FINAL PHARM

#2 QUIZ N.S. The mechanism of action for carbidopa (Lodosyn), used in the treatment of Parkinson's disease is: Select one: a) increasing availability of levodopa available to the CNS by reducing its breakdown b) activating dopamine receptors in the CNS c) decreasing cholinergic receptor activation in the CNS

a

A client with peptic ulcer disease asks the nurse what medications they might be prescribed for this problem. The nurse tells the client that which medications will be prescribed? Select all that apply. Select one or more: a) Antibiotics b) Nonsteroidal anti-inflammatory drugs (NSAIDs) (it's contraindicated in peptic ulcer disease bc of bleeding!!) c) Histamine H2-receptor blockers d) Antacids e) Proton Pump Inhibitors

a, c, d & e

#3 QUIZ CARDIOVASCULAR Intravenous heparin therapy is prescribed for a client. While implementing this prescription, the nurse ensures that which medication is available on the nursing unit? Select one: a) Protamine sulfate (should be readily available for use if excessive bleeding or hemorrhage should occur) b) Potassium chloride (given for a potassium deficit) c) Vitamin K (antidote for warfarin sodium) d) Aminocaproic acid (antidote for thrombolytic therapy)

a

A 17 year-old high school athlete with a history of asthma comes to your clinic seeking a preventative medication for migraine headaches. Which of the following would be contraindicated? a) Propranolol (Inderal) (beta 1-blocker antagonist is contraindicated---would keep the pt's HR is down during exercise & can intervene in beta-2 antagonist bronchodilator (Albuterol) which treats asthma) b) Amitriptyline (Axert) c) Topiramate (Topamax) d) Valproate (valproic acid)

a

A child is receiving a combination albuterol/ipratropium [DuoNeb] inhalation treatment. The patient complains of a dry mouth and sore throat. What will the nurse do? Select one: a) Reassure the patient that these are expected side effects. b) Discontinue the aerosol treatment immediately. c) Contact the provider to report systemic anticholinergic side effects. d) Notify the provider of a possible allergic reaction.

a

A child with otitis media has had three ear infections in the past year. The child has just completed a 10-day course of amoxicillin [Amoxil] with no improvement. The parent asks the nurse why this drug is not working, because it has worked in the past. What will the nurse tell the patient? Select one: a) "The bacteria have synthesized penicillinase." b) "Amoxicillin is too narrow in spectrum." c) "The bacteria have developed penicillin-binding proteins (PBPs) that have a low affinity for penicillins." d) "The bacteria have developed a three-layer cell envelope."

a

A client has a new prescription for metoclopramide (Reglan). On review of the chart, the nurse identifies that this medication can be safely administered with which condition? Select one: a) Vomiting following cancer chemotherapy (Metoclopramide-- GI stimulant & antiemetic / it's contraindicated w/ GI obstruction, hemorrhage & perforation) / used for after surgery, chemo & radiation) b) Diverticulitis with perforation c) Peptic ulcer with melena (bloody stool) d) Intestinal obstruction

a

A client is taking methimazole (Tapazole) for hyperthyroidism and would like to know how soon this medication will begin working. What is the nurse's best response? Select one: a) "You will see some effects of this medication within 2 weeks." (RIGHT, Methimazole blocks thyroid hormone production by preventing iodide binding in thyroid gland--- response to drugs delayed bc pt has large amounts of TSH that keep getting released / more weeks needed to see therapeutic effect) b) "You will see full effects from this medication within 1 to 2 days."(wrong, takes 2 weeks) c) "You will see effects of this medication within 1 week."(wrong, takes 2 weeks) d) "You will see effects of this medication immediately." (wrong, takes 2 weeks)

a

A client with diabetic neuropathy reports a burning, electrical-type in the lower extremities that is not responding to NSAIDs. You anticipate that the physician will order which adjuvant medication for this type of pain? a) Amitriptyline (Elavil) (antidepressant--- given for diabetic neuropathy) b) Methylphenidate (Ritalin) (wrong, given to counteract sedation if client is on opioids) c) Corticosteroids (wrong, given for pain associated w/ inflammation) d) Lorazepam (Ativan) (wrong, it's an anxiolytic)

a

A client with type 1 diabetes mellitus received regular insulin at 7:00 a.m. The client will need to be monitored for hypoglycemia at which time? Select one: a) 11:00am (since regular insulin is short-acting, onset of action is 1/2 to 1 hr. PEAK EFFECT is 2-4 hrs / asses if they eat meals, monitor for hypoglycemia at onset of any insulin) b) 7:30pm c) 7:30 am d) 2:00pm

a

A nurse administers medications to a patient who has asthma. Which medication classification is paired correctly with its physiologic response to the medication? Select one: a) Cholinergic antagonist—causes bronchodilation by inhibiting the parasympathetic nervous system b) Bronchodilator—stabilizes the membranes of mast cells and prevents the release of inflammatory mediators c) Cromolyn—disrupts the production of pathways of inflammatory mediators d) Corticosteroid (Glucocorticoid)—relaxes bronchiolar smooth muscles by binding to and activating pulmonary beta2 receptors

a

A nurse administers quinidine sulfate to a patient with atrial fibrillation. The nurse should assess the electrocardiogram (ECG) tracing knowing that quinidine sulfate has what effect on the ECG? Select one or more: a) Prolongation of the QT interval (widens QRS complex & prolongs QT interval) b) Tall, peaked T waves c) Narrowing of the QRS complex d) Prolongation of the PR interval

a

A nurse is preparing to administer medications. Which patient would the nurse consider to have the greatest predisposition to an adverse reaction? Select one: a) A 30-year-old man with kidney disease b) A 75-year-old woman with cystitis c) A 50-year-old man with an upper respiratory tract infection d) A 9-year-old boy with an ear infection

a

A patient has a prescription to take a powdered form of psyllium after discharge. The nurse should plan to include which information when teaching the client about this medication? Select one: a) Mix the medication with a full glass of water or juice (psyllium, bulk-forming laxative that must be taken w/ glass of water or juice---prevents impaction of med in stomach or small intestine) b) Mix the medication with applesauce. (not true) c) Decrease the amount of fiber in the diet when taking this medication. (not true, not unless told by PCP) d) Decrease fluid intake following administration of the medication. (not true, not unless told by PCP)

a

A patient has an infection caused by Pseudomonas aeruginosa.The prescriber has ordered piperacillin and amikacin, both to be given intravenously. What will the nurse do? Select one: a) Make sure to administer the drugs at different times using different IV tubing. b) Watch the patient closely for allergic reactions, because this risk is increased with this combination c) Suggest that a fixed-dose combination of piperacillin and tazobactam [Zosyn] be used d) Suggest giving larger doses of piperacillin and discontinuing the amikacin.

a

A patient has just received a prescription for fluticasone/salmeterol [Advair Diskus]. What will the nurse include as part of the teaching for this patient about the use of this device? Select one: a) "You do not need good hand-lung coordination to use this device." b) "You will take 2 inhalations twice daily." c) "You will begin to inhale before activating the device." d) "You will need to use a spacer to help control the medication."

a

A patient is admitted to the unit for treatment for an infection. The patient receives IV amikacin [Amikin] twice a day. When planning for obtaining a peak aminoglycoside level, when should the nurse see that the blood is drawn? Select one: a) 30 minutes after the IV infusion is complete b) 1 hour before administration of the IV infusion c) A peak level is not indicated with twice-daily dosing. d) 1 hour after the IV infusion is complete

a

A patient is beginning therapy with oral methotrexate [Rheumatrex] for rheumatoid arthritis. The nurse will teach this patient about the importance of: a) having routine renal and hepatic function tests (methotrexate---chemo agent for RA) (ADRS--- bone marrow suppression (infection, swollen nodes / alters liver function (bleeding, bruising, kidney failure / thus both must have to check liver & kidney routinely) b) reporting alopecia and rash. c) limiting folic acid consumption. d) taking the medication on a daily basis.

a

A patient receives a drug that has a narrow therapeutic range. The nurse administering this medication will expect to do what? Select one: a) Monitor plasma drug levels. b) Teach the patient that maximum drug effects will occur within a short period. c) Administer this medication intravenously. d) Administer the drug at intervals longer than the drug half-life.

a

A patient who has pancreatitis reports a pain level of 8 on a 1 to 10 pain scale with 10 being the most severe pain. The patient has an order for acetaminophen (Tylenol) as needed for pain, and has been taking it as ordered around the clock. Which action by the nurse is correct? Select one: a) Contact the prescriber and request the addition of an opioid b) Administer an additional dose of the acetaminophen (Tylenol) as ordered. c) Contact the provider to discuss nonpharmacologic pain measures d) Explain to the patient the importance not exceeding 4000mg of acetaminophen daily

a

A patient will begin taking hydroxychloroquine [Plaquenil] for rheumatoid arthritis. The patient is currently taking high-dose NSAIDs and methotrexate. What will the nurse teach the patient? Select one: a) That an eye exam is necessary at the beginning of therapy with this drug b) To stop taking methotrexate when starting hydroxychloroquine c) That the dose of NSAIDs may be decreased when beginning hydroxychloroquine d) To obtain tests of renal and hepatic function while taking this drug

a

A patient with chronic congestive heart failure has repeated hospitalizations in spite of ongoing treatment with hydrochlorothiazide [HydroDIURIL] (diuretic). The prescriber has ordered spironolactone [Aldactone] (diuretic) to be added to this patient's drug regimen, and the nurse provides education about this medication. Which statement by the patient is correct? Select one: a) "I need to stop taking potassium supplements." b) "I should use salt substitutes to prevent toxic side effects." c) "I can expect improvement within a few hours after taking this drug." d) "I should watch closely for dehydration."

