based dosing guidelines for use in children. c. They provide federal grants to fund pediatric pharmaceutical research. d. They require drug manufacturers to study pediatric medication use. ANS: D In 2003, a law known as the Pediatric Research Equity Act joined the Best Pharmaceuticals Act of 2002 to require drug manufacturers to study pediatric medication use and offer incentives for pediatric pharmacology research. Providers are not forbidden to prescribe drugs in children that
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are not FDA-approved. The laws do not mandate the use of evidence-based guidelines and do not provide grants to fund research.
5. The nurse will administer an intravenous medication to an adolescent patient. When preparing the adolescent for the IV insertion, which is an appropriate action by the nurse? a. Allowing the patient to verbalize concerns about the procedure b. Covering the insertion site with a bandage after the procedure is completed c. Explaining any possible adverse drug reactions d. Reassuring the patient that only one body part will be used ANS: A Allowing the adolescent to verbalize concerns about the medication and its regimen may offer opportunities to clarify misconceptions and teach new information. Preschool-age children may have concerns about harm to their body and need to have sites covered. Adolescents still have a present focus, so discussing future adverse reactions is not especially helpful. Preschool and school-age children fear bodily harm and require reassurance that only one body part will be affected.
6. An infant will receive a topical medication. What instruction will the nurse include when teaching the parents how to administer the medication? a. Apply a thin layer to the affected area. b. Apply liberally to the skin on and around the area. c. Use the medication less frequently than what is recommended for adults. d. Use the medication more frequently than what is recommended for adults. ANS: A Topical medications may be altered by skin tissue condition. Children have thinner, more porous skin and have a proportionately higher skin surface area than adults and thus absorb topical medications more readily. Caregivers should be advised to use only a thin layer on the affected body part. This difference in skin does not affect the frequency of administering topical medications.
7. The provider has ordered that vitamin D drops be given to a newborn. Based on the
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knowledge of drug distribution in infants, the nurse understands that the infant may need a. a higher dose. b. a lower dose. c. less frequent dosing. d. more frequent dosing. ANS: B Neonates and young infants tend to have less body fat than older children, meaning that they need less of fat-soluble medications since these medications wont be bound in fat tissue. Higher doses would lead to drug toxicity. Body fat does not affect the frequency of dosing.
8. The nurse is caring for a 5-year-old child. The child is taking a drug that has a known therapeutic range in adults, and the nurse checks that the ordered dose is correct and notes that the childs serum drug level is within normal limits. The child complains of a headache, which is a common sign of toxicity for this drug. Which action will the nurse take? a. Administer the drug since the drug levels are normal. b. Attribute the headache to non-drug causes. c. Hold the next dose and contact the provider. d. Request an order for an analgesic medication. ANS: C The therapeutic ranges established for many drug levels are based on adult studies, so it is important for the nurse to assess pediatric patients in conjunction with monitoring drug levels. The nurse should notify the provider of the reaction. Because headaches are a symptom of toxicity for this drug, the nurse should not ignore the symptom.
9. The nurse is preparing to give a 7-year-old child a bitter-tasting oral medication. The child asks the nurse if the medicine tastes bad. To help the child take this medication, which action will the nurse take? a. Allow the child to delay taking the medication until the parent arrives. b. Enlist the assistance of other staff to help restrain the child. c. Tell the child that it doesnt taste bad if it is swallowed quickly. d. Tell the child that it tastes bad and offer a choice of beverages to drink afterwards. ANS: D School-age children should be permitted more control, involvement in the process, and honest
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information. The nurse should tell the child the truth and offer the child a choice about what to drink to wash down the medicine. Medications must be given on schedule, so allowing the child a choice about when to take a medication is not acceptable. Restraining a child should not be used unless other methods have failed. Telling the child the medication doesnt taste bad is not honest and will reduce the childs trust in the nurse.
10. The nurse is preparing to administer an oral liquid medication to an 11-month-old child who is fussy and uncooperative. Which action will the nurse take to facilitate giving this medication? a. Adding honey to the medication to improve the taste b. Putting the medication in the infants formula c. Requesting an injectable form of the medication d. Using a syringe and allowing the parent to give the medication ANS: D When possible, family members or caregivers should be solicited to assist in medication administration. Infants should not receive honey because of the risk of botulism. A syringe allows more control over the amount of medication in the infants mouth and should be used. Mixing the medication in a bottle requires ensuring that the infant takes the entire bottle in order to get the medication dose. Using an injectable form of medication is more traumatic and should be used only when an oral route is not possible or is contraindicated. 11. A 2-year-old child will receive several doses of an intramuscular medication. The nurse caring for this child will use which intervention to help the child cope with this regimen? a. Allowing the child to give pretend shots to a doll with an empty syringe b. Allowing the child to select a Band-Aid to wear after each medication is given c. Ensuring privacy while giving the medication d. Explaining that the medicine will help the child to feel better ANS: A Simple explanations, a firm approach, and enlisting the imagination of a toddler through play may enhance cooperation. Allowing the child to practice on a doll may help the toddler tolerate the injections. Preschool and school-age children fear bodily injury, and Band-Aids are important with those age groups. Adolescents need privacy, and school-age children and adolescents can understand the use of a medication in relation to future outcomes.
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12. A preschool-age child has moderate dehydration and needs a rapid bolus of fluids. To provide atraumatic care and administer fluids most effectively, what action will the nurse take? a. Apply a eutectic mixture of local anesthetic (EMLA) just before inserting an intravenous line. b. Ask the childs parents to restrain the child during venipuncture so fluids may be administered. c. Request an order for nasogastric (NG) fluids to avoid the trauma of venipuncture. d. Use a powdered lidocaine preparation prior to insertion of the intravenous needle. ANS: D One method to ensure atraumatic care is through the use of topical analgesics before IV injections. Powdered lidocaine preparations are effective in reducing the pain and fear associated with invasive procedures, such as venipuncture. EMLA is useful only if applied 1 to 2.5 hours prior to IV insertion. Asking parents to restrain the child for a painful procedure can cause stress and anxiety for both the child and the parents. NG fluids are traumatic and are uncomfortable long past the insertion of the NG tube.
13. The nurse is preparing to administer an intramuscular medication to a 4-year-old child who starts to cry and screams, I dont want a shot! What is the nurses next action? a. Acknowledge that shots hurt and tell the child to be brave. b. Engage the child in a conversation about preschool and favorite activities. c. Enlist the assistance of another nurse to help restrain the child. d. Explain to the child that it will only hurt for a few seconds. ANS: B Distraction may be used for pain and anxiety control in this age group. Engaging the child in a conversation may distract the child from the anxiety of the imminent injection. It is not correct to tell the child to be brave since this belittles the feelings expressed by the child. Preschool children have a limited sense of time, so telling the child that the pain will only last a few seconds may not be effective. Restraining the child with other staff should be used last after other methods have failed.
14. A 14-year-old female who has type 1 diabetes mellitus that has been well-controlled for several years is admitted to the hospital for treatment of severe hyperglycemia. The patients lab values indicate poor glycemic control for the past 3 months. The nurse caring for this patient will suspect which cause for the change in diabetic control? a. Adolescent rebellion and noncompliance
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b. Changes in cognitive function c. Hormonal fluctuations d. Possible experimentation with drugs or alcohol ANS: C In adolescence, hormonal changes and growth spurts may necessitate changes in medication dosages; many children with chronic illness require dosage adjustments in the early teen years.
15. The nurse is teaching a 15-year-old female patient and her parents about an antibiotic the adolescent will begin taking. The drug is known to decrease the effectiveness of oral contraceptive pills (OCPs). The nurse will a. ask the adolescent and her parents whether she is taking OCPs. b. tell her parents privately that pregnancy may occur if she is taking OCPs. c. tell her privately that the medication may decrease the effectiveness of OCPs. d. warn her and her parents that she may get pregnant if she is relying on OCPs. ANS: C When soliciting adolescent health histories, the nurse should consider issues related to sexual practices and should provide privacy when asking sensitive questions or giving sensitive information. The other actions do not allow for patient privacy.
Chapter 60. Special Aspects of Geriatric Pharmacology MULTIPLE CHOICE 1. The nurse is caring for an older adult patient who is receiving multiple medications. When monitoring this patient for potential drug toxicity, the nurse should review which lab values closely? a. Complete blood count and serum glucose levels b. Pancreatic enzymes and urinalysis c. Serum creatinine and liver function tests (LFTs) d. Serum lipids and electrolytes ANS: C With liver and kidney dysfunction, the efficacy of drugs is generally increased and may cause toxicity. The nurse should review serum creatinine levels to monitor renal function and LFTs to monitor hepatic function. The other lab tests may be ordered for specific drugs if they affect
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those body systems. 2. An older patient who reports a 2- to 3-year history of upper gastrointestinal symptoms will begin taking ranitidine (Zantac) to treat this disorder. The patient has completed a health history form. The nurse notes that the patient answered no when asked if any medications were being taken. Which action will the nurse take next? a. Ask whether the patient uses over-the-counter (OTC) medications. b. Obtain a careful dietary history for the past two weeks. c. Recommend that the patient take antacid tablets. d. Suggest that the patient add high-potassium foods to the diet. ANS: A Many patients do not think of OTC products as medications and often do not list them when asked about medication use. A patient who takes ranitidine along with an OTC antacid could be duplicating medications. A dietary history is important as well but would not be the most important action in this case. The nurse should not recommend antacid tablets or high-potassium foods.
3. To assist an older, confused patient to adhere to a multidrug regimen, the nurse will provide which recommendation? a. Avoid the use of over-the-counter medications. b. Bring all medications to each clinic visit. c. Review the manufacturers information insert about each medication. d. Save money by getting each drug at the pharmacy with the lowest price. ANS: B Patients who take multiple medications should be advised to bring medications to each clinic visit. Patients may take OTC medications as long as those are included in the list of medications reviewed by the provider. Manufacturers inserts provide an overwhelming amount of information. Patients should be advised to use only one pharmacy. 4. The nurse is caring for an older patient who is taking 25 mg per day of hydrochlorothiazide. The nurse will closely monitor which lab value in this patient? a. Coagulation studies b. White blood count c. Liver function tests d. Serum potassium
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ANS: D Older patients who take doses of hydrochlorothiazide between 25 to 50 mg/day have increased risk of electrolyte imbalances, so potassium should be monitored closely. 5. The nurse is caring for an 82-year-old patient who takes digoxin to treat chronic atrial fibrillation. When caring for this patient, to monitor for drug side effects, what will the nurse will carefully assess? a. Blood pressure b. Heart rate c. Oxygen saturation d. Respiratory rate ANS: B Most of digoxin is eliminated by the kidneys, so a decline in kidney function can cause digoxin accumulation, which can cause bradycardia. Digoxin should not be given to any patient with a pulse less than 60 beats per minute. 6. The nurse is caring for an 80-year-old patient who is taking warfarin (Coumadin). Which action does the nurse understand is important when caring for this patient? a. Encouraging the patient to rise slowly from a sitting position b. Initiating a fall-risk protocol c. Maintaining strict intake and output measures d. Monitoring blood pressure frequently ANS: B Patients who take anticoagulants have an increased risk of hemorrhage. Older patients have an increased risk of falls that can lead to bleeding complications. Initiating a fall-risk protocol is important. Warfarin does not affect blood pressure and would not cause orthostatic hypotension. Warfarin does not alter urine output. 7. An 80-year-old patient is being treated for an infection. An order for which type of antibiotic would cause concern for the nurse caring for this patient? a. Aminoglycoside b. Cephalosporin c. Penicillin d. Sulfonamide ANS: A Penicillins, cephalosporins, tetracyclines, and sulfonamides are normally considered safe for the
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older adult. Aminoglycosides are excreted in the urine and are not usually prescribed for patients older than 75 years.
