Exam 3 10/2020

The child who is a candidate for treatment with syrup of ipecac after ingestion of a toxic substance or overdose is the child who has ingested which substance? a. Acetaminophen elixir b. Chlorine bleach c. Kerosene d. Toilet cleanser

a. Acetaminophen elixir

The nurse is teaching a group of parents about the use of syrup of ipecac. Which instruction will the nurse provide? a. "Do not administer ipecac without consulting a poison control center." b. "Expect the onset of emesis to be immediate." c. "Give ipecac with a glass of milk to increase its emetic effect." d. "Use ipecac fluid extract and not ipecac syrup."

a. "Do not administer ipecac without consulting a poison control center."

4. The nurse is teaching a patient who is about to take a long car trip about using dimenhydrinate (Dramamine) to prevent motion sickness. What information is important to include when teaching this patient? a. "Do not drive while taking this medication." b. "Dry mouth is a sign of toxicity with this medication." c. "Take the medication 1 to 2 hours prior to beginning the trip." d. "Take 100 mg up to 6 times daily for best effect."

a. "Do not drive while taking this medication." Drowsiness is a common side effect of dimenhydrinate, so patients should be cautioned against driving while taking this drug. Dry mouth is a common side effect and not a sign of toxicity. The drug should be taken 30 minutes prior to travel. The maximum recommended dose is 400 mg per day

A patient who has epilepsy will begin an anticonvulsant medication. The patient asks the nurse how long the medication will be necessary. How will the nurse respond? a. "The medication may be necessary for a lifetime." b. "The medication will be given until you are seizure free." c. "You will need to take the medication for 3 to 5 years." d. "You will take the medication as needed for seizure activity."

a. "The medication may be necessary for a lifetime."

A patient who takes phenytoin reports regular alcohol consumption. The nurse might expect a serum phenytoin level in this patient to be in which range? a. 5 to 10 mcg/mL b. 10 to 20 mcg/mL c. 20 to 30 mcg/mL d. 30 to 50 mcg/mL

a. 5 to 10 mcg/mL

The nurse administers proparacaine HCl (Ophthaine) drops to a patient prior to an eye examination. What sign will the nurse look for to determine when the examination can begin? a. Absence of the blink reflex b. Blurred vision c. Drying of the corneal epithelium d. Photophobia

a. Absence of the blink reflex

The nurse is preparing to administer phenytoin (Dilantin) to a patient who has a seizure disorder. The patient appears drowsy, and the nurse notes that the last random serum drug level was 18 mcg/mL. What action will the nurse take? a. Administer the dose since the patient is not toxic. b. Contact the provider to discuss decreasing the phenytoin dose. c. Give the drug and monitor closely for adverse effects. d. Report drug toxicity to the providers.

a. Administer the dose since the patient is not toxic.

The nurse is preparing to administer phenytoin (Dilantin) to a patient who has a seizure disorder. The nurse notes that the last random serum drug level was 18 mcg/mL. What action will the nurse take? a. Administer the dose since the patient's labs do not indicate toxic phenytoin levels. b. Contact the provider to discuss decreasing the phenytoin dose. c. Give the drug and monitor closely for toxicity. d. Report drug toxicity to the providers.

a. Administer the dose since the patient's labs do not indicate toxic phenytoin levels.

The nurse is preparing to administer olopatadine (Patanol) eyedrops to a patient who has allergic conjunctivitis. The patient tells the nurse that the drops have caused burning and stinging. What action will the nurse take? a. Administer the drops and reassure the patient that this is a normal side effect. b. Offer an over-the-counter eye lubricant to minimize this adverse effect. c. Request an order for antibiotic eyedrops. d. Withhold the medication and notify the provider

a. Administer the drops and reassure the patient that this is a normal side effect

The nurse is preparing to administer phenytoin to an 80-year-old patient and notes the following order: IVP phenytoin 50 mg. The nurse will perform which action? a. Administer the undiluted drug through a Y-tube over 2 minutes. b. Contact the provider to question the route and the dose. c. Dilute the drug in dextrose solution and infuse over 15 to 20 minutes. d. Request an order to administer the drug intramuscularly.

a. Administer the undiluted drug through a Y-tube over 2 minutes.

The nurse is performing a medication history on a patient who has glaucoma. The patient cannot remember the name of the drug prescribed but tells the nurse that the drug causes light sensitivity. The nurse knows that the drug is among which class of medications? a. Alpha-adrenergic agonists b. Beta-adrenergic blockers c. Cholinergic agonists d. Cholinesterase inhibitors

a. Alpha-adrenergic agonists

The nurse is performing a medication history on a patient who has glaucoma. The patient has a prescription for brimonidine (Alphagan P). The nurse knows that this drug belongs to which class of medications? a. Alpha-adrenergic agonists b. Beta-adrenergic blockers c. Cholinergic agonists d. Cholinesterase inhibitors

a. Alpha-adrenergic agonists

The nurse is administering timolol (Timoptic) eye drops to a patient who has glaucoma. To prevent bradycardia, the nurse will perform which action? a. Apply pressure to the lacrimal ducts. b. Have the patient sit up after instilling the drops. c. Prepare to administer an alpha-adrenergic agonist. d. Wait 5 minutes between drops.

a. Apply pressure to the lacrimal ducts

A parent of a child who has been taking valproic acid (Depakote) for several years calls the clinic to report a recent recurrence of seizures and states that the child is having three or four seizures per week. The nurse will perform which action first? a. Ask the parent to describe the child's drug regimen. b. Request an order for a serum valproic acid level. c. Suggest that the parent take the child to the emergency department. d. Tell the parent that the provider will increase the child's dose of Depakote.

a. Ask the parent to describe the child's drug regimen.

A patient has recently begun taking carbamazepine (Tegretol) as an adjunct medication to treat refractory seizures. The patient has a serum carbamazepine level of 18 mcg/mL. Which of the following would be the most appropriate next step? a. Ask the patient about usual dietary preferences. b. Reassure the patient that this is a therapeutic drug level. c. Report a subtherapeutic drug dose to the provider. d. Discontinue the carbamazepine.

a. Ask the patient about usual dietary preferences.