a

A patient with gout who has increasingly frequent acute gouty attacks will begin receiving allopurinol [Zyloprim] and colchicine. The nurse will include which statement when teaching the patient about this drug regimen? Select one: a) "You will take both drugs initially and then stop taking the colchicine." b) "The colchicine is given to enhance the effects of the allopurinol." c) "Allopurinol helps reduce the gastrointestinal side effects of colchicine." d) "Allopurinol reduces the likelihood of gouty episodes that usually occur with initial colchicine therapy."

a

A patient with persistent, frequent asthma exacerbations asks a nurse about a long-acting beta2-agonist medication. What will the nurse tell this patient? Select one: a) LABAs should be combined with an inhaled glucocorticoid. b) LABAs are safer than short-acting beta2 agonists. c) LABAs reduce the risk of asthma-related deaths. d) LABAs can be used on an as-needed basis to treat symptoms.

a

A patient with stable COPD is prescribed a bronchodilator medication. Which type of bronchodilator is preferred for this patient? Select one: a) A long-acting inhaled beta2 agonist (watch out for oral candida / oral thrush) b) An oral beta2 agonist c) A short-acting beta2 agonist d) An intravenous methylxanthine

a

A young adult woman will begin using an inhaled glucocorticoid to treat asthma. The nurse will teach this patient about the importance of which action? Select one: a) Participating in weight-bearing exercises on a regular basis osteoporosis prevention (prevention for osteoporosis) b) Using two reliable forms of birth control to prevent pregnancy c) Lowering her calcium intake and increasing her vitamin D intake d) Taking oral glucocorticoids during times of acute stress

a

An older adult patient with severe gastroesophageal reflux disease (GERD) has had only minimal relief using a histamine2-receptor antagonist (H2RA). The patient is to begin taking omeprazole [Prilosec]. What will the nurse teach this patient? Select one: a) Long-term therapy may be needed. b) Lifestyle changes can be as effective as medication therapy. c) The medication will be used until surgery can be performed. d) A complete cure is expected with this medication.

a

Dopamine is administered to a patient who has been experiencing hypotensive episodes. Other than an increase in blood pressure, which indicator would the nurse use to evaluate a successful response to the dopamine? Select one: a) Increase in urine output b) Weight gain c) Improved gastric motility d) Decrease in pulse.

a

Jane is a 67 year-old woman with a history of mild hypertension and classic angina pectoris. She is seeking treatment for migraine headaches of moderate intensity. Her headaches are preceeded by bilateral light flashes and dizziness that last about 10 minutes prior to the onset of pain. Her headaches are also frequently accompanied by photophobia, severe nausea and occasional vomiting. What medication would be contraindicated for acute treatment of Jane's headaches? a) Sumatriptan (a serontoninergic, can cause vasoconstriction thus it's contraindicated for ppl w/ a history of ischemic heart disease & other peripheral vascular diseases & pregnancy) b) Propranolol c) Caffeine d) Aspirin e) Acetaminophen

a

The clinic nurse is providing instructions to a client with hypertension who will be taking captopril. Which statement by the client indicates a need for further instruction? Select one: a) "I need to drink at least 4 quarts (4 liters) of water daily." (aggrevate hypertension) b) "I need to change positions slowly." (should do this) c) "I need to sit down and rest if dizziness or lightheadedness occurs." (should do this, check OH as well as syncope) d) "I need to avoid taking hot baths or showers." (should do this) Captopril is an antihypertensive medication (angiotensin-converting enzyme [ACE] inhibitor)

a

The nurse is caring for a child who has ingested a toxic amount of aspirin. The provider orders an intravenous drug that will increase pH in the blood and urine. The nurse understands that this effect is necessary to: Select one: a) increase the urinary excretion of aspirin. b) decrease the lipid solubility of aspirin. c) increase the serum protein binding of aspirin. d) decrease the gastric absorption of aspirin.

a

The nurse is caring for a patient on a medical-surgical unit who has a fever of unknown origin. The prescriber has ordered a broad-spectrum antibiotic. Which intervention is the priority? Select one: a) Obtaining all cultures before the antibiotic is administered (not the results of the cultures) b) Delaying administration of the antibiotic until the culture results are available c) Administering antipyretics as soon as possible d) Administering the antibiotic immediately

a

The nurse is teaching a patient about home administration of insulin to treat diabetes mellitus. As part of the teaching, the patient and nurse identify goals to maintain specific blood glucose ranges. This represents which aspect of the nursing process? a) Planning b) Implementation c) Assessment d) Evaluation

a

The nurse is teaching a patient who is taking colchicine for the treatment of gout. Which instruction will the nurse include during the teaching session? Select one: a) "The drug will be discontinued when symptoms are reduced." b) "Fluids should be restricted while on colchicine therapy." c) "Take colchicine with meals." d) "Call your doctor if you have increased pain or blood in the urine."

a

The nurse notes in a patient's medication history that the patient is taking allopurinol (Zyloprim). Based on this finding, the nurse interprets that the patient has which disorder? Select one: a) Gout b) osteoarthritis c) Systemic lupus erythematosus d) rheumatoid arthritis

a

When metronidazole [Flagyl] is a component of the H.pylori treatment regimen, the patient must be instructed to do what? Select one: a) Avoid any alcoholic beverages b) Avoid foods containing tyramine. c) Take the drug with food. d) Take the drug on an empty stomach.

a

When monitoring a patient who is taking a low-dose cholinergic drug, the nurse will watch for which cardiovascular effect? Select one: a) bradycardia b) palpitations c) tachycardia d) vasoconstriction

a

Which statement is INCORRECT about Histamine-receptor blockers? Select one: a) H2 blockers decrease gastric pH b) "Antacids and H2 blockers should not be given together." c) H2 Blockers absorption is slowed if taken with meals d) "Ranitidine and Famotidine are two types of histamine-receptor blocker medications."

a

You are providing discharge teaching to a patient taking Sucralfate (Carafate). Which statement by the patient demonstrates they understand how to take this medication? (Select all that apply) Select one or more: a) "I will continue to take this medication as a preventative therapy" b) "It is best to take this medication with antacids." c) "I will take this medication once a week." d) "I will always take this medication on an empty stomach."

a & d

A client with gout has begun to take allopurinol (uric acid reducer, helps w/ gout). The nurse informs the client that which medication may also be necessary during the beginning phase of medication therapy with allopurinol? Select all that apply. a) Naproxen b) Indomethacin c) Colchicine (help prevent the acute gouty attack from happening d) Hydromorphone (wrong, opioid analgesic & doesn't prevent an attack) e) Oxycodone (wrong, opioid analgesic & doesn't prevent an attack)

a, b & c

Before administering a medication, what does the nurse need to know to evaluate how individual patient variability might affect the patient's physiologic response to the medication? (Select all that apply.) Select one or more: a) Patient's age b) Patient's diagnosis c) Family medical history d) Chemical stability of the medication e) Ease of administration

a, b & c

The nurse determines the client needs further instruction on cimetidine (Tagamet) if which statements were made? Select all that apply (not true, decrease absorption of cimetidine, take it 1 hour apart) Select one or more: a) "Taking the cimetidine with an antacid will increase its effectiveness." (anti-acids decreases absorption of cimetidine, take at least 1 hour apart) b) "I will take the cimetidine with my meals." (food reduces absorption rate, so if taken w/ food it will slow down absorption) c) "I'll know the medication is working if my diarrhea stops." (true, Cimetidine which is a histamine (H2)-receptor antagonist alleviates heartburn symptom NOT DIARRHEA) d) "Some of my blood levels will need to be monitored closely since I also take warfarin for atrial fibrillation."(true, warfarin doses will need to be reduced) e) "My episodes of heartburn will decrease if the medication is effective." (true statement) f) "I will notify my health care provider if I become depressed or anxious." (true, cimetidine crosses BBB & has ADRS such as depression, anxiety, agitation & confusion)

a, b & c

What are the results of using glucocorticoid drugs to treat asthma? (Select all that apply.) Select one or more: a) Reduced edema of the airway b) Reduced bronchial hyper-reactivity c) Increased responsiveness to beta2-adrenergic agonists d) Increased synthesis of inflammatory mediators e) Reduced number of bronchial beta2 receptors

a, b & c

A client with diarrhea for 3 days and inability to eat or drink well is brought to the emergency department (ED) by her family. She states she has been taking her diuretics for congestive heart failure (CHF). What nursing actions are indicated at this time? (Select all that apply.) Select one or more: a) Evaluate the electrolyte levels. (review to check likely loss of Na, K+, Mg secondary to diarrhea from diuretic use) b) Place the client on bed rest (safety needed to prevent falls from weakness due to likely fluid volume deficit & E imbalance / diarrhea leads to hypokalemia) c) Initiate cardiac monitoring (monitor for inverted T wave or presence of U wave on ECG as well as dysrhythmias indicated when hypokalemia is anticipated) d) Administer the ordered diuretic (diuretic increases loss of F&E, question this order bc of assessment data which indicates fluid loss from diuretic & diarrhea) e) Assess for orthostatic hypotension (assessing for orthostatic changes will confirm presence of volume deficit)

a, b, c & e

Which drugs are used to treat COPD? (Select all that apply.) Select one or more: a) Glucocorticoids b) Monoclonal antibodies c) Anticholinergic medications d) Long-acting beta2 agonists e) Leukotriene modifiers

a, c & d

In monitoring a client's response to disease-modifying antirheumatic drugs (DMARDs), which assessment findings would the nurse consider acceptable responses? Select all that apply. a) Radiological findings that show no progression of joint degeneration b) Inflammation and irritation at the injection site 3 days after the injection is given (wrong, sign of infection) c) Control of symptoms during periods of emotional stress (bc it exacerbates the s&s of rheumatoid arthritis, control during this is POSITIVE SIGN) d) A low-grade temperature on rising in the morning that remains throughout the day (wrong, sign of infection) e) Normal white blood cell, platelet, and neutrophil counts f) An increased range of motion in the affected joints 3 months into therapy

a, c, e & f

#1 QUIZ-INTRO TO PHARM What is a desired outcome when a drug is described as easy to administer? Select one: a) It can be stored indefinitely without need for refrigeration. b) It enhances patient adherence to the drug regimen. c) It does not interact significantly with other medications. d) It is usually relatively inexpensive to produce.