8. A 75-year-old patient will be discharged home with a prescription for an opioid analgesic. To help the patient minimize adverse effects, what will the nurse recommend for this patient? a. Sucking on lozenges to moisten oral mucosa b. Taking an antacid with each dose c. Taking the medication on an empty stomach d. Using a stool softener ANS: D Opioid analgesics can cause constipation. Stool softeners can help minimize this effect. Opioids do not cause dry mouth. Drug absorption may be decreased with an antacid. Opioid analgesics should be taken with food or milk to decrease gastrointestinal irritation.
9. A 75-year-old patient is readmitted to the hospital to treat recurrent pneumonia. The patient had been discharged home with a prescription for antibiotics 5 days prior. The nurse admitting this patient will take which initial action? a. Ask the patient about over-the-counter drug use. b. Ask the patient how many doses of the antibiotic have been taken. c. Discuss increasing the antibiotic dose with the provider. d. Obtain an order for a creatinine clearance test. ANS: B There are many reasons for non-adherence to a drug regimen in an older patient, so if a patient is readmitted, the nurse should first ascertain whether or not the medications have been used. Asking the patient how many doses have been taken will help to assess this. If it is determined that the patient is taking the drug as ordered, the other steps may be taken.
10. The nurse is performing an admission assessment on an 80-year-old patient who has frequent hospital admissions. The patient appears more disoriented and confused than usual. Which action by the nurse is correct? a. Asking about medication doses
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b. Asking for a neurologist consult c. Requesting orders for liver function tests d. Suspecting impaired renal function ANS: A An initial sign of drug toxicity in elderly patients may be confusion or changes in behavior. The nurse should ask about drug doses and notify the provider of the behaviors. The provider may order further evaluation based on examination of the patient.
11. An older patient takes ibuprofen for arthritis pain. The patient tells the nurse that the ibuprofen causes gastrointestinal (GI) upset. Which action will the nurse take with this patient? a. Ask the provider about having the patient take a different medication. b. Instruct the patient to cut the ibuprofen dose in half to avoid GI upset. c. Explain that all drugs have adverse effects. d. Explore options to help decrease the drug side effects. ANS: D Older adults are more likely to experience drug side effects, and nurses should be aware of measures that may decrease these side effects and thus improve adherence.
12. The nurse is caring for a 78-year-old patient who lives independently. The patient will begin a new drug regimen that requires taking multiple drugs at various times per day. Which intervention is appropriate for the nurse to implement with this patient? a. Ask the patients family members to monitor the patients drug regimen. b. Develop a log to record the times each drug will be taken. c. Reinforce the need to take the drugs as scheduled. d. Write the medication administration times on each prescription label. ANS: B The patient should be advised to keep a medication record of drugs and when they will be taken. The patient is independent, and this helps maintain independence. Family member support is essential when older patients are confused. Reinforcing information without providing a means to keep track of the medications does not necessarily improve compliance. Writing medication times on prescription labels does not help to organize the medication schedule.
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MULTIPLE RESPONSE 1. The nurse is preparing an 80-year-old patient for discharge home from the hospital. The patient will receive several new medications. The patient lives alone but has several family members who stop by every day. Which suggestions will the nurse make for this family? (Select all that apply.) a. Ask the pharmacy for non-childproof medication bottles. b. Ask the patient to record all medications and the times they are taken. c. Place the pills in an organizer container. d. Provide the patient with the drug manufacturer information sheets. e. Put water bottles near pills for convenience. ANS: A, C, E To help older patients with compliance, medications should be convenient and easy to open. Asking the pharmacist for non-childproof containers will help make medications easier to get. Using an organizer container helps patients remember which drugs should be taken at what time. Placing water bottles nearby eliminates a step in the process and increases the likelihood that a medication will be taken on time.
2. Which drug properties are problematic for older patients? (Select all that apply.) a. Drugs with anticholinergic effects b. Drugs that are highly protein-bound c. Drugs with a short half-life d. Drugs that undergo hepatic conjugation e. Drugs with a narrow therapeutic range ANS: A, B, E Older patients are more susceptible to drug side effects, especially those that cause anticholinergic effects. Older patients have a loss of protein-binder sites for drugs, so those that are highly protein-bound will have higher than usual serum levels and can cause toxicity. Drugs with a narrow therapeutic range require closer monitoring in all patients, but especially in older patients. Drugs with a short half-life are preferred because older patients have a decreased ability to metabolize and excrete drugs. Hepatic conjugation is usually not influenced by older age, liver diseases, or drug interaction.
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Chapter 61. Dermatologic Pharmacology MULTIPLE CHOICE 1.A client is diagnosed with acne. The client expresses concern to the nurse that he has not yet been placed on medication. The nurse explains to the client that the initial nonpharmacologic approach for treating acne vulgaris includes:
a.
application of large doses of vitamin A.
b.
application of large doses of vitamin C.
c.
cleansing of the skin gently several times a day.
d.
vigorously scrubbing skin in the morning and at bedtime.
ANS: C Gentle cleansing is one of the chief nonpharmacologic treatments of acne.
2. The client has been placed on tetracycline (Sumycin) for acne control. In planning a dosage
schedule, the nurse anticipates that the client will be taking:
a.
low doses over a period of months.
b.
low doses for 3 to 4 weeks.
c.
high doses for 10 days to 2 weeks.
d.
high doses for at least 1 year.
ANS: A The most effective course of tetracycline dosage is low doses of the drug over a period of months.
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3. Photosensitivity is a major complication of tetracycline (Sumycin). In providing client
teaching, the nurse should suggest that the client
a.
avoid direct sunlight
b.
wear a hat and long sleeves in the sun
c.
use a tanning bed only with supervision
d.
use a suntan lotion with a high SPF
while on the medication.
ANS: A To avoid photosensitivity, the client should avoid direct sunlight while she is taking the medication. 4. The client is being treated extensively with silver nitrate cream. The nurse plans to closely
monitor the clients level of:
a.
calcium.
b.
sodium.
c.
potassium.
d.
magnesium.
ANS: C Extensive use of silver nitrate can lead to hypokalemia.
5. Upon assessment of the burned client, the nurse notes that the client is exhibiting mottled,
blistered skin and is complaining of intense pain. These findings are congruent with which degree of burn injury?
a.
First
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b.
Second
c.
Third
d.
Fourth
ANS: B Second-degree burns are characterized by mottled, blistered skin, and the client is typically in intense pain.
6. Methoxsalen (Oxsoralen) is a drug used for the treatment of psoriasis. Clients using this agent
should not be in direct sunlight for which reason?
a.
Skin could become lightened or blanched.
b.
Psoriasis would spread.
c.
Exposed skin would burn or blister.
d.
Skin would become sensitive to light.
ANS: C Methoxsalen (Oxsoralen) will produce burning or blistering of the skin if the area is exposed to direct sunlight.
7.A client enters the healthcare providers office with complaints of verruca vulgaris (warts). What is the most accurate instructional point to include in a client teaching session?
a
Warts can become malignant after 1 to 2 years and thus must be monitored
.
closely.
b
The only effective means of wart removal is by surgical excision.
.
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c
Drug therapy to remove a common wart may include systemic side effects.
. d
Electrodesiccation can be used to eradicate the common warts.
. ANS: D Electrodesiccation, along with freezing and surgical excision, can be used to treat the common wart.
8. Contact dermatitis may be caused by chemical or plant irritation. What nonpharmacologic
measure may aid in alleviating the problem?
a.
Determining causative agent
b.
Cleansing the skin area immediately
c.
Wearing protective gloves or clothing
d.
Applying a sterile dressing over the involved area
ANS: B Cleansing is one of the chief methods to decrease the irritation that has been caused by contact dermatitis.
9. The client is being treated with clobetasol propionate (Clobex). In scheduling the clients next
appointment with the primary care provider, the nurse recognizes that the clients lesions need to be reassessed in
weeks.
a.
2
b.
4
c.
6
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d.
8
ANS: A The lesions should be reassessed after 2 weeks of treatment with the medication.
10. The client is being treated with etretinate (Tegison, Soriatane). She has been using the
medication for 6 weeks and is concerned because she has not seen an improvement in her symptoms. The most accurate response from the nurse is that it may be
months for the
client to notice an improvement in her symptoms.
a.
2
b.
8
c.
4
d.
6
ANS: D Treatment with etretinate may take up to 6 months to produce a change in the clients symptoms.
11. The nurse plans to monitor a client with second-degree burns for which adverse reaction to
mafenide acetate (Sulfamylon)?
a.
Increased intraocular pressure
b.
Urinary retention
c.
Fluid retention
d.
Superinfection
ANS: D
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Adverse reactions to mafenide acetate (Sulfamylon) include superinfection, respiratory alkalosis, blistering, and metabolic acidosis.
12. Silver sulfadiazine (Silvadene) is used for the treatment of second- and third-degree burns.
The highest priority nursing intervention related to this drug is to monitor for:
a.
crystalluria.
b.
dehydration.
c.
headaches.
d.
hypertension.
ANS: A Extended use of silver sulfadiazine may lead to crystalluria.
13.A client is ordered to receive isotretinoin. What is a priority diagnostic test for the nurse to complete before beginning therapy?
a.
Blood glucose level
b.
Pregnancy test
c.
Serum electrolytes
d.
Complete blood count
ANS: B Isotretinoin is highly teratogenic and includes strict guidelines related to ensuring safe use. Female clients who are sexually active will be asked to take a pregnancy test.
Chapter 62. Drugs Used in the Treatment of Gastrointestinal Diseases
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1.
What action does the histamine-2 antagonist administered by the nurse have on the human body that will help to prevent peptic ulcer disease?
A)
Destroys Helicobacter pylori
B)
Coats and protects the stomach lining
C)
Increases the pH of the secreted hydrochloric acid
D)
Reduces the amount of hydrochloric acid secreted
Ans:
D Feedback: Histamine-2 antagonists are administered to reduce the amount of hydrochloric acid secreted in the stomach, which helps to prevent peptic ulcer disease. H2 antagonists do not act as an antibiotic to kill bacteria (i.e., H. pylori) coat and protect the stomach lining like sucralfate (Carafate), or increase the pH of the secreted hydrochloric acid.
2.
What classification of drugs does the nurse administer to treat peptic ulcers by suppressing the secretion of hydrochloric acid into the lumen of the stomach?
A)
Antipeptic agents
B)
Histamine-2 antagonists
C)
Proton pump inhibitors
D)
Prostaglandins
Ans:
C Feedback: Proton pump inhibitors suppress the secretion of hydrochloric acid into the lumen of the stomach. Antipeptic agents coat any injured area in the stomach to prevent further injury. H2 antagonists block the release of hydrochloric acid in response to gastrin. Prostaglandins inhibit secretion of gastrin and increase secretion of the mucous lining of the stomach.
3. A)
The nurse is caring for a patient requiring digestive enzyme replacement therapy and establishes what appropriate nursing diagnosis for this patient? Acute pain
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B)
Risk for constipation
C)
Risk for imbalanced nutrition
D)
Bowel incontinence
Ans:
C Feedback: The nurse would be concerned about the patients nutritional status because lack of digestive enzymes results in malnutrition. Replacement digestive enzymes help the patient improve digestion and absorption of essential nutrients. Effectiveness of the therapy is determined by the patients ability to maintain balanced nutrition. The other three options are not applicable to the use of replacement digestive enzymes.
4.
What nursing interventions are included in the plan of care for a patient receiving antacids to relieve GI discomfort?
A)
Administer this drug with other drugs or food.
B)
Administer the antacid 1 hour before or 2 hours after other oral medications.
C)
Limit fluid intake to decrease dilution of the medication in the stomach.
D)
Have the patient swallow the antacid whole and do not crush or chew the tablet.