The nurse is caring for a patient who has increased intraocular pressure. The provider has ordered a cholinergic agonist. The nurse will perform a thorough health history to make sure the patient does not have a history of which condition? a. Asthma b. Diabetes c. Hypertension d. Renal disease

a. Asthma

The nurse is caring for a patient who has increased intraocular pressure. The provider has ordered levobunolol 0.5% ophthalmic solution. The nurse will perform a thorough health history to make sure the patient does not have a history of which condition? a. Asthma b. Diabetes c. Hypertension d. Renal disease

a. Asthma

1. A patient who recently began having mild symptoms of gastroesophageal reflux disease (GERD) is reluctant to take medication. What non-pharmacological measures will the nurse recommend to minimize this patient's symptoms? (Select all that apply.) a. Avoiding hot, spicy foods b. Avoiding tobacco products c. Drinking a glass of red wine with dinner d. Eating a snack before bedtime e. Taking ibuprofen with food f. Using a small pillow for sleeping g. Wearing well-fitted clothing

a. Avoiding hot, spicy foods b. Avoiding tobacco products e. Taking ibuprofen with food Hot, spicy foods aggravate gastric upset, tobacco increases gastric secretions, and ibuprofen on an empty stomach increases gastric secretions, so patients should be taught to avoid these actions. Alcohol should be avoided since it increases gastric secretions. Eating at bedtime increases reflux, as does laying relatively flat to sleep, or wearing fitted clothing.

7. A patient who is receiving chemotherapy will be given dronabinol (Marinol) to prevent nausea and vomiting. The nurse will tell the patient that this drug will be given at which time? a. Before and after the chemotherapy b. During chemotherapy c. Immediately prior to chemotherapy d. 24 hours prior to chemotherapy

a. Before and after the chemotherapy Cannabinoids are indicated for use prior to and after chemotherapy. Dronabinol is given 1-3 hours prior to chemotherapy and then every 2-4 hours after.

The nurse is preparing to assist with blood collection on a newly admitted patient who has been taking phenytoin for several years. The provider has ordered a complete blood count and liver function tests. Which other blood test will the nurse discuss with the provider? a. Blood glucose b. Coagulation studies c. Renal function tests d. Serum electrolytes

a. Blood glucose

The nurse is preparing to administer dipivefrin (Propine) drops as a mydriatic agent. Which assessment would cause the nurse to withhold the drug and notify the provider? a. Blood pressure of 140/90 mm Hg b. Heart rate of 60 beats per minute c. Respiratory rate of 12 breaths per minute d. Temperature of 37.9° C

a. Blood pressure of 140/90 mm Hg

A child exhibits acromegaly caused by a tumor that cannot be destroyed with radiation. Which medication will most likely be used to treat this child? a. Bromocriptine mesylate (Parlodel) b. Octreotide acetate (Sandostatin) c. Somatrem (Protropin) d. Somatropin (Genotropin)

a. Bromocriptine mesylate (Parlodel) Bromocriptine is a prolactin-release inhibitor and is used to inhibit release of growth hormone from the pituitary gland if the tumor cannot be destroyed by radiation. Octreotide may be used as well, but it is expensive and is typically used as adjunct therapy to radiation. Somatrem and somatropin are used to treat growth hormone deficiency and would make acromegaly worse.

The nurse provides teaching for a patient receiving corticotropin. The nurse will instruct the patient to contact the provider if which condition occurs? a. Bruising b. Constipation c. Myalgia d. Nausea

a. Bruising Adverse reactions: ecchymosis, osteoporosis, muscle atrophy, edema Side effects: n/v/d, constipation, mood swings, petechiae, hypokalemia, hypocalcemia Myalgia is not common

8. The nurse is caring for a patient who has Zollinger-Ellison syndrome. Which medication order would the nurse question for this patient? a. Cimetidine (Tagamet) b. Pantoprazole (Protonix) c. Rabeprazole (Aciphex) d. Ranitidine (Zantac)

a. Cimetidine (Tagamet) Cimetidine is not effective for treating Zollinger-Ellison syndrome. The other medications may be used to treat Zollinger-Ellison syndrome.

An intubated child is brought to the emergency department while having a seizure that has been progressing for 20 minutes. Which drug will the nurse anticipate administering to this patient first? a. Diazepam (Valium) b. Phenobarbital (Luminal) c. Phenytoin (Dilantin) d. Valproic acid (Depakote)

a. Diazepam (Valium)

10. A child has been prescribed activated charcoal. What is the likely reason this is being ordered? a. Ingestion of a toxic substance b. Severe vomiting c. Nausea d. Motion sickness

a. Ingestion of a toxic substance Activated charcoal is given to prevent the absorption of ingested toxic substances. Activated charcoal does not have a role in the treatment of nausea, vomiting or motion sickness.

The nurse administers intravenous corticotropin (Acthar) to a patient. A serum cortisol level drawn 60 minutes later shows no change in serum cortisol levels from prior to the dose. What is the nurses first action? a. Notify the provider to discuss a possible non-functioning adrenal gland. b. Recognize the need for an increased dose to treat pituitary insufficiency. c. Request an order for a second dose of corticotropin to treat cortisone deficiency. d. Request an order to repeat the serum cortisol level in 1 to 2 hours.

a. Notify the provider to discuss a possible non-functioning adrenal gland. Corticotropin is given to diagnose adrenal gland disorders as well as to treat adrenal gland insufficiency. When given intravenously, the serum cortisol level should increase within 30 to 60 minutes if the adrenal gland is functioning. The nurse should report adrenal gland dysfunction. The provider will determine how to treat. Since the levels should increase in 30 to 60 minutes, there is no need to repeat the test in 1 to 2 hours.