b

#6 QUIZ MUSCULOSKELETAL A patient with gout has been treated with allopurinol (Zyloprim) for 2 months. The nurse will monitor laboratory results for which therapeutic effect? Select one: a) Increased hemoglobin and hematocrit levels b) decreased uric acid levels c) Decreased white blood cell count d) Decreased prothrombin time

b

A client has just been prescribed with Methotrexate (Trexall) for the treatment of rheumatoid arthritis who did not respond to any other treatment. An important reminder for the client is to? Select one: a) Pregnancy is not contraindicated with the use of the medication b) Strict hand washing (clients taking Methotrexate are more likely to get infections or may worsen any current infections---thus hand washing will help to prevent the spread of infection) c) Get a daily source of sunlight during the day. d) Clay-colored stool is a normal response of the treatment

b

A client is taking large doses of acetylsalicylic acid (ASA) for rheumatoid arthritis. Which assessment findings indicate that the client is experiencing ototoxicity as a result of the medication? a) Gastrointestinal bleeding, ecchymosis, and dizziness (wrong, causes by bleeding) b) Tinnitus, hearing loss, dizziness, and ataxia (this reflects damage on 8th cranial nerve, organ of hearing & balance) c) Dizziness, sore throat, and purpura (wrong, caused by bleeding) d) Gastrointestinal upset and dizziness (wrong, can be caused by ASA but not signs of ototoxicity)

b

A client receives a dose of scopolamine (anticholinergic med) for nausea from motion sickness. The nurse determines that which sign or symptom later displayed by the client is a result of medication side and adverse effects? Select one: a) Excessive urination (wrong, it's urinary retention) b) Dry mouth (true side & adverse effect) c) Diaphoresis (wrong, decreased sweating) d) Pupillary constriction (wrong, dilated pupils)

b

A client with a clot in the right atrium is receiving a heparin sodium infusion at 1000 units/hour and warfarin sodium 7.5 mg at 5:00 p.m. daily. The morning laboratory results are as follows: activated partial thromboplastin time (aPTT), 32 seconds; international normalized ratio (INR), 1.3. The nurse should take which action based on the client's laboratory results? Select one: a) Collaborate with the health care provider (HCP) to discontinue the heparin infusion and administer the warfarin sodium as prescribed. b) Collaborate with the HCP to obtain a prescription to increase the heparin infusion and administer the warfarin sodium as prescribed. c) Collaborate with the HCP to continue the heparin infusion at the same rate and to discuss use of dabigatran (Pradaxa) in place of warfarin sodium. d) Collaborate with the HCP to withhold the warfarin sodium since the client is receiving a heparin infusion and the aPTT is within the therapeutic range When a client is receiving warfarin for clot prevention due to atrial fibrillation, an INR of 2 to 3 is appropriate for most clients. Until the INR has achieved a therapeutic range, the client should be maintained on a continuous heparin infusion with the aPTT ranging between 60 and 80 seconds. Therefore, the nurse should collaborate with the HCP to obtain a prescription to increase the heparin infusion and to administer the warfarin as prescribed

b

A client with type 2 diabetes controlled with Metformin (PO anti-diabetic med) is recovering from surgery. The primary health care provider has placed the client on insulin in addition to the metformin. What is the nurse's best response about why the client needs to take insulin? Select one: a) "You can't take your metformin while in the hospital."(wrong, can be taken at hospital but not when pt is NPO for surgery) b) "Stress, such as surgery, increases blood glucose levels. You'll need insulin to control your blood glucose temporarily." (RIGHT, dosage adjustments for insulin are needed until stress from surgery subsides) c) "You must take insulin from now on because the surgery will affect your diabetes." (wrong, bland answer) d) "Your diabetes is getting worse, so you will need to take insulin." (wrong, no evidence that diabetes has worsened)

b

A diabetic patient has the following presentation: unresponsive to voice or touch, tachycardia, diaphoresis, and pallor. Which of the following actions by the healthcare provider is the priority? Select one: a) Administer oxygen per nasal cannula b) Administer 50% dextrose IV per hypoglycemia protocol c) Administer the prescribed insulin d) Send blood to the laboratory for analysis

b

A nurse assesses a patient who is prescribed levothyroxine (Synthroid) for hypothyroidism. Which assessment finding alerts the nurse that the medication therapy is effective? Select one: a) Total white blood cell count is 6000 cells/mm3 (6 × 109/L). b) Heart rate is 70 beats/min and regular c) Weight has been the same for 3 weeks. d) Thirst is recognized and fluid intake is appropriate.

b

A nurse assesses a patient with diabetes mellitus who self-administers subcutaneous insulin. The nurse notes a spongy, swelling area at the site the patient uses most frequently for insulin injection. What action would the nurse take? Select one: a) Apply ice to the site to reduce inflammation (wrong, can cause more damage to tissue) b) Instruct the patient to rotate sites for insulin injection (pt's tissue has been damaged from continuous use of same site & should be educated about rotation) c) Assess the patient for other signs of cellulitis (wrong, damaged tissues is not bc of infection) d) Consult the provider for a new administration route (wrong, insulin can only be given SQ)

b

A nurse cares for a patient who has elevated levels of antidiuretic hormone (ADH). Which disorder should the nurse identify as a trigger for the release of this hormone? Select one: a) Renal failure (doesn't trigger release of ADH) b) Dehydration (ADH increases tubular permeability--- more H20 absorption into caps / ADH triggered by rising extracellular fluid osmolarity like in dehydration) c) Edema (doesn't trigger release of ADH) d) Pneumonia (doesn't trigger release of ADH)

b

A nurse is administering Hydrochlorothiazide to a client who has gouty arthritis. The nurse should monitor the client for which findings that could indicate an adverse effect from this drug? Select one: a) Hypoglycemia b) Hyperuricemia c) Hyperkalemia d) Hypernatremia

b

A nurse is teaching a nursing student what is meant by "generations" of cephalosporins. Which statement by the student indicates understanding of the teaching? Select one: a) "Cephalosporins are assigned to generations based on their relative costs to administer." b) "Cephalosporins have increased activity against gram-negative bacteria with each generation." c) "Later generations of cephalosporins have lower resistance to destruction by beta-lactamases d) "First-generation cephalosporins have better penetration of the cerebrospinal fluid."

b

A nurse is teaching a patient about a drug that induces P-glycoprotein. The nurse will explain that this drug may cause which effect on other drugs? Select one: a) Increased brain exposure b) Decreased absorption in the intestines c) Increased fetal absorption d) Increased elimination through the kidneys

b

A parent asks a nurse if the provider will prescribe an antibiotic for a child who attends school with several children who have strep throat. The child is complaining of a sore throat and has a fever. What will be the nurse's response? Select one: a) "With good hand washing, your child should not get strep throat." b) "Your child should come to the clinic to have a throat culture done today." c) "Your child probably has strep throat, so your provider will order an antibiotic." d) "Because strep throat is likely, your child should be treated empirically."

b

A patient is admitted for diabetic ketoacidosis (DKA), and an IV drip titrated to maintain blood glucose levels between 120 and 200 is ordered (intravenous infusion). The only insulin that would be administered IV is: Select one: a) None of the above, insulin cannot be administered IV b) Regular insulin c) Lantus (Glargine) insulin d) NPH insulin

b

A patient is receiving intravenous gentamicin. A serum drug test reveals toxic levels. The dosing is correct, and this medication has been tolerated by this patient in the past. Which could be a probable cause of the test result? Select one: a) A loading dose was not given. b) The patient is taking another medication that binds to serum albumin. c) The drug was not completely dissolved in the IV solution. d) The medication is being given at a frequency that is longer than its half-life.

b

A patient is receiving tobramycin 3 times daily. The provider has ordered a trough level with the 8:00 AM dose. The nurse will ensure that the level is drawn at what time? Select one: a) 8:45AM b) 7:45AM c) 4:00AM d) 7:00AM

b

A patient newly diagnosed with PUD reports taking low-dose aspirin (ASA) for prevention of cardiovascular disease. The nurse learns that the patient drinks 2 to 3 cups of coffee each day and has a glass of wine with dinner 3 or 4 nights per week. The patient eats three meals a day. The nurse will counsel this patient to: Select one: a) switch to a decaffeinated coffee and reduce the number of servings. b) change the meal pattern to five or six smaller meals per day c) discontinue taking aspirin, because it can irritate the stomach.