Ans:
B Feedback: A patient taking antacids should be advised to take the antacid 1 hour before or 2 hours after other oral medications. These tablets are often chewed to increase effectiveness. Limiting fluid intake can result in rebound fluid retention so that patients should be encouraged to maintain hydration. It is not necessary to take an antacid with other drugs, nor with food.
5.
An adult patient is prescribed cimetidine (Tagamet). A nurse will instruct the patient that an appropriate dosage and frequency of cimetidine is what?
A)
20 mg PO b.i.d
B)
150 mg PO b.i.d
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C)
300 mg PO at bedtime
D)
800 mg PO at bedtime
Ans:
D Feedback: An appropriate dosage and frequency for cimetidine is 800 mg PO at bedtime. Also, 300 mg can be taken q.i.d at meals and at bedtime. Ranitidine is taken 150 mg daily or b.i.d. Famotidine is taken 20 mg PO b.i.d. Nizatidine can be taken 150 to 300 mg PO at bedtime.
6.
The nurse develops a discharge teaching plan for a patient who was prescribed pancreatic enzyme replacement and includes what important teaching point?
A)
Take the enzymes on an empty stomach.
B)
Crush the capsules and take with food.
C)
Avoid spilling the powder on the skin because it may be irritating.
D)
Pancreatin and pancrelipase are interchangeable.
Ans:
C Feedback: Patients receiving pancreatic enzymes should be taught to avoid spilling the powder on the skin because it can be very irritating. The enzymes should be taken with food and are often in a powder form. Pancreatin and pancrelipase are not interchangeable.
7.
A patient comes to the clinic complaining of acid indigestion and tells the nurse he is tired of buying over-the-counter (OTC) antacids and wants a prescription drug to cure the problem. What would the nurse specifically assess for?
A)
Alkalosis
B)
Hypocalcemia
C)
Hypercholesterolemia
D)
Rebound tenderness at McBurneys point
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Ans:
A Feedback: Prolonged or excessive use of OTC antacids can lead to the development of metabolic alkalosis. Many antacids contain calcium so that low calcium levels would be unlikely. Because metabolic alkalosis is a concern, metabolic acidosis is unlikely. High cholesterol levels are not associated with OTC antacid use. Rebound tenderness at McBurneys point is related to appendicitis and not antacid use.
8.
A patient with a duodenal ulcer is receiving sucralfate for short-term treatment. What will the nurse advise the patient to avoid?
A)
Milk of Magnesia
B)
Tums
C)
Aluminum salts
D)
Proton pump inhibitors
Ans:
C Feedback: If aluminum salts (AlternaGEL) are taken concurrently with sucralfate, a risk of high aluminum levels and related aluminum toxicity exists. The combination of sucralfate and aluminum salts should be avoided or used with extreme caution. Adverse reactions with sucralfate are not associated with Milk of magnesia, Tums, or proton pump inhibitors.
9.
A patient has been prescribed esomeprazole (Nexium). What statement by the patient does the nurse evaluate as indicating that he or she has a good understanding of his newly prescribed drug?
A)
I should open the capsules and crush the drug into applesauce.
B)
It is important that I take the drug after each meal.
C)
I need to swallow the drug whole and not chew the capsules.
D)
I should always take the drug with an antacid.
Ans:
C
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Feedback: Esomeprazole must be swallowed whole, not cut, crushed, or chewed, which would interfere with its effectiveness. The drug should not be taken with an antacid, which could interfere with absorption. The drug is taken once a day, not with each meal. 10 .
Which of these patients would the nurse expect to be the best candidate for misoprostol (Cytotec)?
A)
A 12-year-old with obsessive-compulsive disorder
B)
A 22-year-old pregnant patient
C)
A 46-year-old trial lawyer with hypertension
D)
An 83-year-old man with rheumatoid arthritis
Ans:
D Feedback: The 83-year-old man with rheumatoid arthritis is most likely to be taking nonsteroidal anti-inflammatory drugs (NSAIDs). Misoprostol is indicated for prevention of NSAID induced ulcers in adults at high risk for development of gastric ulcers. The other three patients would not be candidates for this drug.
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headache, and somnolence are associated with all histamine-2 antagonists. 1 2 .
What H2 antagonist would the nurse consider the drug of choice for a patient with advanced liver failure?
A)
Cimetidine
B)
Nizatidine
C)
Ranitidine
D)
Famotidine
An s:
B Feedback: Nizatidine differs from the other three drugs in that it is eliminated by the kidneys, with no first-pass metabolism in the liver. It is the drug of choice for patients with liver disease or dysfunction.
1 3 .
When caring for a patient diagnosed with a peptic ulcer, the nurse administers omeprazole (Prilosec) along with what antibiotic to eradicate Helicobacter pylori?
A)
Gentamicin
B)
Ketoconazole
C)
Tetracycline
D)
Amoxicillin
An s:
D Feedback: Gastric acid pump or proton pump inhibitors are recommended for the short-term treatment of active duodenal ulcers, gastroesophageal reflux disease, erosive esophagitis, and benign active gastric ulcer; for the longterm treatment of pathologic hypersecretory conditions; as maintenance therapy for healing of erosive esophagitis and
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ulcers; and in combination with amoxicillin and clarithromycin for the treatment of H. pylori infection. The other options are not antibiotics used to eradicate H. pylori. 1 4 .
What priority teaching point does the nurse include when instructing patients about the use of antacids?
A)
Reduce calorie intake to reduce acid production.
B)
Take before each meal and before bed.
C)
Be aware of risk of acid rebound with long-term use.
D)
Consider liquid diet if diarrhea occurs.
An s:
C Feedback: Repeated use of antacids can result in rebound acid production because more gastrin is produced when pH of acid level decreases. Patients should be taught that longterm use of antacids requires follow-up care. Calorie and fluid intake does not need to be reduced because it is important to maintain nutrition, especially if diarrhea occurs. Antacids are taken at least 1 hour before or 2 hours after any other drug or meal.
1 5 .
For treatment of a gastric ulcer, what would the recommended dosing schedule of famotidine (Pepcid) be?
A)
10 mg b.i.d
B)
20 mg b.i.d
C)
60 mg at bedtime
D)
40 mg q am
An s:
B Feedback:
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Famotidine should be administered 40 mg every day at bedtime or 20 mg b.i.d for treatment of a gastric ulcer. Options A, C, and D are not correct. 1 6 .
The 59-year-old patient has peptic ulcer disease and is started on sucralfate (Carafate). What is an appropriate nursing diagnosis related to this medication?
A)
Risk for constipation related to GI effects
B)
Risk for injury: bleeding
C)
Imbalanced nutrition related to nausea
D)
Deficient fluid volume
An s:
A Feedback: The adverse effects associated with sucralfate are primarily related to its GI effects. Constipation is the most frequently seen adverse effect. Imbalanced nutrition, if seen, would be related to diarrhea or constipation and not nausea. Fluid volume deficit and bleeding are not common adverse effects of this drug.
1 7 .
The nurse is preparing a patient for discharge with a prescription for sucralfate (Carafate) and teaches the patient to take the medication when?
A)
With meals
B)
With an antacid before breakfast
C)
1 hour before or 2 hours after meals and at bedtime
D)
After each meal
An s:
C Feedback: Administer drug on an empty stomach, 1 hour before or 2
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hours after meals and at bedtime, to ensure therapeutic effectiveness of the drug. Administer antacids, if ordered, between doses of sucralfate and not within 30 minutes of taking the drug. Options A, B, and D are not correct. 1 8 .
The patient will receive ranitidine (Zantac) 150 mg PO at bedtime. Prior to administration, the nurse will inform the patient that common adverse effects related to this medication include what?
A)
Tremors
B)
Headache
C)
Visual disturbances
D)
Anxiety
An s:
B Feedback: Headache, dizziness, somnolence, and mental confusion may occur with H2 antagonists. Visual disturbances, tremors, and anxiety are not normally associated with ranitidine.
1 9 .
The nurse administers ranitidine (Zantac) cautiously to patients with evidence of what conditions?
A)
Renal disease
B)
Diabetes mellitus
C)
Pulmonary disease
D)
Migraine headaches
An s:
A Feedback: All histamine-2 antagonists are eliminated through the kidneys; dosages need to be reduced in patients with renal
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impairment. No caution is necessary with Zantac therapy in people with diabetes, pulmonary disease, or migraine headaches. 2 0 .
The nurse would question an order for misoprostol if the patient was diagnosed with what condition?
A)
Diabetes
B)
Hypertension
C)
Arthritis
D)
Pregnancy
An s:
D Feedback: This drug is contraindicated during pregnancy because it is an abortifacient. The other options are not correct.
2 1.
The nurse is caring for a patient who has had impacted stools twice in the past month. What is an appropriate laxative for this patient?
A)
Milk of Magnesia
B)
Agoral Plain
C)
Colace
D)
Dulcolax
Ans:
B Feedback: Mineral oil (Agoral Plain) is not absorbed and forms a slippery coat on the contents of the intestinal tract. When the intestinal bolus is coated with mineral oil, less water is drawn out of the bolus and the bolus is less likely to become hard or impacted. Other options shown do not have this same effect of reducing the risk of another impaction as well as helping to eliminate stool.
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22 .
The home health nurse is caring for a patient with encopresis who was started on mineral oil therapy. The nurse teaches the patient and family that a common adverse effect is what?
A)
Nausea
B)
Vomiting
C)
Leakage
D)
Vitamin C deficiency
Ans:
C Feedback: Leakage and staining may be a problem when mineral oil is used and the stool cannot be retained by the external sphincter. Mineral oil does not cause nausea, vomiting, or vitamin C deficiency.
23 .
When would it be appropriate for the nurse to administer a cathartic laxative to the patient? (Select all that apply.)
A)
Partial small-bowel obstruction
B)
Appendicitis
C)
After having a baby
D)
After a myocardial infarction (MI)
E)
After anthelmintic therapy
Ans:
C, D, E Feedback: Laxative, or cathartic, drugs are indicated for the short-term relief of constipation; to prevent straining when it is clinically undesirable (such as after surgery, myocardial infarction, or obstetric delivery); to evacuate the bowel for diagnostic procedures; to remove ingested poisons from the lower gastrointestinal (GI) tract; and as an adjunct in anthelmintic therapy when it is desirable to flush helminths from the GI tract. They are not indicated when a patient has an appendicitis or a partial small-bowel obstruction.
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24 .
When would it be appropriate for the nurse to administer castor oil as a laxative?
A)
To ease the passage of stool in the patient who recently had a baby
B)
To remove ingested poisons from the lower gastrointestinal (GI) tract
C)
To evacuate the bowel for diagnostic procedures
D)
To treat chronic constipation
Ans:
C Feedback: Indications include evacuating the bowel for diagnostic procedures and for short-term treatment of constipation. Castor oil is not indicated to remove ingested poisons nor to ease the passage of stool after having a baby. This drug should only be used on a short-term basis and is not for the treatment of chronic constipation because repeated use will cause GI tract exhaustion.
25 .
For what action would the nurse administer magnesium citrate?
A)
Block absorption of fats
B)
Directly stimulate the nerve plexus in the intestinal wall
C)
Form a slippery coat on the contents of intestine
D)
Increase motility, increase fluid, and enlarge bulk of fecal matter
Ans:
D Feedback: Magnesium citrate is a rapid-acting, aggressive laxative that causes fecal matter to increase in bulk. It increases the motility of the gastrointestinal (GI) tract by increasing the fluid in the intestinal contents, which enlarges bulk, stimulates local stretch receptors, and activates local activity. It does not block absorption of fats, stimulate the nerve plexus, or form a slippery coat.