17. A patient reports having three to four stools, which are sometimes hard, per week. The patient states that this represents less bowel movements than normal for her. The nurse will perform which action? a. Recommend increased intake of fluids and dietary fiber. b. Request an order for a stimulant laxative as needed. c. Request an order for a stool softener. d. Request an order for magnesium citrate.

a. Recommend increased intake of fluids and dietary fiber. This patient is having stools that are within the normal range for frequency, but she does state that she generally has more frequent bowel movements. Nonpharmacologic measures, such as increased intake of fluids and dietary fiber, should be used first to help soften stools.

The nurse is preparing to administer atropine sulfate drops as a mydriatic agent. Which of the following is considered a contraindication to therapy? a. Tachycardia b. Diarrhea c. Bradycardia d. Constipation

a. Tachycardia

5. A patient who takes propantheline bromine (Pro-Banthine) and omeprazole (Prilosec) for an ulcer will begin taking an antacid. The nurse will give which instruction to the patient regarding how to take the antacid? a. Take the antacid 2 hours after taking the propantheline. b. Take the antacid along with a meal. c. Take the antacid with milk. d. Take the antacid with the propantheline bromine.

a. Take the antacid 2 hours after taking the propantheline. Antacids can slow the absorption of anticholinergics and should be taken 2 hours after anticholinergic administration. Antacids should be given 1 to 3 hours after a meal and should not be given with dairy products.

18. The nurse is instructing a patient who will take psyllium (Metamucil) to treat constipation. What information will the nurse include when teaching this patient? a. The importance of consuming adequate amounts of water b. The need to monitor for systemic side effects c. The onset of action of 30 to 60 minutes after administration d. The need to use the dry form of Metamucil to prevent cramping

a. The importance of consuming adequate amounts of water Insufficient fluid intake can cause the drug to solidify in the gastrointestinal tract, thus counseling on ingestion of adequate amounts of water is important. Psyllium is not systemically absorbed, so it does not have systemic side effects. Onset of action for psyllium is between 10 and 24 hours. All forms of bulk forming laxatives can contribute to GI side effects such as cramping.

12. A child is brought to the emergency department after ingestion of a toxic substance. The child is alert and conscious and is reported to have ingested kerosene 20 minutes prior. The nurse will anticipate administering a. activated charcoal. b. an anticholinergic antiemetic. c. gastric lavage. d. syrup of ipecac.

a. activated charcoal. Activated charcoal is used when patients have ingested a caustic substance or a petroleum distillate in a patient who is alert and awake. Gastric lavage is no longer used as therapy. Syrup of ipecac is not recommended.

The nurse is caring for a patient who has a seizure disorder being treated with phenytoin. The nurse notes that the patient has reddened gums that bleed when brushing. The nurse recognizes this finding as: a. an adverse effect of the phenytoin. b. likely due to a drug interaction with aspirin. c. a symptom of hepatotoxicity. d. a sign of poor self-care.

a. an adverse effect of the phenytoin.

A patient is taking esomeprazole (Nexium) 15 mg per day to treat a duodenal ulcer. After 10 days of treatment, the patient reports that the pain has subsided. The nurse will counsel the patient to a. continue the medication for 4 more weeks. b. reduce the medication dose by half. c. stop taking the medication. d. take the medication every other day.

a. continue the medication for 4 more weeks.

3. A patient is taking rabeprazole (Aciphex) 20 mg per day to treat a duodenal ulcer. After 10 days of treatment, the patient reports that the pain has subsided. The nurse will counsel the patient to: a. continue the medication for up to 4-8 total weeks of treatment. b. reduce the medication dose by half. c. stop taking the medication. d. take the medication every other day

a. continue the medication for up to 4-8 total weeks of treatment. With treatment, ulcer pain may subside earlier, but the healing process may take 1 to 2 months. Patients should be counseled to take the drug for the length of time prescribed. Reducing the dose or taking less frequently is not recommended.

13. A patient who is taking diphenoxylate with atropine (Lomotil) to treat diarrhea asks the nurse why it contains atropine. The nurse will explain that atropine is added, in part, to: a. decrease abdominal cramping. b. increase intestinal motility. c. minimize nausea and vomiting. d. provide analgesia.

a. decrease abdominal cramping. Atropine is added to decrease abdominal cramping and slow intestinal motility through its anticholinergic effects. It does not affect nausea and vomiting or pain.

A patient who takes the oral antidiabetic agent metformin (Glucophage) will begin taking levothyroxine (Synthroid). The nurse will teach this patient to monitor for a. hyperglycemia. b. hypoglycemia. c. hyperkalemia. d. hypokalemia.

a. hyperglycemia. Insulin and oral antidiabetic drugs may need to be increased in patients taking levothyroxine. Patients should be taught to monitor for hyperglycemia, because of the reduced effects of these drugs.

6. The nurse is teaching a group of nursing students about the use of antipsychotic drugs for antiemetic purposes. The nurse will explain that, when given as antiemetics, these drugs are given: a. in smaller doses. b. less frequently. c. with anticholinergics. d. with antihistamines.

a. in smaller doses. Antipsychotic medications are used in smaller doses when administered for antiemetic purposes.

16. An appropriate goal when teaching a patient who has diarrhea is that the patient: a. will have less frequent, more formed stools. b. will not have a stool for 1 to 2 days. c. will receive adequate intravenous fluids. d. will receive appropriate antibiotic therapy.

a. will have less frequent, more formed stools. An appropriate goal is that patients will have formed, less frequent stools, not an absence of stools. Receiving adequate intravenous fluids or antibiotic therapy are interventions, not goals.

A parent expresses concern that a 5-year-old child may develop epilepsy because the child experienced a febrile seizure at age 18 months. What will the nurse tell this parent? a. "A child who has had a febrile seizure is considered to have epilepsy." b. "A small percentage of children who have febrile seizures develop epilepsy." c. "I recommend discussing prophylactic anticonvulsant drugs with the provider." d. "Treat fevers aggressively with aspirin and NSAIDs to prevent seizures."

b. "A small percentage of children who have febrile seizures develop epilepsy."