b

A patient who has been newly diagnosed with asthma is referred to an asthma clinic. The patient reports daily symptoms requiring short-acting beta2-agonist treatments for relief. The patient has used oral glucocorticoids three times in the past 3 months and reports awakening at night with symptoms about once a week. The nurse will expect this patient to be started on which regimen? Select one: a) Continue current medication regimen as is b) Daily low-dose inhaled glucocorticoid/LABA with a SABA as needed c) No daily medications; just a SABA as needed

b

A patient with asthma is admitted to an emergency department with a respiratory rate of 22 breaths per minute, a prolonged expiratory phase, tight wheezes, and an oxygen saturation of 90% on room air. The patient reports using fluticasone [Flovent HFA] 110 mcg twice daily and has used 2 puffs of albuterol [Proventil HFA], 90 mcg/puff, every 4 hours for 2 days. The nurse will expect to administer which drug? Select one: a) Intravenous theophylline, oxygen, and fluticasone (Flovent HFA) 220 mcg b) Intravenous glucocorticoids, nebulized albuterol and ipratropium, and oxygen c) Four puffs of albuterol, oxygen, and intravenous theophylline d) Intramuscular glucocorticoids and salmeterol by metered-dose inhaler

b

A patient with asthma will be using a metered-dose inhaler (MDI) for delivery of an inhaled medication. The provider has ordered 2 puffs to be given twice daily. It is important for the nurse to teach this patient that: Select one: a) the patient should store the MDI in the refrigerator between doses. b) the patient should wait 1 minute between puffs. c) the patient should activate the device and then inhale. d) the patient should inhale suddenly to receive the maximum dose

b

A patient with chronic pain has been receiving morphine sulfate but now has decreased pain. The prescriber changes the medication to ketolorac [Toradol]. The nurse will monitor the patient for: Select one: a) hypotension. b) nausea and sweating. c) respiratory depression. d) euphoria.

b

A patient with no known drug allergies is receiving amoxicillin [Amoxil] PO twice daily. Twenty minutes after being given a dose, the patient complains of shortness of breath. The patient's blood pressure is 100/58 mm Hg. What will the nurse do? Select one: a) Notify the provider if the patient develops a rash. b) Contact the provider and prepare to administer epinephrine. c) Withhold the next dose until symptoms subside. d) Request an order for a skin test to evaluate possible PCN allergy.

b

A postoperative patient who is worried about pain control will be discharged several days after surgery. The nurse providing discharge teaching tells the patient that the prescribed Lortab is not as strong as the morphine the patient was given in the immediate postoperative period. Which response is the patient likely to experience? Select one: a) Optimistic, realistic expectations about the drug b) A negative placebo effect when taking the medication c) A decreased likelihood of filling the prescription for the drug d) An increased compliance with the drug regimen

b

A pregnant patient asks the nurse whether she should continue to take her prescription for tetracycline [Sumycin] to clear up her acne. Which response by the nurse is correct? Select one: a) "Tetracycline is safe to take during pregnancy." b) "Tetracycline can be harmful to the baby's teeth and should be avoided." c) "Tetracycline will prevent asymptomatic urinary tract infections." d) "Tetracycline may cause allergic reactions in pregnant women."

b

An older adult patient who has cancer and Alzheimer's disease is crying but shakes his or her head "no" when asked about pain. The prescriber has ordered morphine sulfate 2 to 4 mg IV every 2 hours PRN pain. It has been 4 hours since a dose has been given. What will the nurse do? Select one: a) Give 2 mg of morphine for pain to avoid increasing this patient's level of confusion. b) Administer 4 mg of morphine and monitor this patient's verbal and nonverbal responses. c) Withhold any analgesic at this time and reassess the patient in 30 to 60 minutes. d) Request an order for a non-opioid analgesic or an antidepressant adjuvant analgesic.

b

Benign prostatic hypertrophy (BPH) symptoms may be treated with an adrenergic antagonistsuch as tamsulosin (Flomax) because: Select one: a) these agents can increase bladder capacity and thus decrease the sensation of needing to void. b) these agents block alpha1 receptors to reduce contraction of smooth muscle in the bladder neck and prostatic capsule. c) affected patients generally have hypertension also. d) these agents can cause permanent shrinkage of the prostate gland.

b

In caring for a young child with pain, which assessment tool is the most useful? a) Simple description pain intensity scale b) Faces pain-rating scale (appropriate for young children bc of difficulty describing pain or understanding correlation to pain in numbers or verbal descriptors) c) 0-10 numeric pain scale d) McGill-Melzack pain questionnaire The other tools require abstract reasoning abilities to make analogies and use of advanced vocabulary.

b

Place the examples of drugs in the order of usage according to the World Health Organization (WHO) analgesic ladder. a. Morphine, hydromorphone, acetaminophen and lorazepam b. NSAIDs and corticosteroids c. Codeine, oxycodone and diphenhydramine a) A, B, C b) B, C, A c) C, A, B d) B, A, C Step 1 includes non-opioids and adjuvant drugs Step 2 includes opioids for mild pain plus Step 1 drugs and adjuvant drugs as needed. Step 3 includes opioids for severe pain (replacing Step 2 opioids) and continuing Step 1 drugs and adjuvant drugs as needed.

b

Prior to administering a client's daily dose of digoxin, the nurse reviews the client's laboratory data and notes the following results: serum calcium 9.8 mg/dL serum magnesium 1.0 mEq/L serum potassium 4.1 mEq/L serum creatinine 0.9 mg/dL Which result should alert the nurse that the client is at risk for digoxin toxicity? Select one: a) Serum creatinine level b) Serum magnesium level (normal range for magnesium is 1.3-2.1 mEq/L---shows hypomagnesemia) c) Serum potassium level d) Serum calcium level

b

The healthcare provider is assessing the glucose level of a patient with a diagnosis of diabetes. Which of these is most helpful in evaluating this patient's long-term glucose management? Select one: a) Urine glucose b) Hemoglobin A1c (Hgb A1C) c) Fasting blood glucose level d) Urine specific gravity

b

The nurse has administered a dose of decussate. The nurse evaluates that the medication has been effective if the client experiences which finding? Select one: a) Decrease in fatty stools b) Bowel movement with soft, formed stool (decussate is a stool softener, relieves constipation by promoting H20 absorption in the stool making it soft) c) Decreased heartburn d) Relief of sharp abdominal pain

b

The nurse has been caring for a patient who has been taking antibiotics for 3 weeks. Upon assessing the patient, the nurse notices the individual has developed oral thrush. What describes the etiology of the thrush? Select one: a) community-aquired infection b) superinfection c) Antibiotic resistance d) nosocomial infection

b

The nurse is preparing to administer penicillin G intramuscularly to a child. The child's parents ask why the drug cannot be given in an oral liquid form. What is the nurse's reply? Select one: a) "This drug causes severe gastric upset if given orally." b) "This drug would be inactivated by enzymes in the stomach." c) "This drug is absorbed much too quickly in an oral form." d) "This drug has a narrow therapeutic range, and the dose must be tightly controlled."

b

What occurs when a drug binds to a receptor in the body? Select one: a) It prevents the action of the receptor by altering its response to chemical mediators. b) It increases or decreases the activity of that receptor c) It gives the receptor a new function. d) It alters the receptor to become non-responsive to its usual endogenous molecules.

b

When an adrenergic drug stimulates beta1-adrenergic receptors, the result is an increased force of contraction, which is known as what type of effect? Select one: a) negative dromotropic b) positive inotropic c) positive chronotropic d) anti-adrenergic

b

Which route of administration is preferred if immediate analgesia and rapid titration are necessary? a) Intraspinal (wrong, needs special cath placement & more complications w/ route) b) Intravenous (IV) (preferred--- fastest & most amenable to titration) c) Sublingual (wrong, fast but not good for titration, limited med variety form) d) Intramuscular wrong, IV has faster onset & titration bc of it)

b

Which statement about food and drug interactions is true? Select one: a) Foods alter drug absorption and metabolism but not drug action. b) Some foods, such as grapefruit, can inhibit CYP isoenzymes and alter drug metabolism c) Medications are best absorbed on an empty stomach. d) Patient discomfort is the food and drug interaction of most concern.