26 . A)
The nurse administers metoclopramide to the patient with what condition? Chronic diabetic gastroparesis
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B)
Impaction
C)
Encopresis
D)
Patients requiring diagnostic procedures
Ans:
A Feedback: Indications for metoclopramide include relief of acute and chronic diabetic gastroparesis, short-term treatment of gastroesophageal reflux disorder in adults who cannot tolerate standard therapy, prevention of postoperative or chemotherapy-induced nausea and vomiting, facilitation of small-bowel intubation, stimulation of gastric emptying, and promotion of intestinal transit of barium. It would not be used for treatment of impaction, encopresis, and in patients requiring diagnostic procedures.
27 .
What drug does the nurse administer that inhibits intestinal peristalsis through direct effects on the longitudinal and circular muscles of the intestinal wall?
A)
Bismuth subsalicylate
B)
Loperamide
C)
Paregoric
D)
Magnesium citrate
Ans:
B Feedback: Actions of loperamide include that it inhibits intestinal peristalsis through direct effects on the longitudinal and circular muscles of the intestinal wall, slowing motility and movement of water and electrolytes. Bismuth subsalicylate inhibits local reflexes. Paregoric works through action on CNS centers that cause GI spasm and slowing. Magnesium citrate is a laxative.
28 .
A)
The family brings a patient to the emergency department saying he has been hallucinating and falls so deeply asleep he stops breathing when not stimulated. The nurse learns the patient has been self-treating diarrhea and suspects the patient was taking what medication? Paregoric
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B)
Bismuth subsalicylate
C)
Loperamide
D)
Colace
Ans:
A Feedback: Opium derivatives, like paregoric, are associated with light-headedness, sedation, euphoria, hallucinations, and respiratory depression related to their effect on opioid receptors. Nonopioids such as bismuth subsalicylate and loperamide would not cause respiratory depression. Colace is a stool softener, not an antidiarrheal.
29 .
The nurse develops a teaching plan for a 77-year-old patient who has been prescribed loperamide PRN. The nurses priority teaching point is what?
A)
May cause hallucinations or respiratory depression
B)
Take drug after each loose stool
C)
Drug remains in the bowel without being absorbed into the bloodstream
D)
Avoid pregnancy and breast-feeding while taking drug.
Ans:
B Feedback: Loperamide is taken repeatedly after each loose stool. Teaching the patient when to take the drug is the priority teaching point. Paregoric, and not loperamide, can cause hallucinations and respiratory depression. The drug is absorbed systemically. It is unlikely a 77-year-old patient will get pregnant or breast-feed so this is not the highest priority.
30 .
A patient receiving loperamide (Imodium) should be alerted by the nurse to what possible adverse effect?
A)
Anxiety
B)
Bradycardia
C)
Fatigue
D)
Urinary retention
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Ans:
C Feedback: Patients should be aware that they should not drive or operate machinery while taking loperamide (Imodium) because it can cause fatigue. Anxiety, bradycardia, and urinary retention are not commonly associated with loperamide.
3 0.
The nurse is discharging a patient being sent home on antiemetic therapy. How would the nurse evaluate the plan of care that this patient has had while hospitalized?
A)
Monitor for adverse effects.
B)
Provide comfort and safety measures, including mouth care, ready access to bathroom facilities, assistance with ambulation and periodic orientation, ice chips to suck, protection from sun exposure, and remedial measures to treat dehydration if it occurs.
C)
Assess the patient carefully for any potential drugdrug interactions.
D)
Monitor laboratory test results including liver and kidney function tests.
Ans:
A Feedback: Monitor for adverse effects (dizziness, confusion, gastrointestinal alterations, cardiac arrhythmias, hypotension, gynecomastia, pink-to-brown-tinged urine, photosensitivity). The evaluation of the patient care plan would not include monitoring laboratory results (assessment phase), providing comfort measures, or assessing for drugdrug interactions (implementation phase).
31 .
A nursing student correctly identifies which body system as being associated with most of the adverse effects of antiemetics?
A)
Renal
B)
Central nervous system (CNS)
C)
Cardiovascular
D)
Integumentary
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Ans:
B Feedback: Most antiemetics cause some CNS depression. Specific antiemetics may cause adverse effects associated with the renal, cardiovascular, and the integumentary systems, but these systems are not associated with the entire classification of antiemetics.
32 .
A patient has received a prescription for nabilone (Cesamet) for treatment of nausea. The nurse is aware that this medication is used for what reason?
A)
The patient has a substance abuse problem.
B)
The patient is under age 18.
C)
The patient is experiencing motion sickness.
D)
The patient has not responded to other medications.
Ans:
D Feedback: Nabilone is a miscellaneous agent that is developed from the active ingredient of marijuana. It is used to treat nausea and vomiting related to cancer chemotherapy and is used only after the patient has not responded to other antiemetic medications. It should not be used in patients under 18 and because it is derived from marijuana it would not be appropriate to use for a patient with a history of substance abuse.
33 .
The nurse is performing an admission assessment of a female teenage patient who has been experiencing nausea and vomiting. What question would be most important for the nurse to ask this patient?
A)
What is the date of your last period?
B)
What makes your nausea worse?
C)
Have you also had diarrhea?
D)
When did you last urinate?
Ans:
A Feedback:
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Most antiemetics are not appropriate for use by patients who are pregnant or lactating; therefore, it is most important for the nurse to determine whether the patient could be pregnant. Options B, C, and D are not as important as possible pregnancy. 34 .
A patient develops intractable hiccoughs after surgery. The nurse anticipates that the physician will order which drug?
A)
Metoclopramide (Reglan)
B)
Chlorpromazine (Thorazine)
C)
Meclizine (Antivert)
D)
Granisetron (Kytril)
Ans:
B Feedback: Chlorpromazine is a phenothiazine; phenothiazines are the drug of choice for intractable hiccoughs. Thus, options A, C, and D are not correct.
35 .
The nurse is aware that patients who experience motion sickness are experiencing problems with which body system?
A)
Gastrointestinal
B)
Peripheral nervous system
C)
Vestibular
D)
Central nervous system (CNS)
Ans:
C Feedback: Motion sickness is related to the vestibular (i.e., inner ear) system. This disturbance in this system may also cause disturbances in the GI (nausea) and CNS (dizziness) systems. The peripheral nervous system is not involved.
Chapter 63. Therapeutic & Toxic Potential of Over-the-Counter Agents
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1.
A nurse is planning patient teaching about a newly prescribed drug. What is a priority teaching point included by the nurse to improve compliance and safety?
A)
List of pharmacies where the drug can be obtained
B)
Measures to alleviate any discomfort associated with adverse effects
C)
The cost of the brand name drug compared with the generic form
D)
Statistics related to Phase III testing for the prescribed drug
Ans:
B Feedback: If a patient is aware of certain adverse effects and how to alleviate or decrease the discomfort, he or she is more likely to continue taking the medication. A list of pharmacies can be useful information but will not improve safety or compliance. Knowing the cost of the brand name versus the generic form could also be helpful to the patient. However, a substitution may not be allowable and the cost of a drug does not improve patient safety. Most patients are not concerned with the statistics related to drug testing and it would not improve compliance or safety even if the patient was interested in the information.
2.
A patient presents at the clinic complaining of vaginal itching and a clear discharge. The patient reports to the nurse that she has been taking an oral antibiotic for 10 days. The nurse is aware that the patient is experiencing what?
A)
An adverse reaction from the antibiotic
B)
A drug toxicity effect of the antibiotic
C)
An overdose of the drug that is damaging to more than one body system
D)
A superinfection caused by the antibiotic, which has destroyed normal flora
Ans:
D Feedback:
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Superinfections often occur with antibiotic use because the drug kills normal bacterial flora. This is not a result of toxic levels of the antibiotic, but rather an effect of the medication that has killed normal flora, which it is designed to do. Vaginal itching and a clear discharge are not considered adverse effects of an antibiotic. An overdose of a drug that damages more than one body systems is considered drug poisoning. 3.
A 42-year-old male patient is brought to the emergency department by ambulance. The patient is in distress. The nurse suspects an anaphylactic reaction resulting from taking oral penicillin. What assessment findings are important in making this diagnosis?
A)
Blood pressure (BP): 186/100, difficulty breathing
B)
Hematocrit (Hct): 32%, decreased urine output
C)
Temperature: 102, swollen joints
D)
Profuse sweating, Blood Pressure: 92/58
Ans:
A Feedback: An anaphylactic reaction is an immune reaction that causes a massive release of histamine, which results in edema and swelling that can lead to respiratory distress and increased blood pressure. A decreased hematocrit and decreased urine output suggests a cytotoxic reaction. An increased temperature and swollen joints could suggest serum sickness. Profuse sweating and decreased blood pressure may indicate cardiac-related issues.
4.
A patient with seasonal allergies is taking an antihistamine to relieve itchy, watery eyes, and a runny nose. When planning teaching for this patient, the nurse would include what teaching point?
A)
Advise the patient to limit fluid intake to dry out mucous membranes.
B)
Advise the patient to avoid driving or operating machinery.
C)
Advise the patient to report strange dreams or nightmares.
D)
Advise the patient to decrease dietary fat.
Ans:
B
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Feedback: An adverse effect of antihistamines is drowsiness, so that injury to the patient or others can occur if driving or operating machinery. An increase in fluids would be indicated to help keep nasal membranes moist. It is common for dreams to occur when taking medication and it is not necessary to report them. Dietary fat should not interfere with the drug metabolism of antihistamines. 5.
A nurse is providing teaching to a group of patients who are beginning drug therapy for acquired immunodeficiency syndrome (AIDS). What should be included in her instructions to the group?
A)
Take your medications as directed. Poisoning occurs with overdosage causing damage to more than one body system.
B)
Renal injury results from first-pass effect when the drug is excreted from the system.
C)
A blood dyscrasia due to drug therapy can be serious. Call us if your skin looks yellowish or you experience itching.
D)
Most drugs are metabolized in the liver and the first indication of damage is dark red papules, which should be reported immediately.
Ans:
A Feedback: Poisoning resulting from overdosage can lead to the potential for fatal reactions when more than one body system is affected. Liver, not kidney, injury can be caused by the first-pass effect and can cause the skin to have a yellow appearance. Most drugs are metabolized in the liver but liver damage causes jaundice, manifested as a yellow tinge to the skin and sclera. Dark red papules appearing on limbs are characteristic of Stevens-Johnson syndrome, a potentially fatal erythema multiforme exudativum, which should be reported but is not due to liver damage.
6.
A)
The pharmacology instructor is talking to the nursing students about potassium-sparing diuretics and how they can lead to hyperkalemia, indicated by what assessment finding? Urine output of 1,500 mL/24 hours
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B)
Blood pressure of 98/60
C)
Potassium level of 5.9 mEq/L
D)
Calcium level of 11.4 mg/dL
Ans:
C Feedback: The normal range of serum potassium for an adult is 3.5 to 5.0 mEq/L. A level higher than 5.0 mEq/L can indicate hyperkalemia. Normal urinary output is between 1,500 and 2,000 cc per day. Urinary output below 1,000 mL per day would include oliguria and would indicate hyperkalemia. A decrease in blood pressure and pulse can indicate hypokalemia. Hyperkalemia refers to an elevated potassium level and not an elevated calcium level.
7.
An 80-year-old patient presents at the clinic for a follow-up appointment. She is taking a macrolide antibiotic and is experiencing tinnitus. The nurse is talking with family members about home care for the patient. What should the nurse include in her instructions regarding home care?
A)
Keep the patient in a prone position when in bed.
B)
Eliminate salt from the patients diet.
C)
Provide protective measures to prevent falling or injury.
D)
Monitor exposure to sunlight.