15. A patient asks the nurse the best way to prevent traveler's diarrhea. The nurse will provide which recommendation to the patient? a. "Ask your provider for prophylactic antibiotics." b. "Drink bottled water and eat only well-cooked meats." c. "Eat fresh, raw fruits and vegetables." d. "Take loperamide (Imodium) every day."

b. "Drink bottled water and eat only well-cooked meats." Patients traveling to areas with potential traveler's diarrhea should be counseled to drink bottled water and eat meats that are well cooked. Prophylactic antibiotics are not recommended. Patients should eat cooked, washed fruits and vegetables. Loperamide is not recommended for use as a prophylactic agent.

A 25-year-old female patient will begin taking phenytoin for epilepsy. The patient tells the nurse she is taking oral contraceptives (OCPs). Which response will the nurse give? a. "Continue taking OCPs because phenytoin is not safe during pregnancy." b. "You should use a backup method of contraception along with OCPs." c. "You should stop taking OCPs because of drug-drug interactions with phenytoin." d. "You should take low-dose aspirin while taking these medications to reduce your risk of stroke."

b. "You should use a backup method of contraception along with OCPs."

A patient is receiving a glucocorticoid medication to treat an inflammatory condition, and the provider has ordered a slow taper in order to discontinue this medication. The nurse explains to the patient that this is done to prevent which condition? a. Acromegaly b. Adrenocortical insufficiency c. Hypertensive crisis d. Thyroid storm

b. Adrenocortical insufficiency Patients receiving glucocorticoids stop making their own cortisol. These drugs should be tapered slowly to allow the body to resume making this hormone. Acromegaly is associated with growth hormone hypersecretion. Hypertensive crisis and thyroid storm are associated with thyroid replacement.

A patient has hypocalcemia caused by parathyroid hormone deficiency. Which medication will the nurse anticipate giving to this patient? a. Calcitonin b. Calcitriol c. Calcium d. Vitamin D

b. Calcitriol Calcitriol (vitamin D analogue) is given for management of hypocalcemia caused by parathyroid hormone deficiency. Calcitonin is used to treat hyperparathyroidism.

6. Which antacid is most likely to cause acid rebound? a. Aluminum hydroxide b. Calcium carbonate c. Magnesium hydroxide d. Magnesium trisilicate

b. Calcium carbonate While calcium carbonate is most effective among the listed antacids in neutralizing acid, a significant amount can be systemically absorbed and can cause acid rebound. The other antacids do not have significant systemic absorption.

A female patient who takes phenytoin for epilepsy becomes pregnant. The nurse will notify the patient's provider and will anticipate that the provider will take which action? a. Add valproic acid (Depakote) for improved seizure control. b. Change the medication to phenobarbital (Luminal). c. Closely monitor this patient's serum phenytoin levels. d. Discontinue all anticonvulsant medications.

b. Change the medication to phenobarbital (Luminal).

The nurse is caring for a patient who is being treated for hypothyroidism. The patient reports insomnia, nervousness, and flushing of the skin. Before notifying the provider, the nurse will perform which action? a. Assess serum glucose to evaluate possible hypoglycemia. b. Check the patients heart rate to assess for tachycardia. c. Perform an assessment of hydration status. d. Take the patients temperature to evaluate for infection.

b. Check the patients heart rate to assess for tachycardia. The patient has signs of a thyroid crisis, which can occur with excess ingestion of thyroid hormone. The nurse should evaluate heart rate before notifying the provider. These are not symptoms of hypoglycemia. The symptoms are not indicative of infection.

The nurse is caring for a patient who has been diagnosed with (petit mal) absence seizures. The nurse will anticipate teaching this patient about which antiepileptic medication? a. Carbamazepine (Tegretol) b. Ethosuximide (Zarontin) c. Phenobarbital (Luminal) d. Phenytoin (Dilantin)

b. Ethosuximide (Zarontin)

10. A female patient with a peptic ulcer asks the nurse if misoprostol would be a good option for her because it works well for her mother. Upon review of her medication list it is noted that she takes a prenatal vitamin daily. What will the nurse do? a. Recommend use of misoprostol since it works well for her mother. b. Explain to the patient that misoprostol is contraindicated during pregnancy and for women of childbearing age. c. Tell the patient to purchase misoprostol over the counter. d. Tell her that misoprostol is just another PPI and that she should just purchase a PPI that is available over the counter.

b. Explain to the patient that misoprostol is contraindicated during pregnancy and for women of childbearing age. Misoprostol is a synthetic prostaglandin analog that can be used to prevent and treat peptic ulcers, particularly in people using high doses of NSAIDs. As a prostaglandin analog, misoprostol is contraindicated during pregnancy and for women of childbearing age. Misoprostol is available by prescription only.

9. The parent of a child who is receiving chemotherapy asks the nurse why metoclopramide (Reglan) is not being used to suppress vomiting. The nurse will explain that, in children, this drug is more likely to cause which adverse effect? a. Excess sedation b. Extrapyramidal symptoms c. Paralytic ileus d. Vertigo

b. Extrapyramidal symptoms Metoclopramide can cause extrapyramidal symptoms, and these effects are more likely in children. Children are not more prone to sedative effects, paralytic ileus, or vertigo while taking this drug.

3. The parent of an 18-month-old toddler calls the clinic to report that the child has vomited 5 times that day. The nurse determines that the child has had three wet diapers in the past 6 hours. What will the nurse recommend for this child? a. Administering an OTC antiemetic medication such as diphenhydramine b. Giving frequent, small amounts of Pedialyte c. Keeping the child NPO until vomiting subsides d. Taking the child to the emergency department for IV fluids

b. Giving frequent, small amounts of Pedialyte The child is not dehydrated as evidenced by adequate wet diapers, so nonpharmacologic measures, such as oral fluids, are recommended. Antiemetics are not recommended unless dehydration occurs. Intravenous fluids are given when dehydration is present.

2. The nurse is caring for a patient who has unexplained, recurrent vomiting and who is unable to keep anything down. Until the cause of the vomiting is determined, the nurse will anticipate administering which medications? a. Antibiotics and antiemetics b. Intravenous fluids and electrolytes c. Nonprescription antiemetics d. Prescription antiemetics

b. Intravenous fluids and electrolytes Antiemetics can mask the underlying cause of vomiting and should not be used until the cause is determined unless vomiting is so severe that dehydration and electrolyte imbalance occur. Nonpharmacologic measures, such as fluid and electrolyte replacement, should be used. Antibiotics are only used if an infectious cause is determined.