b

A drug that is used for nerve pain (neuropathy) that is also a drug used as an anti-epileptic agent is / are: (Select all that apply) Select one or more: a) Diazepam (Valium) (Diazepam is an excellent choice for both muscle spasm and acute seizures. However, it has not been shown to improve neuropathy) b) Gabapentin (Neurontin) c) Phenytoin (Dilantin) d) Carbamazepine (Tegretol) (FYI...Tegretol (carbamazepine) is indicated for the treatment of epilepsy as well as bipolar disorder, trigeminal neuralgia, and shingles neuralgia. Neuralgia's are considered a form or neuropathy, but the question was intended to address peripheral neuropathy such as that related to diabetes, or neuropathy related to spinal cord / nerve compression. The recommendations for treatment of these neuropathies indicate Tegretol is a third line choice for these classic neuropathies. So, when considering the peripheral neuropathies that you will commonly see, Tegretol was not unacceptable answer choice, as it is not first-line therapy for peripheral diabetic neuropathy or compression of the nerve routes at the area exiting the spinal column due to a disk herniation, etc. Note that it is an acceptable answer choice only due to its use in treating trigeminal neuralgia and shingles)

b & d

Which statement below is true regarding a catecholamine? Select one or more: a) Catecholamines are metabolized slowly b) Catecholamines cannot cross the blood brain barrier c) Catecholamines are cholinergic in their effect d) Catecholamines are commonly given by the enteral route e) Catecholamines must be given by parenteral route

b & e

The nurse is caring for a client who is receiving a loop diuretic for treatment of heart failure. Which of these actions will be included in the plan of care? (Select all that apply.) Select one or more: a) Weigh the client weekly b) Monitor serum potassium (K+ depletion by a diuretic can cause cardiac irritability & weak thready pulse) c) Encourage consumption of citrus fruits and greens (indicated while taking loop diuretic to compensate for urinary loss of potassium) d) Assess daily weights (weight client daily at same time each day, w/ same scale & approx same amount of clothes)

b, c & d

Two nurses are discussing theories of drug-receptor interaction. Which statements are true regarding the affinity of a drug and its receptor? (Select all that apply.) Select one or more: a) Affinity and intrinsic activity are dependent properties. b) Drugs with high affinity are strongly attracted to their receptors. c) Drugs with low affinity are strongly attracted to their receptors. d.) The affinity of a drug for its receptors is reflected in its potency. e) Affinity refers to the strength of the attraction between a drug and its receptor.

b, d & e

#4 QUIZ RESPIRATORY A patient who takes non-steroidal anti-inflammatory drugs (NSAIDs) for arthritis asks a nurse what can be done to prevent ulcers. The nurse will recommend asking the provider about using which medication? Select one: a) Mucosal protectants b) Histamine-2 receptor antagonists c) Proton pump inhibitors d) Antibiotics

c

#5 QUIZ PAIN MANAGEMENT A nursing student asks the nurse why the provider has ordered a combination product containing an opioid analgesic and an NSAID for a patient who has cancer. Which response by the nurse is correct? a) "There are fewer adverse effects from both drugs when used in a combination product." b) "There is a decreased likelihood of opioid dependence when it is given in combination with an NSAID." c) "There is increased pain relief with the combination than when either product is used alone." d) "There are decreased effects of NSAIDs on the GI tract when a combination product is used."

c

#7 QUIZ ENDOCRINE A patient has been prescribed pharmacologic doses of glucocorticoids. It is most important for the nurse to teach the patient to do what? Select one: a) Take antibiotics to prevent infection (wrong, antibiotic given w/ no known infection is inappropriate) b) Increase intake of dietary sodium (wrong, restricted when taken glucocorticoids----ADRS of hyponatremia) c) Never abruptly withdraw therapy (abrupt withdrawal of glucocorticoid cause adrenal insufficiency or adrenal crisis) d) Have an eye examination every year (wrong, eye exam is every 6 months w/ glucocorticoid therapy)

c

#9 QUIZ GASTROINTESTINAL / PEPTIC ULCER DISEASE A patient who takes nonsteroidal anti-inflammatory drugs (NSAIDs) for arthritis asks a nurse what can be done to prevent ulcers. The nurse will recommend asking the provider about using which medication? Select one: a) Antibiotics b) Mucosal protectants c) Proton pump inhibitors d) Histamine-2 receptor antagonists

c

A 23 year old woman with a history of depression comes to your clinic seeking relief for a severe migraine headache that began 20 minutes ago. She is currently taking the SSRI (selective serotonin repute inhibitor) Citalopram for her depression and an estrogen/progesterone combined oral contraceptive. What medication would you avoid using for her acute treatment? a) Morphine b) Topiramate (Topamax) c) Sumatriptan (Imitrex) d) Ergotamine (Ergomar) Migraine is a comorbidity (occur together) with depression- those suffering from migraines are 2-4 times more likely to have depression. Therefore it is no surprise that patients may try to take both a triptan and either an SSRI or SNRI at the same time. Since these different classes of medications both elevate serotonin levels, when combined they can "potentially" cause a serotonin syndrome which can produce hypertension, tachycardia & hyperthermia. Its best to avoid combining two serotonergic drugs whenever possible.

c

A 7-year-old child with asthma uses a daily inhaled glucocorticoid and an albuterol MDI as needed. The provider has added montelukast [Singulair] to the child's regimen. Which statement by the child's parent indicates understanding of this medication? Select one: a) "I will give my child one 4-mg chewable tablet daily." b) "I should give this medication twice daily." c) "I may notice mood changes in my child." d) "This drug can alleviate symptoms during an acute attack."

c

A client has received a dose of dimenhydrinate (Dramamine), The nurse should observe relief of what sign or symptom to evaluate that the medication has been effective? Select one: a) Buzzing sound in the ears b) Headache c) Nausea and vomiting (prevents N&V, dizziness, vertigo which follows motion sickness) d) Chills

c

A client with rheumatoid arthritis is receiving Hydroxychloroquine (Plaquenil) in the recent months. The nurse tells the client to visit which of the following while on the treatment? Select one: a) Dentist b) Pulmonologist c) Ophthalmologist (Plaquenil--- retinal damage / pt should be seen by an ophthalmologist at least once a year) d) Endocrinologist

c

A first day postoperative client on a PCA pump reports that the pain control is inadequate. What is the first action you should take? a) Deliver the bolus dose per standing order. b) Contact the physician to increase the dose c) Assess the pain for location, quality, and intensity. (always asses first, also check changes in response to medication) d) Try non-pharmacological comfort measures.

c

A nurse assesses a patient after administering a prescribed beta-blocker. Which assessment would the nurse expect to find? Select one: a) Respiratory rate decreased from 25 to 14 breaths/min b) Blood pressure increased from 98/42 to 132/60 mm Hg (wrong, decreases BP) c) Pulse decreased from 100 to 80 beats/min (beta-blockers decrease HR) d) Oxygen saturation increased from 88% to 96% Beta-blockers block the stimulation of beta1-adrenergic receptors. They block the sympathetic (fight-or-flight) response and decrease the heart rate (HR)

c

A nurse is caring for a patient who takes an ACE inhibitor and an ARB medication who will begin taking TMP/SMZ to treat a urinary tract infection. Which serum electrolyte will the nurse expect to monitor closely? Select one: a) Sodium b) Magnesium c) Potassium d) Calcium

c

A nurse teaches a patient with diabetes mellitus about sick-day management. Which statement would the nurse include in this patient's teaching? Select one: a) "When ill, avoid eating or drinking to reduce vomiting and diarrhea." (wrong, vomit but still need insulin, contact PCP for guidance) b) "Try to continue your prescribed exercise regimen even if you are sick." c) "Monitor your blood glucose levels at least every 4 hours while sick." d) "If vomiting, do not use insulin or take your oral antidiabetic agent."

c

A nursing student is preparing to give a medication that has a "High Alert" or "Black Boxed Warning". The student asks the nurse what this means. What will the nurse explain about boxed warnings? Select one: a) They indicate that a drug should not be given except in life-threatening circumstances. b) They provide information about antidotes in the event that toxicity occurs. c) They alert prescribers to measures to mitigate potential harm from side effects. d) They provide detailed information about the adverse effects of the drug.

c

A patient claims to get better effects with a tablet of Brand X of a drug than with a tablet of Brand Y of the same drug. Both brands contain the same amount of the active ingredient. What does the nurse know to be most likely? Select one: a) Advertising by pharmaceutical companies can enhance patient expectations of one brand over another, leading to a placebo effect. b) The bioavailability of a drug is determined by the amount of the drug in each dose. c) Brands or generic forms of tablets can differ in composition and can have differing rates of disintegration and dissolution, which can alter the drug's effects in the body. d) Because the drug preparations are chemically equivalent, the effects of the two brands must be identical.

c

A patient diagnosed with type 2 diabetes mellitus is admitted to the medical unit with pneumonia. The patient's oral anti-diabetic medication has been discontinued and the patient is now receiving insulin for glucose control. Which of the following statements best explains the rationale for this change in medication? Select one: a) Infection has compromised beta cell function so the patient will need insulin from now on b) Acute illnesses like pneumonia will cause increased insulin resistance c) Stress-related states such as infections increase risk of hyperglycemia d) Insulin administration will help prevent hypoglycemia during the illness

c

A patient is brought to the emergency department by friends, who report finding the patient difficult to awaken. The friends report removing three fentanyl transdermal patches from the patient's arm. On admission to the emergency department, the patient is slow to respond, has pinpoint pupils and a respiratory rate of 6 breaths per minute. The nurse recognizes the priority intervention as: Select one: a) Obtain an order for a different opioid analgesic to manage the patient's pain. b) Administration of IV fluids containing glucose. c) Administer Naloxone (Narcan) per standing order. d) Obtain an order for a head CT.