Ans:
C Feedback: Macrolide antibiotics can cause severe auditory nerve damage, which can cause dizziness, ringing in the ears (tinnitus), and loss of balance and hearing. The patient would be at high risk for injury due to falls. Usually a person who is dizzy is unable to lie flat and needs to recline with the head elevated. Salt and sunlight are not a component of this patients presenting complaint.
8. A)
Oral antidiabetic drugs can cause alterations in glucose metabolism. Patients who are taking these drugs would need to be observed for what? Increased urination
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B)
Deep Kussmauls respirations
C)
Thirst and hot or flushed skin
D)
Confusion and lack of coordination
Ans:
D Feedback: Antidiabetic medications decrease blood glucose levels. If levels fall too low, symptoms of hypoglycemia would include confusion and lack of coordination. Elevated blood glucose levels can occur when the patient does not take the medications. With inadequate dosage, hyperglycemia can occur, resulting in increased urination in an attempt to eliminate serum glucose, deep Kussmauls respirations to reduce blood pH by eliminating carbon dioxide, thirst, and hot or flushed skin.
9.
A patient is taking chloroquine (Aralen) for rheumatoid arthritis. What problem reported by the patient would the nurse suspect may be an adverse reaction of the medication?
A)
I have to urinate all the time.
B)
Sometimes I have blurred vision.
C)
I have tingling in my arms and legs.
D)
Sometimes I feel like I am off balance.
Ans:
B Feedback: Chloroquine (Aralen) can cause ocular toxicity with blurring of vision, color vision changes, corneal damage, and blindness. Increased urination, tingling, and numbness are signs of hyperkalemia and hypokalemia. Loss of balance can be caused by auditory damage due to drug toxicity.
10 .
A 68-year-old patient who must take antihistamines for severe allergies is planning a vacation to Mexico. The nurse will encourage the patient to do what?
A)
Avoid sightseeing during the hottest part of the day.
B)
Discontinue the antihistamines if he becomes extremely restless.
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C)
Decrease the dosage of the drugs if he experiences excessive thirst.
D)
Continue taking the antihistamines even if he begins to hallucinate.
Ans:
A Feedback: Antihistamines can cause anticholinergic effects, which would result in decreased sweating and place the patient at high risk for heat stroke. Avoiding the hottest part of the day will help prevent dehydration and heat prostration. Extreme restlessness could indicate Parkinson-like syndrome not usually associated with antihistamines. Excessive thirst is characteristic of hyperglycemia. Hallucinations are associated with drugs that affect neurologic functioning. Further, nurses should never tell patients to decrease or discontinue a drug unless the prescriber has instructed them to do so.
11 .
A 77-year-old man is brought to the clinic by his daughter for a routine follow-up appointment. The daughter tells the nurse that her father is only taking half the prescribed dosage of several of his medications. What effect would the nurse explain could result from this behavior?
A)
Increased risk of primary actions
B)
Dermatologic reaction
C)
Superinfection
D)
Reduced therapeutic effect
Ans:
D Feedback: Taking too little of the medication would mean that therapeutic levels are not being reached and the drugs will be less effective at lower dosages. Primary actions are the result of overdose, which is not the case in this patient who is taking too little of the drug. Dermatologic reactions are not likely if the patient is taking too little of the drug unless the drug is treating a dermatologic problem, which is not indicated by the question. Superinfection would only result if the patient was taking an antibiotic, which is not indicated by the question.
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12 .
A patient with Parkinsons disease is taking an anticholinergic drug to decrease the tremors and drooling caused by the disease process. The patient complains that he is having trouble voiding. The nurse would explain that this is what?
A)
A hypersensitive action of the drug
B)
A primary action of the drug
C)
An allergic action of the drug
D)
A secondary action of the drug
Ans:
D Feedback: Sometimes the drug dosage can be adjusted so that the desired effect is achieved without producing undesired secondary reactions. But sometimes this is not possible, and the adverse effects are almost inevitable. In such cases, the patient needs to be informed that these effects may occur and counseled about ways to cope with the undesired effects. The situation described is not a hypersensitivity reaction that would indicate an allergic reaction, a primary reaction that would be excessive therapeutic response, or an allergic reaction to the drug.
13 .
The nurse is assessing a patient new to the clinic. The patient says she is allergic to penicillin. What would be the nurses appropriate next action?
A)
Ascertain the exact nature of the patients response to the drug.
B)
Document the patient is allergic to penicillin.
C)
Mark the patients chart in red that she has a penicillin allergy.
D)
Continue to assess the patient for other allergies.
Ans:
A Feedback: Ask additional questions of patients who state that they have a drug allergy to ascertain the exact nature of the response and whether it is a true drug allergy. Patients may confuse secondary actions of the drug with an allergy. Only after it was determined the action was truly an allergy would the nurse document the allergy, mark the patients chart, and continue to assess for other allergies.
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14 .
The pharmacology instructor is discussing the adrenergic drug ephedrine with the nursing students and lists an adverse reaction of this drug as what?
A)
Bronchoconstriction
B)
Hyperglycemia
C)
Cardiac arrhythmias
D)
Severe constipation
Ans:
B Feedback: Ephedrine (generic), a drug used as a bronchodilator to treat asthma and relieve nasal congestion, can break down stored glycogen and cause an elevation of blood glucose by its effects on the sympathetic nervous system. Ephedrine does not cause bronchoconstriction, cardiac arrhythmias, or severe constipation.
15 .
The nurse needs to consider teratogenic effects of medications when caring for what population of patients?
A)
Older adults
B)
Patients with a history of cancer
C)
Children
D)
Young adult women
Ans:
D Feedback: A teratogen is a drug that can harm the fetus or embryo so the nurse would consider the teratogenic properties of medications when caring for woman of child-bearing age including adolescents and young adult women. Teratogens have no impact on older adults or children. Carcinogens are chemicals that cause cancer.
16 .
The nurse is caring for a patient receiving an antineoplastic medication who reports fever, chills, sore throat, weakness, and back pain. What type of adverse effect does the nurse suspect this patient is experiencing?
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A)
Dermatologic reaction
B)
Blood dyscrasia
C)
Electrolyte imbalance
D)
Superinfection
Ans:
B Feedback: Symptoms of blood dyscrasias include fever, chills, sore throat, weakness, back pain, dark urine, decreased hematocrit (anemia), low platelet count (thrombocytopenia), low white blood cell count (leukopenia), and a reduction of all cellular elements of the complete blood count (pancytopenia). Dermatologic reactions would be reflected in skin alterations, electrolyte imbalances would result in differing symptoms depending on the electrolyte involved but would not cause chills and fever, and a superinfection could cause a fever but would not cause a sore throat, weakness, or back pain unless the infection involved those body parts.
17 .
The pharmacology instructor explains to students that adverse effects can be extensions of what?
A)
Primary action of a drug
B)
Anaphylaxis
C)
Secondary action of a drug
D)
Anticholinergic responses to the drug
Ans:
A Feedback: Primary action adverse effects are extensions of the therapeutic action and are usually the result of overdosage, essentially too much of the therapeutic effect. Anaphylaxis is not an extension of the therapeutic action of the drug but a histamine reaction to an allergen. Secondary actions of a drug are negative effects of the drug that occur even when the drug is in the therapeutic range. Anticholinergic responses occur in response to drugs that block the parasympathetic nervous system.
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18 .
A student nurse asks her study group how to define a drug allergy. What would be the peer groups best response?
A)
A second effect of the body to a specific drug
B)
The formation of antibodies to a drug protein causing an immune response when the person is next exposed to that drug.
C)
A serum sickness caused by a reaction to a drug
D)
Immediate systemic reaction to the drug when exposed to the drug the first time.
Ans:
B Feedback: A drug allergy is the formation of antibodies to a drug or drug protein; causes an immune response when the person is next exposed to that drug. A drug allergy does not occur at the first exposure to a drug. A second action of a specific drug is an adverse response that the drug causes in addition to the therapeutic effect. Serum sickness is one type of allergic reaction but does not define allergic reaction. An immediate systemic reaction to a drug, usually not on first exposure, is an anaphylactic reaction.
19 .
The home health nurse is caring for an elderly patient with benign prostatic hypertrophy. An anticholinergic drug has been prescribed. What would be the nurses priority teaching point for this patient?
A)
Urinary incontinence may develop.
B)
Bladder hypertonia may develop.
C)
An increased dosage may be required.
D)
Empty the bladder before taking the drug.
Ans:
D Feedback:
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A patient with an enlarged prostate who takes an anticholinergic drug may develop urinary retention or even bladder paralysis when the drugs effects block the urinary sphincters, so anticholinergic drugs are avoided whenever possible. However, if the medication is needed, the patient must be taught to empty the bladder before taking the drug. A reduced dosage also may be required to avoid potentially serious effects on the urinary system but this would not be a teaching point for the patient because the provider will make that decision. Hypotonia, not hypertonia, is more likely to occur. Urinary incontinence is not a likely effect in this case. 20 .
The Kardex record of a male patient who is prescribed antihistamines for treating an allergy reads as follows:
Age: 32; Profession: Carpenter; Lifestyle & diet: Lives alone, average smoker, nonalcoholic, no food preferences, practices yoga; Medical history: Suffers from hay fever, recent urinary tract infection that has been treated successfully. What information from the Kardex is likely to have the greatest implication in educating the patient about antihistamine administration? A)
The patients age
B)
The patients smoking habit
C)
The patients profession
D)
The patients medical history
Ans:
C Feedback: Most antihistamines cause drowsiness, so the nurse should advise the patient not to operate machinery or perform tasks that require alertness when taking antihistamines (e.g., climbing ladders, working on rooftops, standing on iron supports at the top of a building). Because the patient is not an older adult, his age has no implications on the therapy. Although encouraging the patient to make better lifestyle choices is an important part of the patients plan of care, this information is not related to administration of antihistamines. There is nothing in the documented medical history that is significant to antihistamine use.
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21 .
The nurse is caring for a patient who experienced a severe headache. When the prescribed number of over-the-counter pain relievers did not work the patient said she took double the dosage an hour later. The nurse recognizes this patient is at greatest risk for what?
A)
An allergic reaction
B)
Anaphylactic reaction
C)
Poisoning
D)
Sedative effects
Ans:
C Feedback: This patient has taken an overdosage of the medication. Poisoning occurs when an overdose of a drug damages multiple body systems, leading to the potential for fatal reactions. Allergic and anaphylactic reactions can occur with any drug administration but this is not the patients greatest risk. More information about the exact type of medication would be needed to determine whether sedative effects are likely.
22 .
What classification of drug allergy would be described as an immune system reaction to injected proteins used to treat immune conditions?
A)
A cytotoxic reaction
B)
Serum sickness
C)
A delayed reaction
D)
An anaphylactic reaction
Ans:
B Feedback: Serum sickness is an immune system reaction to certain medications, injected proteins used to treat immune conditions, or antiserum, the liquid part of blood that contains antibodies that help protect against infectious or poisonous substances. An allergic reaction can occur with any drug, not just those containing protein. Anaphylaxis is an acute, systemic, life-threatening allergic reaction. A cytotoxic reaction is one in which antibodies circulate and attack antigens on cell sites, causing death of that cell.
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23 .
Why does the nurse need to be alert for any indication of an allergic reaction in patients?
A)
To obtain early warning of noncompliance in drug therapy
B)
To increase the effectiveness of a specific medication
C)
To maintain the patients safety during drug therapy
D)
To reduce the risk of adverse effects during drug therapy
Ans:
C Feedback: Being alert to adverse effectswhat to assess and how to intervene appropriatelycan increase the effectiveness of a drug regimen, provide for patient safety, and improve patient compliance. Indications of allergic reactions would not indicate noncompliance or improve effectiveness of a specific medication. Indications of allergic reaction would indicate an adverse effect and would not reduce the risk.
24 .