A patient is admitted to the hospital to treat hypothyroidism. For rapid improvement in symptoms, the nurse will expect to administer which medication? a. Levothyroxine sodium (Synthroid) b. Liothyronine (Cytomel) c. Liotrix (Thyrolar) d. Thyroid desiccated (Armour Thyroid)

b. Liothyronine (Cytomel) Liothyronine has a short half-life and rapid onset of action and is not recommended for maintenance therapy but is used as initial therapy for severe myxedema. Levothyroxine is the drug of choice for replacement therapy and also treats simple goiter, Hashimoto thyroiditis. Thyroid desiccated is used for hypothyroidism to reduce goiter size.

A male patient who has been taking a histamine2 blocker for several months reports decreased libido and breast swelling. What will the nurse do? a. Contact the provider to report possible drug toxicity. b. Reassure the patient that these symptoms will stop when the drug is discontinued. c. Request an order for serum hormone levels. d. Suggest that the patient see an endocrinologist.

b. Reassure the patient that these symptoms will stop when the drug is discontinued.

A patient has recently begun taking phenytoin (Dilantin) for a seizure disorder. The nurse notes a reddish-brown color to the patient's urine. Which action will the nurse take? a. Ask the provider to order a serum drug level. b. Reassure the patient that this is a harmless side effect. c. Report possible thrombocytopenia to the provider. d. Request an order for a urinalysis and creatinine clearance.

b. Reassure the patient that this is a harmless side effect.

1. A patient who has been instructed to use a liquid antacid medication to treat gastrointestinal upset asks the nurse about how to take this medication. What information will the nurse include when teaching this patient? a. Take a laxative if constipation occurs. b. Take 60 minutes after meals and at bedtime. c. Take with at least 8 ounces of water to improve absorption. d. Take with milk to improve effectiveness.

b. Take 60 minutes after meals and at bedtime. Since maximum acid secretion occurs after eating and at bedtime, antacids should be taken 1 to 3 hours after eating and at bedtime. Taking antacids with meals slows gastric emptying time and causes increased gastrointestinal (GI) secretions. Patients should not self-treat constipation or diarrhea. Patients should use 2 to 4 ounces of water when taking to ensure that the drug enters the stomach; more than that will increase gastric emptying time. If possible, antacids should not be taken with milk or foods high in vitamin D.

4. A patient with a peptic ulcer has been diagnosed with H. pylori. The provider has ordered lansoprazole (Prevacid), clarithromycin (Biaxin), and metronidazole (Flagyl). The patient asks the nurse why two antibiotics are needed. The nurse will explain that two antibiotics a. allow for less toxic dosing. b. combat bacterial resistance. c. have synergistic effects. d. improve acid suppression.

b. combat bacterial resistance. The use of two antibiotics when treating H. pylori peptic ulcer disease helps to combat bacterial resistance because H. pylori develops resistance rapidly. Giving two antibiotics, in this case, is not to reduce the dose or to cause synergistic effects. Antibiotics do not affect acid production.

A patient is diagnosed with epilepsy and asks the nurse what may have caused this condition. The nurse explains that epilepsy is most often a. caused by head trauma. b. idiopathic in origin. c. linked to a stroke. d. related to brain anoxia.

b. idiopathic in origin.

A patient is diagnosed with epilepsy and asks the nurse what may have caused this condition. The nurse explains that epilepsy is most often: a. caused by head trauma. b. of unknown origin. c. linked to a stroke. d. related to brain anoxia.

b. of unknown origin.

1. A patient who experiences motion sickness when flying asks the nurse the best time to take the medication prescribed to prevent motion sickness for a 0900 flight. The nurse will instruct the patient to take the medication at which time? a. As needed, at the first sign of nausea b. At 0700, before leaving for the airport c. At 0830, just prior to boarding the plane d. When seated, just prior to takeoff

c. At 0830, just prior to boarding the plane Motion sickness medication has its onset in 30 minutes. The patient should be instructed to take the medication a half hour prior to takeoff. It is not used as needed.

A patient who takes warfarin (Coumadin) and digoxin (Lanoxin) develops hypothyroidism and will begin taking levothyroxine (Synthroid). The nurse anticipates which potential adjustments in dosing for this patient? a. Decreased digoxin and decreased warfarin b. Decreased digoxin and increased warfarin c. Increased digoxin and decreased warfarin d. Increased digoxin and increased warfarin

c. Increased digoxin and decreased warfarin Thyroid preparations increase the effect of oral anticoagulants because of drug displacement from protein-binding sites (highly protein bound) so the warfarin dose may need to be decreased. Levothyroxine can decrease the effectiveness of digoxin, so this dose may need to be increased. Other interactions: - Adrenergic agents (decongestants/vasopressor) = cardiac and CNS actions are increased - Insulin and antidiabetics need to be increased

The parent of a toddler asks the nurse what can be done to prevent otitis media. What will the nurse recommend? a. Administer diphenhydramine when the child has a runny nose. b. Give phenylephrine (Neo-Synephrine Ophthalmic) to prevent congestion. c. Keep the child's immunizations up to date. d. Remove cerumen with carbamide peroxide (Auro Ear Drops).

c. Keep the child's immunizations up to date.