c

A patient is prescribed lovastatin [Mevacor]. The nurse will teach the patient to take the medication at which time? Select one: a) 2 hours after a meal b) With any meal c) With the evening meal (to increase absorption, since cholesterol synthesis increases during night statins are most effective when given during evening) d) 1 hour before breakfast

c

A patient is receiving Interferon Beta for treatment of multiple sclerosis. As the nurse you will stress the importance of? Select one: a) Reporting feelings of severe depression of suicidal thoughts b) Physical exercise to improve fatigue c) Hand hygiene to avoid infection d) Low fat diet

c

A patient is receiving instructions regarding the use of caffeine for migraine headaches. The nurse shares that caffeine should be used with caution if which of these conditions is present? a) Asthma (wrong, not contraindication for caffeine) b) Tension headache (wrong, not contraindication for caffeine) c) A history of peptic ulcers (caffeine will catch peptic ulcers & cardiac dysrthmias) d) A history of kidney stones (wrong, not contraindication for caffeine)

c

A patient is receiving intravenous gentamicin. A serum drug test reveals toxic levels. The dosing is correct, and this medication has been tolerated by this patient in the past. Which could be a probable cause of the test result? Select one: a) The medication is being given at a frequency that is longer than its half-life. b) A loading dose was not given. c) The patient is taking another medication that binds to serum albumin. d) The drug was not completely dissolved in the IV solution.

c

A patient is taking ibuprofen 800 mg three times a day by mouth as treatment for OA. While taking a health history, the nurse finds out that the patient has a few beers on weekends. What concern would there be with the interaction of the alcohol and ibuprofen? a) Increased risk for falls b) Increased nephrotoxic effects c) Increased chance for GI bleeding (NSAID's + alcohol--- high risk of GI bleeding) d) Reduced anti-inflammatory effects of the NSAID

c

A patient recently began receiving clindamycin [Cleocin] to treat an infection. After 8 days of treatment, the patient reports having 10 to 15 watery stools per day. What will the nurse tell this patient? Select one: a) The patient should try taking Lomotil or a bulk laxative to minimize the diarrheal symptoms b) This is a known side effect of clindamycin, and the patient should consume extra fluids c) The patient should stop taking the clindamycin now and contact the provider immediately. d) The provider may increase the clindamycin dose to treat this infection.

c

A patient who has been taking gentamicin for 5 days reports a headache and dizziness. What will the nurse do? Select one: a) Tell the patient to ask for help with ambulation. b) Request an order for a gentamicin peak level c) Suspect ototoxicity and notify the prescriber d) Tell the patient to report any tinnitus

c

A patient who has gastroesophageal reflux disease (GERD) receives a prescription for a proton pump inhibitor (PPI) medication. What will the nurse include when teaching the patient about this drug? Select one: a) "You may experience hypermagnesemia when taking this drug." b) "The FDA has determined that there is a gastric cancer risk with this drug." c) "You should report any fever and cough to your provider." d) "This drug will be given on a short-term basis only."

c

A patient who takes oral theophylline [Theochron] twice daily for chronic stable asthma develops an infection and will take ciprofloxacin. The nurse will contact the provider to discuss: Select one: a) switching from theophylline to a LABA. b) giving theophylline once daily. c) reducing the theophylline dose(there is potential toxicity) d) changing to a different antibiotic.

c

A patient who uses an inhaled glucocorticoid for chronic asthma calls the nurse to report hoarseness. What will the nurse do next? Select one: a) Request an order for an antifungal medication. b) Tell the patient to discontinue use of the glucocorticoid. c) Ask whether the patient is rinsing the mouth after each dose. d) Suggest that the patient be tested for a bronchial infection.

c

A patient with COPD is prescribed tiotropium [Spiriva]. After the initial dose, the patient reports only mild relief within 30 minutes. What will the nurse tell the patient? Select one: a) "You may need to take two inhalations instead of one." b) "You may have another dose in 4 hours." c) "You should see improved effects within the next week." cumulative effect with continued dosing (cumulative effect w/ continued dosing) d) "You should have peak effects in about 6 hours."

c

A patient with a history of heart failure and hypertension is in the clinic for a follow-up visit. The patient is on lisinopril (Prinivil) and warfarin (Coumadin). The patient reports new-onset cough. What action by the nurse is most appropriate initial intervention? Select one: a) Remind the patient that cough is a side effect of Prinivil (if true, still more action must be taken) b) Instruct the patient on another antihypertensive. (depends, may or may not be needed) c) Assess the patient's lung sounds and oxygenation (primary---ABC's) d) Obtain a set of vital signs and document them (important but after assessment of lung sounds & oxygenation)

c

A patient with cancer is admitted to the hospital. The nurse obtains an admission history and learns that the patient has been taking oxycodone and a nonsteroidal anti-inflammatory drug (NSAID) for a year. The patient reports a recent increase in the intensity of pain, along with a new pain described as "burning" and "shooting." The nurse anticipates that the prescriber will order: Select one: a) A combination opioid/NSAID and an adjunctive analgesic. b) Intramuscular morphine sulfate and acetaminophen. c) A fentanyl transdermal patch, acetaminophen, and an adjunctive analgesic for nerve pain. d) An increase in the oxycodone and NSAID doses.

c

A patient with post-operative pain who has been receiving an opioid analgesic reports having pain at a new location even though the previous pain is well controlled. The nurse will contact the provider to discuss: Select one: a) breakthrough pain. b) tolerance to drug therapy. c) complication such as infection or deep vein thrombus. d) drug-seeking behavior.

c

An adrenergic agonist is ordered for a patient in cardiogenic shock. The nurse will note that this drug has had its primary intended effect if which expected outcome occurs? Select one: a) decreased urine output b) reduced anxiety c) increased cardiac output d) volume restoration

c

During therapy with a beta blocker, the patient notices that she has swollen feet, has gained 3 pounds within 2 days, feels short of breath even when walking around the house, and has been dizzy. The nurse suspects that which of these is occurring? Select one: a) More time is needed for the patient to see a therapeutic response to the drug. b) The patient is experiencing expected adverse effects of the drug. c) The patient may be developing heart failure d) The patient is experiencing an allergic reaction.

c

The nurse has been caring for a patient who has been taking antibiotics for 3 weeks. Upon assessing the patient, the nurse notices the individual has developed oral thrush. What describes the etiology of the thrush? Select one: a) Antibiotic resistance b) community-aquired infection c) superinfection d) nosocomial infection

c

The nurse is caring for a client with a diagnosis of gout. Which laboratory value would the nurse expect to note in the client? Select one: a) Calcium level of 9.0 mg/dL b) Potassium level of 4.1 mEq/L c) Uric acid level of 9.0 mg/dL d) Phosphorus level of 3.1 mg/dL

c

The nurse is caring for a patient who is receiving vancomycin [Vancocin]. The nurse notes that the patient is experiencing flushing, rash, pruritus, and urticaria. The patient's heart rate is 120 beats/min, and the blood pressure is 92/57 mm Hg. The nurse understands that these findings are consistent with: Select one: a) Stevens-Johnson syndrome. b) rhabdomyolysis. c) red man syndrome d) allergic reaction.

c

The nurse is overseeing a nursing student who is administering medications to a group of clients receiving treatment for pulmonary embolism. The nurse recognizes the student understands safety and administration of anticoagulant therapy when the student makes which of these statements? Select one: a) "Once the health care provider orders warfarin (Coumadin), the intravenous heparin can be discontinued." (not until INR is in theraputic range, then heparin is discontinued) b) "If bleeding develops, we will give platelets to reverse the anticoagulant." (not true, must be fresh-frozen plasma as antidote for anticoagulant therapy) c) "Therapy with warfarin (Coumadin) is effective when the INR is between 2 and 3." (INR--- diagnostic test used to measure effectiveness of anticoagulant w/ warfarin) d) "The client will receive a dose of enoxaparin (Lovenox) intramuscularly for 3 days." (given subcutaneous not IM)

c

The nurse is preparing to administer prescribed medications to a client with hepatic encephalopathy. The nurse anticipates that the health care provider's prescriptions will include which medication? Select one: a) Psyllium hydrophilic mucilloid (a bulk laxative) b) Bisacodyl suppository (a stimulant laxative) c) Lactulose (an osmotic laxative) (it's a hyperosmotic laxative that has added benefit of lowering serum ammonia levels---associated w/ liver failure / HELPS W/ LIVER FAILURE & ALTERED MENTAL STATUS FROM IT) d) Magnesium hydroxide (saline laxative)

c

The nurse is providing education to a patient who has been prescribed both an antacid and a cimetidine [Tagamet]. Which instruction should the nurse give the patient about taking the medications? Select one: a) "The antacid and ranitidine should be taken at the same time for better effect." b) "Take the antacid 30 minutes after the ranitidine." c) "Take the antacid 1 hour after the ranitidine." d) "Take the antacid 15 minutes before the ranitidine."

c

The nurse is teaching a patient how to self-administer triptan injections for migraine headaches. Which statement by the patient indicates that he needs further teaching? a) "I will keep a journal to record the headaches I have and how the injections are working." b) "This medication does not reduce the number of migraines I will have." c) "I will take this medication regularly to prevent a migraine headache from occurring." (doesn't reduce or prevent headaches, it relieves migraine / can be taken during aura symptoms but NOT PREVENTATIVE MIGRAINE THERAPY) d) "I will take this medication when I feel a migraine headache starting."