The nurse administers erythromycin, a drug that is known to irritate mucosa in the stomach lining. When the patient reports abdominal discomfort after taking the medication, the nurse would classify this discomfort as what type of adverse effect?
A)
Primary action
B)
Secondary action
C)
Hypersensitivity reaction
D)
Allergic reaction
Ans:
D Feedback: Secondary actions are those actions that occur as a result of taking a medication but do not fall under the category of therapeutic action and are often negative. This patient is experiencing a secondary action of erythromycin. Primary actions would be extensions of therapeutic action. Hypersensitivity reaction would be an excessive response to either the primary or secondary effects of a drug. An allergic reaction would be an immune response to the drug.
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25 .
The nurse administers antipsychotic medications to the patient who has taken these same drugs for many years. What signs and symptoms would the nurse attribute to secondary actions of the drug? (Select all that apply.)
A)
Muscular tremors
B)
Drooling
C)
Changes in gait
D)
Yellow discoloration of skin and sclera
E)
Fine red rash on the trunk
Ans:
A, B, D Feedback: Drugs that affect the dopamine levels in the brain (e.g., antipsychotic drugs), cause a syndrome that resembles Parkinsons disease including lack of activity, akinesia, muscular tremors, drooling, changes in gait, rigidity, extreme restlessness or jitters (akathisia), or spasms (dyskinesia). Yellow discoloration of the skin and sclera indicate jaundice and would suggest liver damage. A fine red rash on the trunk would be a dermatologic reaction unrelated to an antipsychotic agents secondary effects.
26 .
The nurse is acting as the triage nurse in the emergency department when a 16-year-old boy is brought in by his friends. The patient is in respiratory distress, he is vomiting, and blood is noted in the vomitus. He is somnolent and his electrocardiogram shows an arrhythmia. The boys friends tell you he was taking a bunch of little green pills he got from the cupboard at his grandparents house. The nurse suspects what?
A)
Overdose of sleeping pills
B)
Poisoning
C)
Anaphylactic shock
D)
Allergic reaction to Dyazide
Ans:
B Feedback:
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Poisoning occurs when an overdose of a drug damages multiple body systems, leading to the potential for fatal reactions. The situation described does not indicate what was contained in the little green pills so it is not possible to say whether the drugs were sedatives or triamterene and hydrochlorothiazide (Dyazide). The symptoms do not indicate an anaphylactic reaction, which would not normally include bloody vomitus. 27 .
The patient with diabetes is also taking ephedrine to treat asthma that causes her blood sugar to increase. The patient asks the nurse, Why does this medication make my blood sugar go up? What is the nurses best response?
A)
The active ingredient in ephedrine is mixed with sugar.
B)
Ephedrine is a placebo containing only sugar.
C)
Stored glycogen is broken down by ephedrine, which is causing higher blood sugar levels.
D)
Insulin is inactivated by ephedrine so it cannot work to control sugar levels.
Ans:
C Feedback: Ephedrine breaks down stored glycogen, which then enters the bloodstream as glucose and causes an increase in serum blood glucose, or blood sugar, levels. Ephedrine is not mixed with sugar and is not a placebo. Ephedrine has no effect on insulin.
28 .
The nurse is writing a plan of care for a patient who is exhibiting Parkinsonlike syndrome. What would be an appropriate intervention if, on assessing the patient, the nurse finds the patient is having difficulty swallowing?
A)
Thicken all liquids.
B)
Keep the patient NPO (not taking anything orally).
C)
Give only soft or pureed foods.
D)
Provide small, frequent meals.
Ans:
D Feedback:
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Provide small, frequent meals if swallowing becomes difficult. Keeping the patient NPO would be inappropriate because these effects often result from medications that will be taken throughout the patients life. Soft or pureed foods are often more difficult to swallow than more rigid foods. Thickening liquids would only be necessary if the dysphagia, or difficulty swallowing, continued to progress. 29 .
The post-anesthesia care unit nurse is serving a patient after a right knee arthroscopy. As the patient begins to wake up from anesthesia, the nurse assesses rigidity, involuntary movements, hyperthermia, and tachycardia. What would the nurse suspect is causing these effects?
A)
Neuroleptic malignant syndrome
B)
Parkinson-like syndrome
C)
Malignant tachycardia
D)
Anaphylactic shock
Ans:
A Feedback: Neuroleptic malignant syndrome is a generalized syndrome that includes extrapyramidal symptoms such as slowed reflexes, rigidity, involuntary movements; hyperthermia; autonomic disturbances (e.g., hypertension, fast heart rate); fever may be noted as well. This is most often seen after administering general anesthesia or drugs with central nervous system (CNS) effects. This syndrome was once known as malignant hyperthermia. These symptoms are not consistent with Parkinson-like syndrome or anaphylactic shock. Malignant tachycardia is a distracter.
30 .
A patient is admitted to the intensive care unit with hyperkalemia. The nurse caring for the patient knows that the most severe adverse effect of hyperkalemia is what?
A)
Renal failure
B)
Cardiac emergency
C)
Liver failure
D)
Respiratory distress
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Ans:
B Feedback: Monitor for cardiac irregularities because potassium is an important electrolyte in the action potential, needed for cell membrane stability. When potassium levels are too high, the cells of the heart become very irritable and rhythm disturbances can occur. Be prepared for a possible cardiac emergency. Hyperkalemia is often found in the patient with renal failure. Liver failure and respiratory distress are not generally caused by hyperkalemia.
31 .
The nurse administers an anticholinergic medication to the patient. When assessing this patient, what finding will the nurse consider a secondary effect of the drug?
A)
Nasal congestion
B)
Tachycardia
C)
Hyperthermia
D)
Profuse sweating
Ans:
A Feedback: Anticholinergic secondary effects include dry mouth, altered taste perception, dysphagia, heartburn, constipation, bloating, paralytic ileus, urinary hesitancy and retention, impotence, blurred vision, cycloplegia, photophobia, headache, mental confusion, nasal congestion, palpitations, decreased sweating, and dry skin. Tachycardia, hyperthermia, and profuse sweating would not be expected findings or consistent with anticholinergic effects and would require further assessment.
32 .
Before administering a macrolide antibiotic the nurse would question the order for what patient?
A)
An 82-year-old woman with hypertension
B)
A 12-year-old boy with hearing loss
C)
A 30-year-old pregnant patient
D)
A 51-year-old man after myocardial infarction
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Ans:
B Feedback: Macrolide antibiotics can cause severe auditory nerve damage so the nurse would question administration of this drug to the child with hearing loss because another antibiotic may be indicated to preserve remaining hearing. This drug is not contraindicated in older adults, although a lower dosage may be indicated. It may safely be given in pregnancy and after myocardial infarction.
33 .
What cardiac effect would the nurse be prepared to see in the patient with an extremely high potassium level?
A)
Arrhythmia
B)
Tachycardia
C)
Sudden death
D)
Bradycardia
Ans:
A Feedback: Elevated potassium levels irritate cardiac cells and increase the likelihood of a cardiac arrhythmia. Tachycardia, sudden death, and bradycardia would be the result of an arrhythmia if they were to occur.
34 .
The nurse administers a loop diuretic to the patient. In addition to sodium and water, what other electrolyte would the nurse expect to be excreted in significant amounts?
A)
Calcium
B)
Magnesium
C)
Potassium
D)
Zinc
Ans:
C Feedback:
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Loop diuretics increase excretion of sodium, water, and potassium most significantly. Although other electrolytes may be excreted, loss of magnesium, calcium, and zinc are usually not significant. 35 .
The nurse administers a medication to the patient that induces the secondary action of hypoglycemia. What organ will be most acutely impacted by inadequate circulating glucose?
A)
Brain
B)
Heart
C)
Lungs
D)
Skin
Ans:
A Feedback: While all cells require glucose to function, the brain uses the greatest amount. As a result, hypoglycemia has the greatest impact on the brain, which explains why hypoglycemia has so many neurological signs and symptoms including fatigue, drowsiness, anxiety, headache, shaking, lack of coordination, numbness and tingling of the mouth, tongue, and /or lips; confusion, and in severe cases, seizures or coma may occur because the brain cannot function without adequate supplies of glucose.
Chapter 64. Dietary Supplements & Herbal Medications 1. What is black cohosh used for?
a .
Preventing miscarriage during the first trimester
b .
Reducing symptoms of premenstrual syndrome
c .
Providing antispasmodic activity of the gastrointestinal (GI) system
d .
Controlling migraine headaches
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ANS: B Black cohosh is used to reduce symptoms of premenstrual syndrome, dysmenorrhea, and menopause. Therapy is not recommended for longer than 6 months. Because of its effect of relaxing the uterus, black cohosh is not used in pregnant women. Black cohosh does not affect the GI system or relieve migraines.
2. Which herbal medicine may improve a patients short term memory loss and cognitive function?
a .
Ginger
b .
Green tea
c .
Feverfew
d .
Ginkgo biloba extract
ANS: D Ginkgo biloba extract is used primarily for increasing cerebral blood flow, particularly in geriatric patients. Conditions treated are short term memory loss, headache, dizziness, tinnitus, and emotional instability with anxiety. Ginger is used to relieve nausea. Green tea has antioxidant effects. Feverfew is used to relieve migraines.
3. Which statement about dietary supplements is true?
a .
Dietary supplements are considered safe and effective.
b .
Dietary supplements have not been tested for safety or efficacy.
c .
There are no serious adverse effects to taking dietary supplements.
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d .
Dietary supplements have full FDA and USP approval.
ANS: B Labels and advertisements of dietary supplements must contain a statement that the product has not yet been evaluated by the FDA for the treatment, cure, or prevention of disease. Legally, dietary supplements are not required to be safe and effective, and unfounded claims of therapeutic benefits abound. There can be serious adverse effects when taking dietary supplements. Dietary supplements are not fully approved by the FDA or the United States Pharmacopeia (USP).
4. Which dietary supplement should be used with extreme caution if the patient is on a platelet inhibitor?
a .
Aloe
b .
Ephedra
c .
Green tea
d .
Garlic
ANS: D Garlic reduces platelet aggregation and should be used with extreme caution in patients receiving platelet inhibitors (e.g., aspirin, ticlopidine, dipyridamole, clopidogrel).
5. What is St. Johns wort used to treat?
a .
Rheumatoid arthritis
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b .
Asthma
c .
Depression
d .
Viral infections
ANS: C St. Johns wort is used to treat mild depression and heal wounds. The action of St. Johns wort is unknown. Studies have shown a prolonged effect of serotonin, dopamine, and norepinephrine as a result of decreased reuptake. Aloe is used to treat arthritis. Ephedra is used to treat asthma. Goldenseal is used to treat viral infections.
Chapter 65-Chapter 66 Rational Prescribing & Prescription Writing Chapter 66. Important Drug Interactions & Their Mechanisms 1.
A nurse is preparing a drug for administration to a patient. The drug does not have an indicated use for the patients medical diagnosis. What should the nurse do?
A)
Administer the drug as ordered.
B)
Question the prescriber concerning the ordered drug.
C)
Ask a coworker his or her thoughts about the ordered drug for the patient.
D)
Ask the patient why the drug has been prescribed for him or her.
Ans:
B Feedback: If the nurse is not sure about giving a drug, the order should be questioned. The nurse should never give a medication that is not clear. Mistakes do happen and the drug ordered, if not approved for the condition that the patient has, could be an error on someones part. The person who wrote the order should be questioned, not a co worker, who probably does not know why an off-label drug is being used. It would be unprofessional and inappropriate to ask the patient about the drug.
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2.
According to Center for Disease Control and Prevention (CDC) recommendations, what is the role of the nurse in preparing for the possibility of bioterrorism?