The nurse is performing a health history on a patient who is ordered to begin therapy with valproic acid (Depakote) to treat epilepsy. Which aspect of the patient's medical history will cause the nurse to be concerned? a. Chronic obstructive pulmonary disease b. Gastrointestinal disease c. Liver disease d. Renal disease

c. Liver disease

A pregnant woman who is in labor has a blood pressure of 189/110 mm Hg and exhibits muscle contractions followed by jerking of her arms and legs. The nurse will prepare to administer which medication to this patient? a. Carbamazepine (Tegretol) b. Diazepam (Valium) c. Magnesium sulfate d. Phenobarbital (Luminal)

c. Magnesium sulfate

A patient reports experiencing flatulence and abdominal distension to the nurse. Which over-the-counter medication will the nurse recommend? a. Alka-Seltzer b. Maalox c. Mylicon d. Tums

c. Mylicon

A patient with Graves disease exhibits tachycardia, heat intolerance, and exophthalmos. Prior to surgery, which drug is used to alter thyroid hormone levels? a. Liotrix (Thyrolar) b. Propranolol (Inderal) c. Propylthiouracil (PTU) d. Thyroid (Thyrotab)

c. Propylthiouracil (PTU) Graves disease is common type of hyperthyroidism, characterized by tachycardia, palpitations, excessive perspiration, heat intolerance, nervousness, irrtability, exophthalmos (bulging eyes) and weight loss. Propylthiouracil and methimazole is a potent antithyroid drug used in preparation for a subtotal thyroidectomy (surgical removal). Liotrix and thyroid are used as thyroid replacement. Propranolol is used to treat hypertension associated with hyperthyroidism.

9. A patient who is diagnosed with peptic ulcer disease has been started on a regimen that includes ranitidine (Zantac) 300 mg daily at bedtime. The patient calls the clinic 2 days later to report no relief from discomfort. What action will the nurse take? a. Contact the provider to discuss changing to cimetidine (Tagamet). b. Notify the provider to discuss increasing the dose. c. Reassure the patient that it may take 1 to 2 weeks to notice an improvement insymptoms. d. Suggest that the patient split the medication into twice daily dosing.

c. Reassure the patient that it may take 1 to 2 weeks to notice an improvement insymptoms. Patients taking histamine2 blockers can expect abdominal pain to decrease after 1 to 2 weeks of drug therapy. Cimetidine is not as potent as ranitidine and interacts with many medications through the cytochrome P450 system. Three hundred milligrams is the maximum recommended dose.

14. A patient reports experiencing flatulence and abdominal distension to the nurse. Which over-the-counter medication will the nurse recommend? a. Alka-Seltzer b. Maalox c. Simethicone d. Tums

c. Simethicone Simethicone is an antigas agent. Maalox Gas contains simethicone, while regular Maalox does not. The other products do not contain simethicone.

The nurse is caring for an African American patient who has been diagnosed with glaucoma. The nurse anticipates that which medication will be most effective for this client? a. Bimatoprost (Lumigan) b. Latanoprost (Xalatan) c. Travoprost (Travatan Z) d. Unoprostone (Rescula)

c. Travoprost (Travatan Z)

8. A woman who is 2 months pregnant reports having morning sickness every day and asks if she can take any medications to treat this problem. The nurse will recommend that the patient try which intervention first? a. Discuss a possible need for intravenous fluids with her provider. b. Contacting the provider to discuss prescribing a prescription antiemetic. c. Use nonpharmacologic measures, such as eating crackers or dry toast. d. Take over-the-counter antiemetics such as diphenhydramine.

c. Use nonpharmacologic measures, such as eating crackers or dry toast. To minimize risk to the fetus, the nurse should first recommend nonpharmacologic measures such as drinking flat soda or weak tea or eating crackers or dry toast. If this is not effective, intravenous fluids may become necessary depending on the severity of vomiting and dehydration. Pregnant women should consult with their provider before taking prescription or over-the-counter antiemetics.

A patient is taking prednisolone and fludrocortisone (Florinef). When teaching this patient about dietary intake, the nurse will instruct the patient to consume a diet a. high in carbohydrates. b. high in fat. c. high in protein. d. low in potassium.

c. high in protein. Patients receiving fludrocortisone are at risk for negative nitrogen balance and should consume a high-protein diet

The parents of an 11-year-old boy ask about growth hormone therapy for their child who is shorter than his 10-year-old sister. The nurse will tell the parents that growth hormone a. does not affect other hormones when given. b. is available as an oral tablet to be taken once daily. c. is given after tests prove that it is necessary. d. may be given until the childs desired height is reached.

c. is given after tests prove that it is necessary. Growth hormone is given only when growth hormone deficiency is determined. It cannot be given orally because they are inactivated by GI enzymes. It antagonizes insulin secretion and thus can lead to the development of diabetes mellitus. Because GU acts on newly forming bone, it cannot be given after the epiphyses are fused.

The nurse is counseling an adolescent patient who has recurrent otitis externa and who works as a lifeguard in the summer about preventing this condition. The nurse will teach this patient to do which of the following? a. avoid using ear plugs while swimming. b. request a prescription for prophylactic antibiotic eardrops. c. use a hair dryer to dry the ears after swimming. d. wear a medical alert bracelet.

c. use a hair dryer to dry the ears after swimming.

The nurse provides teaching for a patient who will begin taking phenytoin. Which statement by the patient indicates understanding of the teaching? a. "If I develop a rash, I should take diphenhydramine to control the itching." b. "If I experience bleeding gums, I should stop taking the medication immediately." c. "I may develop diabetes while I am taking this medication." d. "I should not be alarmed if my urine turns reddish-brown."

d. "I should not be alarmed if my urine turns reddish-brown."

The nurse is providing teaching for a patient who will begin using tobramycin ointment (Nebcin) 0.5 inches 3 times daily. The patient currently uses pilocarpine HCl (Isopto Carpine) drops to treat glaucoma. Which statement by the patient indicates a need for further teaching? a. "I should apply the third dose of tobramycin at bedtime each day." b. "I should instill the drops in the conjunctival sac of the lower eyelid." c. "I should not stop the medications without consulting my provider." d. "I should put the ointment on first and then instill the eyedrops."

d. "I should put the ointment on first and then instill the eyedrops."