c

What is the best way to schedule medication for a client with constant pain? a) IV bolus after pain assessment b) Prior to painful procedures c) Around-the-clock (if pain constant--around-the-clock best for steady analgesia & pain control) d) PRN at the client's request the other options may actually require higher doses to achieve control

c

When considering replacement therapy options for a patient who has Adrenocortical insufficiency, the nurse should recognize that the provider will choose which of the following drugs? Select one: a) Somatotropin b) Glucagon c) Hydrocortisone (glucocorticoid--- replacement therapy for acute & chronic adrenocortical insufficiency like Addison's disease / similar to Cortisol---primary hormone secreted by adrenals) d) Desmopressin

c

When titrating an analgesic to manage pain, what is the priority goal? a) Titrate downwards to prevent toxicity. (wrong, when pain begins to subside) b) Ensure that the drug is adequate to meet the client's subjective needs. (wrong, it's adequate but it has to do more with potent vasoactive drugs) c) Administer smallest dose that provides relief with the fewest side effects. (goal---control pain w/ minimum effects) d) Titrate upward until the client is pain free. (wrong, for severe pain)

c

Which statement(s) about the neuro transmitter acetylcholine is true? Select one: a) "Cholinesterase inhibitors will decrease levels of acetylcholine." b) "Acetylcholine effects are restricted to the parasympathetic nervous system." c) "Acetylcholine activates three cholinergic receptor subtypes." d) "Acetylcholine is a catecholamine."

c

You are working near a war zone and are taking care of a soldier who has been given an irreversible cholinesterase inhibitor during warfare. What action would be the BEST thing to do first in this situation? Select one: a) Give him acetylcholine b) Assess his urine output c) Give the atropine dose that has been ordered d) Notify his family that he has been hospitalized

c

Your patient is taking levodopa (Dopar), and you have been conducting an analysis of the patient's diet. You find that she eats three times the recommended amount of protein at each meal. Your best response to this is to tell her: Select one: a) that she is likely to damage her kidneys if she maintains this diet plan. b) that her protein intake is good, as protein increases the effect of levodopa. c) that too much dietary protein could make the levodopa less effective. d) that protein in her diet will benefit the transport of levodopa throughout her body.

c

patient who has developed opioid tolerance will experience which effect? Select one: a) increased euphoria b) increased respiratory depression c) decreased analgesic effect d) decreased constipation

c

The nurse is administering morning medications. The nurse gives a patient multiple medications, two of which compete for plasma albumin receptor sites. As a result of this concurrent administration, the nurse can anticipate that what might occur? (Select all that apply.) Select one or more: a) The increase in bound drug will intensify effects. b) Plasma levels of free drug will fall. c) Plasma levels of free drug will rise. d) The increase in free drug will intensify effects. e) Binding of one or both agents will be reduced.

c, d & e

#8 QUIZ ANTIBIOTIC & IMMUNE A patient who has been taking gentamicin for 5 days reports a headache and dizziness. What will the nurse do? Select one: a) Tell the patient to report any tinnitus. b) Tell the patient to ask for help with ambulation. c) Request an order for a gentamicin peak level. d) Suspect ototoxicity and notify the prescriber.

d

A child ingests a parent's aspirin tablets, and the prescriber orders sodium bicarbonate to block the toxic effects of the aspirin. The nurse caring for this patient knows that sodium bicarbonate is effective against the aspirin because it: Select one: a) induces CYP isoenzymes to increase drug metabolism. b) alters urinary pH to enhance renal excretion. c) accelerates its passage through the intestine. d) raises the pH of the interstitial fluid to facilitate passage out of the cells.

d

A child with an ear infection is not responding to treatment with amoxicillin [Amoxil]. The nurse will expect the provider to order: Select one: a) penicillin G b) nafcillin c) ampicillin d) amoxicillin-clavulanic acid [Augmentin].

d

A client is being tapered off opioids and the nurse is watchful for signs of withdrawal. What is one of the first signs of withdrawal? a) Nausea b) Fever c) Abdominal cramps d) Diaphoresis (early sign between 6-12 hrs / late signs--- nausea, fever & ABD cramps occur between 48-72 hrs)

d

A client on anticoagulant therapy is being discharged. Which statement by the client indicates an understanding of the anticoagulants drug action? Select one: a) "It might cause me to get injured more often." (not true, however may cause more bleeding & bruising when client is already injured) b) "It will thin my blood". (no change in thickness or viscosity of blood) c) "It is used to dissolve blood clots." (not true, fibronolytics do) d) "It should prevent my blood from clotting." (anticoagulants work by interfering w/ 1 or more steps involved in blood clotting cascade---prevent new clots from forming & limit extension of formed clots)

d

A client reports frequent use of sodium bicarbonate to relieve heartburn after meals. The nurse should monitor the client for which condition that the client is at risk for with long-term frequent use of this medication? Select one: a) Respiratory acidosis b) Urinary calculi c) Chronic bronchitis d) Metabolic alkalosis (sodium bicarb--- electrolyte modifier & antacid --- large doses or long-term it will cause metab alkalosis)

d

A client with gastrointestinal hypermotility has a prescription to receive atropine sulfate. The nurse should withhold the medication and question the prescription if the client has a history of which disease process? Select one: a) Peptic ulcer disease b) Biliary colic c) Sinus bradycardia d) Narrow-angle glaucoma (atropine will cause blockade of muscarinic receptors on iris sphincter---causes mydriasis (dilated pupils)---increases pressure in eye that will worsen glaucoma / worsens cycloplegia (relaxation of ciliary muscles)

d

A client with hypertension is started on verapamil (Calan), a calcium channel blocker. What teaching does the nurse provide for this client? Select one: a) "Monitor for muscle cramping." (occurs with strains not calcium-channel blockers) b) "Consume foods high in potassium." (encouraged but for diuretics not calcium-channel blockers) c) "Monitor for irregular pulse." (bradycardia, not irregular pulse, is typical side effect) d) "Avoid grapefruit juice."(avoid bc it can enhance the action of the drug)

d

A client with thyroid cancer has just received Iodine-131 ablative therapy. Which statement by the client indicates a need for further teaching? Select one: a) "I cannot share my toothpaste with anyone." (this is true bc there will be residual radioactivity & we must lessen exposure to saliva) b) "I need to wash my clothes separately from everyone else's clothes." (this is true, wash separately & run an empty full-cycle before washing clothes of others) c) "I must flush the toilet three times after I use it." (this is true bc it will ensure all urine has been diluted & removed) d) "I'm ready to hold my newborn grandson now." (pt's w/ 131 iodine therapy need to void close contact w/ pregnant women, kids & babies for 1 week after treatment / stay 3 ft away from them)

d

A client with typically well controlled diabetes has a glycosylated hemoglobin (HbA1C) level of 9.4%. Which response by the nurse is most appropriate? Select one: a) "Keep up the good work." (wrong, levels are higher than 7%) b) "This is not good at all." (wrong, no scolding should be done since it doesn't take into account problems the client may have w/ regimen or undiagnosed illness) c) "You need an increase in your insulin dose." (wrong, an assessment of client's regimen is still needed before modifying med) d) "Have you been doing something differently? (diabetic HbA1C levels must be less than 9%, always asses client's changes & accept level is high)

d

A factory worker has been admitted to the emergency department after an industrial accident involving organophosphate insecticides. The nurse knows insecticides belong to which class of potentially toxic drugs? Select one: a) adrenergic agonists b) adrenergic antagonists c) cholinergic agonists d) acetylcholinesterase inhibitors

d

A nurse cares for a patient who has diabetes mellitus. The nurse administers 6 units of regular insulin and 10 units of NPH insulin at 07:00. At which time would the nurse assess the patient for potential problems related to the NPH insulin? Select one: a) 23:00 b) 20:00 (wrong, too late) c) 08:00 (wrong, too soon) d) 16:00 (NPH---intermediate acting insulin, onset is 1.5 hrs while it peaks from 4-12 hrs, duration is 33

d

A nurse cares for a patient with diabetes mellitus who is prescribed metformin (Glucophage) and is scheduled for a contrast-enhanced CT. What action should the nurse take first? Select one: a) Keep the patient NPO for at least 6 hours prior to the examination. (part of plan but not priority) b) Administer intravenous fluids to dilute and increase the excretion of dye (part of plan but not priority) c) Check the patient's bedside blood glucose and administer prescribed insulin (part of plan but not priority) d) Contact the provider and recommend discontinuing the metformin. (discontinue drug for 24 hrs before procedure & not started after 48 hrs, Metmorfin causes lactic acidosis & renal impairment bc of dye interaction)

d

A nurse is administering morphine sulfate to a postoperative patient. Which is NOT an appropriate routine nursing actions when giving this drug? Select one: a) Palpating the patients abdomen twice per shift and monitoring for constipation b) Monitoring respirations before giving the medication and throughout the course of therapy c) Encouraging physical activity and offering increased fluids d) Monitoring the patient's blood pressure closely for hypertension

d

A nurse is caring for an intubated patient who is receiving pancuronium (Pavulon) for neuromuscular blockade. The patient's eyes are closed, and the patient is not moving any extremities. The patient's heart rate is 76 beats per minute, and the blood pressure is 110/70 mm Hg. The nurse caring for this patient will do what? Select one: a) Request an order for serum electrolytes to evaluate for hyperkalemia. b) Request and order for an antihistamine to prevent a further drop in blood pressure. c) Review the patient's chart for a history of myasthenia gravis (MG). d.) Talk to the patient while giving care and explain all procedures.