A)
Post updated information on signs and symptoms of infections caused by biological agents
B)
Provide guidelines for treating patients exposed to, or potentially exposed to, biological agents
C)
Remain current on recognition and treatment of infections caused by biological weapons
D)
Advocate for increased funding for research involving bioterrorism and patient treatment
Ans:
C Feedback: Nurses need to remain current about recognition of and treatment for those exposed to biological weapons because nurses are often called upon to answer questions, reassure the public, offer educational programs, and serve on emergency preparedness committees. The CDC posts updated information on signs and symptoms of infections caused by biological agents that nurses would read. The CDC also provides guidelines for how to treat patients exposed to biological agents and the nurse must remain current on this information. Although nurses could advocate for funding, this is not usually the role of the nurse.
3.
How can the nurse find the most up-to-date information about emergency preparedness related to bioterrorism agents?
A)
Read textbooks devoted to the topic.
B)
Ask coworkers to explain current events.
C)
Read journal articles about bioterrorism agents.
D)
Visit the Centers for Disease Control and Prevention (CDC) Web site.
Ans:
D Feedback:
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The most current information will be found on the CDC Web site because new information can be posted immediately whereas textbooks and journal articles take time to print. Coworkers may or may not remain current on emergency preparedness and should not be the primary source of information. 4.
The nurse is assessing a diabetic patient who has presented at the clinic reporting several hypoglycemic episodes during the past 3 weeks. The nurse questions the patient about the use of herbal or alternative therapies, suspecting what herbal remedy could cause the hypoglycemic episodes?
A)
St. Johns wort
B)
Kava
C)
Fish oil
D)
Ginseng
Ans:
D Feedback: Ginseng is known to decrease blood sugar levels. If the patient used this in combination with his or her oral antidiabetic agent, diet, and exercise, his or her blood sugar could drop below therapeutic levels. St. Johns wort interacts with many drugs, but not with antidiabetic agents. Kava is associated with liver toxicity. Fish oil has been associated with decreased coronary artery disease.
5.
A 22-year-old patient calls the clinic and tells the nurse that she has been depressed and is thinking about taking St. Johns wort but wants to know if it is safe first. The nurse begins by questioning what other medications the patient takes and would be concerned about a drug-alternative drug interaction if the patient is also taking what type of medication?
A)
Antihistamines
B)
Analgesics
C)
Antibiotics
D)
Oral contraceptives
Ans:
D
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Feedback: St. Johns wort can interact with oral contraceptives that alter drug metabolism, which can decrease the effectiveness of the contraceptive. Analgesics, antibiotics, and antihistamines can be taken in combination with St. Johns wort without known adverse effects. 6.
A patient tells the clinic nurse that he or she has been taking over-thecounter (OTC) Pepcid to relieve acid indigestion for several years. This is the first time the patient has ever reported this issue to a health care provider. As part of the teaching plan for this patient, the nurse explains what risk associated with not sharing OTC drug use with the provider?
A)
The OTC drug could be more expensive than seeking health care advice.
B)
The drug could mask symptoms of a serious problem that is undiagnosed.
C)
Use of the drug could cause a rebound effect of Pepcid.
D)
The drug could interact with several cold medicines.
Ans:
D Feedback: OTC drugs allow patients to self-diagnose and treat routine signs and symptoms without seeing a health care provider. This self-prescribed treatment, however, could mask a more serious underlying medical problem and result in a poor outcome for the patient. The issues of drug rebound and drug interaction need to be considered, but the safety issue related to selfdiagnosis and self-prescription presents the greatest risk to the patient. Patients should always be encouraged to discuss the use of OTC products with their health care provider.
7.
What patient populations would the nurse expect is most likely to be prescribed a drug for an off-label use?
A)
Adolescent and middle-aged adult patients
B)
Patients with diabetes or heart disease
C)
Obstetric and neonatal patients
D)
Pediatric and geriatric patients
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Ans:
D Feedback: Drugs being used for an off-label purpose are commonly prescribed for pediatric and geriatric populations due to the lack of drug trial information and minimal premarket testing. Often a trial-and-error method is used in treating both the pediatric and geriatric populations when only adult information is known. The geriatric population responds to medication more like children because of their decreased ability to metabolize medications. Adolescents, especially later adolescents, use medications similarly to young adults as do middle-aged adults. Patients with different diagnoses are often involved in drug testing including those with diabetes and heart disease. Drugs are discouraged for use in obstetric patients.
8.
A patient calls the clinic and asks to speak to a nurse. The patient questions the nurse about the use of a drug that was advertised on TV. The patient tells the nurse he or she is sure that the drug will make him or her feel the same way as described in the commercial. What response is most appropriate for the nurse to make?
A)
Im glad that you want to be involved in treatment decisions but you are not qualified to decide what medications are best for your condition.
B)
Its important to remember that drug advertisements emphasize the positive effects of drug therapy and not the adverse effects or contraindications.
C)
You need to remember that the drugs being advertised are much more expensive than other drugs that have the same effect.
D)
Ive seen those advertisements and I would want to take that medication too if I had the condition it was designed to treat.
Ans:
B Feedback:
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It would be important for the nurse to remind the patient that advertisements always emphasize the positive effects of drug therapy. The patient should not be discouraged from contributing to the plan of care by being told she is not adequately qualified to make decisions because no one is more qualified to make decisions about her own body. Although the drug may be more expensive, this is not a reason to choose or avoid a medication that could be more effective. Agreeing with the patient is not meeting the nurses obligation to teach and inform. 9.
The clinic nurse is talking with a patient about information concerning a drug her or she bought online. What is the nurses responsibility to the patient concerning this information?
A)
Encourage the patient to seek information about drugs from a pharmacist.
B)
Explain that information obtained from the Internet is not always accurate.
C)
Offer the patient a drug reference guide to read and learn more about the drug.
D)
Interpret the information and explain it in terms that the patient will understand.
Ans:
D Feedback: The Internet can be a good reference for drug information. However, the amount and reliability of the information can be overwhelming. The nurse should always try to interpret the information and explain it in terms that the patient will understand. A pharmacist is a good resource person but may not be able to teach from a holistic perspective. Drug reference guides may be hard for the patient to understand and he or she would still need someone to interpret the information.
10 .
The triage nurse in the emergency department sees a patient suspected of abusing amphetamines brought in by friends. While assessing this patient, what would the nurse be likely to find if steroids are being abused?
A)
Hypertension
B)
Bradycardia
C)
Drowsiness
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D)
Elated mood
Ans:
A Feedback: Increases in blood pressure, tachycardia, and insomnia are symptoms of amphetamine abuse. Elation can indicate abuse of cannabis.
11 .
The nursing instructor is discussing the off-label use of drugs. What group of drugs would the instructor tell the nursing students is often used for off-label indications?
A)
Drugs used to treat psychiatric problems
B)
Drugs used to treat gastrointestinal (GI) problems
C)
Drugs used to treat cardiovascular problems
D)
Drugs used to treat musculoskeletal problems
Ans:
A Feedback: Drugs often used for off-label indications include the drugs used to treat various psychiatric problems. Drugs used to treat GI, cardiovascular, or musculoskeletal problems do not fall in the category of frequent off-label uses.
12 .
The patient calls the clinic nurse and says, I looked this medication up on the Internet after it was prescribed yesterday and there is nothing in the literature about this drug being used to treat my disorder. Should I still take it? What is the nurses best response?
A)
No, stop taking it immediately until I can consult with the doctor because it is obvious a mistake was made.
B)
Oh, thats okay. Go ahead and take it because the doctor wouldnt order it if he or she didnt think it would be effective.
C)
It is quite common for drugs to be found to have positive effects for a condition not originally intended so it is safe to take.
D)
Let me talk with the physician about why this medication was ordered for you and I will call you back.
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Ans:
D Feedback: Off-label use is relatively common because new information is gathered when the drug is used by large numbers of people that may indicate another condition for which the drug is effective. However, if the nurse does not know for a fact that the drug prescribed is the right drug for the patients condition, it is always best to consult with the prescriber to make sure the patient is taking the right drug and to avoid a medication error. The medication may be perfectly safe so the patient should not be told the doctor made a mistake.
13 .
When a drug is ordered off-label, what must the nurse be clear about before administering the drug? (Select all that apply.)
A)
Why the drug is being given
B)
Its potential for problems
C)
The research that has been done
D)
The age group it was pretested on
E)
The intended use
Ans:
A, B, E Feedback: Liability issues surrounding many of these uses are very unclear, and the nurse should be clear about the intended use, why the drug is being given, and its potential for problems. Knowing the age group it was pretested on and knowing the research that has been done are not factors the nurse needs to know before administering the drug.
14 .
It is important for the nurse to be aware of what related to the way drugs are marketed?
A)
The adverse effects the advertisements do not mention
B)
What magazines and Web sites contain the advertisement
C)
What patients are seeing in the advertisements about these drugs
D)
The name of the cheerful, happy models who are advertising these drugs
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Ans:
C Feedback: As the marketing power for prescription drugs continues to grow, the nurse must be constantly aware of what patients are seeing, what the ads are claiming, and the real data behind the indications and contraindications for these hot drugs. The Food and Drug Administration regulates the information that needs to be contained within medication ads. Where the patient saw the ad and the actors in the ads are unimportant.
15 .
When evaluating information accessed over the Internet, an important question the nurse should teach the patient to ask is what?
A)
Is the information anecdotal?
B)
Where has this information been obtained?
C)
Is this information paid for by the drug company?
D)
How many patients have had input into the information?
Ans:
A Feedback: Many people do not know how to evaluate the drug-related information that they can access over the Internet. Is it accurate or anecdotal is an important concept for the nurse to teach the patient to assess to verify the accuracy of the information. Where the information came from is unimportant. It would be expected that all drug advertising is paid for by the drug company and this is not an important concern. Number of patients with input into the information is most likely none because information is gathered from health care professionals.
16 .
How has the patients access to drug information changed the way the patient interacts with the nurse and other health care providers?
A)
Patients share information from research reports with health care providers.
B)
Patients are contacting drug companies to see what their latest reports say.
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C)
Patients are more likely to challenge the health care provider with their own research.
D)
Patients are more likely to self-prescribe and not obtain prescriptions from their health care provider.
Ans:
C Feedback: Access to consumer advertising, mass media health reports, and the Internet influence some patients to request specific treatments, to question therapy, and to challenge the health care provider. Consumers do not generally read research reports from medical facilities and contact drug companies to see what their reports say, and they cannot self-medicate because many of these drugs require a prescription to obtain them.
17 .
What can make a nurse or any health care provider lose credibility with the patient?
A)
Being unprepared to deal with the disease of the week
B)
Refusing to write prescriptions for the drug the patient requests
C)
Not being knowledgeable about diseases described on House
D)
Being prepared to discuss the role of concierge doctor
Ans:
A Feedback: Some health care providers have learned to deal with the disease of the week as seen on talk shows; others can be unprepared to deal with what was presented and may lose credibility with the patient.
18 .
Today, an abundance of information is available in the health care arena for consumers, resulting in the nurse encountering patients who have a much greater use of what?
A)
Over-the-counter (OTC) therapies
B)
Alternative therapies
C)
Prescription drugs
D)
Off-label drugs
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Ans:
B Feedback: The patient now comes into the health care system burdened with the influence of advertising, the Internet, and a growing alternative therapy industry. Many patients no longer calmly accept whatever medication is selected for them. Indeed, an increasing number of patients are turning to alternative therapies with the belief that they will treat their disorder and reduce risk of adverse effects. Although more prescription drugs are used today, that is not related to abundant information. No indication exists of an increase in use of OTC or off-label drugs.
19 .
Because of the amount of care now being done in the home care setting, it is imperative that the nurse teach the patients what? (Select all that apply.)
A)
Care givers educational level.