11. A patient asks the nurse about using loperamide (Imodium) to treat infectious diarrhea. Which response will the nurse give? a. "Loperamide results in many central nervous system (CNS) side effects." b. "Loperamide has no effect on infectious diarrhea." c. "Loperamide is taken once daily." d. "Loperamide can be used to treat diarrheal symptoms but may also slow the exit of the infectious organisms from the GI tract."

d. "Loperamide can be used to treat diarrheal symptoms but may also slow the exit of the infectious organisms from the GI tract." Patients with infectious diarrhea should be cautioned about using loperamide since slowing transit through the intestines may prolong the exposure to the infectious agent. Loperamide causes less CNS depression than other antidiarrheals. It is taken multiple times per day as needed.

The nurse is providing teaching to the parents of a 5-year-old child who will begin taking phenytoin (Dilantin). What information will the nurse include when teaching these parents about their child's medication? a. "Drug interactions are uncommon with phenytoin." b. "There are very few side effects associated with this drug." c. "The therapeutic range of phenytoin is between 15 and 30 mcg/mL." d. "Your child may need a higher dose than is usually used in adults."

d. "Your child may need a higher dose than is usually used in adults."

5. The nurse is caring for a patient who has postoperative nausea and vomiting. The surgeon has ordered promethazine HCl (Phenergan). Which aspect of this patient's health history would be of concern? a. Asthma b. Diabetes c. GERD d. Glaucoma

d. Glaucoma Promethazine is contraindicated in patients with glaucoma since it is an anticholinergic medication. It should be used with caution in patients with asthma. The other two conditions are not concerning with this medication.

A patient has an infection of the eyelash follicles and in the gland on the eyelid margin. The nurse recognizes these symptoms as being consistent with which condition? a. Blepharitis b. Chalazion c. Endophthalmitis d. Hordeolum

d. Hordeolum

11. A patient who has been taking ranitidine (Zantac) continues to have pain associated with a peptic ulcer. A noninvasive breath test is negative. Which treatment does the nurse expect the provider to order for this patient? a. Adding an over-the-counter antacid to the patient's drug regimen b. A dual drug therapy regimen c. Amoxicillin (Amoxil), clarithromycin (Biaxin), and omeprazole (Prilosec) d. Lansoprazole (Prevacid) instead of ranitidine

d. Lansoprazole (Prevacid) instead of ranitidine This patient does not have H. pylori ulcer disease, so dual and triple drug therapy with antibiotics is not indicated. Patients who fail treatment with a histamine2 blocker should be changed to a proton pump inhibitor (PPI) such as lansoprazole. PPIs tend to inhibit gastric acid secretion up to 90% greater than the histamine antagonists.

A 35-year-old woman reports lethargy, difficulty remembering things, facial edema, dry skin, and cessation of menses. The nurse notes a heart rate of 60 beats per minute and a weight increase of 5 pounds from a previous visit. The nurse will notify the provider of which possible condition? a. Cretinism b. Early menopause c. Hyperthyroidism d. Myxedema

d. Myxedema Myxedema is severe hypothyroidism Symptoms: lethargy, memory loss, emotional changes, slow speech, deep coarse voice, facial edema, dry skin, cold intolerance, low HR, weight gain, abnormal menses Cretinism is congenital hypothyroidism. Hyperthyroidism would include tachycardia and weight loss.

Which would be a contraindication for hormone therapy with somatropin (Genotropin) in a school-age child? a. Asthma b. Dwarfism c. Enuresis d. Prader-Willi syndrome

d. Prader-Willi syndrome Somatropin (Genotropin) is a GH to treat growth failure (GH deficiency). It is contraindicated in pediatric patients who have Prader-Willi syndrone, severely obese or severe respiratory impairment because fatalities have been reported. It is not contraindicated in patients with asthma or enuresis. Dwarfism is an indication for hormone therapy.

7. An elderly patient reports using Maalox frequently to treat acid reflux. The nurse should notify the patient's provider to request an order for which laboratory tests? a. Liver enzymes and serum calcium b. Liver enzymes and serum magnesium c. Renal function tests and serum calcium d. Renal function tests and serum magnesium

d. Renal function tests and serum magnesium Maalox contains magnesium and carries a risk of hypermagnesemia, especially with decreased renal function. Older patients have an increased risk of poor renal function, so this patient should especially be evaluated for hypermagnesemia.

A patient who takes high-dose aspirin to treat arthritis will need to take prednisone to treat an acute flare of symptoms. What action will the nurse perform? a. Observe the patient for hypoglycemia. b. Monitor closely for increased urine output. c. Observe the patient for hypotension. d. Request an order for enteric-coated aspirin

d. Request an order for enteric-coated aspirin. Glucocorticoids can increase gastric distress, so an enteric-coated aspirin product is indicated. Glucocorticoids increase the risk of hyperglycemia, fluid retention (edema), and hypertension.

14. The nurse is caring for an older adult who is receiving diphenoxylate with atropine (Lomotil) to treat severe diarrhea. The nurse will monitor this patient closely for which effect? a. Bradycardia b. Fluid retention c. Urinary incontinence d. Respiratory depression

d. Respiratory depression Diphenoxylate is an opioid agonist and can cause respiratory depression. Children and older adults are more susceptible to this effect. It contains atropine, so it will increase heart rate and potentially contribute to urinary retention. It does not contribute to fluid retention.

The nurse is caring for a patient who has myasthenia gravis. The nurse will be alert to symptoms affecting which body system which may indicate that the patient has transitioned to myasthenic crisis? a. Cardiovascular system b. Central nervous system (CNS), memory, and cognition c. Gastrointestinal system (GI) and lower extremity muscles d. Respiratory system

d. Respiratory system

The nurse is caring for a patient who is receiving growth hormone. Which assessment will the nurse monitor daily? a. Complete blood count b. Height and weight c. Renal function d. Serum glucose

d. Serum glucose Growth hormone antagonizes insulin secretion, so serum glucose should be monitored.

A patient who has hyperthyroidism will begin treatment with an antithyroid medication. The patient asks the nurse about dietary requirements. The nurse will counsel the patient to avoid which food(s)? a. Fava beans b. Foods high in purine c. Grapefruit d. Shellfish

d. Shellfish Shellfish contains iodide which suppresses thyroid function. There is no need to avoid fava beans, purine, or grapefruit.