d

A nursing professor is teaching a class about a medication that alters the parasympathetic nervous system functions. To evaluate understanding, the nurse asks the students to describe which functions the parasympathetic nervous system regulates. Which of the following statements represent functions that are primarily regulated by the parasympathetic nervous system: Select one: a) "Body temperature" b) "The cardiovascular system" c) "The fight-or-flight response" d) "The digestive functions of the body"

d

A patient admitted to the hospital has a history of peptic ulcer disease. The patient takes ranitidine [Zantac] and sucralfate [Carafate]. The patient tells the nurse that discomfort is usually controlled but that symptoms occasionally flare up. What will the nurse do? Select one: a) Ask the provider about ordering an endoscopic examination. b) Contact the provider to discuss serologic testing and an antibiotic. c) Contact the provider to discuss switching to a proton pump inhibitor. d) Counsel the patient on non-drug intervention such as avoiding beverages containing alcohol

d

A patient asks the nurse what can be given to alleviate severe, chronic cancer pain of several months' duration. The patient has been taking oxycodone [OxyContin] and states that it is no longer effective. The nurse will suggest discussing which medication with the provider? Select one: a) Naloxone (Narcan) b) Hydrocodone [Vicodin] PO c) Pentazocine [Talwin] PO d) Fentanyl [Duragesic] transdermal patch

d

A patient has a long history of hypertension. Which category of medications would the nurse expect to be ordered to avoid chronic kidney disease (CKD)? Select one: a) Antibiotic (wrong, fights infection) b) Bronchodilator (wrong, increases size of bronchi) c) Histamine blocker (wrong, decreases inflammation) d) Angiotensin-converting enzyme (ACE) inhibitor (ACE inhibitors stop conversion of angiotensin I to the vasoconstrictor angiotensin II. This category of medication also blocks bradykinin and prostaglandin, increases renin, and decreases aldosterone, which promotes vasodilation and perfusion to the kidney)

d

A patient has had three gouty flare-ups in the past year. Which drug class will the nurse expect the provider to order for this patient? Select one: a) Colchicine b) Glucocorticoids c) Nonsteroidal anti-inflammatory drugs d) Urate-lowering drugs

d

A patient with rheumatoid arthritis is experiencing sudden vision changes. Which medication found in the patient's medication list can cause retinal damage? Select one: a) Lefluomide (Arava) b) Sulfasalazine (Azulfidine) c) Methylprednisolone (Medrol) d) Hydroxychloroquine (Plaquenil) (DMARD---can cause retinal damage / pt should be monitored for vision changes)

d

A patient with stable COPD is prescribed a bronchodilator medication. Which type of bronchodilator is preferred for this patient? Select one: a) An oral beta2 agonist b) A short-acting beta2 agonist c) An intravenous methylxanthine d) A long-acting inhaled beta2 agonist

d

A patient with stable COPD receives prescriptions for an inhaled glucocorticoid and an inhaled short acting beta2-adrenergic agonist. Which statement by the patient indicates understanding of this medication regimen? Select one: a) "I should use the glucocorticoid as needed when symptoms flare." b) "The beta2-adrenergic agonist suppresses the synthesis of inflammatory mediators." c) "I will need to use the beta2-adrenergic agonist drug daily." d) "The glucocorticoid is used as prophylaxis to prevent exacerbations."

d

A physician prescribes a Proton-Pump Inhibitor to a patient with a gastric ulcer. Which medication is considered a PPI? Select one: a) Famotidine b) Famotidine c) Metronidazole d) Pantoprazole

d

An older adult patient with chronic obstructive pulmonary disease (COPD) develops bronchitis. The patient has a temperature of 39.5°C. The nurse will expect the provider to: Select one: a) obtain a sputum culture and wait for the results before prescribing an antibiotic. b) treat symptomatically, because antibiotics are usually ineffective against bronchitis c) treat the patient with more than one antibiotic without obtaining cultures. d) order empiric antibiotics while waiting for sputum culture results

d

An unresponsive patient who has diabetes is brought to the emergency department with slow, deep respirations. Additional findings include: blood glucose 450 mg/dL (24.9 mmol/L), arterial pH 7.2 (acidosis), and urinalysis showing presence of ketones and glucose. Which of the following best describes the underlying cause of this patient's presentation? Select one: a) Respiratory acidosis b) Hyperosmolar Hyperglycemic Syndrome (HHS) c) Hypoglycemia d) Diabetic Ketoacidosis (DKA)

d

The U.S. Food and Drug Administration (FDA) recommends genetic testing of patients receiving certain medications. Genetic testing helps prescribers: Select one: a) identify racial characteristics that affect psychosocial variation in drug response. b) better establish a drug's therapeutic index. c) produce a drug that is tailored to an individual patient's genetic makeup. d) determine whether a patient is a rapid or slow metabolizer of the drug.

d

The nurse instructs a patient on how to correctly use an inhaler with a spacer. In which order would these steps occur?1. "Press down firmly on the canister to release one dose of medication."2. "Breathe in slowly and deeply."3. "Shake the whole unit vigorously three or four times."4. "Insert the mouthpiece of the inhaler into the nonmouthpiece end of the spacer."5. "Place the mouthpiece into your mouth, over the tongue, and seal your lips tightly around the mouthpiece."6. "Remove the mouthpiece from your mouth, keep your lips closed, and hold your breath for at least 10 seconds." Select one: a) 5, 3, 6, 1, 2, 4 b) 3, 4, 5, 1, 6, 2 c) 2, 3, 4, 5, 6, 1 d) 4, 3, 5, 1, 2, 6

d

The nurse is aware that adrenergic drugs produce effects similar to which of these nervous systems? Select one: a) somatic nervous system b) central nervous system c) parasympathetic nervous system d) sympathetic nervous system

d

The nurse is caring for a patient with atrial fibrillation (AF). In addition to an antidysrhythmic, what medication does the nurse plan to administer? Select one: a) Magnesium sulfate (not used unless depletion is noted) b) Dobutamine (inotropic agent used to imrpove CO, can cause tachycardia---worsens AF) c) Atropine (treats bradycardia, nor rapid HR associated AF) d) Heparin (anticoagulant bc of thrombus formation)

d

The nurse is teaching a client about thyroid replacement therapy. Which statement by the client indicates a need for further teaching? Select one: a) "If I gain weight and feel tired, I may need an increased dose." (wrong choice, statement is correct) b) "I will take the medication every morning." (wrong choice, the statement is correct) c) "I will have more energy with this medication." (wrong choice, hypothyroidism causes lack of energy & with thyroid therapy it would increase pts energy) d) "If I continue to lose weight, I may need an increased dose." (weight loss indicates need for decreased dose, not increased dose)

d

The nurse receives an order to give morphine 5 mg IV every 2 hours PRN pain. Which action is not part of the six rights of drug administration? Select one: a)Documenting the reason the medication was given in the patient's electronic medical record b) Consulting a drug manual to determine whether the amount the prescriber ordered is appropriate c) Checking the medication administration record to see when the last dose was administered d) Assessing the patient's pain level 15 to 30 minutes after giving the medication

d

The nurse recognizes that adrenergic drugs cause relaxation of the bronchi and bronchodilation by stimulating which type of receptors? Select one: a) Alpha1 adrenergic b) Beta1 adrenergic c) dopaminergic d) Beta2 adrenergic

d

The prescriber's order says to administered the diuretic Lasix 40 mg IV twice a day. The patient has bilateral lower extremity edema and complains of leg pain. The patient has the following morning labs: Na+ 148, K+ 2.9, and BUN 10. Which of the following is a nursing priority? Select one: a) Notify the prescriber of the Na+ level b) Assess the patient's lung sounds c) Administer Lasix as ordered d) Hold the Lasix dose and notify the prescriber of the potassium level

d

When a patient is taking an adrenergic drug, the nurse expects to observe which effect? Select one: a) increased intestinal peristalsis b) bronchial constriction c) constricted pupils d) increased heart rate

d

Which client is most likely to receive opioids for extended periods of time? a) A client with trigeminal neuralgia (treated w/ anti-seizure meds, like carbamazepine (tegretol) b) A client with phantom limb pain (subsides after ambulation begins) c) A client with fibromyalgia (treated w/ non-opioids & adjuvant meds) d) A client with progressive pancreatic cancer (bc of disease progression, doses more generous)

d

Which medication should be used for asthma patients as part of step 1 management? Select one: a) Long-acting beta2 agonists b) Inhaled low-dose glucocorticoids c) Combination inhaled glucocorticoids/long-acting beta2 agonists d) Short-acting beta2 agonists

d

Which of the following insulins have no peak but a duration of 24 hours? Select one: a) Aspart insulin b) Humulin R (Regular insulin) c) NPH insulin d) Lantus (insulin glargine)

d

Which of the following insulins have no peak but a duration of 24 hours? Select one: a) NPH insulin b) Aspart insulin c) Humulin R (Regular insulin) d) Lantus (insulin glargine)

d

Which of the following is NOT a common adverse effect of opioid analgesics? Select one: a) Sedation b) Nausea c) Respiratory Depression d) Diarrhea

d

Which of the following terms describe the sympathetic nervous system? Select one: a) sympatholytic, parasympathomimetic, adrenergic blockers, sympathomimetic b) adrenergic, parasympatholytic, nicotinic, muscarinic c) cholinergic, sympatholytic, parasympathomimetic, antiandrenergic d) adrenergic, anticholinergic, sympathomimetic, parasympatholytic

d

Which side effect of clindamycin [Cleocin] causes the most concern and may warrant discontinuation of the drug? Select one: a) Nausea b) None of the above c) Headache d) Diarrhea

d

Which groups of people are especially sensitive to medication effects? (Select all that apply.) Select one or more: a) Caucasians b) Women c) Minorities d) Older Adults e) Infants

d & e