B)
Generic names of medication
C)
Over-the-counter (OTC) drugs that need to be avoided
D)
Alleviation of adverse effects
E)
How to calculate safe dosages
Ans:
B, C, D Feedback: The responsibility of meeting the tremendous increase in teaching needs of patients frequently resides with the nurse. Patients need to know exactly what medications they are taking (generic and brand names), the dose of each medication, and what each is supposed to do. Patients also need to know what they can do to alleviate some of the adverse effects that are expected with each drug (e.g., small meals if gastrointestinal upset is common, use of a humidifier if secretions will be dried and make breathing difficult), which OTC drugs or alternative therapies they need to avoid while taking their prescribed drugs, and what to watch for that would indicate a need to call the health care provider.
20 .
What concerns might the nurse legitimately have related to the use of alternative therapies? (Select all that apply.)
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A)
The Food and Drug Administration (FDA) does not test or regulate active ingredients.
B)
The incidental ingredients are clearly marked on the label.
C)
The dosage contained in each tablet may vary greatly.
D)
No alternative therapies have been found to be effective.
E)
Advertising of alternative products is not as restrictive or accurate.
Ans:
A, C, E Feedback: Alternative products are not controlled or tested by the FDA and advertising is not as restrictive or accurate as with classic drugs. Incidental ingredients are often unknown and strength of tablets may vary within the bottle depending on the conditions under which they were grown. While some alternative therapies have been found to be effective, there are others who have not been studied.
21 .
The nurse provides teaching to the patient using herbal therapies and includes what important information related to the effects of the herbal therapy?
A)
They can interact with prescription drugs.
B)
They always contain known ingredients.
C)
They are natural so they are effective and safe.
D)
The ingredients are natural, meaning toxicity is not a concern.
Ans:
A Feedback: Herbal therapies can produce unexpected adverse effects and toxic reactions, can interact with prescription drugs, and can contain various unknown ingredients that alter the therapies effectiveness and toxicity.
22 . A)
When patients do not understand the information provided with their medication, whose responsibility is it to help them sort through and comprehend the meaning? Care giver
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B)
Nurse
C)
Patient
D)
Physician
Ans:
B Feedback: Many pharmacies provide written information with each drug that is dispensed, but trying to organize these sheets of information into a usable and understandable form is difficult for many patients. The nurse is often the one who needs to sort through the provided information to organize, simplify, and make sense of it for the patient.
23 .
The nurse is providing an inservice on alternative therapies for peers and explains that the term alternative therapies includes what?
A)
Holistic drug therapy
B)
Hospice care
C)
Nondrug measures
D)
Home care
Ans:
C Feedback: Herbal medicines and alternative therapies are found in ancient records and have often been the basis for discovery of an active ingredient that is later developed into a regulated medication. Today, alternative therapies can also include non-drug measures, such as imaging and relaxation. Options A, B, and D are not included in alternative therapies.
24 .
The patient calls the clinic and talks to the nurse saying, I found the same drug the provider prescribed on the Internet and it is much cheaper. Is it safe for me to order my drug from this site? What is the nurses best response?
A)
It is usually safe to order drugs from Internet Web sites if it is a reliable site.
B)
Most drugs ordered online come from another country and are safely used there.
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C)
The drug you get will be the same chemical prescribed but the dosage may differ.
D)
The Food and Drug Administration (FDA) has issued warnings to consumers about the risk of taking unregulated drugs.
Ans:
D Feedback: The FDA has begun checking these drugs when they arrive in this country and have found many discrepancies between what was ordered and what is in the product, as well as problems in the storage of these products. Some foreign brand names are the same as brand names in this country but are associated with different generic drugs. The FDA has issued many warnings to consumers about the risk of taking some of these drugs without medical supervision, reminding consumers that they are not protected by U.S. laws or regulations when they purchase drugs from other countries.
25 .
With the need to protect our environment, what is it now important for the nurse to teach patients to do?
A)
Dispose of drugs no longer used on an annual basis.
B)
Flush drugs down the toilet.
C)
Bury unused in the yard.
D)
Throw unused pill bottles in the trash in original containers.
Ans:
A Feedback: Patients should go through their medicine cabinet annually and dispose of drugs no longer used. Unused drugs should not be flushed down the toilet or buried in the yard because they seep into the community water supply. Pills should be removed from their bottle and mixed with an undesirable substance to prevent someone from using the medication if found.
26 . A)
The nurse receives a call from a frantic mother saying, My child swallowed some of my birth control pills. Should I give Ipecac? What is the nurses best response? Yes, give Ipecac and follow the dosage directions on the bottle.
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B)
Ipecac is not effective for this use so you should not give it to your child.
C)
Give the Ipecac only if you are absolutely sure your child swallowed the pills.
D)
No, dont give Ipecac because it will cause your child to vomit and make a mess.
Ans:
B Feedback: Ipecac is a drug that the Food and Drug Administration tested in 2003 and found, despite its use for many years, that it was not effective in inducing vomiting in children suspected of poisoning. As a result, it is no longer used. The mother should be instructed not to give it and to call poison control to get up-to-date instructions on how to deal with this emergency. Whether the pills were swallowed, this child requires appropriate intervention because it is better to err on the side of caution. Making a mess is not a concern.
27 .
The patient tells the nurse that he or she has begun ordering his or her medications over the Internet because it is cheaper. What statement made by the nurse in response to this information is accurate?
A)
All drugs are manufactured with the same quality controls.
B)
Any drug that is shipped into this country is safe to use.
C)
Foreign drugs may have the same name as domestic drugs, but they are not the same drug.
D)
If you order from Canada or Mexico, the drugs are safe because they undergo testing.
Ans:
C Feedback: The Food and Drug Administration has begun checking these drugs when they arrive in this country and have found many discrepancies between what was ordered and what is in the product, as well as problems in the storage of these products. Some foreign brand names are the same as brand names in this country but are associated with different generic drugs. Options A, B, and D are incorrect because not all drugs are manufactured the same and they are not always safe coming from another country.
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28 .
The increasing number of patients who go to their health care provider and request a drug they have seen advertised on television or in a magazine has created what continuing challenge to health care providers?
A)
Treating infections appropriately
B)
Treating sicker patients
C)
Prescribing cost-effectively
D)
Staying knowledgeable about drug therapy
Ans:
D Feedback: As the marketing power for prescription drugs continues to grow, the health care provider must be constantly aware of what patients are seeing (or reading), what the commercials and ads are promising, and the real data behind the indications and contraindications for these hot drugs. It is a continuing challenge to stay up-to-date and knowledgeable about drug therapy.
29 .
Ipecac, formerly used as the drug of choice by parents for treatment of suspected poisoning in children, was tested by the Food and Drug Administration (FDA) in 2003. What was the finding of this testing?
A)
Ipecac is ineffective for its intended use.
B)
Ipecac is the safest treatment for poisoning in children.
C)
Ipecac was grandfathered in as an ineffective drug.
D)
Ipecac induces vomiting.
Ans:
A Feedback: Ipecac, a formerly standard over-the-counter drug, was used for many years by parents to induce vomiting in children in cases of suspected poisoning or suspected drug overdose. The drug was finally tested and in 2003, the FDA announced that it was not found to be effective for its intended use. Although it was grandfathered in as an effective drug, this was not what the study researched. Ipecac is not effective and does not consistently induce vomiting.
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30 .
Federal guidelines state that when advertising a drug, if the company states what the drug is used for, what other information must also be included in the advertisement? (Select all that apply.)
A)
Symptoms
B)
Contraindications
C)
Adverse effects
D)
Precautions
E)
Cost
Ans:
B, C, D Feedback: If a drug advertisement states what the drug is used for, it must also state contraindications, adverse effects, and precautions. The advertisement does not have to state symptoms or cost.
31 .
The parent of a 2-year-old child is visiting his or her pediatric health care provider and shows the nurse the advertisement for allergy medication found in a magazine in the waiting room saying, This drug sounds like it would be far more effective to treat my sons asthma and Id only have to give it once a day. What is the nurses best response?
A)
Talk with your health care provider about this drug, but be aware that advertisements do not always provide all the important information you need to know.
B)
Oh, I need to throw that magazine away because so many people show me that ad and it is all complete nonsense with no truth to it at all.
C)
Ive been seeing amazingly positive results from that medication so you are absolutely right to want to give it to your child.
D)
That drug is dangerous and should not be given to children under the age of 5 unless there are no other good options.
Ans:
A Feedback:
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The health care provider should make the decision about what medications are to be prescribed, not the nurse. However, the nurse can make the mother aware of the fact that there is often more that goes into choosing the correct drug than the bit of information disclosed in the advertisement. Becoming upset with the mother, agreeing with the mother, or frightening the mother about the medication is the wrong approach for the nurse to use. 32 .
The local news has been discussing a specific rare disorder that killed a child in the community this week, describing the symptoms of the disease as including nasal congestion, ear pain, and a cough. The pediatricians office is receiving numerous calls asking to make appointments to rule out this rare disease. What is the nurses best action?
A)
Prepare a handout that describes the disorder discussed in the news in greater detail.
B)
Tell parents their child is experiencing the common cold and do not need to be seen.
C)
Direct all calls to the local news agency to answer questions and provide details.
D)
Become familiar with the disorder and screen each call for more specific symptoms.
Ans:
A Feedback: The nurse needs to not only become more familiar with the disorder in the news, but also needs to be prepared to teach parents about the disease of the week to allay fears so a handout with detailed information would allow the parents to have something to consult after leaving the providers office. Turning parents away without seeing their child will increase fears and the office will lose credibility for lack of interest in their childs well-being. Directing calls to the news agencies will not provide parents with essential information. Screening calls without seeing the child could be potentially very dangerous.
33 .
The nurse is teaching the patient how to safely use the Internet for health information and includes what information in the teaching plan?
A)
The Web site where information is obtained needs to be evaluated for credibility.
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B)
Most information found on the Internet is accurate.
C)
Information on the Internet is most reliable when people give their reviews of the drug.
D)
Only a health care professional can tell whether a Web site is reliable.
Ans:
A Feedback: There are excellent sites for reliable drug information, but each site must be evaluated for credibility and the nurse can teach the patient things to look for to increase confidence in the site. However, a lot of information on the Internet is not accurate; the patient needs to learn how to recognize unreliable information when he or she comes across these sites. Just because a person reviews a drug and gives it multiple stars or a thumbs up does not mean the drug is any more effective or useful in the patients care.
34 .
The nursing instructor is teaching the class about how prescription drugs become over-the-counter (OTC) drugs and lists what factor as preventing a drug from becoming classified as OTC?
A)
If the patient cannot reliably self-diagnose the condition the drug is intended to treat
B)
If it would mask signs and symptoms of an underlying problem, the drug remains available by prescription only.
C)
If the drug would cause toxic effects if not taken as directed, it remains a prescription drug.
D)
OTC drugs must not have any adverse effects that could harm the patient.
Ans:
A Feedback: If a diagnosis requires medical intervention, such as hyperlipidemia, which can only be diagnosed through laboratory studies, there is no point in making the drug an OTC medication. Most, if not all, OTC drugs have the capacity to mask signs and symptoms of an underlying disease so this is not a factor in deciding if a drug can be sold OTC. All drugs have the potential for toxic effects if not taken as directed and virtually all drugs have the potential for adverse effects.
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35 .
The nurse needs to ask what specific questions when collecting a drug history? (Select all that apply.)
A)
Do you take any over-the-counter medications?
B)
Do you take any herbal supplements?
C)
Do you use any alternative therapies?
D)
Do you take any natural supplements or vitamins?
E)
What unusual therapies do you take?
Ans:
A, B, D Feedback: The nurse needs to specifically question the patients use of over-the-counter drugs, herbal supplements, natural supplements, and vitamins. Use of terms like alternative therapies or unusual therapies is too vague and may not elicit the kind of information needed.
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