. A patient will begin taking the antiepileptic drug ethosuximide (Zarontin). Ethosuximide works by which of the following mechanisms? a. Suppressing sodium influx b. Increasing GABA activity c. Decreasing GABA activity d. Suppressing calcium influx

d. Suppressing calcium influx

The nurse is caring for a patient who has hypothyroidism. To assist in differentiating between primary and secondary hypothyroidism, the nurse will expect the provider to order which drug? a. Liothyronine sodium (Cytomel) b. Liotrix (Thyrolar) c. Methimazole (Tapazole) d. Thyrotropin (Thytropar)

d. Thyrotropin (Thytropar) Thyrotropin is a purified extract of thyroid-stimulating hormone and is used as a diagnostic agent to differentiate between primary and secondary hypothyroidism. Primary = caused by thyroid gland disorder Secondary = decerase in TSH secretion Liothyronine, liotrix are thyroid replacement drugs. Methimazole decreases thyroid hormone secretion

he nurse is caring for a patient who is receiving desmopressin acetate (DDAVP). Which assessments are important while caring for this patient? a. Blood pressure and serum potassium b. Heart rate and serum calcium c. Lung sounds and serum magnesium d. Urine output and serum sodium

d. Urine output and serum sodium Desmopressin is an antidiuretic hormone. The nurse should monitor intake and output as well as serum sodium levels.

The parents of a 16-year-old boy who plays football want their child to receive growth hormone to improve muscle strength. What will the nurse tell the parents? a. Growth hormone may be used to improve strength in young athletes. b. If the epiphyses are not fused, growth hormone may be an option. c. Small doses of growth hormone may be used indefinitely for this purpose. d. Using growth hormone to build muscle mass is not recommended.

d. Using growth hormone to build muscle mass is not recommended Athletes should be advised not to take growth hormone to build muscle because of its effects on blood sugar and other side effects.

The nurse is caring for a patient who has experienced head trauma in a motor vehicle accident. The patient is having excessive output of dilute urine. The nurse will notify the provider and will anticipate administering which medication? a. Calcifediol (Calderol) b. Corticotropin (Acthar) c. Prednisolone (AK-Pred) d. Vasopressin (Pitressin)

d. Vasopressin (Pitressin) The posterior pituitary gland secretes antidiuretic hormone (ADH) (vasopressin and desmopression). When there is a deficiency of ADH, sometimes caused by head trauma/brain tumor, patients excrete large amounts of urine (diabetes insipidus). ADH replacement is necessary to prevent fluid imbalance. Calcifediol is used to treat parathyroid disorders. Corticotropin and prednisolone do not prevent diuresis.

A woman who is pregnant is taking an anticonvulsant medication to treat a seizure disorder. The nurse will ensure that the patient takes which dietary supplement toward the end of her pregnancy? a. Vitamin D b. Iron c. Vitamin C d. Vitamin K

d. Vitamin K

12. A patient has been taking famotidine (Pepcid) 20 mg bid to treat an ulcer but continues to have pain. The provider has ordered lansoprazole (Prevacid) 15 mg per day. The patient asks why the new drug is necessary, since it is more expensive. The nurse will explain that lansoprazole: a. can be used for long-term therapy. b. does not interact with other drugs. c. has fewer medication side effects. d. is more potent than famotidine.

d. is more potent than famotidine. Famotidine is a histamine2 (H2) blocker. When patients fail therapy with these agents, proton pump inhibitors, which can inhibit gastric acid secretion up to 90% greater than the H2 blockers, are used. Lansoprazole is not for long-term treatment and has drug interactions and drug side effects, as do all other medications.

13. The nurse is caring for a patient who will begin taking omeprazole (Prevacid) 20 mg per day for 4 to 8 weeks to treat gastroesophageal reflux disease esophagitis. The nurse learns that the patient takes digoxin. The nurse will contact the provider for orders to: a. decrease the dose of omeprazole. b. increase the dose of digoxin. c. increase the omeprazole to 60 mg per day. d. monitor for digoxin toxicity.

d. monitor for digoxin toxicity. Proton pump inhibitors can enhance the effects of digoxin, so patients should be monitored for digoxin toxicity. Changing the dose of either medication is not indicated prior to obtaining lab results that indicated elevated digoxin levels.

The nurse is preparing to administer piperacillin to a patient to treat an infection caused by pseudomonas. The nurse learns that the patient receives corticotropin to treat multiple sclerosis. The nurse will request an order for a. a different antibiotic. b. blood glucose monitoring. c. cardiac monitoring. d. serum electrolytes.

d. serum electrolytes. Corticotropin can interact with piperacillin and diuretics to cause hypokalemia, so serum electrolytes should be monitored. Other interactions: Phenytoin, rifampin, barbiturates increase metabolic rate, which decreases effect of corticotropin It is not necessary to change the antibiotic. Blood glucose monitoring and cardiac monitoring are not indicated.

A patient who has symptoms of peptic ulcer disease will undergo a test that requires drinking a liquid containing 13C urea and breathing into a container. The nurse will explain to the patient that this test is performed to a. assess the level of hydrochloric acid. b. detect H. pylori antibodies. c. measure the pH of gastric secretions. d. test for the presence of 13CO2.

d. test for the presence of 13CO2.

2. A patient who has symptoms of peptic ulcer disease will undergo a test that requires drinking a liquid containing 13C urea and breathing into a container. The nurse will explain to the patient that this test is performed to a. assess the level of hydrochloric acid. b. detect H. pylori antibodies. c. measure the pH of gastric secretions. d. test for the presence of H. pylori.

d. test for the presence of H. pylori. When H. pylori is suspected, a noninvasive test is performed by administering 13C urea, which, in the presence of H. pylori, will release 13CO2. The test does not measure the amount of HCl acid or the pH and does not detect H. pylori antibodies.

A patient will begin taking the antiepileptic drug ethosuximide (Zarontin) and asks the nurse whether to take the drug with or without food. The nurse will counsel the patient to take this medication a. at bedtime. b. 1 hour before meals. c. 2 hours after meals. d. with meals.

d. with meals.